Physicians' Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study

mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice

BACKGROUND

A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling.

OBJECTIVES

To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings.

METHODS

We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis.

RESULTS

In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods.

CONCLUSION

To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.

Adoption and perception of prescribable digital health applications (DiGA) and the advancing digitalization among German internal medicine physicians: a cross-sectional survey study

BACKGROUND

Therapeutic digital health applications (DiGAs) are expected to significantly enhance access to evidence-based care. Since 2020, German physicians and psychotherapists have been able to prescribe approved DiGAs, which are reimbursed by statutory health insurance. This study investigates the usage, knowledge and perception of DiGAs as well as the growing digitalization among internal medicine physicians in Germany.

METHODS

A web-based survey was distributed at the 2024 annual congress of the German Society for Internal Medicine. Participants could respond by scanning a QR code or directly on a tablet.

RESULTS

A total of 100 physicians completed the survey, with a mean age of 43.4 years. The majority were internal medicine physicians (85%). Of the respondents, 31% had already prescribed DiGAs, and 29% had tested one. Self-rated knowledge of DiGAs was low (median score 3.17/10). The main barriers identified were lack of knowledge about effective implementation (60%), lack of time for patient onboarding (27%), and concerns about patient adherence (21%). However, 92% believed that DiGAs could improve care, and 88% expressed interest in specific digital health training. The majority (64%) stated that digitalization had a positive impact on medical care and 39% of physicians expected their daily workload to decrease due to digitalization. In addition, 38% believed that the physician-patient relationship would improve as a result of digitalization.

CONCLUSIONS

While physicians widely acknowledged the potential benefits of DiGAs, adoption and understanding remain limited. Specific training in digital health is crucial to accelerate digitalization in internal medicine.

[Telemedical Interventions in Ambulant Psychotherapeutic Practices: Online Survey of Psychotherapists and Patients in Germany on the use of Digital Interventions in Psychotherapy]

BACKGROUND

Psychotherapy is going digital. The study investigated the usage behavior and acceptance of digital psychotherapy interventions among outpatient psychotherapists and patients.

METHOD

269 therapists and 157 patients answered questions in an online survey on the use and satisfaction of digital psychotherapy interventions (video therapy, apps, VR, sensor-based psychotherapy), affinity for technology, acceptance of technology, digital therapy relationship.

RESULTS

All participants were satisfied with video therapy, stated that they used apps, VR, etc. less. Patients were more open, more tech-savvy and felt more competent in their use compared to therapists. Psychotherapists rated the digital therapeutic relationship better than patients.

DISCUSSION

The use of digital technologies in psychotherapy is not yet established in outpatient care. Measures to promote acceptance are necessary to break down barriers.

Applicability of a digital health application for cancer patients: a qualitative non-participation analysis

BACKGROUND

The use of digital health applications (German acronym DiGA) for comprehensive patient care is increasing rapidly. Patients with non-organic insomnia can be prescribed an application to manage insomnia. Due to the high prevalence of insomnia in patients with cancer, we were interested in the effect of it and what barriers need to be overcome for its use. The focus of existing studies on acceptance and benefits prompted us to emphasise the analysis of barriers and thus to formulate possible solutions.

METHODS

To analyse the barriers of use, the study population (patients with self-reported tiredness or sleep disturbance via validated instruments and cancer disease) was divided into 3 groups. In groups 1 (patients who refused to participate in advance) and 2 (patients who refused a prescription), short close-ended questionnaires were used for non-response assessment by treating oncologists. Problem-centred guidelines were used for the telephone interviews with group 3 (patients who did not provide information on DiGA use). Alternatively, group 3 was invited to complete and return the close-ended questionnaire. A quantitative analysis of the non-response reasons was conducted using SPSS in groups 1 and 2, while MAXQDA was used for the qualitative data in group 3.

RESULTS

Patients refused to participate at several stages of our study. Quantitative data are available for groups 1 and 2. In the largest group 1, 62% of patients refused to participate due to non-subjective sleep disturbance (177 out of 189 patients) during recruitment by treating oncologists, despite high scores on the screening tool. In the small group 2 (11 out of 15), the most common reasons for withdrawal documented by the oncologists were loss of interest and deteriorating health. The problem-centred qualitative interviews with group 3 (17 patients) revealed that some of them used the prescribed DiGA, despite not being included in the main study and being categorized as lost to follow-up.

CONCLUSION

Analysis of barriers to DiGA use showed that reducing administrative barriers and providing digital and personal support can increase acceptance of the use of DiGAs among cancer patients. Additionally, screening tools can act as a door opener to further communication regarding DiGAs.

TRIAL REGISTRATION

German Register of Clinical Trials DRKS00034198, registration date: 7/05/24 (retrospectively registered).

Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment

BACKGROUND

Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students' information preferences regarding DMHIs.

OBJECTIVE

This study aims to explore information preferences for DMHIs for personal use among medical students in Germany.

METHODS

A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis.

RESULTS

Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies.

CONCLUSIONS

Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students' interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step.

Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience

BACKGROUND

Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, "DiGA") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to "free and non-transparent" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.

METHODS

Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).

RESULTS

A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).

CONCLUSIONS

As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.

Clinical Use of Mental Health Digital Therapeutics in a Large Health Care Delivery System: Retrospective Patient Cohort Study and Provider Survey

Background

While the number of digital therapeutics (DTx) has proliferated, there is little real-world research on the characteristics of providers recommending DTx, their recommendation behaviors, or the characteristics of patients receiving recommendations in the clinical setting.

Objective

The aim of this study was to characterize the clinical and demographic characteristics of patients receiving DTx recommendations and describe provider characteristics and behaviors regarding DTx.

Methods

This retrospective cohort study used electronic health record data from a large, integrated health care delivery system. Demographic and clinical characteristics of adult patients recommended versus not recommended DTx by a mental health provider between May 2020 and December 2021 were examined. A cross-sectional survey of mental health providers providing these recommendations was conducted in December 2022 to assess the characteristics of providers and recommendation behaviors related to DTx. Parametric and nonparametric tests were used to examine statistical significance between groups.

Results

Of 335,250 patients with a mental health appointment, 53,546 (16%) received a DTx recommendation. Patients recommended to DTx were younger, were of Asian or Hispanic race or ethnicity, were female, were without medical comorbidities, and had commercial insurance compared to those without a DTx recommendation (P<.001). More patients receiving a DTx recommendation had anxiety or adjustment disorder diagnoses, but less had depression, bipolar, or psychotic disorder diagnoses (P<.001) versus matched controls not recommended to DTx. Overall, depression and anxiety symptom scores were lower in patients recommended to DTx compared to matched controls not receiving a recommendation, although female patients had a higher proportion of severe depression and anxiety scores compared to male patients. Provider survey results indicated a higher proportion of nonprescribers recommended DTx to patients compared to prescribers (P=.008). Of all providers, 29.4% (45/153) reported using the suggested internal electronic health record-based tools (eg, smart text) to recommend DTx, and of providers recommending DTx resources to patients, 64.1% (98/153) reported they follow up with patients to inquire on DTx benefits. Only 38.4% (58/151) of respondents report recommending specific DTx modules, and of those, 58.6% (34/58) report following up on the impact of these specific modules.

Conclusions

DTx use in mental health was modest and varied by patient and provider characteristics. Providers do not appear to actively engage with these tools and integrate them into treatment plans. Providers, while expressing interest in potential benefits from DTx, may view DTx as a passive strategy to augment traditional treatment for select patients.

Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project

BACKGROUND

Currently, there is a need to optimize knowledge on digital transformation in mental health care, including digital therapeutics (eg, prescription apps), in medical education. However, in Germany, digital health has not yet been systematically integrated into medical curricula and is taught in a relatively small number of electives. Challenges for lecturers include the dynamic field as well as lacking guidance on how to efficiently apply innovative teaching formats for these new digital competencies. Quality improvement projects provide options to pilot-test novel educational offerings, as little is known about the acceptability of participatory approaches in conventional medical education.

OBJECTIVE

This quality improvement project addressed the gap in medical school electives on digital health literacy by introducing and evaluating an elective scoping study on the systematic development of different health app concepts designed by students to cultivate essential skills for future health care professionals (ie, mobile health [mHealth] competencies).

METHODS

This proof-of-concept study describes the development, optimization, implementation, and evaluation of a web-based elective on digital (mental) health competencies in medical education. Implemented as part of a quality improvement project, the elective aimed to guide medical students in developing app concepts applying a design thinking approach at a German medical school from January 2021 to January 2024. Topics included defining digital (mental) health, quality criteria for health apps, user perspective, persuasive design, and critical reflection on digitization in medical practice. The elective was offered 6 times within 36 months, with continuous evaluation and iterative optimization using both process and outcome measures, such as web-based questionnaires. We present examples of app concepts designed by students and summarize the quantitative and qualitative evaluation results.

RESULTS

In total, 60 students completed the elective and developed 25 health app concepts, most commonly targeting stress management and depression. In addition, disease management and prevention apps were designed for various somatic conditions such as diabetes and chronic pain. The results indicated high overall satisfaction across the 6 courses according to the evaluation questionnaire, with lower scores indicating higher satisfaction on a scale ranging from 1 to 6 (mean 1.70, SD 0.68). Students particularly valued the content, flexibility, support, and structure. While improvements in group work, submissions, and information transfer were suggested, the results underscore the usefulness of the web-based elective.

CONCLUSIONS

This quality improvement project provides insights into relevant features for the successful user-centered and creative integration of mHealth competencies into medical education. Key factors for the satisfaction of students involved the participatory mindset, focus on competencies, discussions with app providers, and flexibility. Future efforts should define important learning objectives for digital health literacy and provide recommendations for integration rather than debating the need for digital health integration.

Standardized assessment of evidence supporting the adoption of mobile health solutions: A Clinical Consensus Statement of the ESC Regulatory Affairs Committee: Developed in collaboration with the European Heart Rhythm Association (EHRA), the Association of Cardiovascular Nursing & Allied Professions (ACNAP) of the ESC, the Heart Failure Association (HFA) of the ESC, the ESC Young Community, the ESC Working Group on e-Cardiology, the ESC Council for Cardiology Practice, the ESC Council of Cardio-Oncology, the ESC Council on Hypertension, the ESC Patient Forum, the ESC Digital Health Committee, and the European Association of Preventive Cardiology (EAPC)

Mobile health (mHealth) solutions have the potential to improve self-management and clinical care. For successful integration into routine clinical practice, healthcare professionals (HCPs) need accepted criteria helping the mHealth solutions' selection, while patients require transparency to trust their use. Information about their evidence, safety and security may be hard to obtain and consensus is lacking on the level of required evidence. The new Medical Device Regulation is more stringent than its predecessor, yet its scope does not span all intended uses and several difficulties remain. The European Society of Cardiology Regulatory Affairs Committee set up a Task Force to explore existing assessment frameworks and clinical and cost-effectiveness evidence. This knowledge was used to propose criteria with which HCPs could evaluate mHealth solutions spanning diagnostic support, therapeutics, remote follow-up and education, specifically for cardiac rhythm management, heart failure and preventive cardiology. While curated national libraries of health apps may be helpful, their requirements and rigour in initial and follow-up assessments may vary significantly. The recently developed CEN-ISO/TS 82304-2 health app quality assessment framework has the potential to address this issue and to become a widely used and efficient tool to help drive decision-making internationally. The Task Force would like to stress the importance of co-development of solutions with relevant stakeholders, and maintenance of health information in apps to ensure these remain evidence-based and consistent with best practice. Several general and domain-specific criteria are advised to assist HCPs in their assessment of clinical evidence to provide informed advice to patients about mHealth utilization.

[Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany]

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Value of a quality label and European healthcare professionals' willingness to recommend health apps: An experimental vignette study

This study aimed to evaluate healthcare professionals' (HCPs') willingness to recommend health apps presented with versus without the CEN-ISO/TS 82304-2 health app quality label. The study was an experimental vignette study describing 12 short hypothetical scenarios, with Label (absent vs present) as a between and Type of App (prevention vs self-monitoring vs healthcare) and Patient Socioeconomic Status (low vs high) as within-subjects factors. The main outcome measure was HCPs' willingness to recommend apps. A total of 116 HCPs took part in the study. A significant main effect of the label was found. Further, HCPs were most willing to recommend self-management apps and more willing to recommend apps to high as opposed to low SES patients. However, the effect of the label did not differ between apps or according to patients' SES. Results confirm that the quality label has potential for increasing willingness to changing HCPs' recommendation behavior.

Healthcare professionals' perspectives towards the digitalisation of paediatric growth hormone therapies: expert panels in Italy and Korea

Introduction

To analyse the perspectives of healthcare professionals (HCPs) regarding the acceptance of digital health solutions for growth hormone (GH) deficiency care. This study identified factors impacting HCPs' intent to use and recommend digital solutions supporting recombinant-human growth hormone (r-hGH) therapy in Italy and Korea with a use case of connected drug delivery system (Aluetta® with Smartdot™) integrated in a platform for GH treatment support (the Growzen™ digital health ecosystem).

Methods

Participatory workshops were conducted in Rome, Italy, and Seoul, Korea, to collect the perspectives of 22 HCPs on various predefined topics. HCPs were divided into two teams, each moderated by a facilitator. The workshops progressed in five phases: introduction of the project and experts, capturing views on the current context of digitalisation, perceived usefulness and ease of use of Aluetta® with Smartdot™, exploration of the perception of health technology evolution, and combined team recommendations. Data shared by HCPs on technology acceptance were independently analysed using thematic analysis, and relevant findings were shared and validated with experts.

Results

HCPs from both Italy and Korea perceived Aluetta® with Smartdot™ and the Growzen™ based digital health ecosystem as user-friendly, intuitive, and easy-to-use solutions. These solutions can result in increased adherence, a cost-effective healthcare system, and medication self-management. Although technology adoption and readiness may vary across countries, it was agreed that using digital solutions tailored to the needs of users may help in data-driven clinical decisions and strengthen HCP-patient relationships.

Conclusion

HCPs' perspectives on the digitalisation in paediatric GH therapies suggested that digital solutions enable automatic, real-time injection data transmission to support adherence monitoring and evidence-based therapy, strengthen HCP-patient relationships, and empower patients throughout the GH treatment process.

Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study

BACKGROUND

Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered.

OBJECTIVE

The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients.

METHODS

Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology.

RESULTS

A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention.

CONCLUSIONS

There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.

The use of medical health applications by primary care physicians in Israel: a cross-sectional study

BACKGROUND

The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated.

METHODS

From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them.

RESULTS

From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps.

CONCLUSIONS

mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.

Patient-Centered Chronic Wound Care Mobile Apps: Systematic Identification, Analysis, and Assessment

Background

The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published.

Objective

The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians.

Methods

Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians.

Results

This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6).

Conclusions

The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups.

Integration of digital health applications into the German healthcare system: development of "The DiGA-Care Path"

Introduction

Since 2019 people who have insured in the German statutory health insurance are entitled to use certified apps called the Digitale Gesundheitsanwendungen [Digital Health Applications (DiGAs)]. The prerequisite for this is that an app certified as DiGA and suitable for their diagnosis exists. The DiGA can then either be prescribed by a physician or psychotherapist or requested by the patient from the statutory health insurance fund. Given the novelty of this type of healthcare, the implementation of a DiGA should be closely monitored to identify potential weaknesses and achieve quality improvements. To enable an analysis of the supply of DiGAs step-by-step, we aimed to create the DiGA-Care Path.

Methods

We conducted three steps to create the DiGA-Care Path. First, a knowledge base was created based on a structured literature research matched with knowledge gathered from the superordinate research project "QuaSiApps" funded by the German Federal Joint Committee. Second, we aimed to create an "ideal-typical" DiGA-Care Path using a flowchart. Third, based on the first path, a final path was developed using the graphical modeling language "Event-Driven Process Chain."

Results

The DiGA-Care Path was developed to depict the supply of DiGAs in Germany. The final path is constituted by a "main path" as well as a corresponding "sub-path". While the "main path" focuses more on the supply environment in which a DiGA is used, the "sub-path" depicts the supply delivered by the DiGA itself. Besides the process itself, the paths include relevant actors to indicate responsibilities for individual process steps.

Discussion

The DiGA-Care Path helps to analyze the current supply of DiGAs step-by-step. Thereby, each step can be investigated in detail to identify problems and to detect further steps where quality improvements can be enabled. Depending on the perspective, focused either on the supply environment, or the supply delivered by the DiGA itself, the "main path" or the "sub-path" can be used, respectively. Besides the potential of the DiGA-Care Path to improve the current supply of DiGAs, it can help as an orientation for international policymakers or further stakeholders either to develop their own integration of apps into healthcare systems or for international manufacturers to consider entering the German market.

Understanding inherent influencing factors to digital health adoption in general practices through a mixed-methods analysis

Extensive research has shown the potential value of digital health solutions and highlighted the importance of clinicians' adoption. As general practitioners (GPs) are patients' first point of contact, understanding influencing factors to their digital health adoption is especially important to derive personalized practical recommendations. Using a mixed-methods approach, this study broadly identifies adoption barriers and potential improvement strategies in general practices, including the impact of GPs' inherent characteristics - especially their personality - on digital health adoption. Results of our online survey with 216 GPs reveal moderate overall barriers on a 5-point Likert-type scale, with required workflow adjustments (M = 4.13, SD = 0.93), inadequate reimbursement (M = 4.02, SD = 1.02), and high training effort (M = 3.87, SD = 1.01) as substantial barriers. Improvement strategies are considered important overall, with respondents especially wishing for improved interoperability (M = 4.38, SD = 0.81), continued technical support (M = 4.33, SD = 0.91), and improved usability (M = 4.20, SD = 0.88). In our regression model, practice-related characteristics, the expected future digital health usage, GPs' digital affinity, several personality traits, and digital maturity are significant predictors of the perceived strength of barriers. For the perceived importance of improvement strategies, only demographics and usage-related variables are significant predictors. This study provides strong evidence for the impact of GPs' inherent characteristics on barriers and improvement strategies. Our findings highlight the need for comprehensive approaches integrating personal and emotional elements to make digitization in practices more engaging, tangible, and applicable.

Big 5 Personality Traits and Individual- and Practice-Related Characteristics as Influencing Factors of Digital Maturity in General Practices: Quantitative Web-Based Survey Study

BACKGROUND

Various studies propose the significance of digital maturity in ensuring effective patient care and enabling improved health outcomes, a successful digital transformation, and optimized service delivery. Although previous research has centered around inpatient health care settings, research on digital maturity in general practices is still in its infancy.

OBJECTIVE

As general practitioners (GPs) are the first point of contact for most patients, we aimed to shed light on the pivotal role of GPs' inherent characteristics, especially their personality, in the digital maturity of general practices.

METHODS

In the first step, we applied a sequential mixed methods approach involving a literature review and expert interviews with GPs to construct the digital maturity scale used in this study. Next, we designed a web-based survey to assess digital maturity on a 5-point Likert-type scale and analyze the relationship with relevant inherent characteristics using ANOVAs and regression analysis.

RESULTS

Our web-based survey with 219 GPs revealed that digital maturity was overall moderate (mean 3.31, SD 0.64) and substantially associated with several characteristics inherent to the GP. We found differences in overall digital maturity based on GPs' gender, the expected future use of digital health solutions, the perceived digital affinity of medical assistants, GPs' level of digital affinity, and GPs' level of extraversion and neuroticism. In a regression model, a higher expected future use, a higher perceived digital affinity of medical assistants, a higher digital affinity of GPs, and lower neuroticism were substantial predictors of overall digital maturity.

CONCLUSIONS

Our study highlights the impact of GPs' inherent characteristics, especially their personality, on the digital maturity of general practices. By identifying these inherent influencing factors, our findings support targeted approaches to drive digital maturity in general practice settings.

Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study

BACKGROUND

The enactment of the "Act to Improve Healthcare Provision through Digitalisation and Innovation " (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape.

OBJECTIVE

This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps.

METHODS

Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021.

RESULTS

The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps.

CONCLUSIONS

Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.

Dissemination Strategies for mHealth Apps: Systematic Review

BACKGROUND

Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app.

OBJECTIVE

The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps.

METHODS

A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps.

RESULTS

Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns.

CONCLUSIONS

mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use.

Mental health provider and youth service users' perspectives regarding implementation of a digital mental health platform for youth: A survey study

Background

For youth and young adults (YYAs) with mental health concerns, digital mental health (dMH) can improve access to care and support collaboration with providers. Measurement-based care using a dMH platform may further optimize YYA outcomes by individualizing treatment approaches. Engaging service providers and YYA provides an opportunity to better understand how to mitigate implementation challenges.

Aim

Explore the experiences of mental health care providers and YYAs regarding the implementation of a dMH platform for YYAs accessing mental health care in multiple care settings.

Methods

Mental health care providers and YYA service users completed an electronic survey exploring their experiences and perceptions of implementing a dMH platform. Survey design, data analysis, and reporting were informed by the Consolidated Framework for Implementation Research (CFIR).

Results

A total of 195 individuals (100 providers, 95 YYAs) responded. Of those, 48 providers and 79 YYAs reported using the platform at least once. Both groups identified several important factors supporting implementation including collaborative relationships between providers and YYAs, the ability to monitor mental health outcomes, and increased YYA engagement in care. The need for increased provider training and automatic reminders for YYAs to use the platform were common barriers. Each group perceived the other to be uninterested in using the platform, highlighting the importance of using all stakeholder views to inform implementation planning.

Conclusions

Successful implementation of dMH for care of YYA requires ongoing, user-informed training, integration into existing workflows, and alignment with YYA priorities for care. Future work exploring provider and youth perceptions of the others' "buy-in" is needed to inform future implementation strategies.

[Digital health applications (DiGA) in the area of tension between progress and criticism : Discussion paper from the "Digital health" specialist group of the German Informatics Society]

Since December 2019, digital health applications (DiGA) have been included in standard care in Germany and are therefore reimbursed by the statutory health insurance funds to support patients in the treatment of diseases or impairments. There are 48 registered DiGA listed in the directory of the Federal Institute of Drugs and Medical Devices (BfArM), mainly in the areas of mental health; hormones and metabolism; and muscles, bones, and joints. In this article, the "Digital Health" specialist group of the German Informatics Society describes the current developments around DiGA as well as the current sentiment on topics such as user-centricity, patient and practitioner acceptance, and innovation potential. In summary, over the past three years, DiGA have experienced a positive development, characterized by a gradually increasing availability of various DiGA and coverage areas as well as prescription numbers. Nevertheless, significant regulatory adjustments are still required in some areas to establish DiGA as a well-established instrument in long-term routine healthcare. Key challenges include user-centeredness and the sustainable use of the applications.

Acceptance of mobile application-based clinical guidelines among health professionals in Northwestern Ethiopia: A mixed-methods study

Background

Globally, healthcare providers have faced significant difficulties in adhering to clinical guidelines. Applying mobile health systems is a crucial strategy for enhancing the dissemination and accessibility of clinical guidelines. This study aimed to assess the acceptance of mobile app-based primary healthcare clinical guidelines and associated factors among health professionals in central Gondar health centers.

Methods

A cross-sectional study supplemented with qualitative data was conducted on 403 health workers. Data were collected using a pre-test structured printed questionnaire and entered into EpiData version 4.6. Analysis was conducted using Stata version 14, which included bivariable and multivariable logistic regression analyses. For qualitative data, thematic analysis was conducted using Open Code v.4.2.

Results

Approximately 28% (95% confidence interval (CI): 23%-32%) of health professionals had utilized mobile app-based clinical guidelines. The availability of IT support (adjusted odds ratio (AOR)  = 3.51, 95% CI: 1.82-6.78), good knowledge (AOR = 3.46, 95% CI: 1.5-6.78), perceived usefulness (AOR = 2.21, 95% CI: 1.00-4.99), m-Health app exposure (AOR = 2.34, 95% CI: 1.2-4.50), and ease of use (AOR = 5.77, 95% CI: 2.50-13.32) were significantly associated with the acceptance of the mobile app-based clinical guideline. In qualitative data, lack of training and supervision and access to smartphones were barriers to acceptance of the mobile app-based clinical guideline.

Conclusion

In summary, acceptance of the app is currently low. However, it can be increased by improving the availability of IT support in the workplace, offering training and supervision, and enhancing access to smartphones.

A sociotechnical framework to assess patient-facing eHealth tools: results of a modified Delphi process

Among the thousands of eHealth tools available, the vast majority do not get past pilot phases because they cannot prove value, and only a few have been systematically assessed. Although multiple eHealth assessment frameworks have been developed, these efforts face multiple challenges. This study aimed to address some of these challenges by validating and refining an initial list of 55 assessment criteria based on previous frameworks through a two-round modified Delphi process with in-between rounds of interviews. The expert panel (n = 57) included participants from 18 countries and 9 concerned parties. A consensus was reached on 46 criteria that were classified into foundational and contextual criteria. The 36 foundational criteria focus on evaluating the eHealth tool itself and were grouped into nine clusters: technical aspects, clinical utility and safety, usability and human centricity, functionality, content, data management, endorsement, maintenance, and developer. The 10 contextual criteria focus on evaluating the factors that vary depending on the context the tool is being evaluated for and were grouped into seven clusters: data-protection compliance, safety regulatory compliance, interoperability and data integration, cultural requirements, affordability, cost-benefit, and implementability. The classification of criteria into foundational and contextual helps us assess not only the quality of an isolated tool, but also its potential fit in a specific setting. Criteria subscales may be particularly relevant when determining the strengths and weaknesses of the tool being evaluated. This granularity enables different concerned parties to make informed decisions about which tools to consider according to their specific needs and priorities.

Two years of approved digital health applications in Germany - Perspectives and experiences of general practitioners with an affinity for their use

BACKGROUND

Since 2020, physicians in Germany can prescribe approved digital health applications (DHAs) with the costs covered by the health system. There has so far been a lack of studies on attitudes and experiences amongst GPs in using DHAs.

OBJECTIVES

The aim was to elucidate the experiences and observations of GPs that have used DHAs in health care and to examine the conditions necessary for DHAs to gain a foothold in primary care according to the GPs.

METHODS

In 2022, 96 qualitative semi-standardised interviews were conducted with German GPs with experience in prescribing DHAs. The GPs were all organised in digitalisation-oriented physicians' associations. Fifty-four interviews were carried out in person and 42 by phone. The data were analysed according to qualitative content analysis.

RESULTS

Unlike health apps, the interviewees saw DHAs as reliable tools for enhancing the relationship between GPs and their patients. They saw the DHAs they had been prescribing as useful and reported various benefits, including improvements in compliance, mobility, information for patients and weight reduction. The physicians also saw room for further improvement (usability, gamification, training, information sources). Interviewees saw the inclusion of DHAs in evidence-based guidelines as a major step forward.

CONCLUSION

The interviewees rated DHAs favourably regarding healthcare potential and as safer and more reliable than conventional health apps. Many saw benefits to healthcare from using such applications. From the interviewees' point of view, DHAs can be integrated more effectively into patient care.

Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review

BACKGROUND

During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented.

OBJECTIVE

The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic.

METHODS

A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

RESULTS

The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines.

CONCLUSIONS

This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic.

TRIAL REGISTRATION

PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu.

A Web Application for Reporting Eye Donors: Idea, Development and Doctor's Opinion

BACKGROUND

Obtaining corneas in a country of 38 million, Poland, is extremely inefficient. In Poland, about 1000 corneas are transplanted annually, of which over 500 come from multi-organ donations. To our knowledge, such a low percentage of donations is in the absence of reporting of potential corneal donors. There is no computer system in our country for tissue donor reporting. The aim of the work is to present an innovative application developed for this purpose.

MATERIAL AND METHODS

It was a cross-sectional, observational study. The questionnaires were collected from doctors who had access to the app.

RESULTS

Almost all participants (47/52) answered that they would use this app if it was available in the hospital, 46 acknowledged that the application could encourage doctors to report tissue donors, and 48 confirmed it should be integrated with the IT system of hospitals and should be available in all of them.

CONCLUSION

Despite advances in medicine and technology and increased awareness of organ donation and transplantation, the gap between supply and demand is constantly growing. Due to the large number of patients awaiting corneal transplants in Poland, it is necessary to introduce changes aimed at improving this situation. The newly developed app may contribute to increasing donor reporting.

Covering digital health applications in the public insurance system: how to foster innovation in patient care while mitigating financial risks-evidence from Germany

Context

Digital health applications that support patients in managing their condition can have a positive impact on patients' health and improve the overall care process. In late 2019, as the first country worldwide, Germany included digital health applications in the benefit basket of the statutory health insurance (SHI) system to enable fast, broad-scale patient access and encourage innovation in the digital health industry. While the policy is widely recognized as a pioneering step toward improving patient care through digital technologies, there are concerns regarding the mechanics of the policy and the resulting financial risks for the SHI system.

Goals

The primary objective of this article is to provide a comprehensive and balanced overview of the German policy by evaluating its success in achieving its goals and by reviewing challenges that have emerged. The secondary objective is to delineate prospective policy options and areas warranting future research.

Approach

The article analyzes publicly available data of the Federal Institute for Drugs and Medical Devices collected between February 1st and July 17th, 2023, and complements it with empirical findings published by academic institutions and sickness funds. It discusses policy options and related areas of future research to overcome the identified challenges without jeopardizing the purpose of the legislation to encourage innovation in the digital health industry to improve patient care.

Conclusion

In line with the goals of the reimbursement policy, the inclusion of digital health applications in the SHI benefit basked has entailed new digital treatment options for patients across multiple disease areas. However, from a health policy perspective, the policy has several shortcomings, including low prescription rates, the temporary reimbursement of digital health applications that lack proven benefit, and a pricing framework that does not take into account the efficacy and efficiency of a treatment and may lead to a suboptimal allocation of public resources. Rather than the public system covering digital health applications without proven benefit, the authors suggest giving SHI organizations more budget authority to directly incentivize research and development activities and to introduce value-based pricing. More research is needed to determine the details of these mechanisms.

Health Providers' Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis

BACKGROUND

Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential.

OBJECTIVE

This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs.

METHODS

A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach.

RESULTS

A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth.

CONCLUSIONS

This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs.

Trust and Health Information Exchanges: Qualitative Analysis of the Intent to Share Personal Health Information

BACKGROUND

Digital health has the potential to improve the quality of care, reduce health care costs, and increase patient satisfaction. Patient acceptance and consent are a prerequisite for effective sharing of personal health information (PHI) through health information exchanges (HIEs). Patients need to form and retain trust in the system(s) they use to leverage the full potential of digital health. Germany is at the forefront of approving digital treatment options with cost coverage through statutory health insurance. However, the German population has a high level of technology skepticism and a low level of trust, providing a good basis to illuminate various facets of eHealth trust formation.

OBJECTIVE

In a German setting, we aimed to answer the question, How does an individual form a behavioral intent to share PHI with an HIE platform? We discussed trust and informed consent through (1) synthesizing the main influence factor models into a complex model of trust in HIE, (2) providing initial validation of influence factors based on a qualitative study with patient interviews, and (3) developing a model of trust formation for digital health apps.

METHODS

We developed a complex model of the formation of trust and the intent to share PHI. We provided initial validation of the influence factors through 20 qualitative, semistructured interviews in the German health care setting and used a deductive coding approach to analyze the data.

RESULTS

We found that German patients show a positive intent to share their PHI with HIEs under certain conditions. These include (perceived) information security and a noncommercial organization as the recipient of the PHI. Technology experience, age, policy and regulation, and a disposition to trust play an important role in an individual's privacy concern, which, combined with social influence, affects trust formation on a cognitive and emotional level. We found a high level of cognitive trust in health care and noncommercial research institutions but distrust in commercial entities. We further found that in-person interactions with physicians increase trust in digital health apps and PHI sharing. Patients' emotional trust depends on disposition and social influences. To form their intent to share, patients undergo a privacy calculus. Hereby, the individual's benefit (eg, convenience), benefits for the individual's own health, and the benefits for public welfare often outweigh the perceived risks of sharing PHI.

CONCLUSIONS

With the higher demand for timely PHI, HIE providers will need to clearly communicate the benefits of their solutions and their information security measures to health care providers (physicians, nursing and administrative staff) and patients and include them as key partners to increase trust. Offering easy access and educational measures as well as the option for specific consent may increase patients' trust and their intention to share PHI.

Digital tool to identify and monitor regorafenib-associated hand-foot skin reactions: A proof-of-concept study protocol

BACKGROUND

The FACET study is a prospective, open-label, low risk interventional clinical trial aiming at exploring the fitness-for-purpose and usability of an electronic device suite for the detection of hand-foot skin reaction symptoms in patients with metastatic colorectal cancer treated with regorafenib.

METHODS

38 patients with metastatic colorectal cancer are being selected in 6 centers in France, and will be followed for 2 regorafenib treatment cycles, or for approximately 56 days. The electronic device suite includes connected insoles and a mobile device equipped with a camera and a companion application with electronic patient-reported outcomes questionnaires and educational material. The FACET study is intended to provide information useful for the improvement of the electronic device suite and its usability before the testing of its robustness in a larger follow-up study. This paper describes the protocol of the FACET study and discusses the limitations to consider for the implementation of digital devices in real-life practice.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

BACKGROUND

Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

OBJECTIVE

In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

METHODS

A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

RESULTS

We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

CONCLUSIONS

The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

Digital health applications from a government-regulated directory of reimbursable health apps in Germany-a systematic review for evidence and bias

Background

The Digital Healthcare Act, passed in November 2019, authorizes healthcare providers in Germany to prescribe digital health applications (DiGA) to patients covered by statutory health insurance. If DiGA meet specific efficacy requirements, they may be listed in a special directory maintained by the German Federal Institute for Drugs and Medical Devices. Due to the lack of well-founded app evaluation tools, the objectives were to assess (I) the evidence quality situation for DiGA in the literature and (II) how DiGA manufacturers deal with this issue, as reflected by the apps available in the aforementioned directory.

Methods

A systematic review of the literature on DiGA using PubMed, Scopus, and Web of Science was started on February 4, 2023. Papers addressing the evidence for applications listed in the directory were included, while duplicates and mere study protocols not reporting on data were removed. The remaining publications were used to assess the quality of the evidence or potential gaps in this regard. Results were aggregated in tabular form.

Results

The review identified fourteen relevant publications. Six studies suggested inadequate scientific evidence, five mentioned shortcomings of tools for validating DiGA-related evidence, and four publications described a high potential for bias, potentially influencing the validity of the results. Concerns about limited external generalizability were also raised.

Conclusions

The literature review found evidence-related gaps that must be addressed with adequate measures. Our findings can serve as a basis for a plea for a more detailed examination of the quality of evidence in the DiGA context.

Enablers and inhibitors to the adoption of mHealth apps by patients - A qualitative analysis of German doctors' perspectives

OBJECTIVE

Germany is the first country that approved validated mobile health apps (called DiGA) for prescription by doctors and psychotherapists. The aim of this study is to investigate doctors' perspectives towards these mobile health apps and their intentions to prescribe them. Additionally, we investigated the influence of different roles and expectations of outcomes.

METHODS

We used a qualitative study design to determine doctors' viewpoints on prescribing DiGAs. We conducted 28 semi-structured interviews and used the grounded theory method for analysis. We adopted a classical conceptualist approach to gain theoretical insights.

RESULTS

The results show that doctors' acceptance and support of DiGAs are critical in mobile health uptake and utilisation. Although mobile health is seen to be supportive of patient management and patient education doctors nevertheless need to adopt a motivating and persuasive role in the process.

CONCLUSIONS

Doctors consider DiGAs complementary to their role in patient management and are predominantly positive about DiGAs. A trusted relationship with patients must be developed to ensure the appropriate support of DiGAs.

PRACTICE IMPLICATIONS

Our study suggests that targeted education, user-centred DiGAs, consideration of social presence and user engagement, and co-development with doctors can improve longer-term DiGA use and effectiveness.

Rating analysis and BERTopic modeling of consumer versus regulated mHealth app reviews in Germany

Germany introduced prescription-based mobile health (mHealth) apps in October 2020, becoming the first country to offer them fully reimbursed by health insurance. These regulated apps, known as DiGAs, undergo a rigorous approval process similar to pharmaceuticals, including data protection measures and sometimes clinical trials. This study compares the user experience of DiGAs with non-prescription mHealth apps in Germany, analyzing both average app store ratings and written reviews. Our study pioneers the use of BERTopic for sentiment analysis and topic modeling in the mHealth research domain. The dataset comprises 15 DiGAs and 50 comparable apps, totaling 17,588 German-language reviews. Results reveal that DiGAs receive higher contemporary ratings than non-regulated apps (Android: 3.82 vs. 3.77; iOS: 3.78 vs. 3.53; p < 0.01; non-parametric Mann-Whitney-Wilcoxon test). Key factors contributing to positive user experience with DiGAs are customer service and personalization (15%) and ease of use (13%). However, challenges for DiGAs include software bugs (24%) and a cumbersome registration process (20%). Negative user reviews highlight concerns about therapy effectiveness (11%). Excessive pricing is the main concern for the non-regulated group (27%). Data privacy and security receive limited attention from users (DiGAs: 0.5%; comparators: 2%). In conclusion, DiGAs are generally perceived positively based on ratings and sentiment analysis of reviews. However, addressing pricing concerns in the non-regulated mHealth sector is crucial. Integrating user experience evaluation into the review process could improve adherence and health outcomes.

Mental Health Professionals' Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study

BACKGROUND

Digital health apps are among the most visible facets of the ongoing digital transition in health care, with mental health-focused apps as one of the main therapeutic areas. However, concerns regarding their scientific robustness drove regulators to establish evaluation procedures, with Germany's Digitale Gesundheitsanwendungen program pioneering in app prescription with costs covered by statutory health insurance. Portugal gathers a set of conditions and requirements that position it as an excellent test bed for digital health apps. Its daunting mental health landscape reinforces the potential interest in new interventions. To understand if they would be acceptable, we need to understand the supply side's attitudes and perceptions toward them, that is, those of psychiatrists and psychologists.

OBJECTIVE

This study aims to understand the attitudes and expectations of psychiatrists and psychologists toward digital mental health apps (DMHAs) in the Portuguese context, as well as perceived benefits, barriers, and actions to support their adoption.

METHODS

We conducted a 2-stage sequential mixed methods study. Stage 1 consisted of a cross-sectional web survey adapted to the Portuguese context that was delivered to mental health professionals and psychologists. Stage 2 complemented the insights of the web survey results with a key opinion leader analysis.

RESULTS

A total of 160 complete survey responses were recorded, most of which were from psychologists. This is the most extensive study on mental health professionals' attitudes and perceptions of DMHAs in Portugal. A total of 87.2% (136/156) of the respondents supported the opportunity to prescribe DMHAs. Increased health literacy (139/160, 86.9%), wider adherence to treatment (137/160, 85.6%), and proper disease management (127/160, 79.4%) were the most frequently agreed upon benefits of DMHAs. However, only less than half (68/156, 43.6%) of the respondents planned to prescribe or recommend DMHAs, with psychologists being more favorable than psychiatrists. Professionals faced substantial barriers, such as a lack of information on DMHAs (154/160, 96.3%), the level of initial training effort (115/160, 71.9%), and the need for adjustments of clinical processes and records (113/160, 70.6%). Professionals reported that having more information on the available apps and their suitability for health objectives (151/160, 94.4%), more scientific evidence of the validity of the apps as a health intervention (147/160, 91.9%), and established recommendations of apps by specific clinical guidelines or professional societies (145/160, 90.6%) would be essential to foster adoption.

CONCLUSIONS

More information about DMHAs regarding their clinical validity and how they work is necessary so that such an intervention can be adopted in Portugal. Recommendations from professional and scientific societies, as well as from governmental bodies, are strongly encouraged. Although the benefits of and the barriers to using these apps are consensual, more evidence, along with further promotion of mental health professionals' digital literacy, is needed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/41040.

Exploring mHealth applications for self-management of chronic low back pain: A survey of features and benefits

The adoption of Mobile Health (mHealth) for self-management is growing. mHealth solutions are commonly used in public healthcare and health services, where they are appreciated for their ease of use, broad reach, and wide acceptance. Chronic Low Back Pain (CLBP) is one of the most common health problems and a leading cause of disability. As such, it imposes a tremendous burden on patients and society. Studies have proposed that mHealth self-management solutions, such as mobile applications, can supplement traditional care methods and benefit patients, particularly in self-managing CLBP easier. To this end, the number of available mobile applications for CLBP has increased. This paper i) provides an overview of scientific studies on mobile applications for CLBP management from three different viewpoints: researchers, health professionals, and patients, ii) uncovers the application features that were seen as beneficial in the studies, and iii) contrasts the currently available applications for CLBP in Google Play Store and Apple App Store against the discovered features. The findings show that "Personalization and customization" is the most significant feature as it is beneficial from stakeholders' viewpoint and is represented by most applications. In contrast, "Gamification" and "Artificial intelligence" are the least significant features, indicating a lack of attention from application creators and researchers in this area.

Global trends and hotspots in the digital therapeutics of autism spectrum disorders: a bibliometric analysis from 2002 to 2022

Introduction

Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder that has become a major cause of disability in children. Digital therapeutics (DTx) delivers evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. This study objectively analyzed the current research status of global DTx in ASD from 2002 to 2022, aiming to explore the current global research status and trends in the field.

Methods

The Web of Science database was searched for articles about DTx in ASD from January 2002 to October 2022. CiteSpace was used to analyze the co-occurrence of keywords in literature, partnerships between authors, institutions, and countries, the sudden occurrence of keywords, clustering of keywords over time, and analysis of references, cited authors, and cited journals.

Results

A total of 509 articles were included. The most productive country and institution were the United States and Vanderbilt University. The largest contributing authors were Warren, Zachary, and Sarkar, Nilanjan. The most-cited journal was the Journal of Autism and Developmental Disorders. The most-cited and co-cited articles were Brian Scarselati (Robots for Use in Autism Research, 2012) and Ralph Adolphs (Abnormal processing of social information from faces in autism, 2001). "Artificial Intelligence," "machine learning," "Virtual Reality," and "eye tracking" were common new and cutting-edge trends in research on DTx in ASD.

Discussion

The use of DTx in ASD is developing rapidly and gaining the attention of researchers worldwide. The publications in this field have increased year by year, mainly concentrated in the developed countries, especially in the United States. Both Vanderbilt University and Yale University are very important institutions in the field. The researcher from Vanderbilt University, Warren and Zachary, his dynamics or achievements in the field is also more worth our attention. The application of new technologies such as virtual reality, machine learning, and eye-tracking in this field has driven the development of DTx on ASD and is currently a popular research topic. More cross-regional and cross-disciplinary collaborations are recommended to advance the development and availability of DTx.

Dr. Smartphone, can you support my trauma? An informatics analysis study of App Store apps for trauma- and stressor-related disorders

Background

Psychological trauma is prevalent in developed countries, with prevalence rates and treatment needs exceeding health system capacity. As telemedicine and out-of-patient care are promoted, there has been an expansion of digital apps to compliment therapeutic stages in psychological trauma. To date there are no reviews that have compared these apps and their clinical utility. This study aims to identify the availability of trauma- and stressor-related mhealth apps, assess their functionality, and review their therapeutic abilities.

Methodology

The authors conducted a systematic search using an iPhone 13 Pro in the Australian IOS App Store to extract trauma- and stressor-related apps that resulted from the search criteria. A cross-adaptation of the Mobile App Rating Scale (MARS) and the Comprehensive App Evaluation Model (CAEM) were used as a framework to produce the mTrauma App Evaluation Conceptual Model and Informatics Framework. App content descriptors were analysed based on their general characteristics, usability, therapeutic focus, clinical utility, data integration. Following an applicability in concordance with psychological trauma-informed delivery.

Results

A total of 234 apps resulting from the search strategy were screened, with 81 apps that met the inclusion criteria. The majority of apps were marketed to 4+ to 17+ years of age, categorised as 'health and fitness', with the highest target markets observed for adolescents, children, parents, clinicians, and clients. A total of 43 apps (53.1%) contained a trauma-informed specified section, and 37 (45.7%) incorporated a section useful to support trauma-related symptoms. A significant number of apps there was an absence of therapeutic utility (in 32 apps (39.5%)). Most apps were supporting post-traumatic stress disorder-informed, cognitive behavioural therapy and eye movement desensitisation and reprocessing. Provision of psychoeducation, courses, guided sessions, trainings, self-reflection/journaling, symptom management and progress tracking were highly present.

Conclusions

Trauma-informed mobile apps are available in the App Store, expanding in its target market reach and usability, with an increase of creative psychotherapies being introduced alongside conventional modalities. However, based on the app descriptors, the scarcity of evidenced-based testimonials and therapeutic applicability remains questionable for clinical validity. Although mhealth tools are marketed as trauma-related, current available apps employ a multifunctional approach to general psychological symptomatology, through to associated comorbid conditions and emphasizes on passive activity. For higher uptake on user engagement, clinical application and validity, trauma-apps require curated specification to fulfil its role as complimentary psychological treatment.

Removing Dust From the German Health Care System by Introducing Health Apps Into Standard Care: Semistructured Interview Study

BACKGROUND

In 2019, Germany launched the Digital Healthcare Act. The reform enables physicians to prescribe health apps as treatments to their statutory-insured patients.

OBJECTIVE

We aimed to determine the extent to which the integration of health apps into standard care could be considered beneficial and which aspects of the regulation could still be improved.

METHODS

We conducted a semistructured interview study with 23 stakeholders in Germany and analyzed them thematically. We used descriptive coding for the first-order codes and pattern coding for the second-order codes.

RESULTS

We created 79 first-order codes and 9 second-order codes following the interview study. Most stakeholders argued that the option of prescribing health apps could improve treatment quality.

CONCLUSIONS

The inclusion of health apps into German standard care could improve the quality of treatment by expanding treatment portfolios. The educational elements of the apps might additionally lead to more patient emancipation through a better understanding of personal conditions. Location and time flexibility are the biggest advantages of the new technologies, but they also raise the most significant concerns for stakeholders because app use requires personal initiative and self-motivation. Overall, stakeholders agree that the Digital Healthcare Act has the potential to remove dust from the German health care system.

Going digital in Germany: An exploration of physicians’ attitudes towards the introduction of electronic prescriptions – a mixed methods approach

PURPOSE

Digitalization of medical prescriptions is a core element for the digitalization of healthcare. While some countries have introduced electronic prescriptions over 20 years ago and nearly reached 100 % penetration, physicians in Germany have only been able to use electronic prescriptions since mid-2021 and currently only 0.1 % of prescriptions are transmitted electronically. This study investigates German physicians' viewpoint towards electronic prescriptions as a potential reason for the low penetration and investigates levers to drive adoption.

BASIC PROCEDURES

We conducted a two-stage sequential mixed methods study consisting of semi-structured interviews followed by an online survey among 1136 physicians testing the main dimensions of the Unified Theory of Acceptance and Use of Technology model.

MAIN FINDINGS

Our initial interviews suggested that there was a high technology acceptance by physicians, but due to technical barriers, they were not able to use the system, explaining the low penetration. However, with the larger sample size of the survey, we identified, that while physicians see barriers for introducing electronic prescriptions, such as unclear cost reimbursement or lack of time to deal with the implementation, the majority believes these can be overcome within twelve months. Furthermore, we found that only one third of physicians is in favor of replacing paper-based prescriptions with electronic prescriptions and most physicians considers it unlikely that they will issue more than half of their prescriptions electronically within the next twelve month. Additionally, respondents perceived limited usefulness and expect high effort for using electronic prescriptions.

PRINCIPAL CONCLUSION

Low electronic prescription penetration in Germany seems to be driven by low technology acceptance, not technical barriers. This can be linked to low perceived usefulness, high effort expectancy and low perceived patient demand. Improving technical stability, system functionality and increasing physicians' level of information were seen as main levers to drive electronic prescription adoption.

Assessing the Quality and Impact of eHealth Tools: Systematic Literature Review and Narrative Synthesis

BACKGROUND

Technological advancements have opened the path for many technology providers to easily develop and introduce eHealth tools to the public. The use of these tools is increasingly recognized as a critical quality driver in health care; however, choosing a quality tool from the myriad of tools available for a specific health need does not come without challenges.

OBJECTIVE

This review aimed to systematically investigate the literature to understand the different approaches and criteria used to assess the quality and impact of eHealth tools by considering sociotechnical factors (from technical, social, and organizational perspectives).

METHODS

A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the PubMed, Cochrane, Web of Science, Scopus, and ProQuest databases for studies published between January 2012 and January 2022 in English, which yielded 675 results, of which 40 (5.9%) studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with a thematic analysis and narrative synthesis of emergent themes.

RESULTS

Similar measures from the different papers, frameworks, and initiatives were aggregated into 36 unique criteria grouped into 13 clusters. Using the sociotechnical approach, we classified the relevant criteria into technical, social, and organizational assessment criteria. Technical assessment criteria were grouped into 5 clusters: technical aspects, functionality, content, data management, and design. Social assessment criteria were grouped into 4 clusters: human centricity, health outcomes, visible popularity metrics, and social aspects. Organizational assessment criteria were grouped into 4 clusters: sustainability and scalability, health care organization, health care context, and developer.

CONCLUSIONS

This review builds on the growing body of research that investigates the criteria used to assess the quality and impact of eHealth tools and highlights the complexity and challenges facing these initiatives. It demonstrates that there is no single framework that is used uniformly to assess the quality and impact of eHealth tools. It also highlights the need for a more comprehensive approach that balances the social, organizational, and technical assessment criteria in a way that reflects the complexity and interdependence of the health care ecosystem and is aligned with the factors affecting users' adoption to ensure uptake and adherence in the long term.

Attitudes of Physicians and Individuals Toward Digital Mental Health Tools: Protocol for a Web-Based Survey Research Project

BACKGROUND

Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions.

OBJECTIVE

The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health.

METHODS

Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal.

RESULTS

The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study's survey and 539 answers to the second study's survey. Data analysis is concluded, and both studies' results are expected to be published in 2023.

CONCLUSIONS

The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41040.

Interventions Aimed at Enhancing Health Care Providers' Behavior Toward the Prescription of Mobile Health Apps: Systematic Review

BACKGROUND

Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients.

OBJECTIVE

This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps.

METHODS

A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The "National Institute of Health's quality assessment tool for before-and-after (pretest-posttest design) studies with no control group" and "the mixed methods appraisal tool (MMAT)" were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions.

RESULTS

In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up.

CONCLUSIONS

This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption.

What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors

BACKGROUND

The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition.

METHODS

This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity.

RESULTS

The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use.

CONCLUSION

This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.

A Chilean survey of perinatal women and health care professionals' views towards perinatal apps

BACKGROUND

Women around the globe are increasingly engaging with pregnancy and parenting apps, almost becoming a routine part of the maternity experience. However, little is known about what perinatal women and health care professionals feel about those apps in Latin American countries, where the digital transformation has been slower but where digital technologies could also bridge gaps in access to quality health care.

METHODS

This study aimed to assess views towards pregnancy and parenting apps in perinatal women and perinatal health care professionals in Chile through an online survey. In perinatal women, we explored app use, what they value in the apps they use, and what an "ideal app" would be for them. In health professionals, we explored opinions about women using perinatal apps and what they think a perfect app for their clients would be.

RESULTS

The survey was completed by 451 perinatal women and 54 perinatal health care professionals. Results show that perinatal women in Chile frequently use perinatal apps, and they and health care professionals show a positive attitude towards them. The most valued attributes are information and monitoring of body changes during pregnancy, information and monitoring of the baby's development (in the uterus and after birth), information and tips on how to stay healthy, and having the possibility to interact with other women.

CONCLUSIONS

Perinatal apps are accepted by perinatal women and health care professionals in Chile. Some needs for an "ideal app" emerged. Participants mentioned the need to address mental health, including the mental health of their partner, and the need for support during the transition to parenthood.

Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study

Background

Since 2020, physicians and psychotherapists in Germany can prescribe digital mental health services (dMHSs). However, even future healthcare professionals (HCPs), such as medical and psychology students, remain reluctant to use dMHSs, although they are a risk group for mental health issues themselves. Reasons include scepticism and lacking awareness of dMHSs, which can be addressed by acceptance-facilitating interventions (AFIs) such as information strategies. To date, though, little is known about their information needs.

Methods

Semi-structured interviews with n = 21 students were conducted between August and September 2021. Students of legal age studying psychology or medicine at a German university could participate. Interview recordings were transcribed verbatim and content-analyzed according to Mayring, using deductive and inductive coding.

Results

Most students reported having little experience with dMHSs. Digital health has barely been raised in their study, even though it was perceived as crucial for personal needs as well as in preparation for their work as HCPs. Students favoured receiving information on and recommendations for dMHSs from their university via, e.g. social media or seminars. Among others, information about data safety, scientific evidence base and application scope were preferred. Additionally, information on costs as well as user reviews seemed to be essential components of information strategies because students were concerned that high costs or low usability would hinder uptake.

Conclusions

The results give first insights on how future HCPs would like to be informed on dMHSs. Future research should focus on systematic variations of AFIs' components mimicking real-world decision scenarios to increase the adoption of dMHSs.

Functions of mHealth Diabetes Apps That Enable the Provision of Pharmaceutical Care: Criteria Development and Evaluation of Popular Apps

Personal digital health apps for managing diabetes should include functions that enable the provision of pharmaceutical care services and allow within-app communication with pharmacists and other healthcare providers, thereby improving patient outcomes. The primary aim of this study was to assess the functions of diabetes apps that were relevant to providing pharmaceutical care services (i.e., medication management, adherence, non-pharmacological management, interoperability, and communication). Sixteen criteria related to pharmaceutical care were developed and then used to assess ten popular diabetes apps. The highest numbers of pharmaceutical care criteria were met by the apps Diabetes:M and mySugr (11 criteria); Contour™Diabetes, Dario Health, and OneTouch Reveal^® (ten); and DiabetesConnect and ESYSTA (nine); followed by Glucose Buddy (eight), meala (seven), and lumind (three). The most prevalent functions were related to promoting adherence and non-pharmacological management, but most criteria relevant to medication management were lacking. Five apps allowed within-app communication between patients and healthcare professionals (HCPs); however, no app included communication with pharmacists. High-quality diabetes apps are powerful tools to support pharmaceutical care and remotely monitor diabetes patients. Improvements are needed as they often lack many medication management functions, including within-app communication with HCPs (especially pharmacists). To maximize diabetes app use and improve outcomes, app developers should consider including pharmacists alongside other healthcare providers when customizing app designs.

[What potential and added value do DiGA offer for primary care?-Results of a survey of general practitioners in Germany]

BACKGROUND

For almost two years, physicians have been able to prescribe digital health applications (DiGA) to patients. So far, there has been a lack of studies that shed light on the possible use of DiGA in the context of primary care and take stock of the benefits and potential for optimization.

OBJECTIVES

This study explores general practitioners' (GPs) attitudes, expectations, and experiences with regard to the application potential of DiGA.

METHODS

In the spring of 2022, all 13,913 general practitioners in the federal states Baden-Württemberg, Hesse, Rhineland-Palatinate, and Saarland were invited to take part in an online survey. Included in the evaluation were 3829 completed questionnaires (response rate: 28%). A t-test on independent samples was used to determine significant differences between two groups. Moreover, a factor analysis was carried out.

RESULTS

A majority of those surveyed consider DiGA to be reliable (67%) and secure (61%) applications. In addition, 22% trust themselves to competently advise patients on DiGA, 14% have already prescribed DiGA, and 13% plan to do so. Of the GPs with DiGA experience, 83% rate the prescribed applications as useful. Observed healthcare effects mainly relate to the improvement of compliance (95%), mobility (94%), and education (93%) as well as weight reduction (82%). The respondents suggest further optimization of DIGA, especially with regard to usability (59%), systematic further training of doctors (52%), and the expansion of gamification elements (49%).

CONCLUSIONS

It is important to better inform GPs about the basics of the Digital Healthcare Act (DVG) and to address concerns in a targeted manner. Comprehensive training courses that explain the framework conditions and advantages of using DiGA appear to be crucial. There is also a need for more well-founded sources of information and research for doctors.