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Steele Gray C, Ramachandran M, Brinton C, Forte M, Loganathan M, Walsh R, Callaghan J, Upshur R, Wiljer D. Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care. Soc Sci Med 2024; 353:116962. [PMID: 38908092 DOI: 10.1016/j.socscimed.2024.116962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/21/2024] [Accepted: 05/09/2024] [Indexed: 06/24/2024]
Abstract
Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a "digital-first" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.
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Affiliation(s)
- Carolyn Steele Gray
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Meena Ramachandran
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; School of Physical and Occupational Therapy, McGill University, Canada
| | - Christopher Brinton
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Michael G. DeGroote School of Medicine, McMaster University, Canada
| | - Milena Forte
- Mount Sinai Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada
| | - Mayura Loganathan
- Mount Sinai Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada
| | | | - Julie Callaghan
- Community Health and Quality, Unison Health and Community Services, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, University of Toronto, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Canada; The Centre for Addiction and Mental Health, Canada; Education Technology Innovation, University Health Network, Canada
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Burns K, Bloom S, Gilbert C, Merner B, Kalla M, Sheri S, Villanueva C, Matenga Ikihele A, Nazer L, Sarmiento RF, Stevens L, Blow N, Chapman W. Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches. JMIR Res Protoc 2024; 13:e53855. [PMID: 38838333 PMCID: PMC11187514 DOI: 10.2196/53855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/21/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In the rush to develop health technologies for the COVID-19 pandemic, the unintended consequence of digital health inequity or the inability of priority communities to access, use, and receive equal benefits from digital health technologies was not well examined. OBJECTIVE This scoping review will examine tools and approaches that can be used during digital technology innovation to improve equitable inclusion of priority communities in the development of digital health technologies. The results from this study will provide actionable insights for professionals in health care, health informatics, digital health, and technology development to proactively center equity during innovation. METHODS Based on the Arksey and O'Malley framework, this scoping review will consider priority communities' equitable involvement in digital technology innovation. Bibliographic databases in health, medicine, computing, and information sciences will be searched. Retrieved citations will be double screened against the inclusion and exclusion criteria using Covidence (Veritas Health Innovation). Data will be charted using a tailored extraction tool and mapped to a digital health innovation pathway defined by the Centre for eHealth Research roadmap for eHealth technologies. An accompanying narrative synthesis will describe the outcomes in relation to the review's objectives. RESULTS This scoping review is currently in progress. The search of databases and other sources returned a total of 4868 records. After the initial screening of titles and abstracts, 426 studies are undergoing dual full-text review. We are aiming to complete the full-text review stage by May 30, 2024, data extraction in October 2024, and subsequent synthesis in December 2024. Funding was received on October 1, 2023, from the Centre for Health Equity Incubator Grant Scheme, University of Melbourne, Australia. CONCLUSIONS This paper will identify and recommend a series of validated tools and approaches that can be used by health care stakeholders and IT developers to produce equitable digital health technology across the Centre for eHealth Research roadmap. Identified evidence gaps, possible implications, and further research will be discussed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53855.
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Affiliation(s)
- Kara Burns
- Centre for Digital Transformation of Health, University of Melbourne, Carlton, Australia
| | | | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Carlton, Australia
| | - Bronwen Merner
- Centre for Health Equity, University of Melbourne, Carlton, Australia
| | - Mahima Kalla
- Centre for Digital Transformation of Health, University of Melbourne, Carlton, Australia
| | - Sreshta Sheri
- Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Cleva Villanueva
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Lama Nazer
- King Hussein Cancer Center, Amman, Jordan
| | - Raymond Francis Sarmiento
- National Telehealth Center, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Lindsay Stevens
- School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Ngaree Blow
- Medical Education Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Carlton, Australia
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Kepper M, L'Hotta A, Shato T, Kwan BM, Glasgow RE, Luke D, Graham AK, Baumann AA, Brownson RC, Morse B. Supporting Teams with Designing for Dissemination and Sustainability: the Design, Development, and Usability of a Digital Interactive Platform. RESEARCH SQUARE 2024:rs.3.rs-4276919. [PMID: 38853949 PMCID: PMC11160915 DOI: 10.21203/rs.3.rs-4276919/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background The use of Designing for Dissemination and Sustainability (D4DS) principles and methods can support the development of research products (interventions, tools, findings) to match well with the needs and context of the intended audience and setting. D4DS principles and methods are not well-known or used during clinical and public health research; research teams would benefit from applying D4DS. This paper presents the development of a new digital platform for teams to learn and apply a D4DS process to their work. Methods A user-centered design (UCD) approach engaged users (n=14) and an expert panel (n=6) in an iterative design process from discovery to prototyping and testing. We led five design sessions using Zoom and Figma software over a 5-month period. Users (71% academics; 29% practitioners) participated in at least 2 sessions. Following design sessions, feedback from users were summarized and discussed to generate design decisions. A prototype was then built and heuristically tested with 11 users who were asked to complete multiple tasks within the platform while verbalizing their decision-making using the 'think aloud' procedure. The System Usability Scale (SUS) was administered at the end of each testing session. After refinements to the platform were made, usability was reassessed with 7 of 11 same users to examine changes. Results The interactive digital platform (the D4DS Planner) has two main components: 1) the Education Hub (e.g., searchable platform with literature, videos, websites) and 2) the Action Planner. The Action Planner includes 7 interactive steps that walk users through a set of activities to generate a downloadable D4DS action plan for their project. Participants reported that the prototype tool was moderately usable (SUS=66) but improved following refinements (SUS=71). Conclusions This is a first of its kind tool that supports research teams in learning about and explicitly applying D4DS to their work. The use of this publicly available tool may increase the adoption, impact, and sustainment of a wide range of research products. The use of UCD yielded a tool that is easy to use. The future use and impact of this tool will be evaluated, and the tool will continue to be refined and improved.
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Affiliation(s)
- Maura Kepper
- Washington University In St Louis: Washington University in St Louis
| | - Allison L'Hotta
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Thembekile Shato
- Washington University In St Louis: Washington University in St Louis
| | - Bethany M Kwan
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Russell E Glasgow
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Douglas Luke
- Washington University In St Louis: Washington University in St Louis
| | | | - Ana A Baumann
- Washington University in St Louis School of Medicine
| | - Ross C Brownson
- Washington University In St Louis: Washington University in St Louis
| | - Brad Morse
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
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Evans L, Evans J, Fletcher M, Abdullah A, Ahmed Z. Mapping Respiratory Health Digital Interventions in South and Southeast Asia: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e52517. [PMID: 38214954 PMCID: PMC10818234 DOI: 10.2196/52517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The last 2 decades have been a time of exponential growth and maturation for digital health, while the global burden of respiratory disease continues to grow worldwide. Leveraging digital health interventions (DHIs) to manage and mitigate respiratory disease and its adverse health effects presents itself as an obvious path forward. OBJECTIVE We aimed to understand the current digital landscape and enabling environment around respiratory health to reduce costs, avoid duplication, and understand the comprehensiveness of DHIs. METHODS This study will follow a scoping review methodology as outlined by Arksey and O'Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, PakiMedNet, and MyMedR databases will be searched along with key websites, repositories, and gray literature databases. The terms "respiratory health," "digital health," "South Asia," and "Southeast Asia," as well as related terms will be searched. The results will be screened for duplicates and then against the inclusion and exclusion criteria. For the studies included, data will be extracted, collated, and analyzed. RESULTS The scoping review was started in July 2023 and will be finalized by February 2024. Results will be presented following the World Health Organization's classification of DHIs to categorize interventions in a standardized format and the mobile health evidence reporting and assessment checklist to report on the effectiveness of interventions. Further exposition of the evidence extracted will be presented through narrative synthesis. CONCLUSIONS As DHIs continue to proliferate, the need to understand the current landscape becomes more pertinent. In this scoping review, we will seek to more clearly understand what digital health tools and technologies are being used in the current landscape of digital health in South and Southeast Asia for respiratory health and to what extent they are addressing the respiratory health needs of the region. The results will inform recommendations on digital health tools for respiratory health in South and Southeast Asia will help funders and implementers of DHIs leverage existing technologies and accelerate innovations that address documented gaps in the studied countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52517.
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Affiliation(s)
- Laura Evans
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jay Evans
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Monica Fletcher
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zakiuddin Ahmed
- Riphah Institute of Healthcare Improvement and Safety, Islamabad, Pakistan
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Radu I, Scheermesser M, Spiess MR, Schulze C, Händler-Schuster D, Pehlke-Milde J. Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6962. [PMID: 37887700 PMCID: PMC10606156 DOI: 10.3390/ijerph20206962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.
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Affiliation(s)
- Irina Radu
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Mandy Scheermesser
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Martina Rebekka Spiess
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
- UMIT TIROL Institute for Nursing Science, Private University of Health Sciences and Health Technology, 6060 Hall in Tirol, Austria
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Jessica Pehlke-Milde
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
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Behavioral Patterns of Supply and Demand Sides of Health Services for the Elderly in Sustainable Digital Transformation: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138221. [PMID: 35805878 PMCID: PMC9266778 DOI: 10.3390/ijerph19138221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The aging transformation of digital health services faces issues of how to distinguish influencing factors, redesign services, and effectively promote measures and policies. In this study, in-depth interviews were conducted, and grounded theory applied to open coding, main axis coding, and selective coding to form concepts and categories. Trajectory equifinality modeling clarified the evolution logic of digital transformation. Based on the theory of service ecology, a digital health service aging model was constructed from the “macro–medium–micro” stages and includes governance, service, and technology transformation paths. The macro stage relies on organizational elements to promote the institutionalization of management and guide the transformation of governance for value realization, including the construction of three categories: mechanism, indemnification, and decision-making. The meso stage relies on service elements to promote service design and realize service transformation that is suitable for aging design, including the construction of three categories: organization, resources, and processes. The micro stage relies on technical elements to practice experiencing humanization, including the construction of three categories: target, methods, and evaluation. These results deepen the understanding of the main behaviors and roles of macro-organizational, meso-service, and micro-technical elements in digital transformation practice and have positive significance for health administrative agencies to implement action strategies.
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