Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review

Establishing a Digital Health Care Ecosystem in a Health Sciences University in South Africa: Protocol for a Mixed Methods Study

BACKGROUND

Comprehensive and formalized digital health care ecosystems in health sciences tertiary education in South Africa do not currently exist, but they have the potential to influence teaching and learning, research, and community engagement.

OBJECTIVE

A total of 3 key objectives underpin the study, that is, determining the health care curriculum needs and required content for the development of a formalized digital health ecosystem, determining the level of readiness of staff and students to participate in a digital health care ecosystem, and determining whether community engagement and strategic partnerships can contribute to the sustainability of a digital health care ecosystem.

METHODS

A multipronged approach will be used to address the objectives, with a mixed methods design being undertaken. The qualitative phases will be phenomenological in nature, and triangulation of information along with thematic analysis will be conducted on the collected data. Quantitative data will be collected prospectively and cross-sectionally and analyzed using descriptive analysis. Sampling will include subject experts for the Delphi technique, staff and students at the University, clinical training and education partners, and community leaders. This study has received ethical approval from the Sefako Makgatho Health Sciences University Research and Ethics Committee (SMUREC/H/260/2023:PG).

RESULTS

Data collection for the first phase will begin in January 2024 and conclude in December 2024. Phase 2 and 3 of the study will be conducted concurrently, with data collection starting in January 2025 and concluding in December 2026.

CONCLUSIONS

The establishment of a digital health care ecosystem has the potential to benefit staff, students, and communities through stakeholder collaboration, educational opportunities, research projects, and improved service delivery.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57821.

Promoting mental health in the age of new digital tools: balancing challenges and opportunities of social media, chatbots, and wearables

The promotion of mental health is essential for global health, affecting millions with disorders such as anxiety and depression. Although stigma and discrimination hinder progress, these conditions are often preventable or manageable at minimal cost. The adoption of digital tools in mental health promotion, including telemedicine, online therapy, social media, and wearables, offers promising new avenues to address these issues. This review proposes a framework that focuses on the use of digital tools to enhance health literacy, foster behavioral change, and support sustained positive health behaviors. Platforms such as TikTok, Facebook, and Instagram can effectively disseminate health information, increase awareness, and enhance social accountability. Artificial intelligence-driven virtual agents offer personalised mental health interventions, providing motivational support and customised advice. Additionally, wearable technology (e.g., fitness trackers and smartwatches) enables real-time monitoring of vital health metrics, encouraging ongoing healthy activities. Nonetheless, these technologies introduce challenges including privacy issues, data security, and equitable access to digital resources, raising a new class of rights to protect mental privacy, guard against algorithm bias, and prevent personality-changing manipulations. The absence of human interaction in fully digital solutions also raises concerns about a lack of empathy and emotional connection. For optimal use of digital tools in mental health, integration with conventional care practices and adaptation to diverse cultural and social backgrounds are necessary. The results of this review suggest that digital tools, when carefully implemented, can significantly improve mental health outcomes by making care more accessible, tailored, and effective, especially for underserved communities.

Implementation of mHealth to support cancer diagnosis in Sub-Saharan Africa: A systematic review

BACKGROUND

 A reduction in communicable diseases in sub-Saharan Africa (SSA) over recent decades has led to an increased life expectancy and non-communicable diseases such as cancer. However, cancer services in SSA remain inadequate. With increasing mobile use, mobile health (mHealth) has the potential to expand healthcare access.

AIM

 This systematic review aims to synthesise literature reporting on barriers and facilitators to the implementation and use of mHealth tools by patients or the public to support symptomatic cancer diagnosis in SSA.

METHOD

 A comprehensive literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two researchers independently conducted title and abstract screening, full-text review and data extraction. Extraction templates were compared and data were synthesised. Quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

 Of 7695 records identified, three quantitative and two mixed-methods studies were included, published between 2016 and 2022. The studies focused on Kaposi's sarcoma, cervical cancer, breast cancer and any cancer. Three inter-related themes describe the barriers and facilitators: (1) user or population-related factors including access to mobile devices and connectivity, and language literacy; (2) mHealth tool-related factors such as tool accessibility and language translation; and (3) structural, societal or systemic factors such as sociocultural significance and stigma.

CONCLUSION

 Although SSA countries experienced similar challenges to mHealth tool use as high-income nations, some barriers such as limited mobile devices and connectivity were more severely evident.Contribution: The study findings can be used to guide future mHealth tool design and implementation strategies that are relevant to SSA.

Unveiling the digital future: perspectives of Hungarian physicians under 35 years old on eHealth solutions

Background

The COVID-19 pandemic has catalysed the emergence of digital solutions in all areas of medicine. Our prior study on the digital health related experiences and opinions of Hungarian physicians highlights the crucial role of age in shaping attitudes towards digital health solutions among medical doctors. Our aim was to examine how under 35-year-old Hungarian physicians relate to digital technologies, the advantages and disadvantages they perceive, and how they would like to incorporate these technologies into their everyday medical practice.

Methods

As part of the "E-physicians and E-patients in Hungary" study, we conducted an online representative survey among medical practitioners in Hungary between July 2021 and May 2022 (n = 1,774). The main target group of our research were physicians under 35 years of age: n = 399 (25.3%). Besides descriptive statistical analyses, cluster analysis and binary logistic regression were applied to analyse the digital health related attitudes of the young age group.

Results

Our cluster analysis confirmed that younger doctors perceived more advantages (on average 7.07 items vs. 8.52 items) and disadvantages (on average 4.06 vs. 4.42) of digital health solutions. They also demonstrated greater familiarity with (8.27 vs. 9.79) and use of (1.94 vs. 2.66) a broader spectrum of technologies. Proficiency and active utilization of diverse technologies correlates with a more comprehensive understanding of both pros and cons, as well as a more realistic self-assessment of areas of further improvement. Doctors under 35 years express a notable demand for significantly increased incentives, both in terms of knowledge transfer/training and infrastructure incentives. Multivariate analyses revealed that young doctors, compared to their older counterparts, perceived enhanced patient adherence as one of the greatest benefits of digital health solutions. Additionally, young doctors expect that digital health solutions could reduce burnout.

Conclusion

Our results underscore the inevitable transformation of the 21st-century physician role: the success of digital health solutions hinges on active patient involvement and management, which requires proper patient education and professional support in navigating the digital space. Digital health solutions can be a bridge between different generations of doctors, where young people can help their older colleagues navigate the digital world.

Practical Recommendations for Navigating Digital Tools in Hospitals: Qualitative Interview Study

BACKGROUND

The digitalization of health care organizations is an integral part of a clinician's daily life, making it vital for health care professionals (HCPs) to understand and effectively use digital tools in hospital settings. However, clinicians often express a lack of preparedness for their digital work environments. Particularly, new clinical end users, encompassing medical and nursing students, seasoned professionals transitioning to new health care environments, and experienced practitioners encountering new health care technologies, face critically intense learning periods, often with a lack of adequate time for learning digital tools, resulting in difficulties in integrating and adopting these digital tools into clinical practice.

OBJECTIVE

This study aims to comprehensively collect advice from experienced HCPs in Switzerland to guide new clinical end users on how to initiate their engagement with health ITs within hospital settings.

METHODS

We conducted qualitative interviews with 52 HCPs across Switzerland, representing 24 medical specialties from 14 hospitals. The interviews were transcribed verbatim and analyzed through inductive thematic analysis. Codes were developed iteratively, and themes and aggregated dimensions were refined through collaborative discussions.

RESULTS

Ten themes emerged from the interview data, namely (1) digital tool understanding, (2) peer-based learning strategies, (3) experimental learning approaches, (4) knowledge exchange and support, (5) training approaches, (6) proactive innovation, (7) an adaptive technology mindset, (8) critical thinking approaches, (9) dealing with emotions, and (10) empathy and human factors. Consequently, we devised 10 recommendations with specific advice to new clinical end users on how to approach new health care technologies, encompassing the following: take time to get to know and understand the tools you are working with; proactively ask experienced colleagues; simply try it out and practice; know where to get help and information; take sufficient training; embrace curiosity and pursue innovation; maintain an open and adaptable mindset; keep thinking critically and use your knowledge base; overcome your fears, and never lose the human and patient focus.

CONCLUSIONS

Our study emphasized the importance of comprehensive training and learning approaches for health care technologies based on the advice and recommendations of experienced HCPs based in Swiss hospitals. Moreover, these recommendations have implications for medical educators and clinical instructors, providing advice on effective methods to instruct and support new end users, enabling them to use novel technologies proficiently. Therefore, we advocate for new clinical end users, health care institutions and clinical instructors, academic institutions and medical educators, and regulatory bodies to prioritize effective training and cultivating technological readiness to optimize IT use in health care.

Feasibility and acceptability of a digital tool to support community-based screening for COVID-19 and other priority medical conditions across rural and peri-urban communities in Guinea

Access to primary healthcare, including diagnostic testing, is limited in Guinea, particularly for low-income residents of rural communities. Here we share findings from an interventional operational research study evaluating the feasibility of deploying a digital tool and rapid diagnostic tests to support community-based testing for priority medical conditions across three rural and peri-urban communities in Guinea. An existing web-based application was modified to include integrated symptom screening for malaria and COVID-19, maximize workflow efficiency and conduct end-to-end data capture on tablet devices. Using the application, community health workers screened participants for symptoms of malaria and COVID-19, with eligible participants tested using rapid diagnostic tests. All participants also underwent blood pressure and blood glucose measurements, while malnutrition screening was offered to pregnant women or children under 5 years. Services were provided to residents through mass consultations and home care visits across the study locations. The intervention reached 5204 people overall, with 3241 people enrolled via the application. 32.4% and 15.8% of participants had elevated blood pressure and blood glucose levels, the majority of whom were previously undiagnosed. Of those tested for malaria, 3.2% (n = 28/876) tested positive. The digital tool was successful in providing end-to-end data capture, with 99% of participants having their rapid diagnostic test results captured in real-time, and all outcomes reported into the Ministry of Health database. Together, the study demonstrates the feasibility of using a web-based digital tool to support community health workers with providing community-based diagnostic services in rural and peri-urban communities in a low-resource setting.

Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review

BACKGROUND

Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users.

OBJECTIVE

This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation.

METHODS

Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used.

RESULTS

A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions.

CONCLUSIONS

In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.

The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study

BACKGROUND

Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being.

OBJECTIVE

The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines.

METHODS

Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed.

RESULTS

Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT.

CONCLUSIONS

Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.

Digital leadership: Norwegian healthcare managers' attitudes towards using digital tools

Background

Health services are undergoing digitalization and applying new digital tools. These changes may provide healthcare managers with opportunities to exercise digital leadership. However, managers' attitudes may influence the extent to which they demonstrate digital leadership. This study explores the attitudes of Norwegian healthcare managers towards: (1) digital tools and change and (2) to what extent digital tools are applicable to various tasks of managers.

Methods

Cross-sectional study including 154 managers in hospitals and municipal health services in a Norwegian county. The questionnaire was about management and digital tools, and the data was analyzed by descriptive statistics, correlations, and content analysis.

Results

The healthcare managers perceived that digital tools facilitated a positive change in organizational work processes aligned with values and goals. Digital tools supported administrative tasks such as gaining control over responsibilities. However, 76 managers stated that certain tasks, including interactions with employees (e.g. performance appraisals and sick leave follow-up) and the building of an organizational culture, should not be performed using digital tools or using them only to a limited extent; for these tasks, they preferred in-person meetings.

Discussion

Norwegian healthcare managers' attitudes toward digital tools are generally positive, but there are areas where they find the tools less suitable.

Conclusions

The results provide new insights into healthcare by indicating that many managers may have positive attitudes toward digital tools. However, digital leadership may not be applicable equally in all areas of healthcare managers' work. This raises the question of whether digital leadership can or should be exercised uniformly in every area of health services.