Client Experiences, Perceptions and Acceptability of a Digital Health Enabled Student-Led Exercise Physiology Clinic for Metabolic Conditions: A Qualitative Study

Digital public health has influenced how countries use health data for research and practice, how we deliver healthcare, and how health professionals monitor infectious diseases. The COVID-19 pandemic accelerated the international adoption of digital health interventions for public health aims. While some European countries were already advanced in digital health and digital public health before the pandemic, other nations took the opportunity to catch up. Internationally, governments introduced contact-tracing apps, telemedical services, digitally supported health promotion programs, nationally regulated medical apps, and education programs for citizens and experts to improve digital (health) literacy. The planned European Health Data Space will lift the level of digital public health in Europe once more. However, the maturity of digital public health among European countries varies drastically. While some are global leaders in digitalizing their health systems, others barely implemented the necessary infrastructure. But there is also a third perspective: Some countries that led Europe through the pandemic from a digital public health perspective started withdrawing from digitalizing their healthcare and health promotion and returning to “normal”. It is time to examine what this new “normal” post-pandemic means and how countries evolved. We will learn from the experience of 4 different European countries (Romania, Ireland, Slovenia, and Germany) how COVID-19 changed their health system and if digital public health is still applied now that the pandemic is officially over. The workshop's ultimate goal is to highlight and discuss which digital transformations in European health systems were permanent and whether or not Europe will continue to take a leading role in digital public health in the future. Each representative will have 10 minutes to contextualize their country's digital public health strategy before the pandemic (the old normal), their strategy to address the crisis, and how the country includes digital public health in its health system after the pandemic (the new normal). We will use the remaining 20 minutes of the workshop for a discussion between the speakers and the audience. Key messages • The COVID-19 crisis pushed Europe's digital public health transformation so that countries were enabled to use digital health data for improved healthcare and health promotion on a national level. • In order for the transformation to be sustainable, countries need to fundamentally rethink their health systems and make way for better digital innovation.

Cancer pain is a common symptom among cancer patients, and although opioid drugs are effective, they have side effects and abuse issues. In recent years, mobile apps have gradually been used as digital healthcare for cancer pain management. By visualizing and analyzing the literature on the control of cancer pain through mobile apps, we aim to understand the current research status and hot issues in this field and explore future directions for digital smart healthcare research. CiteSpace software was used to visually analyze 252 articles on mobile app-based cancer pain control indexed by the Web of Science core collection database from 1995 to 2024. Microsoft Excel 2021 and GraphPad were used to draw world maps to evaluate the number of national articles and generate trend charts for annual publications. Visual analysis revealed that the number of publications has been increasing annually. In terms of the number of published articles, the top 3 countries are the United States, China, and Australia. The analysis of highly cited literature indicates that the main apps involved are Pain Buddy, mHealth, The Pain Guard app, The mHealth Pain Squad+, and STAR, which target adults, children, and adolescents. Keywords and citation analysis indicate that quality of life, pain, breast cancer, palliative care, and mobile health may be hotspots and future directions of cancer pain research in mobile apps. Digital healthcare via mobile apps provides intelligent assistance for treating cancer pain, which is conducive to developing intelligent and painless cancer treatment and management strategies.

BackgroundIn our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners’ (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP.ObjectiveThe aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients’ choice to enlist.MethodsWe invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed.ResultsWe generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people’s experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice.ConclusionsOlder patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients’ experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice.

BackgroundThe COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services.ObjectiveThis study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia).MethodsEligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches.ResultsA total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the “relational space” are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy.ConclusionsShared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.

Background: There is a significant demographic transition and economic development taking place in the Arab countries. Women’s health and reproductive healthcare services are also affected by this transition. In digital health, technology is used to improve patient care through telemedicine, mobile health, electronic health records, and artificial intelligence. Aim: the study examined women’s acceptance of digital health devices and mobile Apps during pregnancy, as well as their perceived barriers to using it. Methods: a cross-sectional study was conducted at maternal and children Minia University Hospital, included 880 patients from obstetrics and gynecology departments. Self-administered questionnaires are used for data collection. The questionnaire consisted of three sections: (a) background information and obstetric history (b) adoption of health-related applications (c) acceptance, barriers, and concerns. Results: the majority of respondents (76.7%) accepted the use of a digital device or an app to keep track of the mother and fetus during pregnancy. About one third (33.9%) of participants used mobile health apps. The lack of recommendations from healthcare providers and the cost were cited by (3.9%) and (3%) of respondents, respectively, as reasons for limited use of digital devices or mobile apps. A negative correlation exists between women’s age and their readiness to use digital devices and apps (P value 0.034). Using digital devices and apps is highly correlated with women’s education level, language preference, and cost of payment (P value 0.000). Conclusion: In obstetrics, telehealth interventions, such as remote monitoring, improve outcomes. With digital home devices and apps, obstetric care can be improved. This includes eliminating travel, detecting complications early and preventing recurrences, and reducing the need for hospital admissions. A recommendation for the upcoming research is to identify the apps pregnant women are willing to use and choose the best app based on their perspectives.

Bridging the digital divide in health care

Digital health technologies have been enhancing the capacity of healthcare providers and, thereby, the delivery of targeted health services. The Southeast Asia Region (SEAR) has invested in strengthening digital public health. Many digital health interventions have been implemented in public health settings but are rarely assessed using the holistic health technology assessment (HTA) approach. A systematic literature review was performed to provide an overview of evaluations of digital public health interventions in the World Health Organization (WHO) SEAR. Searches were conducted on four electronic databases. Screening title abstracts and full texts was independently conducted by two reviewers, followed by data extraction. Dimensions of HTA were analyzed against the EUnetHTA Core Model 3.0. Quality assessment of included articles was conducted using the JBI Checklist for Economic Evaluation and Consolidated Health Economic Evaluation Reporting Standards 2022 checklist to assess the reporting quality. The findings are presented using systematic evidence tables and bar charts. Of the forty-three studies screened at the full-text stage, thirteen studies conducted across six countries were included in the analysis. Telemedicine and m-health interventions were assessed in ten studies. Nine studies conducted cost-effectiveness analysis, and five assessments were conducted from a societal perspective. Four studies utilized more than one perspective for the assessment. Health problem definition and current use of technology, description and technical characteristics of the technology, clinical effectiveness, costs, economic evaluation, and organizational aspects were assessed by all the studies, whereas legal aspects were least assessed. The lack of HTAs on digital public health interventions in the region highlights the need for capacity-building efforts.

Untact cultures have rapidly spread around the world as a result of the prolongation of the COVID-19 pandemic, leading to various types of research and technological developments in the fields of medicine and health care, where digital health care refers to health care services provided in a digital environment. Previous studies relating to digital health care demonstrated its effectiveness in managing chronic diseases such as hypertension and diabetes. While many studies have applied digital health care to various diseases, daily health care is needed for healthy individuals before they are diagnosed with a disease. Accordingly, research on individuals who have not been diagnosed with a disease is also necessary. This study aimed to identify the effects of using a customized digital health care service (CDHCS) on risk factors for metabolic syndrome (MS) and lifestyle improvement. The population consisted of 63 adults who underwent a health checkup at the National Health Insurance Service Ilsan (NHIS) Hospital in 2020. Measured variables include basic clinical indicators, MS-related variables, and lifestyle variables. All items were measured at NHIS Ilsan Hospital before the use of the CDHCS and 3 months thereafter. The CDHCS used in this study is a mobile app that analyzes the health condition of the user by identifying their risk factors and provides appropriate health care content. For comparison between before and after CDHCS use (pre-post comparison), paired t test was used for continuous variables, and a chi-square test was used for nominal variables. The study population included 30 (47.6%) male and 33 (52.4%) female participants, and the mean age was 47.61 (SD 13.93) years. The changes in clinical indicators before and after intervention results showed a decrease in weight, waist circumference, triglyceride, and high-density lipoprotein cholesterol and increases in systolic blood pressure and diastolic blood pressure. The distribution of the risk group increased from 32 (50.8%) to 34 (54%) and that of the MS group decreased from 18 (28.6%) to 16 (25.4%). The mean metabolic syndrome age-chronological age before the CDHCS was 2.20 years, which decreased to 1.72 years after CDHCS, showing a decrease of 0.48 years in the mean metabolic syndrome age-chronological age after the intervention. While all lifestyle variables, except alcohol consumption, showed a tendency toward improvement, the differences were not statistically significant. Although there was no statistical significance in the variables under study, this pilot study will provide a foundation for more accurate verification of CDHCS in future research.

Digital health is an area of growing interest for physicians, patients, and technology companies alike. It promises the ability to engage patients in their care, before, during, and after an emergency department visit. Current efforts to create, study, and disseminate digital health have been limited by lack of user engagement. In this commentary, we outline the imperative for engaging end-users in each phase of digital health design, as well as a few techniques to facilitate better digital health design and implementation.

Investments in digital health technologies such as artificial intelligence, wearable devices, and telemedicine may support Africa achieve United Nations (UN) Sustainable Development Goal for Health by 2030. We aimed to characterize and map digital health ecosystems of all 54 countries in Africa in the context of endemic infectious and non-communicable diseases (ID and NCD). We performed a cross-national ecological analysis of digital health ecosystems using 20-year data from the World Bank, UN Economic Commission for Africa, World Health Organization, and Joint UN Programme on HIV/AIDS. Spearman’s rank correlation coefficients were used to characterize ecological correlations between exposure (technology characteristics) and outcome (IDs and NCDs incidence/mortality) variables. Weighted linear combination model was used as the decision rule, combining disease burden, technology access, and economy, to explain, rank, and map digital health ecosystems of a given country. The perspective of our analysis was to support government decision-making. The 20-year trend showed that technology characteristics have been steadily growing in Africa, including internet access, mobile cellular and fixed broadband subscriptions, high-technology manufacturing, GDP per capita, and adult literacy, while many countries have been overwhelmed by a double burden of IDs and NCDs. Inverse correlations exist between technology characteristics and ID burdens, such as fixed broadband subscription and incidence of tuberculosis and malaria, or GDP per capita and incidence of tuberculosis and malaria. Based on our models, countries that should prioritize digital health investments were South Africa, Nigeria, and Tanzania for HIV; Nigeria, South Africa, and Democratic Republic of the Congo (DROC) for tuberculosis; DROC, Nigeria, and Uganda for malaria; and Egypt, Nigeria, and Ethiopia for endemic NCDs including diabetes, cardiovascular disease, respiratory diseases, and malignancies. Countries such as Kenya, Ethiopia, Zambia, Zimbabwe, Angola, and Mozambique were also highly affected by endemic IDs. By mapping digital health ecosystems in Africa, this study provides strategic guidance about where governments should prioritize digital health technology investments that require preliminary analysis of country-specific contexts to bring about sustainable health and economic returns. Building digital infrastructure should be a key part of economic development programs in countries with high disease burdens to ensure more equitable health outcomes. Though infrastructure developments alongside digital health technologies are the responsibility of governments, global health initiatives can cultivate digital health interventions substantially by bridging knowledge and investment gaps, both through technology transfer for local production and negotiation of prices for large-scale deployment of the most impactful digital health technologies.

Background In 2019, Digital Health was on the agenda of the European Union (EU) and its Member States (MS), and the digital health transformation of both healthcare services and Public Health has been well underway for several years. The COVID-19 pandemic crisis required an unexpectedly quick adaptation of social norms and exerted great pressure on healthcare and public health systems. Although implemented strategies and results have varied, Digital Health tools emerged as a fundamental aspect of the pandemic fight across the EU. Methods The objective of this study was to determine and compare Digital Health Strategies and COVID-19 Response in EU MS 43% had no interoperability with other apps. We analyzed the 27 MS of the EU and determined several parameters relevant before and during the pandemic: 1 - Preexisting national digital health strategy in 2019; 2 - COVID-19 General Information Website; 3 - Real time updated COVID-19 online dashboard; 4 - Mobile application for contact tracing; 4.1 - Mobile app launch date; 4.2 - Interoperability with other mobile apps; 5 - Shift to telemedicine; 6 - Official public health communication through social media; 7 - Dedicated COVID-19 Information System for Public Health Workforce. Information from publicly available sources. Results All EU MS had a preexisting digital health strategy before the pandemic, developed a dedicated COVID-19 General Information Website and a COVID-19 dashboard with real-time updates on relevant statistics. The majority of MS (79%) developed a mobile app for contact tracing (43% had no interoperability with other apps), and of those that had not developed an app as of April 30th 2021, 50% had one under development. Most apps were launched in the first trimester of 2021. Other results were heterogeneous. Conclusions In some aspects, there is a clear convergence between EU MS in the deployment of digital health tools to fight the COVID-19 pandemic. Key messages All European Union Member States used digital health tools to fight the COVID-19 pandemic. The success of national level deployment of specific digital health tools must be assessed in order to develop a more integrated digital health response plan at the European level in the future.

BackgroundDigital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together.ObjectiveThis review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities.MethodsWe searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion.ResultsA total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up.ConclusionsWhile studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.

BackgroundTechnologies such as mobile apps, continuous glucose monitors (CGMs), and activity trackers are available to support adults with diabetes, but it is not clear how they are used together for diabetes self-management.ObjectiveThis study aims to understand how adults with diabetes with differing clinical profiles and digital health literacy levels integrate data from multiple behavior tracking technologies for diabetes self-management.MethodsAdults with type 1 or 2 diabetes who used ≥1 diabetes medications responded to a web-based survey about health app and activity tracker use in 6 categories: blood glucose level, diet, exercise and activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale, and general health literacy was assessed using the Brief Health Literacy Screen. We analyzed descriptive statistics among respondents and compared health technology use using independent 2-tailed t tests for continuous variables, chi-square for categorical variables, and Fisher exact tests for digital health literacy levels. Semistructured interviews examined how these technologies were and could be used to support daily diabetes self-management. We summarized interview themes using content analysis.ResultsOf the 61 survey respondents, 21 (34%) were Black, 23 (38%) were female, and 29 (48%) were aged ≥45 years; moreover, 44 (72%) had type 2 diabetes, 36 (59%) used insulin, and 34 (56%) currently or previously used a CGM. Respondents had high levels of digital and general health literacy: 87% (46/53) used at least 1 health app, 59% (36/61) had used an activity tracker, and 62% (33/53) used apps to track ≥1 health behaviors. CGM users and nonusers used non-CGM health apps at similar rates (16/28, 57% vs 12/20, 60%; P=.84). Activity tracker use was also similar between CGM users and nonusers (20/33, 61% vs 14/22, 64%; P=.82). Respondents reported sharing self-monitor data with health care providers at similar rates across age groups (17/32, 53% for those aged 18-44 y vs 16/29, 55% for those aged 45-70 y; P=.87). Combined activity tracker and health app use was higher among those with higher Digital Health Care Literacy Scale scores, but this difference was not statistically significant (P=.09). Interviewees (18/61, 30%) described using blood glucose level tracking apps to personalize dietary choices but less frequently used data from apps or activity trackers to meet other self-management goals. Interviewees desired data that were passively collected, easily integrated across data sources, visually presented, and tailorable to self-management priorities.ConclusionsAdults with diabetes commonly used apps and activity trackers, often alongside CGMs, to track multiple behaviors that impact diabetes self-management but found it challenging to link tracked behaviors to glycemic and diabetes self-management goals. The findings indicate that there are untapped opportunities to integrate data from apps and activity trackers to support patient-centered diabetes self-management.

Digital health technologies enabling the transition from pregnancy to early parenthood: A scoping review.

The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.