Cost-consequence analysis of a digital health-enabled non-communicable disease management intervention in Ghana

The use of digital pain management interventions has grown since the Covid 19 pandemic. The aim of this study was to systematically review and synthesise evidence from qualitative studies regarding the experiences of individuals with chronic pain participating in digital pain management interventions in primary care and community settings. Fourteen databases were searched, as well as citation tracking and hand-searching reference lists of included articles. The latest search was completed by 07/07/2023. Qualitative studies of patient and carer perspectives of digital pain management interventions for adults aged 18 and over with non-malignant chronic pain were included. All studies were appraised for quality using the Critical Appraisal Skills Programme Qualitative Checklist. A narrative synthesis approach was used to synthesise the findings. Normalisation Process Theory was used to understand how individuals with chronic pain make sense of digital pain management interventions and incorporate knowledge, skills and strategies learnt into their day-to-day lives. Eleven studies, encompassing both digital applications for use on smartphones/ mobile devices and user-directed online modular programmes, were included in the synthesis. Three main themes and related subthemes were identified from the included studies: 1) Making sense of the digital intervention (Subthemes: Tailoring to user's needs; Human contact and support; Accessibility of the digital intervention; Personal and environmental factors affecting engagement with digital interventions); 2) Initiating and Maintaining Behaviour Change (Subthemes: Planning activity; Being active); and 3) Personal Growth (Subthemes: Gaining understanding and skills; Gaining and acting on feedback; Negotiating a new relationship with pain). Recommendations. The key recommendations from our findings are that digital pain management interventions should provide: Specific and tailored information for individual participants.Focus on changing attitudes and behaviours and reframing perceptions of pain.Structured goal setting with prompts to review goals.Potential healthcare professional support alongside the digital intervention.Limitations of the review. To reduce bias, it would have been preferable for more than one author to independently fully analyse each paper and to identify themes and sub-themes. Instead, the identified themes and sub-themes were discussed with two other authors in the team (ES, LW) to reach a consensus view on final themes and sub-themes. One author (JS) received a Research Internship and Research Initiation Award funded by NIHR Applied Research Collaboration (ARC) Wessex (https://www.arc-wx.nihr.ac.uk/) and NHS England (https://www.england.nhs.uk/). The protocol for this review was registered with the National Institute of Health Research (NIHR) PROSPERO international database for registering systematic reviews (PROSPERO Registration Number CRD42021257768).

BackgroundDigital interventions for weight management provide a unique opportunity to target daily lifestyle choices and eating behaviors over a sustained period of time. However, recent evidence has demonstrated a lack of user engagement with digital health interventions, impacting on the levels of intervention effectiveness. Thus, it is critical to identify the factors that may facilitate user engagement with digital health interventions to encourage behavior change and weight management.ObjectiveThe aim of this study was to identify and synthesize the available evidence to gain insights about users’ perspectives on factors that affect engagement with digital interventions for weight management.MethodsA rapid review methodology was adopted. The search strategy was executed in the following databases: Web of Science, PsycINFO, and PubMed. Studies were eligible for inclusion if they investigated users’ engagement with a digital weight management intervention and were published from 2000 onwards. A narrative synthesis of data was performed on all included studies.ResultsA total of 11 studies were included in the review. The studies were qualitative, mixed-methods, or randomized controlled trials. Some of the studies explored features influencing engagement when using a Web-based digital intervention, others specifically explored engagement when accessing a mobile phone app, and some looked at engagement after text message (short message service, SMS) reminders. Factors influencing engagement with digital weight management interventions were found to be both user-related (eg, perceived health benefits) and digital intervention–related (eg, ease of use and the provision of personalized information).ConclusionsThe findings highlight the importance of incorporating user perspectives during the digital intervention development process to encourage engagement. The review contributes to our understanding of what facilitates user engagement and points toward a coproduction approach for developing digital interventions for weight management. Particularly, it highlights the importance of thinking about user-related and digital tool–related factors from the very early stages of the intervention development process.

ObjectiveTo evaluate the adoption, effectiveness and cost-effectiveness of digital health interventions for rheumatic disease management.MethodsBetween 25 May 2024 and 2 June 2024, we systematically searched PubMed®, Scopus, ClinicalTrials.gov, the Global Observatory for eHealth and the World Bank Open Knowledge Repository for randomized controlled trials (RCTs) evaluating digital health interventions for rheumatic disease management. We included studies published between 2000 and 2024 that reported on adoption rates and efficacy. Two reviewers independently screened the studies, extracted data and categorized the digital interventions according to the World Health Organization’s classification of digital health interventions.FindingsOf the 455 unique records identified, 21 RCTs met the inclusion criteria. Most digital health interventions (15 studies) focused on individual-centric interventions, such as targeted communication, personal health tracking, educational tools and wearable devices. Studies in high-income countries implemented advanced, integrated digital interventions combining individual-focused approaches with health worker interventions and data services using telemedicine platforms and decision support systems. In contrast, studies in low- and middle-income countries adapted accessible technologies such as mobile messaging and telephone-based education. Many telehealth, wearable technologies and educational interventions significantly improved disease control, patient adherence, knowledge and self-efficacy. Of the five studies assessing cost-effectiveness, all found digital interventions to be cost-effective.ConclusionDigital health interventions show promise for managing rheumatic diseases. Tailoring these interventions to local infrastructure and emphasizing patient engagement are crucial for successful adoption. Future research should focus on standardizing evaluation methods, addressing digital divides and enhancing provider support and data services.

Bariatric surgery is an effective long-term treatment for severe obesity, but relapse rates remain high. Digital interventions can enhance patient care, yet research on the intention to use digital discharge management interventions is lacking. This study aims to assess the behavioral intention to use digital discharge management interventions after bariatric surgery and to identify differences in sociodemographic and medical characteristics, as well as potential key drivers and barriers. A cross-sectional study with N = 514 patients was conducted using the Unified Theory of Acceptance and Use of Technology (UTAUT). Mean scores for behavioral intention and predictors were calculated. Group differences were analyzed with independent t-tests and analyses of variance with post hoc tests. Drivers and barriers were assessed through multiple hierarchical regression analysis. The behavioral intention to use digital discharge management interventions was high. Significant predictors included age (β = −0.17, p < 0.001), eHealth literacy (β = 0.10, p = 0.037), internet anxiety (β = −0.15, p = 0.003), and time since bariatric operation (β = −0.13, p = 0.005). The predictors performance expectancy (β = 0.23, p < 0.001), effort expectancy (β = 0.36, p < 0.001), and social influence (β = 0.26, p < 0.001) were significantly positive key factors. These results confirm the need for implementing digital discharge interventions after bariatric surgery, with various drivers and barriers identified for application usage.

BackgroundStress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited.ObjectiveThis study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months.MethodsRecruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer’s perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping.ResultsFrom a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56% probability of being cost-effective at a willingness-to-pay (WTP) of €0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55% being cost-effective per QALY gained relative to the WLC. This probability increased to 80% at a societal WTP of €20,000 per QALY gained. Taking the employer’s perspective, the digital intervention showed a probability of a positive return on investment of 78%.ConclusionsDigital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers.Trial RegistrationGerman Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699

Current evidence on digital health interventions is disproportionately concerned with high-income countries and hospital settings. This scoping review evaluates the extent of use and effectiveness of digital health interventions for non-communicable disease (NCD) management in primary healthcare settings of low- and middle-income countries (LMICs) and identifies factors influencing digital health interventions’ uptake. We use PubMed, Embase, and Web of Science search results from January 2010 to 2021. Of 8866 results, 52 met eligibility criteria (31 reviews, 21 trials). Benchmarked against World Health Organization’s digital health classifications, only 14 out of 28 digital health intervention categories are found, suggesting critical under-use and lagging innovation. Digital health interventions’ effectiveness vary across outcomes: clinical (mixed), behavioral (positively inclined), and service implementation outcomes (clear effectiveness). We further identify multiple factors influencing digital health intervention uptake, including political commitment, interactivity, user-centered design, and integration with existing systems, which points to future research and practices to invigorate digital health interventions for NCD management in primary health care of LMICs.

BackgroundSome guidelines state that in-person weight management interventions are more efficacious than those delivered digitally. However, digital programs are more scalable and accessible. We hypothesized that one-on-one health coaching via app-based video chat would simulate an in-person experience and help achieve outcomes comparable to those of in-person interventions.MethodsA 12-month digital weight management intervention was provided to overweight or obese adults recruited from a large technology company. One-on-one health coaching sessions were offered during a 24-week intensive phase as well as subsequent maintenance phase. Focused on sustainable changes in activity and diet, the intervention incorporates SMART goals, in-app food and activity logs, Fitbit integration, as well as optional sleep and stress modules. Self-Determination Theory and the Transtheoretical Model are incorporated to drive behavior change. Multilevel mixed-effects models were used to analyze weight changes retrospectively.ResultsSix hundred eighty-three participants reported 29,051 weights. At 12 months, mean percent changes in body weight were -7.2% and -7.6% for overweight and obese groups, respectively. A weight change of -5% is commonly targeted for in-person weight management interventions. Observed weight loss exceeded this target by 2.2% (95% CI, 0.7% to 3.8%; P < .01) for the overweight group and 2.6% (95% CI, 1.4% to 3.9%; P < .01) for the obese group.ConclusionsFurther research is needed with randomization to in-person or digital interventions. Though limited by an observational, retrospective design, preliminary results suggest that some digital weight management programs with one-on-one coaching may achieve outcomes comparable to those of robust, in-person interventions.

Chronic pain is prevalent among adults with sickle cell disease (SCD) and can be worsened by psychosocial factors such as depression and inadequate social support. Effective behavioral interventions (eg, cognitive behavioral therapy [CBT]) exist for chronic pain in various populations; however, few have been developed to address chronic pain in SCD. Several barriers have restricted the development and dissemination of CBT pain interventions in SCD, such as limited accessibility and time constraints. Digital interventions provide accessible and cost-effective pain management tools, offering self-management strategies, real-time monitoring, and personalized treatment options. Yet, there are limited data regarding patients' experiences with such interventions within the SCD population. The Cognitive Behavioral Therapy and Real-Time Pain Management Intervention for Sickle Cell Via Mobile Applications (CaRISMA) trial evaluated the effectiveness of a digital CBT intervention compared with a digital educational intervention for pain management in SCD. Evaluating participants' experiences can guide refinement of digital pain interventions in SCD. This study aimed to gain a deeper understanding of the lived experiences of participants in the CaRISMA trial and to determine how to better adapt this intervention to the SCD population. The study examined individuals' overall experience with the trial and their perspectives of the trial components: a health coach, a chatbot-delivered digital CBT program, and an electronic pain diary. Respondents were randomly selected to participate in semistructured interviews at (1) baseline, (2) the end of the intervention period at 3 months, and (3) the postintervention time point at 6 months or beyond. Interviews were audiotaped, transcribed verbatim, and analyzed using conventional content analysis. A total of 48 participants (women: 33/48, 69%) completed the interviews, with 24 and 19 completing midpoint and postintervention interviews, respectively. Participants generally had a positive experience in the trial. Many found value in learning about the connection between pain and mental health, considering it an important aspect of their well-being. The health coach played a key role in offering personalized support and guidance. Although the chatbot reinforced pain management strategies, its usefulness and engagement varied based on participants' prior knowledge of SCD. The pain diary helped increase self-awareness of pain patterns but was perceived as tedious and irrelevant by those without current pain episodes. This qualitative substudy of the CaRISMA trial showed that participants valued the personalized support of the health coach, education about the connection between stress and pain, and the self-reflection fostered by the pain diary. These findings highlight the potential of digital, patient-centered approaches to address the multifaceted needs of SCD care. For digital interventions, the inclusion of personalized support with ongoing communication appears to be a critical component that can influence treatment adherence and effectiveness. ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/study/NCT04419168. RR2-10.2196/29014.

Digital health interventions have gained prominence in the management of chronic diseases like Type 1 Diabetes Mellitus (T1DM), helping patients adhere to their treatment plans. However, the effectiveness of these interventions in improving adherence to T1DM management varies globally. To systematically review existing digital interventions designed to improve adherence to T1DM management. To identify key features of digital tools that enhance adherence and glycaemic control in T1DM patients. Primary outcomes were improvements in patient adherence, measured by frequency of insulin administration, self-monitoring of blood glucose, and HbA1c levels. Secondary outcomes included patient satisfaction and engagement with digital interventions. A systematic review of randomized controlled trials (RCTs) was conducted using the PICO framework. The review encompassed studies from various global regions. Studies included T1DM patients across different age groups. Databases such as PubMed, Cochrane, and Ovid were searched for relevant studies. A total of 12 randomized controlled trials (RCTs) were included in this review, focusing on improving adherence in T1DM patients. The digital interventions evaluated included mobile health applications, continuous glucose monitoring, telemedicine platforms, and educational video games. Most studies demonstrated significant improvements in patient adherence behaviours, such as insulin administration and self-monitoring of blood glucose, reductions in HbA1c levels were also noted. The improvements in HbA1c as seen in this review for individuals with T1DM are in line with findings from prior studies. The evidence showed that digital health technologies could enhance glycaemic control. These findings are in line with other studies where real-time data monitoring equipment of the emergent CGM systems and mobile apps facilitated accurate and timely modification of diabetes self-management. The reviewed studies also highlighted the effectiveness of digital technology-targeted interventions in enhancing the aspect of self-management and health behaviour among T1DM patients. These results are also aligned with the behavioural change theories which highlight the significance of education, perceived self-ability and continuous feedback in adopting good health behaviour. Digital interventions have a positive impact on adherence to T1DM management and glycaemic control. Their application, particularly in low-resource settings, holds great potential for improving health outcomes. Not applicable. The aim of this review was to look at how mobile applications among other digital tools can assist people living with Type 1 Diabetes (T1DM) through continuous glucose monitoring to manage their health condition in a better way. For this purpose, we reviewed 12 different studies and found that interventions delivered through digital tools enhanced patients' adherence to their treatment by helping them lower the blood sugar levels as measured by HbA1c levels. Main findings reflected how digital tools improved health behaviours and self-management of T1DM. This was facilitated by real-time data monitoring and feedback for the diabetes care. In conclusion, Digital health interventions have the potential to positively impact the T1DM treatment leading to improved health outcomes especially in low resource settings.

BackgroundTraditional lifestyle interventions have shown limited success in improving diabetes-related outcomes. Digital interventions with continuously available support and personalized educational content may offer unique advantages for self-management and glycemic control.ObjectiveIn this study, we evaluated changes in glycemic control among participants with type 2 diabetes who enrolled in a digital diabetes management program.MethodsThe study employed a single-arm, retrospective design. A total of 950 participants with a hemoglobin A1c (HbA1c) baseline value of at least 7.0% enrolled in the Vida Health Diabetes Management Program. The intervention included one-to-one remote sessions with a Vida provider and structured lessons and tools related to diabetes management. HbA1c was the primary outcome measure. Of the 950 participants, 258 (27.2%) had a follow-up HbA1c completed at least 90 days from program start. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up. Additionally, a cluster-robust multiple regression analysis was employed to evaluate the relationship between high and low program usage and HbA1c change. A repeated measures analysis of variance was used to evaluate the difference in HbA1c as a function of the measurement period (ie, pre-Vida enrollment, baseline, and postenrollment follow-up).ResultsWe observed a significant reduction in HbA1c of –0.81 points between baseline (mean 8.68, SD 1.7) and follow-up (mean 7.88, SD 1.46; t257=7.71; P<.001). Among participants considered high risk (baseline HbA1c≥8), there was an average reduction of –1.44 points between baseline (mean 9.73, SD 1.68) and follow-up (mean 8.29, SD 1.64; t139=9.14; P<.001). Additionally, average follow-up HbA1c (mean 7.82, SD 1.41) was significantly lower than pre-enrollment HbA1c (mean 8.12, SD 1.46; F2, 210=22.90; P<.001) There was also significant effect of program usage on HbA1c change (β=–.60; P<.001) such that high usage was associated with a greater decrease in HbA1c (mean –1.02, SD 1.60) compared to low usage (mean –.61, SD 1.72).ConclusionsThe present study revealed clinically meaningful improvements in glycemic control among participants enrolled in a digital diabetes management intervention. Higher program usage was associated with greater improvements in HbA1c. The findings of the present study suggest that a digital health intervention may represent an accessible, scalable, and effective solution to diabetes management and improved HbA1c. The study was limited by a nonrandomized, observational design and limited postenrollment follow-up data.

Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Unplanned rehospitalisation rates after discharge remain high, reflecting the chronic nature of CVD and the frequent need for complex, multidisciplinary follow-up care. Digital interventions may provide a valuable complement to traditional discharge management in addressing these challenges. Patients and methods: This study aims to assess the acceptance of digital discharge management interventions (DDMI) and to investigate the underlying factors influencing acceptance among patients with CVD following inpatient treatment. A cross-sectional survey-based study was conducted from June to October 2024 with N = 259 patients with CVD following inpatient treatment. Sociodemographic, medical, mental health, and e-Health-related data were assessed. Acceptance of DDMI and its underlying factors were assessed using a modified model of the Unified Theory of Acceptance of Use of Technology (UTAUT). Results: The overall acceptance of DDMI was high (M = 3.99, SD = 0.92, range = 1-5). The extended UTAUT model explained 62.7% of the variance in acceptance, with male gender (β = -0.36, p < .001) and the UTAUT predictors effort expectancy (β = 0.40, p < .001), performance expectancy (β = 0.24, p < .001), and social influence (β = 0.20, p < .001) being significant predictors. Conclusions: These findings indicate a generally high acceptance of DDMI among patients with CVD following inpatient treatment. To develop and implement such interventions, key drivers and barriers such as effort expectancy, performance expectancy, and social influence should be addressed. Furthermore, such interventions should be tailored to patients' specific needs.

BackgroundThe Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support.ObjectiveThe ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors.MethodsThis qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis.ResultsQualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence.ConclusionsThis study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback.International Registered Report Identifier (IRRID)RR2-10.2196/12782

WHAT MAKES DIGITAL INTERVENTIONS EFFECTIVE FOR EXERCISE PROMOTION: A SYSTEMATIC REVIEW OF REVIEWS AND META-ANALYSIS

There is insufficient evidence to demonstrate a clear benefit or harm of digital technology interventions with or without supported self-management, or multi-component interventions compared to usual care in improving the 6MWD or self-efficacy. We found there may be some short-term improvement in quality of life with digital interventions, but there is no evidence about whether the effect is sustained long term. Dyspnoea symptoms may improve over a longer duration of digital intervention use. The evidence for multi-component interventions is very uncertain and as there is little or no evidence for adverse events, we cannot determine the benefit or harm of these interventions. The evidence base is predominantly of very low certainty with concerns around high risk of bias due to lack of blinding. Given that variation of interventions and blinding is likely to be a concern, future, larger studies are needed taking these limitations in consideration. Future studies are needed to determine whether the small improvements observed in this review can be applied to the general COPD population. A clear understanding of behaviour change through the BCT classification is important to gauge uptake of digital interventions and health outcomes in people with varying severity of COPD. Currently there is no guidance for interpreting BCT components of a digital intervention for changes to health outcomes. We could not interpret the BCT findings to the health outcomes we were investigating due to limited evidence that was of very low certainty. In future research, standardised approaches need to be considered when designing protocols to investigate effectiveness of digital interventions by including a standardised approach to BCT classification in addition to validated behavioural outcome measures that may reflect changes in behaviour.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: We will assess the benefits and harms of digital interventions for the management of chronic obstructive pulmonary disease. As a second objective, we will use the Behaviour Change Technique taxonomy to describe and explore intervention content.