Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study.

BackgroundDespite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years.ObjectiveThis study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer.MethodsThe National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design.ResultsThe prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed.ConclusionsDigital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty.

Globally nursing practice changed in 2020 with the outbreak of the COVID-19 pandemic and a rapid increase in the use of digital health technologies by nurses. This 2022 study is part of a wider international project investigating nurses’ use and perception of digital technologies during the COVID-19 pandemic with data collected through an anonymous online survey of nurses. This paper reports on the Aotearoa New Zealand arm of the study where 191 nurses from a range of clinical settings, including acute hospital care, mental health and addiction services, and community care, completed the online survey. The majority of technologies used by nurses were online communication tools (n=48; 29.5%), electronic patient records (n=41; 25.2%), or patient monitoring/data sharing (n=40; 24.5%). Nearly two thirds of the nurses (n=62; 61%) considered they had received sufficient training to use the technology effectively. Nurses rated usability of systems using the System Usability Scale (SUS) and patient monitoring/data sharing systems and electronic prescribing achieved scores above 70, indicating good usability. However, electronic patient records had the lowest System Usability Scale score suggesting these were not found to be as easy to use as other technologies. Recommendations from this work include that nurse leaders and academics also need to consider the digital health technologies training and education needs to ensure an appropriately trained workforce. Furthermore, it is recommended that the international collaborative work continues as this may assist in planning and preparing New Zealand and international nurses for use of digital health now and for future pandemic events. Te Reo Māori Translation Te whakamahinga, me ngā whakaaro o ngā tapuhi o Aotearoa, o te hauora matihiko i te wā o te urutā COVID-19 Ngā Ariā Matua I panoni ngā tikanga mahi tapuhi i te tau 2020, i te pānga o te urutā COVID-19, me te pikinga hohoro o te whakamahinga o ngā hangarau hauora matihiko e ngā tapuhi. He wāhanga tēnei rangahau mai i 2022 nō tētahi rangahau ā-ao whānui kē atu e tūhura nei i te whakamahinga me ngā whakaaro o ngā tapuhi mō ngā hangarau matihiko i te wā o te urutā COVID-19. i kohia mā ētahi raraunga mai i tētahi uiuinga ipurangi ingoa-muna o ngā tapuhi. Ka tuku pūrongo tēnei tuhinga mō te wāhanga o Aotearoa o tēnei rangahau, i whakaotingia ai te uiuinga ipurangi e ētahi tapuhi 191 mai i te huhua o ngā horopaki tiaki tūroro, tae atu ki te tiaki mate hōhipera taumaha, ngā ratonga hauora hinengaro, waranga hoki, me te tiaki hapori. Ko te nuinga o ngā hangarau i whakamahia e ngā tapuhi ko ngā taputapu whakawhiti kōrero tuihono (n=48; 29.5%), ngā rēkoata tūroro matihiko (n=41; 25.2%), te aroturuki tūroro matihiko/whakawhiti raraunga matihiko rānei (n=40; 24.5%). Tata ki te rua hautoru o ngā tapuh i kī (n=62; 61%) i rahi anō ngā whakangungu i a rātou i whai hua ai tā rātou whakamahi i aua hangarau. I whakatau ngā tapuhi i te ngāwari o ngā pūnaha ki te whakamahi mā te whakamahi i te Inenga Ngāwaritanga Whakamahi Pūnaha [System Usability Scale] (SUS) ā, i tohua ngā pūnaha arotake tūroro/whakawhiti raraunga me te whakahau rongoā matihiko ki ngā tatau neke atu i te 70, heoi anō, he tohu tēnei he pai te ngāwari o te whakamahi. Ahakoa tērā, ko ngā pūkete tūroro matihiko i pāpaku rawa te Inenga Ngāwaritanga Whakamahi Pūnaha [System Usability Scale], ā, te āhua nei kāore ēnei i rite ki tērā atu hangarau ki te whakamahi. Ko ngā tūtohu whai muri i ēnei mahi, kia āta whakaaro ngā kaihautū tapuhi me ngā kairangahau mō te taha whakangungu hangarau hauora matihiko, me ngā hiahia akoranga, kia tika ai te whakaputa ohu kaimahi i āta whakangungua. Waihoki, ko te tūtohu kia haere tonu ngā mahi pāhekoheko ā-ao nā te mea mā konei ka pai ake te whakamahere me te whakatikatika i ngā tapuhi o Aotearoa, o te ao hoki mō te hauora matihiko o nāianei, me ngā urutā o raurangi.

BackgroundSexual minority youth, particularly sexual minority youth of color, report elevated mental health challenges and persistent barriers to care. The COVID-19 pandemic exacerbated these disparities and catalyzed a shift toward digital health and digital mental health services. This rapid transition has made it challenging to understand digital exclusion and the digital divide.ObjectiveThis cross-sectional study identified the prevalence of digital health and digital mental health service use among US adolescents during the COVID-19 pandemic and examined heterogeneity by sexual orientation, race and ethnicity, and their intersection.MethodsNationally representative data were obtained from the 2021 Adolescent Behaviors and Experiences Survey (N=7705). Weighted distributions of digital health and digital mental health use were calculated, and modified Poisson regression models estimated adjusted prevalence ratios (aPRs) by sexual orientation, race and ethnicity, and their intersection.ResultsAcross the sample, digital health and digital mental health use were 25.8% and 8.5%, respectively. (All percentages reported are weighted estimates.) Digital mental health use was 5.6% among heterosexual participants and 18.1% among all sexual minority youth. In adjusted models, sexual minority subgroups had higher prevalence of digital mental health use than heterosexual peers (lesbian, gay, and bisexual [LGB]: aPR 2.60; sexually diverse: aPR 2.41; all P≤.05). This pattern held among White, Black or African American, and multiracial LGB participants. Digital mental health use was 10.2% among White participants and ranged from 4.8% to 15% among racially or ethnically minoritized participants. Black or African American, Hispanic or Latino, and Asian or Pacific Islander participants had lower prevalence of digital mental health use than White peers overall (Black or African American: aPR 0.70; Hispanic or Latino: aPR 0.55; Asian or Pacific Islander: aPR 0.48; all P≤.05) and among sexual minority youth (Black or African American: aPR 0.60; Hispanic or Latino: aPR 0.35; Asian or Pacific Islander: aPR 0.23; all P≤.05). Racial and ethnic disparities in digital mental health use were pronounced among LGB (Hispanic or Latino: aPR 0.52; P≤.05) and sexually diverse participants (Black or African American: aPR 0.36; Hispanic or Latino: aPR 0.17; Asian or Pacific Islander: aPR 0.10; all P≤.05), but not heterosexual participants. Digital health use did not differ by sexual orientation. However, Black or African American and Hispanic or Latino participants had lower prevalence of digital health use than White peers (28.8%) overall (Black or African American: aPR 0.76; Hispanic or Latino: aPR 0.78; all P≤.05) and among heterosexual (Black or African American: aPR 0.73; Hispanic or Latino: aPR 0.80; all P≤.05) and sexual minority youth participants (Hispanic or Latino: aPR 0.75).ConclusionsDigital platforms offer promise for expanding access to mental health care among sexual minority youth, but persistent inequities must be addressed. Cocreation with lived-experience experts may be critical to ensure digital services are trusted, inclusive, and accessible for all youth.

BackgroundDigital health literacy is a key factor in enabling users to navigate in an increasingly digitalized health care system. Low levels of digital health literacy are associated with higher age, low education, and income, as well as low functional health literacy. Around 6.2 million adults living in Germany have low reading and writing skills. Due to their low literacy, this group is often underrepresented in research studies and therefore little is known about their digital health literacy and use of digital health tools.ObjectiveThe objectives of this study were to assess digital health literacy in adults with low reading and writing skills and to explore which digital health tools they use in daily life.MethodsAn interviewer-administered survey and focus groups were conducted with adult residents of Bremen, Germany, who were aged 18‐64 years and had low reading and writing skills. In addition, a stakeholder workshop was held to derive recommendations on how digital health literacy could be improved. The survey questionnaire included 21 items addressing the use of digital health technologies and digital health literacy (eHealth Literacy Scale). Focus group participants completed several tasks on web-based health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and linear regression. Qualitative content analysis was applied to analyze the focus group data and the written documentation of the stakeholder workshop.ResultsSurvey participants (n=96) were on average 43 (SD 10.7) years old, 72% (69/96) were female, and 92% (88/96) were not born in Germany. Participants reported mainly using information-related digital health technologies such as health apps (40/96, 42%), health websites (30/96, 31%), or activity trackers (27/96, 28%). The mean digital health literacy score was 22 (SD 8) points, with 35% (34/96) of participants classified as having a low digital health literacy (score between 8-19/40 points). Digital health technology use was associated with higher digital health literacy. For participants in the 5 focus groups (total n=39; mean age 43, SD 12.6 years; n=34, 87% female), limited technical skills and language problems were the most important challenges. Furthermore, focus group participants reported that they favor videos when searching for web-based health information and prefer to seek support from family members or local organizations for health issues. Stakeholders (n=15) recommended that health websites should be available in multiple languages, contain simple and easy-to-read language, and use images, symbols, and videos.ConclusionsWhile adults with low reading and writing skills use digital health technologies, many find it challenging to search for health information on the internet due to lacking technical skills and language problems. To ensure that adults with low reading and writing skills are not further left behind, future research should focus on developing tailored interventions to promote digital health literacy.

Digital health technologies can potentially increase the efficiency and quality of pediatric palliative care (PPC), yet their use in home-based PPC remains limited. Limited digital health care literacy and inadequate training can reduce confidence and foster negative attitudes, whereas positive experiences and basic digital health care literacy may encourage adoption. This study aims to explore the use of digital health technologies by Norwegian health care personnel in home-based PPC and examine the association between their digital health care literacy and their attitudes toward digital health. A cross-sectional study was conducted from September 2023 to May 2024, with an online survey targeting health care personnel involved in home-based PPC through primary or specialist health care services. Data were collected using selected items from the Norwegian Healthcare Personnel Survey on eHealth 2022, the Digital Health Care Literacy Scale (DHLS), and the Information Technology Attitude Scales for Health (ITASH), alongside demographic characteristics. Higher DHLS scores indicate greater digital health care literacy, while higher ITASH scores reflect more positive attitudes toward digital health technologies. Pearson correlation, ANOVA, and multiple linear regression analyses were conducted to comprehensively explore the relationships and associations among the variables. Health care personnel (n=148) from diverse health care services responded to the survey. Half of the respondents (72/144, 50%) had experience with real-time video consultation, while phone calls were the primary communication method (138/145, 95.2%). Additionally, 55.6% (79/142) of the respondents had limited or minimal access to electronic health records from other health care services. Health care personnel perceived digital health technologies for remote PPC as a supplement (126/135, 93.3%) rather than a replacement for in-person care. Mean digital health care literacy was 18.29 (SD 3.8) on a scale from 0 to 23. On a scale from 1 to 4, the highest recorded scores pertained to attitudes toward digital health technologies in supporting care (mean 3.17, SD 0.39) and the perceived need for training (mean 3.16, SD 0.43). A statistically significant association was found between the respondents' level of digital health care literacy and their attitudes toward digital health technologies in supporting care (β=0.030, 95% CI 0.014-0.047; P<.001). This study examined the use of digital health technologies by Norwegian health care personnel in home-based PPC, their digital health care literacy, and attitudes toward digital health. Despite positive attitudes and high digital health care literacy, use of digital health technologies was limited, suggesting that inadequate digital health solutions may hinder effective implementation. Addressing these barriers is crucial to enhancing the implementation of digital health in home-based PPC. Future research should focus on integrating digital health technologies into existing infrastructure and workflows while exploring their impact on personalized care to ensure high-quality home-based PPC.

South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. The aim of the review is to identify South Asian individuals' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services. The Arksey and O'Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review. Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians. Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups' access to health care services to support individual health needs, and consequently enhance health status.

BackgroundDigital health plays a vital role in healthcare services. Governments in many countries, including China, are increasingly advocating for the appropriate use of digital technologies to address significant health system challenges. It is crucial to incorporate digital health education into the curriculum for future nurses to adapt to the changes in the digital medical system. This study aimed to evaluate the impact of an online Digital Health and Informatics Course in China on the knowledge and comprehension of key digital health and informatics topics, self-assessment of nursing informatics competencies, and satisfaction among undergraduate nursing students. The findings of this study provide recommendations for the design and implementation of future digital health education.MethodsThis study employed a one-group, quasi-experimental mixed-methods design with pre- and post-assessments. The participants received digital health and informatics education through six three-hour online sessions in six interactive days, with online self-learning materials in between. An online quiz and focus group discussions pre- and post the course were designed to evaluate the knowledge and comprehension of key digital health and informatics topics. Also, a validated Chinese version of the Self-assessment of Nursing Informatics Competencies Scale was conducted pre- and post-course to assess self-assessment of nursing informatics competencies. Additionally, all students were invited to participate in an online survey with a performance-focused course evaluation form as well as focus group discussions to gather their feedback on the learning experience and their evaluations of the course.ResultsA total of 24 undergraduate nursing students were enrolled in the course. All students completed all sessions of this course, resulting in an attendance rate of 100%. Additionally, all students completed both pre- and post-assessments. In terms of the knowledge and comprehension of key digital health and informatics topics, scores of the quiz on knowledge assessment improved from the pre-test [mean pretest score: 78.33 (SD 6.005)] to the post-test [mean post-test score: 83.17 (SD 4.86)] upon completion of the course (P < 0.001). Also, students acknowledged that the course enhanced their knowledge and comprehension of informatics and digital health, the benefits of (nursing) informatics in clinical practice, and the role of health care professionals in informatics and digital health. In terms of self-assessment of nursing informatics competencies, scores on nursing informatics attitudes demonstrated significant improvement (P < 0.001). Furthermore, students reported high satisfaction with various aspects of this course, including the opportunity to explore broad horizons in informatics for future careers, engaging in group discussions, and analyzing case studies on the use of informatics and digital health in clinical practice.ConclusionsThis Online Digital Health and Informatics education effectively improved undergraduate nursing students’ knowledge and comprehension of the key digital health and informatics topics, nursing informatics attitudes in the self-assessment of nursing informatics competency with high levels of satisfaction. In order to ensure that future education in digital health and informatics for nursing students is in line with the technological advancements in clinical settings, it is necessary to foster collaboration between medical school training and clinical practice. This collaboration should involve the use of clinical examples to illustrate advanced digital health applications and the inclusion of practical exercises on the use of digital health technology in clinical settings.

Introduction Digital health is a broad term that includes telecommunication technologies to collect, share and manipulate health information to improve patient health and health care services. With the growing use of wearables, artificial intelligence, machine learning, and other novel technologies, digital health is particularly relevant to the field of cardiac arrhythmias, with roles pertinent to education, prevention, diagnosis, management, prognosis, and surveillance. Areas covered This review summarizes information on the clinical use of digital health technology in arrhythmia care and discusses its opportunities and challenges. Expert opinion Digital health has begun to play an essential role in arrhythmia care regarding diagnostics, long-term monitoring, patient education and shared decision making, management, medication adherence, and research. Despite remarkable advances, integrating digital health technologies into healthcare faces challenges, including patient usability, privacy, system interoperability, physician liability, analysis and incorporation of the huge amount of real-time information from wearables, and reimbursement. Successful implementation of digital health technologies requires clear objectives and deep changes to existing workflows and responsibilities.

No AccessMar 2023How Digital Health Technology Is Transforming Health Care for Older AdultsAuthors/Editors: Gabriel Catan Burlac, Xiaohui HouGabriel Catan BurlacSearch for more papers by this author, Xiaohui HouSearch for more papers by this authorhttps://doi.org/10.1596/978-1-4648-1958-2_ch4AboutView ChaptersPDF (0.5 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract: Documents how digital health innovations may improve health and well-being for older people, including in lower-income settings. Digital health can transform care for older populations, but many older adults face access gaps. Digital technologies support older people’s health through clinical applications, information integration, and case management applications and by enabling healthier lifestyles. Key digital health access barriers for older people reflect technology design, affordability, and ease of use. A senior-centric design approach can optimize digital technologies for older adult care. Assessing older adults’ preferences, capabilities, and challenges with digital health technology presents a first step for effective policy. To promote older people’s use of digital health, governments and partners can enlist families and caregivers as key allies. Countries can leverage new business models for digital health in older populations, including public-private partnerships, by offering financial incentives and an enabling ecosystem that can foster local start-ups and expand this promising market. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: March 2023ISBN: 978-1-4648-1958-2e-ISBN: 978-1-4648-1965-0 Copyright & Permissions Related TopicsHealth Nutrition and PopulationInformation and Communication Technologies KeywordsAGING POPULATIONPRIMARY HEALTH CAREACCESS TO HEALTH SERVICESHEALTH POLICYHEALTH CARE REFORMHEALTH OUTCOMESQUALITY OF HEALTH CAREDIGITAL DEVELOPMENTHEALTH INFORMATIONHEALTH MANAGEMENT INFORMATION SYSTEMHMISPUBLIC-PRIVATE PARTNERSHIPS PDF DownloadLoading ...

The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization's European region. Extracted data were mapped against Cochrane's PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed.

BackgroundDigital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low.ObjectiveThe objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH.MethodsThis study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH.ResultsSocial influence (adjusted odds ratio [aOR] 1.68, 95% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non–stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95% CI 1.10-3.80; P=.02).ConclusionsOverall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health.

BackgroundFollowing the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems.ObjectiveThis study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030.MethodsWe conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations.ResultsData from 52 patients indicated that, from the patients’ point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of €76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between €3.73 and €9.53 per patient.ConclusionsWe presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations.Trial RegistrationGerman Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n

LGBTQ older adults face distinct challenges accessing healthcare. Digital health solutions offer responsive approaches that broaden availability of health information and care, especially for those experiencing isolation, discrimination, and barriers to care. While some LGBTQ older adults prefer digital health technologies, others face difficulties with electronic literacy that prevent use. The current study examined the association of sexual and gender identity and health access factors (barriers to care; health literacy; help-seeking beliefs; healthcare discrimination) with past 12-month use of digital health technologies for communication, insurance matters, and health-information seeking. Data were analyzed from the 2015 healthcare access module of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) (N=2,322). Results indicated digital health use varied across LGBTQ older adult subgroups and access factors. Transgender older adults, compared to cisgender, were more likely to use each digital resource to manage their health and healthcare. Participants with experiences of healthcare discrimination more likely communicated with their providers online, while those with lower health literacy turned to the internet to find health information. Older cohorts (65-79; 80+), poverty-impacted, and Black and Hispanic participants were less likely to use digital resources. Digital health technologies may enhance healthcare access for LGBTQ older adults, potentially bridging gaps in service availability and acceptability. This is particularly evident for certain LGBTQ subpopulations such as transgender older adults and those facing greater barriers to care and discrimination. It remains imperative to create digital access and address literacy needs among older cohorts and LGBTQ communities with multiple marginalized identities.

IntroductionIntegrating digital health technologies to improve the overall performance of healthcare systems counts among the top priorities of the WHO. As evidenced in recent research, there are specific factors that...

Digital health technologies and social networking services have become an inherent part of physical activity, exercise routines and fitness training. Adolescents obtain significant parts of their health-related knowledge and beliefs from such technologies and social media, which in turn can influence how they approach sports and physical activity. These processes have been accelerated and intensified by the Covid-19 pandemic. Against this background, this paper aims to discuss the relevance of digital health education as a topic for the subject PE. First, potential benefits and risks of digital health technologies and networks are explained with a focus on adolescents as the target group for digital health education. In this context ideas and recommendations to implement digital health education in teaching practices are illustrated. It is argued that young people should be supported to develop their own critical viewpoints and attitudes towards the use of digital health technologies and networks to pursue individual health-related goals. Second, results from a qualitative interview study with 32 PE teachers in Austria regarding their perspectives on digital health education in PE are presented. The most significant findings of the survey are that asked teachers see digital technology mainly as a tool for functional health promotion and are aware of normative body representations in social networks. Some PE teachers also orchestrate PE as a counterpart to an increasingly digitalized world excluding digital technology form their lessons. However, a holistic approach to digital health education requires that the digital culture of health, body, exercise and fitness is experienced and discussed from different perspectives. In doing so, students can be enabled to use digital health technologies and networks in an informed, responsible and self-determined way.