From screens to sensors: a contextual integrity approach to understanding privacy norms across mobile health contexts

Digital technology is perceived as a solution to meet the ‘challenges’ of ageing and promote independent and healthy ageing. This approach, often driven by policymakers, is leading to the vast development of a so-called ‘Age-tech’ market, mainly focused on healthcare technologies. Despite the potential positive outcomes, adoption and actual use of digital healthcare technologies are often low, and chronological age is often considered a barrier to the adoption of digital technology. Yet, the role of ageism in adoption and actual use is overlooked. This chapter discusses the potential theoretical influence of ageism in applying digital technology in care and healthcare. First, the chapter provides an overview of the perception of age in relation to digital technology and the manifestation of ageism in healthcare. It continues by providing recent evidence, from the field and from the authors’ research experience, in an attempt to describe two potential ways in which ageism is related to adoption and actual use of digital healthcare technology: (1) through the perspectives of different stakeholders (older adults, healthcare professionals, caregivers, and designers) and (2) through the design of digital technology. Finally, the chapter discusses possible implications for practice in healthcare, design, research, and policy concerning digital technology.

BackgroundImplementation of digital technology has been suggested as a potential solution to future healthcare challenges. Healthcare personnel’s attitudes are important in the acceptance and implementation of digital technologies.AimThe aims of this study were to (1) translate and validate two different questionnaires to Norwegian and Swedish respectively, and then (2) use these to examine nursing students’ attitudes towards digital technology in healthcare, as well as their attitudes towards older adults’ abilities to use digital technology.DesignCross-sectional.MethodsA web-based questionnaire was distributed in first year nursing students in a Norwegian and a Swedish university college, respectively. The questionnaire consisted of the short form of the ‘Information Technology Attitude Scales for Health (ITASH)’ and the ‘Attitudes Towards Older Adults Using Digital technology (ATOAUT-11)’ questionnaire. The questionnaires were translated and validated in both countries. Frequencies, Student’s t-test, and one-way ANOVA were used to analyze the data.ResultsIn total 236 students responded to the questionnaire in the period September 2022 to April 2023. Students mainly reported positive attitudes towards digital technology use in general. They most agreed with the items ‘Using digital technology devices makes my communication with other health professionals faster’, ‘The sort of information I can get from the digital technology devices helps me give better care to patient’, and ‘Digital technology skills are becoming more and more necessary for healthcare professionals’. However, they reported more negative attitudes towards older adults using digital technology. They most agreed with the items ‘One needs a lot of patience to explain to an older adult how to use digital technologies’, ‘It’s hard to explain to older adults how to use digital technology’, ‘Using digital technology is harder for most older adults’, and ‘Most older adults fear using digital technology because they fear of being scammed or cheated’.ConclusionThe ITASH and the ATOAUT-11 is appropriate for use in a Norwegian and Swedish setting. Even if nursing students are positive to digital technology in healthcare in general, they are sceptical to older adults using digital technology. This may impact on their attitudes to using digital technology in the healthcare of older adults. These aspects need emphasis when revising nursing education curricula focusing on developing technological competencies in nursing, and gaining knowledge regarding older adults’ use of digital technology.

The increasing integration of digital technologies in healthcare, such as electronic health records, telemedicine, and diagnostic algorithms, improved efficiency but raised concerns about the depersonalization of care. Narrative medicine has emerged as a pedagogical and clinical response to this shift, emphasizing the value of patient stories, socio-cultural contexts, and reflective practice. Understanding how digital tools support, rather than undermine, narrative competencies is critical for developing a more human-centered healthcare education. This review systematically examined empirical and theoretical studies on the integration of digital technologies and narrative medicine within healthcare education. Databases including PubMed, MEDLINE, and Google Scholar were searched using defined inclusion and exclusion criteria. Studies were screened, reviewed, and thematically analyzed to identify patterns in outcomes, pedagogical applications, and integration strategies. The findings indicate that narrative medicine nurtures empathy, communication, and professional identity formation among healthcare trainees. Digital tools, such as virtual reality simulations, mobile health applications, and e-portfolios, reinforce these outcomes by providing immersive, interactive, and reflective learning experiences. The integration of narrative methods into digital platforms and curricular models provides a promising approach for linking clinical competence with relational care. The convergence of digital and narrative medicine provides a compelling pedagogical framework for healthcare education. This integrated approach supports technological proficiency and humanistic values, for advancements in digital health to improve rather than displace the interpersonal foundations of patient care. Further empirical research might assess long-term outcomes and guide implementation into curricula, faculty development, and institutional policy. Background: The increasing integration of digital technologies in healthcare, such as electronic health records, telemedicine, and diagnostic algorithms, has improved efficiency but raised concerns about the depersonalization of care. Narrative medicine has emerged as a pedagogical and clinical response to this shift, emphasizing the value of patient stories, socio-cultural contexts, and reflective practice. Objective: To understand how digital tools can support, rather than undermine, narrative competencies and contribute to a more human-centered healthcare education. Methods: This review systematically examined empirical and theoretical studies on the integration of digital technologies and narrative medicine within healthcare education. Databases including PubMed, MEDLINE, and Google Scholar were searched using defined inclusion and exclusion criteria. Identified studies were screened, reviewed, and thematically analyzed to extract patterns in outcomes, pedagogical applications, and integration strategies. Results: The findings indicate that narrative medicine nurtures empathy, communication, and professional identity formation among healthcare trainees. Digital tools, including virtual reality simulations, mobile health applications, and e-portfolios, reinforce these outcomes by providing immersive, interactive, and reflective learning experiences. Integrating narrative methods into digital platforms and curricular models presents a promising approach for linking clinical competence with relational care. Conclusion: The convergence of digital and narrative medicine offers a compelling pedagogical framework for healthcare education. This integrated approach supports both technological proficiency and humanistic values, enabling advancements in digital health to enhance rather than displace the interpersonal foundations of patient care. Further empirical research is needed to assess long-term outcomes and guide implementation in curricula, faculty development, and institutional policy.

Digital technologies hold great promise and have the ability to change healthcare and drug development by changing the way we collect, process, and visualize health data. The implementation of digital technologies in healthcare can make the public healthcare more accessible and flexible. This includes patient’s treatment, complications, open data on health, latest biomedical research developments, among other things. Medical services and diagnostic tools are becoming more accessible and available, even in less developed economies. However numerous issues concerning digital health technologies, such as safety, testing, reliability, and ethical considerations, remain unresolved. The aim of the study is to discuss and analyze the recent progress in the application of digital healthcare such as ICT, smart/wearable devices, artificial intelligence, big data, and telemedicine in healthcare. Scopus database was used for the publication search. We merged descriptive analysis and bibliometric analysis to determine the temporal evolution, most productive journals, top authors, most productive countries, and co-occurrence of keywords (to identify well-explored topics) in the available scientific literature concerning digital technology in the healthcare field. Using content analysis, we have determined the research hotspots of the scientific publications during the past five years

The collection of devices networked via the internet, also referred to as the Internet of Things, is poised to grow in adoption. With this rise has come equally increasing concerns for security and privacy. Considering Nissenbaum's framework of Contextual Integrity, we examined users' perceptions of IoT environmental and wearable devices to investigate acceptable norms surrounding privacy perceptions. We present results from a qualitative analysis of an interview study of 19 parent-young adult dyads to give insights on how privacy norms in context of two IoT environments were varying across two generations. We strongly believe understanding these variations can inform IoT system designs and government policies concerning the privacy and management of IoT devices.

BackgroundAutomated, self-reported medical history-taking has the potential to provide comprehensive patient-reported data across a wide range of clinical issues. In the Clinical Expert Operating System‐Chest Pain Danderyd Study (CLEOS-CPDS), medical history data were entered by patients using tablets in an emergency department (ED). Since successful implementation of this technology depends on understanding patients’ views and willingness to use it, we have studied these factors following patients’ use of the CLEOS program.ObjectiveThis study aimed to develop and use a questionnaire to investigate patients’ attitudes, perceptions and skills related to using digital technology in health care in general, and specifically their experiences with the CLEOS program during their visit to an ED with a chief complaint of chest pain.MethodsThe study included the development of a questionnaire, followed by a cross-sectional study. Questionnaire design and the technology acceptance model underpinned the development of the questionnaire. The think-aloud method was used to test the questionnaire. Adults who participated in the CLEOS-CPDS were invited consecutively to respond to the questionnaire. Descriptive and correlational analyses were performed.ResultsThe refinement of the questionnaire included language revision, removal of similar items, and replacement of some response formats. The final questionnaire consisted of 16 items and one free text comment that assessed attitudes, perceptions, and skills related to the use of digital technology in health care in general and the specific experience of using self-reported history-taking by CLEOS. The majority of the 129 patients (mean age 56, SD=17.3 y) who answered the questionnaire found it easy to use digital technology in general (118/129, 91%), that digital technology has a role when seeking health care (115/129, 91%), and that patient-reported symptoms are helpful in making a diagnosis (83/129, 65%). There were some concerns that the patient-physician interaction would be disrupted when using digital technology (48/129, 38%). The overall experience of using CLEOS was positive and most felt confident in answering the questions on a tablet (118/129, 91%). Older age was associated with less ease (P<.001), confidence (P<.001), and trust (P=.002) when using digital technology, as well as less confidence in answering the questions in CLEOS (P=.019). Moreover, older age was associated with more worry about the potential disruption of the patient-physician personal contact when using digital technology (P<.001).ConclusionsThis study suggests strong approval of usefulness and trust in digital technology among patients with chest pain visiting a cardiology ED, but the concern for lack of personal contact should be acknowledged. End users found the CLEOS program to perform well but recommend some adjustments for future studies. The questionnaire responses provided some new insights on perceived usability of digital technology for health care delivery, and it appears relevant for future evaluations of CLEOS in other contexts.

The COVID-19 pandemic has led to increased adoption of digital technologies in healthcare. According to most researchers, this contributed to increasing the resilience of medical institutions, healthcare systems and communities to the pandemic challenges. The dynamic development of HealthTech continues in the post-pandemic period. The article purpose is to summarise the current directions of HealthTech development, analyse main patterns of the global and Ukrainian digital health market development and study possibilities of HealthTech use to increase the resilience of communities and healthcare systems to natural and man-made emergencies. The article systematises the types of HealthTech by components, types of technology and stages of application. It was determined that all basic digital technologies such as the Internet of Things, artificial intelligence, BigData, AR/VR, 3D modelling and others are used in modern healthcare systems. Specific areas of applying digital technologies in healthcare are telemedicine, wearable devices recording health data, specialised mobile software, etc. The analysis of the global digital health market development allowed us to identify the largest volumes and growth dynamics of the digital health market in the European and North American regions. By type of technology, the largest share of investment is directed to mHealth and telemedicine. By components, the digital health market development is almost equal. The article defines the forecast volume of the global and European digital health market for 2024. It examines development of the Ukrainian Electronic Healthcare System, which registers electronic medical records of created and performed medical referrals, examinations, procedures, diagnostic reports, treatment plans, medical conditions, electronic prescriptions, vaccination records, medical conclusions on temporary disability and birth. Dynamics decrease in electronic medical records from March 2022 due to full-scale war invasion was revealed. Digital health technologies contribute to raising efficiency and effectiveness of healthcare systems by reducing costs; increasing availability of medical services, flexibility and adaptability of these systems. Achieving these benefits should be accompanied by ensuring the protection of patients’ personal data and clearly regulating levels of access to this data, as well as minimizing digital gaps and maximizing the coverage of the population with HealthTech services.

Privacy is regarded as a crucial factor in the development of Central Bank Digital Currency (CBDC), particularly for the digital euro in Europe. Currently, research on privacy in CBDC is scarce and focuses largely on its technical implementation or its influence on technology adoption. This work aims to act as a first step towards uncovering privacy norms in digital euro transactions for German citizens. To this end, we investigate privacy parameters and acceptable flows of information for digital euro transactions using an exploratory mixed-method approach based and contextual integrity theory. The privacy parameters, derived through the analysis of 21 qualitative interviews of experts and non-experts, are used to measure acceptability of various information flows in digital euro transactions for 129 respondents in a first quantitative evaluation. The results demonstrate the importance of acceptable and unacceptable recipients of transaction- and identity-related information as well as different transmission principles. The contributions of this work, the creation of a contextual integrity framework and the evaluation of first privacy norms in digital euro transactions, can be used by central banks and policy makers to design and implement CBDC that does not violate individuals’ privacy norms.

According to the theory of contextual integrity (CI), privacy norms prescribe information flows with reference to five parameters — sender, recipient, subject, information type, and transmission principle. Because privacy is grasped contextually (e.g., health, education, civic life, etc.), the values of these parameters range over contextually meaningful ontologies — of information types (or topics) and actors (subjects, senders, and recipients), in contextually defined capacities. As an alternative to predominant approaches to privacy, which were ineffective against novel information practices enabled by IT, CI was able both to pinpoint sources of disruption and provide grounds for either accepting or rejecting them. Mounting challenges from a burgeoning array of networked, sensor-enabled devices (IoT) and data-ravenous machine learning systems, similar in form though magnified in scope, call for renewed attention to theory. This Article introduces the metaphor of a data (food) chain to capture the nature of these challenges. With motion up the chain, where data of higher order is inferred from lower-order data, the crucial question is whether privacy norms governing lower-order data are sufficient for the inferred higher-order data. While CI has a response to this question, a greater challenge comes from data primitives, such as digital impulses of mouse clicks, motion detectors, and bare GPS coordinates, because they appear to have no meaning. Absent a semantics, they escape CI’s privacy norms entirely .

BackgroundIn recent times, digital technologies in health care have been well recognized in Nepal. It is crucial to understand what is works well and areas that need improvements in the digital health ecosystem. This rapid review was carried out to provide an overview of Nepal's challenges and opportunities for implementing digital health interventions.MethodsThis study is reported according to PRISMA guidelines and used telehealth, telemedicine, e-health, mobile health, digital health, implementation, opportunities, challenges and Nepal as key search terms to identify primary studies published between 1 January 2010 and 30 December 2021 in four databases, namely PubMed, Google Scholar, Scopus, and CINAHL. Initially, identified studies were screened against predetermined selection criteria, and data were extracted, and the findings were narratively synthesized.ResultThe review identified various challenges, opportunities, and benefits of implementing digital health initiatives in Nepal. The most expressed challenge was inadequate technical facilities (lack of electricity and internet) and rugged geographical distribution, which makes transportation difficult in hilly and mountain areas. Shortage of skilled workforce and supportive policies were also notable challenges documented. Meanwhile, major opportunities identified were education and training of the students and health practitioners and increasing awareness among the general population.ConclusionThis review identified various factors associated with the successful implementation of digital health initiatives in Nepal. Our findings may guide the formulation of digital health policy and interventions to improve mass health outcomes using digital health services.

Sub-Saharan Africa (SSA) accounts for up to 67% of the global HIV burden yet grapples with health system challenges like distant health facilities, low doctor-to-patient ratio, and poor or non-functioning post-hospital follow-up mechanisms. The rising phone ownership and internet penetration in SSA (46% and 67%, respectively) offer an opportunity to leverage technology to address these gaps and drive toward achieving the UNAIDS (Joint United Nations Programme on HIV and AIDS) 95-95-95 targets. We undertook a scoping review to understand how digital technologies have been integrated into HIV prevention, care, and treatment services delivery in SSA. A scoping review involving 4 databases (PubMed, CINAHL, Cochrane, and Google Scholar) was carried out, encompassing studies related to technology use in the delivery of HIV prevention, care, and treatment published from January 1, 2019, to December 30, 2023. Search terms like "telemedicine," "telehealth," "mobile health," "eHealth," "mHealth," "telecommunication," "mobile application," and "digital health," among others, were used. Of the 310 papers identified, 11 were excluded due to duplicity, 299 were from outside SSA and the intervention was not well described, and 149 were due to the year of publication and study type being a literature review or study protocols, leaving 17 papers that were considered for the review. From the 17 studies summarized, the technologies identified included social media (n=1), interactive voice response (n=1), hotlines (n=1), mobile apps (n=7), health information systems (n=2), chatbots (n=1), and SMS text messages (n=5). Adolescents (11-14 years) and youths (20-35 years) formed the majority of users. The use cases included reminders on facility events, teleconsultations, patient registration, and health information dissemination, among others. Different parameters of individual digital tools were tracked, including feasibility, usability, adoption, and impact on the desired outcome. The integration of digital technologies in health care can address the known challenges in the delivery of HIV prevention, care, and treatment services, facilitate customization of care to individual needs, and thus increase or diversify options available to patients.

Many healthcare providers in the US are seeking increased efficiency and effectiveness by rapidly adopting information technology (IT) solutions such as electronic medical record (EMR) systems. Legislation such as the Health Information Technology for Economic and Clinical Health Act (HITECH), which codified the adoption and “meaningful use” of electronic records in the US, has further spurred the industry-wide adoption of EMR. However, despite what are often large investments in EMR, studies indicate that the healthcare industry maintains a culture of system workarounds. Though perhaps not uncommon, the creation of informal workflows among healthcare workers is problematic for assuring information security and patient privacy, particularly when involving decisions of information management (e.g., information storage, retrieval, and/or transmission). Drawing on the framework of contextual integrity, we assert that one can often explain workarounds involving information transmissions in terms of trade-offs informed by context-specific informational norms. We surveyed healthcare workers and analyzed their willingness to engage in a series of EMR workaround scenarios. Our results indicate that contextual integrity provides a useful framework for understanding information transmission and workaround decisions in the health sector. Armed with these findings, managers and system designers should be better able to anticipate healthcare workers’ information transmission principles (e.g., privacy norms) and workaround patterns (e.g., usage norms). We present our findings and discuss their significance for research and practice.

In discussing the potential benefits and drawbacks of healthcare technologies, questions arise within a social perspective as to what digital healthcare technologies have to offer. Objective: To analyze the symbolic interaction framework to understand the implementation of digital healthcare technologies and the resulting interaction with medical doctors. Methods: Interviews were conducted with eight doctors; five Taiwanese and three Swedish doctors were participated. Semi-structured interviews were used to collect data from the participants. Interviews were audio-recorded, transcribed, and data analysis guided by symbolic interaction theory. Results: Four themes were identified from the interviews: 1) Interpreting digital healthcare technologies, 2) Interaction with digital healthcare technologies, 3) Digital dilemma and (4) Future of digital culture. Conclusions: The results reveal many issues regarding digital healthcare technologies, such as: symbolic meanings, purposes of usage, expectations, problems, and possible solutions. To the best of the author’s knowledge, this is the first study to explore the perspectives of Taiwanese and Swedish medical doctors towards digital healthcare technologies using symbolic interactionism.

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Digital healthcare technology adoption by elderly people: A capability approach model