Practitioner review: Co-design of digital mental health technologies with children and young people.

To paraphrase a classic, evaluating digital technologies in health is a bit like eating spinach - no one is against it in principle because it is good for you. However, no one would do it unless being asked to. In recent years, the sheer number of digital health technologies that potentially fulfil public health purposes has increased tremendously. The basis for evaluating such tools for public health purposes however has not met this pace, and in particular frameworks for the systematic development and evaluation of digital technologies in public health are rare. Existing frameworks for digital technologies focus on clinical aspects of digital health applications (e.g., NICE Evidence standards framework for digital health technologies), thus lacking both a population and prevention focus. Generic frameworks such as the Health Technology Assessment (HTA) methodology do not contain items specific to digital technologies and public health purposes. Here, we describe the process of developing a framework specific for the development and evaluation of digital public health technologies based on the core HTA model. We conduct a scoping review of frameworks for the development and the evaluation of technologies in public health and digital health, following PRISMA-SCR guidelines. The identified frameworks are then mapped onto the core HTA model to develop additional items specific for the development and the evaluation of digital technologies in public health. These additional items can be used to integrate the development and evaluation of digital technologies for public health purposes within the wider HTA context, making this process both transferable and scalable.

BackgroundThere is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies.ObjectiveThis study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients’ mental health.MethodsYouth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients.ResultsA total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (χ23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy.ConclusionsTechnology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health.

Designing digital health applications for climate change mitigation and adaptation.

Digital health technologies and health-care privatisation

There are dynamic interactions between (digital) technologies and society. Digital technologies have a(re-)structuring effect on social relationships and social innovations in avariety of ways. Because of these characteristics, technological innovations affect our individual lifestyles and living environments. In particular, the development and implementation of interventions with digital (health) technologies is attracting increasing national and international attention (e.g. telematics GP consultations and app-supported patient education programs).Digital health technologies enable new forms of interaction and knowledge-based reproduction in the field of health. The integration of potential users in the development process of digital health technologies and interventions requires the discussion of new research approaches. The interests, needs, and requirements of users may influence the nonuse of digital health technologies. It is above all the successful implementation, involving potential users, that can have an influence on acceptance and integrative use in the later course of care. The discourse on the participatory development and implementation of interventions with digital health technologies in the field of digital public health presents itself as acomplex process characterized by various theoretical approaches and methodological procedures and requiring representation, evaluation, and classification.

Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N=51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

ZusammenfassungDie rasante Entwicklung neuer digitaler Technologien hat nicht nur die medizinische Praxis verändert, sondern bietet auch große Chancen und Herausforderungen für Public Health, insbesondere in Gesundheitsförderung und Prävention.Gleichzeitig ist dieses neue Feld auch gekennzeichnet durch begriffliche und konzeptuelle Unschärfen, einen bemerkenswerten Mangel an qualitativ hochwertiger Evidenz sowie eine fehlende Diskussion von unerwünschten Effekten und Begleiterscheinungen. Eine weitere Herausforderung liegt darin, dass die Entwicklung von Technologien aktuell durch den technologischen Fortschritt und weniger durch evidenzbasierte und evidenzorientierte Forschung vorangetrieben wird.In diesem Überblicksartikel wird das Feld „Digital Public Health“ konzeptuell beschrieben und anhand von grundlegenden Public-Health-Funktionen als Anforderungsprofil definiert. Wir diskutieren einige Beispiele, wie digitale Technologien aktuell zur Erfüllung von Public-Health-Aufgaben genutzt werden, und schlagen eine bedarfsorientierte Entwicklung von digitalen Gesundheitstechnologien vor.Wir gehen außerdem auf spezifische Herausforderungen, insbesondere sozioökonomische Unterschiede in der Nutzung und in den Effekten von digitalen Gesundheitstechnologien, sowie Datenschutz- und ethische Aspekte ein.

Many digital mental health technologies have been developed to address the psychological needs of trauma survivors and those with posttraumatic stress disorder (PTSD), and recent efforts have been aimed at improving the implementation of such technologies. Despite several overlapping expert summaries and recommendations for procedures and processes necessary to deploy digital mental health solutions for the public, there remains a need for a comprehensive, at-scale model that guides ongoing optimization of digital mental health technologies once created and deployed. The National Center for PTSD (NCPTSD) Model for Digital Mental Health has been developed to address existing gaps and has been used to achieve broad reach, positive reception, and measurable public health benefit in the United States and around the world. The NCPTSD Model for Digital Mental Health is outlined, highlighting key elements and using examples to provide guidance to other programs intent on implementing digital health tools. Strategies are provided to facilitate wider use of the model in a variety of settings, particularly those with limited resources, as well as key challenges and potential paths forward. The NCPTSD Model for Digital Mental Health provides an evidence-based and pragmatic approach for how digital mental health technologies can be optimized to improve the lives of veterans and members of the public who are living with the psychological consequences of trauma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a "digital divide," inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70% (1580/2258) to 82.5% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services.

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.

Exploring the societal implications of digital mental health technologies: A critical review

Digital health is typically driven, in part, by the principle of personalised care. However, the underlying values and associated ethical design considerations at the intersection of personalised care, youth mental health, and digital technology are underexplored. Through a value sensitive design lens, this work aims to contribute a prototype conceptual framework for the ethical design and evaluation of personalised youth digital mental health technology, which comprises three values–personalisation, empowerment, and autonomy–and 15 design norms as fundamental yet non-exhaustive ethical criteria. Furthermore, it provides illustrative applications of the framework by applying it to (1) the proactive design of two exemplary digital mental health technologies to draw out emerging ethical considerations and (2) the retrospective evaluation of three existing technologies to assess whether they are designed to support personalisation, empowerment, and autonomy. This work creates an understanding of personalised care and related values in this socio-technical context, with key design recommendations going forward for youth digital mental health research, practice, and associated policy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10676-025-09866-x.

Has traditional medicine had its day? The need to redefine academic medicine

BACKGROUND Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. OBJECTIVE A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. METHODS Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association’s Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. RESULTS Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. CONCLUSIONS Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind.

Although digital health technologies have the potential to improve cardiac patient health outcomes, there are significant digital health inequities experienced by immigrant communities. It is important to understand the barriers to digital health equity within cardiovascular healthcare for immigrants. The purpose of this paper is to apply the Health Equity Impact Assessment, Digital Health Supplement within the context of immigrant communities with an intersectional lens. The Health Equity Impact Assessment, Digital Health Supplement can be used to ensure health equity remains central in digital health technologies used within cardiovascular healthcare. The instrument includes 5 steps: (1) scoping, (2) potential impacts, (3) mitigation, (4) monitoring, and (5) dissemination. Social determinants of health, intersectional factors, and patient and family involvement are necessary to understand digital health inequities experienced among immigrants. Access is one of the potential impacts highlighted by the framework. Access can be promoted through funding and tailored digital health technologies. Immigrants need to be active partners in the design and development of the digital health technologies. It is important that equity remains a central outcome. Multiple experts are needed to analyze the results in a fair manner. Findings should be disseminated within various avenues. Future research is necessary to strengthen the evidence base for applying the Health Equity Impact Assessment, Digital Health Supplement among immigrant populations. Since digital health equity research requires an intersectional lens, the diversity dimensions can serve as a foundational framework in future studies.