Survey on e-health knowledge and usage in general cardiology of the Council of Cardiology Practice and the Digital Health Committee

Designing digital health applications for climate change mitigation and adaptation.

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.

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 and health-care privatisation

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.

U.S. seniors' digital health and everyday technology use when their health declines are unknown. Longitudinal cohort using the National Health and Aging Trends Study, a nationally representative, annually administered sample of community-dwelling Medicare beneficiaries (n = 4,037). We used difference-in-differences to assess the adjusted difference (AD) in technology use from 2011 to 2014 between those with and without health declines. Health decline measures included new-onset dementia; new-onset depression; decreases in activities of daily living (ADLs), short physical performance battery (SPPB), grip strength, and self-reported health; relocation to nursing facility; increased hospitalizations; and new-onset comorbidity. Digital health included use of the Internet to research health conditions, contact clinicians, fill prescriptions, and address insurance matters. Between 2011 and 2014, seniors experiencing health decline used various digital health technologies at low absolute rates (range: 1%-20%). Between 2011 and 2014, use of everyday technology decreased significantly among seniors with new-onset dementia (from 73% to 51%; AD, -26%), decreased ADLs (from 76% to 67%; AD, -10%), decreased SPPB (from 88% to 86%; AD, -3%), and relocation to a nursing facility (from 49% to 22%; AD, -31%) compared to seniors without comparable decline (all p < .05). Use of digital health decreased significantly among seniors with new-onset probable dementia (from 9% to 4%; AD, -6%) and decreased SPPB (from 24% to 25%; AD, -4%; all p < .05). The type of health decline a senior experiences predicts technology use, which may allow better targeting of digital health to specific seniors. Seniors with new dementia, relocation to a nursing home, and declining physical performance seem especially poor candidates for technology interventions.

BackgroundChronic urticaria (CU) is a complex and unpredictable skin condition that significantly affects patients’ quality of life. As the healthcare landscape increasingly integrates digital health technologies, understanding their perceived usefulness in CU management from both patient and physician perspectives is crucial.ObjectiveThis study investigates the acceptance, perceived usefulness, and potential barriers to using digital health services, such as medical apps and video consultations, among patients with CU and their healthcare providers.MethodsA quantitative survey was conducted across multiple specialized centers, specialist clinics, and general practices, involving both patients and physicians. The study utilized standardized questionnaires to assess digital health literacy, technology readiness, and attitudes toward adopting digital health services in CU management. Descriptive and inferential statistics, including Fisher’s exact test, were employed to analyze the data.ResultsA substantial proportion of the 121 surveyed patients and 101 physicians perceived digital health technologies as beneficial in managing CU, with 59.5% of patients and 75.3% of physicians agreeing on their advantages. However, 21.5% of patients and 14.9% of physicians remained neutral, while 8.3% of patients and 4.0% of physicians found these technologies unhelpful. Key barriers to adoption were identified, including concerns over data privacy, limitations in technical infrastructure, and a lack of awareness of available digital health solutions.ConclusionWhile many patients and physicians recognize the potential of digital health technology to improve urticaria management, some remain uncertain or skeptical. Addressing concerns and improving digital understanding is critical to the future implementation and integration of these technologies into care. Due to the cross-sectional design of the study and the self-reported data, further research may be needed to confirm these results.

BACKGROUND Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that impairs bowel functions and patients’ overall quality of life. IBS-focused digital health technologies (DHTs), including online health resources and mobile health (mHealth) apps, have recently proliferated for patient use. However, research exploring patients’ experiences with navigating, adopting, or using commercial or publicly available DHTs for IBS self-management is limited. OBJECTIVE To explore IBS patients’ user experiences and decision-making in navigating, adopting, and using DHTs for disease self-management. METHODS Semi-structured focus group interviews were conducted virtually to explore IBS patients’ experiences using DHTs, including their perspectives towards design and features, their decision-making process in using DHTs, and recommendations on improving user experience and uptake. Canadian-based IBS patients who were using or have used mHealth apps to manage symptoms were recruited through purposive sampling from previous IBS-related studies. Discussions were transcribed verbatim, and inductive thematic analysis was performed using NVivo 14. A modified version of the Expanded Unified Theory of Acceptance and Use of Technology (UTAUT2) model was applied to guide the interpretation of the dynamic relationship between the influences in participants’ decisions around DHTs. RESULTS Among the eight participants (all females, mean age 55.3 years), two themes were identified: (1) uncertainty impacts the trustworthiness of DHTs, and (2) influences that drive IBS patients’ decision-making process to adopt and use DHTs. The observed influences aligned with the constructs of the UTAUT2 model (performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, habit), with the addition of trust and risk in participants’ decision-making. Digital health literacy and patient engagement were also raised as crucial components of participants’ experiences and perspectives on DHTs. CONCLUSIONS Findings of this study highlight the current landscape of digital health in IBS and existing gaps and challenges for patients in navigating, adopting, and using DHTs for IBS self-management. While DHTs were generally viewed positively for their value and potential, patients consider several coexisting factors and trade-offs in their decision-making. Further investigations on the influences and perspectives of DHTs could enhance future developments and iterations of these tools and improve patient confidence and uptake.

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that impairs bowel functions and patients' overall quality of life. IBS-focused digital health technologies (DHTs), including online health resources and mobile health (mHealth) apps, have recently proliferated for patient use. However, research exploring patients' experiences with navigating, adopting, or using commercial or publicly available DHTs for IBS self-management is limited. This study aims to explore the user experiences and decision-making of patients with IBS as they navigate, adopt, and use diverse DHTs for disease self-management. We conducted virtual semistructured focus group interviews to explore the experiences of patients with IBS using DHTs, including their perspectives on design and features, their decision-making process in using DHTs, and recommendations for improving user experience and uptake, given the heterogeneous nature of these tools. Canada-based patients with IBS who were using or had used mHealth apps to manage symptoms were recruited through purposive sampling from previous IBS-related studies. Discussions were transcribed verbatim, and inductive thematic analysis was performed using NVivo (version 14; Lumivero). A modified version of the Expanded Unified Theory of Acceptance and Use of Technology (UTAUT2) model was applied to guide the interpretation of the dynamic relationship between the influences on participants' decisions regarding DHT use. Among the 8 participants (all female; mean age 55.3, SD 13.5 years), two themes were identified: (1) uncertainty impacts the trustworthiness of DHTs, and (2) influences that drive the decision-making process to adopt and use DHTs. The observed influences aligned with the constructs of the UTAUT2 model (performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, and habit), with the addition of trust and risk in participants' decision-making. Digital health literacy and patient engagement were also raised as crucial components of participants' experiences and perspectives on DHTs. Findings of this study highlight the current landscape of digital health in IBS and existing gaps and challenges for patients in navigating, adopting, and using DHTs for IBS self-management. While DHTs were generally viewed positively for their value and potential, patients with IBS consider several coexisting factors and trade-offs in their decision-making. Further investigations on the influences on and perspectives toward DHTs could enhance future development and iterations of these tools and improve patient confidence and uptake.

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.

The rapid advancement of digital medicine and health technologies in neurology offers both significant potential and challenges. This article outlines fundamental aspects of digital medicine related to neurological research and highlights application examples of digital technologies in neurological research. To provide acomprehensive overview of current digital developments in neurology and their impact on neurological research. In this narrative review articles from various sources and references related to digital medicine and health technologies in neurology were compiled and analyzed. The data presented indicate that digital health technologies and digital therapeutics have the potential to decisively shape neurological care and research; however, it is emphasized that acritical evaluation and evidence-based approach to these technologies are essential to determine their actual value in neurology.

BACKGROUND Patient empowerment is widely recognized for improving health outcomes, increasing patient satisfaction, and enhancing the overall effectiveness of health care. Digital health technologies (DHTs) contribute to this empowerment by keeping patients informed, involved, and engaged in their own health. However, more evidence is needed to better understand which aspects of empowerment patients value when using DHTs and how DHTs can support these values. OBJECTIVE Drawing on Sen’s capability approach, this paper conceptualizes patient empowerment in digital health by defining distinct capabilities, resources, and conversion factors that contribute to patient empowerment through DHTs. METHODS We based our scoping review on the methodology recommended by the Joanna Briggs Institute Manual for evidence synthesis and an a priori registered protocol. Papers were included if they focused on patient empowerment in relation to DHTs among patients with chronic diseases (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, and neurodegenerative diseases), with particular emphasis on the patient perspective. PubMed, Scopus, and Web of Science were searched for evidence published from January 2013 to April 2024. Data were extracted and thematically analyzed via a multidisciplinary workshop to identify empowerment components relevant to the capability framework, such as capabilities, DHTs as resources, and conversion factors. RESULTS Our analysis identified 3 core capabilities to achieve patient empowerment supported by DHTs: health information and knowledge management, self-management, and emotional and social support. DHTs as resources supported these capabilities through distinct functional components, including informing patients, communication with the health care team, monitoring, behavior change interventions, individualized feedback, or peer support, each contributing to a varying degree. Conversion factors such as demographic and socioeconomic status, digital literacy, disease status, perceived value of DHTs, sociocultural values and norms, doctor-patient relationship, connectivity, and cost influenced the development of empowering capabilities resulting from using DHTs. CONCLUSIONS While the capabilities related to patient empowerment in DHTs were clearly distinguishable, our analysis revealed a notable interconnectedness among these components. Our conceptualization of patient empowerment serves as a valuable resource for researchers seeking to understand or assess patient empowerment via DHTs. It also provides guidance for DHT developers, helping them design DHTs that enhance valued capabilities and account for the conversion factors and ultimately promote patient empowerment across diverse population groups.

Patient empowerment is widely recognized for improving health outcomes, increasing patient satisfaction, and enhancing the overall effectiveness of health care. Digital health technologies (DHTs) contribute to this empowerment by keeping patients informed, involved, and engaged in their own health. However, more evidence is needed to better understand which aspects of empowerment patients value when using DHTs and how DHTs can support these values. Drawing on Sen's capability approach, this paper conceptualizes patient empowerment in digital health by defining distinct capabilities, resources, and conversion factors that contribute to patient empowerment through DHTs. We based our scoping review on the methodology recommended by the Joanna Briggs Institute Manual for evidence synthesis and an a priori registered protocol. Papers were included if they focused on patient empowerment in relation to DHTs among patients with chronic diseases (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, and neurodegenerative diseases), with particular emphasis on the patient perspective. PubMed, Scopus, and Web of Science were searched for evidence published from January 2013 to April 2024. Data were extracted and thematically analyzed via a multidisciplinary workshop to identify empowerment components relevant to the capability framework, such as capabilities, DHTs as resources, and conversion factors. Our analysis identified 3 core capabilities to achieve patient empowerment supported by DHTs: health information and knowledge management, self-management, and emotional and social support. DHTs as resources supported these capabilities through distinct functional components, including informing patients, communication with the health care team, monitoring, behavior change interventions, individualized feedback, or peer support, each contributing to a varying degree. Conversion factors such as demographic and socioeconomic status, digital literacy, disease status, perceived value of DHTs, sociocultural values and norms, doctor-patient relationship, connectivity, and cost influenced the development of empowering capabilities resulting from using DHTs. While the capabilities related to patient empowerment in DHTs were clearly distinguishable, our analysis revealed a notable interconnectedness among these components. Our conceptualization of patient empowerment serves as a valuable resource for researchers seeking to understand or assess patient empowerment via DHTs. It also provides guidance for DHT developers, helping them design DHTs that enhance valued capabilities and account for the conversion factors and ultimately promote patient empowerment across diverse population groups.

There is an increasingly diverse range of mobile apps and digital health devices available to help patients manage their health. Despite evidence for the effectiveness of such technologies, their potential has not been fully realized because adoption remains low. Such limited uptake can have direct implications for the intended benefits of these technologies. This study aimed to understand what matters most to US military veterans when deciding whether to use digital health technologies (DHTs) such as mobile health apps or devices to manage their health and compare these factors between veterans with and without prevalent chronic physical and mental health conditions. We conducted a cross-sectional analysis of survey data collected from a national sample of veterans who receive care from the Veterans Health Administration (VHA), which was predominantly gathered as part of the last wave of a larger longitudinal data collection effort. Among respondents (n=857), 86.7% (736/849) reported currently using or having previously used ≥1 devices to manage their health, and 78.4% (639/815) also reported using either VHA or non-VHA health apps. Considerations most frequently endorsed as "very important" by veterans when deciding whether to use DHTs included receiving secure messages from their health care team about DHTs, knowing data from DHTs would be used to inform their care, and receiving recommendations from providers to use DHTs. Conversely, considerations most frequently endorsed as "not at all important" included seeing information about DHTs on social media, having community support to use DHTs, and receiving encouragement from peers to use DHTs. Considerations did not significantly differ between veterans with or without prevalent chronic health conditions; however, a greater proportion of veterans with prevalent mental health conditions reported the following considerations to be "very important:" seeing information about DHTs on social media, having community support to use DHTs, having other veterans encourage DHT use, and having help from family, friends, or other important people to use DHTs. Understanding what matters most to patients when they are deciding to adopt a technology for their health can, and should, inform implementation strategies and other approaches to enhance health-related technology use. Our results suggest that, for veterans, recommendations from health care team members and knowing that the data from DHTs will be used in clinical care are more important than information from social media, community sources, or peers when deciding to use DHTs, although perceptions of importance regarding the latter may differ among patients with different conditions. Our findings suggest that communication from health care team members to patients, perhaps either in-person or electronically, could help encourage DHT adoption and use.

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