What Matters Most to Veterans When Deciding to Use Technology for Health: Cross-Sectional Analysis of a National Survey.

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.

Informal caregivers can leverage digital health technologies to support their own health while also assisting patients, particularly those with mental or physical challenges. This study investigated the sociodemographic factors associated with the use of digital health technology among informal caregivers. Data from the 2022 Health Information National Trends Survey (HINTS) were examined for this cross-sectional study. The survey identified key outcomes related to the use of online medical records, health apps, digital wearable health devices, and the digital sharing of health information with professionals, on social media, or with others facing similar health issues. Sociodemographic factors (gender, race/ethnicity, feelings of one's household income, education, and census division) were also analyzed. Weighted multivariable logistic regression models were employed. A total of 831 individuals were included, representing about 36,960,385 national informal caregivers in 2022. Caregivers with a high school education or less (vs. those with at least some college education) and non-Hispanic Black caregivers (vs. non-Hispanic White caregivers) were significantly less likely to be offered access to online medical records by their healthcare providers. Additionally, online medical record usage was lower among caregivers with high school education or less, but higher among caregivers aged 50-64 (vs. those aged 35-49). Caregivers with a high school education or less were less likely to use health apps and digital wearable health devices, but more likely to share personal health information on social media. Men caregivers, those aged 50-64 and over 65 (vs. the 35-49 age group), and caregivers who were dissatisfied with their income were less likely to use digital wearable health devices. The findings underscore disparities in the utilization of caregivers' digital health technology, particularly in digital wearable health devices. Recognizing and addressing these disparities are crucial for tailoring interventions to enhance equitable access to digital health technology among diverse informal caregiver populations.

Digital health technologies (DHTs) aiming to monitor, treat, and manage diseases can be prescribed for patients with multimorbidity; yet most DHTs are designed for individual conditions or problems, while approximately half of patients with chronic conditions have multiple chronic conditions. To identify DHTs approved by the US Food and Drug Administration (FDA) or listed in the Organisation for the Review of Care and Health Apps (ORCHA) library and prescribable for a hypothetical patient with 5 conditions and to model the number of DHTs this patient should be prescribed to receive benefits health professionals considered important. The FDA databases (Premarket Notification 510(k), Premarket Approval, and De Novo) and the ORCHA App Library from National Health Service Somerset were systematically searched for DHTs registered or updated between January 1, 2019, and December 31, 2022, that could be prescribed to a hypothetical woman with 5 chronic conditions (type 2 diabetes, hypertension, chronic obstructive pulmonary disease, osteoporosis, and osteoarthritis). After abstracting each DHT's elementary functions (ie, simple and delineated features to monitor, treat, and/or manage conditions), an assessment was undertaken to determine the fewest DHTs this hypothetical patient should be prescribed to receive benefit from digital functions health professionals considered important. A total of 148 DHTs were identified (68 [46%] from FDA databases), of which 96 (65%) involved devices and 52 (35%) were standalone health apps. Only 5 DHTs (3.4%) were intended for 2 or more conditions. DHTs offered 140 elementary functions, ranging from recording, tracking, or visualizing health parameters to providing information to digital therapeutics with just-in-time interventions. The hypothetical patient would need to be prescribed up to 13 apps and 7 devices (a blood pressure monitor, a smartwatch, a pulse oximeter, a connected weight scale, a sensor-attached inhaler to monitor adherence, a lung function monitor, and a blood glucose sensor) to receive benefits from 28 functions at least 3 of 5 health professionals considered important. This systematic review found that almost all prescribable DHTs were developed for a single condition or problem. Thus, patients with multiple chronic conditions would have to routinize many DHTs concurrently in daily life to benefit from digital functions health professionals considered important.

Type 1 diabetes is a constraining disease due to the burden of its management, and diabetes outcome largely depends on the effectiveness of diabetes self-care. Digital health technology (DHT), which includes continuous glucose monitoring, insulin delivery devices, and related mobile health apps, can support diabetes self-care and thereby improve diabetes outcomes. In literature, experiences with the use of DHT vary widely among people with diabetes and are a less studied area among adults with type 1 diabetes. The study aimed to explore experiences of using DHT for diabetes self-care among adults with type 1 diabetes. A qualitative design with an inductive approach was used. Adults with type 1 diabetes who are users of DHT and could understand Swedish were included in the study. Participants were recruited primarily via digital advertisements through social media. A convenient sampling method was used. Data were collected through open-ended questions in a web-based survey (autumn 2022) and 2 digital group interviews (autumn 2024). The survey questionnaire and interview guide attempted to capture positive and negative experiences of using DHTs for diabetes self-care through personally relevant incidents and behavioral details. Data from a total of 161 participants (n=156 survey participants and n=5 interview participants), using 1 or more forms of DHTs, were included in the study. Data were analyzed using qualitative content analysis with an inductive approach as per Graneheim and Lundman. The data in this study generated 324 meaning units relevant to the aim. The participants experienced using DHTs in diabetes self-care as a balancing act between feeling empowered and feeling exasperated. This is described under 5 categories: promoting autonomy in daily life, self-awareness through collaborative learning, feeling secure, tackling technical challenges and the need for support, and navigating the burden of psychosocial challenges. DHTs were experienced as empowering when they supported autonomy in daily life, enhanced self-awareness through collaborative learning, and fostered a sense of security. However, having to tackle technical challenges and the need for support, and navigating the burden of psychosocial challenges, led to feelings of exasperation. The exasperating experiences hindered participants from experiencing a full sense of empowerment with DHT use. This study sheds light on both positive and negative experiences of using DHTs for diabetes self-care in a real-life setting. The exasperating experiences may widen the digital health inequities and therefore are important to address. Improving technological literacy and ongoing support from health care or device manufacturers may help users to address exasperating experiences. Further studies are needed to validate our findings.

Chronic pain is a highly prevalent condition, estimated to affect as many as 30% of people worldwide. The need for more innovative solutions for chronic pain management is clear, and digital health technology (DHT) may be the best way to address this challenge. Much of the digital health research focusing on chronic pain focuses on patient-facing solutions; however, DHT for health care professionals (HCPs) is equally important to support evidence-based practice, which, in turn, improves patient outcomes. Despite this, no review has investigated the availability of professional-facing DHT for chronic pain management. This scoping review aims to identify the available professional-facing DHTs for chronic pain management. Specifically, the objectives were to investigate the components of the DHTs as well as development methods, user features, outcomes, and HCP perspectives on DHTs for chronic pain care. Databases, including MEDLINE, Embase, CINAHL, PsycINFO, and Inspec, were searched using comprehensive search strategies. Two independent reviewers screened titles and abstracts for inclusion of studies in the review and conducted full-text screening. Any conflicts in each stage of the screening process were first resolved through discussion and then through a third independent reviewer. Data extraction and quality assessment were completed using the Template for Intervention Description and Replication (TiDIER) checklist and Quality Assessment for Diverse Studies. Qualitative analysis involved inductive content analysis of user features and thematic synthesis of HCP perspectives. In total, 52 studies were included in the review, reporting on 44 professional-facing DHTs. The included DHTs were intended for remote patient monitoring, clinical decision support, assessment and diagnosis, education of HCPs, or a combination. The most common target population for DHT use was multidisciplinary care teams; the most common setting for implementation was primary care. Approximately half (26/44, 59%) of the professional-facing DHTs had a connected patient-facing system. Inductive content analysis of the user features produced 4 themes: guiding initial consultation, supporting chronic pain management, facilitating ongoing patient management, and supporting routine clinical duties. The thematic synthesis of HCP perspectives produced the following 4 themes, reflecting factors affecting the use of DHTs in chronic pain care: additional value, integration into clinical workflow, ease of navigation, and trust in the DHTs. Most (43/52, 83%) of the included studies did not adequately report appropriate stakeholder involvement in a proper co-design of DHTs; only 7% (3/44) of the DHTs were reported to have been developed with guidance from a system development framework. There are various DHTs available for HCPs to use in the management of chronic pain. The included studies neither reported adequate stakeholder involvement in the DHT development nor any specific frameworks to guide rigorous co-design. Therefore, future research should focus on developing professional-facing DHTs with active involvement of stakeholders in the design process. RR2-10.2196/51311.

ObjectivesTo explore how healthcare practitioners (HCPs) made decisions about the implementation of digital health technologies (DHTs) in their clinical practice before and during the COVID-19 pandemic.DesignA multimethods study, comprising semistructured...

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

BackgroundLoneliness among older adults has become a major public health concern associated with cognitive decline, depression, and increased health care use. The advancement of digital health technologies such as wearable devices, smart home systems, and mobile health apps provides new opportunities to monitor and mitigate loneliness through continuous physiological and behavioral assessment. However, the effectiveness of such technologies largely depends on user interface design, ensuring that older adults can understand, trust, and comfortably engage with the technology. Existing research on interactive platforms and user interfaces for psychological and emotional monitoring has mainly focused on usability testing and technology feasibility, with limited attention to structured design frameworks that integrate psychological, emotional, and accessibility dimensions for older adults. Furthermore, most studies rely on qualitative assessments and lack quantitative prioritization of design indicators.ObjectiveThis study aimed to build on the DELONELINESS (Design for Healthy Ageing: a Smart System to Decrease Loneliness for Older People) system to develop a user-centered hierarchical framework of interface design indicators for older adults.MethodsA mixed methods design was applied, integrating literature search, qualitative focus group analysis, and expert consultation to build an initial indicator pool. A hierarchical indicator structure with 7 first-level and 26 second-level indicators was developed. The analytic hierarchy process was used to assign indicator weights through surveys of 20 experts with academic or professional experience in human-computer interaction, digital health, gerontology, and health informatics. Based on the weighted results, 3 interface design solutions were developed and comparatively evaluated using the Technique for Order Preference by Similarity to Ideal Solution.ResultsAll expert judgment matrices satisfied the analytic hierarchy process consistency requirement (consistency ratio <0.1). The Kendall coefficient of concordance indicated good agreement among experts for both first-level indicators (W=0.313; P<.001) and second-level indicators (W=0.156; P<.001). Among the 7 first-level indicators, trust and safety (weight=0.206), ease of use (weight=0.187), and accessibility (weight=0.167) received the highest weights, indicating their importance in enhancing user confidence and engagement. Technique for Order Preference by Similarity to Ideal Solution evaluation results showed that design solution 2 achieved the highest overall performance score (relative closeness coefficient C=0.877), emphasizing clear interaction pathways, visual clarity, and guided feedback as key factors for optimal usability.ConclusionsThis study developed a user-centered framework for interface design in loneliness monitoring among older adults by integrating user insights, literature-derived indicators, and expert consensus, and providing a structured data-driven approach to prioritizing design requirements. The proposed framework bridges subjective user experience with objective evaluation, offering practical guidance for developing empathetic, inclusive, and trustworthy digital mental health technologies for older adults.

Utilization, challenges, and training needs of digital health technologies: Perspectives from healthcare professionals.

IntroductionThe ever-increasing number of new and innovative digital health technologies (DHTs) also sets new demands on health technology assessment (HTA) methods in addition to traditional HTA domains. In 2018, the Finnish Ministry of Social Affairs and Health recognized the need for new HTA methods for DHTs in Finland and commissioned method development.MethodsThe development work of the new HTA method for DHTs and the findings related to it were based on three substudies:(i) The new HTA method was developed through a literature review, expert interviews, and four multiprofessional workshops.(ii) Feedback about new HTA recommendations was collected from healthcare decision-makers through a web-based survey (n=24). Feedback on the developed HTA framework was collected through a web-based survey for companies offering DHT products (n=8).(iii) Initial experiences about the state of data security and protection of assessed products were gathered through the assessment process.ResultsA new Digi-HTA method that supports a wide range of DHTs, such as health apps, AgeTech, artificial intelligence, and robotic solutions, was published in 2019. According to the healthcare decision-makers participating in the study, although the Digi-HTA recommendations included clear and beneficial information, their integration into healthcare decision-making processes should be improved. Responses from companies offering different DHTs indicated that the Digi-HTA framework would be an appropriate tool for performing assessments for their products. During the assessments, deficiencies in compliance with the best practices of data security and protection as well as data security problems were found.ConclusionsThe rapid development of DHTs requires that the HTA methods also adapt to the development so that no new and innovative products are excluded from the assessments. In addition to the value of DHTs, their quality, such as data security and protection, should be assessed so that decision-makers can be supported in the best possible ways.

ObjectiveDuring the Coronavirus Disease 2019 (COVID-19) pandemic, digital health technologies (DHTs) became increasingly important, especially for older adults. The objective of this systematic review was to synthesize evidence on the rapid implementation and use of DHTs among older adults during the COVID-19 pandemic.MethodsA structured, electronic search was conducted on 9 November 2021, and updated on 5 January 2023, among five databases to select DHT interventional studies conducted among older adults during the pandemic. The bias of studies was assessed using Version 2 of the Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I).ResultsAmong 20 articles included in the review, 14 (70%) focused on older adults with chronic diseases or symptoms, such as dementia or cognitive impairment, type 2 diabetes, and obesity. DHTs included traditional telehealth interventions via telephone, video, and social media, as well as emerging technologies such as Humanoid Robot and Laser acupuncture teletherapy. Using RoB 2 and ROBINS-I, four studies (20%) were evaluated as high or serious overall risk of bias. DHTs have shown to be effective, feasible, acceptable, and satisfactory for older adults during the COVID-19 pandemic compared to usual care. In addition, some studies also highlighted challenges with technology, hearing difficulties, and communication barriers within the vulnerable population.ConclusionsDuring the COVID-19 pandemic, DHTs had the potential to improve various health outcomes and showed benefits for older adults’ access to health care services.

BackgroundInterventions using commercial digital health tools do favorably affect health outcomes. However, the effect of digital tools on cardiorespiratory fitness, a more novel indicator cardiovascular risk, is unclear.PurposeSynthesize the digital health intervention literature and answer the following question: What is the effect of interventions using mobile health apps, wearable activity trackers, and/or text messaging on cardiorespiratory fitness?MethodsA systematic review and a meta-analysis (PROSPERO CRD42023423925) were conducted to evaluate the immediate digital health intervention effect on adult cardiorespiratory fitness. In March 2023, a search of databases Embase, MEDLINE, CINHAL, and Cochrane Library was completed. Studies were included if the intervention used a mobile health app, text messaging, and/or activity tracker. Studies were excluded if an objective measure of fitness was not used; the sample included children; the setting was hospital-based; and the digital health technology was only used for data collection or described as virtual reality. Using a random-effects model, two separate meta-analyses were completed: one for single-group studies and one for multi-group studies. Standardized mean difference effect sizes (Cohen's d) were calculated. Study quality was evaluated with the Cochrane Risk of Bias tool and ROBINS-I tool.ResultsFifty-three studies (3657 individuals) with pre-post designs (12 single-group, 41 multi-group) were included. Most studies targeted participants with a specific chronic health condition. Digital health interventions in the single-group studies had a moderate-to-large effect size (d = 0.62, 95% confidence interval (CI) [0.41–0.84], p < 0.001), and multi-group studies had small-to-moderate effect size (d = 0.38, 95% CI 0.21–0.55, p < 0.001). Significant heterogeneity of effects was observed in both the single-group and multi-group studies.ConclusionsInterventions using text messaging, a mobile app, or activity tracker alone or in combination are effective in improving cardiorespiratory fitness in adults, particularly for those with a chronic health condition.

Digital health technology, especially digital and health applications ("apps"), have been developing rapidly to help people manage their diabetes. Numerous health-related apps provided on smartphones and other wireless devices are available to support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. However, regulations and guidelines have not caught up with the burgeoning field to standardize how mobile health apps are reviewed and monitored for patient safety and clinical validity. The available evidence on the safety and effectiveness of mobile health apps, especially for diabetes, remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore conducted a joint review of the current landscape of available diabetes digital health technology (only stand-alone diabetes apps, as opposed to those that are integral to a regulated medical device, such as insulin pumps, continuous glucose monitoring systems, and automated insulin delivery systems) and practices of regulatory authorities and organizations. We found that, across the U.S. and Europe, mobile apps intended to manage health and wellness are largely unregulated unless they meet the definition of medical devices for therapeutic and/or diagnostic purposes. International organizations, including the International Medical Device Regulators Forum and the World Health Organization, have made strides in classifying different types of digital health technology and integrating digital health technology into the field of medical devices. As the diabetes digital health field continues to develop and become more fully integrated into everyday life, we wish to ensure that it is based on the best evidence for safety and efficacy. As a result, we bring to light several issues that the diabetes community, including regulatory authorities, policy makers, professional organizations, researchers, people with diabetes, and health care professionals, needs to address to ensure that diabetes health technology can meet its full potential. These issues range from inadequate evidence on app accuracy and clinical validity to lack of training provision, poor interoperability and standardization, and insufficient data security. We conclude with a series of recommended actions to resolve some of these shortcomings.

Digital health technology, especially digital and health applications ('apps'), have been developing rapidly to help people manage their diabetes. Numerous health-related apps provided on smartphones and other wireless devices are available to support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. However, regulations and guidelines have not caught up with the burgeoning field to standardise how mobile health apps are reviewed and monitored for patient safety and clinical validity. The available evidence on the safety and effectiveness of mobile health apps, especially for diabetes, remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore conducted a joint review of the current landscape of available diabetes digital health technology (only stand-alone diabetes apps, as opposed to those that are integral to a regulated medical device, such as insulin pumps, continuous glucose monitoring systems, and automated insulin delivery systems) and practices of regulatory authorities and organisations. We found that, across the USA and Europe, mobile apps intended to manage health and wellness are largely unregulated unless they meet the definition of medical devices for therapeutic and/or diagnostic purposes. International organisations, including the International Medical Device Regulators Forum and WHO, have made strides in classifying different types of digital health technology and integrating digital health technology into the field of medical devices. As the diabetes digital health field continues to develop and become more fully integrated into everyday life, we wish to ensure that it is based on the best evidence for safety and efficacy. As a result, we bring to light several issues that the diabetes community, including regulatory authorities, policymakers, professional organisations, researchers, people with diabetes and healthcare professionals, needs to address to ensure that diabetes health technology can meet its full potential. These issues range from inadequate evidence on app accuracy and clinical validity to lack of training provision, poor interoperability and standardisation, and insufficient data security. We conclude with a series of recommended actions to resolve some of these shortcomings.