Digital Health Innovation Research Articles

Canada's Digital Health Workforce: The Role of Innovation, Research and Policy.

The rapid growth of digital health and use of technology has led to an increased demand for qualified professionals in the areas of health informatics (HI) and health information management (HIM). This is reflected by the growth in the number of educational programs and graduates in these areas. However, to develop a culture of digital health innovation in Canada, the role of research needs to be critically examined. In this paper we discuss some of these issues around the relation between research and innovation, and the development of an innovation culture in health informatics, health information management and digital health in Canada. Recommendations for facilitating this development in terms of funding, granting and policy are also explored.

How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals

BackgroundDevelopments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic.Method(s)UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers.ResultsTwo hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including ‘a new way of working’, ‘developing a new approach to learning’ and ‘impacting care’.Conclusion(s)Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.

Feasibility of Self-Management of Hypertension and Diabetes Using Patient-Generated Health Data Through M-health in Central India.

Digital health innovations are modern solutions for the management and treatment of diseases, particularly non-communicable diseases. This study was conducted to assess the feasibility of the management of diabetes and hypertension through patient-generated health data (PGHD). A mobile application (One Health) was used for the entry of data on blood pressure, blood glucose, physical activity, and dietary intake for six months by the patients. Frequency of application download, monthly data entry, and change in control of blood pressure and glycemic markers during six months of application use were used to assess the feasibility and impact of the application for the management of hypertension and type 2 diabetes mellitus (T2DM). A higher proportion of patients entered data generated non-invasively (blood pressure) as compared to data generated via invasive techniques (glycemic control measures). The frequency of monthly data entry remained unchanged during One Health use. At the end of six months, control of hypertension and glycemic control was achieved in 53.3% and 33.9% of patients, respectively. Furthermore, there was a significant reduction of mean diastolic blood pressure (0.60 (±2.31); p=0.03) and glycosylated hemoglobin (0.657 (±1.808); p=0.04). The acceptability of One Health appears to be associated with the frequency of data entry. The entry of health data by patients was sufficient to effect positive change in health indicators.Although mobile applications enable the monitoring and management of chronic health conditions, additional research shall help in optimizing interventions to be adopted as acceptable tools of patient management.

Adoption of Digital Healthcare Interventions and Innovations in Reducing Mental Health Stigma: A Perspective on (COVID)-19

Objectives: During the COVID-19 pandemic, Chinese people with mental health difficulties faced a major issue of mental health stigma. The pandemic's constant stress and social isolation intensified the stigma attached to people suffering from mental illnesses. To address this issue, a study was done in China to investigate mental health stigma in the context of digital media arts. Methods: The study involves randomly distributing 1300 questionnaires on a 5-point Likert scale. Only 500 questionnaires, however, were found adequate for data analysis using partial least squares (PLS). Results: Digital health innovation and adoption are crucial for enhancing mental health. The study's focus was confined to the adoption of innovation in mental healthcare in China because this sector received less attention in previous research that sought to establish a link between digital health innovation and digital mental healthcare. Conclusion: The study has important theoretical and practical implications for improving people's lives by strengthening their mental health systems with digital technologies and raising awareness of digital healthcare tools. The findings are important for policymakers to make people aware of the importance of caring for their mental health by digital healthcare tools.

Variability in the Integration of Peers in a Multi-site Digital Mental Health Innovation Project

Peer support specialists (“peers”) who have the lived experience of, and are in recovery from, mental health challenges are increasingly being integrated into mental health care as a reimbursable service across the US. This study describes the ways peers were integrated into Help@Hand, a multi-site innovation project that engaged peers throughout efforts to develop and offer digital mental health interventions across counties/cities (“sites”) in California. Using a mixed methods design, we collected quantitative data via quarterly online surveys, and qualitative data via semi-annual semi-structured phone interviews with key informants from Help@Hand sites. Quantitative data were summarized as descriptive findings and qualitative data from interviews were analyzed using rapid qualitative analysis methods. In the final analytic phase, interview quotes were used to illustrate the complex realities underlying quantitative responses. 117 quarterly surveys and 46 semi-annual interviews were completed by key informants from 14 sites between September 2020 and January 2023. Peers were integrated across diverse activities for support and implementation of digital mental health interventions, including development of training and educational materials (78.6% of sites), community outreach (64.3%), technology testing (85.7%), technology piloting (90.9%), digital literacy training (71.4%), device distribution (63.6%), technical assistance (72.7%), and cross-site collaboration (66.7%). Peer-engaged activities shifted over time, reflecting project phases. Peer-provided digital literacy training and technology-related support were key ingredients for project implementations. This study indicates the wide range of ways peers can be integrated into digital mental health intervention implementations. Considering contextual readiness for peer integration may enhance their engagement into programmatic activities.

Optimization of medical care in regional health care: perspectives and barriers

The perspectives of Russian health care in the transition to personalized medicine are realized in the formation of an innovative digital health care system. Forming with the use of digital technologies the accessibility of health care provides enormous social advantages in regional conditions and assumes a qualitatively new level of regional health care system.
 The problems of the COVID-19 pandemic, requiring isolation, quarantine and social distancing and characterized by the formation of trends of social “atomization”, accelerated the dependence on digital health care, and served as a “catalyst for the development and implementation of a wide range of remote monitoring technologies in health care delivery”. However, the digitalization process is “objectively slow” in Russia. The research establishes a high differentiation of digitalization of regional health care systems in the Russian Federation.
 The implementation in regional health care of digital technologies, which have a high potential for improving the efficiency of the health care system, is limited by institutional barriers.
 The article presents a typology of institutional barriers to the digitalization of the regional health care system: on federal level [legal barriers, organizational and managerial (logistical) and technological barriers], regional level (financial barriers), level of medical organizations and users (medical staff and patients) [behavioral barriers, organizational and managerial (logistic) and technological barriers].
 Modern health care is experiencing large-scale digital technology inclusion, which can radically change the health care system by determining the accessibility and quality of medical care. However, the provision of cost-effective and quality health care initiated by the regional health care digitalization process is limited by institutional barriers at the federal, regional, medical organization and user levels.

Users' involvement in digital health collaborative projects

PurposeThis research analyzes the roles of users in innovative digital health collaborative projects from the perspective of the user by considering three dimensions: their motivation, project activities and the support of the partnership for their effective involvement.Design/methodology/approachThe authors unraveled profiles of users by using a Q-methodological analysis of 24 statements and 44 service users. The statements for the three dimensions were designed according to previous models of stakeholder identification and customer participation in new product management.FindingsThe authors obtained two profiles that advocate active participation of users, though with a different degree of involvement. One of them supports the role of users as “advisors” of users' preferences and needs, and the other indicates a higher involvement of users as “cocreators” of the innovation, with the same contribution and responsibility as the other partners.Originality/valuePrevious research has analyzed user involvement in digital health, as part of wider research on factors leading to the success and adoption of innovations. Moreover, previous research has analyzed user involvement in innovation projects, but without differentiating between projects carried out by an individual organization and those conducted by a partnership. This research contributes to filling this gap by revealing users' expectations about their involvement and how they think they will fit in with the dynamics of collaborative projects.

Transparency and Efficiency through Digital Healthcare? Results of a Survey of Generation Y

Generation Y represents a special target group in healthcare. Young, healthy and digitally socialized with integration of technologies into everyday life, they have specific needs. In the context of societal challenges such as demographic change and securing a skilled workforce, taking these needs into account, especially for maintaining health, should be the goal of public health as well as specific actors such as health insurers and employers. The research was intended to test and deepen the findings of two previous stages of work, specifically a qualitative survey. In this way, two research questions were to be answered: I: the importance of transparency and efficiency in the use of digital health innovations by Generation Y and II: the influence of socio-demographic and technology-associated factors on the use of digital health innovations by Generation Y in addition to the needs. As a conclusion of a sequential approach, assessments of transparency- and efficiency-associated needs in context of the use of digital health innovations of persons from Generation Y were collected in a quantitative online survey. 355 fully completed data sets were analyzed using SPSS software. An ordinal regression analysis was used to test the influence of predictors from six previously formulated hypotheses. The study was able to describe influences of the constructs transparency and efficiency on the use of apps and smart devices. The need for a sense of control had a significantly negative effect, while the need for structuring and seamless integration into everyday life had a significantly positive effect. Gender and technology readiness also had an impact. According to the data analysis, efficiency and thus a concrete everyday benefit from digital health innovations seems to be more relevant for Generation Y than autonomous empowerment and thus transparency. By taking into account the needs described as well as corresponding preferences, the target group could be addressed and usage could potentially be increased. Prevention and health promotion, as well as their organization, should be able to be incorporated into everyday life at a low threshold, and everyday life should be positively supplemented and efficiently supported.

User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study.

Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants' desires for relationality, accountability, and care. We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing.

Putting the usability of wearable technology in forensic psychiatry to the test: a randomized crossover trial.

Forensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On average, these treatments are effective, but the magnitude of effect sizes tends to be small, even when considering more recent advancements in digital mental health innovations. Recent research indicates that wearable technology has positive effects on the physical and mental health of the general population, and may thus also be of use in forensic psychiatry, both for patients and staff members. Several applications and use cases of wearable technology hold promise, particularly for patients with mild intellectual disability or borderline intellectual functioning, as these devices are thought to be user-friendly and provide continuous daily feedback. In the current randomized crossover trial, we addressed several limitations from previous research and compared the (continuous) usability and acceptance of four selected wearable devices. Each device was worn for one week by staff members and patients, amounting to a total of four weeks. Two of the devices were general purpose fitness trackers, while the other two devices used custom made applications designed for bio-cueing and for providing insights into physiological reactivity to daily stressors and events. Our findings indicated significant differences in usability, acceptance and continuous use between devices. The highest usability scores were obtained for the two fitness trackers (Fitbit and Garmin) compared to the two devices employing custom made applications (Sense-IT and E4 dashboard). The results showed similar outcomes for patients and staff members. None of the devices obtained usability scores that would justify recommendation for future use considering international standards; a finding that raises concerns about the adaptation and uptake of wearable technology in the context of forensic psychiatry. We suggest that improvements in gamification and motivational aspects of wearable technology might be helpful to tackle several challenges related to wearable technology.

Diverse Preconception Cohort of Digital Health Platform Shows Promise for Addressing Fertility Care Gaps

About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant. Addressing fertility challenges requires an understanding of not only the causes of infertility, but also modifiable risk factors that can impact the likelihood of pregnancy. However, current research on factors influencing conception is often conducted among people who are already engaged in medical fertility treatments. In addition, existing databases are not representative of the U.S. population demographically. This retrospective study describes the demographics of participants of a digital fertility platform who were seeking fertility guidance prior to conception. Demographic data collected from participants who enrolled in Doveras Fertility Inc. (Doveras)’s digital health offerings in 2023 and 2024 were analyzed. Doveras offers personalized preconception lifestyle and behavioral intervention programs, delivered through an innovative digital fertility health platform, for individuals and couples to improve various endpoints along the reproductive and maternal health journey. This paper reports on the inception cohort of the first 600 enrolled participants (Doveras Preconception Cohort I), a subset of a wider pool of Doveras participants enrolled. Doveras achieved this enrollment of a notably diverse and representative population: 65.9% of female-identifying participants identify as White and 34.1% as non-white; 60.5% of male-identifying participants identify as White and 39.5% identify as non-white. The cohort also demonstrates a wide geographical spread, with participants recruited from 46 U.S. states, and represents a population that may have limited access to preconception healthcare: more than half (61%) of participants live in states with 13 OBGYNS or fewer per 100,000 population. The Doveras digital fertility platform presented herein may provide an opportunity to reach a broader and more diverse U.S. population during the preconception period than currently has access to medical fertility care.

Advancing Healthcare Accessibility: Fusing Artificial Intelligence with Flexible Sensing to Forge Digital Health Innovations.

Advancing Healthcare Accessibility: Fusing Artificial Intelligence with Flexible Sensing to Forge Digital Health Innovations.

Identification of required capabilities of digital health ecosystems when preventing and managing non-communicable diseases.

Non-communicable diseases cause annual mortality for 41 million people worldwide. These diseases include coronary heart disease, cancer, stroke, diabetes, and musculoskeletal as well as mental disorders. Innovation ecosystems in healthcare are multifactor networks in which different stakeholders interact together to create socio-economic (patient and cost) value via research, co-creation, and traditional market activities. Although there is much evidence about the impact of digital health interventions and the capabilities needed to support individual actors and specific diseases in non-communicable disease prevention and management, the current understanding of the concept of innovation ecosystems associated with theories is not well understood. There is also a lack of research about innovation ecosystems in the healthcare context. Or understanding of the holistic perspective of the capabilities needed in innovation ecosystems to support future digital health. The objective of this study was to answer this research gap by identifying what capabilities are needed in future digital health ecosystems related to people with non-communicable diseases or at risk of non-communicable diseases. By doing this, the study will help different organisations and policies address this very challenging situation. To answer this objective, a qualitative interview-based study including 34 semi-structured interviews was conducted in Finland. Complex adaptive systems theory was used as a theoretical lens to analyse empirical data. Several new capabilities were identified for digital health innovation ecosystems to make organisation managers and policymakers aware of how to deal with future health system demands. From the organisational perspective, capabilities are needed to use non-medical and heterogeneous data to support better treatments and clinical decision-making and provide better and safer data access. From the management perspective, hospitals need capabilities to allow critical experts to participate in innovation work, and overall, all ecosystem actors need capabilities to orchestrate research and innovation actions in the area of digital health.

Embracing Digital Health Innovations: Strategies for Anticipation and Adaptation

Embracing Digital Health Innovations: Strategies for Anticipation and Adaptation

Forgotten and ignored: making digital health work for migrant population in Africa

Abstract The African continent has experienced an alarming increase in forcibly displaced individuals, driven by socio-political conflict, economic instability and climate-induced calamities. The urgent need for contextualized and adaptable health solutions in the face of ongoing conflicts and crises underscores the importance of harnessing digital health innovations while ensuring inclusivity and equity for all. This commentary explores the potential of digital health to address healthcare disparities among migrant populations, examining the barriers to adoption and providing recommendations for policymakers and stakeholders to promote inclusivity and improve healthcare access. While digital health emerged as a promising avenue for improving healthcare access, there is also a greater necessity for tailoring these innovations to the specific needs and vulnerabilities of the target populations.

Developing the BornFyne prenatal management system version 2.0: a mixed method community participatory approach to digital health for reproductive maternal health

ABSTRACT Despite the growing number of global initiatives aimed at reducing adverse maternal health outcomes, there remain critical gaps and disparities in access to maternal health services in Cameroon and across the sub-Saharan Africa. Digital health innovations represent unique opportunities for addressing maternal and newborn child health in sub-Saharan Africa. This article documents the approach to developing the BornFyne-Prenatal Management System (PNMS) as an intervention to support maternal health issues in Cameroon. The mixed-method design employed the three-delays model conducted in four health districts purposefully selected with a mix of urban and rural settings as defined in the context. The study employed focus group discussions and interviews to inform the development features. A total of 25 providers were interviewed, 12 focus group discussions and 4 workshops were held and a total of 3654 households were surveyed. Participants highlighted multifaceted advantages of using digital health platform such as BornFyne-PNMS to enhance communication and care during pregnancy such as remote consultations, emergency response, increased patient engagement and improved continuity of care and convenience. Most respondents believed that the use of a digital platform like BornFyne-PNMS would greatly facilitate access to health facilities, especially during emergencies. The BornFyne-PNMS deployment includes community engagement, training and practical skills building of health workers in the use of digital technologies, the establishment of an emergency transport mechanism for response to emergency cases, assessment and upgrading of the computer hardware of enrolled health facilities and support to health system managers to review and interpret the BornFyne data and interoperability with the national health management information system.

Overcoming the not-invented-here syndrome in healthcare: The case of German ambulatory physiotherapists' adoption of digital health innovations.

Healthcare is characterized by professional, organizational, and institutional boundaries. Digital health innovations can help overcome these boundaries by providing information access to all healthcare professionals. Such innovations emerge from inputs from different health professionals at different positions along the entire care process and have the potential to substantially change the way in which interprofessional tasks are performed among the involved professionals. Consequently, as less empowered professionals, physiotherapists may resist the adoption of digital health innovations in particular if the innovation is dominated by physicians, and thus the not-invented-here syndrome may become a major barrier. We aim to examine whether the origin of a digital health innovation affects German physiotherapists' adoption decision and whether the collaboration quality and physiotherapists' proactive job crafting behavior may help overcome adoption barriers. We applied a mixed-method sequential design with a qualitative study one in which we interviewed 20 physiotherapists to provide exploratory insights, and a quantitative study two in which we tested our proposed hypotheses with survey data including an experimental vignette from 165 physiotherapists. Physiotherapists adopt digital health innovations developed by their own professional group more likely than digital health innovations developed by physicians. Our results also confirm that physiotherapists' job crafting behavior and the quality of the collaboration with physicians weaken the resistance against physician-driven innovations. Our study underlines (1) the need to involve allied health professionals as physiotherapists in digital health innovation development, (2) the relevance of interprofessional collaboration in daily practice and, (3) an open mind set of allied health professionals to cope with innovation adoption barriers.

Telehealth and digital health innovations: A mixed landscape of access.

In the wake of emergent natural and anthropogenic disasters, telehealth presents opportunities to improve access to healthcare when physical access is not possible. Yet, since the beginning of the COVID pandemic, lessons learned reveal that various populations in the United States do not or cannot adopt telehealth due to inequitable access. We explored the Digital Determinants of Health (DDoHs) for telehealth, characterizing the role of accessibility, broadband connectivity and electrical grids, and patient intersectionality. In addition to its role as an existing Social Determinant of Health, Policies and Laws directly and indirectly affect these DDoHs, making access more complex for marginalized populations. Digital systems lack the flexibility, accessibility, and usability to inclusively provide the essential services patients need in telehealth. We propose the following recommendations: (1) design technology and systems using accessibility and value sensitive design principles; (2) support a range of technologies and settings; (3) support multiple and diverse users; and (4) support clear paths for repair when technical systems fail to meet users' needs. Addressing these requires change not only from providers but also from the institutions providing these systems.

Investigating the Impact of Automation on the Health Care Workforce Through Autonomous Telemedicine in the Cataract Pathway: Protocol for a Multicenter Study.

While digital health innovations are increasingly being adopted by health care organizations, implementation is often carried out without considering the impacts on frontline staff who will be using the technology and who will be affected by its introduction. The enthusiasm surrounding the use of artificial intelligence (AI)-enabled digital solutions in health care is tempered by uncertainty around how it will change the working lives and practices of health care professionals. Digital enablement can be viewed as facilitating enhanced effectiveness and efficiency by improving services and automating cognitive labor, yet the implementation of such AI technology comes with challenges related to changes in work practices brought by automation. This research explores staff experiences before and after care pathway automation with an autonomous clinical conversational assistant, Dora (Ufonia Ltd), that is able to automate routine clinical conversations. The primary objective is to examine the impact of AI-enabled automation on clinicians, allied health professionals, and administrators who provide or facilitate health care to patients in high-volume, low-complexity care pathways. In the process of transforming care pathways through automation of routine tasks, staff will increasingly "work at the top of their license." The impact of this fundamental change on the professional identity, well-being, and work practices of the individual is poorly understood at present. We will adopt a multiple case study approach, combining qualitative and quantitative data collection methods, over 2 distinct phases, namely phase A (preimplementation) and phase B (postimplementation). The analysis is expected to reveal the interrelationship between Dora and those affected by its introduction. This will reveal how tasks and responsibilities have changed or shifted, current tensions and contradictions, ways of working, and challenges, benefits, and opportunities as perceived by those on the frontlines of the health care system. The findings will enable a better understanding of the resistance or susceptibility of different stakeholders within the health care workforce and encourage managerial awareness of differing needs, demands, and uncertainties. The implementation of AI in the health care sector, as well as the body of research on this topic, remain in their infancy. The project's key contribution will be to understand the impact of AI-enabled automation on the health care workforce and their work practices. PRR1-10.2196/49374.

Developments in respiratory self-management interventions over the last two decades.

This paper describes developments in the fields of asthma and COPD self-management interventions (SMIs) over the last two decades and discusses future directions. Evidence around SMIs has exponentially grown. Efficacy on group level is convincing and both asthma and COPD SMIs are currently recommended by respiratory guidelines. Core components of asthma SMIs are defined as education, action plans, and regular review, with some discussion about self-monitoring. Exacerbation action plans are defined as an integral part of COPD management. Patient's adherence to SMI's is however inadequate and significantly reducing the intervention's impact. Adherence could be improved by tailoring of SMIs to patients' needs, health beliefs, and capabilities; the use of shared decision making; and optimising the communication between patients and health care providers. Due to the COVID-19 pandemic, digital health innovations have rapidly been introduced and expanded. Digital technology use may increase efficiency, flexibility, and efficacy of SMIs. Furthermore, artificial intelligence can be used to e.g., predict exacerbations in action plans. Research around digital health innovations to ensure evidence-based practice is of utmost importance. Current implementation of respiratory SMIs is not satisfactory. Implementation research should be used to generate further insights, with cost-effectiveness, policy (makers), and funding being significant determinants.