Digital Health Interventions Research Articles

Navigating digital health: perspectives of Australian community pharmacists—a short communication

Abstract Objective This study explores the perspectives of Australian community pharmacists regarding digital health interventions, examining adoption rates, advantages, and barriers. Methods A national voluntary online survey was conducted with Australian community pharmacists from September 2022 to June 2023. Results Of the 120 responses received, 118 were analysed. The main benefits identified included improved access to health records and patient care quality while major concerns included technical issues and data security. Suggestions for increased digital health adoption included digital health education and regulation. Conclusions Australian community pharmacists play a crucial role in adopting digital health yet face significant challenges. Despite the potential of telehealth, community pharmacists have not widely embraced its adoption in their practice. The digital healthcare transformation necessitates collaborative efforts and strict guideline adherence for effective integration.

Use of Technology to Improve Adherence in Allergy/Immunology

The integration of technology into health care has shown significant promise in enhancing patient adherence, particularly in the field of allergy/immunology. This article explores the multifaceted approaches through which digital health interventions can be used to improve adherence rates among patients with allergic diseases and immunologic disorders. By reviewing recent advancements in telemedicine, mobile health applications, wearable devices, and digital reminders, as well as smart inhalers, we aim to provide a comprehensive overview of how these technologies can support patients in managing their conditions. The analysis highlights the role of personalized digital health plans, which, through the use of artificial intelligence and machine learning algorithms, can offer tailored advice, monitor symptoms, and adjust treatment protocols in real time. Moreover, the article discusses the impact of electronic health records and patient portals in fostering a collaborative patient-provider relationship, thereby enhancing communication and adherence. The integration of these technologies has been shown to not only improve clinical outcomes but also increase patient satisfaction and engagement.

Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services

There is a substantial gap between demand for and availability of mental health services. Digital mental health interventions (DMHIs) are promising tools for bridging this gap, yet little is known about their comparative effectiveness. To assess whether patients randomized to a cognitive behavioral therapy (CBT)-based or mindfulness-based DMHI had greater improvements in mental health symptoms than patients randomized to the enhanced personalized feedback (EPF)-only DMHI. SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between May 13, 2020, and December 12, 2022, with follow-up at 6 weeks. Adult patients of outpatient psychiatry services across various clinics within the University of Michigan Health System with a scheduled or recent outpatient psychiatry appointment were recruited. Eligible patients were randomized to an intervention arm. All analyses followed the intent-to-treat principle. Participants were randomized to 1 of 5 intervention arms: (1) EPF only; (2) Silvercloud only, a mobile application designed to deliver CBT strategies; (3) Silvercloud plus EPF; (4) Headspace only, a mobile application designed to train users in mindfulness practices; and (5) Headspace plus EPF. The primary outcome was change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9; score range: 0-27, with higher scores indicating greater depression symptoms). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms. A total of 2079 participants (mean [SD] age, 36.8 [14.3] years; 1423 self-identified as women [68.4%]) completed the baseline survey. The baseline mean (SD) PHQ-9 score was 12.7 (6.4) and significantly decreased for all 5 intervention arms at 6 weeks (from -2.1 [95% CI, -2.6 to -1.7] to -2.9 [95% CI, -3.4 to -2.4]; n = 1885). The magnitude of change was not significantly different across the 5 arms (F4,1879 = 1.19; P = .31). Additionally, the groups did not differ in decrease in anxiety or substance use symptoms. However, the Headspace arms reported significantly greater improvements on a suicidality measure subscale compared with the Silvercloud arms (mean difference in mean change = 0.63; 95% CI, 0.20-1.06; P = .004). This randomized clinical trial found decreases in depression and anxiety symptoms across all DMHIs and minimal evidence that specific applications were better than others. The findings suggest that DMHIs may provide support for patients during waiting list-related delays in care. ClinicalTrials.gov Identifier: NCT04342494.

Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review

IntroductionHealth behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence...

Leveraging digital health technologies in heart failure self-care interventions to improve health equity

For patients with heart failure, self-care is crucial, but recommendations for self-care are often not adhered to. Digital health interventions have the potential to help patients improve their self-care and, ultimately, their health outcomes, but without careful examination, digital interventions may generate further inequality. In this study, we use a digital health equity framework to examine challenges and opportunities related to digital health interventions across many domains of influence that may affect health equity. We draw from our own experience in conducting a decentralized clinical trial with multiple sensors and apps to help patients with heart failure improve adherence to key self-care behaviors. Finally, we provide recommendations for leveraging digital health interventions in research and practice to address health equity.

HEALET-PATH TO WELLNESS

Abstract— In This research paper explores Healet, a platform designed to promote wellness and improve mental health. Healet integrates various tools and techniques to assist individuals in their journey towards better well-being. Through this platform, users can access resources such as guided meditation, stress management techniques, exercise routines, and personalized wellness plans.The paper investigates the effectiveness of Healet in enhancing mental health outcomes, particularly in reducing stress, anxiety, and depression. It examines user satisfaction with the platform and its impact on daily life functioning. Additionally, the research explores the accessibility and usability of Healet across different demographics. Through surveys, interviews, and usage data analysis, the study aims to provide insights into the strengths and limitations of Healet as a wellness resource. It also discusses potential areas for improvement and future directions for research and development in the field of digital mental health interventions. Index Term : Frontend development HTML, CSS, React, Backend NodeJS, Express, MongoDB

Co-design and usability testing in the development of a digital health intervention for the secondary prevention of cardiovascular disease: The INTERCEPT Study (Preprint)

Co-design and usability testing in the development of a digital health intervention for the secondary prevention of cardiovascular disease: The INTERCEPT Study (Preprint)

Factors associated with adherence to a public mobile nutritional health intervention: Retrospective cohort study

BackgroundObesity is a global health issue affecting over 2 billion people. Mobile health apps, specifically nutrition apps, have been identified as promising solutions to combat obesity. However, research on adherence to nutrition apps is scarce, especially for publicly available apps without monetary incentives and personal onboarding. Understanding factors associated with adherence is essential to improve the efficacy of these apps. This study aims to identify such factors by analyzing a large dataset of a free and publicly available app (“MySwissFoodPyramid”) that promotes healthy eating through dietary self-monitoring and nutrition literacy delivered via a conversational agent. MethodsA retrospective analysis was conducted on 19,805 users who used the app for at least two days between November 2018 and May 2022. Adherence was defined as completing a food diary by tracking dietary intake over a suggested period of three days. Users who finished multiple diaries were considered long-term adherent. The associations between the day and time of installation, tutorial use, reminder use, and conversational agent choice were examined regarding adherence, long-term adherence, and the number of completed diaries. ResultsOverall, 66.8% of included users were adherent, and 8.5% were long-term adherent. Users who started the intervention during the day (5 a.m.–7 p.m.) were more likely to be adherent and completed more diaries. Starting to use the intervention between Sunday and Wednesday was associated with better adherence and a higher number of completed diaries. Users who chose the female conversational agent were more likely to be adherent, long-term adherent, and completed more diaries. Users who skipped the tutorial were less adherent and completed fewer diaries. Users who set a follow-up reminder were more likely to be long-term adherent and completed more diaries. ConclusionsThis study demonstrates the potential of digital health interventions to achieve comparably high adherence rates, even without monetary incentives or human-delivered support. It also reveals factors associated with adherence highlighting the importance of app tutorials, customizable reminders, tailored content, and the date and time of user onboarding for improving adherence to mHealth apps. Ultimately, these findings may help improve the effectiveness of digital health interventions in promoting healthy behaviors.

Engagement With a Mobile Chat-Based Intervention for Smoking Cessation

Determining how individuals engage with digital health interventions over time is crucial to understand and optimize intervention outcomes. To identify the engagement trajectories with a mobile chat-based smoking cessation intervention and examine its association with biochemically validated abstinence. A secondary analysis of a pragmatic, cluster randomized clinical trial conducted in Hong Kong with 6-month follow-up. From June 18 to September 30, 2017, 624 adult daily smokers were recruited from 34 community sites randomized to the intervention group. Data were analyzed from March 6 to October 30, 2023. Chat-based cessation support delivered by a live counselor via a mobile instant messaging app for 3 months from baseline. Group-based trajectory modeling was used to identify engagement trajectories using the participants' weekly responses to the messages from the counselor over the 3-month intervention period. The outcome measures were biochemically validated tobacco abstinence at 3-month (end of treatment) and 6-month follow-ups. Covariates included sex, age, educational level, nicotine dependence, past quit attempt, and intention to quit at baseline. Of 624 participants included in the analysis, 479 were male (76.8%), and the mean (SD) age was 42.1 (16.2) years. Four distinct engagement trajectories were identified: low engagement group (447 [71.6%]), where participants maintained very low engagement throughout; rapid-declining group (86 [13.8%]), where participants began with moderate engagement and rapidly decreased to a low level; gradual-declining group (58 [9.3%]), where participants had high initial engagement and gradually decreased to a moderate level; and high engagement group (58 [5.3%]), where participants maintained high engagement throughout. Compared with the low engagement group, the 6-month validated abstinence rates were significantly higher in the rapid-declining group (adjusted relative risk [ARR], 3.30; 95% CI, 1.39-7.81), gradual-declining group (ARR, 5.17; 95% CI, 2.21-12.11), and high engagement group (ARR, 4.98; 95% CI, 1.82-13.60). The corresponding ARRs (95% CI) of 3-month validated abstinence were 4.03 (95% CI, 1.53-10.59), 5.25 (95% CI, 1.98-13.88), and 9.23 (95% CI, 3.29-25.86). The findings of this study suggest that higher levels of engagement with the chat-based smoking cessation intervention were associated with greater biochemically validated tobacco abstinence. Improving engagement with digital interventions may increase intervention benefits. ClinicalTrials.gov Identifier: NCT03182790.

Behavior Change Theories and Models Within Health Belief Model Research: A Five-Decade Holistic Bibliometric Analysis.

The health belief model (HBM) has gained significant scholarly attention over the past five decades. This study aims to provide a comprehensive bibliometric analysis of the HBM research landscape to reveal its evolving trends and impact. The analysis utilized data from the Scopus database to explore publication patterns, influential sources and researchers, international collaborations, and thematic trends in the HBM-related literature. The findings demonstrate a substantial growth in HBM publications, with a peak of more than 11% in 2022-2023. The United States, Iran, China, the United Kingdom, and Australia are the most productive countries, and prominent HBM researchers include Lau JTF, Champion VL, and Jeihooni AK. Thematic analysis reveals a shift from broader topics of HBM to more specific areas, such as COVID-19, health behavior, and digital health interventions. The current study highlights the sustained and growing interest in HBM, its diverse applications, and the collaborative efforts of researchers worldwide to develop and refine this influential theoretical framework in public health and behavioral science.

Briefings

Capital design platform for athletics departments Student loans canceled for 160,000 borrowers Revenue‐sharing for college athletes Digital mental health interventions on college campuses

Effectiveness of digital health interventions on adherence and control of hypertension: a systematic review and meta-analysis.

Hypertension, a risk factor for developing cardiovascular disease, is becoming increasingly prevalent worldwide. Digital health is now widely utilized for hypertension management, and numerous studies have assessed its effectiveness. The review aims to analyse the effectiveness of digital health (i.e., mobile health (mHealth), telehealth, and the combination of mHealth & telehealth) on hypertensive patients, concerning three key areas: clinical outcomes, medication adherence, and adherence to lifestyle changes, as compared to standard care. The review followed the PRISMA framework. Eight electronic databases were scanned for randomized control trials focusing on the effects of mHealth or telehealth on hypertensive patients, published between 2010 and 2023. All processes were conducted by the first two authors independently. A meta-analysis was conducted for quantitative data, while a narrative synthesis was conducted for qualitative data. In total, 74 studies involving 92 686 participants were identified. The meta-analysis favoured the interventions, revealing a significant decrease in systolic blood pressure and diastolic blood pressure for mHealth, telehealth and mHealth & telehealth groups. Nevertheless, medication adherence showed improvement only in the mHealth group, while blood pressure control showed improvement in both mHealth and mHealth & telehealth groups, and BMI showed improvement only in the mHealth group. Evidence for adherence to physical activity and DASH diet/salt intake remained inconclusive. In general, mHealth and telehealth have demonstrated their merits in improving the clinical outcomes of hypertensive patients.

Strategies, processes, outcomes, and costs of implementing experience sampling-based monitoring in routine mental health care in four European countries: study protocol for the IMMERSE effectiveness-implementation study

BackgroundRecent years have seen a growing interest in the use of digital tools for delivering person-centred mental health care. Experience Sampling Methodology (ESM), a structured diary technique for capturing moment-to-moment variation in experience and behaviour in service users’ daily life, reflects a particularly promising avenue for implementing a person-centred approach. While there is evidence on the effectiveness of ESM-based monitoring, uptake in routine mental health care remains limited. The overarching aim of this hybrid effectiveness-implementation study is to investigate, in detail, reach, effectiveness, adoption, implementation, and maintenance as well as contextual factors, processes, and costs of implementing ESM-based monitoring, reporting, and feedback into routine mental health care in four European countries (i.e., Belgium, Germany, Scotland, Slovakia).MethodsIn this hybrid effectiveness-implementation study, a parallel-group, assessor-blind, multi-centre cluster randomized controlled trial (cRCT) will be conducted, combined with a process and economic evaluation. In the cRCT, 24 clinical units (as the cluster and unit of randomization) at eight sites in four European countries will be randomly allocated using an unbalanced 2:1 ratio to one of two conditions: (a) the experimental condition, in which participants receive a Digital Mobile Mental Health intervention (DMMH) and other implementation strategies in addition to treatment as usual (TAU) or (b) the control condition, in which service users are provided with TAU. Outcome data in service users and clinicians will be collected at four time points: at baseline (t0), 2-month post-baseline (t1), 6-month post-baseline (t2), and 12-month post-baseline (t3). The primary outcome will be patient-reported service engagement assessed with the service attachment questionnaire at 2-month post-baseline. The process and economic evaluation will provide in-depth insights into in-vivo context-mechanism-outcome configurations and economic costs of the DMMH and other implementation strategies in routine care, respectively.DiscussionIf this trial provides evidence on reach, effectiveness, adoption, implementation and maintenance of implementing ESM-based monitoring, reporting, and feedback, it will form the basis for establishing its public health impact and has significant potential to bridge the research-to-practice gap and contribute to swifter ecological translation of digital innovations to real-world delivery in routine mental health care.Trial registrationISRCTN15109760 (ISRCTN registry, date: 03/08/2022).

Briefings

Digital Mental Health Interventions on College Campuses ChatGPT Edu Introduced Capital Design Platform for Athletics Departments Revenue‐Sharing for College Athletes Student Loans Canceled for 160,000 borrowers

Existing Digital Health Technology Index Summary Report for Older Adults Living with Neurocognitive Disorders (Mild and Major) and Their Informal Caregivers: An Environmental Scan.

Digital health has added numerous promising solutions to enhance the health and wellness of people with neurocognitive disorders (NCDs) and their informal caregivers. (1) Background: It is important to obtain a comprehensive view of currently available technologies, their outcomes, and conditions of success to inform recommendations regarding digital health solutions for people with NCDs and their caregivers. This environmental scan was performed to identify the features of existing digital health solutions relevant to the targeted population. This work reviews currently available digital health solutions and their related characteristics to develop a decision support tool for older adults living with mild or major neurocognitive disorders and their informal caregivers. This knowledge will aid the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate digital health solutions according to their needs and preferences based on trustable information. (2) Methods: We conducted an environmental scan to identify digital health solutions from a systematic review and targeted searches in the grey literature covering the regions of Canada and Europe. Technological tools were scanned based on a preformatted extraction grid. We assessed their relevance based on selected attributes and summarized the findings. (3) Results: We identified 100 available digital health solutions. The majority (56%) were not specific to NCDs. Only 28% provided scientific evidence of their effectiveness. Remote patient care, movement tracking, and cognitive exercises were the most common purposes of digital health solutions. Most solutions were presented as decision aid tools, pill dispensers, apps, web, or a combination of these platforms. (4) Conclusions: This environmental scan allowed for identifying current digital health solutions for older adults with mild or major neurocognitive disorders and their informal caregivers. Findings from the environmental scan highlight the need for additional approaches to strengthen digital health interventions for the well-being of older adults with mild and major NCDs and their informal and formal healthcare providers.

Evaluating the Impact of Digital Health Interventions on Workplace Health Outcomes: A Systematic Review

Evaluating the Impact of Digital Health Interventions on Workplace Health Outcomes: A Systematic Review

Current status of digital health interventions in the health system in Burkina Faso

BackgroundDigital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina Faso aims to harmonize its digital health interventions to guide its digital health strategy for the coming years. The current assessment represents upstream work to steer the development of this strategic plan.MethodsThis was a quantitative, descriptive study conducted between September 2022 and April 2023. It involved a two-part survey: a self-administered questionnaire distributed to healthcare information managers in facilities, and direct interviews conducted with software developers. This was complemented by a documentary review of the country’s strategic and standards documents on digital transformation.ResultsBurkina Faso possesses a relatively comprehensive collection of governance documents pertaining to digital transformation. The study identified a total of 35 digital health interventions. Analysis showed that 89% of funding originated from technical and financial partners as well as the private sector. While the use of open-source technologies for the development of the applications, software, or platforms used to implement these digital health interventions is well established (77%), there remains a deficiency in the integration of data from different platforms. Furthermore, the classification of digital health interventions revealed an uneven distribution between the different elements across domains: the health system, the classification of digital health interventions (DHI), and the subsystems of the National Health Information System (NHIS). Most digital health intervention projects are still in the pilot phase (66%), with isolated electronic patient record initiatives remaining incomplete. Within the public sector, these records typically take the form of electronic registers or isolated specialty records in a hospital. Within the private sector, tool implementation varies based on expressed needs. Challenges persist in adhering to interoperability norms and standards during tool design, with minimal utilization of the data generated by the implemented tools.ConclusionThis study provides an insightful overview of the digital health environment in Burkina Faso and highlights significant challenges regarding intervention strategies. The findings serve as a foundational resource for developing the digital health strategic plan. By addressing the identified shortcomings, this plan will provide a framework for guiding future digital health initiatives effectively.

Evaluating usability of and satisfaction with mHealth app in rural and remote areas-Germany GIZ collaboration in Bosnia-Herzegovina to optimize type 1 diabetes care.

Type 1 diabetes mellitus (T1DM) management in children and adolescents requires intensive supervision and monitoring to prevent acute and late diabetes complications and to improve quality of life. Digital health interventions, in particular diabetes mobile health apps (mHealth apps) can facilitate specialized T1DM care in this population. This study evaluated the initial usability of and satisfaction with the m-Health intervention Diabetes: M app, and the ease of use of various app features in supporting T1DM care in rural and remote areas of Bosnia-Herzegovina with limited access to specialized diabetes care. This cross-sectional study, performed in February-March 2023, evaluated T1DM pediatric patients who used the Diabetes: M app in a 3-month mHealth-based T1DM management program, along with their parents and healthcare providers (HCPs). All participants completed self-administered online questionnaires at the end of the 3-month period. Data were analyzed by descriptive statistics. The study population included 50 T1DM patients (children/parents and adolescents) and nine HCPs. The mean ± SD age of the T1DM patients was 14 ± 4.54 years, with 26 (52%) being female. The mean ± SD age of the HCPs was 43.4 ± 7.76 years; all (100%) were women, with a mean ± SD professional experience of 17.8 ± 8.81 years. The app was reported usable in the domains of ease-of-use and satisfaction by the T1DM children/parents (5.82/7.0), T1DM adolescents/young adults (5.68/7.0), and HCPs (5.22/7.0). Various app features, as well as the overall app experience, were rated positively by the participants. The results strongly support the usability of mHealth-based interventions in T1DM care, especially in overcoming care shortage and improving diabetes management and communications between HCPs and patients. Further studies are needed to compare the effectiveness of apps used to support T1DM management with routine care.

MT22 Mapping Definitions of Patient-Facing Digital Health Intervention in Published Frameworks Against the PICOTS-ComTeC Minimum Information Framework

MT22 Mapping Definitions of Patient-Facing Digital Health Intervention in Published Frameworks Against the PICOTS-ComTeC Minimum Information Framework

Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse

BackgroundThe internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. ObjectiveTo explore the barriers and enablers to the future integration of i-Minds into clinical practice. Participants and settingTwelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). MethodsSemi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. ResultsPractitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. ConclusionsPractitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.