Digital Health Programs Research Articles

From fragmentation to functionality: Enhancing coherence of digital health integration in health systems.

Digital health programs continue to be implemented within Canadian health systems at a steady pace. The effectiveness of digital health initiatives has been rigorously analyzed, with both benefits and drawbacks extensively commented on. While the discussion about digital health continues, both positive and negative perspectives of it are approaching saturation in their themes. Accepting that digital health is here to stay post-pandemic, the focus should shift to strategies and supports needed to avoid the fragmentation of care through digital health implementation. This short article poses three questions which policy-makers and decision-makers should explore as part of a level-setting exercise with involved stakeholders at the outset of a digital health program's consideration. An implementation team should design the digital health program to have equity as its foundational focus, conduct value-based evaluations, and position the program in a learning health system framework to guard against the fragmentation of care.

2.B. Scientific session: Learning from intercountry comparisons in digital healthcare transition monitoring

Abstract In many countries, healthcare is facing several challenges, including increasing healthcare demand, healthcare workforce shortages, rising healthcare costs, and keeping healthcare accessible. It is thought that the use of digital health might help to tackle these challenges. However, digital health programs and interventions are often not (systematically) monitored or evaluated. Monitoring of the digital healthcare transition in countries over time helps policymakers and healthcare professionals to investigate which digital services work well, and which do not, to (partly) solve the experienced challenges. In Europe, several countries monitor the digital healthcare transition within the primary and secondary care in their country. Comparing and sharing the monitoring methodologies between countries and describing the current state of the digital healthcare transition in primary and secondary care, will help to learn from other countries about how digital health could help to tackle the frequently experienced healthcare challenges. During this workshop, three countries throughout Europe (the Netherlands, Italy and Denmark) will briefly share their methodologies used for monitoring the digital healthcare transition in their country and will provide an up-to-date overview of the current state of the digital healthcare transition in primary and secondary care in their country. Challenges, achievements and future plans for the monitoring of this transition will also be shortly discussed in 10-minute presentations. Further, there will be 25 minutes for audience interaction which will be moderated by the chairperson. During this discussion, there is time to hear experiences from other countries and explore best practices in monitoring the digital healthcare transition. Key messages • The digital healthcare transition can be monitored in different ways. Experiences from three European countries may inspire others to organize national monitoring programs. • The speed and nature of the digital healthcare transition differs between European countries. Experiences from three European countries provide insight into state of the art of national transitions.

Empowering patients with heart failure: a digital health solution improved self-care and metabolic outcomes in a randomized controlled trial

Abstract Background/Introduction Heart failure is a common cause of morbidity and mortality and poses a significant burden on patients and healthcare providers. Purpose The aim of the study was to evaluate whether a digital health program improves quality of life and clinical outcomes for patients with heart failure. Methods A single-center, randomized controlled trial (RCT) was conducted with patients receiving standard of care (SoC) at a heart failure outpatient clinic. Patients were randomized (1:1) to receive either SoC alone or SoC with an additional six-month digital health program. The program consisted of remote patient monitoring (RPM) with symptom tracking, disease-specific education, and lifestyle coaching, designed to empower patients with heart failure. After the main program concluded, a six-month maintenance program was initiated, consisting of recurrent educational materials, with reduced coaching- and RPM frequency. The primary endpoint was the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at six months. Secondary endpoints included the European Heart Failure Self-care Behaviour Scale-9 (EHFScB-9), 6-question heart failure knowledge questionnaire, and metabolic outcomes. Here we report on the Intention-to-Treat (ITT) population analysis for the primary and significant secondary endpoints at six and 12 months. Results The ITT included 175 participants, 86 in the program group and 89 in the control. Program group: mean age (SD) 64.7 (13.2), 66.3% male, 87.2% with NYHA stages I-II. Control group: mean age (SD) 66.2 (11.1) years, 69.7% male, 87.6% with NYHA stages I-II. Median compliance with RPM was 93% and in-app retention was 80% at six months. Results for primary and secondary endpoints are presented in Table 1 and Figure 1. No statistical difference was observed in the KCCQ score between groups at six or 12 months. The program group had statistically significant improvements in EHFScB-9 score at six and 12 months and in heart failure knowledge at 12 months compared to the control group. Metabolic outcomes: a significant difference in glucose levels was also observed between groups at six months, and in HbA1c and triglycerides levels at 12 months. Conclusions The difference between groups in the primary endpoint of heart failure symptoms and quality of life, as measured by the KCCQ-12, was not statistically significant. However, significant differences were observed in self-care behaviour and heart failure knowledge, as well as metabolic outcomes at six and 12 months, when compared with standard care alone. These findings, along with good retention and engagement, indicate the value to patients of digital health interventions in the management of heart failure.

Youth voices: A participatory approach to promoting mental health literacy through digital means

Abstract A concerning number of young people worldwide experience mental health challenges, often compounded by limited mental health literacy, such as a lack of knowledge about how to recognize mental disorders and strategies for seeking help (Cairns & Rossetto, 2019). Therefore, it is crucial to promote mental health literacy among youth. Due to the scarcity and often high cost of readily available mental health services, as well as concerns about anonymity, digital programs have become an alternative means of reaching youth. To this end, a digital prevention program was developed. The pivotal question now is how to effectively promote young people’s mental health literacy through digital means, more specifically: How to develop (1) evidence-based and (2) target group-specific content? To investigate these questions, two systematic reviews were conducted that analyzed a total of 65 digital evidence-based mental health programs. Since the active use of programs also depends on how suitable and appealing the content is for the target group, a participatory approach was chosen to actively involve the target group in the process of developing the program’s design and content. Therefore, four participatory workshops were conducted in Slovenia, Poland, and Austria, with 12-15-year-old students (N = 182). Selected results from the systematic reviews and cross-national results from the workshops will be presented. It was found that psychoeducation is an important and effective method for promoting mental health literacy among youth and that young people prefer this content to be delivered as briefly and concisely as possible, and in a multimodal format. The discussion will highlight key takeaways regarding the benefits and challenges of this approach, emphasizing the necessity of including student voices in the creation of psychoeducational content for a digital mental health program in order to highlight and recognize young people’s right to participate. Key messages • The value of youth participation - Involving young people in the development of content for a digital mental health literacy program is a means to increase its relevance and appeal to them. • The intricacies of youth participation - Involving young people in the development of a digital mental health literacy program presents challenges that require careful consideration.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

Preparedness, Challenges, and Opportunities for Digital Intervention for Chronic Disease Management: A Qualitative Study in Rural Areas of South Korea

ABSTRACT Motivated by the prevalence of an aging population and the associated increase in chronic diseases, coupled with rising medical expenditure, the Korean government initiated a pilot project in Pyeongchang-gun, Gangwon-do, a rural area, to implement a “smart online-to-offline (O2O) digital health care model” aimed at managing and preventing chronic diseases. However, there is limited understanding regarding perspectives and levels of preparedness for digital health among stakeholders at various levels. In-depth focus group interviews were conducted with elderly and non-elderly community members, health care providers, and staff members at Pyeongchang Health and Medical Center. The study found the presence of both positive and negative perceptions and a lack of preparedness across different levels. At the end-user level, it was observed that community members, especially the elderly, have low levels of health and digital literacy, compounded by limited access to social support. At the health care provider level, there was uncertainty about the acceptance of the digital health program. At the area level, the need to bolster health staff members and enhance their capacity was observed. Recommendations include: customizing the design of the online and offline service components by considering end-user factors (such as age, occupation, and household type) that may contribute to disparities in health; establishing a platform for providers to share their experiences to facilitate the effective incorporation of digital health into their practices; and preparing an appropriate provider payment mechanism.

The Impact of a Digital Cancer Survivorship Patient Engagement Toolkit on Older Cancer Survivors' Health Outcomes.

Cancer predominantly affects older adults. An estimated 62% of the 15.5 million American cancer survivors are 65 years or older. Provision of supportive care is critical to this group; however, limited resources are available to them. As older survivors increasingly adopt technology, digital health programs have significant potential to provide them with longitudinal supportive care. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit for older adults, Cancer Survivorship Patient Engagement Toolkit Silver. The study examined the preliminary impact of the Cancer Survivorship Patient Engagement Toolkit Silver on older survivors' health outcomes. This was a 2-arm randomized controlled trial with two observations (baseline, 8 weeks) on a sample of 60 older cancer survivors (mean age, 70.1 ± 3.8 years). Outcomes included health-related quality of life, self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. At 8 weeks, the Cancer Survivorship Patient Engagement Toolkit Silver group showed more improved physical health-related quality of life (P < .001, effect size = 0.64) and symptom burden (P = .053, effect size = -0.41) than the control group. Self-efficacy (effect size = 0.56), mental health-related quality of life (effect size = 0.26), and communication (effect size = 0.40) showed clinically meaningful effect sizes of improvement. Most participants reported benefits on health management (mean, 19.41 ± 2.6 [3-21]). Further research is needed with larger and more diverse older cancer populations.

Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil.

Digital mental health interventions (DMHIs) have surged in popularity over the last few years. However, adherence to self-guided interventions remains a major hurdle to overcome. The current study utilized a phased implementation design, incorporating diverse samples and contexts to delve into the engagement challenges faced by a recently launched online mental health platform in Brazil with self-evaluation forms. Employing an iterative mixed-methods approach, including focus groups, online surveys, and think-aloud protocols, the research aims to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions. Engagement in the platform was evaluated by descriptive statistics of the number of instruments completed, and qualitative interviews that were interpreted thematically. In the fully self-guided mode, 2,145 individuals registered, but a substantial majority (88.9%) engaged with the platform for only 1 day, and merely 3.3% completed all activities. In another sample of 50 participants were given a choice between online-only or a hybrid experience with face-to-face meetings. 40% of individuals from the hybrid group completed all activities, compared to 8% in the online-only format. Time constraints emerged as a significant barrier to engagement, with suggested improvements including app development, periodic reminders, and meetings with healthcare professionals. While the study identified weaknesses in the number and length of instruments, personalized results stood out as a major strength. Overall, the findings indicate high satisfaction with the mental health platform but underscore the need for improvements, emphasizing the promise of personalized mental health information and acknowledging persistent barriers in a digital-only setting.

Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack.

Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors' research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual's condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use.

Using digital technology as a platform to strengthen the continuum of care at community level for maternal, child and adolescent health in Tanzania: introducing the Afya-Tek program

Inadequate care within Tanzania’s primary health system contributes to thousands of preventable maternal and child deaths, and unwanted pregnancies each year. A key contributor is lack of coordination between three primary healthcare actors: public sector Community Health Workers (CHWs) and health facilities, and private sector Accredited Drug Dispensing Outlets (ADDOs). The Afya-Tek program aims to improve the continuity of care amongst these actors in Kibaha district, through a mobile-application based digital referral system that focuses on improving maternal, child and adolescent health. The digital system called Afya-Tek was co-created with users and beneficiaries, and utilises open-source technology in-line with existing government systems. The system guides healthcare actors with individualised decision support during client visits and recommends accurate next steps (education, treatment, or referral). From July 2020 to June 2023, a total of 241,000 individuals were enrolled in the Afya-Tek program covering 7,557 pregnant women, 6,582 postpartum women, 45,900 children, and 25,700 adolescents. CHWs have conducted a total of 626,000 home visits to provide health services, including screening clients for danger signs. This has resulted in 38,100 referrals to health facilities and 24,300 linkages to ADDOs. At the ADDO level, 48,552 clients self-presented; 33% of children with pneumonia symptoms received Amoxicillin; 34% of children with diarrhoea symptoms received ORS and zinc; and 4,203 referrals were made to nearest health facilities. Adolescents preferred services at ADDOs as a result of increased perceived privacy and confidentiality. In total, 89% of all referrals were attended by health facilities. As the first digital health program in Tanzania to demonstrate the linkage among public and private sector primary healthcare actors, Afya-Tek holds promise to improve maternal, child and adolescent health as well as for scale-up and sustainability, through incorporation of other disease conditions and integration with government’s Unified Community System (UCS).

Advancing Digital Health Equity: An Interdisciplinary Educational Approach to Digital Health Access and Inclusivity.

The innovatively structured BCIT Digital Health program is designed to build digital-care capacity within the healthcare workforce to improve outcomes across healthcare communities and optimize clinical transformation. An equity-oriented focus and an active commitment to reducing health disparities puts the patient voice at the centre of the program. To improve accessibility in digital health, the program focuses on inclusivity strategies such as capacity building, Indigenous perspectives, equity-oriented care and providing training to build an effective digital healthcare system. By combining clinical expertise with technological competencies and anchoring it all in a commitment to equity, this program will help reshape the future of innovative and equitable healthcare delivery.

Nurse-led digital health program for home blood pressure monitoring in stroke patients: protocol for a pooled analysis of randomized controlled trials.

Hypertension is a major risk factor for stroke recurrence in stroke patients. Home blood pressure monitoring, facilitated by digital health technologies and led by nurses, may improve blood pressure control in this high-risk population. However, the evidence is not yet conclusive. This study protocol outlines a pooled analysis of the current literatures to evaluate the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. We will conduct a comprehensive search of some major electronic databases (e.g., PubMed, EMBASE, Cochrane Library, and CINAHL) and trial registries for randomized controlled trials evaluating nurse-led digital health programs for home blood pressure monitoring in stroke patients. Two reviewers will independently screen titles and abstracts, review full-text articles, extract data, and assess risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The primary outcome measures will be changes in both systolic and diastolic blood pressure from baseline to the end of the intervention period. Secondary outcomes include adherence to the program, patient satisfaction, and stroke recurrence. Data will be pooled and analyzed using meta-analysis techniques, if appropriate. This study will provide comprehensive evidence on the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. The findings could have substantial implications for clinical practice and health policy, potentially informing the development of guidelines and policies related to hypertension management and stroke prevention. By pooling the results of randomized controlled trials, this study will offer a robust evidence base to inform clinical practice and health policy in the context of stroke patients. Despite potential limitations such as heterogeneity among studies and risk of publication bias, the rigorous methodology and comprehensive approach to data synthesis will ensure the reliability and validity of the findings. The results will be disseminated through a peer-reviewed publication and potentially at relevant conferences. https://doi.org/10.17605/OSF.IO/59XQA.

Study on the management effect of chronic disease intelligent information management platform in post percutaneous coronary intervention patients.

In 2019, approximately 330 million individuals in China were affected by cardiovascular diseases, with 11.4 million cases specifically attributed to coronary artery disease (CAD). A national public health report indicated that the mortality rate for CAD ranged from 121.59 to 130.14 per 100,000 individuals in 2019. The treatments for CAD include lifestyle changes, medications, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. To investigate the management effect of a digital health program in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). This retrospective study compares blood pressure, blood glucose, low-density lipoprotein cholesterol (LDL-C), medication adherence, lifestyle modification, and readmission rate between digital health users and traditional follow-up in post-PCI CAD patients. In this study of 698 CAD patients, the 6-month readmission rate of all patients was 27.4%, with digital health users showing lower rates than those in traditional follow-up (22.6% vs. 32.1%, p= 0.005). Digital health users had significantly higher target achievements rates in blood pressure (79.7% vs. 54.7%, p< 0.001), blood glucose (98.9% vs. 82.5%, p< 0.001) and LDL-C level (71.3% vs. 52.7%, p< 0.001) at 6-month post-PCI. The digital health group had more patients adopting lifestyle changes, including quitting smoking, maintaining a healthy diet, and exercising regularly. In risk factor analysis, digital health utilization (OR = 0.60, 95%CI: 0.40-0.90, p= 0.014) and multivessel disease (double: OR = 1.72, 95%CI: 1.09-2.72, p= 0.02; triple: OR = 2.59, 95%CI: 1.61-4.17, p< 0.001) were independent predictors of CAD-related cardiovascular readmissions. Post-PCI patients using digital health platforms exhibited improved blood pressure, glucose, and LDL-C control, greater treatment adherence, enhanced lifestyle changes, and reduced six-month readmission rates versus those with traditional follow-up.

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents

Abstract Objective This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. Methods Parent–child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, “Making Mistakes”, consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. Results Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. Conclusions Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

The role of governance in the digital transformation of healthcare: Results of a survey in the WHO Europe Region

Optimal governance is among the key facilitators of the digital transformation of health systems intended to improve access to healthcare, quality, safety, and efficiency, and to attain universal health coverage. This paper highlights the findings of a survey assessing the status of governance of digital health in the WHO European Region.The 2022 survey is a continuation of the 2015 WHO Global Survey on eHealth. The survey focused on national digital health governance, monitoring and evaluation of digital health interventions, and funding and investment in digital health and was conducted through April to October 2022. All 53 Member States of the WHO European Region participated in the survey.The results showed that 83% of the Member States reported having a national digital health strategy in place, and 79% of the Member States reported having a health information system strategy. Most of the priorities of the national digital health strategies were devoted to increasing the accessibility, quality, safety, and efficiency of the health systems, strengthening health information systems, and improving information sharing and interoperability of data. Measures to ensure equity in access to digital healthcare services were directed towards improving broadband connectivity, information and communication technology, digital literacy, and digital health promotion. Oversight for the implementation and operation of the national digital health strategies are mostly delegated to government agencies. The prime source of funding for digital health programs was public funding, though a combination of funding sources was also noted. This analysis revealed increasing adoption of national digital health strategies for access to healthcare and creation of digital health agencies and funding programs for digital health.

Digital health program for patients with cancer to support self-management: A retrospective real-world analysis.

1570 Background: Sidekick Health’s 13-week digital health program was built to support cancer self-management. It was available free of charge to US-based cancer patients through commercial health insurance. The program includes disease education, mindfulness, medication adherence support, and asynchronous messaging with a care manager. We hypothesized that highly engaged users had reduced symptom frequency and severity, and improved quality of life (QoL) outcomes. Methods: In-app data were analyzed for registrations Aug 2021-Jan 2024: n(registered)=1286; n(retained ≥7 days)=795; n(QoL/symptoms)=284. QoL was defined as self-reported sleep quality, energy and stress (10-point scale, ≤4x/week). Symptoms were also self-reported (10-point scale, ≤7x/week). Generalized linear mixed models for repeated measures were used to investigate QoL, symptom frequency and severity changes over the program. Subgroup analysis: weekly iterative k-means clustering into highly- and less-engaged (based on total active days) to mitigate survival bias. Results: Diverse patients from 37 states engaged: mean age 58.0 years (SD=10.5), 71% female; 49% diagnosed &lt;6 months ago, 36% ≥12 months ago; 23% early-stage disease, 26% stable disease, 6% in remission and 2% terminal; 60% received chemotherapy, 24% radiation therapy, and 21% immunotherapy. Most (61%) registered users were active after 7 days and 29% after 90 days. Less-engaged users reported higher mean baseline weight (85.3kg (SD=26.7)) vs highly engaged (76.9kg (SD=18.3); p=0.010) but were otherwise similar (age, gender, height, time since diagnosis and treatment: p&gt;0.05). For QoL, highly engaged users had improved energy (p=0.013) and sleep (p=0.002), but not stress (p=0.164) vs less engaged. A significant time-group interaction for sleep (p&lt;0.001) showed highly engaged users had better sleep, and larger improvements over time vs less-engaged. Overall, users reported fewer symptoms over the program (IRR (95% CI)=0.965 (0.953, 0.978), p&lt;0.001). Symptom frequency decreased significantly for stress (p=0.034) and nausea (p=0.003), but not numbness (p=0.320) or fatigue (p=0.530). Highly engaged users’ symptom severity had a downward trajectory, compared with less-engaged, for fatigue (p=0.044) and nausea (p=0.001), but not stress (p=0.234) or numbness (p=0.680). Conclusions: Theprogram was accessed by a broad patient group and retention was high. Highly engaged users reported improved QoL (energy, sleep) and reduced symptom severity (fatigue, nausea). Total symptom frequency was reduced over the program, as well as for stress and nausea specifically. These findings indicate digital self-management is not only achievable for patients with cancer, but that higher engagement may improve patient-reported outcomes.

Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial.

Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86).There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. RR2-10.1186/s13063-016-1511-1.

Digital patient care program following successful ablation or cardioversion of patients with atrial fibrillation

Abstract Background The current ESC guidelines on atrial fibrillation recommend the assessment of disease burden and the rigorous management of cardiovascular risk factors. A digital patient care program (Digital Health Program Atrial Fibrillation) was offered to patients following pulmonary vein isolation or cardioversion in cooperation with a major German statutory health insurer and a leading cardiology clinic. The 12 month program consists of the following functions: (1) self-recording of 1-channel-ECGs by patients with the possibility to receive short-term assessment by a teledoctor; (2) Patient education on health literacy, management of risk factors and lifestyle optimization via an App; (3) Monitoring of blood pressure and body weight; (4) Medication management via the App; und (5) videoconsultations on demand. When needed, medication was optimized by the teledoctors, or patients were referred to their family practice or cardiologists. Results an interim analysis of 72 patients that have participated in the first 6 months of the program showed: 1.) Over 20,000 ECGs were written, or a mean of approx. 1.5 ECGs/patient/day. Based on the teledoctor assessment of the ECGs and the videoconsultation over the platform recurring atrial fibrillation could be detected early and with high reliability, and patients could be advised. 2.) Figure A.: In patients with known, but insufficiently controlled arterial blood pressure at baseline (systolic blood pressure &amp;gt; 130 mmHg), blood pressure was reduced by 7.2 ±7.8 mmHg (mean ± std); n = 20. 3.) Figure B.: In obese patients at baseline (BMI ≥ 30) the body weight was reduced by 3.03 ±4.71 KG (mean ± std); n = 26. Summary: The combination self-recorded ECGs with high adherence, the feedback by the App and the possibility to book a short-term teledoctor appointment made it possible to perform quick and reliable assessment and give concrete recommendations to the patient. Furthermore, the accompanying education program led to reduced blood pressure and body weight. This systematic analysis of a real world digital patient care program indicates that the program is feasible and effective. These results need to be confirmed in a controlled study.Figure 1

Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study.

Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults.

Predictors for interest to participate in digital mental health therapy: a cross-sectional survey of individuals with anxiety and depression

BackgroundDue to a multitude of factors, the onset of the COVID-19 pandemic resulted in a significant increase in mental health issues within society, including depression and anxiety. Due to the increased trend of mental health disorders in society, digital mental health therapies are more useful than ever. With the emergence of programs utilizing Internet Cognitive Behavioral Therapy (iCBT), mental health resources are easily accessible and can be widely implemented to those in need.The aim of this study was to identify predictors for interest to participate in SilverCloud digital mental health therapy among individuals with mild to severe anxiety and/or depression based on preliminary findings from the COVIDsmart study.MethodsCOVIDSmart participants who had moderate to severe anxiety and/or depression based on the PHQ-9 and GAD-7 scores, and who consented to be contacted for future studies, were invited to complete a needs assessment survey via Research Electronic Data Capture (REDCap). This assessment used self-reported measures including medical diagnoses, mental health services received, reasons for anxiety and/or depression, the use of coping strategies, suicidal ideology using the Ask Suicide Questions tool, and whether they would be interested in receiving free digital mental therapy. Descriptive statistics were used to report participants’ demographics and a logistic regression was used to find predictors for interest in participation in SilverCloud. SAS 9.4 was used and p values < 0.05 were considered significant.ResultsOut of the original 782 COVIDsmart participants, 634 consented to be contacted for future studies, 280 were subsequently invited to complete the SilverCloud needs assessment, and 120 individuals completed it. The largest demographic among these participants were females (70.83%) who identified as White (80.83%). The mean age was 48.74 years (SD = 14.66). Results revealed that having a mental health comorbidity significantly predicted the likelihood of interest in participating in the SilverCloud digital mental health program (p = 0.027).ConclusionsIn this study, mental illness comorbidities predicted the interest to participate in digital mental therapy. Fragmented healthcare and perceptions of unmet care needs are likely contributor factors. Further research with a diverse sample of participants is necessary for generalizability. Findings may have important implications for healthcare best practices.