Digital Health Services Research Articles

Exploring university staff experiences gained during COVID-19 in the provision of digital mental health services through e-health tools: A case of a selected South African University

The recent COVID-19 pandemic significantly exacerbated mental health issues worldwide, with South African university staff facing unique stressors that led to the adoption of e-health tools for digital mental health services. This study explores the university staff experiences gained during COVID-19 pandemic in the provision of digital mental health services through e-health tools. We conducted a case study at a public university in Cape Town, South Africa complemented by a survey using quantitative methods. Data from 348 respondents were collected via voluntary response sampling and analysed with Statistical Software Package for Social Sciences (SPSS) version 28, employing exploratory factor analysis. High factor loadings above 0.4 confirmed significant contributions from seven items: perceived usefulness of e-health tools, perceived usefulness of social media, user experience and satisfaction, university commitment, variety of digital mental health services, post-COVID-19 delivery mode preference and ethical considerations. These seven items revealed that during COVID-19, e-health tools provided significant benefits to university staff including increased access to digital mental services. However, the study findings revealed that university staff were concerned about the lack of a legal framework during COVID-19, and the role of AI-powered mental health applications did not significantly influence their experiences during the pandemic. Our study provides theoretical insights into the effectiveness and perceived usefulness of e-health tools for digital mental health services during COVID-19, reinforcing their significance in reducing anxiety, stress, and depression while enhancing emotional resilience. Practically, our study findings suggest that universities should integrate e-health tools into the provision of digital mental health services given that these tools proved effective during COVID-19.

Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study

Background The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time. Objective This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes–mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19–related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations.

Elderly Perceptions and Barriers in Accessing Digital Health Services: A Case Study in Tanjung Jaya Village, Panimbang District

Elderly Perceptions and Barriers in Accessing Digital Health Services: A Case Study in Tanjung Jaya Village, Panimbang District

The Shift to Online Psychotherapy: Adaptation and Implications for Brazilian Clinical Psychologists Amid Covid-19

The Covid-19 pandemic disrupted traditional psychotherapy practices, prompting a rapid transition to online modalities. This qualitative study investigates how Brazilian clinical psychologists adapted to online psychotherapy during and after the pandemic. Semi-structured interviews were conducted with five psychologists, each with an average professional experience of 8.9 years. Using the Iramuteq software for lexical analysis, six thematic classes were identified: uncertainties during the transition, emerging possibilities, adaptability movements, pandemic context, new professional perspectives, and academic and professional trajectories. The findings highlight significant challenges, including managing technological tools, maintaining therapeutic relationships, and addressing client concerns in virtual settings. However, the transition also revealed notable advantages, such as reduced operational costs, enhanced flexibility, and expanded access to psychological care. The analysis underscores the critical role of digital competencies, including technical, communicational, and cultural skills, in ensuring effective online therapy. Additionally, the results point to gaps in academic training and professional preparation for telepsychology, emphasizing the need for curriculum reform to include digital literacy and teletherapy-specific strategies. The study concludes that online psychotherapy represents not only a response to crisis but also a sustainable model for expanding access to mental health care. It calls for targeted professional development and ethical guidelines to support psychologists in navigating digital environments effectively. These insights contribute to understanding the evolving dynamics of psychotherapy and provide actionable recommendations for improving digital mental health services in Brazil and beyond.

EHealth Literacy and Gender Disparities: Insights from an Internal Survey

The increasing reliance on digital health services, particularly in light of recent global health crises, has highlighted the importance of eHealth literacy. This study explores the role of eHealth literacy in managing health outcomes, with a specific focus on gender disparities. Using data from the “Truck Tour-Banca del Cuore 2023” survey, which included 354 participants, we examined how integrated technology influences health monitoring and management strategies. Our findings underscore the critical role of eHealth literacy in improving health outcomes and reducing gender disparities, particularly in the context of digital health interventions.

Digital health literacy in Norwegian patients with hip and knee arthroplasty: normative data from a cross-sectional study.

As digital health services become increasingly important in osteoarthritis treatment, understanding patients' digital health literacy (eHL) is crucial, including those undergoing total hip and knee arthroplasty (THA/TKA). We primarily aimed to provide eHL norms in a representative group of Norwegian patients, and secondarily to examine the relationships between eHL and health-related quality of life (QoL). We invited 800 randomly selected THA/TKA patients from the Norwegian Arthroplasty Register to complete a paper-based questionnaire, which included sociodemographic variables. eHL was measured using the eHealth Literacy Questionnaire (eHLQ) with 7 domains: Using technology, Understand, Engage, Control, Motivation, Access, and Needs, scored from 1 (strongly disagree) to 4 (strongly agree). The EuroQol EQ-5D-5L measured health-related QoL. We used multivariable regression to examine relationships between eHL domains and health-related QoL controlling for sociodemographic variables. Respondents' (N = 383, 48%) mean age was 70 years (SD 9.0) and 246 (64%) were female. Mean eHLQ and the proportion of patients with low eHL (≤ 2.5) were Technology 2.7 (34%), Understanding 3.0 (14%), Engage 2.7 (28%), Control 3.2 (7.7%), Motivation 2.8 (35%), Access 2.8 (33%), and Needs 2.6 (46%). Low eHL correlated with older age and low education, but not with sex or type of surgery. Regression analyses showed that lower scores on the domains Technology, Engage, Control, Access, and Needs were associated with poorer QoL after adjusting for sociodemographic factors. About one-third of THA/TKA patients have low eHL, and low eHL was associated with poor QoL.

Contributions of Municipal Initiatives to Digital Health Equity

Sustainable initiatives play a crucial role in promoting digital health equity by addressing barriers to access and ensuring equitable use of digital health technologies and services. These initiatives may arise in various contexts, including local collaborative networks that emerge in the municipal context. This study aims to identify and characterize the municipal initiatives that have been developed in Portugal to promote digital health equity. It adopts a mixed methods approach to initially quantify the distribution of these projects in the Portuguese territory and, at a later stage, to understand the level of influence of these projects, considering their impact on individual, interpersonal, community, and societal levels. The findings identified 22 municipal sustainable initiatives and concluded that there is a strong relationship between the areas of community and individual influence. The results of this study are relevant to deepening the knowledge of bottom-up innovation in the digital health field and establishing public policies to increase the impact of these projects at the territorial level, the communities involved, and the social objectives addressed, contributing to greater social cohesion.

Ethical Considerations Regarding Digital Health Services in Home-Based Palliative Care

Historically, in-person contact between patients and nurses in home-based care has been pivotal in palliative care and hospice care. The provision of home-based palliative care services could be challenged by the projected increase in patients who need palliative care and by the expected shortage of nurses. Digital health services could constitute one measure for delivering high-quality palliative care, enabling patients to stay home. Nurses often follow up these patients remotely. Because digital health services are increasingly implemented in home-based palliative care, it is imperative that nurses consider the ethical concerns regarding such service delivery. Neglecting ethical concerns could result in unintended consequences for patients and nurses and inhibit care delivery. The aim of this article was to explore ethical concerns of digital health services in home-based palliative care through the lens of the 4 biomedical principles: autonomy, beneficence, nonmaleficence, and justice. This study utilized a bottom-up methodology conducting a subanalysis of the results of 2 previous reviews.

Nurse Practitioner and General Practitioner Error Rates in a Large Digital Health Service: A Retrospective Cohort Analysis.

Nurse practitioners have been prescribing medication within a narrow scope of practice throughout the world for several decades as a means of meeting rising demand for community health services. Prominent medical bodies have alleged that the Australian government's decision to remove the need for general practitioner collaboration in the context of a nurse practitioner prescribing medication compromises patient safety. This study aimed to determine whether nurse practitioner prescribing increases patient risk relative to general practitioner prescribing in a large digital health service. Investigators retrospectively analyzed prescription errors from all audited consults of the Eucalyptus Australia service over a 6 month period between 1 October 2023 and 31 March 2024. Of the 8359 consults, errors were observed in 911 (14.22%) of NP and 417 (21.37%) of general practitioner consults and this difference was found to be statistically significant, X2 (1, N = 8359), =57.33, p ≤ 0.001. No statistically significant difference was observed in the incidence of high-risk or never events between nurse practitioners and general practitioners. Most high-risk and never events pertained to medical contraindications, insufficient side-effect counselling, and the insufficient assessment of a patient's medical history. These findings suggest that nurse practitioners are capable of safely performing patient assessments and prescribing medications for a select range of conditions in digital health services.

Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study.

Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming "super users" of all resources.

Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island.

Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts.

Advanced Practice Nurse-Led Research: Challenges and Approaches to Digital Health Programs' Evaluation Using Big Data.

Advanced practice nurse leaders are in key positions within health systems to provide time and resources for implementation and evaluation of digital health services. As virtual monitoring programs become more embedded within nursing, nurse leaders and educators need to ensure that nurses are prepared to work within interprofessional teams to administer and evaluate them. This article discusses challenges and implementation strategy considerations for data curation and analysis using large datasets from the Medicaid population for research.

Centering equity, diversity, and inclusion in youth digital mental health: findings from a research, policy, and practice knowledge exchange workshop.

Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Key policy, training and practice implications are discussed.

University staff intentions to adopt e-health tools for digital mental health services in post-pandemic South Africa

University staff intentions to adopt e-health tools for digital mental health services in post-pandemic South Africa

Defining digital health literacy profiles in Spanish adults: a latent class analysis

Abstract Background According to different reports, Spain is among the European countries that use digital health technologies the most. However, to develop inclusive and fair digital health services, there is the need to feature digital health knowledge, skills, confidence, and a positive attitude about their significance. This work aims to draw a picture of digital health literacy levels in Spain. Methods A stratified sample of the Spanish population regarding gender, age group and area of residence was used. Participants were recruited from an online panel and by direct approach to balance quotas. Between May 2021- May 2022, participants filled a self-administered online survey, including the Spanish version of the eHealth Literacy Questionnaire (eHLQ) and the eHealth Literacy Scale (eHEALS). Results Digital health literacy showed similar mean scores, between 2.6-2.7 out of 5 with similar SD on each of the 7 dimensions of the eHLQ. The highest scores were related to knowledge about filling data in digital health services and knowledge about health and how the body works, and feelings about the usefulness of digital technology for health. In contrast, lower scores were related to sharing health information by technology, thinking that using technology gives access to better health services, and the possibility to contact usual health professionals with technology. Latent profile analysis identified 5 user profiles. Significant differences were found according to age, inhabitants per municipality, technology use, self-perceived health status, educational level, socioeconomic index and eHEALS scores; not by gender. Conclusions As the scores are similar in the different subscales, competencies, attitudes and confidence in digital health that they measure are balanced. However, the main challenge appears in granting users access to digital services that work, which involves the definition and monitoring of strategies until the final implementation. Key messages • Digital Health literacy in Spain differs according to different aspects, not only age, educational or socioeconomic level. • Confidence in usefulness is a common denominator among the five digital health service user profiles identified.

Adoption and Utilization of Telemedicine and Digital Health Services among Older Adults in Israel

Abstract Background As the population ages and the prevalence of long-term diseases rises, telecare is being used increasingly frequently to aid elderly people. Aims We aimed to explore the usage and adoption of 3 types of telehealth services among the senior population in Israel- prior, during, and after the COVID-19 pandemic rise in Israel. Methods We explored the usage characteristics of older adults (age 65 and above) belonging to ‘Clalit’, in the use of three types of telehealth services: digital services for administrative tasks, synchronous ‘online visits’ with the patient’s personal physician during clinic business hours, and ‘afterhours’ consultations during evenings, nights, and weekends. The data was collected and analyzed throughout three distinct time periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic and following the COVID-19 ‘peak’. Results Data of 618850 patients who met the inclusion criteria was extracted. Telehealth services utilized for administrative purposes were the most popular. The older population significantly increased their use of all types of telehealth services during the COVID-19 period, and in the majority of types, this usage decreased after the COVID-19 peak, but to a level that was higher than the baseline level prior to the COVID-19 period. Prior to the COVID-19 period, 23.1% of the study population used ‘online visits’, and 2.2% used ‘afterhours’ consultations, at least once. The percentage of usage for these services increased during the COVID-19 period to 59.2% and 5.0%, and then decreased during the third period to 39.5% and 2.4%, respectively (P &amp;lt; 0.001). Multiple patient variables have been found to be associated with the use of the different telehealth services, in each time-period. Conclusions The senior population uses telehealth services, and can increase their consumption, when they are needed. Suitable and straightforward telehealth solutions tailored for this population should be created. Key messages • The senior population uses telehealth services, and can increase their consumption, when they are needed. • Suitable and straightforward telehealth solutions tailored for this population should be created.

Video consultations among registered nurses in public sector and associated factors

Abstract Background In digital health services, including services for older people, video consultations can enhance access to care while enabling interaction through audio and visual means. Registered nurses are pivotal in digital care delivery and there is a need for more understanding regarding the use of video consultations in nursing. This study aims to examine factors associated with nurses’ video consultations in the public sector. Methods The Finnish ‘Survey on information systems for registered nurses’ was delivered for registered nurses in March 2023. The respondents were asked whether their work had included video consultations in the past six months. Binary logistic regression was used to examine if career stage and digital skills (basic IT-skills, proficiency in data security, skills in digital working environments) were associated with nurses’ video consultations, adjusted for working unit and location of employment. Results The study included 2,525 public sector nurses (92.7% female, mean age 47.34, SD 10.47). Of them, twelve percent had used video consultations with patients. Most nurses used video consultations in outpatient units (63.3%), whereas they were less used among those working in acute care (3.3%), housing services (3.3%) and home-based services (8.2%). Early-career nurses had lower odds (OR .38, 95% CI .19-.73) of video consultations compared to mid-career nurses. Nurses who had good skills in working in digital environments (OR 2.07, 95% CI 1.26-3.39) had greater odds of video consultations than those with poorer skills. Conclusions The study suggests a limited adoption of video consultations among public sector nurses, particularly among early-career professionals. Increasing targeted support and training, and the availability of tools for various patient service needs in video consultations, are needed. By recognizing the importance of nurses’ digital skills, digital care delivery could be enhanced and potential public health benefits promoted. Key messages • Relatively few registered nurses used video consultations in the public sector. More research is needed to explore if their usage could be increased safely for patients, also in early nursing careers. • Proficiency in digital work environments is imperative for ensuring the quality of care in video consultations. Therefore, collaborative efforts are required to enhance professionals’ digital skills.

Enhance physical, mental and academic wellbeing of pupils in Germany through digital health literacy

Abstract Background Digital health literacy (DHL) involves the ability to find, understand, appraise, and apply health information from digital sources. It serves as the foundation for informed decision-making about one’s health and well-being using digital technology and online health information sources and services. Despite its significance, the role of DHL in relation to schoolchildren’s wellbeing remains underexplored. Therefore, this study aims to investigate how schoolchildren’s DHL influences their physical, mental, and academic well-being. Methods The cross-sectional survey comprised a representative sample of N = 1448 school-aged children (9-18 years) living in Germany. DHL was assessed via a translated and adapted version of the DHL instrument. The assessment of physical, mental, and academic well-being relied on the KINDL questionnaire. Linear regression analyses were conducted, with the scale score of physical, mental, and academic well-being serving as dependent variables and DHL as predictor. Additionally, potential confounding variables such as sex, age, migration background, subjective family wealth, chronic illness, and subjective health status were included in the analyses. Results All three regression models were significant (physical: F(9,1325) = 34.99, p &amp;lt; .001; R2 = 0.19; mental: F(9,1320) = 27.43, p &amp;lt; .001; R2 = 0.16; academic: F(9,1336) = 15.19, p &amp;lt; .001; R2 = 0.09). DHL significantly predicted physical (B=.08, p=.01), mental (B=.17, p&amp;lt;.001), and academic (B=.21, p&amp;lt;.001) wellbeing. Conclusions This study provides the first evidence of the predictive power of DHL for schoolchildren’s physical, mental, and academic well-being. It emphasizes the importance of promoting DHL in schoolchildren to empower them to find, understand, appraise, and apply digital health information effectively. Key messages • Digital health literacy significantly predicts schoolchildren’s physical, mental, and academic well-being. • Promoting digital health literacy can empower schoolchildren to make informed decisions about their well-being.

Digital health divide in Indonesia: evidence from national-level data

Abstract Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).

Ecommerce and Public Health: Managing the Digital Transformation of Healthcare Services

The study investigates the impact of demographic factors, usage frequency, and professional roles on user satisfaction with digital health platforms. A sample of 300 participants, including healthcare professionals, platform operators, and patients, was analyzed to assess the role of age, gender, professional role, and frequency of platform use on satisfaction levels. The results show that the gender did not significantly influence satisfaction, suggesting that platforms may cater equally to both male and female users. Multivariate Analysis of Variance (MANOVA) revealed that professional role also significantly influenced perceptions of digital healthcare transformation and willingness to adopt new services, with platform operators displaying the most positive views. Patients, however, showed more reluctance to adopt new services, suggesting that additional trust-building measures are needed for wider adoption. The study concludes that digital health platforms must prioritize user experience across demographics, particularly focusing on older users and patients, to increase satisfaction and engagement. Collaborating with healthcare professionals in platform development and enhancing communication about the benefits of digital health services can drive greater adoption and satisfaction.