Digital Health Research Articles

Implementing sensor-based digital health technologies in clinical trials: Key considerations from the eCOA Consortium.

The increased use of sensor-based digital health technologies (DHTs) in clinical trials brought to light concerns about implementation practices that might introduce burden on trial participants, resulting in suboptimal compliance and become an additional complicating factor in clinical trial conduct. These concerns may contribute to the lower-than-anticipated uptake of DHT deployment and data use for regulatory decision-making, despite well-articulated benefits. The Electronic Clinical Outcome Assessment (eCOA) Consortium gathered collective experience on deploying sensor-based DHTs and supplemented this with relevant literature focusing on mechanisms that may enhance participant compliance. The process for DHT implementation starts with identifying a clinical concept of interest followed by a digital measure selection, defining active or passive data capture and their sources, the number of sensors with respective body location, plus the duration and frequency of use in the context of perceived participant burden. Roundtable discussions among patient groups, physicians, and technology providers prior to protocol development can be very impactful for optimizing trial design. While diversity and inclusion are essential for any clinical trial, patient populations should be considered carefully in the context of trial-specific aims, requirements, and anticipated patient burden. Minimizing site burden includes assessment of training, research engagement, and logistical burden which needs to be triaged differently for early and late-stage clinical trials. Additional considerations include sharing trial results with study participants and leveraging publicly available data for compliance modeling. To the best of our knowledge, this report provides holistic considerations for sensor-based DHT implementation that may optimize participant compliance.

The Surge in Human Papillomavirus Vaccine Rejection in Nigeria.

In October 2023, Nigeria integrated the single-dose human papillomavirus (HPV) vaccine into its routine immunization program, aiming to protect 7.7 million girls aged 9 to 14 years. This milestone in the fight against HPV-related cancers, especially cervical cancer, faces significant challenges due to high vaccine rejection rates driven by misinformation and cultural barriers. Despite the vaccine's proven safety and efficacy, uptake remains low. This communication highlights the urgent need for a comprehensive public health education campaign to address these barriers. Proposed strategies include leveraging digital health technologies, integrating HPV education into school curricula, training community health workers, engaging religious and cultural leaders, and launching media campaigns featuring personal narratives. Implementing these evidence-based interventions is crucial for dispelling myths, misconceptions, and skepticism surrounding HPV vaccines. This will enhance acceptance and uptake, ultimately reducing cervical cancer mortality in Nigeria.

Step Length and Gait Speed Estimation Using a Hearing Aid Integrated Accelerometer: A Comparison of Different Algorithms.

Gait is an indicator of a person's health status and abnormal gait patterns are associated with a higher risk of falls, dementia, and mental health disorders. Wearable sensors facilitate long-term assessment of walking in the user's home environment. Earables, wearable sensors that are worn at the ear, are gaining popularity for digital health assessments because they are unobtrusive and can easily be integrated into the user's daily routine, for example, in hearing aids. A comprehensive gait analysis pipeline for an ear-worn accelerometer that includes spatial-temporal parameters is currently not existing. Therefore, we propose and compare three algorithmic approaches to estimate step length and gait speed based on ear-worn accelerometer data: a biomechanical model, feature-based machine learning (ML) models, and a convolutional neural network. We evaluated their performance on a step and walking bout level and compared it with an optical motion capture system. The feature-based ML model achieved the best performance with a precision of 4.8cm on a walking bout level. For gait speed, the machine learning approach achieved an absolute percentage error of 5.4 % ( ± 4.0 %). We find that the ML model is able to estimate step length and gait speed with clinically relevant precision. Furthermore, the model is insensitive to different age groups and sampling rates but sensitive to walking speed. To our knowledge, this work is the first contribution to estimating step length and gait speed using ear-worn accelerometers. Moreover, it lays the foundation for a comprehensive gait analysis framework for ear-worn sensors enabling continuous and long-term monitoring at home.

Impact of virtual consultations on quality of care in type 2 diabetes: a systematic review and narrative synthesis protocol.

Around 463 million people globally have diabetes, of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (ie, patient-centeredness, effectiveness, efficiency, timeliness, equity and safety). PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), COCHRANE Library, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration's tool will be used to assess the quality of the randomised studies, and the Risk of Bias in Non-Randomised Studies of Interventions will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 15 November 2023 (registration number: CRD42023474219). This review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.

Protocol for a pilot study: Feasibility of a web-based platform to improve nutrition, mindfulness, and physical function in people living with Post COVID-19 condition (BLEND)

Individuals with Post COVID-19 condition (PCC), or long COVID, experience symptoms such as fatigue, muscle weakness, and psychological distress, including anxiety, depression, or sleep disorders that persist after recovery from COVID-19. These ongoing symptoms significantly compromise quality of life and diminish functional capacity and independence. Multimodal digital interventions targeting behavioural factors such as nutrition and mindfulness have shown promise in improving health outcomes of people with chronic health conditions and may be beneficial for those with PCC. The BLEND study (weB-based pLatform to improve nutrition, mindfulnEss, and physical function, in patients with loNg COVID) study is an 8-week pilot randomized controlled trial evaluating the feasibility of a digital wellness platform compared to usual care among individuals with PCC. The web-based wellness platform employed in this study, My Viva Plan (MVP)®, integrates a holistic, multicomponent approach to promote wellness. The intervention group receives access to the digital health platform for 8 weeks with encouragement for frequent interactions to improve dietary intake and mindfulness. The control group receives general content focusing on improvements in dietary intake and mindfulness. Assessments are conducted at baseline and week 8. The primary outcome is the feasibility of platform use. Secondary and exploratory outcomes include a between-group comparison of changes in body composition, nutritional status, quality of life, mindfulness, physical activity, and physical performance after 8 weeks. Findings of this study will inform the development of effective web-based wellness programs tailored for individuals with PCC to promote sustainable behavioural changes and improved health outcomes.

Partnering With Nurse Inventors and Entrepreneurs: A Guide for Nursing Professional Development Leaders.

Health care innovation and entrepreneurship are key drivers of transformation in health care, re-shaping the way care is delivered, managed, and experienced. Innovation in health care spans a range of areas, including digital health, bio-technology, medical devices, tele-health, and health information systems. Entrepreneurs are leveraging technology to create solutions to improve patient outcomes, reduce costs, and address inefficiencies. Nurse inventors and entrepreneurs are blazing new trails that require nursing professional development leaders to consider new opportunities for collaboration. For nursing professional development leaders, fostering relationships with nurse entrepreneurs can unlock numerous benefits, from improving patient safety to enhancing nursing practice and facilitating advisory board appointments. [J Contin Educ Nurs. 2024;55(11):517-519.].

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.

Factors influencing digital health literacy among older adults: a scoping review

Factors influencing digital health literacy among older adults: a scoping review

Transforming the Future of Digital Health Education: Redesign of a Graduate Program Using Competency Mapping.

Digital transformation has disrupted many industries but is yet to revolutionize health care. Educational programs must be aligned with the reality that goes beyond developing individuals in their own professions, professionals wishing to make an impact in digital health will need a multidisciplinary understanding of how business models, organizational processes, stakeholder relationships, and workforce dynamics across the health care ecosystem may be disrupted by digital health technology. This paper describes the redesign of an existing postgraduate program, ensuring that core digital health content is relevant, pedagogically sound, and evidence-based, and that the program provides learning and practical application of concepts of the digital transformation of health. Existing subjects were mapped to the American Medical Informatics Association Clinical Informatics Core Competencies, followed by consultation with leadership to further identify gaps or opportunities to revise the course structure. New additions of core and elective subjects were proposed to align with the competencies. Suitable electives were chosen based on stakeholder feedback and a review of subjects in fields relevant to digital transformation of health. The program was revised with a new title, course overview, course intended learning outcomes, reorganizing of core subjects, and approval of new electives, adding to a suite of professional development offerings and forming a structured pathway to further qualification. Programs in digital health must move beyond purely informatics-based competencies toward enabling transformational change. Postgraduate program development in this field is possible within a short time frame with the use of established competency frameworks and expert and student consultation.

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

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

BackgroundYouth 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.MethodsTo 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.ResultsEleven 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.ConclusionKey policy, training and practice implications are discussed.

Health Literacy in Africa—A Scoping Review of Scientific Publications

Africa’s health landscape is rapidly changing, requiring new solutions such as a focus on health literacy. However, there is currently a limited overview of the development and application of health literacy in African countries and societies. This scoping review aims to analyze scientific publications on health literacy in Africa with regards to research approaches, historical developments, geographic origins, target populations and settings, and topical interests. The research followed Arksey and O’Malley six steps of scoping reviews and employed the Joanna Briggs Institute’s PCC method for search string formulation and the PRISMA-SCR checklist for reporting. On 11 July 2022, the following six databases were searched for scientific articles including included reports, policy briefs, book chapters, and research publications: PubMed, PsycINFO, Cochrane Library, ERIC, African Journals Online, and African Index Medicus. A total of 336 articles were identified. The research team co-developed a codebook and three researchers independently extracted data. The analysis provided the most comprehensive overview of the current scope and scale of health literacy in Africa to date. The publications represented 37 of the 54 African Union countries and dated back to 2001, although most were published in the last decade. The content analysis identified 13 broad themes, including mental health, communicable diseases, non-communicable diseases, maternal health, digital health, information and communication, health care, prevention and health promotion, conceptual perspectives, cultural perspectives, and outcomes and measurement. The analysis of target groups revealed a wide range of actors involved in different settings, mostly in health care or community settings. These comprehensive and novel findings can be used to prioritize future actions for public and professional capacity building, policy development, and improved practice to improve health literacy for all in Africa.

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

An analysis of virtual triage utilization by pregnant women prior to and during the COVID-19 pandemic

ObjectiveThis analysis describes the use patterns of web-based virtual triage (VT) by pregnant patients before and during the first two years of the COVID-19 pandemic, and how the pandemic influenced frequency of VT use, nature of symptoms reported, and the associated implications for maternal healthcare delivery.MethodsAn online survey of 36,910 patients who reported pregnancy was completed between January 1, 2019 and June 30, 2022. The data were segmented into six month periods to allow comparative analyses of usage frequency and changes in initial complaints over the study period, with particular emphasis on the early months of the COVID-19 pandemic. Descriptive statistics and trend analyses were used to identify significant shifts in symptom reporting and user demographics.ResultsA marked increase in the utilization of VT by pregnant women during the pandemic occurred. The percentage of pregnant users grew from 0.32% in the first half of 2019 to 0.85% in late 2021, with the greatest rise (213%) in the first six months of 2020. The most common symptoms reported were abdominal pain, headache, nausea, back pain, fatigue and cough. Pre-pandemic, VT use focused on prospective mothers learning about the potential causes of typical symptoms occurring during pregnancy, but during the pandemic there was a substantial increase in reporting symptoms associated with acute respiratory infections such as cough, nasal congestion, and dyspnea.ConclusionsThe COVID-19 pandemic significantly influenced the use of VT by pregnant women, with a shift towards addressing concerns related to respiratory symptoms and potential COVID-19 exposure. These findings underline the significant role of digital health tools in maintaining access to health information during times of crisis and highlight the evolving needs of pregnant patients in such settings.

Evaluating the Effectiveness of “I LIKE VST” Digital Technology in Enhancing Tuberculosis Treatment Adherence in Moldova

This study assessed the acceptance and feasibility of the implementation of Video Supported Treatment (VST) “I LIKE VST” digital application as an approach to increase tuberculosis (TB) treatment adherence in the Republic of Moldova. It employed mixed quantitative and qualitative method among TB patients and healthcare providers. The analysis encompasses socio-demographic factors, adherence levels, technological accessibility, and user experiences with the VST app. Results indicate that VST app method is acceptable and feasible to implement for people who find it convenient, regardless of their level of education. Adherence data from the I LIKE VST system shows that 75% of participants have over 90% adherence rate, due to VST app’s digital nature offering convenience and flexibility. No cases of less than 50% adherence were found. Challenges include technological, financial barriers and the need for patient-centric customization. Less than 2% of TB patients have their own phones which support the app work. Moreover, 13.3% of TB patients and 19.7% medical staff stated that they did not have own resources to cover mobile internet costs, until they were covered by the project. This study demonstrates the effectiveness of digital health interventions in resource-limited settings. The findings are particularly relevant for policymakers and health practitioners aiming to innovate TB treatment adherence strategies.

How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars.

The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. This study examined scholars' conceptualization and scope of work focused on HL and DHL. Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators' research. A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues.

Validity And Reliability Of Digital Health Education On Diabetic Foot Care Based On Health Belief Model Among Type Ii Diabetic Patients

The study aims to evaluate the effectiveness of digital health education on diabetic foot care among type II diabetic patients using the Health Belief Model (HBM). A total of 30 participants were recruited from local diabetes clinics to receive digital health education focused on diabetic foot care practices. To ensure the validity and reliability of the assessment tools, we employed multiple methods. Content validity was established through expert reviews, while construct validity was examined using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), which confirmed a good factor structure aligned with the HBM constructs. Reliability was assessed using Cronbach’s alpha for internal consistency, which showed acceptable values ranging from 0.67 to 0.84, and test-retest reliability with Intraclass Correlation Coefficients (ICC) ranging from 0.74 to 0.78. The results indicate that the digital health education program significantly improved the participants' understanding and practices related to diabetic foot care. These findings underscore the potential of digital education interventions for chronic disease management, particularly for enhancing self-care behaviors in diabetic patients. Future studies should consider larger sample sizes to further validate these tools and results. Overall, this study provides evidence supporting the effectiveness of digital health education for diabetic foot care and validates the reliability and validity of the instruments used.

Education of the "SusCatinTing" application on changes in knowledge, attitudes, and behavior of brides-to-be

The "SusCatinTing" application is a digital health intervention designed to enhance the knowledge, attitudes, and practices (KAP) of brides-to-be regarding stunting prevention during the critical first 1000 days of life. This study aimed to evaluate the effectiveness of this application in improving stunting prevention efforts among brides-to-be in Bengkulu Province, Indonesia. The application provides educational content on healthy pregnancy, maternal nutrition, and stunting prevention strategies, incorporating both text and audio explanations to ensure accessibility for illiterate and visually impaired users. A quantitative research design was employed, utilizing a single-group pretest-posttest approach involving 50 pairs of brides-to-be with internet-connected Android smartphones. Data collection was conducted through structured questionnaires administered by trained enumerators, focusing on KAP related to stunting prevention. The results indicated a significant improvement in KAP scores post-intervention (knowledge score increase: 42.59, p < 0.001). The application’s unique features, including interactive quizzes and a certification process for marriage registration at the Office of Religious Affairs, contributed to its effectiveness. The study concludes that the "SusCatinTing" application is a promising tool for enhancing health education and promoting preventive behaviors among brides-to-be. Further research is recommended to explore the long-term impact of such digital interventions on stunting rates and maternal-child health outcomes.

Transforming Telehealth with GenAI: Personalized Care Solutions for the Digital Health

Transforming Telehealth with GenAI: Personalized Care Solutions for the Digital Health

2SpamH: A Two-Stage Pre-Processing Algorithm for Passively Sensed mHealth Data

Recent advancements in mobile health (mHealth) technology and the ubiquity of wearable devices and smartphones have expanded a market for digital health and have emerged as innovative tools for data collection on individualized behavior. Heterogeneous levels of device usage across users and across days within a single user may result in different degrees of underestimation in passive sensing data, subsequently introducing biases if analyzed without addressing this issue. In this work, we propose an unsupervised 2-Stage Pre-processing Algorithm for Passively Sensed mHealth Data (2SpamH) algorithm that uses device usage variables to infer the quality of passive sensing data from mobile devices. This article provides a series of simulation studies to show the utility of the proposed algorithm compared to existing methods. Application to a real clinical dataset is also illustrated.