Digital Health Research Articles

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

Background 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. Objective 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. Methods 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. Results 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). Conclusions 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.

Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study

Background Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults’ use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity.

Beyond Hemoglobin A1c—Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study

Background Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. Objective This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. Methods A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. Results An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking “beyond A1c” toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre– and post–COVID-19 perspectives on virtual care. Conclusions Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

Non-Participation in a Digital Health Intervention Study Among Older Adults: Uneven Involvement, Biased Outcomes and the Effect of Weighting.

The involvement of older adults in research on digital health is uneven with respect to e.g. age, gender, health status, and digital skills. However, little is known regarding the impact of the uneven involvement of older adults in digital health research on researched outcomes. This study helps to fill this knowledge gap and identifies the effects of uneven involvement of older adults in digital health research on researched outcomes, and also develops a correction for this. Data are retrieved from a digital health intervention for postoperative monitoring of people who underwent day surgery in Sweden. Based on field information on the recruitment process and researched outcomes for the intervention, this study (1) tested intervention effects by using two standard unweighted procedures in a sample of 281 individuals aged 50 years or older, and then (2) used the information on participants, non-participants and their respective probabilities to be involved in the intervention study to perform a weighting of the intervention effects for each step of selection and for the study group membership. The intervention effects were found to be overestimated due to overrepresentation of groups which gained from receiving the intervention. No intervention effects were found after adjustment for participation bias. Selective participation of older adults in digital health research biases research outcomes and can lead to overestimation of intervention effects. Weighting allows researchers to correct and describe the impact of selective participation on researched outcomes.

A Narrative Review of the Digital Equity Gap of Apps for Cigarette Smoking Cessation for Persons Living in the Hispanosphere

Abstract Purpose of Review The Hispanosphere is a vast region of the world that has received little attention in the digital health literature. No study to date has examined the availability and quality of publicly available mobile applications (apps) for cigarette smoking cessation in this region. Three coders utilized the American Psychiatry Association (APA)’s Brief App Evaluation Model Screener (Brief-AEM Screener) to evaluate the quality of the label and public-facing screens of smoking cessation apps in Spanish. Availability of apps in the Hispanosphere was compared to availability of apps in the Anglosphere. Recent Findings We identified and reviewed 19 apps in Spanish in Google Play. The median score using the Brief-AEM Screener was 63 out of 100 suggesting generally acceptable app quality and features according to the quality standards for digital health tools proposed by the APA. However, we found (1) notable inaccurate and misleading labelling claims, (2) poor grammar or incomplete translations, and (3) a lack of cultural and linguistic adaptation to countries in the Hispanosphere. Our comparison of smoking cessation apps between the Hispanosphere and the Anglosphere suggested that there is a large digital equity gap between these two regions, with a four to sevenfold gap in app availability. Summary There is a relative shortage of quality and quantity of digital health apps for smoking cessation in the Hispanosphere. To ensure the cultural appropriateness of those digital interventions, it is essential that developers of digital health tools establish community partners in the region prior to developing apps for smoking cessation.

Adoption and perception of prescribable digital health applications (DiGA) and the advancing digitalization among German internal medicine physicians: a cross-sectional survey study.

Therapeutic digital health applications (DiGAs) are expected to significantly enhance access to evidence-based care. Since 2020, German physicians and psychotherapists have been able to prescribe approved DiGAs, which are reimbursed by statutory health insurance. This study investigates the usage, knowledge and perception of DiGAs as well as the growing digitalization among internal medicine physicians in Germany. A web-based survey was distributed at the 2024 annual congress of the German Society for Internal Medicine. Participants could respond by scanning a QR code or directly on a tablet. A total of 100 physicians completed the survey, with a mean age of 43.4 years. The majority were internal medicine physicians (85%). Of the respondents, 31% had already prescribed DiGAs, and 29% had tested one. Self-rated knowledge of DiGAs was low (median score 3.17/10). The main barriers identified were lack of knowledge about effective implementation (60%), lack of time for patient onboarding (27%), and concerns about patient adherence (21%). However, 92% believed that DiGAs could improve care, and 88% expressed interest in specific digital health training. The majority (64%) stated that digitalization had a positive impact on medical care and 39% of physicians expected their daily workload to decrease due to digitalization. In addition, 38% believed that the physician-patient relationship would improve as a result of digitalization. While physicians widely acknowledged the potential benefits of DiGAs, adoption and understanding remain limited. Specific training in digital health is crucial to accelerate digitalization in internal medicine.

Attitudes of Health Professionals Toward Digital Health Data Security in Northwest Ethiopia: Cross-Sectional Study.

Digital health is a new health field initiative. Health professionals require security in digital places because cybercriminals target health care professionals. Therefore, millions of medical records have been breached for money. Regarding digital security, there is a gap in studies in limited-resource countries. Therefore, surveying health professionals' attitudes toward digital health data security has a significant purpose for interventions. This study aimed to assess the attitudes of health professionals toward digital health data security and their associated factors in a resource-limited country. A cross-sectional study was conducted to measure health professionals' attitudes toward digital health data security. The sample size was calculated using a single population. A pretest was conducted to measure consistency. Binary logistic regression was used to identify associated factors. For multivariable logistic analysis, a P value ≤.20 was selected using Stata software (version 16; StataCorp LP). Of the total sample, 95% (402/423) of health professionals participated in the study. Of all participants, 63.2% (254/402) were male, and the mean age of the respondents was 34.5 (SD 5.87) years. The proportion of health professionals who had a favorable attitude toward digital health data security at specialized teaching hospitals was 60.9% (95% CI 56.0%-65.6%). Educational status (adjusted odds ratio [AOR] 3.292, 95% CI 1.16-9.34), basic computer skills (AOR 1.807, 95% CI 1.11-2.938), knowledge (AOR 3.238, 95% CI 2.0-5.218), and perceived usefulness (AOR 1.965, 95% CI 1.063-3.632) were factors associated with attitudes toward digital health data security. This study aimed to assess health professionals' attitudes toward digital health data security. Interventions on educational status, basic computer skills, knowledge, and perceived usefulness are important for improving health professionals' attitudes. Improving the attitudes of health professionals related to digital data security is necessary for digitalization in the health care arena.

Nephrology Services in Telangana

Telangana has well-developed state-of-art nephrology services. The state boasts of a unique hub-and-spoke model of hemodialysis and an active deceased donor program called “Jeevandan.” The state was one of the first to initiate the public-private model of kidney care under the cashless “Aarogyasri” scheme. Digital health has made easy access to lab investigations for the doctors as well as patients. Telemonitoring of remote dialysis units is another policy undertaken by the Telangana government that has immensely improved the dialysis quality. This review describes the various nephrology services available, current state of renal care services in the state.

Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study.

Despite the efficacy of digital mental health technologies (DMHTs) in clinical trials, low uptake and poor engagement are common in real-world settings. Accordingly, digital technology experts or "digital navigators" are increasingly being used to enhance engagement and shared decision-making between health professionals and clients. However, this area is relatively underexplored and there is a lack of data from naturalistic settings. In this paper, we report observational findings from the implementation of a digital navigator in a multidisciplinary mental health clinic in Sydney, Australia. The digital navigator supported clients and health professionals to use a measurement-based DMHT (the Innowell platform) for improved multidimensional outcome assessment and to guide personalized decision-making. Observational data are reported from implementation logs, platform usage statistics, and response rates to digital navigator emails and phone calls. Ultimately, support from the digital navigator led to improved data collection and clearer communications about goals for using the DMHT to track client outcomes; however, this required strong partnerships between health professionals, the digital navigator, and clients. The digital navigator helped to facilitate the integration of DMHT into care, rather than providing a stand-alone service. Thus, collaborations between health professionals and digital navigators are mutually beneficial and empower clients to be more engaged in their own care.

Disparities in Cervical Cancer Knowledge and Trust in Information Sources Among Diverse American Women.

Cervical cancer rates have declined due to prevention and screening, but disparities remain. This study examines how trust and preference in information sources affect knowledge and behaviors, alongside demographic differences to identify health disparities. This study used Health Information National Trends Survey data and employed weighted chi-square tests and multivariate logistic regression to analyze associations between knowledge, behaviors, and demographic differences. The results revealed significant disparities in HPV awareness, with lower awareness among Black (OR, 0.521), Hispanic (OR, 0.398), and Asian (OR, 0.138) women compared to Whites. Age and education also played roles, as older and less-educated women were less informed. Trust in doctors was crucial; women with low trust in doctors (aOR, 0.499; 95% CI, 0.252-0.989) had lower odds of having heard of HPV. Preference for written materials as a primary information source (aOR, 0.312; 95% CI, 0.122-0.793) also correlated with lower HPV awareness compared to preferring information from doctors. Furthermore, women with low trust in charity organizations (aOR, 0.647; 95% CI, 0.461-0.909) were less likely to believe HPV causes cervical cancer, while those who preferred the internet as an information source (aOR, 1.544; 95% CI, 1.026-2.324) had higher odds of having heard of HPV compared to those preferring doctors. Minority populations, older women, and those with lower education levels had significantly lower HPV knowledge. These findings highlight the need for tailored communication, community outreach, policy initiatives, culturally sensitive approaches, digital health interventions, and strategies promoting patient-provider trust to address these disparities.

The adaptation of a single institution diabetes care platform into a nationally available turnkey solution.

Digital decision support and remote patient monitoring may improve outcomes and efficiency, but rarely scale beyond a single institution. Over the last 5 years, the platform Timely Interventions for Diabetes Excellence (TIDE) has been associated with reduced care provider screen time and improved, equitable type 1 diabetes care and outcomes for 268 patients in a heterogeneous population as part of the Teamwork, Targets, Technology, and Tight Control (4T) Study (NCT03968055, NCT04336969). Previous efforts to deploy TIDE at other institutions continue to face delays. In partnership with the diabetes technology non-profit, Tidepool, we developed Tidepool-TIDE, a clinic-agnostic, turnkey solution available to any clinic in the United States. We present how we overcame common technical and operational barriers specific to scaling digital health technology from one site to many. The concepts described are broadly applicable for institutions interested in facilitating broader adoption of digital technology for population-level management of chronic health conditions.

Bibliometric analysis of citizen science in global healthcare: Current trends, challenges, and future directions

With the development of information technologies such as big data, cloud computing, and artificial intelligence, the application scenarios of citizen science worldwide are no longer limited to natural science research. A large number of application cases have emerged in the field of medical health, which suggests that the development of citizen science may bring new impetus to medical health. This study employs CiteSpace for a bibliometric analysis to evaluate the current status, objectives, and methodologies of citizen science in global healthcare. An analysis of 248 articles from the Web of Science Core Collection reveals that citizen science is predominantly implemented in high-income countries, including the United States, the United Kingdom, Germany, and the Netherlands, with significant applications in public health, chronic disease management, infectious disease surveillance, and digital health. The COVID-19 pandemic has further catalyzed the integration of citizen science into health surveillance and public health responses. Conversely, in low- and middle-income countries (LMICs), the development and implementation of citizen science remain nascent, primarily concentrated in traditional domains such as environmental science, ecology, and biodiversity conservation, with limited penetration into the healthcare sector. Several structural barriers, including inadequate technological infrastructure, insufficient policy support, limited public engagement, and constrained resource allocation, have impeded the broader adoption of citizen science in these regions. To mitigate these challenges, this study proposes targeted strategies, these interventions are anticipated to facilitate the expansion of citizen sciences role in global health governance, ultimately contributing to improved public health outcomes and social welfare.

Telehealth utilization among patients with chronic disease: Insights from the 2022 Health Information National Trends Survey.

Telehealth has been effectively used for managing chronic disease conditions; however, utilization patterns vary across populations. This study aims to examine the prevalence of telehealth utilization, the associated factors of telehealth modality (e.g., audio, video) among patients with chronic diseases, and the role of health literacy. Participants with at least one diagnosed chronic disease from the 2022 Health Information National Trends Survey (HINTS 6) data (n=3686) were analyzed. Differences in participant characteristics between telehealth users and non-users were compared using χ² statistics. Multinomial logistic regression models were employed to investigate factors associated with telehealth modality. About 52% of participants reported using telehealth in the past 12 months, with 34.7% using audio-only modality. Telehealth use was highest among participants with depression (61.6%) and lowest among those with high blood pressure (47.6%). Participants over 75 years old (OR, 3.11 [95% CI, 1.99-4.85]; P < 0.001) were more likely to use audio-only modality compared to the youngest group (18-34 years). Respondents with a higher educational level (bachelor's degree: OR, 0.77 [95% CI, 0.59-1.00], P = 0.049; post-baccalaureate degree: OR, 0.60 [95% CI, 0.43-0.82]; P < 0.001) and higher health literacy (OR, 0.81 [95% CI, 0.66-0.99]; P =0.04) were more likely to use audio-video modality compared to their counterparts. Telehealth use varied across demographics and chronic diseases, revealing significant disparities. Elderly individuals, those with lower socioeconomic status, and those with lower health literacy tended to use the audio-only modality. Providing support for digital platforms and health literacy can empower patients with chronic diseases to effectively use telehealth for self-management.

Enhancing digital citizenship education in Saudi Arabian elementary schools: designing effective activities for curriculum integration

In an era where digital technologies significantly influence children’s lives globally, promoting responsible digital citizenship is crucial to equip them with the skills to navigate the digital world safely and responsibly. This study examines the integration and current state of Digital Citizenship Education (DCE) in Saudi Arabian elementary schools, assessing its alignment with international standards and identifying local challenges faced by educators, and pedagogical strategies used. Employing a mixed-methods approach, quantitative data was collected through surveys from 398 teachers and qualitative insight gained from semi-structured interviews with 15 teachers. Quantitative analysis employed descriptive statistics and multivariate analysis of variance (MANOVA) to explore demographic influences on DCE practices. The findings reveal a strong emphasis on Digital Emotional Intelligence and Digital Security, Privacy, and Health and Wellness; however, significant gaps exist in Digital Participation and Agency, and Digital Footprint and Identity. These gaps are attributed to factors such as insufficient teacher training, lack of effective structured guidelines, and insufficient resources. Significant interaction effects between teachers’ demographics and DCE perceptions highlight the need for targeted professional development. The study concludes with actionable recommendations for enhancing curriculum integration, teacher training, and policy development to promote digital citizenship among elementary school students aligned with global standards.

Digital health intervention for children with ADHD to improve mental health intervention, patient experiences, and outcomes: a study protocol

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT).Methods/designWe will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period.DiscussionIndividuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes.This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024.

Privacy-Preserving Data Analytics in Internet of Medical Things

The healthcare sector has changed dramatically in recent years due to depending more and more on big data to improve patient care, enhance or improve operational effectiveness, and forward medical research. Protecting patient privacy in the era of digital health records is a major challenge, as there could be a chance of privacy leakage during the process of collecting patient data. To overcome this issue, we propose a secure, privacy-preserving scheme for healthcare data to ensure maximum privacy of an individual while also maintaining their utility and allowing for the performance of queries based on sensitive attributes under differential privacy. We implemented differential privacy on two publicly available healthcare datasets, the Breast Cancer Prediction Dataset and the Nursing Home COVID-19 Dataset. Moreover, we examined the impact of varying privacy parameter (ε) values on both the privacy and utility of the data. A significant part of this study involved the selection of ε, which determines the degree of privacy protection. We also conducted a computational time comparison by performing multiple complex queries on these datasets to analyse the computational overhead introduced by differential privacy. The outcomes demonstrate that, despite a slight increase in query processing time, it remains within reasonable bounds, ensuring the practicality of differential privacy for real-time applications.

From face-to-face to screen-to-screen: exploring the multifaceted dimensions of digital mental health care

BackgroundWith the onset of the COVID-19 pandemic, the world witnessed an unprecedented surge in the adoption of digital platforms across various sectors, including mental health care. In countries such as Pakistan, where traditional face-to-face therapy practices hold social and cultural significance, transitioning to digital therapeutic methods presents a range of unique opportunities and challenges.ObjectivesThis research aimed to explore the dynamics, implications, and perceptions surrounding digital therapeutic care within the Pakistani sociocultural context. Given the paucity of literature on this subject in the Pakistani context, this study aims to bridge the evidence gap between trends in digital therapy and localized practices. The main goal was to understand the benefits, issues, and challenges therapists and clients face when adopting digital modes for therapeutic care.MethodFor this study, primary data was gathered from counsellors and therapists using a qualitative in-depth interview guide. Using a thematic analysis approach, key themes were derived from the interviews that provided insights into the experiences and perceptions of the participants.ResultsThe study revealed that digital platforms have great potential in breaking down geographical barriers making therapeutic interventions more accessible to a wider demographic. This increased accessibility also brought about a level of comfort for clients as they could access therapy from their familiar surroundings. Among the challenges that needed attention, security and confidentiality stood out, requiring strict measures to safeguard client’s data. The shift also brought to light the diverse range of feedback from clients, which was influenced by factors like age and technological proficiency. Moreover, the digital transition posed challenges for both therapists and clients, with many facing an adjustment period as they transitioned from face-to-face to online sessions. One significant challenge was the perceived difficulty in fostering a deep interpersonal connection in a virtual environment. This was further compounded by the need for therapists to modify traditional therapeutic techniques to fit the online mode.Conclusion and implicationsThe study underscores the evolving nature of digital therapy in Pakistan, setting a foundation for further exploration in aligning technology with therapeutic needs, ensuring optimal benefits for clients while preserving the sanctity and efficacy of the therapeutic relationship.

Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research.

Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research.

Relationships Among eHealth Literacy, Physical Literacy, and Physical Activity in Chinese University Students: Cross-Sectional Study.

eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one's understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL. This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables. In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables. The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t636=4.94; P<.001) and PL (t636=3.18; P<.001), but no significant differences were found in eHealth literacy (t636=1.23; P=.22). The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.

The Evolving Role of Pharmacists in Healthcare: A Systematic Review of Clinical, Community, and Digital Health Interventions

The Evolving Role of Pharmacists in Healthcare: A Systematic Review of Clinical, Community, and Digital Health Interventions