eHealth Interventions Research Articles

The Effectiveness of eHealth Interventions in Promoting the Health Literacy of Informal Caregivers: A Systematic Literature Review Protocol

Background: Digital Information and Communication Technologies (ICTs) offer significant opportunities to enhance public health, particularly through their strategic use in promoting health literacy. Objectives: This systematic review protocol aims to outline the methodological steps necessary to conduct a systematic review of the effectiveness of digital interventions in improving health literacy among informal caregivers. Methods: This review will include studies involving adult informal caregivers (≥18 years) undergoing a digital health intervention promoting health literacy. Intervention, effectiveness or efficacy, RCT, quasi-experimental, and observational studies will be eligible. This review will follow the methodology for Cochrane Systematic Review and Meta-Analysis. The search strategy will identify studies published in the databases SCOPUS and Web of Science, as well as CINAHL (via EBSCO) and PubMed and gray literature sources. Two in-dependent reviewers will screen the studies, extract data, and critically appraise the selected studies. It is planned that the risk of bias will be assessed using the RoB2, Newcastle-Ottawa Scale (NOS), and the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions). From the included studies, data will be extracted on the identification of the study, the aim of the study, characteristics of the population, study method and intervention and control conditions, study variables, and significant results. Conclusions: It is anticipated that the results of the study will guide healthcare professionals and managers in incorporating digital technologies into health literacy programs for informal caregivers. Whenever possible, a statistical meta-analysis will be performed to combine study results. The PROSPERO registration number is CRD42024589465.

Effects of Nurse-Led e-Health Interventions on the Health-Related Outcomes of Pregnant Women: A Systematic Review.

Pregnancy is a special time for women that involves substantial emotional, physical, social, and family changes, which can lead to physical and psychological harm. The rapid development of e-health has provided a favourable platform for managing health-related outcomes in pregnant women, and nurses are the professional group that is most likely to provide e-health services. Nurse-led e-health interventions have attracted increasing attention, but their effects are uncertain. To identify the effectiveness of nurse-led e-health interventions in improving health-related outcomes in pregnant women. A systematic review. The PubMed, PsycINFO, EMBASE, CINAHL, ProQuest, MEDLINE, Scopus, Web of Science and Cochrane Library databases were searched from inception to March 2023. Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias tool was used for quality assessment. The findings of this review are presented using a narrative synthesis. This review included 14 studies involving 2016 participants. Three out of five studies reported that nurse-led e-health interventions significantly reduced depressive symptoms. Four studies reported significant improvements in stress and self-efficacy after the intervention. Two studies reported significant improvements in anxiety symptoms, self-management ability, and quality of life after the intervention. One study showed that weight gain and physical activity significantly improved after the intervention. Due to the heterogeneity in the included studies, no meta-analysis was conducted. Nurse-led e-health interventions may be beneficial for improving anxiety symptoms, depressive symptoms, stress, self-efficacy, weight gain, self-management ability, physical activity, and quality of life in pregnant women. Nurse-led e-health interventions could provide individualised, economic, interactive, and convenient nursing modes for pregnant women. Rigorous and high-quality evidence confirming the long-term effects of these interventions on pregnant women is necessary. The patients had no direct involvement in the present study. PROSPERO registration ID: CRD42023401973.

An eHealth intervention for patients with a low socioeconomic position during their waiting period preceding cardiac rehabilitation: a randomized feasibility study

Abstract Aims Cardiac rehabilitation (CR) shows lower effectiveness and higher dropouts among people with a low socioeconomic position (SEP) compared to those with a high SEP. This study evaluated an eHealth intervention aimed at supporting patients with a low SEP during their waiting period preceding CR. Methods and results Participants with a low SEP in their waiting period before CR were randomized into an intervention group, receiving guidance videos, patient narratives, and practical tips, or into a control group. We evaluated adherence (usage metrics), acceptance (modified Usefulness, Satisfaction, and Ease of use questionnaire), and changes in feelings of certainty and guidance between the waiting period’s start and end. Semi-structured interviews provided complementary insights. The study involved 41 participants [median interquartile range (IQR) age 62 (14) years; 33 males], with 21 participants allocated to the intervention group, using the eHealth intervention for a median (IQR) duration of 16 (10) days, using it on a median (IQR) of 100% (25) of these days, and viewing 88% of the available messages. Key adherence themes were daily routine compatibility and curiosity. Acceptance rates were 86% for usability, 67% for satisfaction, and 43% for usefulness. No significant effects on certainty and guidance were observed, but qualitative data suggested that the intervention helped to inform and set expectations. Conclusion The study found the eHealth intervention feasible for cardiac patients with a low SEP, with good adherence, usability, and satisfaction. However, it showed no effect on feelings of certainty and guidance. Through further optimization of its content, the intervention holds promise to improve emotional resilience during the waiting period. Registration This trial is registered as follows: ‘Evaluation of a Preparatory eHealth Intervention to Support Cardiac Patients During Their Waiting Period (PReCARE)’ at ClinicalTrials.gov (NCT05698121, https://clinicaltrials.gov/study/NCT05698121).

Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study.

Although personalization and tailoring have been identified as alternatives to a "one-size-fits-all" approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth.

Experiences of gender-affirming healthcare among transgender and gender diverse (TGD) people during the COVID-19 pandemic: an explanatory sequential mixed methods study

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.

Participatory Action Research and Knowledge Dissemination in Virtual Photovoice: Methodological Insights.

Despite the methodological spread of virtual photovoice, alignments to and potential advances for the participatory action research (PAR) and knowledge dissemination (KD) components of in-person photovoice are poorly understood. Detailing the PAR and KD processes, practices, and products drawn from a virtual photovoice study examining men's experiences of and perspectives about equitable intimate partner relationships, the current article offers three thematic findings. The first theme Processes and pragmatics for selecting representative photographs describes adapting established analytics of preview, review, and cross-photo comparisons to categorize and select images from a large collection of participant-produced photographs (n = 714). Specifically, detailed are the reconciling of researchers deciding which images and accompanying narratives to include guided by PAR principles. Theme 2, Democratizing and disrupting in-person PAR with virtual focus group polls (VFGPs), chronicles participant voting through Zoom to collectively decide and subsequently discuss their favorite photographs. While anonymity for the poll was democratizing in terms of participant equality for voting on the photographs, connecting men virtually from diverse locales could differentiate cultural norms. The third theme KD pledges and pitfalls with online photovoice exhibitions details the potential benefits and challenges for reaching diverse end-users. Evident was the importance of marketing and media for driving traffic to the online exhibition, and the centrality of interactivity for fostering engagement to build and adjust photovoice e-health interventions. With virtual photovoice continuing to grow in popularity post COVID-19, this article offers important methodological lessons for adapting and advancing components of in-person PAR and KD.

Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review.

eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients' limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. RR2-10.2196/38615.

Young mothers and eHealth: a scoping review.

Young mothers, defined as those age 25 and under, are at an increased risk of experiencing mental health problems. Despite this increased risk, very few mental health and parenting interventions that target the unique needs of this group are available. This scoping review summarized extant research on mental health and parenting eHealth interventions aimed at young mothers. CINAHL, MEDLINE, PsycINFO, PsycARTICLES, and PubMed databases were used for searches, and articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Arksey and O'Malley's five-stage method for scoping reviews. The eligibility criteria included being peer-reviewed, written in English, published between January 1, 2000, and May 9, 2024, and being an eHealth program targeting mental health and/or parenting skills for women-identifying mothers under the age of 26. After duplicate removal, 3,431 titles and abstracts were screened, and 112 articles moved to full-text review. Four studies were included, each assessing intervention components, targeting mental health and parenting, and outlining participant feedback on the treatment. Each study evaluated a different type of intervention, with depression being the most studied mental health outcome and coping skills being the most studied parenting outcome. Preliminary findings suggest that eHealth features such as flexibility, text messaging, and peer support are appreciated among young mothers. Further research on mental health and parenting eHealth interventions aimed at addressing the needs of young mothers is needed.

Patient and clinician perspectives of an eHealth intervention for supporting cancer treatment in the UK: mixed methods evaluation of the eRAPID randomised controlled trial

ObjectivesDuring 2015–2018, a randomised controlled trial (RCT) evaluated eRAPID, an eHealth intervention designed to capture patient-reported symptoms online during cancer treatment. eRAPID provides patients with advice on when to self-manage...

Health promotion interventions for children and adolescents using e-health: a systematic review

Abstract Background The utilization of e-health in healthcare interventions has become increasingly prevalent due to its cost-effectiveness. Nevertheless, there is a paucity of evidence regarding the use of e-health in children, as the majority of e-health interventions are focused on adults. This study aimed to identify the components and effects of e-health intervention for the promotion of children’s health and to suggest strategies for their implementation. Methods A systematic review was conducted in accordance with the PRISMA guidelines. A literature review of relevant studies published between January 2013 and November 2023 was conducted. A search of databases including PubMed, EMBASE, CINAHL, MEDLINE, and Cochrane Review Library was conducted using a combination of medical subject headings (MeSH) and keywords. A qualitative appraisal of the studies was conducted using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Sixteen studies were selected. Most studies showed good methodological quality. The majority of studies (n = 15) focused on improving children’s physical health, while only one study focused on mental health. There were a variety of components to the intervention, including internet education, web-based home-exercise, serious games, mobile apps, email counseling, and active video games, and only one type of intervention was provided, or a combination with additional methods such as phone calls and counseling. A review of the literature indicates that e-health interventions have been effective in increasing children’s physical activity, reducing weight, relieving stress, and reducing depression. Conclusions This study identified the effectiveness of e-health interventions for improving children’s physical and mental health. The use of e-health to promote children’s health should be actively developed and implemented in a variety of clinical and community settings. Key messages • E-health interventions have been demonstrated to be an effective means of improving the physical and mental health of children and adolescents. • It is recommended that health promotion interventions utilizing e-health be developed and tested in a variety of communities and settings for children and adolescents.

EHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study.

As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes "cues to action" that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts' chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention.

Are there unique facets of therapeutic alliance for users of digital mental health interventions? An examination with the eHealth Therapeutic Alliance Inventory

Therapeutic alliance (TA) is a well-established predictor of clinical outcomes in traditional psychotherapy. However, its association with outcomes in eHealth interventions has been inconsistent, which might be due to the absence of measurements specifically designed to capture TA in eHealth settings. The eHealth Therapeutic Alliance Inventory (ETAI) incorporates conventional as well as unique eHealth TA subscales, enabling to examine the contribution of new facets of TA beyond traditional concepts. This study investigates the predictive contribution of eHealth TA subscales compared to conventional TA subscales on clinical outcomes and evaluates the concurrent criterion validity of the ETAI. The study was conducted within the framework of a randomized controlled trial involving a 10-week digital parent training program aimed at addressing child disruptive behaviors. Parents were randomly assigned to either an enhanced-quality or a standard-quality program. Parents from 68 families completed the ETAI at five weeks' post-program initiation and at the post-intervention phase. The primary outcome was the improvement in child behavior, measured by the Eyberg Child Behavior Inventory. Positive Pearson correlations were found between all ETAI subscales covering unique eHealth TA aspects, measured at the 5-week time-point, and improvement in child behavior at post-intervention (rs ≥ 0.23, ps < 0.03). The conventional TA subscale showed no significant Pearson correlation with improvement in child behavior. When examining the unique contributions of ETAI-subscales to explain the improvement in child behavior, only ETAI-Perceived Emotional Investment subscale was found to have a unique contribution (β = 0.29, p = 0.019). In addition, scores on most ETAI subscales were significantly higher among parents using the enhanced-quality program compared with the standard program (Cohen's ds > 0.48), reinforcing ETAI's criterion validity. The development of TA scales that incorporates unique eHealth TA subscales show initial promise in predicting outcomes. Further research is needed to better understand how different factors of eHealth TA relate to clinical outcomes across diverse clinical targets and programs.

How effective are eHealth literacy interventions? A meta-analysis of experimental studies

Abstract The rapid evolution of digital health emphasises the need for effective eHealth literacy (eHL) to ensure equitable access to health information and improve patient outcomes. This systematic review and meta-analysis aim to assess the effectiveness of eHL interventions, addressing the significant gap in knowledge about which strategies are most beneficial. Adhering to PRISMA guidelines, we systematically retrieved, quantitatively pooled and critically appraised available experimental evidence on the effectiveness of eHL interventions across different populations. PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies reporting original quantitative outcomes of eHL, assessed by the eHealth Literacy Scale or other validated scales. Data were pooled using a random-effects model, with critical appraisal of the included studies. From the 504 records screened, 15 studies met the inclusion criteria. They encompass interventions targeting adults with chronic diseases (6 studies), older adults (5), and young people (4) and examine either individualistic or collaborative approaches (respectively, 9 and 5 studies, and 1 assessing both). The meta-analysis revealed significant improvements in eHL, both pre- vs post-intervention (UMD 5.81, 95%CI 3.38-8.26, N = 1,025) and experimental vs control groups (OR 3.65, 95%CI 2.06-6.46, N = 1,258). Meta-regression showed a significant correlation between pre/post-intervention outcomes and baseline eHL levels (slope=-0.91, p-value=0.009). Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights (role of baseline eHL levels and intervention approach) for intervention design and implementation that are adaptable to various demographic contexts. This research was supported by the National Plan for Complementary Investments to the NRRP Hub Life Science-Digital Health (PNC-E3-2022-23683267, DHEAL-COM).

A call to action about promoting healthy sleep among children

Abstract Infancy is an ideal time to engage parents in foundational sleep health promotion, as many parents have concerns about infant sleep. However, recent work suggests most Canadian public health resources on infant sleep does not meet clear communication criteria and that these resources often only focus on sleep safety, rather than broader sleep health. Information is also limited with respect to how parents can manage infant sleep difficulties. While eHealth intervention programs can increase the accessibility of evidence-based pediatric sleep health information, recent parental feedback indicates that usability, personalization, and flexibility are key factors in facilitating use. Additional co-design workshops with care providers and parents provided critical guidance on the need to develop more inclusive infant sleep interventions, consistent with previous literature. This guidance suggests infant sleep interventions should be culturally humble and non-judgmental, inclusive of parenting partners, and provide credible, timely, and meaningful information.

Leveraging epidemiological data for the development of interventions to promote healthy nutrition and physical activity among adolescents from disadvantaged backgrounds

Abstract ePro-Schools is a public health initiative designed to promote healthy nutrition and physical activity among adolescents from socially disadvantaged backgrounds using a targeted e-health intervention to be deployed in the school context. A central theme of ePro-Schools is its robust cross-sectoral collaboration, involving stakeholders from academia, healthcare, education, and local communities. This cooperative approach not only enhances the intervention’s relevance and efficacy but also ensures its cultural, social, and economic adaptability to the needs of the target population. The project embodies a truly interdisciplinary effort, integrating insights from epidemiology, behavioural science, public health, and digital technology to innovate and improve health promotion strategies. This presentation will explore how data from epidemiological studies, such as the Health Behaviour in School-aged Children (HBSC) study, are used to support the development of the ePro-Schools intervention. Utilizing high-quality epidemiological data, the project identifies key determinants of physical activity, dietary habits, and sedentary behaviour amongst adolescents growing up in low-SES contexts, allowing to craft tailored strategies to promote healthier lifestyles within this vulnerable population.

9.N. Practice session: From Data to Action – Joining forces to close the inequity gap in adolescent health

Abstract Persistent adolescent health inequalities exist in Europe, necessitating interventions that address both individual and societal factors, especially those pertinent to youths in unfavourable contexts. Collaborative efforts involving cross-sectoral partnerships and adolescent engagement are crucial in identifying and mitigating these disparities. Three case studies exemplify this approach. Case study 1: Effective intervention development hinges upon the translation of epidemiological insights into tangible actions. Heiko Schmengler will discuss how individual and contextual-level data is made actionable for the development of ePro-schools, an e-health intervention to promote healthy dietary habits and physical activity amongst adolescents in socially disadvantaged settings. ePro-schools brings together stakeholders from academia, the health sector, the education system, and local communities. This collaborative approach ensures that the intervention is not only grounded in solid scientific evidence but also fits the specific cultural, social, and economic contexts of the adolescents it aims to serve. Case study 2: Adolescents are not passive consumers of interventions, but active agents who frequently understand best what they need to improve regarding their health. Lourdes Cantarero Arevalo will share innovative methodologies and best practices for involving adolescents in data collection, intervention design, and policy development processes with the final aim to empower the voices of adolescents in vulnerable situations while addressing problems that are relevant for them. Case study 3: Filipa Alves da Costa will draw attention to the health concerns of adolescents resulting from incarceration. This talk will outline the development of a policy brief derived from UN global study data, which highlights the importance of cross-sectoral collaboration in developing actions to safeguard access to high quality healthcare for adolescents within the criminal justice system. A cross-sectoral approach is critical given that criminal justice systems typically fall outside the direct oversight of health ministries. The goal is to encourage policymakers, practitioners, and advocates to consider inter-sectoral strategies to address the complex health challenges these adolescents face. Following the presentations, we will facilitate a dynamic discussion with the audience, encouraging an exchange of ideas on strategies to address adolescent health inequalities from a multilevel perspective. This discussion aims to draw on the collective expertise of participants from diverse backgrounds, including practitioners, researchers, and policymakers. This dialogue aims to identify common barriers and opportunities, fostering a collaborative approach to tackling inequalities. The goal is to emerge from the workshop with a richer understanding of effective strategies that can be leveraged to close the gap in adolescent health across Europe. Key messages • Health inequalities among adolescents must be tackled collaboratively across different sectors and with participation of adolescents. • Participants will gain valuable insights on innovative solutions and effective methodologies from the case studies to inform their own efforts in addressing adolescent health inequalities.

Short- and Long-Term Outcomes of e-Health and Internet-Based Psychological Interventions for Chronic Tinnitus: A Systematic Review and Meta-Analysis.

Objective: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. Methods: Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. Results: We found a statistically significant large effect size for improvement in tinnitus distress (d = 0.83; [confidence interval 0.61-1.06] with total n = 450 for the experimental group and total n = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size d = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. Conclusions: Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.

Game-Based eHealth Interventions for the Reduction of Fatigue in People With Chronic Diseases: Systematic Review and Meta-Analysis.

Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients' quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] -0.65, 95% CI -1.09 to -0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD -0.47, 95% CI -0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI -0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD -1.19, 95% CI -1.95 to -0.42, P=.002). Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning.

Comparative effects of behaviour change techniques using eHealth and mHealth in promoting dietary behaviour: protocol for a systematic review and component network meta-analysis

IntroductionGlobally, it is estimated that dietary habits contribute to 22% of adult deaths and 15% of disability-adjusted life years, highlighting the critical role of dietary behaviour in public health. Despite...

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders: ‘eHealth: it's TIME’

Objective This study aimed to co-design and develop a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for adults with musculoskeletal disorders. Design A three-step system development cycle was employed. Step 1 involved creating intervention features and content, with two focus groups reviewing prioritised eHealth intervention elements based on earlier research. Step 2 involved heuristic testing using Nielsen's 10 heuristic principles. Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale. Setting Republic of Ireland. Participants Step 1 included adults with musculoskeletal disorders (n = 12). Step 2 involved five reviewers. Step 3 included people with musculoskeletal disorders (n = 5) and musculoskeletal physiotherapists (n = 5). Results Participants in step 1 approved four main intervention components, which map to recognised theoretical frameworks, and suggested increased use of visual and interactive elements. Heuristic testing in step 2 identified design and navigation issues. In Step 3, usability testing, additional navigation, content and design recommendations were identified. The overall median system usability score (interquartile range) was 75 (0) out of 100 for adults with musculoskeletal disorders and 77.5 (2.5) out of 100 for musculoskeletal physiotherapists, indicating good usability. Conclusion A theory-based, user-centred eHealth-mediated follow-up self-management support prototype has been developed for people with musculoskeletal disorders, with the next steps focusing on feasibility testing in clinical practice, with a more diverse population.