eHealth Interventions Research Articles

Promoting Sexual Health in Colorectal Cancer Patients and Survivors: Results from a Systematic Review.

Colorectal cancer diagnosis and treatment negatively impact sexual health. However, there is still a lack of interventions targeting the sexual healthcare needs of colorectal cancer patients and survivors. This systematic review aimed to identify and summarize the efficacy of available psychological interventions aimed at improving colorectal cancer patients' and survivors' sexual health. This review followed PRISMA guidelines for systematic reviews. A database search was conducted for studies published until July 2023 on EBSCO Host, Web of Science, PubMed, and the Cochrane Library. Manuscripts were screened according to inclusion and exclusion criteria. The risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies. From the 1499 records screened, four studies describing psychological interventions to improve the sexual health of the target population were identified. All studies reported on e-health programs and showed evidence of their efficacy in the improvement of participants' sexual function. The studies presented low scores on the Quality Assessment Tool for Quantitative Studies. Despite the evidence that tele/e-health psychological interventions have the potential to effectively promote sexual health in colorectal cancer patients and survivors, more robust research is needed to allow for generalization. Future research should further assess the efficacy of e-health interventions (eMental Health) in promoting sexual health in patients with colorectal cancer.

Efficacy of e-health interventions for smoking cessation management in smokers: a systematic review and meta-analysis

Smoking is one of the major risk factors for shortened lifespan and disability, while smoking cessation is currently the only guaranteed method to reduce the harm caused by smoking. E-health is a field that utilizes information and communication technology to support the health status of its users. The emergence of this digital health approach has provided a new way of smoking cessation support for smokers seeking help, and an increasing number of researchers are attempting to use e-health for a wide range of effective smoking cessation interventions. We conducted a systematic review and meta-analysis of studies that used e-health as a smoking cessation support tool. This systematic review and meta-analysis searched the PubMed, Embase, and Cochrane Library databases until December 2022. The included studies were randomized controlled trials (RCTs) comparing the use of e-health interventions and traditional offline smoking cessation care interventions. The primary outcome of the studies was the point smoking cessation rate (7-day and 30-day), and the secondary outcome was sustained smoking cessation rates. Studies were excluded if there was no clear e-health intervention described or if standard-compliant cessation outcomes were not clearly reported. Fixed-effects meta-analysis and meta-regression analyses were performed on the included study data to evaluate the effectiveness of the interventions. The meta-analysis outcome was the risk ratio (RR) and a 95% confidence interval. The study was registered with PROSPERO, CRD42023388667. We collectively screened 2408 articles, and ultimately included 39 articles with a total of 17,351 eligible participants, of which 44 studies were included in the meta-analysis. The meta-analysis revealed that compared to traditional smoking cessation interventions, e-health interventions can increase point quit rates (RR 1.86, 95% CI 1.69-2.04) as well as sustained quit rates in the long-term (RR 1.79, 95% CI 1.60-2.00) among smokers. Subgroup analysis showed that text and telephone interventions in e-health significantly improved short-term quit rates for up to 7 days (RR 2.10, 95% CI 1.77-2.48). Website and app interventions also had a positive impact on improving short-term quit rates for up to 7 days (RR 1.74, 95% CI 1.56-1.94). The heterogeneity of the study results was low, demonstrating the significant smoking cessation advantages of e-health interventions. We have found that personalized e-health interventions can effectively help smokers quit smoking. The diverse remote intervention methods of e-health can provide more convenient options for further customization. Additionally, further follow-up research is needed to evaluate the sustained effectiveness of interventions on smokers' continuous abstinence over a longer period (greater than one year). In the future, e-health can further optimize smoking cessation strategies. No funding.

Evaluation of the nurse-assisted eHealth intervention ‘eHealth@Hospital-2-Home’ on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial

BackgroundPatients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care.MethodsA randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention—eHealth@Hospital-2-Home—for six weeks. The intervention includes remote monitoring of vital signs; patients’ self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients’ and nurse navigators’ engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis.DiscussionThis protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice.Trial registrationClinical trials.gov (ID 301472).

Qualitative Evaluation of Treatment Partners for People With HIV in Botswana: Current Healthcare Provider Practices and Recommendations for Improvement.

Botswana has an adult HIV prevalence of 20.8% and annual incidence of 0.2%. We aimed to evaluate current practices and advance recommendations for treatment partners (informal adherence supporters) for people with HIV in Botswana. In January-February 2020, we conducted seven focus groups with 36 healthcare providers at seven HIV clinics in Gaborone, Botswana. Providers perceived treatment partners to be critical for quality patient care. They shared that in the new era of universal antiretroviral therapy (ART) initiation immediately after diagnosis ("test-and-treat"), providers no longer require patients to select treatment partners at ART initiation. Providers suggested a renewed emphasis on treatment partners. They believed that standard guidance for providers around treatment partner selection would ensure that providers cover similar topics across patients and endorsed implementation of workshops to educate treatment partners on how to support patients. However, streamlined ART initiation policies require innovative strategies, including eHealth interventions, to engage treatment partners.

The Trauma PORTAL-A Blended e-Health Intervention for Survivors of Childhood Interpersonal Trauma: An Open-Label Pilot Study.

Adults with mental health symptoms stemming from childhood interpersonal trauma require specialized trauma-focused psychological interventions. Limitations in accessing treatment interventions for this population necessitate innovative solutions. This study explored the feasibility of a protocol for a blended e-health psychoeducational treatment intervention for this population called the Trauma PORTAL (Providing Online tRauma Therapy using an Asynchronous Learning platform), combining asynchronous online modules and weekly live virtual group sessions. From October 2021 to February 2022, this prospective, single-arm study recruited participants who were waitlisted for trauma therapy at an academic hospital. The primary outcome was protocol feasibility, including recruitment, adoption, and intervention acceptability. Secondary outcomes were pre- and post-intervention post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5 [PCL-5]), depression/anxiety/stress (Depression and Anxiety Stress Scale [DASS-21]), and emotion regulation (Difficulties in Emotion Regulation Scale [DERS-18]), which were compared using paired t-tests and presented as mean differences (MDs) and 95% confidence intervals (CIs). A total of 66 participants (median age = 37, female = 61) were enrolled, and they completed on average 53.5% of the online modules. There were 51 (77%) participants who completed post-intervention questionnaires. Acceptability was very high, with 49 respondents (98%) reporting that the intervention increased their access to health care. There were reductions from pre- to post-intervention on the PCL-5 (49.1 vs. 36.7, MD -12.4, 95% CI 8.3-16.5), DERS-18 (51.8 vs. 48.8, MD -3.3, 95% CI 0.2-6.4), and DASS-21 (60.1 vs. 50.7, MD -9.4, 95% CI 2.3-16.6). The Trauma PORTAL intervention was feasible to implement, well-adopted, and highly acceptable in an ambulatory trauma therapy program. The findings show promising evidence for symptom reduction. Further evaluation of the Trauma PORTAL's efficacy in a randomized trial is warranted.

Beyond effectiveness in eHealth trials: Process evaluation of a stepped-care programme to support healthcare workers with psychological distress (RESPOND-HCWs).

This study presents the process evaluation of an effective stepped-care programme of eHealth interventions (Doing What Matters in Times of Stress [DWM] and Problem Management Plus [PM+]) for healthcare workers (HCWs) with psychological distress (RESPOND-HCWs trial) conducted in Spain. The aim is to analyse the context in which the programme was delivered, assess key implementation outcomes and explore mechanisms of action. We used mixed methods. Quantitative data came from routine randomised control trial monitoring and structured observation, and qualitative data were collected using semi-structured, in-depth interviews with trial participants (n = 12) and decision-makers (n = 7) and a focus group discussion with intervention providers (n = 7). We conducted a descriptive analysis of quantitative data using R software and a thematic analysis of qualitative data using NVivo. Context analysis revealed implementation barriers, including unrealistic expectations of participants about the programme and mental health-related stigma. The flexibility of interventions and the opportunity for mental health actions were enabling factors. Implementation outcomes showed that the trial was feasible, appropriate and timely, and that the intervention was delivered with minimal protocol deviations and good acceptance among participants. Mechanisms of action included confidence in the positive effect of the intervention, a good therapeutic relationship and specific intervention components. These results supplement the outcome evaluation and can help inform large-scale implementation in similar settings. Specific recommendations include increasing mental health awareness and reducing stigma in the implementation setting, including a short orientation session and ensuring flexibility in schedules and peer support. NCT04980326.

Associations and gender differences between OHI-seeking behaviors and eHealth literacy among Chinese university students.

to explore associations and gender differences between OHI-seeking (online health information seeking) behaviors and eHealth (electronic health) literacy among Chinese university students. Online questionnaires of eHealth literacy scale and OHI-seeking behaviors created in software Wenjunxing were used in this survey. Chi-squared tests, t-test, and Pearson correlation analysis were performed using SPSS for data analysis. Among 5,383 participants, 72.4% were girls, 77.5% lived in rural areas, 51.2% majored in liberal arts, 76.6% with low education parents. The average C-eHEALS scores of boys and girls were 26.53 ± 5.861 and 26.84 ± 5.816, respectively, with no significant difference (P = 0.084). The top three OHI-seeking behaviors for boys and girls, as well as for the C-eHEALS low and high groups, were "finding information about physical exercises" "reading or sharing health information via social media" "finding information about nutrition and diet", all of which had significant gender and eHealth literacy differences. Gender and eHealth literacy differences should be focused for intervention when developing and implementing eHealth intervention training for parents and adolescents in schools and communities.

Student mental health: towards sustainable community of caring approach based on the public mental health perspective.

Attending university can be stressful and involve significant lifestyle changes: adjusting to the demands of a new learning environment, interacting with a diverse range of new people
 and environments, and (coping with) being away from trusted support networks. Although sixty per cent of students navigate higher education without emotional problems, forty per cent experience mental health issues, and approximately one in five struggles with mental disorders.
 Against this background, the Flemish Community (Belgium) has rolled out a sustainable student mental health strategy which takes a public mental health perspective as its starting point. Such an approach shifts the focus from high-risk students and mental disorders to the emotional health of the entire student population, and, accordingly, interventions that can improve the resilience of all students. 
 The new policy has several strengths. Monitoring is undertaken through the WHO World Mental Health International College Student initiative. A wide range of low-threshold e-health interventions free of charge to students is available on the MoodSpace internet platform. Going beyond these, the Flemish policy helps universities to adopt a more proactive, preventive approach. Students are actively involved in the development and evaluation of interventions and policy implementation.
 Structure:
 - Introduction: 15’ (Ronny Bruffaerts)
 The introduction focuses on the key elements of the new mental health strategy policy
 - Key element 1: Mental Health Monitor: 20’ (Ronny Bruffaerts - Maarten Vansteenkiste)
 This contribution provides an overview of the Monitor which includes a set of process variables that are sensitive to monitoring student mental health, study motivation and detecting policy effects. The 2022 results and specific action points translated to the macro, meso and micro levels will be presented.
 Q&A 10’
 - Key element 2: MoodSpace: 20’ (Valérie Van Hees)
 This contribution provides an overview of MoodSpace. This contribution will bring an overview of the results of students’ engagement with the e-interventions.
 - Q&A 10’ 
 - Key element 3: Community of Caring: 15’: (Valérie Van Hees, Ronny Bruffaerts)
 This contribution provides a presentation of the gatekeeping training ‘We-care’. The training, designed for students and staff respectively, has been developed at Flemish level with the aim to detect emotional problems early and refer students to the help they need. Preliminary results are presented.
 - Q&;A 10’
 - Closing: Take home messages 15’ (Valérie Van Hees)
 This contribution summarises the next steps and initiates a group discussion on the take home messages.
 How to engage with the audience:
 - Rooms will be organised in roundtables or a fish bowl setup
 - Interactive tools will be used during presentations (eg., dynamic dashboard mental health monitor, video testimonials, demonstrations MoodSpace and We-care).
 - Polling via mentimeter:
 - Each speaker shares different angles of the new policy. After each contribution, a moderator will ask the audience questions through mentimeter about their
 thoughts about each key element.
 How to summarise the take home messages:
 - The session will end with a last question asked by the moderator to the audience through the mentimeter app, on the take away that participants will bring home.

E-Health, m-Health, personalised medicine – challenges faced by healthcare systems in Central and Eastern Europe

Background and purpose: The purpose of this study aims to explore measures intended to remove barriers to the implementation of innovative interventions and identify best practices applicable in European countries that support the implementation of cutting-edge e-health, m-health and personalised medicine (PM) interventions at the micro-, meso- and macro-regional levels. Thanks to PM, people are closer to more accurate, predictable and powerful healthcare tailored to individual patients [1]. PM indicates treatment adapted to the patient's characteristics, needs and preferences. PM categorises patients according to the risk of developing a particular disease or degree of response to a given treatment using appropriate diagnostic markers. PM also aims to increase control over the optimisation of medical treatment outcomes and increase the precision of medical treatment, as well as improve disease prediction [2]. The study concept constitutes one of the indicators of the Regions4PerMed project entitled "Interregional coordination for a fast and deep uptake of personalised health" (Horizon 2020).
 Group of respondents: The group of respondents included stakeholders of the Regions4PerMed project - members of the Regions4PerMed Advisory Board, organisations associated with the Patients’ Organisations Council, small and medium enterprises involved in e-health innovation, presenters at conferences and workshops associated with research institutions, private funders, policymakers, policy advisors, project managers, researchers, patient representatives, physicians, academic staff and healthcare consultants.
 Techniques and tools: The qualitative research took the form of online questionnaires and focus group interviews (semi-structured) to identify key barriers and facilitators to the implementation of innovative e-health interventions at the micro-, meso- and macro-regional levels within health and social care systems conducted according to the following five thematic priorities of the Regions4PerMed project which are:
 1.Medical Big Data, Electronic Health Records and Health Governance
 2.Connected health: Better system integration and patient management
 3.Health industry: Driving healthcare innovations
 4.Facilitation of the flow of innovation in healthcare
 5.Socio-Economic Aspects – basic principles.
 
 Outcomes and contexts: The ongoing research will provide data for the development of recommendations that identify the limitations to and benefits of the implementation of innovative e-health interventions for health and social care, with regard to chronic diseases, at the micro-, meso-, and macro-regional levels. In Poland (as well as throughout Eastern Europe), there are still tangible barriers to the development of e-health and m-health in terms of chronic diseases.
 

Adaptation of an eHealth Intervention: iSupport for Carers of People with Rare Dementias.

'iSupport' is an online psychoeducation and skills development intervention created by the World Health Organisation to support people with dementia. This project adapted iSupport for carers of people with rare dementias (iSupport RDC), creating a new resource to support the health and wellbeing of this underserved population. The adaptation involved three phases: (1) Co-design methods to generate preliminary adaptations; (2) Analysis of phase one findings informing adaptations to iSupport to develop; iSupport RDC; (3) Post-adaptation survey to ascertain participant agreement with the adaptations in iSupport RDC. Fourteen participants contributed, resulting in 212 suggested adaptations, of which 94 (92%) were considered practical, generalisable, and aligned with iSupport principles. These adaptations encompassed content and design changes, including addressing the challenges of rare dementias (PCA, PPA, LBD, and FTD). iSupport RDC represents a significant adaptation of the WHO iSupport intervention. Its tailored nature acknowledges the unique needs of people caring for someone with a rare dementia, improving their access to specialised resources and support. By extending iSupport to this population, it contributes to advancing dementia care inclusivity and broadening the understanding of rare dementias. A feasibility study is underway to assess iSupport RDCs acceptability, with prospects for cultural adaptations to benefit carers globally.

An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice

BackgroundThe number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined.MethodsWe implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3).ResultsThe pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders’ input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy.ConclusionThis case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.

CHALLENGES OF E-INTERVENTION RESEARCH: LESSONS FROM THE ISUPPORT FOR DEMENTIA-PT FEASIBILITY STUDIES

Abstract E-interventions have become popular in delivering healthcare services, offering benefits such as increased accessibility and scalability. However, they also present ethical, technological, and research-related challenges. This poster aims to identify challenges of e-intervention research by analyzing feasibility studies of “iSupport for Dementia-PT”, an online training and support program for informal dementia caregivers (IDC) culturally adapted to Portugal from the original version by the Word Health Organization. A mixed-methods study collected data on user satisfaction and requirements for the program’s contents and interface through focus groups and usability test sessions with IDC (N=17) and health/social support professionals (N=13). A subsequent pilot study followed a mixed-methods experimental parallel between-group design with two arms (iSupport, N=21 and e-book, N=21). Ethical challenges unearthed by both studies included data privacy, e-consent reliability, equity in accessing e-health interventions, and e-health literacy. Challenging methodological decisions for an RCT protocol included defining criteria for a per protocol analysis in the context of a self-help e-intervention, timing for post-test or follow-up assessments, managing attrition, and the implications of resorting to online outcome measurements. The feasibility studies suggest that iSupport for Dementia-PT is a promising resource to support informal dementia caregivers. However, innovation is required in e-intervention research as replicating conventional procedures and methods have shown to be inadequate. Guidelines are needed on how to address the ethical, technological, and research-related challenges in e-intervention research.

Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis.

Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and β-blockers. We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] -0.01, 95% CI -0.03 to 0.03 at 6 months and RD -0.02, 95% CI -0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD -0.01, 95% CI -0.04 to 0.02 and RD -0.01, 95% CI -0.03 to 0.02), aspirin (RD 0.00, 95% CI -0.06 to 0.07 and RD -0.00, 95% CI -0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD -0.01, 95% CI -0.04 to 0.02 and RD 0.01, 95% CI -0.04 to 0.05), and β-blockers (RD 0.00, 95% CI -0.03 to 0.03 and RD -0.01, 95% CI -0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context.

“A Friendly Conversation.” Developing an eHealth Intervention to Increase COVID-19 Testing and Vaccination Literacy Among Women with Criminal and Legal System Involvement

Many women leaving jails are ill-prepared to follow recommended COVID-19 mitigation practices, including testing and vaccination. Low COVID-19-related health literacy, exposure to disinformation, and mistrust in authorities put women at increased risk. Research on this population has shown significant use of mobile devices for communication and web access and public Wi-fi for the internet. Using inductive (formative empirical research with the community) and deductive (theory-based) practices, we designed, developed, and pilot-tested a multimedia, culturally tailored web-based electronic health (eHealth) application to increase COVID-19-specific health literacy and promote testing and vaccination among women with criminal and legal system involvement (CLSI). The intervention included a serialized animated multimedia component and a telenovela-style series, complementing each other and addressing knowledge needs identified in the formative research phase of the project. The eHealth intervention was pilot-tested with 13 CLSI women by using online activity logs and semi-structured telephone interviews. Findings confirmed that eHealth interventions employing multimodal information delivery had increased chances of engaging audiences, especially when developed with input from the target population and are culturally tailored. In addition, using a web-based delivery optimized for mobile made the intervention accessible on various devices and decreased the risk of technical problems.

EFFECTIVENESS OF PHYSIOTHERAPY FOR MUSCO-SKELETAL DISORDERS AND THE ROLE OF REMOTE PHYSIOTHERAPEUTIC INTERVENTIONS

For patients with musculoskeletal diseases, physiotherapy is a safe and efficient treatment option that can help them manage their symptoms and enhance their health. In primary care, physiotherapists aid in the diagnosis, cure, and manage of a broad spectrum of acute and chronic disorders, as well as promote physical exercise, mobility, and function. Physiotherapists in basic medical teams maximize patients’ mobility in accordance with their lifelong needs. This brief study emphasizes the significance of musculoskeletal disorders treatable with physiotherapy. Physiotherapy interventions, when delivered remotely through e-Health platforms, have gained prominence as accessible and effective tools for managing musculoskeletal conditions. These interventions provide patients with valuable resources for self-management, while greatly used to improve everyones quality of life. At the same time, helping to moderate the challenges that this load can create on healthcare systems. The use of telehealth in physiotherapy offers opportunities for personalized care, continuous monitoring, and the implementation of evidence-based interventions. The relevancy of this approach is mainly noticed when put in the context of the COVID-19 pandemic, where the need for remote healthcare delivery has become paramount. Telehealth allows patients to receive timely care and support while adhering to social distancing guidelines. The concept of adherence to eHealth technology in physiotherapy is crucial for ensuring the success of remote interventions. Understanding when and how patients engage with eHealth platforms can guide the development of more effective interventions. It is essential to explore factors that influence patient adherence to technology-driven physiotherapy interventions to optimize their benefits. As healthcare systems worldwide face increasing demands, the implementation of remote physiotherapeutic e-Health interventions can help alleviate the burden by offering scalable and cost-effective solutions. These interventions have the potential to reach a broader patient population and improve access to care for individuals with musculoskeletal disorders. The evaluation of the effectiveness of these remote interventions is essential to provide evidence-based guidance for their integration into clinical practice. By conducting systematic reviews and meta-analyses, researchers can contribute valuable insights into the outcomes and impact of telehealth-based physiotherapy on pain management and overall patient well-being.

Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach.

People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide's content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide's design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of "the inclusive eHealth guide." The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality.

Effect of an eHealth intervention to support care management in caregivers of people with dementia: a pre‐post pilot study

AbstractBackgroundMost people with dementia are cared for by family members. The workload associated with caregiving tasks is often associated with physical, mental, and social impairment. In line with the WHO’s Global Action Plan on Dementia 2017‐2025 (WHO, 2017), calling for the provision of affordable and accessible interventions for dementia caregivers, we tested an eHealth intervention to improve self‐efficacy and mental health in dementia caregivers.Method8‐week eHealth psycho‐educational intervention aiming at increasing the knowledge of neurocognitive disorders, their at‐home management, and the presence of national and local support services. The intervention was conducted by an experienced psychotherapist assisted by a professional expert (e.g., geriatrician, educator, social worker, lawyer and advocacy patient organisations), according to the topic of each meeting. A pre‐post study design was used and validated psychosocial self‐report questionnaires were administered before and after the intervention (e.g., State‐Trait Anxiety Inventory ‐STAI‐Y1‐2, Zarit Burden Interview ‐ZBI, Beck Depression Inventory‐II BDI‐II, Revised Scale of Caregiving Self‐Efficacy ‐RSCSE). Pre‐post differences were tested with paired t‐test, correlations between scales with Pearson correlation coefficientResult41 caregivers (mean age: 57; range 31‐82; female: 78%; children: 61%) completed the study. The intervention had high participation (88% attended at least seven meetings). Following the intervention, the self‐efficacy regarding the ability to respond to the patient’s disruptive behaviours effectively improved (RSCSE‐RDB subscale: t(40) = ‐2.817, p = 0.007), anxiety and burden levels decreased (STAI‐Y1: t(40) = 3.170, p = 0.003; STAI‐Y2: t(40) = 2.327, p = 0.025; ZBI: t(40) = 2.290, p = 0.027), while depression scores did not change significantly (BDI‐II: t(40) = 1.164, p = 0.251). Correlation analysis showed that the change of STAI‐Y1 was positively associated with the change of STAY‐Y2 (r = 0.440, p = 0.004), and the increase of RSCE‐RDB subscale was positively associated with the improvement of caregiver burden (r = 0.430, p = 0.005).ConclusionOur study showed that the eHealth intervention improved the caregiver’s ability to deal effectively with the disruptive behaviours of patients, and this change was associated with a reduction of caregiver burden. The results and participation rates support the implementation of online psycho‐educational interventions to meet the need for knowledge of disease management and avoid detrimental effects on caregivers’ health.

Effect of an eHealth intervention to support care management in caregivers of people with dementia: a pre‐post pilot study

AbstractBackgroundMost people with dementia are cared for by family members. The workload associated with caregiving tasks is often associated with physical, mental, and social impairment. In line with the WHO’s Global Action Plan on Dementia 2017‐2025 (WHO, 2017), calling for the provision of affordable and accessible interventions for dementia caregivers, we tested an eHealth intervention to improve self‐efficacy and mental health in dementia caregivers.Method8‐week eHealth psycho‐educational intervention aiming at increasing the knowledge of neurocognitive disorders, their at‐home management, and the presence of national and local support services. The intervention was conducted by an experienced psychotherapist assisted by a professional expert (e.g., geriatrician, educator, social worker, lawyer and advocacy patient organisations), according to the topic of each meeting. A pre‐post study design was used and validated psychosocial self‐report questionnaires were administered before and after the intervention (e.g., State‐Trait Anxiety Inventory ‐STAI‐Y1‐2, Zarit Burden Interview ‐ZBI, Beck Depression Inventory‐II BDI‐II, Revised Scale of Caregiving Self‐Efficacy ‐RSCSE). Pre‐post differences were tested with paired t‐test, correlations between scales with Pearson correlation coefficientResult41 caregivers (mean age: 57; range 31‐82; female: 78%; children: 61%) completed the study. The intervention had high participation (88% attended at least seven meetings). Following the intervention, the self‐efficacy regarding the ability to respond to the patient’s disruptive behaviours effectively improved (RSCSE‐RDB subscale: t(40) = ‐2.817, p = 0.007), anxiety and burden levels decreased (STAI‐Y1: t(40) = 3.170, p = 0.003; STAI‐Y2: t(40) = 2.327, p = 0.025; ZBI: t(40) = 2.290, p = 0.027), while depression scores did not change significantly (BDI‐II: t(40) = 1.164, p = 0.251). Correlation analysis showed that the change of STAI‐Y1 was positively associated with the change of STAY‐Y2 (r = 0.440, p = 0.004), and the increase of RSCE‐RDB subscale was positively associated with the improvement of caregiver burden (r = 0.430, p = 0.005).ConclusionOur study showed that the eHealth intervention improved the caregiver’s ability to deal effectively with the disruptive behaviours of patients, and this change was associated with a reduction of caregiver burden. The results and participation rates support the implementation of online psycho‐educational interventions to meet the need for knowledge of disease management and avoid detrimental effects on caregivers’ health.

P47: Impact of the FindMyApps intervention on Social health in community-dwelling people with dementia: results from a randomized controlled trial

Background:Most frequently felt needs in dementia concern maintaining self-management and participation in meaningful activities. E-health interventions may support these aspects of social health but few have undergone large-scale evaluations. The effectiveness of the FindMyApps intervention, an app selection tool and tablet training, designed to support people to find and use tablet apps that meet their needs and interests, was evaluated.Methods:A non-blinded, single-centre, randomized controlled trial and process evaluation were conducted in the Netherlands between January 2020 and November 2022. Participants were community-dwelling people with mild dementia (MMSE <26 and >17) or mild cognitive impairment, and their informal caregivers. FindMyApps was compared with digital care as usual (normal tablet computer and general advice). Data regarding primary outcomes (self-management and social participation of the person with dementia, sense of competence of the caregiver) and secondary outcomes (including quality of life) were collected with standardized instruments at baseline and after a three months intervention period. ANCOVAs were conducted on post-test outcome measures, corrected for baseline scores, to investigate group differences.Results:Data collection was completed in November 2022 and analyses are underway. Of 150 dyads randomized, 128 completed the three-month follow-up (64 experimental, 64 control). Results of ANCOVAs investigating the effect and effect size of FindMyApps on the primary and secondary outcomes at three months, will be reported, as well as results of post-hoc analyses that explored the effect on outcomes of: previous tablet experience and education level of participants; observed use of the FindMyApps app; and reported adherence to recommended frequency of tablet use.Discussion and conclusions:Results of this study will indicate whether FindMyApps is an effective intervention for supporting social health of people with mild dementia and MCI. Comparisons with previous studies of FindMyApps and other digital interventions for social health in dementia will be drawn and implications for professionals, concerning implementation of FindMyApps, and for researchers regarding further development, translation and evaluation of FindMyApps discussed. Finally, establishing feasibility and utility of randomized controlled trials in this field, the results of this study will set the bar for future evaluations of eHealth interventions in general.

Implementation and dissemination of home and community‐based interventions for informal caregivers of people living with dementia: A systematic scoping review

AbstractBackgroundInformal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real‐world outcomes of evidence‐based interventions (EBIs) for informal caregivers. This scoping review aims to systematically synthesize the literature that reports implementation strategies employed to deliver home‐ and community‐based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation of these EBIs.MethodsEmbase, MEDLINE, Web of Science and Cochrane Library were searched from inception to March 2021; included studies focused on “implementation science”, “home‐ and community‐based interventions” and “informal caregivers of people with dementia”. Titles and abstracts were screened using ASReview (an innovative AI‐based tool for evidence reviews) and data extraction was guided by the ERIC taxonomy, the Implementation Outcome Framework, and the Consolidated Framework for Implementation Science Research; each framework was used to examine a unique element of implementation.Results67 studies were included in the review. Multi‐component (26.9%) and eHealth (22.3%) interventions were most commonly reported, and 31.3% of included studies were guided by an implementation science framework. Training and education‐related strategies and provision of interactive assistance were the implementation strategy clusters of the ERIC taxonomy where most implementation strategies were reported across the reviewed studies. Acceptability (82.1%), penetration (77.6%) and appropriateness (73.1%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient’s needs and resources and available resources (infrastructure) constructs as per the CFIR framework, reflected the most frequently reported barriers and facilitators to implementation.ConclusionCurrent studies focused largely on intervention outcomes rather than implementation outcomes and lacked detailed insights on inner and outer setting determinants of implementation success or failure. Future dementia studies must prioritize implementation science for more contextually relevant findings and structurally examine the mechanisms through which implementation partners can strategically leverage existing resources and regional networks to streamline local implementation. Mapping local evidence ecosystems will facilitate structured implementation planning and support implementation‐focused theory‐building.