eHealth Tools Research Articles

THU0581 USE OF EHEALTH BY PATIENTS WITH RHEUMATOID ARTHRITIS: AN OBSERVATIONAL, CROSS SECTIONAL, MULTICENTER STUDY

Background:The use of eHealth tools (internet, mobile applications, connected devices) in chronic diseases and in the field of rheumatoid arthritis (RA) is growing (1). eHealth may improve the overall care of patients suffering from chronic diseases (2,3).Objectives:The main objective of this study was to describe the use of eHealth by RA patients in France. The secondary objectives were to identify differences in demographic and disease characteristics between patients using eHealth tools or not. We also assessed patients’ expectations about digital devices.Methods:We conducted a cross-sectional, multicenter study. Patients with RA according to the ACR / EULAR 2010 criteria were recruited in 5 university hospitals (Bordeaux, Clermont-Ferrand, Limoges, Montpellier and Toulouse). Patients completed an anonymous self-questionnaire including demographic data, assessment about the use of eHealth (access, support, frequency of use, type of use, reason for use). The treating rheumatologist of the patient filled in an independent medical questionnaire collecting the disease characteristics, the activity of RA and the treatments. Data were collected from December 2018 to July 2019.Results:The questionnaires were completed by 575 patients, with an average age of 62±13 years, 78% of whom were women. 473 (82%) patients had access to eHealth through a computer (n=402, 86%), a tablet (n=188, 40%) and/or a smartphone (n=221, 47%). Among them, 36% (170/473) used internet for health in general and 29% (134/473) specifically for RA. Regarding the use of eHealth for RA, all patients used it to learn about their disease and 66% (89/134) as a tool to help monitoring RA. Most of them (n=87/125, 70%) had a paper medical record, 24/125 patients (19%) used a digital tool (spreadsheet n=10, 8% and / or mobile application n=9, 7% and / or website n=5, 4%) and 31/125 patients (25%) did not use any tool to monitor their RA. Few patients (16/126, 13%) used numeric reminders for their treatments. A specific application for RA was used by 27/127 patients (21%) using eHealth. Age, level of study, employment, treatment, comorbidities, membership of a patient association group and patient education program were associated with the use of eHealth for RA in univariate analysis. In multivariate analysis, membership of patient’s association (OR: 5.8 [3.0-11.2]), bDMARDs use (OR: 0.6 [0.4-1]) and comorbidities (OR: 0.7 [0.6-0.8]) remained associated with eHealth use for RA. According to the patients, recommendation by a doctor (n=225/330, 68%), ease of use (n=105/330, 32%) and data security (n=69/330, 21%) were the factors that would favor the use of eHealth.Conclusion:To date, few patients used eHealth for their disease. The use of a reliable and validated eHealth tool in RA could therefore be promoted by rheumatologist and might optimize the therapeutic adherence.

E-health and multiple sclerosis.

To outline recent applications of e-health data and digital tools for improving the care and management of healthcare for people with multiple sclerosis. The digitization of most clinical data, along with developments in communication technologies, miniaturization of sensors and computational advances are enabling aggregation and clinically meaningful analyses of real-world data from patient registries, digital patient-reported outcomes and electronic health records (EHR). These data are allowing more confident descriptions of prognoses for multiple sclerosis patients and the long-term relative benefits and safety of disease-modifying treatments (DMT). Registries allow detailed, multiple sclerosis-specific data to be shared between clinicians more easily, provide data needed to improve the impact of DMT and, with EHR, characterize clinically relevant interactions between multiple sclerosis and other diseases. Wearable sensors provide continuous, long-term measures of performance dynamics in relevant ecological settings. In conjunction with telemedicine and online apps, they promise a major expansion of the scope for patients to manage aspects of their own care. Advances in disease understanding, decision support and self-management using these Big Data are being accelerated by machine learning and artificial intelligence. Both health professionals and patients can employ e-health approaches and tools for development of a more patient-centred learning health system.

State of eHealth in Cancer Care: Review of the Benefits and Limitations of eHealth Tools.

eHealth has the potential to improve patient access to care through the use of various tools. This article provides a review of some eHealth technologies, including a discussion of their benefits and limitations. An overview of studies using eHealth technologies are summarized, and future directions are explored. A review of the eHealth literature was conducted, with a focus on outcomes of telehealth interventions in cancer care. eHealth can transform health care by expanding the reach of clinical cancer care. Examples of this expansion of care include patients who live in remote areas with limited access to oncology providers, patients who find travel challenging, and patients who prefer the convenience of communicating with their provider from their home. Such telehealth interventions can increase patient satisfaction, but additional research is needed to further evaluate patient outcomes.

Patients’ experiences of using an e-Health tool for self-management support after prostate cancer surgery: a deductive interview study explained through the FITT framework

ObjectiveTo evaluate patients’ experiences of using a web-based application, especially its usability as support for self-care activities after prostate cancer surgery.DesignA deductive content analysis was used, stemming from the Fit...

Usability, acceptability, and feasibility of the Implementation of Infant Pain Practice Change (ImPaC) Resource.

The Implementation of Infant Pain Practice (ImPaC) Resource is an eHealth tool designed to support infant pain practice change and ultimately enhance pain outcomes. The aim of this study was to determine users' perspectives on usability, acceptability, and feasibility of the ImPaC Resource. A descriptive prospective mixed‐methods quality improvement study was conducted at a pediatric hospital in Canada. Individual “think aloud” interviews were conducted in a nonclinical environment (Phase A); “near live” testing was conducted while users interacted with the Resource in clinical setting (Phase B); individual “think‐aloud” interviews were conducted in a nonclinical environment (Phase C). Outcomes included usability (System Usability Scale—SUS), acceptability (Acceptability E‐Scale—AES), and feasibility. Interview transcripts were coded per a priori themes using deductive content analysis to create a structured categorization matrix. In Phase A, 10 clinicians interacted with the Resource in individual sessions. Median SUS score was 73.75 (range 52.5‐92.5). In Phase B, four clinicians implemented the Resource in the neonatal intensive care unit (NICU) over 4 months. Median SUS score was 85 (82.5‐92.5), and median AES score was 24 (21‐24). In Phase C, an enhanced prototype was produced, and the same users from Phase B navigated the Resource in individual sessions. Median SUS score was 88.75 (85‐95), and median AES score was 27.5 (25‐29). Users considered the Resource as feasible for implementation, easy to navigate, engaging, intuitive, comprehensive, and evidence‐based. Users highlighted the potential transferability of the Resource to other contexts and settings. The enhanced version of the ImPaC Resource was usable, acceptable, feasible, and met users' expectations and requirements. Results lead the way for evaluation of the Resource in a nationwide cluster randomized trial including 18 NICUs. This knowledge‐rich platform is expected to enhance infant pain practices and outcomes in diverse clinical settings.

A Digital Patient Portal for Patients With Multiple Sclerosis.

Background: Multiple Sclerosis is a chronic inflammatory disease of the central nervous system that requires a complex, differential, and lifelong treatment strategy, which involves high monitoring efforts and the accumulation of numerous medical data. A fast and broad availability of care, as well as patient-relevant data and a stronger integration of patients and participating care providers into the complex treatment process is desirable. The aim of the ERDF-funded project “Integrated Care Portal Multiple Sclerosis” (IBMS) was to develop a pathway-based care model and a corresponding patient portal for MS patients and health care professionals (HCPs) as a digital tool to deliver the care model.Methods: The patient portal was created according to a patient-centered design approach which involves both the patients' and the professionals' view. Buurmann's five iterative phases were integrated into a design science research process. A problem analysis focusing on functions and user interfaces was conducted through surveys and workshops with MS patients and HCPs. Based on this, the patient portal was refined and a prototype of the portal was implemented using an agile software development strategy.Results: HCPs and patients already use digital hardware and are open to new technologies. Nevertheless, they desire improved (digital) communication and coordination between care providers. Both groups require a number of functions for the patient portal, which were implemented in the prototype. Usability tests with patients and HCPs are planned to consider whether the portal is deemed as usable, acceptable as well as functional to prepare for any needed ameliorations.Discussion: After testing the patient portal for usability, acceptability, and functionality, it will most likely be a useful and high-quality electronic health (eHealth) tool for patient management from day care to telerehabilitation. It implements clinical pathways in a manner which is comprehensible for patients. Future developments of the patient portal modules could include additional diseases, the integration of quality management and privacy management tools, and the use of artificial intelligence to personalize treatment strategies.

Preparing for an orthopedic consultation using an eHealth tool: a randomized controlled trial in patients with hip and knee osteoarthritis

BackgroundTo evaluate the effect of a stand-alone mobile and web-based educational intervention (eHealth tool) compared to usual preparation of a first orthopedic consultation of patients with hip or knee osteoarthritis (OA) on patients’ satisfaction.MethodsA two-armed randomized controlled trial involving 286 patients with (suspicion of) hip or knee OA, randomly allocated to either receiving an educational eHealth tool to prepare their upcoming consultation (n = 144) or usual care (n = 142). Satisfaction with the consultation on three subscales (range 1–4) of the Consumer Quality Index (CQI - primary outcome) and knowledge (assessed using 22 statements on OA, range 0–22), treatment beliefs (assessed by the Treatment beliefs in OsteoArthritis questionnaire, range 1–5), assessment of patient’s involvement in consultation by the surgeon (assessed on a 5-point Likert scale) and patient satisfaction with the outcome of the consultation (numeric rating scale), were assessed.ResultsNo differences between groups were observed on the 3 subscales of the CQI (group difference (95% CI): communication 0.009 (− 0.10, 0.12), conduct − 0.02 (− 0.12, 0.07) and information provision 0.02 (− 0.18, 0.21)). Between group differences (95% CI) were in favor of the intervention group for knowledge (1.4 (0.6, 2.2)), negative beliefs regarding physical activities (− 0.19 (− 0.37, − 0.002) and pain medication (− 0.30 (− 0.49, − 0.01)). We found no differences on other secondary outcomes.ConclusionsAn educational eHealth tool to prepare a first orthopedic consultation for hip or knee OA does not result in higher patient satisfaction with the consultation, but it does influence cognitions about osteoarthritis.Trial registrationDutch Trial Register (trial number NTR6262). Registered 30 January 2017.

Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project.

Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients.

Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective.

Telemedicine and e-Health Solutions for COVID-19: Patients' Perspective.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems.

Introduction eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. Materials and Methods In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). Results 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. Conclusions Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.

Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool.

BackgroundSpinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic‐like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient‐specific recommendations for referral and selection of SCS in chronic pain.MethodsA multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in four pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment.ResultsAppropriateness of SCS was strongly determined by the neuropathic or neuropathic‐like pain component, location and spread of pain, anatomic abnormalities and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were as follows: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and unwillingness to reduce high‐dose opioids. An educational e‐health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS.ConclusionsThe RUAM was useful to establish a consensus on patient‐specific criteria for referral/selection for SCS in chronic pain. The e‐health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors.SignificanceDetermining the eligibility of SCS in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e‐health tool (https://www.scstool.org/).

Rhinology Future Debates 2018, a EUFOREA Report.

The third Rhinology Future Debates was organized by the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) in 2018 in Brussels. Experts from different specialties and countries, alongside patients, health policy makers and industry representatives discussed relevant topics in Rhinology, in an attempt to improve current clinical practices, through implementation of precision medicine, by empowering patients' participation and the use of eHealth tools. The debates which are available on-line (www.rhinology-future.com) dealt with 5 topics in Rhinology: the adoption of allergen-specific immunotherapy (AIT) by implementing change management strategies, the needs and obstacles in care delivery in respiratory diseases, 3D technology in nose and sinus surgery, ambulatory nasal surgery, and clinical evidence for efficacy of biologicals in CRSwNP and asthma. This report summarizes the outcomes of the brainstorming sessions highlighting novel approaches and unmet needs in the field of respiratory diseases by focusing on integrated care pathways.

Exploring User-Centreddesign Features for E-health Applications to Support Physical Activity Behaviors in Solid Organ Transplant Recipients

Despite the benefits of physical activity (PA) after solid organ transplant (SOT), low PA levels persist. Electronic-health (e-health) tools may be effective in engaging SOT recipients in adopting/maintaining a physically active lifestyle. This study explores from the perspective of SOT recipients, barriers and motivators to exercise, and core features of an e-health tool that may address adoption and maintenance of PA. A qualitative, descriptive study was conducted with SOT recipients, age >18, residing in Canada, who received a transplant at least 1 year ago. Semi structured interviews were conducted in English or French. Thematic analysis, via NVivo 12 was conducted. 21 participants (11 men, 10 women, aged: 47 ±15 years) completed interviews. Transplant type included heart = 4, lung =3, liver = 5, kidney = 5, multi-organ = 4. Emerging findings suggest that motivations to exercise are driven by increasing quality of life and longevity, honouring donors and second chances, new physical abilities and sensations, and SOT community engagement and support. Identified barriers to exercise are risk aversion, frequent appointments, health disruptions (i.e. illness and injury) and limited access to appropriate fitness facilities/advice/training. Lung recipients have concerns about oxygen saturation and immediate availability of supplemental oxygen, while heart recipients have concerns about over exertion. For both heart and lung groups, concerns about immunosuppression are a barrier. Desired features in an eHealth tool include comfortable, user friendly design, smart reward systems recognizing the PA trajectories of SOT recipients, possibility of sharing data with health care teams/other SOT recipients, capability of supporting multiple facets of SOT recipient specific health (water intake, medication reminders), and access to transplant specific fitness and diet guidance. A reliable heart rate monitor is stressed by heart transplant recipients, and for lung transplant recipients, oxygen saturation monitors. Emergent findings suggest that SOT recipients have unique relationships with PA based on transplant type. These results suggest that an e-health tool with modifiable features depending on transplant type, may be of value.

The Role of e-Health in the Delivery of Care for Patients with Hematological Cancers: A Systematic Literature Review

Background: Hematological cancer survivors have significant unmet needs. The use of e-health interventions has been shown to be effective in improving patient experiences and outcomes in other diseases. The aim of this review is to explore the role of e-health interventions in the delivery of care for patients with hematological cancers across the illness trajectory. Methods: A systematic narrative review approach using thematic analysis was used to identify the key issues and themes in the literature. Medical subject headings and keywords were used in several databases: Medline, Embase, PsycInfo, CINAHL, and The Cochrane Collaboration Cochrane Review Database. This review focuses on the use of e-health interventions for patients with hematological cancers within any study design. Results: Twenty-three (n = 23) studies were identified in this review. The studies were of varying designs: randomized controlled trials (n = 6); pre- and postdesign (n = 1); feasibility and acceptability (n = 11) and varying methodological quality. Seven studies included patients with any cancer diagnosis rather than focusing specifically on hematology patients. Our thematic analysis identified four main categories of intervention: information provision (n = 4); self-help (n = 6); communication facilitation (n = 5); and patient-reported outcome recording or monitoring (n = 8). Conclusion: The clinical management of patients with hematological cancers, particularly those in survivorship, presents opportunities to explore e-health approaches to improve patient care. This review highlights that e-health tools may be acceptable and feasible to use with a hematology patient population, but more robust and well-designed trials that engage patients and health professionals are required to determine which and how interventions can be used most effectively.

Supporting colorectal cancer survivors using eHealth: a systematic review and framework suggestion.

eHealth could potentially support colorectal cancer survivors; however, little is known regarding the overall recent eHealth systems for colorectal cancer survivors. The present study was conducted to address which types of eHealth supports have been provided to colorectal cancer survivors in the past two decades. An electronic search was conducted in four databases including Scopus, PubMed, Embase, and Web of Science. The search query was based on two concepts: the first concept represented colorectal cancer and the second one comprised of information technology tools. The search was limited to 20years (from 19 January 1999 to 19 January 2019). Obtained results were tabulated and represented as a framework. Fifteen papers were included in this systematic review. Information including intervention type, eHealth tools, main features of the system, and outcomes were extracted from selected papers. Obtained results were characterized using a four-layer framework. This framework included layers of hardware, software, service (educating the patient, medication intake, physical activity, health status monitoring, hospital visit reminder, and discussion group), and outcome. Outcome layer was composed of the following domains: quality of life, psychological and cognitive, physical activity, physical functioning, symptoms, engagement, and the outcome of the process and IT tools. eHealth could provide useful services for supporting colorectal cancer survivors. Represented framework might be used for a better understanding of current technology and services provided to support these survivors. Also, this framework may be used as a basis for designing eHealth applications for colorectal cancer survivors after further validations.

Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Tromsø Study - Part 3): Population-Based Questionnaire Study.

BackgroundElectronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients’ psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature.ObjectiveThis study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools.MethodsWe analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models.ResultsThe use of eHealth tools made 72.41% (6740/9308) of the participants feel more knowledgeable and 47.49% (4421/9308) of the participants feel more reassured about their health status. However, 25.69% (2392/9308) reported feeling more anxious and 27.88% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services.ConclusionsThe search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web.

Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial.

BackgroundPhysical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common.ObjectiveThis study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA counseling by PCPs and estimate intervention effectiveness on patients’ PA levels.MethodsA pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with 4 pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants before their PHR via an email or a tablet; data were used to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on the Health Action Process Approach behavior change theory.ResultsA total of 1028 patients receiving care from 34 PCPs were invited to participate and 530 (51.55%) consented (intervention [n=296] and control [n=234]). Of the participants who completed a process evaluation, almost half (88/178, 49.4%) stated they received a PA prescription, with only 42 receiving the full intervention including tailored resources from their PCP. A cluster-level linear regression analysis yielded a non–statistically significant positive difference in MET-minutes reported per week at follow-up between intervention and control conditions (mean difference 1027; 95% CI −155 to 2209; P=.09). No statistically significant differences were observed for secondary outcomes.ConclusionsOur results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but suboptimal intervention fidelity suggests greater work must be done to address PCP barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data.Trial RegistrationClinicalTrials.gov NCT03181295; https://clinicaltrials.gov/ct2/show/NCT03181295

Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis.

BackgroundElectronic health (eHealth) tools are increasingly being applied in health care. They are expected to improve access to health care, quality of health care, and health outcomes. Although the advantages of using these tools in health care are well described, it is unknown to what extent eHealth tools are effective when used by vulnerable population groups, such as the elderly, people with low socioeconomic status, single parents, minorities, or immigrants.ObjectiveThis study aimed to examine whether the design and implementation characteristics of eHealth tools contribute to better use of these tools among vulnerable groups.MethodsIn this systematic review, we assessed the design and implementation characteristics of eHealth tools that are used by vulnerable groups. In the meta-analysis, we used the adherence rate as an effect size measure. The adherence rate is defined as the number of people who are repetitive users (ie, use the eHealth tool more than once). We also performed a meta-regression analysis to examine how different design and implementation characteristics influenced the adherence rate.ResultsCurrently, eHealth tools are continuously used by vulnerable groups but to a small extent. eHealth tools that use multimodal content (such as videos) and have the possibility for direct communication with providers show improved adherence among vulnerable groups.ConclusionseHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups. However, most of the eHealth tools are not embedded within the health care system. They are usually focused on specific problems, such as diabetes or obesity. Hence, they do not provide comprehensive services for patients. This limits the use of eHealth tools as a replacement for existing health care services.

When people who inject drugs speak: Qualitative thematic analysis of the perception of a mobile app for needle exchange programs.

Spain is the Western European country with the highest prevalence of Human Immunodeficiency Virus among people who inject drugs. The Hepatitis-C Virus affects over fifty per cent of this population. At the same time, the World Health Organization considers that the average coverage of injection material for drug user per year is low. Harm reduction programs and services have been deployed for over thirty years, and these could now incorporate the advantages of eHealth and mHealth to improve harm reduction. The aim of this qualitative and descriptive study is to analyze how people who inject drugs perceive an application for mobile devices. Fifty-one such drug users participated actively in five focus groups. The main results of the thematic content analysis indicated that the application was welcomed as easy and useful. Participants reported that the application contributed to improving access to injection material, reducing the stigma of drug-dependence and optimizing the organization of the ritual of injection. Excessive preventive information and problems downloading the web app were identified as aspects for improvement. In conclusion, the application was seen as a useful eHealth tool that complements the normal intervention of needle exchange programs.

Understanding Nutritional Problems of Metastatic Breast Cancer Patients: Opportunities for Supportive Care Through eHealth.

Metastatic breast cancer patients are now living longer but cope with potential symptoms of metastatic disease and prolonged cancer treatment. Nutrition can play a vital role in managing these sequelae, and eHealth tools are emerging as promising delivery options for nutrition interventions. To qualitatively assess nutritional problems and concerns of women with metastatic breast cancer and to explore how to address these problems within an existing eHealth platform. Semistructured interviews were conducted with 21 women with metastatic breast cancer participating in an ongoing eHealth study. Interviews were audiotaped, transcribed verbatim, and analyzed using a team-based content analysis approach. Most respondents reported currently or previously experiencing nutritional problems due to adverse effects of cancer treatment or the disease itself; these were rarely addressed during routine clinical care. Five major themes emerged: (1) knowledge about nutrition, (2) nutrition information-seeking, (3) social aspects of nutrition, (4) nutrition interest, and (5) how to address nutrition with an eHealth platform. The respondents reported diverse experiences and perspectives regarding nutrition and diet in the context of metastatic breast cancer within each theme. Findings indicate the importance of providing women with metastatic breast cancer with information about nutrition that is tailored to their specific disease, as these patients report both nutritional problems and uncertainty regarding nutritional strategies. These findings are a first step toward designing supportive care interventions that could fill the gap related to nutritional concerns not addressed during routine clinical care.