eHealth Tools Research Articles

A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery.

The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P = 0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P = 0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P = 0.042) but mental-component HRQoL and depressive symptoms were unchanged. Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it. NCT03157973 (http://www.clinicaltrials.gov).

Patient Perspectives and Expectations in Inflammatory Bowel Disease: A Systematic Review.

BackgroundIn this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine.MethodsThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research checklist.ResultsOur search identified 240 citations and 52 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst patients with IBD.ConclusionThis systematic review demonstrates that patients with IBD expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to patients with IBD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10620-021-07025-y.

An eHealth Framework for Managing Pediatric Growth Disorders and Growth Hormone Therapy.

BackgroundThe use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder.ObjectiveOur objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy.MethodsA total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy.ResultsA total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed.ConclusionsThe use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway.

The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome.

BackgroundHealth care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes.ObjectiveThe aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators.MethodsA systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories.ResultsEleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)—all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely “deployment of human resources” (n=11), in the inner setting theme within the structure category; “ease of use” (n=16) and “technical issue” (n=10), both in the technology theme within the structure category; and “health logistics” (n=26), in the efficiency theme within the outcome category.ConclusionsThree principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results.

Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study.

BackgroundSelf-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.ObjectiveThis study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.MethodsThe eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months’ access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.ResultsThree main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants’ experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.ConclusionsFindings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.Trial RegistrationClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016851

Aplicación de la telemedicina en la asistencia a pacientes con cefaleas: situación actual y recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología

IntroductionThe COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. MethodThe study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology's Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. ResultsCOVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. ConclusionsThe GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre's management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

Using e-health tools and PROMs to support self-management in patients with inflammatory bowel disease

The use of digital health or e-health is growing. The potential positive impact on IBD care from supported self-management using these tools emerged from a literature review carried out in preparation for a service improvement project. A patient-reported outcomes measure (PROM) with validation across IBD sub-types was already available for use. This internationally recognised tool has potential for use with existing or new e-health systems. In order to test the concept of using PROMs to support practice and follow up a small-scale pilot study was designed. The aim of the study was to understand if empowering patients to undertake supported self-management could lead in turn to improved flow through outpatient services. An audit was carried out of PROMs looking at quality of life (QoL) as well as disease activity using an electronic platform in real time at the point of patient contact. The disease activity indices used were the Harvey Bradshaw Index and the Simple Clinical Colitis Activity Index, due to the author's familiarity with these tools. Of the 15 participants, 10 reported themselves as 'well' or 'well with questions' all participants reported an acceptance of supported remote self-management using e-health. This evaluation led to PROMs being captured on a tablet in the outpatient setting in the pre-pandemic period. Allowing patients to use the PROM as a tool in the outpatient setting has led to longitudinal data being added to the e-health system for each individual. Well patients could be managed remotely, freeing capacity in outpatient clinics.

EHealth for patients with rare diseases: the eHealth Working Group of the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN)

BackgroundThe European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) was launched in 2017 and involves, to date, 35 highly specialised multidisciplinary expert centres (from the 30 full Healthcare Provider members) coming from 11 countries and more than 70 patient organizations from 16 countries. The eHealth Working Group (WG) of VASCERN was set up to develop practical, patient-centred solutions and strategies for effective use of eHealth tools to answer the needs of patients with multisystemic vascular rare diseases.The eHealth WGFollowing the identified patients’ needs and following the guiding principles of collaboration and patient-centredness, the eHealth WG was created with the following aims: to develop a mobile app to help patients find expert centres and patient organizations, and to develop resources (Pills of Knowledge, PoK) for training and education via digital platforms (eLearning). The mobile app includes, to date, functionalities that allow users to find expert centres and patient organizations across Europe in the area of rare multisystemic vascular diseases. Discussed app developments include personalized digital patient passports, educational material, emergency management guidelines and remote consultations. Regarding training and education, a variety of PoK have been developed. The PoK cover several topics, target several user groups, and are delivered in various formats so that they are easy-to-use, easy-to-understand, informative, and viable for delivery and sharing through digital platforms (eLearning) including, e.g., the VASCERN YouTube™ channel.ConclusionOverall, the work carried out by the eHealth WG of VASCERN can be seen as a pilot experience that may serve as a basis to for collaborative development of patient-centred eHealth tools that answer the needs of patients with various rare diseases, not limited to rare multisystemic vascular diseases. By expanding the multidisciplinary approach here described, clinical and research networks can take advantage of eHealth services and use them as strategic assets in achieving the ultimate goal of ensuring equity of access to prevention programs, timely and accurate diagnosis and specialized care for patients with rare diseases throughout Europe.

Adaptation of a french e-health tool for suicide prevention in young populations: Modalities and benefits

IntroductionFrance’s suicide rate is among the highest in Europe, with the young among the more at risk than others. Several European projects have demonstrated the effectiveness of using e-tools in suicide prevention particularly for hard-to-reach populations. Lessons from StopBlues, an e-health tool (application/website) for suicide prevention in the general population developed in 2018 which was promoted by municipalities and general practitioners, shows the necessity to adapt its content for young people.ObjectivesThe objective is to develop an e-health tool, BlueZberry, for suicide prevention targeting adolescents and young adults with psychological pain by adapting StopBlues and its promotional plan.MethodsThe detailed content of BlueZberry and its promotional plan were determined via a literature review and 26 individual and group interviews with experts and youth with StopBlues as a starting part.ResultsThe literature review and interviews confirmed the need to adapt the tool according to age of the user since the context and source of psychological pain vary rapidly at this time of life. BlueZberry consists of three modules for age groups 12-14, 15-17 and 18-25 years with specific graphics and messages. Its locally organized promotion should include youth hangouts on top of usual places.ConclusionsThis adaptation of StopBlues will reach a larger audience by offering a more suitable solution for this vulnerable population. A web-portal will serve as an entry point for both StopBlues and BlueZberry where users will be redirected to one of the tools/modules according to their profile and respective needs.

The benefits of involving general practitioners in the promotion of e-health tools for primary prevention of suicide in the general population: The stopblues case

IntroductionIn France about 10,000 suicides/year are recorded. General practitioners (GPs) have an important role in prevention, with consultation rates between 20% and 76% the day preceding suicide. StopBlues is an application/website for primary prevention of suicide in the general population. Its promotion was supported by municipalities and involved GPs.ObjectivesTo evaluate how the involvement of GPs in the promotion of StopBlues had an impact on its utilization.MethodsStopBlues was promoted in 25 French municipalities randomly assigned to a ‘basic’ promotion group organized by municipalities only or an ‘intensified’ promotion group that also includes promotion in GPs’ waiting rooms. StopBlues users were asked how they found out about StopBlues. After two years, an ad hoc questionnaire was sent to all GPs (N=2,111).ResultsStopBlues users from those municipalities (N=885) were 16% to learn about StopBlues from GPs, 93% of them living in municipalities with ‘intensified’ promotion. In the ‘basic’ group, where no GPs have heard about StopBlues, 15% would like to know more about it/will have a look at it and 8% will use it and recommend it to colleagues. Half of GPs from the ‘intensified’ group had heard about the program, with 24% who recommended StopBlues to some patients. 21% of GPs agreed that they will use it and recommend it to colleagues.ConclusionsInvolving GPs in the use of e-health tools is of major interest to improve their utilization. Our results show that GPs are in need of those in dealing with patients with psychological pain/distress.DisclosureNo significant relationships.

A174 PATIENT PERSPECTIVES AND EXPECTATIONS IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW

Abstract Background Shared decision making is gaining favour in clinical practice and increasingly patients want to be involved in their disease process. Aims In this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research (SRQR) checklist. Results Our search identified 240 citations and 51 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst IBD patients. Conclusions This systematic review demonstrates that IBD patients expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to IBD patients. Funding Agencies None

A Store-forward Method for Biosignal Acquisition in Smart Health Care System using Wearable IoT Device

Smart Health Care System has been developed massively in the last decade. Internet of Things implementation has accelerated the development of smart health technology. Now people have realized the importance of doing independent health monitoring. Supported by more affordable e-health tools, motivation in using the smart health system is increasing. The availability of cloud as storage services triggers demands to always be connected to the Internet. However, there are times when interference occurs so the measurement results cannot be stored in the cloud database properly. The idea of using a store-forward mechanism to overcome the problem of disconnected smart healthcare system is proposed in this paper. From the test results, the data can be sent properly eventhough disconnected status occurs for 30 minutes. Smartwatch’s memory usage has increase 30 percent during temporary storage occupied.

Ten statements to support nurse leaders implement e-health tools for nursing work in hospitals: A modified Delphi study.

To use expert consensus to develop guidance for nurse leaders implementing e-health tools to support nursing work in hospitals. Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e-health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. A two-phase modified Delphi study. Phase one involved in-depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Ten guidance statements to support nurse leaders to implement e-health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55-item Delphi response survey. Implementation of e-health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e-health tools to support nursing work in hospitals. The ten statements developed by this research provide a resource to assist policy and practice decisions about e-tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e-health tools to ensure suitability and adaptation for nursing work in hospitals.

The psychological determinants of making lifestyle and dietary behaviours after using an online cognitive health tool and its associated recommendations for protective cognitive health behaviours

Background & objectivesThe Covid-19 pandemic has revolutionised how we receive services, with a huge shift to online delivery. Online health promotion tools could be a cost-effective and safe way to improve population health. We used mixed methods to explore user responses to an online cognitive health tool. Methods15–28 months after completing an online tool, comprising a cognitive test, lifestyle questionnaire; and dietary and lifestyle behaviour feedback, 4826 participants completed an online survey about their perceptions of it; and questions about their capability, opportunity and motivation for behavioural change developed using the COM-B behaviour change model. We reported how responses to the behaviour change questionnaire predicted decisions to make lifestyle and dietary changes. 24 participants attended focus groups to further explore their responses. ResultsMost users reported that the tool was useful (88%), with 37% reporting they made lifestyle or dietary changes after using it. More positive responses to questions regarding capability and motivation predicted making changes. Over a third (36%) felt more fearful after completing the tool. In qualitative findings, we identified barriers to engagement across the three COM-B domains: a sense that information was “nothing new” (so did not enhance capability); that “experts don’t agree” and that the tool may not be credible (influencing motivation), and a lack of support from peers and lower availability of healthy food (reducing opportunities for change). ConclusionsFuture e-health tools will be most effective if they have high credibility, demonstrate advice is evidence-based and provide opportunities for support and follow up.

The Effectiveness of mHealth and eHealth Tools in Improving Provider Knowledge, Confidence, and Behaviors Related to Cancer Detection, Treatment, and Survivorship Care: a Systematic Review.

Mobile health (mHealth) and eHealth interventions have demonstrated potential to improve cancer care delivery and disease management by increasing access to health information and health management skills. However, there is a need to better understand the overall impact of these interventions in improving cancer care and to identify best practices to support intervention adoption. Overall, this review intended to systematically catalogue the recent body of cancer-based mHealth and eHealth education and training interventions and assess the effectiveness of these interventions in increasing health care professionals’ knowledge, confidence, and behaviors related to the delivery of care along the cancer continuum. Our initial search yielded 135 articles, and our full review included 23 articles. We abstracted descriptive data for each of the 23 studies, including an overview of interventions (i.e., intended intervention recipients, location of delivery, topic of focus), study methods (i.e., design, sampling approach, sample size), and outcome measures. Almost all the studies reported knowledge gain as an outcome of the education interventions, whereas only half assessed provider confidence or behavior change. We conclude that there is some evidence that mHealth and eHealth interventions lead to improvements in cancer care delivery, but this is not a consistent finding across the studies reviewed. Our findings also identify gaps that should be addressed in future research, offer guidance on the utility of mHealth and eHealth interventions, and provide a roadmap for addressing these gaps.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-01961-z.

Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study

BackgroundEvidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure.ObjectiveThe objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption.MethodsData from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models.ResultsCompared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2% to 17.5% less) and mobile health for self-regulation (0.8% to 9.7% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8% higher in 2018, P=.01; 10.1% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95% CI 1.26-3.11).ConclusionsOur results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities.

Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review.

BackgroundCancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan.ObjectiveThis review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults?MethodsThis systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ≥65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format.ResultsA total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind and older adults’ lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults.ConclusionseHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population.

Development of an eHealth programme for self-management of persistent physical symptoms: a qualitative study on user needs in general practice

BackgroundPersistent physical symptoms (PPS) are estimated to be present in 17% of patients in general practice. Hence, general practitioners (GPs) play a key role in both the diagnostic assessment and the management of PPS. However, research indicates a need to improve their strategies to support self-help in patients, and eHealth tools may serve as an opportunity. This study aimed to explore patients’ and GPs’ needs related to self-management of PPS. The study was designed to inform the future development of eHealth interventions in this field.MethodsThis qualitative study was based on 20 semi-structured interviews (6 GPs and 14 patients with PPS). Interviews were audiotaped, transcribed verbatim and analysed through a five-step thematic analysis approach. First, we conducted an inductive analysis to identify and explore emerging subthemes. Second, using a deductive mapping strategy, we categorised the derived subthemes according to the COM-B behaviour change model and its three domains: capability, opportunity and motivation.ResultsWe identified eleven subthemes in the patient interviews and seven subthemes in the GP interviews. Several unmet needs emerged. First, we identified a need to consider PPS early in the illness trajectory by taking a bio-psycho-social approach. Second, both patients and GPs need better skills to manage uncertainty. Third, hope is important for the patients. Fourth, patients need guidance from their GP in how to self-manage their PPS.ConclusionsThis study provides important insight into key issues and needs related to capability, opportunity and motivation that should be addressed in the design of future eHealth self-management interventions targeting patients with PPS in general practice in order to support and improve care.

Primary Health Care Providers' Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study.

PurposePhysical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers’ perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings.MethodsThis qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data.ResultsThree physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15–100 patients/day (median 40) and spent 2–20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients’ limitations.ConclusionA well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.

Seasonality of Back Pain in Italy: An Infodemiology Study.

Background: E-health tools have been used to assess the temporal variations of different health problems. The aim of our infodemiology study was to investigate the seasonal pattern of search volumes for back pain in Italy. Methods: In Italian, back pain is indicated by the medical word “lombalgia”. Using Google Trends, we selected the three search terms related to “lombalgia” with higher relative search volumes (RSV), (namely, “mal di schiena”, “dolore alla schiena” and “dolore lombare”), representing the semantic preferences of users when performing web queries for back pain in Italy. Wikipedia page view statistics were used to identify the number of visits to the page “lombalgia”. Strength and direction of secular trends were assessed using the Mann–Kendall test. Cosinor analysis was used to evaluate the potential seasonality of back pain-related RSV. Results: We found a significant upward secular trend from 2005 to 2020 for search terms “mal di schiena” (τ = 0.734, p < 0.0001), “dolore alla schiena” (τ = 0.713, p < 0.0001) and “dolore lombare” (τ = 0.628, p < 0.0001). Cosinor analysis on Google Trends RSV showed a significant seasonality for the terms “mal di schiena” (pcos < 0.001), “dolore alla schiena” (pcos < 0.0001), “dolore lombare” (pcos < 0.0001) and “lombalgia” (pcos = 0.017). Cosinor analysis performed on views for the page “lombalgia” in Wikipedia confirmed a significant seasonality (pcos < 0.0001). Both analyses demonstrated a peak of interest in winter months and decrease in spring/summer. Conclusions: Our infodemiology approach revealed significant seasonal fluctuations in search queries for back pain in Italy, with peaking volumes during the coldest months of the year.