Health Preparedness Research Articles

Digital Health Readiness: Making Digital Health Care More Inclusive.

This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person's stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person's goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care.

Prevalence of visual abnormalities detected through paediatric vision screening in Queensland, Australia.

Vision screening programs can provide epidemiological information regarding visual impairment in children. This study aims to report the characteristics of visual abnormalities diagnosed through the Primary School Nurse Health Readiness Program (PSNHRP) in Queensland, Australia. A retrospective review of vision screening records from the PSNHRP between January 2017 and December 2020 was undertaken. Children aged between 4 and 7 who underwent vision screening were included for review. Children with a visual acuity of worse than 6/9-1 using the Parr 4 m letter-matching chart or those who failed the SPOT Vision Screener were referred to an optometrist or ophthalmologist for review. 164 890 children underwent vision screening. 12148 children failed visual screening (7.4%) and were referred for an eye assessment. 6011 (69.4%) of the 8659 children who attended ophthalmic review had a confirmed visual abnormality. Of 164 890 screened children, 1187 (0.72%) were confirmed to have anisometropia, 3843 (2.33%) had refractive error, 194 (0.12%) had strabismus, 755 (0.46%) had anisometropic amblyopia, 136 (0.08%) had strabismic amblyopia, and 1356 (0.82%) had an unspecific abnormality. There was no statistically significant difference in the age at screening between any visual abnormality (p = 0.94). Anisometropia, refractive error, and strabismus were significantly more common in females than males (p = 0.03, p < 0.01, and p = 0.03 respectively), whereas anisometropic amblyopia was more common in males (p < 0.01). We report the prevalence of visual abnormalities detected through the PSNHRP vision screening program. Identification of medical or socioeconomic risk factors that are likely to be associated with visual abnormalities can help to optimise vision screening programs.

Digital Health Readiness and Health Equity

Digital Health Readiness and Health Equity

Development and Preliminary Validation of a Screener for Digital Health Readiness

While telehealth use has grown, patient uptake is variable, which has the potential to increase health disparities. Identifying and understanding individuals' barriers to digital health readiness can help health systems efficiently deploy resources to provide personalized patient-centered support. To develop and validate an instrument to evaluate digital health readiness to identify and quantify barriers to digital readiness. In this qualitative mixed-methods study conducted from April 26, 2022, to June 8, 2023, the instrument was created in 4 phases. Patients and health care professionals were interviewed to explore barriers to telehealth use, scale items were developed for the screener, cognitive interviews were conducted to refine scale items, and psychometric properties of the screener were evaluated. The study was conducted in an urban, multisite academic health system and the surrounding community. Participants were older than 18 years, English-speaking, and able to provide informed consent. Professionals worked within the Jefferson Health system and were involved in telehealth services. Participants completed a semistructured interview (duration: 6-19 minutes), a cognitive interview (duration: 13-137 minutes), or the draft screener survey (duration: 5-10 minutes). Development and validation of a screener for digital health readiness. Of 519 patients approached, 19 were ineligible, 122 declined, and 11 were excluded from analysis, resulting in inclusion of 367 participants (32 patient interviews, 16 professional interviews, 15 cognitive interviews, 304 psychometric survey testing). All 16 professionals who were approached participated. Most patient participants were Black (46.7%) or White (37.9%), male (56.4%), and had a high school degree or some college (49.6%); mean (SD) age was 45 (23) years for participants in cognitive interviews, 53 (18) years for survey respondents, and 57 (14) years for patient interviews. The structured interviews uncovered 21 concepts, leading to 48 items that were refined through cognitive interviews. Psychometric analyses of the 29 items that emerged from the cognitive interviews resulted in a final screener with 24 items across 2 factors: technical readiness (18 items; factor loading range, 0.488-0.968) and quality-of-care concerns (6 items; factor loading range, 0.619-0.942). In this qualitative study of digital health readiness, the findings suggest that the screener items may be valid to assess the complexity of factors influencing digital health uptake and highlight several areas for potential intervention.

“Addressing barriers to digital health readiness among a Latino population”

ObjectiveThere are many potential barriers to an individual's readiness and ability to use telehealth, including technology access, trust and knowledge. This qualitative study was a partnership between Jefferson and Esperanza Health Center (EHC), focused on addressing barriers to digital readiness among the Latino population served by EHC. MethodsWe conducted semi-structured interviews with Latino patients to assess their experiences with technology and willingness to learn more about technology for healthcare. Interviews were transcribed, coded, and analyzed using a content analysis approach. ResultsWe completed 28 interviews. Most interviews (n = 23, 82 %) were conducted in Spanish. Barriers to using health technology included forgetting passwords, platforms not being available in multiple languages, and lacking digital skills. ConclusionParticipants identified a need and interest in receiving support to develop technological skills needed to access health information and engage in digital health services. Future work is needed to develop patient-centered interventions to support the digital health readiness needs of underserved populations. InnovationHealthcare systems and community health organizations can partner to build the capacity of community members to identify barriers in digital health use. These partnerships have the potential to empower communities to create culturally sensitive interventions that aim to increase digital health literacy.

Development and Validation of a Mobile-Centered Digital Health Readiness Scale (mDiHERS): Health Literacy and Equity Scale.

There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness. We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services. This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale's validity and reliability were assessed through exploratory factor analysis and Cronbach α. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings. The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale's construct validity, with 4 factors explaining 65.05% of the total variance. The scale's reliability was established with Cronbach α values ranging from 0.84 to 0.91. The scale's development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy. The mDiHERS is a validated tool for measuring patients' readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care.

Narrative Preparedness: Policy-makers Must Engage with People's Values and Experiences to Ensure Effective Implementation of Interventions in Health Emergencies; Comment on "Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness"

Engebretsen and Baker’s conceptual paper ‘Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness’ advocates for the adoption of narrative preparedness in addition to health preparedness, emphasising the importance of engaging with people's stories and values during health emergencies. This ensures that policymakers and health authorities gain the trust of communities as there is evidence this leads to improved outcomes. Their key argument is that science cannot be used effectively in policy unless it makes sense to people and is presented in a way that resonates with their values. This commentary draws on the wider literature and some key examples showing the wisdom of this approach. However, it also suggests that to be successful in integrating narrative preparedness in policy we need to look beyond working with health authorities and use a more transdisciplinary approach as well as addressing both the process and normative challenges in its adoption.

Digital health readiness for Japanese patients with cardiovascular disease

Digital health readiness for Japanese patients with cardiovascular disease

Digital health readiness, health literacy, and patients' awareness in cardiac (tele)rehabilitation participation

Digital health readiness, health literacy, and patients' awareness in cardiac (tele)rehabilitation participation

Longitudinal association of health behaviors and health-related quality of life with military spouse readiness.

Unhealthy behaviors impose costs on health-related quality of life (HRQOL) reducing productivity and readiness among military members (Hoge et al., JAMA 295:1023-32, 2006; Mansfield et al. 362:101-9, 2010). Among married personnel in particular, patterns of spouse health behaviors may play an interdependent role. As a result, the identification of military spouse health factors related to readiness may inform strategies to screen for and identify those in need of greater support and enhance readiness. This study explored behavioral and HRQOL predictors and potential mediators of military spouse readiness utilizing data from the Millennium Cohort Family Study. The analytic sample comprised of 3257 spouses of active-duty, non-separated service members who responded to both waves 1 and 2 of the survey. Sample characteristics are described with respect to demographics (e.g., age, sex, race/ethnicity, etc.), readiness measures (i.e., military satisfaction, lost workdays, health care utilization, military-related stress, and satisfaction), health behaviors (i.e., exercise, sleep, smoking, and alcohol use) and HRQOL (Veterans RAND 12-Item Short Form Survey). We conducted multivariate mediation analyses to evaluate the role of mental and physical HRQOL as mediators between the baseline health behaviors and the health readiness outcomes at follow-up, while adjusting for spouse and service member demographics. HRQOL had direct effects for all five readiness outcomes examined. Multiple health behaviors (insomnia, smoking, binge drinking, and exercise) were further significantly associated with spouse readiness outcomes, although most effects were mediated through HRQOL, suggesting this may be a useful index of military spouse readiness. Insomnia was the specific health behavior most consistently associated with poorer readiness across outcomes, and effects were only partially mediated by physical and mental HRQOL. The results show spouse health behaviors are directly and indirectly (through HRQOL) associated with readiness indicators. This suggests that assessments of modifiable health behaviors (e.g., insomnia symptoms) and mental and physical HRQOL are important indicators of readiness among military spouses and should be used to inform future programs designed to improve population health.

Investing in health preparedness, response and resilience: a genomics costing tool focused on next generation sequencing.

The world has seen unprecedented gains in the global genomic surveillance capacities for pathogens with pandemic and epidemic potential within the last 4 years. To strengthen and sustain the gains made, WHO is working with countries and partners to implement the Global Genomic Surveillance Strategy for Pathogens with Pandemic and Epidemic Potential 2022-2032. A key technical product developed through these multi-agency collaborative efforts is a genomics costing tool (GCT), as sought by many countries. This tool was developed by five institutions - Association of Public Health Laboratories, FIND, The Global Fund to Fight AIDS, Tuberculosis and Malaria, UK Health Security Agency, and the World Health Organization. These institutions developed the GCT to support financial planning and budgeting for SARS-CoV-2 next-generation sequencing activities, including bioinformatic analysis. The tool costs infrastructure, consumables and reagents, human resources, facility and quality management. It is being used by countries to (1) obtain costs of routine sequencing and bioinformatics activities, (2) optimize available resources, and (3) build an investment case for the scale-up or establishment of sequencing and bioinformatics activities. The tool has been validated and is available in English and Russian at https://www.who.int/publications/i/item/9789240090866. This paper aims to highlight the rationale for developing the tool, describe the process of the collaborative effort in developing the tool, and describe the utility of the tool to countries.

Training of future physical education teachers to physical culture and health activities in the secondary school

The article examines the actual problems of training of future physical education teacher for physical culture and health activities in a secondary school. The process of preparing students of the Faculty of Physical Education and Sports for the organization of a physical culture and health environment at school has been revealed. The components of physical culture and health activities and the level of training of students for this type of activity are established. It has been proven that the issues of physical culture and health activities in Ukrainian schools are quite relevant for improving physical fitness, harmonious development and recovery of students. The purpose of the work is to establish the level of readiness of future physical education teacher for physical culture and health activities in a secondary school. The research methodology was to reveal the current state of solving the problem of training future physical education teachers for physical culture and health activities in a secondary school using analytical investigation methods and problem-based research methods. The following scientific methods were used in the study: analysis of literary sources, pedagogical observation, conversation, questionnaires, expert assessment and self-assessment of the level of knowledge, skills and abilities in physical culture and health activities, methods of mathematical statistics. The research was carried out at Zhytomyr Ivan Franko State University in 2021–2023, in which students of the third and fourth years (84 persons) of the Faculty of Physical Education and Sports took part, who are studying under the educational and professional bachelor's program in the field of knowledge 01 Education/Pedagogy, specialty 014, Secondary education in subject specialty 014.11 Secondary education (Physical culture). The scientific novelty consists in the disclosure of the dynamics of the formation of physical culture and health readiness of students of the Faculty of Physical Education and Sports for professional activities at school. Third-year students have a low level of readiness for physical education and health activities at school (61.1–65.1 points). The students of the fourth course showed good grades (73.2–76.9 points) in all components of readiness for physical culture and health activities. Conclusions. The preparation of future physical education teacher for physical culture and health activities at school can be presented as a system of organizational, psychological and pedagogical measures of a higher education institution aimed at acquiring knowledge, abilities and skills in health preservation and experience of implementing various forms of physical culture.

Determinant of Early Marriage Adolescent to Risk Giving Birth Child in Case of Stunting

Background: Early marriage by adolescents aged less than 16 years can affect the reproductive health readiness of mothers or prospective mothers in giving birth to children with low birth weight potential and risk of stunting. Method: The method used for systematic article review was obtained from 5 databases with 15 relevant articles screened using the PRISMA method. Results: The results of the data obtained are that economic status is very influential on the incidence of stunting, this is due to poor fulfillment of toddler nutrition, lack of education of parents of toddlers, and lack of information and access to good health services. Conclusion: Educational background, economic status, cultural background and environment are the strongest factors that can encourage early marriage for adolescents with the majority living in less developed areas.

Inpatient Costs of Treating Patients With COVID-19.

With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies. To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics. This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US. Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices. The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284). In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.

Validity and reliability of the Chinese version of digital health readiness questionnaire among hypertension patients in rural areas of China.

Digital health has the potential to support health care in rural areas by overcoming the problems of distance and poor infrastructure, however, rural areas have extremely low use of digital health because of the lack of interaction with technology. There is no existing tool to measure digital health literacy in rural China. This study aims to test and validate the digital health readiness questionnaire for assessing digital readiness among patients in rural China. Due to the different Internet environments in China compared to Belgium, a cultural adaptation is needed to optimize the use of Digital Health Readiness Questionnaire in China. Then, a prospective single-center survey study was conducted in rural China among patients with hypertension. Confirmatory factor analysis was computed to test the measurement models. A total of 330 full questionnaires were selected and included in the analysis. The model-fit measures were used to assess the model's overall goodness of fit (Chi-square/degrees of freedom = 5.060, comparative fit index = 0.889, Tucker-Lewis index (TLI) = 0.869, root mean square error of approximation (RMSEA) = 0.111, standardized root mean square residual (SRMR) = 0.0880). TLI is a little bit lower than the borderline (more than 0.9) and RMSEA is higher than it (less than 0.08 means good model fit). We deleted two items 2 and 4 and the result shows a better goodness of fit (Chi-square/degrees of freedom = 4.897, comparative fit index = 0.914, TLI = 0.895, RMSEA = 0.109, SRMR = 0.0765). To increase applicability and generalizability in rural areas, it should be considered to use the calculation of only the parts Digital skills, Digital literacy and Digital health literacy which are equally applicable in a Belgian population as in a rural Chinese population.

Etiology and Epidemiology of Travelers' Diarrhea among US Military and Adult Travelers, 2018-2023.

Travelers' diarrhea has a high incidence rate among deployed US military personnel and can hinder operational readiness. The Global Travelers' Diarrhea study is a US Department of Defense--funded multisite surveillance effort to investigate the etiology and epidemiology of travelers' diarrhea. During 2018-2023, we enrolled 512 participants at partner institutions in 6 countries: Djibouti, Georgia, Egypt, Honduras, Nepal, and Peru. Harmonized laboratory methods conducted at each partner institution identified >1 pathogens, including Escherichia coli (67%-82%), norovirus (4%-29%), and Campylobacter jejuni (2%-20%), in 403 (79%) cases. Among cases, 79.7% were single infections, 19.6% were double infections, and 0.7% were triple infections. The most common enterotoxigenic E. coli colonization factors identified were CS3 (25%) and CS21 (25%), followed by CS2 (18%) and CS6 (15%). These data can inform best treatment practices for travelers' diarrhea and support US military health readiness.

Increasing Hearing Readiness Using Boothless Audiometry

ABSTRACT Introduction U.S. Army regulations require all soldiers to undergo annual audiometric testing to maintain hearing readiness. The standard method of monitoring hearing in the DoD is via multi-person testing in sound-treated booths using the Defense Occupational and Environmental Health Readiness System—Hearing Conservation. COVID-19 significantly hindered the standard method, resulting in alarming declines in hearing readiness. In response, the Army Hearing Program initiated a pilot program to use boothless audiometers to supplement standard methods to increase hearing readiness. Materials and Methods Funding from the Coronavirus Aid, Relief, and Economic Security Act was used to purchase 169 boothless audiometers and increase staffing at dozens of Army Hearing Program clinics. Standard operating procedures were established for audiometric testing outside the booth using a process matching standard test parameters (i.e., test frequencies, tone characteristics, and interstimulus intervals). Additional capabilities developed to leverage this new technology during the annual hearing exam include the administration of automated contralateral masking, enhanced tinnitus screening, and hearing health education and training. Results Monitoring audiometry using boothless audiometers has been conducted for nearly 12,000 service members worldwide. Thresholds obtained via boothless audiometers are comparable to follow-up thresholds obtained from the standard test methods in the booth (mean difference 95% CI, −1.2, 0.9), and hearing readiness has returned to pre-pandemic levels at installations where this novel technology is being used regularly. Conclusions Significant reductions in patient encounters as a direct result of the COVID-19 pandemic have led to innovative solutions leveraging boothless audiometers. While this has aided the primary mission to maintain a medically ready force, innovations from this endeavor highlight several additional improvements relative to current standards of care that should be considered for permanent inclusion in DoD Hearing Conservation Programs.

Exploring attitudes towards health preparedness in the Middle East and North Africa against chemical, biological, radiological, and nuclear threats: A qualitative study

AbstractSince 1970, Middle East and North African (MENA) countries have witnessed evolutionary industrial development and long‐running terrorist and inter‐country conflicts. Additionally, the risk of accidental, deliberate or natural chemical, biological, radiological, and nuclear (CBRN) threats has also increased, requiring a collaborative review of the health sectors’ preparedness for potential CBRN risks within the region. This study aimed to explore the opinion of multidisciplinary experts interested in disaster management research in MENA about perspectives and challenges on readiness for potential CBRN incidents.A modified interview online link was sent to the participants. A qualitative thematic analysis was performed on the responses using Nvivo®12 software, following semi‐structured modified interviews using the Phonic® application.A total of 29 participants were sufficient to reach the data saturation. Through an inductive coding approach, five themes were identified: ‘CBRN‐Related Incidents are a Threat’, ‘Inadequate National Practice and Policy’, ‘Need for International Cooperation’, ‘Importance of Better Mass Gathering Management’, and ‘Ineffective Hospital Preparedness’.With the assistance of the World Health Organization, there is a consensus on the need for cooperation between the MENA countries to ensure adequate healthcare preparedness for CBRN threats. Suggested measures should be considered, such as creating a unified database and liaison officer designation.

182 Emergency Department Characteristics Associated With Pediatric Behavioral Health Readiness

182 Emergency Department Characteristics Associated With Pediatric Behavioral Health Readiness

Enhancing corporate readiness for and resilience to future public health threats, development and deployment of the public health readiness and resilience (PHRR) assessment tool.

As the world suffered through the COVID-19 pandemic, it is increasingly clear that the health of populations is foundational to a high-functioning economy, corporate well-being, and a core driver of social justice. Thus, companies need to understand how to become more resilient to current and future threats. This study (1) explored dimensions of resilience from a public health risk-specific lens and reviewed existing evaluation tools and frameworks to develop a methodology and framework (Public Health Readiness and Resilience-PHRR Assessment Tool) for organizations; and (2) leveraged the framework to evaluate a sample of large corporations to validate the insights the tool can provide, confirm functionality, and evaluate the ability to leverage publicly available vs. propriety data to complete the assessment. We conducted a non-exhaustive search for relevant indices using key word searches and cascade sampling. For the initial review of indices (n = 24), the team evaluated each document based on predefined criteria. Gaps identified in the available indices informed the development of the PHRR assessment tool. The tool was then used to examine real-world companies (n = 22) from eight different industries. Findings from the PHRR tool illustrated variation in readiness and resilience as well as the availability of data. Approximately half of the companies analyzed (n = 11) indicated high levels of potential resilience and readiness with significant data available. Leveraging the PHRR Assessment Tool can inform investments and cross-sector partnerships that enhance companies' readiness and resilience to a variety of public health threats. Additional research is needed to further validate this tool.