E-health Implementation Research Articles

The potential of non-clinical guidance alongside e-mental Health to overcome non adherence

Abstract Background Mental health problems account worldwide for over an eighth of the global burden of disease and waiting lists nowadays are commonplace. E-Health has potential to reduce mental illness, whilst waiting for therapy or as a stand alone. A big problem with implementation of E-health in clinical practice is non adherence. Non-clinical guidance could make a difference as compared to the non guidance modus. Our research question is: what factors contribute to the potential of non-clinical guidance in overcoming non adherence for e-mental Health for patients with depressive, anxiety and stress symptoms? Methods We did a qualitative study in a Dutch general practice. The treatment consisted of several modules accompanied by non-clinical guidance by a healthcare assistant. Out of 190 invited patients, 31 patients participated. Eight weeks after being invited, 11 semi-structured interviews were conducted until data saturation. Thematic analysis was used with open, axial and selective coding. Results Three major themes emerged: 1) The patients were satisfied with the non-clinical guidance in almost all aspects: Negative comments arose from an urge for more contact or tailoring. 2) The form of the guidance (e.g. non-clinical; used interface) was subordinate to the amount and tailoring of it. 3) Adherence could further be improved through a more personal introduction, explaining the benefits of certain exercises and more time management. Conclusions The potential of non-clinical guidance in overcoming non adherence for e-mental Health can be improved by further tailoring and increasing the interactivity when needed. Further research is also needed, after the suggested improvements, whether the intervention is effective, compared to a therapist guided and a non guided version. This study needs to be repeated in other clinical settings. Key messages • Non-clinical guidance, alongside e-mental health has potential to help with non adherence, thereby decreasing the burden of waiting lists. • Non-clinical guidance was positively received by patients who received e-mental health, although further tailoring could make online treatment even a larger success.

Determinants of e-Health Routinization in Public Healthcare Facilities in Kenya

The integration of e-Health into health has the potential to transform healthcare service delivery by increasing quality. Quality service delivery has the following components: safety, timeliness, effectiveness, efficiency, patient-centeredness, and equity. However, the uptake and routinization of these systems remain a challenge, particularly in developing countries. The paper adopted a narrative literature review approach to explore determinants that influence e-Health routinization in public healthcare facilities. The search was conducted across multiple academic databases, including PubMed, Google Scholar, and JSTOR, using the key terms “e-Health,” “routinization,” “Kenya,” “health facilities,” “health information systems,” and “digital health adoption.” The study peer-reviewed articles, reports, and relevant policy documents published between 2014 and 2023. The findings show that organizational support, user training, technological infrastructure, and the involvement of stakeholders in design as critical to the successful implementation of e-Health and its routinization. Challenges such as inadequate infrastructure, user involvement during implementation, and resistance to change hinder uptake and widespread use of routinization. If these challenges are adequately addressed, uptake of e-Health routinization will easily be achieved.

Determinants of e-Health Routinization in Public Healthcare Facilities in Kenya

The integration of e-Health into health has the potential to transform healthcare service delivery by increasing quality. Quality service delivery has the following components: safety, timeliness, effectiveness, efficiency, patient-centeredness, and equity. However, the uptake and routinization of these systems remain a challenge, particularly in developing countries. The paper adopted a narrative literature review approach to explore determinants that influence e-Health routinization in public healthcare facilities. The search was conducted across multiple academic databases, including PubMed, Google Scholar, and JSTOR, using the key terms “e-Health,” “routinization,” “Kenya,” “health facilities,” “health information systems,” and “digital health adoption.” The study peer-reviewed articles, reports, and relevant policy documents published between 2014 and 2023. The findings show that organizational support, user training, technological infrastructure, and the involvement of stakeholders in design as critical to the successful implementation of e-Health and its routinization. Challenges such as inadequate infrastructure, user involvement during implementation, and resistance to change hinder uptake and widespread use of routinization. If these challenges are adequately addressed, uptake of e-Health routinization will easily be achieved.

Core Mechanisms in Mediating eHealth Implementation and Uptake: A Case Study of Eastern Uganda

Researchers agree that, globally, in both developing and developed countries, healthcare management is faced with acute challenges: expanding areas of health needs, operationalizing health management, constrained budget allocations, as well as resource limitations. Hence, there is an imminent drive to find solutions to stimulate health system transformation through health system innovation. Therefore, effective national operational strategies to minimize resource wastage and contain the costs of health service delivery are critical. The study adopted a methodology that incorporated different research approaches and strategies. Deductive and inductive approaches were used; the strategies were surveys and case studies. A sample of 178 health professionals and administrators in three Health care facilities in Eastern Uganda, were determined and surveyed. Eligible respondents were stratified and selected through simple random sampling. Self-administered questionnaires and interview guides were used to gather the data. The captured data was analysed using Stata version 17. Regression analysis was used to determine the impact of eHealth Implementation core mechanisms on Quality Health Service Delivery. From the results of regression analysis, the core mechanisms variable had a p-value of 0.049 which was significant. For eHealth Implementation Core Mechanisms, the respondents have less control over them since they are dependent on several environmental factors, such as government funding or grants, Government regulations, and policies among others.

Factors Influencing the Successful Implementation of eHealth in Healthcare Facilities in Developing Countries: A Scoping Review

eHealth is the leveraging of Information and Communication Technologies (ICT) in health. Its use in complementing health services has risen substantially in the previous 20 years. The study explored the factors that influence the implementation of eHealth in healthcare delivery in developing countries. Three scientific bibliographical databases: PubMed, EBSCO Host, and Google Scholar were reviewed. Titles and abstracts were assessed using predefined inclusion and exclusion criteria. An exploratory study was done to assess the factors (facilitators and barriers) influencing the successful implementation of eHealth in developing countries. The searches yielded 11,001 resources, with 33 articles meeting the inclusion criterion of being in English and describing eHealth implementation in developing countries in the period January 2016 to December 2023. These were included in the study and thoroughly analyzed. Some key factors that influence the successful implementation of eHealth services were presented with computer literacy having the highest frequency in eHealth implementation. It is worth noting that barriers are factors that have a negative impact on implementation; nevertheless, by addressing barriers early on, they can be viewed as facilitators.

Barriers and facilitators to the implementation of personalised medicine at the micro-, meso- and macro-regional levels

Abstract Background/Introduction Personalised Medicine (PM) involves tailoring treatment to a patient's characteristics, needs and preferences. It classifies patients based on their disease risk or response to treatment using diagnostic markers and aims to improve treatment control, precision and disease prediction. An organised approach is crucial for the integration of PM into European healthcare systems in order to shape the future of health and social care. PM's dynamic evolution, which takes into account individual factors in disease progression and drug efficacy, allows for more accurate and tailored care. Despite its emergence, the economic focus on specific interventions has neglected a comprehensive theoretical framework, potentially hindering the progress of PM in clinical practise. [1] Purpose The purpose of the study was to identify barriers and facilitators to the implementation of innovative interventions and to identify best practises that are applicable across European countries and support the implementation of e-health, m-health and PM interventions at micro-, meso- and macro-regional levels. The research was funded and carried out as part of the international Regions4PerMed (H2020) project. Methods The methodology of the study consisted of a combination of desk research and qualitative research methods. Desk research involved analysing existing articles, with a focus on the literature related to barriers and facilitators in e-health and m-health. Following the desk research, a semi-structured questionnaire entitled "Barriers and facilitators of Personalised Medicine implementation - qualitative study under Regions4PerMed (H2020) project" was developed. In addition, three focus groups were organised to explore the topic of the study in greater depth. Results The findings on potential support for adapting e-health, m-health and PM to citizens' needs were categorised into different areas of need, including education, funding, dissemination, data protection/data sharing, data analysis, system changes, integrated care policies, cooperation, healthcare providers, physicians, public and patient engagement. The barriers and facilitators were categorised according to the primary stakeholders involved in the implementation challenges. Conclusion(s) The implementation of technological solutions improves diagnostic procedures and decision making in health and social care, leading to more precisely tailored treatments, lower costs and shorter treatment durations. PM plays a crucial role in rationalising the diagnosis, prevention and treatment of diseases. The overall aim is to break down barriers between healthcare providers such as public authorities and hospitals in order to promote closer collaboration. However, PM faces challenges, including incongruent legislation, bureaucratic procedures and lengthy legislative processes. Obstacles also include the approach to physician education and the lack of social awareness of PM.

Formative Evaluation of the Implementation of eHealth in the Philippines: A Qualitative Study.

The utilization of information and communications technology (ICT) to support health, known as eHealth, is a crucial enabler of universal healthcare. It is important to identify various aspects that could support or hinder eHealth, especially in limited-resource settings. This study determined the factors influencing the implementation of eHealth solutions in the Philippines, in consideration of the development process and initial outputs of the Philippine eHealth Strategic Framework and Plan 2014-2020. The descriptive-qualitative study was conducted among 15 municipalities/cities in the Philippines, recognized as early adopters of eHealth programs. Records review of eHealth solutions and key informant interviews among stakeholders (i.e., physicians and nurses) per study site were facilitated to gather data. Using directed content analysis, contextual, process, and content factors influencing eHealth implementation in the country were synthesized. Results showed a range of eHealth solutions in the selected facilities, majority of which involved electronic medical records. Various contextual, process, and content-related factors could serve as facilitators or barriers to eHealth implementation in the country. Particularly, contextual factors include individual characteristics (ICT experience/training, organizational commitment, readiness for change), perceived need/urgency for eHealth (provisions, policies, regulatory issues), and third-party involvement for financial/technical support. Meanwhile, process-related factors involve implementation team practices, appropriate top-down and bottom-up approaches in leader/member engagement, and resource management (ICT equipment, stable internet connection, power supply). Content-specific factors mainly include the eHealth design (complexity, adaptability to local context and service demands, interoperability or the capacity to connect or exchange information with other platforms/systems). Notably, limitations across the three dimensions could make eHealth implementation more complicated, which could lead to poor time management and resource wastage. This study highlighted the importance of a multidimensional understanding of factors that influence the utility of eHealth in the health system. There is a need for leadership and governance, stakeholder engagement, resource and funding, implementation readiness, appropriate design of eHealth solutions, and proper training to ensure the successful implementation of eHealth in the country.

Implementation of E-Health Based Technology to Improve the Health Status of the Elderly: A Literature Review

The number of elderly from year to year continues to increase, this has a significant impact on health services. The significant addition of the elderly and the worsening of the situation including decreased health, altered emotional status, inability to do activities independently make some people consider the elderly a burden. Objective: Providing ideas and ideas from the results of literature review on the implementation of E-health-based technology to improve the health status of the elderly, using smartphones to measure elderly activities, security and safety of the elderly. The method used in this research is literature review with keywords namely "technology", "elderly", and "degree of health". Searching for academic journals through Online Databases including: Science Direct, Google Scholar, ProQuest and clinical key from 2015-2022. The results of the review of 10 journals that discuss the technology of monitoring the elderly remotely via smartphones can be concluded if the development of technology to monitor the development of the elderly remotely is very satisfying because it can help caregivers and health workers in monitoring activities, the state of the elderly, and minimizing adverse events. It is hoped that future researchers can examine the ability of users to apply technology and user preparedness and costs in using this technology.

E-Health Implementation Challenges and HIS Evaluation in Accordance with EMRAM in Iran

The implementation of electronic health (e-Health) in healthcare organizations consistently encounters numerous challenges. These barriers hinder the widespread adoption of this promising technology within healthcare settings. This study addresses the challenges of implementing e-Health across various hospitals and also aims to evaluate the maturity of hospital information systems (HIS) in Iranian hospitals based on the electronic medical record adoption model (EMRAM). Through two rounds of literature review and case studies, a comprehensive understanding of these previously unexplored issues has been developed. The findings identify 13 social and technical challenges, including the lack of standard applications, high costs associated with e-Health and training, legal issues, security concerns, inconsistencies and diversities in perceived e-Health benefits and barriers, lack of proficiency, and difficulties healthcare professionals face in integrating e-Health into their daily tasks. There are also negative perceptions among physicians and patients regarding the use of e-Health software, the lengthy implementation times for HIS systems, technical difficulties due to platform diversity, resistance to change, and the limited use of pilot projects, particularly in Iran. Moreover, the maturity of hospital cases in Iran is at 3 stages, in contrast to the 7 stages of EMRAM. These results underscore the need to develop an effective strategy to address the challenges identified in this research. Additionally, a specific program should be implemented for developers to enhance the maturity of HISs and advance them to higher stages of EMRAM.

A narrative review of e-health systems' evolution - evidence from a regional study.

The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers. We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information. Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations. Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation. No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.

Implementing e-Health initiatives in Zimbabwe’s public health sector

The Zimbabwean government has instigated various policies and strategies as part of e-government initiatives to provide members of the public with convenient access to health information and services. Efforts have been made to embrace ICTs in Zimbabwe’s public health sector. The performance of health institutions in Zimbabwe however continues to deteriorate at a time when the use of ICTs in health is gaining momentum in Africa. This paper therefore seeks to assess the implementation of the E-health strategy revealing the current state of e-health or digital technology systems in Zimbabwe’s public hospitals. The study adopted an exploratory research design. Participants in this study were selected using purposive sampling. Data were gathered through participant observations, in-depth interviews and documentary research. The study established that even though e-health is an indispensable tool in improving quality, timely and cost effective health care, its implementation in Zimbabwe has not been easy and it is still in its infancy stages. The study concluded that e-health is a reliable tool for promoting successful and effective public health service provision in Zimbabwe. The study therefore reflects and proposes elements necessary for the successful implementation of e-health in Zimbabwe’s public health sector.

EmpRess: an eHealth implementation readiness checklist for dementia developed through an interview study of stakeholder needs

Objective This study aimed to create a tool to assess eHealth interventions for dementia by adapting an existing implementation readiness (ImpRess) checklist that assessed manualised interventions. Methods In Part 1, online semi-structured interviews with individual stakeholders (N = 9) with expertise in eHealth and dementia were conducted (response rate 83%). The Nonadoption, Abandonment, and challenges to the Scale-Up, Spread, and Sustainability of Health and care technologies (NASSS) framework was applied, both to guide the construction of the interview guide, as well as to use its subdomains as codes in the deductive qualitative thematic analysis. Respondents were industry professionals (n = 3), researchers (n = 3), policy officers (n = 2), and a clinician (n = 1). In Part 2, the items of the original ImpRess checklist were supplemented by items that covered determinants discussed in the interviews, that were not included in the original checklist. Results The main findings from the interviews included: Participants’ preference for a non-dementia-specific, more general approach to the checklist; the importance of searching for shared values with implementers; and the need for more systematic monitoring of implementation. Conclusions The EmpRess checklist applies an inclusive design approach. The checklist will help evaluate the implementation determinants of eHealth interventions for dementia and provide up-to-date information on what is, and is not, working in eHealth for dementia care.

Analisis Efektivitas E-Health Menggunakan Metode E-Govqual dan IPA Di Puskesmas Gading Kota Surabaya

E-Health, a public service that leverages Information Technology to enhance the health sector's knowledge base, faces developmental challenges. At Gading Health Center in Surabaya City, dissatisfied assessments of the health center's rating stem from discontent with both services and the e-Health system. Issues include disparities in service time compared to the targeted e-Health Service System queue, as well as variations between online registration times and the actual services provided at the health center. Moreover, human resource factors such as knowledge, experience, and technological skills among Gading Community Health Center staff significantly influence the successful implementation of the e-Health system. This study employs e-GovQual and IPA methods to evaluate the effectiveness of e-Government Implementation, focusing on dimensions like efficiency, trust, reliability, and citizen support. The research findings, analyzing the effectiveness of e-Health at Puskesmas Gading using e-GovQual and IPA methods, lead to the conclusion that the implementation of e-Health at Puskesmas Gading in Surabaya City positively impacts the quality of health services

The implementation of smart continence care for people with disabilities: A qualitative study of key stakeholders' first-hand experiences.

Innovative technological applications like smart continence care (SCC) offer potential benefits in healthcare delivery, particularly for individuals with profound intellectual and multiple disabilities (PIMD). SCC aims to prompt caregivers to change continence materials, potentially improving clients' quality of life and reducing caregivers' workload. Although the use of SCC in PIMD care is promising, research is needed to improve its use in these complex settings. The aim of this study was to reflect on the SCC implementation process in care organizations for people with PIMD. Fifteen semi-structured interviews were conducted with key stakeholders, caregivers, and SCC project leaders, across four care organizations. Interviews utilized an integrated framework drawing from the centre for eHealth research roadmap and the nonadoption, abandonment, scale-up, spread, and sustainability framework, both addressing eHealth implementation. Thematic analysis and open coding were employed to identify key themes and sub-themes in the implementation process. Four main themes emerged as crucial for successful SCC implementation: creating support, communication between stakeholders, problem-solving, and willingness to adopt SCC. The first three themes were perceived as contributors to the success of SCC implementation, whereas the last theme showed factors impacting willingness to adopt SCC. Early involvement of key stakeholders and clear communication about expectations of their roles was perceived as crucial and created clarity. Adequate problem-solving was identified as influential in SCC utilization and willingness to adopt person-centred continence care. Implementation of SCC requires changes in the work routines of those involved, and key stakeholders' early involvement appears to improve support for these changes. Fostering communication between key stakeholders and adequate problem-solving contributes to positive experiences and the perceived success of sustainable implementation. This study offered a rich understanding of day-to-day practices around implementing SCC in disability care organizations. The findings may also be relevant for the implementation of technologies in other care settings.

Relevance of e-Health Needs and Usage in Indonesia

The eHealth application can be used for healthcare, supervision, literature, education, and research. It is a cost-efficient and secure application based on information and communication technology for the health and medical fields. The use of Information and Communication Technology (ICT) as an infrastructure or medium that connects hospitals and health centers using the eHealth electronic health application is the key problem facing the implementation of eHealth on a worldwide scale. eHealth is an ICT-based application for the healthcare industry and one of the Action Plans of the World Summit on the Information Society (WSIS) Geneva 2003. The goal of using the eHealth app is to increase patient access, medical process efficiency, effectiveness, and process quality. This covers the administration of medical services provided by hospitals, clinics, health centers, medical professionals (including therapists and doctors), laboratories, pharmacies, and insurance

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

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

EHealth profile of patients with diabetes

Abstract Background Digital health technology can be useful to improve the health of patients with diabetes, to support patient-centered care, and self-management. In this cross-sectional study, we described the eHealth profile of patients with diabetes, based on their use of digital health technology, and its association with sociodemographic characteristics. Methods We used data from the “Qualité Diabète Valais” cohort study, conducted in one region of Switzerland (Canton Valais) since 2020. Participants with type 1 or type 2 diabetes completed questionnaires on sociodemographic characteristics and on the use of digital health technology. We defined eHealth profiles based on three features, i.e., ownership or use of 1) internet-connected devices (smartphone, tablet, or computer), 2) mHealth applications, and 3) connected health tools (activity sensor, smart weight scale, or connected blood glucose meter). We assessed the association between sociodemographic characteristics and participants’ eHealth profiles using stratified analyses and logistic regression models. Results 398 participants (38% women) with a mean age of 65 years were included. The vast majority (94%) were Swiss citizens or bi-national; 14% had a primary level education, 51% a secondary level, and 32% a tertiary level. Some 75% of participants had type 2 diabetes. Some 90% of the participants owned internet-connected devices, 43% used mHealth applications, and 44% owned a connected health tool. Older age and a lower educational level were associated with lower odds of all features of the eHealth profile. Conclusions While most participants owned internet-connected devices, only about half of them used mHealth applications or owned connected health tools. Older participants and those with a lower educational level were less likely to use digital health technology. eHealth implementation strategies need to consider these sociodemographic patterns among patients with diabetes. Key messages • eHealth use among patients with diabetes was associated with younger age and higher education. • eHealth strategies need to consider that patients at higher risk of complications are those who use eHealth the least.

Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study.

The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called "digital divide" due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group.

Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study.

Implementation of eHealth is progressing slowly. In-depth insight into patients' preferences and needs regarding eHealth might improve its use. This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice. A multimethod study was conducted. Two meetings of ~5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected. The way patients want to use eHealth varies between patients and moments of a patient's care pathway. Patients' digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits. Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients' preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care.

The nurse-led GILL eHealth intervention for improving physical health and lifestyle behaviours in clients with severe mental illness: design of a cluster-randomised controlled trial

BackgroundClients with severe mental illness (SMI) have overall poor physical health. SMI reduces life expectancy by 5–17 years, primarily due to physical comorbidity linked to cardiometabolic risks that are mainly driven by unhealthy lifestyle behaviours. To improve physical health in clients with SMI, key elements are systematic somatic screening and lifestyle promotion. The nurse-led GILL eHealth was developed for somatic screening and the implementation of lifestyle activities in clients with SMI. Aims of this study are to evaluate the effectiveness of the GILL eHealth intervention in clients with SMI compared to usual care, and to evaluate the implementation process, and the experiences of clients and healthcare providers with GILL eHealth.MethodsThe GILL study encompasses a cluster-randomised controlled trial in approximately 20 mental health care facilities in the Netherlands. The randomisation takes place at the team level, assigning clients to the eHealth intervention or the usual care group. The GILL eHealth intervention consists of two complementary modules for somatic screening and lifestyle promotion, resulting in personalised somatic treatment and lifestyle plans. Trained mental health nurses and nurse practitioners will implement the intervention within the multidisciplinary treatment context, and will guide and support the participants in promoting their physical health, including cardiometabolic risk management. Usual care includes treatment as currently delivered, with national guidelines as frame of reference. We aim to include 258 clients with SMI and a BMI of 27 or higher. Primary outcome is the metabolic syndrome severity score. Secondary outcomes are physical health measurements and participants’ reports on physical activity, perceived lifestyle behaviours, quality of life, recovery, psychosocial functioning, and health-related self-efficacy. Measurements will be completed at baseline and at 6 and 12 months. A qualitative process evaluation will be conducted alongside, to evaluate the process of implementation and the experiences of clients and healthcare professionals with GILL eHealth.DiscussionThe GILL eHealth intervention is expected to be more effective than usual care in improving physical health and lifestyle behaviours among clients with SMI. It will also provide important information on implementation of GILL eHealth in mental health care. If proven effective, GILL eHealth offers a clinically useful tool to improve physical health and lifestyle behaviours.Trial registrationClinical trial registration NCT05533749, registration date: 8 September 2022.