Information Technology Interventions Research Articles

Information and Communication Technology (ICT) Interventions for Enhancing Access to Education in Rural sub-Saharan Africa: A Systematic Review

The incorporation of ICT in the learning environment is essential for preparing learners for future employment, as education is an ever-evolving process. However, sub-Saharan African learners are being left behind due to limited access to ICT infrastructure, resulting in disparities in education. This study presents the findings of a systematic review conducted in accordance with the PRISMA protocol, which aimed to investigate various ICT interventions, challenges, barriers, and key factors that contribute to their successful implementation and scalability in enhancing access to education in rural sub-Saharan Africa. The review was based on scientific databases, which were the primary sources of articles retrieved. The selected articles underwent a process of defining and applying inclusion and exclusion criteria, resulting in the selection of 17 articles that aligned with the study. The study further identified four focus areas that aided in discussions of the findings and recommendations to enhance ICT adoption and integration in education in rural sub-Saharan Africa. The findings revealed a disproportionate focus of research on ICT interventions in rural sub-Saharan Africa, with a notable bias towards South Africa.

The preferred IT sources and tools of Iranian people for accessing health information

IntroductionPeople need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.MethodsThis national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.ResultsThe participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).ConclusionThe results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study.

Participation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). This study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. A total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. The study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others') negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. This study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together.

Emergency department pathology order support tool (ED POST): a protocol using qualitative inquiry to inform design and development of a prototype to reduce low value care

AbstractLaboratory tests have an important role in informing diagnosis and aiding in the determination of appropriate courses of management and/or treatment in the Emergency Department setting. Over-ordering of laboratory tests can lead to increased costs and/or unnecessary patient procedures, whilst under-ordering can lead to patient safety concerns and/or diagnostic error. Reducing over/under ordering through appropriate use of pathology has the potential to improve patient safety and/or reduce healthcare costs. As a dynamic electronic decision support tool, the Emergency Department Pathology Order Support Tool (ED POST) aims to facilitate effective ordering of pathology tests. This protocol details the methodological approach to be undertaken during the design and development of ED POST, commencing from the outset of the initial development of a prototype design. The research will undertake qualitative methods (interviews, focus group, and think-aloud observations) to develop business process models through collaboration with Emergency Department clinicians. The pre-development research will constitute stage 1 of the approach, with stage 2 focussed on evaluating the utility, usability and business process impact of the prototype to refine the prototype’s design. The collaborative and qualitative multi-method approach aims to elucidate an in-depth understanding of existing laboratory test ordering and decision-making processes in the Emergency Department, serving to inform the development of a relevant and practicable solution. Health researchers and digital health developers can draw on this approach to inform research planning activities for health information technology intervention design projects and can follow the developmental journey of ED POST as its outcomes are reported in the literature.

Caring for Hospitalized Children in Foster Care: Provider Training, Preparedness, and Practice.

Children and youth in foster care (CYFC) have high rates of health care utilization, including inpatient care. The objective of this study was to explore the inpatient provider experience caring for CYFC. Semistructured interviews were conducted with inpatient pediatric providers from Mid-Atlantic hospitals. Interview questions focused on 3 domains: provider training and preparedness, practice challenges, and strategies to improve care for CYFC. Conventional content analysis was applied to interview transcripts. Thirty-eight interviews were completed with providers from 6 hospitals, including 14 hospitalists, 1 advanced practice provider, 11 registered nurses, 10 social workers (SWs), and 2 case managers. Nearly all (90%) reported at least monthly interactions with CYFC. Themes related to training and preparedness to care for CYFC included: medical providers' lack of formal training, limited foster care knowledge, and feeling of preparedness contingent on access to SWs. Themes related to unique practice challenges included: identifying CYFC, obtaining consent, documenting foster care status, complex team communication, and navigating interpersonal stress. Participants' suggestions for improving their ability to care for CYFC included increasing SW capacity, expanding provider training, standardizing electronic medical record documentation and order sets, and improving team communication and information sharing. There are unique medical, social, and legal aspects of caring for hospitalized CYFC; pediatric medical providers receive limited training on these topics and rely heavily on SWs to navigate associated practice challenges. Targeted educational and health information technology interventions are needed to help inpatient providers feel better prepared to effectively meet the needs of CYFC.

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Abstract Objectives As part of a study to assess whether a technologically enabled pillbox prescribed to patients at hospital discharge can improve medication safety, we sought to assess participant experiences with the intervention. Methods We conducted a series of semi-structured phone interviews with patients, patient caregivers, and inpatient and outpatient clinicians who participated in the Smart Pillbox Transition Study. We developed an interview guide using the Systems Engineering Initiative for Patient Safety (SEIPS) framework, which included the a priori domains of (1) barriers to implementation, (2) facilitators of the intervention, and (3) general feedback regarding experience with the intervention. Within these domains, we employed SEIPS-informed themes of environment and organization, logistics and tasks, personnel and patients, and technology and tools. Interviews were conducted between May 2018 and January 2019. We used content analysis to interpret findings. Results We interviewed 6 patients, 2 caregivers, and 5 inpatient and 2 outpatient clinicians. Patient-endorsed barriers in the theme of technology and tools included signal issues, inappropriate alarms, and portability. Barriers in the theme of logistics and tasks included coordination with pharmacists in the event of a prescription change. Barriers mentioned by clinicians included patients who were poor fits for the intervention (theme: personnel and patients) and competing demands at discharge (theme: logistics and tasks). Facilitators that were frequently mentioned by patients and caregivers in the theme of technology and tools included useful alarms and ease of use. Clinicians stated that communication with pharmacy and study staff helped facilitate the intervention (theme: personnel and patients). Conclusion We identified several key barriers and facilitators from patients, caregivers, and clinicians to successful implementation of this intervention. Reconciling these sometimes contrasting viewpoints will be crucial if the Smart Pillbox or similar health information technology interventions are to be adopted as tools to improve medication safety during care transitions.

Establishment in productive occupations and perceived work ability among former students with special educational needs one year after upper secondary education.

Establishment in productive occupations i.e. work and further studies, is challenging for students who experience special educational needs (SEN). The study aim was to investigate productive occupations and perceived work ability one year after upper secondary education among former students with SEN who had received a student-centred information and communication technology (ICT) intervention. Questionnaire data on productive occupations (n = 81) were complemented with the semi-structured Worker Role Interview (WRI) concerning perceived work ability (n = 20), in an embedded mixed methods design. Group comparisons between participants who were and were not established in productive occupations were performed. Written notes from the WRI were analysed with a deductive content analysis. Findings demonstrated that almost two-thirds (63% n = 51) of the former students with SEN were established in productive occupations. The established group had to a higher extent obtained pass grades and had to a lesser extent received time-assisting ICT. Managing daily routines in combination with a productive role in a satisfactory manner was perceived as most challenging for the participants in relation to their work ability. The results indicate that students with SEN need person-centred support to handle difficulties both in and outside upper secondary school to promote the transition from school to establishment in productive occupations.

Development and Assessment of an Information Technology Intervention to Improve the Clarity of Radiologist Follow-up Recommendations

It is challenging to ensure timely performance of radiologist-recommended additional imaging when radiologist recommendation language is incomplete or ambiguous. To evaluate whether voluntary use of an information technology tool with forced structured entry of recommendation attributes was associated with improved completeness of recommendations for additional imaging over time. This cohort study of imaging report data was performed at an academic quaternary care center in Boston, Massachusetts, and included consecutive adults with radiology examinations performed from September 12 to 13, 2019 (taxonomy validation), October 14 to 17, 2019 (before intervention), April 5 to 7, 2021 (1 week after intervention), and April 4 to 7, 2022 (1 year after intervention), with reports containing recommendations for additional imaging. A radiologist scored the 3 groups (preintervention group, 1-week postintervention group, and 1-year postintervention group) of 336 consecutive radiology reports (n = 1008) with recommendations for additional imaging. Final implementation on March 27, 2021, of a voluntary closed-loop communication tool embedded in radiologist clinical workflow that required structured entry of recommendation attributes. The a priori primary outcome was completeness of recommendations for additional imaging, defined in a taxonomy created by a multidisciplinary expert panel. To validate the taxonomy, 2 radiologists independently reviewed and scored language attributes as present or absent in 247 consecutive radiology reports containing recommendations for additional imaging. Agreement was assessed with Cohen κ. Recommendation completeness over time was compared with with 1-sided Fisher exact tests and significance set at P < .05. Radiology-related information for consecutive radiology reports from the 4 time periods was collected from the radiology department data warehouse, which does not include data on patient demographic characteristics or other nonimaging patient medical information. The panel defined 5 recommendation language attributes: complete (contains imaging modality, time frame, and rationale), ambiguous (equivocal, vague language), conditional (qualifying language), multiplicity (multiple options), and alternate (language favoring a different examination to that ordered). Two radiologists had more than 90% agreement (κ > 0.8) for these attributes. Completeness with use of the tool increased more than 3-fold, from 14% (46 of 336) before the intervention to 46% (153 of 336) (P < .001) 1 year after intervention; completeness in the corresponding free-text report language increased from 14% (46 of 336) before the intervention to 25% (85 of 336) (P < .001) 1 year after the intervention. This study suggests that supplementing free-text dictation with voluntary use of a structured entry tool was associated with improved completeness of radiologist recommendations for additional imaging as assessed by an internally validated taxonomy. Future research is needed to assess the association with timely performance of clinically necessary recommendations and diagnostic errors. The taxonomy can be used to evaluate and build interventions to modify radiologist reporting behaviors.

Intelligent gloves: An IT intervention for deaf-mute people

Abstract Deaf-mute people have much potential to contribute to society. However, communication between deaf-mutes and non-deaf-mutes is a problem that isolates deaf-mutes from society and prevents them from interacting with others. In this study, an information technology intervention, intelligent gloves (IG), a prototype of a two-way communication glove, was developed to facilitate communication between deaf-mutes and non-deaf-mutes. IG consists of a pair of gloves, flex sensors, an Arduino nano, a screen with a built-in microphone, a speaker, and an SD card module. To facilitate communication from the deaf-mutes to the non-deaf-mutes, the flex sensors sense the hand gestures and connected wires, and then transmit the hand movement signals to the Arduino nano where they are translated into words and sentences. The output is displayed on a small screen attached to the gloves, and it is also issued as voice from the speakers attached to the gloves. For communication from the non-deaf-mutes to the deaf-mute, the built-in microphone in the screen senses the voice, which is then transmitted to the Arduino nano to translate it to sentences and sign language, which are displayed on the screen using a 3D avatar. A unit testing of IG has shown that it performed as expected without errors. In addition, IG was tested on ten participants, and it has been shown to be both usable and accepted by the target users.

“WASTEAPP” Application Based on Android for Household Waste Self-Tracking

Rapid population growth has both a positive and a negative impact, such as an increase in household waste generation. This also becomes a new chain of problems in other aspects, such as health, flood, air pollution, and environmental pollution. To overcome this problem, an integrated waste management system is needed. Household waste, especially inorganic waste, was valuable. The application was developed to promote a new paradigm; waste is a new source of money. As well as help run a circular economy in the waste recycling industry. The application to be built is "WasteApp", an independent household waste management application that can track and help manage it. This application is built using the Android operating system to make it a user-friendly tool. An application trial was conducted in Geulanggang Baro village, Bireuen district involving the operator, local government, and community. This location was chosen because they already have informal waste management, and it is easier to maximize by information technology intervention. The final result of this research is the “WasteApp” application based on android to manage household waste independently. The community, operator, and local government can work waste independently and systematically through this system. This application contains several menus, including the Home menu, login, register, and the main menu, namely the waste sell history and selling waste, as well as educational articles that contain how to manage waste, from sorting waste to the recycling process. Community participation was needed to increase to full implementation of good waste management.

The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity

BackgroundThe first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. MethodsThis study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. ConclusionsBy delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.

Assessing Usability of Smartwatch Digital Health Devices for Home Blood Pressure Monitoring among Glaucoma Patients.

Glaucoma is a leading cause of blindness worldwide. Blood pressure (BP) dysregulation is a known risk factor, and home-based BP monitoring is increasingly used, but the usability of digital health devices to measure BP among glaucoma patients is not well studied. There may be particular usability challenges among this group, given that glaucoma disproportionately affects the elderly and can cause visual impairment. Therefore, the goal of this mixed-methods study was to assess the usability of a smart watch digital health device for home BP monitoring among glaucoma patients. Adult participants were recruited and given a smartwatch blood pressure monitor for at-home use. The eHEALS questionnaire was used to determine baseline digital health literacy. After a week of use, participants assessed the usability of the BP monitor and related mobile app using the Post-study System Usability Questionnaire (PSSUQ) and the System Usability Scale (SUS), standardized instruments to measure usability in health information technology interventions. Variations in scores were evaluated using ANOVA and open-ended responses about participants' experience were analyzed thematically. Overall, usability scores corresponded to the 80th-84th percentile, although older patients endorsed significantly worse usability based on quantitative scores and additionally provided qualitative feedback describing some difficulty using the device. Usability for older patients should be considered in the design of digital health devices for glaucoma given their disproportionate burden of disease and challenges in navigating digital health technologies, although the overall high usability scores for the device demonstrates promise for future clinical applications in glaucoma risk stratification.

Findings From Talking Tech: A Technology Training Pilot Intervention to Reduce Loneliness and Social Isolation Among Homebound Older Adults.

Background and ObjectivesSocial isolation and loneliness are common among older adults and associated with negative health outcomes including cognitive decline, depression, suicide ideation, and mortality. Information and communication technology interventions are often used to combat loneliness and social isolation; however, homebound older adults face barriers to access. This study reports findings from a novel pilot intervention, called Talking Tech, designed to reduce loneliness and social isolation in homebound older adults by providing one-on-one, in-home technology training, a tablet, and the internet, to promote digital literacy and participation in a virtual senior center.Research Design and MethodsTwenty-one homebound older adults participated in this 14-week, volunteer-delivered program. We used qualitative interviews with participants, volunteers, and program staff, weekly progress reports from volunteers, and quantitative pre- and postintervention surveys with participants to examine experiences and to evaluate the impact of the intervention on loneliness and social isolation. Qualitative data were analyzed using content analysis and pre- and postintervention survey data were compared.ResultsParticipants reported increased technological literacy and use, increased access to online activities, and improved facilitation of social connections to existing and new networks. Additionally, during interviews, many participants reported that participating in Talking Tech alleviated their loneliness. While not statistically significant, our quantitative analysis revealed trends toward decreased participant feelings of loneliness and increased technology use. Additionally, intervention adoption and retention were high, with only one participant withdrawing from the intervention.Discussion and ImplicationsThis evaluation of the novel Talking Tech pilot intervention provides critical insights into strategies to reduce loneliness and isolation for older adults, with implications for future research, policy, and practice. Findings demonstrate that individualized technology training may be an acceptable way to improve well-being for homebound older adults.

Communities of practice for digital knowledge management: a case study of Web 2.0 in the University of Delhi

Man is a social being who craves for communities to share experiences, gain knowledge and solve problems. Modern-day problems are complex and necessitate teamwork, collaboration and collective brainstorming. Though people engage in face-to-face meetings and discussions, the paucity of time and geographical distances make coordination among them difficult. Revolutions in information technology and related interventions have solved these issues to a large extent and have drastically changed the way people communicate and interact with each other. Web 2.0 technologies are a new force to reckon with in this digital era and its followers are multiplying worldwide exponentially. With their acceptability, accessibility, convenience and low cost, they have become routine to the digital natives (Prensky, 2001; Kirschner and Karpinski, 2010; Amin et al., 2018). The purpose of this paper is to determine how the online communities of practice (COPs) using Web 2.0 technologies affected the performance of its members in an educational institution.

User needs gathering for the design of information and communications technology-supported occupational stress management intervention: A quantitative study.

IntroductionThe software industry is considered a growing industry with a high propensity to cause stress reactions among employees due to its demanding and technology-driven nature. There are convincing shreds of evidence that information and communications technology (ICT) interventions can effectively solve stress-related disorders. However, several identified constraints have hindered its potential benefits, such as poor adherence, lack of engagement, high attrition and lack of personalisation.ObjectiveThe study presented in this article aims to gather the user needs of software employees in Sri Lanka to identify design ideas for an ICT-supported intervention for occupational stress management (ICTSMI) in the software industry.Materials and methodsThe study followed a quantitative approach using an online questionnaire in which three key areas were investigated: (1) stressors, (2) coping strategies and (3) design preferences. A total of 408 valid responses were collected and analysed using SPSS software.ResultsFindings revealed that the majority of software employees were with a moderate level of stress. They perceived work stressors and role stressors as common causes of stress. The most frequently used coping strategy was to seek social support, followed by digital activities and sports and physical exercises. The male and female design preferences varied to a greater extent but only slightly varied based on their job category. However, findings suggested the necessity of further elicitation of user needs to support the design process.

The effect of information technology intervention on using appropriate VTE prophylaxis in non-surgical patients: A systematic review and meta-analysis.

IntroductionClinical decision support systems (CDSSs) play an important role in summarizing the best clinical practices, thereby promoting high standards of care in specific medical fields. These systems can serve as tools for gaining knowledge and mediating between clinical guidelines and physicians thereby providing the right information to the right person at the right time.ObjectiveThis review aims to evaluate the effect of CDSSs on adherence to guidelines for venous thromboembolism (VTE) prophylaxis and VTE events compared to routine care without CDSSs in non-surgical patients.MethodsIn order to conduct a systematic literature review, the published studies were identified through screening EMBASE, the international clinical trials registry, OVID, Cochrane database, PubMed, ISI Web of Science, and Scopus databases, from 1982 to March 2021. The included studies were reviewed by two independent reviewers; the proportion of patients that correctly received VTE prophylaxis has been next extracted for further analysis. Additionally, patients were divided into two groups: CDSS-recommended VTE prophylaxis and routine care without using a CDSS.ResultsTwelve articles (three randomized controlled trials, seven prospective cohort trials, and two retrospective cohort trials) were in fine analyzed. The use of CDSSs is found to be associated with a significant increase in the rate of using the appropriate prophylaxis for VTE (p < 0.05) and a significant decrease in the incidence of VTE (p < 0.05).ConclusionImplementation of CDSSs can help improving the appropriate use of VTE prophylaxis in non-surgical patients. Further, evidence-based and interventional studies on the development of CDSSs can provide more in-depth knowledge on both this tool design and efficiency.

Information and communication technology to improve school participation among upper secondary school students with special educational needs

Background Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required. Aim To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs. Materials and methods Data on 300 students’ assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students’ ordinal SSI ratings. Results In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline. Conclusion An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

Smart urban mobility for mitigating carbon emissions, reducing health impacts and avoiding environmental damage costs

Significant global investments are being made into smart urban mobility technologies but there is limited evidence of the potential co-benefits for reducing carbon emissions, environmental pollutants and human health impacts at scale and over the long-term. We use conservative estimates of vehicle electrification and grid decarbonisation to focus specifically on information and communication technology (ICT) interventions. In doing so, we develop a smart mobility framework focusing on more efficient road networks and driving behaviour enabled by rapid ICT deployment. Our scenarios suggest that a combination of ambitious policy measures aimed at smoothing traffic speeds as well as improving driver behaviour in urban areas could reduce carbon emissions for cars ∼29% saving ∼7 MtCO2 and for vans ∼33% saving ∼3 MtCO2 by 2050. Potential reductions in nitrogen oxides and particulate matter 2.5 for cars are ∼22% and vans ∼10% and ∼16% respectively. We use human toxicological classification of air pollution (HCA) to assess the potential damage on human health and our scenarios suggest an upper range of ∼23% and ∼30% reductions in HCA by 2050 for cars and vans respectively. Using conservative cost values, we estimate damage costs could be avoided from car emissions range from ∼£42–£130 million and vans ∼£89–£163 million per year. However, our baseline projections indicate that emissions and damage costs avoided from passenger cars could be partially offset by growing demand for urban van delivery and freight services that are currently outpacing improved fuel and emissions performance of the vehicle stock. This may reflect broader lifestyle and consumer trends towards on-line shopping, food and delivery services, which warrants further investigation.

Building and experimenting with an agent-based model to study the population-level impact of CommunityRx, a clinic-based community resource referral intervention.

CommunityRx (CRx), an information technology intervention, provides patients with a personalized list of healthful community resources (HealtheRx). In repeated clinical studies, nearly half of those who received clinical "doses" of the HealtheRx shared their information with others ("social doses"). Clinical trial design cannot fully capture the impact of information diffusion, which can act as a force multiplier for the intervention. Furthermore, experimentation is needed to understand how intervention delivery can optimize social spread under varying circumstances. To study information diffusion from CRx under varying conditions, we built an agent-based model (ABM). This study describes the model building process and illustrates how an ABM provides insight about information diffusion through in silico experimentation. To build the ABM, we constructed a synthetic population ("agents") using publicly-available data sources. Using clinical trial data, we developed empirically-informed processes simulating agent activities, resource knowledge evolution and information sharing. Using RepastHPC and chiSIM software, we replicated the intervention in silico, simulated information diffusion processes, and generated emergent information diffusion networks. The CRx ABM was calibrated using empirical data to replicate the CRx intervention in silico. We used the ABM to quantify information spread via social versus clinical dosing then conducted information diffusion experiments, comparing the social dosing effect of the intervention when delivered by physicians, nurses or clinical clerks. The synthetic population (N = 802,191) exhibited diverse behavioral characteristics, including activity and knowledge evolution patterns. In silico delivery of the intervention was replicated with high fidelity. Large-scale information diffusion networks emerged among agents exchanging resource information. Varying the propensity for information exchange resulted in networks with different topological characteristics. Community resource information spread via social dosing was nearly 4 fold that from clinical dosing alone and did not vary by delivery mode. This study, using CRx as an example, demonstrates the process of building and experimenting with an ABM to study information diffusion from, and the population-level impact of, a clinical information-based intervention. While the focus of the CRx ABM is to recreate the CRx intervention in silico, the general process of model building, and computational experimentation presented is generalizable to other large-scale ABMs of information diffusion.

Health information technology to improve care for people with multiple chronic conditions.

ObjectiveTo review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps.Data SourcesWe searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020.Study DesignWe identified studies of health IT interventions for PLWMCC across three domains as follows: self‐management support, care coordination, and algorithms to support clinical decision making.Data Collection/Extraction MethodsStructured search queries were created and validated. s were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers.Principal FindingsThe search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi‐experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient‐centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality.ConclusionsDespite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.