Digital Health

Objective The purpose of this study is to examine how care workers’ characteristics are related to the perceived benefits and drawbacks of using videoconferencing in the care of older people. The factors chosen for this study are: age, education, perceived information and communication technology (ICT) support, interest in technology, ICT skills and possible prior experience of using videoconferencing tools. Methods Our data source was the second wave (2021) of the University of Jyväskylä survey on elder care work (N = 3607), collected from four large trade unions in Finland. We used a multinomial logistic regression to group respondents according to their experiences of technology use and a path analysis to estimate the effects of care workers’ characteristics and prior experiences on the perceived benefits of videoconferencing tools in eldercare work. Results We found that the personal characteristics of a care worker are associated with both the use of videoconferencing and its perceived benefits and drawbacks. In addition, we discovered that prior use of videoconferencing tools, especially in direct care work, affects the perceived benefits of them. Those who have used videoconferencing in direct care work perceive them as more beneficial for both their own work and for clients. Conclusions Based on these results, we suggest that healthcare and social welfare organizations pay attention to the characteristics of care workers, especially when estimating the necessary amount of ICT support. More ICT support should be targeted to those with a lower level of education and higher age.

Objective Engaging users during physical exercise is crucial for fostering long-term commitment, however, sustaining that engagement remains a significant challenge. This study explores the design of a voice-enabled exoskeleton-based virtual exercise coach (VEC) that provides real-time verbal feedback to enhance user engagement. The objectives of this study are twofold: (i) to compare user engagement with real-time verbal feedback from both VEC and human exercise coach (HEC) during physical exercise, and (ii) to understand users’ perceptions and gather their recommendations for improving future VEC technologies. Methods We developed an exoskeleton-based VEC that delivers real-time verbal feedback on users’ exercise performance. To evaluate its impact on user engagement, we conducted a lab-based mixed-methods study ( N = 32 ) over a period of 6 weeks comparing users’ engagement with the VEC and HEC using User Engagement Scale (UES) questionnaire and conducted semi-structured interviews to understand users’ perceptions of the VEC. Results Participants in this study found the VEC more engaging than the HEC, in terms of focused attention ( Z = 156.5 , p < .001 ) and perceived usability ( Z = 32 , p < .001 ). Post-interaction interviews revealed that (i) users found the VEC to be engaging, intuitive, easy to use, and convenient; (ii) users perceived the VEC as a valuable training companion that could help reduce the emotional insecurities often associated with going to the gym; and (iii) users expressed a desire for the VEC to have a personality and embodiment that motivates and supports personalized interactions. Conclusion Based on our results, we discuss the challenges and implications for designing future voice-enabled VECs that support engaging physical exercises.

Introduction The spread and implementation of digital synchronous video communication in telecare and teletherapy has recently increased significantly, not just because of COVID-19 but also due to a global trend towards more digital healthcare services in the last two decades. This shift prompts the question of how digital telesetting differs from a face-to-face setting and which aspects are fundamental. Methods As the first part of a mixed-method study, qualitative interviews (n = 20) were conducted from July 2021 to January 2022. Health professionals (n = 13) and patients (n = 7) from occupational therapy, physiotherapy, speech therapy, and nursing were interviewed. All interviewees came from Germany, Austria, and Switzerland. The results were categorized using structured content analysis. Results Six main categories and 20 sub-categories were summarized, which can act as barriers or resources in a telesetting. Both sides described a high level of acceptance and approval of telesetting. Motivation and digital skills were of great importance. Furthermore, special features in communication and interaction were described, as well as changes in organizational procedures and a specific process flow in telesetting. Including relatives was more feasible, although several environmental factors should be considered. Discussion A number of specific changes in a telesetting compared to a face-to-face setting show the need for a structured guide for interested parties. Appropriate basic principles must be taught in training and further education to support the spread of this new form of care. Furthermore, it is crucial to adapt the methodological and content-related aspects of telesetting and develop new approaches that specifically integrate audio-visual possibilities.

Objective Despite the benefits of digital transformation, many healthcare organisations still rely on manual, traditional processes to transfer clinical images and videos to electronic patient records (EPRs), consuming valuable nurse–patient-facing time. Our study aimed to outline tasks performed by nurses to traditionally transfer clinical images and videos to EPRs, assess the impact on nurses’ time and efficiency cost, and report on nurse experiences when transitioning to a digitised process. Methods Observations spanned two one-week periods in the ENT outpatient department of Royal Devon University Healthcare NHS Foundation Trust, using direct observational time and predetermined motion time system analysis to map nurses’ tasks pre-and post-implementation of a Medical Video Recorder and Centralised Medical Content Management. Two staff experience surveys were conducted, and data was aggregated to evaluate the impact of digitisation. Results Nurses traditionally followed two processes to transfer clinical images and video to EPRs. Digitisation saved 43 seconds per endoscopy (a 10% efficiency gain) compared to Process 1, in which nurses print, attach, scan, and digitise images off-site to EPRs, and 3 minutes and 8 seconds (a 33% efficiency gain) compared to Process 2, where urgent content is recorded on an iPad and transferred to EPRs. Digitising could save nurses 26 working days annually by reducing non-patient-facing tasks in the ENT department, leading to an annual time efficiency cost-saving of £6780. Furthermore, 75% of nurses reported significantly improved morale, 63% strongly agreed that digitisation improved confidence in the accuracy of patient details, and all paper processes were eliminated. Conclusion Our findings highlight the inefficiency of traditional methods in transferring images and videos to EPRs. Digital transformation could enhance nursing efficiency and morale, improving care quality. Future studies should evaluate the effectiveness of Medical Video Recorders and Centralised Medical Content Management in other departments.

Objective Healthcare delivery and research are moving increasingly towards digital engagement, which could inequitably exclude some populations due to differential technology access and uptake. We sought to evaluate study-related digital access, preferences, and use among parents of patients with Medicaid insurance enrolled in research in a pediatric emergency department (ED). Methods We conducted a secondary analysis within a randomized trial at an academic pediatric ED. Children with public insurance and a language of English or Spanish who were treated for asthma symptoms were enrolled; parents completed surveys regarding digital access, preferences and demographics. Associations were tested using Fisher's exact test. Results We enrolled 80 families, of whom 18% had a language for care of Spanish; 31% of children identified as Hispanic, and 25% as Black. All baseline survey respondents (n = 79) endorsed having an internet-connected computer (73%) or smartphone (99%); 85% of smartphone holders reported unlimited data. When given the choice, 73% of participants requested a physical gift card instead of an electronic gift card. Only 31% had patient portal access 6 months after study end. Parents who spoke Spanish or with a child identified as Hispanic or Black more often requested physical gift cards and less often had patient portal access, but these differences were not statistically significant. Conclusion Despite ubiquitous access to internet-connected digital devices among this Medicaid-insured population, patient portal use was low and many families preferred non-digital reimbursement. Efforts to enhance research inclusion should consider digital preferences in addition to digital access when planning study procedures.

Objective Determine whether data collected from a smartphone camera can be used to detect anemia in a pediatric population. Methods HEMO-AI (Hemoglobin Easy Measurement by Optical Artificial Intelligence), a clinical study carried out from December 2020 to February 2023, recruited patients from the Pediatric Emergency Department, Pediatric Inpatient Department and Pediatric Hematology Unit of the Haemek Medical Center, Afula, Israel. A population-based sample of 823 patients aged 6 months to 18 years who had undergone a venous blood draw for a complete blood count since being admitted to the hospital were enrolled. Patients with total leukonychia, nailbed darkening or discoloration due to medication, nail clubbing, clinically indicated jaundice, subungual hematoma, nailbed lacerations, avulsion injuries, or nail polish applied on fingernails were not eligible for study recruitment. Video and images of the patients’ hand placed in a collection chamber were collected using a smartphone camera. Results About 823 samples, 531 from a 12.2 megapixel camera and 256 from a 12.2 megapixel camera, were collected. About 26 samples were excluded by the study coordinator for irregularities. About 97% of fingernails and 68% of skin samples were successfully identified by a post-trained machine learning model. Separate models built to detect anemia using images taken from the Pixel 3 had an average precision of 0.64 and an average recall of 0.4, whereas models built using the Pixel 6 had an average precision of 0.8 and an average recall of 0.84. Further supplementation of training data with synthetic data boosted the precision of the latter to 0.84 and the average recall to 0.87. Conclusions This study lays the groundwork for the future evolution of non-invasive, pain-free, and accessible anemia screening tools tailored specifically for pediatric patients. It identifies important sample collection parameters and design, provides critical algorithms for the pre-processing of fingernail data, and reports an initial capability to detect anemia with 87% sensitivity and 84% specificity. Trial Registration Prospectively registered on www.clinicaltrials.gov (Identifier: NCT04573244) on 15 September 2020, prior to subject recruitment.

Background Generative artificial intelligence (AI) integrated programs such as Chat Generative Pre-trained Transformers (ChatGPT) are becoming more widespread in educational settings, with mounting ethical and reliability concerns regarding its usage. This paper explores the experiences, perceptions, and usability of ChatGPT in undergraduate health sciences students. Methods Twenty-seven students at Carleton University (Canada) were enrolled in a crossover randomized controlled trial study from a Health Sciences course during the Fall 2023 academic term. The intervention condition involved the use of ChatGPT-3.5, whereas the control condition involved using conventional web-based tools. Technology usability was compared between ChatGPT-3.5 and the traditional tools using questionnaires. Focus group discussions were conducted with seven students to further elaborate on student perceptions and experiences. Reflexive thematic analysis was employed to identify themes from the focus group data. Results Easiness of learnability for personal use and a perception of quick learnability towards ChatGPT-3.5 were significantly higher, compared to conventional online tools from the Systems Usability Scale. Qualitative results highlighted strong benefits of ChatGPT-3.5, such as being a tool for increased overall productivity and brainstorming. However, students identified challenges associated with reliability and accuracy, and concerns about academic integrity. Conclusions Despite the benefits and positive usability of ChatGPT-3.5 identified by students, an explicit need for the development of policies, procedures and regulations remains. An established framework of best practices for the usage of AI within health science education is necessary. This will ensure accountability of users and lead to a more effective integration of AI technologies into academic settings.

Objective Adopting healthy behavior is vital for preventing chronic diseases. Mobile health (mHealth) interventions utilizing virtual coaches (i.e., artificial intelligence conversational agents) can offer scalable and cost-effective solutions. Additionally, targeting multiple unhealthy behaviors, like low physical activity and smoking, simultaneously seems beneficial. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to simultaneously promote smoking cessation and physical activity. Through innovative methods (e.g., sensor technology) and iterative development involving end-users, we strive to overcome challenges encountered by mHealth interventions, such as shortage of evidence-based interventions and insufficient personalization. This paper outlines the content of Perfect Fit and the protocol for evaluating its feasibility, acceptability, and preliminary effectiveness, the role of participant characteristics, and the study's feasibility. Methods A single-arm, mixed-method, real-world evaluation study will be conducted in the Netherlands. We aim to recruit 100 adult daily smokers intending to quit within 6 weeks. The personalized intervention will last approximately 16 weeks. Primary outcomes include Perfect Fit's feasibility and acceptability. Secondary outcomes are preliminary effectiveness and study feasibility, and we will measure participant characteristics. Quantitative data will be collected through questionnaires administered at baseline, post-intervention and 2, 6, and 12 months post-intervention. Qualitative data will be gathered via semi-structured interviews post-intervention. Data analysis will involve descriptive analyses, generalized linear mixed models (quantitative) and the Framework Approach (qualitative), integrating quantitative and qualitative data during interpretation. Conclusions This study will provide novel insight into the potential of interventions like Perfect Fit, as a multiple health behavior change strategy. Findings will inform further intervention development and help identify methods to foster feasibility and acceptability. Successful mHealth interventions with virtual coaches will prevent chronic diseases and promote public health.

Objective The widespread penetration of the internet and digital technology have profoundly impacted the global economy and people's lives. Although the impact of digital skills on social development and personal lifestyles is well-documented, their influence on health and health inequalities remains underexplored. This study aims to analyze the impact of digital skills on health and health inequalities and to investigate the underlying mechanisms. Methods This study utilized cross-sectional data from the 2017 China General Social Survey (N = 2195). We employed the Ordered Probit (O-Probit) model and ordinary least squares regression to examine the impact of digital skills on health and explore the underlying mechanisms. Health inequalities across different groups were measured using the health concentration index. Results Enhancing digital skills enhances population health by boosting economic status, increasing social participation, and improving access to information. However, the impact varies by age and residence. Digital skills have a stronger effect on the health of young and middle-aged individuals, as well as urban residents, compared to older adults and rural populations. Furthermore, digital skills exacerbate health inequalities, benefiting high-income groups and widening the gap between income levels. Conclusions Widespread promotion and continuous improvement of digital skills are key to enhancing public health. We need to focus on the popularization of digital skills and the construction of digital infrastructure for low-income disadvantaged groups and rural areas, as well as use various means to reduce group and regional differences in the impact of digital skills on health conditions.

Background Unless a health intervention is acceptable to target audience and aligns with their needs and preferences, there is increased likelihood that they would not engage with and benefit from it as planned. Despite that, there is paucity of studies exploring acceptability of oral health promotion interventions prior to implementation. This cross-sectional study was designed to investigate Egyptian women's “prospective acceptability” to use mobile technologies in promoting access to oral health services. Methods A total of 959 participants completed a questionnaire, based on Sekhon's theoretical framework of acceptability, either in-person or virtually. Data was collected on sociodemographics, smartphones’ ownership and usage patterns, acceptability to use mHealth interventions, and any potential motivators and barriers. Chi-square test was used for descriptive statistics and regression analysis was performed to identify predictors of acceptability to use digital technology in improving oral and dental health. Results 83 % of women residing in urban settings versus 80.7% in rural settings believed that mHealth could improve health outcomes. WhatsApp was identified by 68% of participants as the preferred application for adopting mobile health services. Health awareness (36.8%) and effort & time saving (29%) were the most commonly cited motivators for using mHealth while lack of time (33%) and privacy issues (14.2%) were the main barriers. Conclusions mHealth is perceived as a highly acceptable approach for promoting oral health among Egyptian women. However, mHealth interventions should take into consideration privacy concerns and personal security when targeting this group.

Objective The purpose of the study was to investigate the feasibility of using existing data to better understand what pupils purchase during the school day and its nutritional quality. This report highlights the ethical challenges experienced in attempting to obtain anonymised school canteen transaction data for public health research. Methods Semi-structured interviews were conducted before a variety of approaches were tried to recruit secondary schools for the study via purposive sampling. Results Barriers encountered included (i) identifying data providers, (ii) identifying data owners, (iii) data sharing and (iv) engaging stakeholders. The approaches taken to mitigate each of these barriers and subsequent ethical issues are summarised so that future researchers are aware of any potential problems. Failure to overcome these blockages meant that the original study had to be curtailed. Conclusions School canteen transactional big data remains an underutilised research resource which has immense potential for understanding adolescents’ dietary choices and nutritional intake across the school day. The inaccessibility of anonymised datasets for public health research and complex political issues surrounding data ownership and sharing must be discussed and effort should be made to circumvent barriers. Establishing the current landscape of school food and drink would be beneficial for policymakers, educators and public health researchers.

Objective The World Health Organization approved HIV self-test (HIVST) to break the barriers to HIV testing. Black men who have sex with men (Black MSM) in the United States are less likely to test for HIV or link to care due to several factors, such as stigma and distance. We explored Black MSM's knowledge of HIVST and their willingness to use a mobile application (mHealth) to link to HIV care and engage with health providers. Methods Between March and September 2023, we interviewed 12 Black MSM in small urban areas and explored HIVST awareness and willingness to use mHealth. Participants were recruited through purposive and snowball sampling. The data were analyzed inductively. Results The age range was 20–42 years. Participants had mixed knowledge of HIVST. The barriers to HIVST uptake are poor knowledge of HIVST, lack of adequate medical insurance to access HIVST kits, and concerns about the efficacy of HIVST kits. Black MSM were willing to link to care via mHealth but expressed concerns related to safety, confidentiality, and the risk of HIV stigma. Participants recommended wider awareness via social media and that the proposed mobile application has a simple interface for ease of use. Conclusion To encourage uptake among Black MSM, the Iowa Department of Health and Human Services should make HIVST accessible (low-cost or free). The proposed mHealth should be developed with a simple and interactive interface, including images and videos to guide HIVST and linkage to health professionals for assistance.

Objectives Technology, mobile health (mHealth), and “eHealth” are broadly used in childhood overweight and obesity interventions. However, the impact of technology-based interventions where parents or caregivers are involved is unclear. Thus, the objective of this manuscript is to provide valuable insights about the development of a parent–child web-based tool to promote healthy eating among preadolescents. Methods The tool development was an iterative process and comprised of two phases. In Phase 1, formative research (focus groups and interviews) were conducted with parents of children around the topics of dietary behaviors, technology use, and proposed intervention components. In Phase 2, a brief survey, focus groups, interviews, and user-centered approaches were used to confirm/finalize content, assess the website wireframe, and conduct usability testing. Results From the Phase 1 formative research, parents preferred reading/looking up health-related information on larger laptop/tablet screens, but preferred smartphones when reading “on-the-go.” Suggestions for an online health tool included quick/easy/low-cost recipes, tips for healthy feeding and involving their children around healthy dietary-related behaviors, clear tool navigation, and using pictures/visuals. In Phase 2, when finalizing the tool wireframe and content, parents preferred a variety of motivational healthy feeding tips, local family-oriented community events, and a simple layout with minimal clicking to access links. During usability testing, parents responded positively to the content (healthy feeding tips, recipes, coupons, and free community events) and the clean layout. Conclusions Formative research and user-centered approaches with parents of preadolescents resulted in a web-based, mobile-friendly health promotion tool.

Background Given that ‘digitally native’ children and young people spend much time at school, universal e-mental health interventions (ueMHIs) may have a role in supporting their wellbeing and reducing common mental health problems like anxiety and depression. However, the efficacy of school-based ueMHIs has never formally been evaluated. Methods During this systematic review and meta-analysis, we searched online databases MEDLINE, ERIC and ACM and the grey literature for trials of school-based ueMHIs targeted at improving wellbeing or reducing anxiety or depression in students aged 5–18. Primary outcomes were changes in symptoms of wellbeing, anxiety and depression at <3 months. Secondary outcomes were changes in these symptoms at 3–12 months and >12 months. Meta-analysis was conducted using a random effects model. Quality of included studies was appraised using the Cochrane risk of bias (RoB) tool. This study was registered with PROSPERO, CRD42023421872. Findings From 11,026 screened records, 15 papers were found and included in a systematic review. Of these, 14 papers including 8844 students were analysed in the meta-analysis. School-based ueMHIs did not significantly reduce anxiety (SMD = −0.55, 95% CI −1.68, 0.59) or depression (SMD = −0.29, 95% CI = −0.89, 0.32) at <3 months. School-based ueMHIs also did not significantly reduce anxiety (SMD = −1.03, 95% CI −3.20, 1.14) or depression (SMD = −0.47, 95% CI −1.40, 0.46) at 3–12 months. School-based ueMHIs did not significantly improve wellbeing at <3 months (SMD = 0.01, 95% CI −0.12, 0.14) and favoured control condition at 3–12 months (SMD = −0.14, 95% CI −0.23, −0.05). RoB was high across most studies and the overall quality of evidence was very low. Interpretation Although existing school-based ueMHIs show promise for addressing pupil mental health concerns, further higher-quality evidence is needed. There is room for the development of new school-based ueMHIs for reducing pupil anxiety and depression and improving wellbeing in a scalable, clinically and cost-effective manner, whilst not causing harm.

Background Musculoskeletal (MSK) conditions are the leading cause of disability worldwide. In MSK care, access to physical therapy is a major issue. The effectiveness of telerehabilitation phone assessment in improving access to care for MSK conditions has not yet been established in Saudi Arabia. Purpose To compare the effect of using a telerehabilitation phone with face-to-face care initial assessment on access to care, number of sessions and goals achievement at discharge. Methods This is a retrospective unmatched case-control analysis of a total of 724 Epic ® Electronic Medical Records guided by the Evidence standards framework for digital health technologies. Closed referrals from January 1st, 2022, to August 4th, 2022, for adults referred to Physical Therapy for MSK conditions were included. Participants who received a phone assessment were compared to those who received face-to-face care. The t-test was used to compare the means of the lead time, days to second appointment and number of treatment sessions. Univariate logistic regression was conducted to obtain the odds ratio of the outcome factors in the phone group. Statistical significance was set at p ≤ .05. Additionally,we compared the percentage of goal achievement at discharge. Results The lead time in days was significantly lower for the phone group (3.82 ± 5.36) compared to the face-to-face group (15.65 ± 17.71) p < 0.0001. Longer lead times from referral to first appointment were less likely to be a phone appointment and more likely to be a face-to-face appointment p < 0.001. However, the time from the first to the second appointment was significantly longer for the phone group p<0.0001. There was no significant difference in the number of appointments between both groups. The majority of the patients in both groups achieved all therapy goals (over 80% for phone and over 75% for face-to-face). Conclusion Initial telerehabilitation phone assessments compared to face-to-face care were associated with improved access to care, and there was no difference in the number of therapy sessions associated with achieving treatment goals. Future research is needed to determine the clinical effectiveness of phone initial assessments in the management of musculoskeletal conditions.

Persons with autism spectrum disorder (ASD) and/or intellectual disability (ID) have difficulties in planning, organising and coping with change, which impedes the learning of daily living skills (DLSs), social participation and self-management across different environmental settings. Assistive technologies (ATs) is a broad term encompassing devices and services designed to support individuals with disabilities, and if used in a self-controlled manner, they may contribute inclusion in all domains of participation. This comprehensive literature review aims to critically assess and unify existing research that investigates the use of assistive technology within the practical domain for individuals with ASD and/or ID. The 18 relevant studies included in this review highlighted the benefits of AT for social participation and independence in daily activities of individuals with ASD and/or ID. Professionals working with this target group should be knowledgeable of the speedy progress of AT products and the potential of persons with ASD and/or ID to use mainstream devices to meet their individual needs. This awareness provides an opportunity to advocate for the universal benefits of AT for everyone. Technologies such as virtual reality, mobile applications and interactive software have been shown to improve DLSs, communication and social interaction. These tools offer engaging, user-friendly platforms that address the specific needs of these individuals, enhancing their learning and independence.

Objective As highlighted by the COVID-19 pandemic, identifying strategies for home-based patient management is crucial. As pain is highly prevalent and imposes significant burdens, interest in its remote management is steadily increasing. Transcranial Direct Current Stimulation (tDCS) seems promising in this context. Methods This systematic review and meta-analysis aimed to determine the effectiveness of home-based tDCS in pain management (PROSPERO, CRD42023452899). The extracted data included clinical conditions, interventions, comparators, outcome measures, adverse effects, and risk of bias; the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment was carried out. Results 12 records (9 randomized controlled trials [RCTs], 446 participants, 266 undergoing tDCS) were included in the systematic review. The meta-analysis showed that home-based tDCS might produce large and clinically relevant improvement in chronic pain intensity at the end of the intervention (standard mean difference [SMD] −0.95, 95% CI −1.34 to −0.56; p < 0.01; 404 participants, low certainty), as well as small clinically unimportant improvement at short-term follow-up (SMD −0.50, 95% CI −0.82 to −0.19; p < 0.01; 160 participants, moderate certainty). A subgroup analysis showed that it might clinically improve the chronic pain related to fibromyalgia and knee osteoarthritis. Moreover, home-based tDCS seems to modulate pressure pain threshold, heat pain threshold, and heat and cold tolerance at the end of the intervention. Notably, tDCS appeared to be generally safe, well-accepted and easily applied at home. Conclusions Low to moderate certainty evidence suggests that home-based self-administered tDCS is a safe and effective tool for managing various types of chronic pain. Further well-designed, large-scale RCTs are warranted.

Study objectives Obesity-related health data is needed for studies and precision medicine, but existing registers, medical chart systems, and digital platforms are seldom compatible. Before creating improved ways of sharing health data, this study aimed to gather opinions, experiences, and wishes from stakeholders that may use obesity-related health data: healthcare, researchers, people with overweight or obesity, the pharmaceutical industry, and IT-specialists. Methods We performed semistructured interviews with 28 stakeholders and analyzed qualitative text data with inductive content analysis. We grouped the suggested parameters in categories. Results Time efficient data entering was perceived crucial. Access to health data was important to all participants. Some parameters, such as age, BMI, and sex were requested by all stakeholders. Other data were stakeholder specific, such as population-specific laboratory references, suggested by healthcare professionals only. For people with overweight or obesity, ability to share data with healthcare staff about fitness level or previous weight loss attempts, was important. Conclusion The results from this study can be used in the design and implementation of a national health data sharing solution that may be used for precision healthcare use and to evaluate and guide obesity treatment and preventive measures. Data parameters requested by all populations, such as BMI, sex, and age, should be prioritized when designing a data solution. Ability for individuals with overweight or obesity to share health data, may improve healthcare appointments and reduce weight stigma.

Background While anxiety disorders are one of the most prevalent mental diseases, they are often overlooked due to shortcomings of the existing diagnostic procedures, which predominantly rely on self-reporting. Due to recent technological advances, this source of information could be complemented by the so-called observable cues – indicators that are displayed spontaneously through individuals’ physiological responses or behaviour and can be detected by modern devices. However, while there are several individual studies on such cues, this research area lacks a synthesis. In line with this, our scoping review aimed to identify observable cues that offer meaningful insight into individuals’ anxiety and to determine how these cues can be measured. Methods We followed the PRISMA guidelines for scoping reviews. The search string containing terms related to anxiety and observable cues was entered into four databases (Web of Science, MEDLINE, ERIC, IEEE). While the search – limited to English peer-reviewed records published from 2012 onwards – initially yielded 2311 records, only 33 articles fit our selection criteria and were included in the final synthesis. Results The scoping review unravelled various categories of observable cues of anxiety, specifically those related to facial expressions, speech and language, breathing, skin, heart, cognitive control, sleep, activity and motion, location data and smartphone use. Moreover, we identified various approaches for measuring these cues, including wearable devices, and analysing smartphone usage and social media activity. Conclusions Our scoping review points to several physiological and behavioural cues associated with anxiety and highlights how these can be measured. These novel insights may be helpful for healthcare practitioners and fuel future research and technology development. However, as many cues were investigated only in a single study, more evidence is needed to generalise these findings and implement them into practice with greater confidence.

Background The rehabilitation process for cognitive disorders is long and complex, which can lead to reduced rehabilitation outcomes and reduced quality improvement. Thus, there is a need to use new methods to boost conventional rehabilitation (e.g., drug therapy, herbal therapy, paper, and pencil tasks). Innovations such as RehaCom can be helpful to remove the obstacles to treatment, but evidence for their effectiveness is limited. Objectives To compare the effectiveness of RehaCom with other cognitive therapies (computer-based, non- computer) in patients with cognitive impairment (CI). Methods Eight bibliographic databases (PubMed, Cochran Library, Scopus, Science Direct, Web of Science, Embase, ProQuest, and google scholar) were used in this research. The initial search resulted in the extraction of 2466 articles; after the review of the title, abstract, and full text, 19 articles were selected. Quality assessment was performed using the CONSORT checklist. Then, data extraction was done using the form set by the researcher in Word 2016 software. Results Overall, RehaCom achieved more positive clinical effects compared to other cognitive therapies (e.g., improvement in memory, attention, and motor function) on multiple sclerosis (n = 7), schizophrenia (n = 6), stroke (n = 3), Parkinson (n = 1), mild CI (n = 1), and acquired brain damage (n = 1). In six studies, a follow-up period of some weeks to 6 months has been used. Additionally, six studies used conventional therapy plus RehaCom for intervention. Except one study, all studies used RehaCom individual training. Conclusions This review provides evidence for the potential effectiveness of RehaCom for the improvement of clinical outcomes in patients with CI. However, more robust Randomised Controlled Trials (RCTs) are needed to confirm the observed positive effects.

Objectives This study explores the influence of clinic-led onboarding and interaction processes on patient engagement within a digital health program for long COVID care, the Living with COVID Recovery (LWCR) program. We compared clinical practices and patient engagement levels across seven clinics utilising LWCR, gaining insights that could optimise digital health interventions (DHIs) for long COVID care. Methods Using a mixed-methods approach, we conducted qualitative interviews with clinicians from seven clinics (out of thirty five) to understand their onboarding and interaction strategies for the LWCR program. We also performed a descriptive quantitative analysis of patient and clinic usage data to rank and classify patient engagement. These rankings were then compared against qualitative insights to explore the influence of clinic-led strategies on patient engagement. Additionally, we conducted interviews with 12 patients under the care of seven clinics to complement our mixed-method analysis. Results Four key practices were identified in clinics with higher patient engagement: pre-assessment onboarding, proactive communication, patient education and the involvement of clinically experienced staff. Clinics that integrated these interdependent practices into a cohesive strategy demonstrated notably higher patient engagement levels. Conclusion This study highlights the critical role of integrating multiple, interdependent clinic-led strategies to optimise patient engagement in DHIs, particularly for long COVID care. These findings provide actionable insights for healthcare providers and policymakers, suggesting that a comprehensive approach is essential for maximising patient engagement and improving care outcomes. The study lays the groundwork for future research to explore the broader applicability of these strategies across different healthcare contexts.

Objective The main aim of this review was to systematically collect and summarize the available evidence on health information-seeking behavior among people living with the two common types of chronic diseases in LMICs. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, Google Scholar, and forward and backward citations from included studies. The preferred reporting items for Systematic Reviews and Meta-Analyses (PRISMA) procedure were followed to develop and report the review. The pooled effect size and the effect's 95% confidence interval were calculated using a random-effect model meta-analysis for each research. A sub-group analysis was done to investigate potential sources of heterogeneity. To identify publication bias, Egger-weighted regression tests were employed. Results A total of 4281 articles were retrieved, with ten studies meeting the eligibility criteria for qualitative synthesis and only seven studies were eligible for the meta-analysis. The pooled extent of health information-seeking behavior among chronic disease patients was 50.5% (95% CI: 35.36–65.70, p = 0.00), with high heterogeneity (I2 = 98.25). Based on the sub-group analysis, it was found that 55% (95% CI: 29.9–79.4) of cancer patients and 40% (95% CI: 36.9%–43.9%) of DM patients sought out health-related information. In studies conducted before 2015, the level of health information seeking was 49%, increasing to 52% (95% CI: 41.0%–62.2%) after 2015. Conclusion The overall health information seeking behavior among diabetes and cancer patients has increased over time, but remains relatively low, with only nearly half actively seeking information. The findings also emphasize that patients require health-related information on various topics.. Health educators and health professionals should consider this diversity when developing interventions and educational materials to provide patients with the most comprehensive information and education regarding their healthcare issues. Protocol registration number CRD42023433169.

Objective Rapid digitisation of health occurred during the COVID-19 pandemic worldwide. In October 2020, we conducted a survey on digital health technology use in Germany. This study aimed to conduct a second survey to investigate in more detail the internet use in health context and digital technology use for health promotion and disease prevention in Germany. Methods A cross-sectional, nationwide telephone survey was conducted in November 2022. Anonymous data on internet and digital technology use, digital health literacy, and sociodemographic characteristics were analysed using descriptive statistics and binary logistic regressions. Results The 1020 participants were aged 18–92 years, 53% were male, 62% completed primary or secondary education, 71% resided in large cities, and 45% reported a country-average net household income. Overall, 61% reported internet use in health context via 1–4 devices. Among those, more than 50% used the internet and apps to obtain general health information and less than 50% used digital technologies for physical activity promotion or cancer prevention. Overall, 34% were confident in using the internet for health decisions and 71% preferred to receive health information non-digitally (e.g. on paper). Internet, app, and digital technology use were associated with higher digital health literacy and income, and residence in larger cities. Digital technologies were used for physical activity promotion by younger and for cancer prevention by older participants. Conclusion The internet and digital technologies were predominantly used to obtain health information, but less often for health promotion and disease prevention in 2022 in Germany. While health app and digital technology use for physical activity promotion increased, the confidence in using online information for health decisions decreased in 2022 relative to 2020. Factors that promote confidence in online health information and digital technology use for health promotion and disease prevention need to be investigated in future studies.

Objective Mobile health (mHealth) applications are emerging as important healthcare technologies that can provide cost savings, better access to care, contribute to improved clinical outcomes, and support public health. An increasing number of mobile health (mHealth) applications are becoming available to download and use on mobile devices. However, unlocking this potential requires ensuring widespread acceptance and adoption of these applications. In this context, the aim of the study is to determine the impact of individuals’ digital literacy levels on mobile health application usability and the mediating role of patient expertise in this impact. Methods The population of our study consists of individuals who reside in Yozgat city center and are 18 years old and over. Within the scope of the study, 647 individuals who agreed to participate in the research were reached. A survey form consisting of four sections (Socio-demographic characteristics, Digital Literacy Scale, mHealth App Usability Questionnaire, and Patient Expertise Scale) was used as a data collection tool in the study. Descriptive statistical methods were used to analyze the data and partial least squares path analysis (PLS-SEM) was used to analyze the research model. Results Digital literacy affects both patient expertise (β = 0.790, t = 35.560, p = 0.000) and mHealth app usability (β = 0.831, t = 46.020, p = 0.000). Additionally, it has been determined that patient expertise has a mediating role in the effect of digital literacy on mHealth app usability (β = 0.536, t = 17.477, p = 0.000). Conclusions It appears that individuals’ digital literacy is an important precursor to the usability of mHealth apps and increases their usage experience. In this sense, it is thought that the concept of digital literacy can be used to increase the usability of mHealth apps for individuals. Overall, the findings provide new evidence for the healthcare context by integrating user diversity, particularly individuals’ digital literacy, mHealth apps, and prior experience with mHealth.

Background Patients with chronic pain often struggle to engage in physical activity despite its health benefits. The eVISualisation of physical activity and pain intervention (eVIS) was developed to support adherence to physical activity plans in Interdisciplinary Pain Rehabilitation Programs (IPRPs) by visualising activity, pain levels, pain interference, and pharmacological use. This pilot study assesses the feasibility and acceptability of trial design and trial conduct of a registry-based randomised clinical trial (R-RCT). Method This randomised clinical pilot study included the first 10% (n = 39, mean age 43.5, 74.4% females) of the R-RCT sample (n≈400). Participants with non-cancer chronic pain from six IPRP units were randomly assigned to either the intervention group (IPRP + eVIS, n = 19) or the control group (IPRP, n = 20). Feasibility and acceptability were evaluated using pre-defined criteria on recruitment- and data collection procedures (e.g., inclusion rates, representativeness, adverse events), physiotherapists’ ratings of trial design and conduct (e.g., acceptability, feasibility), and outcome data characteristics and completeness (e.g., adherence, data accessibility). Results Recruitment was largely feasible, though attrition differences and the need for refined eligibility screening were noted. Physiotherapists cited time and implementation challenges. Both groups had satisfactory data completeness, but the control group showed lower adherence to daily reporting in the final third of the study. The intervention group had greater improvements in physical health, with 19.5% more participants achieving the minimum clinically important difference (≥3) on the physical component summary scale (PCS). No adverse events occurred. Conclusion With minor adjustments, the R-RCT design is mostly feasible, though some challenges to feasibility were identified and addressed.