Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study.

BACKGROUND: Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions. OBJECTIVE: This study aimed to identify and model the key factors leading to health consumers' engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT. METHODS: This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis. RESULTS: Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant). CONCLUSIONS: The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process.

Home testing for COVID-19 and other virus outbreaks: The complex system of translating to communities.

Home testing is an emerging innovation that can enable nations and health care systems to safely and efficiently test large numbers of patients to manage COVID-19 and other viral outbreaks.  In this position paper, we explore the process of moving home testing across the translational continuum from labs to households, and ultimately into practice and communities for optimal public health impact. We focus on the four translational science drivers to accelerate the implementation of systems-wide home testing programmes 1) collaboration and team science, 2) technology, 3) multilevel interventions, and 4) knowledge integration. We use the Socio Ecological Model (SEM) as a framework to illustrate our vision for the ideal future state of a comprehensive system of stakeholders utilising tech-enabled home testing for COVID-19 and other virus outbreaks, and we suggest SEM as a tool to address key translational readiness and response questions.

An Exercise Using a Social Ecological Lens to Understand the Vast Network of Stakeholders Required to Manage a Pandemic

The COVID-19 pandemic is uniquely challenging due to pace and scale, calling for swift responses across a multitude of societal and organizational levels and a vast network of stakeholders to address its effects. Thus, COVID-19 provides an impactful case from which students can understand the relevance and importance of multiple and multilevel stakeholder engagement, within and outside the healthcare arena, in sustaining public health. We embrace this teachable opportunity to leverage the Social Ecological Model (SEM) as a valuable framework for identifying the stakeholders, the roles they fulfill, and the information and communication technologies that connect them in working toward positive outcomes for the numerous issues faced in pandemic situations. COVID-19 also illuminated how a stakeholder's inability to fulfill an important role can affect stakeholders at various levels, whether by intent or due to barriers beyond their control. We illustrate a progressive and interconnected approach that educators may use in varying educational formats (e.g., face-to-face, hybrid, or online) to apply this multilevel framework in engaging students to recognize the players, roles, and connecting technologies to map the courses of action needed to manage viral outbreaks, such as the COVID-19 pandemic.