Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021).

BACKGROUND: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. OBJECTIVE: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. METHODS: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. RESULTS: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. CONCLUSIONS: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty.

Rethinking the improvisation of digital health technology: A niche construction perspective

The COVID-19 pandemic has sent shock waves through healthcare organisations and catalysed an impromptu digital shift, creating a demand for telemedicine and other digital health technologies. Under such conditions, improvisation, adaptation, and innovation emerge as core dimensions to an organisation's capacity to generate a response to crisis. This paper integrates a process perspective on the radical improvisation of a digital health technology and investigates how the radical improvisation of a digital health technology emerges and develops during a health crisis. Through a combination of supporting case evidence and literature, a multi-phase conceptual process model anchored in the crisis management cycle and illustrating the radical improvisation of digital health technology is developed and proposed. We conclude with discussion on the long-term implications of radical improvisation and crisis learning, with possible theoretical explanation using niche construction theory, and providing suggestions for future information systems and crisis management research © The Author(s) 2022. (Copyright notice)

A Digital Health Initiative (COVIDsmart) for Remote Data Collection and Study of COVID-19's Impact on the State of Virginia: Prospective Cohort Study.

BACKGROUND: The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. COVID-19-induced economic setbacks have also likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. We describe how digital tools were used to capture the effects of the pandemic on the overall well-being of diverse communities across large geographical areas within the state of Virginia. OBJECTIVE: The aim is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share the preliminary study results. METHODS: COVIDsmart conducted digital recruitment, e-Consent, and survey collection through a Health Insurance Portability and Accountability Act-compliant digital health platform. This is an alternative to the traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over 3 months using widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education or work functioning, social or family functioning, and economic impact. Data were collected using validated questionnaires or surveys, completed in a cyclical fashion and reviewed by an expert panel. To retain a high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving a monthly gift card and one of multiple grand prizes. RESULTS: Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3737), and 782 (21.1%) consented to participate in the study. The most successful recruitment technique was the effective use of newsletters or emails (n=326, 41.7%). The primary reason for contributing as a study participant was advancing research (n=625, 79.9%), followed by the need to give back to their community (n=507, 64.8%). Incentives were only reported as a reason among 21% (n=164) of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6% (n=693). CONCLUSIONS: The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic's effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies.

Lessons Learned from Natural Disasters around Digital Health Technologies and Delivering Quality Healthcare.

As climate change drives increased intensity, duration and severity of weather-related events that can lead to natural disasters and mass casualties, innovative approaches are needed to develop climate-resilient healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas. Digital health technologies are touted as a potential contributor to healthcare climate change adaptation and mitigation, through improved access to healthcare, reduced inefficiencies, reduced costs, and increased portability of patient information. Under normal operating conditions, these systems are employed to deliver personalised healthcare and better patient and consumer involvement in their health and well-being. During the COVID-19 pandemic, digital health technologies were rapidly implemented on a mass scale in many settings to deliver healthcare in compliance with public health interventions, including lockdowns. However, the resilience and effectiveness of digital health technologies in the face of the increasing frequency and severity of natural disasters remain to be determined. In this review, using the mixed-methods review methodology, we seek to map what is known about digital health resilience in the context of natural disasters using case studies to demonstrate what works and what does not and to propose future directions to build climate-resilient digital health interventions.

Digital Health Technologies Usage among Older Adults for Healthy Ageing during COVID-19: A Review

Digital health technologies are being increasingly developed with the aim of allowing older adults to maintain functional independence throughout the old age, a process known as healthy ageing. Such digital health technologies for healthy ageing are expected to mitigate the pandemic effects and improve the quality of life of older adults. However, digital health technology diffusion is still in its early stage and there is slow rate of adoption among elderly people. Little is known regarding the needs of older adults regarding digital health technologies during pandemic. More reviews are needed to investigate on this issue so that engagement strategies for a better-quality digital health solution can be develop for promoting healthy ageing later. Therefore, the aim of this paper is to review on the perceptions and digital health technologies usage among older adults for healthy ageing during the COVID-19 epidemic. Summary of digital health technologies issues and recommended strategies for older adults is also presented. Related studies from the articles will be reviewed to highlights potential rooms for improvement for digital health technologies usage within older adults. © 2022 IJETAE Publication House. All rights reserved.

Real-World Evidence-Current Developments and Perspectives.

Real-world evidence (RWE) is increasingly involved in the early benefit assessment of medicinal drugs. It is expected that RWE will help to speed up approval processes comparable to RWE developments in vaccine research during the COVID-19 pandemic. Definitions of RWE are diverse, marking the highly fluid status in this field. So far, RWE comprises information produced from data routinely collected on patient's health status and/or delivery of health care from various sources other than traditional clinical trials. These sources can include electronic health records, claims, patient-generated data including in home-use settings, data from mobile devices, as well as patient, product, and disease registries. The aim of the present update was to review current RWE developments and guidelines, mainly in the U.S. and Europe over the last decade. RWE has already been included in various approval procedures of regulatory authorities, reflecting its actual acceptance and growing importance in evaluating and accelerating new therapies. However, since RWE research is still in a transition process, and since a number of gaps in this field have been explored, more guidance and a consented definition are necessary to increase the implementation of real-world data.

The Power of Patient Engagement With Electronic Health Records as Research Participants.

Electronic health record (EHR) technology has become a central digital health tool throughout health care. EHR systems are responsible for a growing number of vital functions for hospitals and providers. More recently, patient-facing EHR tools are allowing patients to interact with their EHR and connect external sources of health data, such as wearable fitness trackers, personal genomics, and outside health services, to it. As patients become more engaged with their EHR, the volume and variety of digital health information will serve an increasingly useful role in health care and health research. Particularly due to the COVID-19 pandemic, the ability for the biomedical research community to pivot to fully remote research, driven largely by EHR data capture and other digital health tools, is an exciting development that can significantly reduce burden on study participants, improve diversity in clinical research, and equip researchers with more robust clinical data. In this viewpoint, we describe how patient engagement with EHR technology is poised to advance the digital clinical trial space, an innovative research model that is uniquely accessible and inclusive for study participants.

Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: a systematic review.

Aims: To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019 (COVID-19) and the challenges associated with their use. Methods: To determine the status of digital health utilization during COVID-19 in South Africa, the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study. We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021. Results: Total of 24 articles were included into this study. This study revealed that South Africa adopted digital technologies such as SMS-based solutions, mobile health applications, telemedicine and telehealth, WhatsApp-based systems, artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic. These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases, disease surveillance and monitoring, medication and treatment compliance, creating awareness and communication. The study also revealed that teleconsultation and e-prescription, telelaboratory and telepharmacy, teleeducation and teletraining, teledermatology, teleradiology, telecardiology, teleophthalmology, teleneurology, telerehabilitation, teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa. However, these smart digital health technologies face several impediments such as infrastructural and technological barriers, organization and financial barriers, policy and regulatory barriers as well as cultural barriers. Conclusion: Although COVID-19 has invigorated the use of digital health technologies, there are still some shortcomings. The outbreak of pandemics like COVID-19 in the future is not inevitable. Therefore, we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.

INSTITUTIONS OF HIGHER EDUCATION IN COVID-19 RISK COMMUNICATIONS: TEXAS STUDY

This case study research aimed to explore risk communication processes and strategies adopted by Institutions of Higher Education (IHEs) in the state of Texas during COVID-19. Because higher learning and interactions with students during the initial stages of the pandemic resided predominantly in virtual space, the study design considered website content analysis as appropriate in addressing risk communications chosen by universities. Markedly, website content analysis was conducted among 43 IHEs accredited by the Southern Association of Colleges and Schools Commission on Colleges and part of a Texas University System. This sampling replicates previous IHE research in the state. The conceptual model entitled “Conceptual Model for Evaluating Emergency Risk Communication (EERC)” developed in public health was used to ground focused risk communication dimensions to (a) review whether or to what degree messaging from IHEs aligned with the components used by experts;(b) record the types of patterns that are found in messaging as well as characteristics that foster a Disaster Resilient University (DRU);and (c) provide insights on areas that may need more focus to ensure greater efficacy in the future. The ERC model yielded the following dimensions used for analysis: (a) accurate/reliable;(b) open/transparent;(c) clear;(d) tailored messages;(e) consistent/timely;(f) sufficient;and (g) actionable. In addition to ERC, content regarding technological solutions was assessed from websites of chosen universities to gauge how universities have responded to tools needed during the pandemic to make informed judgments for the campus and to share information openly for the community. Our findings point to various components that IHEs in Texas targeted when communicating COVID-19 related information. For example, less than 60% of IHE in our sample defined terms, reviewed general COVID-19 information, and identified at risk groups on their respective campuses and only 6% provided an option for translating information. Meanwhile, IHEs fared generally better at providing timely updates regarding campus operations (i.e., 80%). Implications for our finding are discussed within the lens of Disaster Resilient University (DRU). © 2021 WIT Press.

Understanding Decision-Making in the Adoption of Digital Health Technology: The Role of Behavioral Economics' Prospect Theory.

The decision to accept or reject new digital health technologies remains an ongoing challenge among health care patients, providers, technology companies, and policymakers. Over the past few decades, interest in understanding the choice to adopt technology has led to the development of numerous theories and models. In 1979, however, psychologists Kahneman and Tversky published their seminal research article that has pioneered the field of behavioral economics. They named their model the prospect theory and used it to explain decision-making behaviors under conditions of risk and uncertainty as well as to provide an understanding of why individuals may make irrational or inconsistent choices. Although the prospect theory has been used to explain decision-making in economics, law, political science, and clinically, at the individual level, its application to understanding choice in the adoption of digital health technology has not been explored. Herein, we discuss how the main components of the prospect theory's editing phase (framing effect) and evaluation phase (value function and weighting function) can provide valuable insight on why health care patients, providers, technology companies, and policymakers may decide to accept or reject digital health technologies.

Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians.

BACKGROUND: Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools-a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform-into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. OBJECTIVE: The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. METHODS: Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). RESULTS: Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. CONCLUSIONS: Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.

Ensuring patient and public involvement in the transition to AI-assisted mental health care: A systematic scoping review and agenda for design justice.

BACKGROUND: Machine-learning algorithms and big data analytics, popularly known as 'artificial intelligence' (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI-assisted health care is essential for design justice based on diverse patient needs. OBJECTIVE: To inform the future development of PPI in AI-assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health. METHODS: Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers. RESULTS: The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI-assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI-assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies. CONCLUSION: The new data-rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.

Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States.

OBJECTIVE: Obsessive-compulsive disorder (OCD) can be a chronic and disabling illness with a lifetime prevalence of 2%, twice that of schizophrenia. Although effective treatments exist, OCD often remains underdetected and undertreated. METHODS: The authors performed a scoping review of the literature (of articles in PubMed and PsycINFO published from January 1, 2000, to February 1, 2020) to define gaps in OCD diagnosis and treatment among U.S. adults. Interventions at the patient, clinician, and health care system levels used to address these gaps are described, and promising approaches from around the world are highlighted. RESULTS: Of 102 potential studies identified in the search, 27 (including five non-U.S. studies) were included. The studies revealed that lack of clinician and patient knowledge about OCD and misdiagnosis contributes to its underdetection. Suboptimal prescribing of selective serotonin reuptake inhibitor medications and limited use of exposure and response prevention, as a first-line psychotherapy, contribute to OCD undertreatment. Digital health technologies show promise in increasing OCD detection and delivery of evidence-based care and in ensuring continuity of care (including during the COVID-19 pandemic). CONCLUSIONS: Given the significant rates of disability, morbidity, and mortality associated with OCD, addressing gaps in OCD care will reduce the U.S. burden of mental illness. Further research is needed to determine how the use of digital health technologies can increase the detection and management of OCD.

Deployment of a Smart Handwashing Station in a School Setting During the COVID-19 Pandemic: Field Study.

BACKGROUND: Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices. OBJECTIVE: The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic. METHODS: We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users. RESULTS: The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station's electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing. CONCLUSIONS: This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children.

Drug Information Association (DIA) 2020 Virtual Global Annual Meeting (June 14-18, 2020).

At the 56th Global Annual Meeting of the Drug Information Association (DIA), attendees met virtually during the height of the global COVID-19 pandemic for "rapid cross-stakeholder, cross-border collaboration" to support health worldwide. Sessions included presenters and speakers from regulatory, patient advocacy and academia sectors, with patients at the forefront of those discussions. This report covers various presentations and panel discussions from the 4-day meeting that focus on COVID-19, innovative trial designs spurred by a need to adapt amid a pandemic, digital health, novel products inspiring new regulatory standards, clinical trials, data collection and management, the need for more and better data and the ever-increasing importance of the patient perspective.

Digital technology applications for contact tracing: the new promise for COVID-19 and beyond?

Among the most critical strategies in the fight against the Corona Virus Disease (COVID-19) is the rapid tracing and notification of potentially infected persons. Several nations have implemented mobile software applications ("apps") to alert persons exposed to the coronavirus. The expected advantages of this new technology over the traditional method of contact tracing include speed, specificity, and mass reach. Beyond its use for mitigating and containing COVID-19, digital technology can complement or even augment the traditional approach to global health program implementation. However, as with any new system, strong regulatory frameworks are necessary to ensure that individual information is not used for surveillance purposes, and user privacy will be maintained. Having safeguarded this, perhaps the global health community will witness the beginning of a new era of implementing mass health programs through the medium of digital technology.