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Mobile technology is increasingly being used to widen access to and support the delivery of public health interventions. Human immunodeficiency viruses (HIV) self-testing (HIVST) enables individuals to have autonomy. We evaluated the feasibility of a novel application called ITHAKA to support HIVST among youth aged 16–24 years in Zimbabwe. This study was nested within a trial of community-based delivery of integrated HIV and sexual and reproductive health services called CHIEDZA. Youth accessing CHIEDZA were offered provider-delivered HIV testing or HIVST supported by ITHAKA, either on a tablet on-site at a community centre or on their mobile phone off-site. ITHAKA incorporated pre and post-test counselling, and instructions for conducting the test and the appropriate actions to take depending on test result, including reporting HIV test results to health providers. The outcome was completion of the testing journey. Semistructured interviews with CHIEDZA providers explored the perceptions of and experiences with the application. Between April and September 2019, of the 2,181 youth who accepted HIV testing in CHIEDZA, 128 (5.8%) initiated HIVST (the remainder opting for provider-delivered testing) using ITHAKA. Nearly all who performed HIVST on-site (108/109 (99.1%)) compared to only 9/19 (47.4%) who tested off-site completed their testing journey. Low digital literacy, lack of agency, erratic network coverage, lack of dedicated phone ownership, the limited functionality of smartphones challenged implementation of ITHAKA. Digitally supported HIVST had low uptake among youth. The feasibility and usability of digital interventions should be carefully assessed before implementation, paying careful attention to digital literacy, network availability, and access to devices. [ABSTRACT FROM AUTHOR]

• The awareness of emergency contraception (EC) among Female Factory Workers (FFWs) is significantly lacking, putting them at risk of unintended pregnancies and unsafe abortions. What is particularly troubling is that a considerable number of FFWs who have experienced unintended pregnancies and unsafe abortions have not utilized Emergency Contraceptive Pills (ECPs) in their lives, potentially due to a lack of awareness and knowledge about these available options. • Despite experiencing unintended pregnancies and/or unsafe abortions, individuals have not obtained the crucial, accurate knowledge, rendering them susceptible to recurring incidents. This situation prompts questions about the effectiveness of current Sexual and Reproductive Health (SRH) programs and the quality of post-abortion counseling within this restricted setting. • The study reveals the urgent need for improved family planning programs that target FFWs, with a focus on increasing knowledge and access to ECP as a means of reducing unintended pregnancy and unsafe abortion. Digital health interventions with innovative ICT tools would be a feasible solution in the factory settings. In Sri Lanka, the Emergency Contraceptive Pill (ECP) is categorized as a Schedule 2A medication, allowing it to be purchased over-the-counter without a prescription, but exclusively from licensed pharmacists. It is estimated that around 3 million ECPs are consumed by Sri Lankan women each year. This study aims to assess the knowledge and practices of Female Factory Workers (FFWs) on ECP and to unearth the association with unintended pregnancy and unsafe abortion. After receiving written informed consent, a structured interview schedule was administered among 585 FFWs attached to eight factories in a selected Export Processing Zone (EPZ). Data analysis was performed using SPSS software. Only 26 % of FFWs were aware of the effective time period to take an ECP to prevent a pregnancy. Most (67 %) had the impression that a valid prescription is required to purchase ECP from the pharmacies. Around one-tenth of the FFWs (11.3 %, n = 66) had used ECP during their lifetime. Among the 65 respondents who reported having experienced unintended pregnancies, only 26.2 % (n = 17) had utilized ECPs. In contrast, among the 22 respondents who disclosed a history of abortion, only two women had ever employed ECPs. The study highlights the low knowledge and use of ECP among FFWs in Sri Lanka, contributing to unintended pregnancy and unsafe abortion. Results call for targeted interventions to improve knowledge and access to ECP, helping to reduce unintended pregnancy and improve reproductive health outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported. Objective: This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings). Methods: We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively. Results: Of 2711 records identified, we included 13 (0.48%) articles in the effectiveness review (3/13, 23% for web-based outreach; 7/13, 54% for web-based case management; and 3/13, 23% for targeted web-based health information), 15 (0.55%) articles in the values and preferences review, and 1 (0.04%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms. Conclusions: Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs). J Med Internet Res 2022;24(12):e40150 doi:10.2196/40150 [ABSTRACT FROM AUTHOR]

Background: Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition.Objective: This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS-digital health interventions that were intended to support a program of engagement over a defined period-and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs).Methods: We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators.Results: There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively.Conclusions: This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type. [ABSTRACT FROM AUTHOR]

Background: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs.Objective: This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used.Methods: We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain.Results: We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy.Conclusions: Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective. [ABSTRACT FROM AUTHOR]

Background: An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.Objective: This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.Methods: This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs.Results: A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions.Conclusions: The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988. [ABSTRACT FROM AUTHOR]

Background: Engagement emerges as a predictor for the effectiveness of digital health interventions. However, a shared understanding of engagement is missing. Therefore, a new scale has been developed that proposes a clear definition and creates a tool to measure it. The TWente Engagement with Ehealth Technologies Scale (TWEETS) is based on a systematic review and interviews with engaged health app users. It defines engagement as a combination of behavior, cognition, and affect.Objective: This paper aims to evaluate the psychometric properties of the TWEETS. In addition, a comparison is made with the experiential part of the Digital Behavior Change Intervention Engagement Scale (DBCI-ES-Ex), a scale that showed some issues in previous psychometric analyses.Methods: In this study, 288 participants were asked to use any step counter app on their smartphones for 2 weeks. They completed online questionnaires at 4 time points: T0=baseline, T1=after 1 day, T2=1 week, and T3=2 weeks. At T0, demographics and personality (conscientiousness and intellect/imagination) were assessed; at T1-T3, engagement, involvement, enjoyment, subjective usage, and perceived behavior change were included as measures that are theoretically related to our definition of engagement. Analyses focused on internal consistency, reliability, and the convergent, divergent, and predictive validity of both engagement scales. Convergent validity was assessed by correlating the engagement scales with involvement, enjoyment, and subjective usage; divergent validity was assessed by correlating the engagement scales with personality; and predictive validity was assessed by regression analyses using engagement to predict perceived behavior change at later time points.Results: The Cronbach alpha values of the TWEETS were .86, .86, and .87 on T1, T2, and T3, respectively. Exploratory factor analyses indicated that a 1-factor structure best fits the data. The TWEETS is moderately to strongly correlated with involvement and enjoyment (theoretically related to cognitive and affective engagement, respectively; P<.001). Correlations between the TWEETS and frequency of use were nonsignificant or small, and differences between adherers and nonadherers on the TWEETS were significant (P<.001). Correlations between personality and the TWEETS were nonsignificant. The TWEETS at T1 was predictive of perceived behavior change at T3, with an explained variance of 16%. The psychometric properties of the TWEETS and the DBCI-ES-Ex seemed comparable in some aspects (eg, internal consistency), and in other aspects, the TWEETS seemed somewhat superior (divergent and predictive validity).Conclusions: The TWEETS performs quite well as an engagement measure with high internal consistency, reasonable test-retest reliability and convergent validity, good divergent validity, and reasonable predictive validity. As the psychometric quality of a scale is a reflection of how closely a scale matches the conceptualization of a concept, this paper is also an attempt to conceptualize and define engagement as a unique concept, providing a first step toward an acceptable standard of defining and measuring engagement. [ABSTRACT FROM AUTHOR]

Background: The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved.Objective: This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users' views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders.Methods: A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies.Results: A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants' initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care.Conclusions: Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions. [ABSTRACT FROM AUTHOR]

Background: Previous data have validated the benefit of digital health interventions (DHIs) on weight loss in patients following acute coronary syndrome entering cardiac rehabilitation (CR).Objective: The primary purpose of this study was to test the hypothesis that increased DHI use, as measured by individual log-ins, is associated with improved weight loss. Secondary analyses evaluated the association between log-ins and activity within the platform and exercise, dietary, and medication adherence.Methods: We obtained DHI data including active days, total log-ins, tasks completed, educational modules reviewed, medication adherence, and nonmonetary incentive points earned in patients undergoing standard CR following acute coronary syndrome. Linear regression followed by multivariable models were used to evaluate associations between DHI log-ins and weight loss or dietary adherence.Results: Participants (n=61) were 79% male (48/61) with mean age of 61.0 (SD 9.7) years. We found a significant positive association of total log-ins during CR with weight loss (r2=.10, P=.03). Educational modules viewed (r2=.11, P=.009) and tasks completed (r2=.10, P=.01) were positively significantly associated with weight loss, yet total log-ins were not significantly associated with differences in dietary adherence (r2=.05, P=.12) or improvements in minutes of exercise per week (r2=.03, P=.36).Conclusions: These data extend our previous findings and demonstrate increased DHI log-ins portend improved weight loss in patients undergoing CR after acute coronary syndrome. DHI adherence can potentially be monitored and used as a tool to selectively encourage patients to adhere to secondary prevention lifestyle modifications.Trial Registration: ClinicalTrials.gov (NCT01883050); https://clinicaltrials.gov/ct2/show/NCT01883050. [ABSTRACT FROM AUTHOR]

Background: Digital health interventions (DHIs) are poised to reduce target symptoms in a scalable, affordable, and empirically supported way. DHIs that involve coaching or clinical support often collect text data from 2 sources: (1) open correspondence between users and the trained practitioners supporting them through a messaging system and (2) text data recorded during the intervention by users, such as diary entries. Natural language processing (NLP) offers methods for analyzing text, augmenting the understanding of intervention effects, and informing therapeutic decision making.Objective: This study aimed to present a technical framework that supports the automated analysis of both types of text data often present in DHIs. This framework generates text features and helps to build statistical models to predict target variables, including user engagement, symptom change, and therapeutic outcomes.Methods: We first discussed various NLP techniques and demonstrated how they are implemented in the presented framework. We then applied the framework in a case study of the Healthy Body Image Program, a Web-based intervention trial for eating disorders (EDs). A total of 372 participants who screened positive for an ED received a DHI aimed at reducing ED psychopathology (including binge eating and purging behaviors) and improving body image. These users generated 37,228 intervention text snippets and exchanged 4285 user-coach messages, which were analyzed using the proposed model.Results: We applied the framework to predict binge eating behavior, resulting in an area under the curve between 0.57 (when applied to new users) and 0.72 (when applied to new symptom reports of known users). In addition, initial evidence indicated that specific text features predicted the therapeutic outcome of reducing ED symptoms.Conclusions: The case study demonstrates the usefulness of a structured approach to text data analytics. NLP techniques improve the prediction of symptom changes in DHIs. We present a technical framework that can be easily applied in other clinical trials and clinical presentations and encourage other groups to apply the framework in similar contexts. [ABSTRACT FROM AUTHOR]