Zrubka, Zsombor, Champion, Annette, Holtorf, Anke-Peggy, Di Bidino, Rossella, Earla, Jagadeswara Rao, Boltyenkov, Artem T., Tabata-Kelly, Masami, Asche, Carl, and Burrell, Anita
Digital health definitions are abundant, but often lack clarity and precision. We aimed to develop a minimum information framework to define patient-facing digital health interventions (DHIs) for outcomes research. Definitions of digital-health-related terms (DHTs) were systematically reviewed, followed by a content analysis using frameworks, including PICOTS (population, intervention, comparator, outcome, timing, and setting), Shannon-Weaver Model of Communication, Agency for Healthcare Research and Quality Measures, and the World Health Organization's Classification of Digital Health Interventions. Subsequently, we conducted an online Delphi study to establish a minimum information framework, which was pilot tested by 5 experts using hypothetical examples. After screening 2610 records and 545 full-text articles, we identified 101 unique definitions of 67 secondary DHTs in 76 articles, resulting in 95 different patterns of concepts among the definitions. World Health Organization system (84.5%), message (75.7%), intervention (58.3%), and technology (52.4%) were the most frequently covered concepts. For the Delphi survey, we invited 47 members of the ISPOR Digital Health Special Interest Group, 18 of whom became the Delphi panel. The first, second, and third survey rounds were completed by 18, 11, and 10 respondents, respectively. After consolidating results, the PICOTS-ComTeC acronym emerged, involving 9 domains (population, intervention, comparator, outcome, timing, setting, communication, technology, and context) and 32 optional subcategories. Patient-facing DHIs can be specified using PICOTS-ComTeC that facilitates identification of appropriate interventions and comparators for a given decision. PICOTS-ComTeC is a flexible and versatile tool, intended to assist authors in designing and reporting primary studies and evidence syntheses, yielding actionable results for clinicians and other decision makers. • Abundant, yet vaguely defined definitions in digital health represent a challenge for clinicians, decision makers, developers, and researchers. Despite having several guidelines/checklists for the standardization of evidence generation and assessment for digital health interventions (DHIs), the identification of comparable DHIs remains difficult because of their personalized nature, complex technologies, and linkages to larger systems. This may restrict the validity of evidence syntheses. • We introduce the PICOTS-ComTeC (population, intervention, comparator, outcome, timing, setting, communication, technology, and context) framework, a newly developed, flexible, and versatile tool to help the formulation of sufficiently specific and detailed definitions for patient-facing digital health interventions and related research questions. • To overcome the limitations of terminology in digital health, the PICOTS-ComTeC framework of patient-facing DHIs should be specified in sufficient detail, to allow the identification of comparable interventions and allow for the selection of appropriate comparators that deliver similar effects to patients; therefore, the fit of DHIs in clinical, financing or development decision contexts, and specific research questions can be assessed. [ABSTRACT FROM AUTHOR]