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Background: As the digital health landscape continues to evolve, analyzing the progress and direction of the field can yield valuable insights. The Journal of Medical Internet Research (JMIR) has been at the forefront of disseminating digital health research since 1999. A comprehensive network analysis of JMIR publications can help illuminate the evolution and trends in digital medicine over the past 25 years., Objective: This study aims to conduct a detailed network analysis of JMIR's publications to uncover the growth patterns, dominant themes, and potential future trajectories in digital health research., Methods: We retrieved 8068 JMIR papers from PubMed using the Biopython library. Keyword metrics were assessed using accuracy, recall, and F 1 -scores to evaluate the effectiveness of keyword identification from Claude 3 Opus and Gemini 1.5 Pro in addition to 2 conventional natural language processing methods using key bidirectional encoder representations from transformers. Future trends for 2024-2026 were predicted using Claude 3 Opus, Google's Time Series Foundation Model, autoregressive integrated moving average, exponential smoothing, and Prophet. Network visualization techniques were used to represent and analyze the complex relationships between collaborating countries, paper types, and keyword co-occurrence., Results: JMIR's publication volume showed consistent growth, with a peak in 2020. The United States dominated country contributions, with China showing a notable increase in recent years. Keyword analysis from 1999 to 2023 showed significant thematic shifts, from an early internet and digital health focus to the dominance of COVID-19 and advanced technologies such as machine learning. Predictions for 2024-2026 suggest an increased focus on artificial intelligence, digital health, and mental health., Conclusions: Network analysis of JMIR publications provides a macroscopic view of the evolution of the digital health field. The journal's trajectory reflects broader technological advances and shifting research priorities, including the impact of the COVID-19 pandemic. The predicted trends underscore the growing importance of computational technology in future health care research and practice. The findings from JMIR provide a glimpse into the future of digital medicine, suggesting a robust integration of artificial intelligence and continued emphasis on mental health in the postpandemic era., (©Robert Kaczmarczyk, Theresa Isabelle Wilhelm, Jonas Roos, Ron Martin. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.11.2024.)

Background: During the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs., Methods: This study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs., Results: Primary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14)., Conclusions: Digital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies., Competing Interests: Declarations Ethics approval and consent to participate The authors confirm that all methods were carried out in accordance with relevant guidelines and regulations.The research has ethical approval by TUKEB (Hungarian Scientific Research and Research Ethics Committee) with the reference number IV-10927–1 TUKEB. This is a national body, so the ethical approval is not from the authors affiliation.The authors confirm that all experimental protocols were approved the TUKEB (Hungarian Scientific Research and Research Ethics Committee).The authors confirm that informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Understanding the potential adverse effects of the COVID-19-pandemic on mental health remains a challenge for public health. Differentiation between potential consequences of actual infection with SARS-CoV-2 and the subjective burden of the pandemic due to measures and restrictions to daily life still remains elusive. Therefore, we investigated the differential association between infection with SARS-Cov-2 and subjective burden of the pandemic in a study cohort of 7601 participants from the German population-based cohort for digital health research (DigiHero), who were recruited between March 4th and April 25th 2022. Data was collected using the online survey tool LimeSurvey® between March and October 2022 in consecutive surveys, which included questionnaires on infection status and symptoms following COVID-19 as well as retrospective assessment of the subjective burden of the pandemic. We observed an association of a past SARS-CoV-2 infection on deteriorated mental health related symptoms, whereas no association or interaction with burden of the pandemic occurred. The association was driven by participants with persistent symptoms 12 weeks after infection. On a symptom specific level, neuropsychiatric symptoms such as exhaustion and fatigue, concentration deficits and problems with memory function were the primary drivers of the association with small effect sizes between 0.048 and 0.062 η p 2 ., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Purpose: During the COVID-19 pandemic, regulatory and reimbursement policy changes provided patients improved access to neuro-oncology by telehealth. Here we discuss benefits and limitations of telehealth use in neuro-oncology. We review utilization of telemedicine services following the COVID-19 pandemic., Recent Findings: Utilization of telemedicine by neuro-oncology during the COVID-19 pandemic was 52%, compared to 27-29% for other solid tumors groups. Following the pandemic, between January 2021 and April 2024, telehealth utilization has remained high in neuro-oncology with approximately 30% of all visits completed by telemedicine, compared to 10-15% for other solid tumor groups. The striking difference between telehealth visit utilization in neuro-oncology and general medical oncology even after expiration of the COVID-19 Public Health Emergency expiration and end of pandemic-related restrictions, underscores the potential value of convenient access to care for patients with central nervous system tumors. Given widespread use of telehealth in neuro-oncology, prospective evaluation to determine the safety, usability, and acceptance of video-enabled, telehealth visits is critical. Such data may lead to broader adoption of telehealth, lead to regulatory and reimbursement reform for telehealth sustainability, and improve clinical trial access and accruals., Competing Interests: Declarations. Competing Interests: Joshua Pritchett has nothing to disclose. Joon Uhm has nothing to disclose. Ugur Sener has served on an advisory board for Servier Pharmaceuticals LLC; unrelated to this work. Tufa Haddad has received research grant funding from Takeda Oncology (Institutional) and served on an advisory board for Puma Biotechnology (no personal compensation); both are unrelated to this work. Conflict of Interest: Joshua Pritchett has nothing to disclose. Joon Uhm has nothing to disclose. Ugur Sener has served on an advisory board for Servier Pharmaceuticals LLC; unrelated to this work. Tufa Haddad has received research grant funding from Takeda Oncology (Institutional) and served on an advisory board for Puma Biotechnology (no personal compensation); both are unrelated to this work., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The COVID-19 pandemic has added to the pre-existing challenges of diabetes management in many countries. It has accelerated the wider use of digital health solutions which have tremendous potential to improve health outcomes for people with diabetes. However, little is known about the attributes and the implementation of these solutions., Objective: To identify and describe digital health solutions for community-based diabetes management and to highlight their key implementation outcomes., Methods: We searched Ovid Medline, CINAHL, Embase, PsycINFO, and Web of Science for relevant articles. A purposive search was also used to identify grey literature. Articles that described digital health solutions that aimed to improve community-based diabetes management were included in this review. We applied a thematic synthesis of evidence to describe the characteristics of digital health solutions, and to summarize their key implementation outcomes., Results: We included 15 articles that reported digital health solutions that primarily focused on community-based diabetes management. Nine of the 15 innovations involved were mobile applications and/or web-based platforms, and five were based on social media platforms. The majority of the digital health solutions were used for diabetes education and support. High engagement, utilization, and satisfaction rates with digital health solutions were observed. The use of digital health solutions was also associated with improvement in self-management, taking medication, and reduction in glycated hemoglobin (HbA1c) levels., Conclusion: COVID-19 triggered digital health solutions have tremendous potential to improve health outcomes for people with diabetes. Further studies are needed to evaluate the sustainability and scale-up of these solutions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary health care (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence., Objective: This study aims to provide policy makers, health managers, and researchers with a summary of evidence on digital interventions used in PHC., Methods: This overview of reviews searched the Web of Science and MEDLINE databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC published from January 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or health care providers (HCPs) were included., Results: A total of 236 records were identified from the search strategy, of which 42 (17.8%) full-text papers were selected for analysis, and 18 (7.6%) reviews met the eligibility criteria. In total, 61% (11/18) of the reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine, provider-to-provider telemedicine, health worker decision support systems, systems for tracking patients' health status, client participation and self-care platforms, and provision of education and training to health workers), and 39% (7/18) of the reviews focused on specific topics related to PHC (preventive care, chronic disease management, behavioral health disorders, the COVID-19 pandemic, multicomponent PHC interventions, and care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and apps developed without involving end users, the lack of training of HCPs and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients' clinical conditions and behavior changes., Conclusions: Research in digital health applied to PHC is still concentrated in high-income countries, mainly in North America and Europe. The mixed results related to health service quality and patients' clinical conditions or behavior changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal relationship among implementation, health service quality, and clinical condition outcomes to support the spread of digital health in PHC settings., (©Virgínia Maria Dalfior Fava, Luís Velez Lapão. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.10.2024.)

Introduction: Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service., Methods: A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care., Results: There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients' expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications., Conclusion: The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care., Trial Registration: NCT05069103., (© 2024. The Author(s).)

The COVID-19 pandemic, patient preference, and economic opportunity are shifting acute care from the hospital to the home, supported by the transformation in remote monitoring technology. Monitoring patients with digital medical devices gives unprecedented insight into their physiology. However, this technology does not exist in a vacuum. Distinguishing pathology from physiological variability, user error, or device limitations is challenging. In a hospital, patients are monitored in a contrived environment. Monitoring at home instead captures activities of daily living alongside patients' trajectory of disease and recovery. Both settings make for "noisy" data. However, we are familiar with hospital noise, accounting for it in our practice and perceptions of normal. Home monitoring as a diagnostic intervention introduces a new set of downstream consequences, dependent on device, cadence of collection, adherence, duration, alarm thresholds, and escalation criteria. We must accept greater ambiguity and contextualize vital signs. All devices balance accuracy with acceptability, so compromises are inevitable and perfect data should not be expected. Alarms must be specific as well as sensitive, balancing clinical risk with capacity for response. By setting expectations around data from the home, we can smooth the adoption of remote monitoring and accelerate the transition of acute care., (©Matt Wilkes, Annabel Kramer, Juliana Pugmire, Christopher Pilkington, Benjamin Zaniello, Nicole Zahradka. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 11.10.2024.)

Objective: The current study aims to understand how Apple Watch helped users maintain wellness routines during the COVID-19 lockdown period, where access to public gyms and spaces was curtailed. We explore the effectiveness of biofeedback engagement aspects of Apple Watch: goals, alerts and notifications, and sociability aspects of the device or social interaction with other users. Methods: We report the results of a 2-week digital diary study based in the United States with 10 adults with 6 months or longer exposure to Apple Watch, followed by online survey responses gathered from 330 additional users. Results: The study findings show how Apple Watch transforms notifications from distractions into positive wellness tools. Data suggests that personal context (custom goals and supported intent) combined with motivational nudges from alerts and notifications as well as contextually triggered nudges contribute to Apple Watch user adoption and satisfaction. Conclusion: This study highlights how Apple Watch transforms notifications from distractions into positive wellness tools; emphasizing the importance of balancing nudging with customization with user control. Sociability and privacy remain crucial, especially with biofeedback-enabled fitness trackers. We conclude that Apple Watch enhances user engagement by triggering context-relevant interactions, nudging users to achieve their goals through small, motivated behaviors., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The arrival of COVID-19 in Brazil had a marked impact on the health network as well as on the professionals involved, due to the significant number of cases and constantly updated information. In this context, the Cooperative Intelligence Platform for Primary Health Care - Picaps - is set up as a technological platform that assists by systematizing the communication and negotiation processes among actors, with a focus on science and technology. This article sets out to describe the processes of Picaps, which consist of a collaborative system conceived of as a public solution capable of generating innovations in the areas of Science, Technology and Health, in order to tackle COVID-19 in territories with populations in socially vulnerable situations in the Federal District (DF). It integrates data collection and processing, as well as the dissemination of information for its use, both at the governmental and societal levels. Picaps can be seen as a powerful government instrument to help societies across the country, especially those in vulnerable situations, capable of assisting in the use of cooperative intelligence in primary care and health surveillance actions to build innovative solutions such as rapid responses to face health crises in modern times.

The COVID-19 pandemic created critical challenges for hospitals and health care providers. Suddenly clinics were forced to close; elective procedures were delayed; scheduled visits were canceled; emergency rooms were overcrowded; hospital beds, equipment, and personal protective equipment (PPE) were in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma, and personal risk. To better address challenges of the ongoing COVID-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment Resource Center (TTAC) was asked to develop a Pandemic Response Action Plan that would allow its users to address critical issues with available telemedicine and related technologies. The project was constructed in 3 phases. Phase 1-Develop a Pandemic Response Action Plan and a Pandemic Response Action Plan Policy and Regulatory Summary, which identifies the regulatory challenges as well as policy recommendations. Phase 2-Publish the Action Plan and the Policy and Regulatory Summary. Phase 3-Look at health care providers who used the approaches, tools, and technology in the Pandemic Action Plan and document the results. This document represents Phase 3. This document is Phase 3. In this report we look back at health care providers who used the approaches in the Phase 1 Pandemic Response Action Plan as published in Phase 2. In this document we report on the challenges and results of implementing parts of the Pandemic Action Plan. It records the findings, conclusions, and recommendations resulting from the experience of health care providers and the professional experiences of the team and their organizations in implementing parts or all of the plan. Methods: The same multidisciplinary team that constructed Phase 1 and Phase 2 were engaged to develop this Phase 3 report. The members of the team represent leadership expertise and key stakeholders in health care delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, and information technology) as well as a facilitator. For Phase 3, the group used structured brainstorming to define the findings, issues, and results of their own organizations' digital health response to the pandemic. In addition, eight health care providers (hospitals) identified by the Telemedicine Resource Centers' (TRCs) organizations, who used the Pandemic response Plan (created in Phases 1 and 2), were interviewed. All interviews were conducted by the same facilitator with leaders (CEO, and leaders of the telemedicine programs) in each of the eight programs, using a standard questionnaire created by the team. Current literature references are included in this report to illustrate when findings are known to have broader applicability. Conclusions: The impact of the COVID-19 Pandemic was severe and identified multiple critical challenges and weaknesses. Applying the approaches, tools, and technology outlined in the Pandemic Response Action Plan proved to be effective in addressing critical provider challenges. However, implementing these tools during a crisis was difficult unless the organization had experience with the tools and necessary workflows in advance. Implementing these tools as part of standard workflows and everyday operations increased the capabilities and resilience of these organizations in the provision of care during this and for future pandemics.

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands' advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Introduction: The global pandemic caused by coronavirus (COVID-19) sped up the adoption of telemedicine. We aimed to assess whether factors associated with no-show differed between in-person and telemedicine visits. The focus is on understanding how social economic factors affect patient no-show for the two modalities of visits., Methods: We utilized electronic health records data for outpatient internal medicine visits at a large urban academic medical center, from February 1, 2020 to December 31, 2020. A mixed-effect logistic regression was used. We performed stratified analysis for each modality of visit and a combined analysis with interaction terms between exposure variables and visit modality., Results: A total of 111,725 visits for 72,603 patients were identified. Patient demographics (age, gender, race, income, partner), lead days, and primary insurance were significantly different between the two visit modalities. Our multivariable regression analyses showed that the impact of sociodemographic factors, such as Medicaid insurance (OR 1.23, p < 0.01 for in-person; OR 1.03, p = 0.57 for telemedicine; p < 0.01 for interaction), Medicare insurance (OR 1.11, p = 0.04 for in-person; OR 0.95, p = 0.32 for telemedicine; p = 0.03 for interaction) and Black race (OR 1.36, p < 0.01 for in-person; OR 1.20, p < 0.01 for telemedicine; p = 0.03 for interaction), on increased odds of no-show was less for telemedicine visits than for in-person visits. In addition, inclement weather and younger age had less impact on no-show for telemedicine visits., Discussion: Our findings indicated that if adopted successfully, telemedicine had the potential to reduce no-show rate for vulnerable patient groups and reduce the disparity between patients from different socioeconomic backgrounds., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a "digital divide," inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage., Objective: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic., Methods: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors., Results: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70% (1580/2258) to 82.5% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020., Conclusions: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services., (©Inge Tuitert, Jesse D Marinus, Jelle R Dalenberg, Job TB van 't Veer. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.09.2024.)

Background: Digital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects., Objective: We aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention., Methods: The resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact-tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions., Results: The current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted., Conclusions: DigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge., (©Tina Jahnel, Chen-Chia Pan, Núria Pedros Barnils, Saskia Muellmann, Merle Freye, Hans-Henrik Dassow, Oliver Lange, Anke V Reinschluessel, Wolf Rogowski, Ansgar Gerhardus. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.09.2024.)

Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula., Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health., Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective., Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business., Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development., (© Swathi Ramachandran, Hsiu-Ju Chang, Catherine Worthington, Andre Kushniruk, Francisco Ibáñez-Carrasco, Hugh Davies, Geoffrey McKee, Adalsteinn Brown, Mark Gilbert, Ihoghosa Iyamu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: The COVID-19 pandemic prompted various containment strategies, such as work-from-home policies and reduced social contact, which significantly altered people's sleep routines. While previous studies have highlighted the negative impacts of these restrictions on sleep, they often lack a comprehensive perspective that considers other factors, such as seasonal variations and physical activity (PA), which can also influence sleep., Objective: This study aims to longitudinally examine the detailed changes in sleep patterns among working adults during the COVID-19 pandemic using a combination of repeated questionnaires and high-resolution passive measurements from wearable sensors. We investigate the association between sleep and 5 sets of variables: (1) demographics; (2) sleep-related habits; (3) PA behaviors; and external factors, including (4) pandemic-specific constraints and (5) seasonal variations during the study period., Methods: We recruited working adults in Finland for a 1-year study (June 2021-June 2022) conducted during the late stage of the COVID-19 pandemic. We collected multisensor data from fitness trackers worn by participants, as well as work and sleep-related measures through monthly questionnaires. Additionally, we used the Stringency Index for Finland at various points in time to estimate the degree of pandemic-related lockdown restrictions during the study period. We applied linear mixed models to examine changes in sleep patterns during this late stage of the pandemic and their association with the 5 sets of variables., Results: The sleep patterns of 27,350 nights from 112 working adults were analyzed. Stricter pandemic measures were associated with an increase in total sleep time (TST) (β=.003, 95% CI 0.001-0.005; P<.001) and a delay in midsleep (MS) (β=.02, 95% CI 0.02-0.03; P<.001). Individuals who tend to snooze exhibited greater variability in both TST (β=.15, 95% CI 0.05-0.27; P=.006) and MS (β=.17, 95% CI 0.03-0.31; P=.01). Occupational differences in sleep pattern were observed, with service staff experiencing longer TST (β=.37, 95% CI 0.14-0.61; P=.004) and lower variability in TST (β=-.15, 95% CI -0.27 to -0.05; P<.001). Engaging in PA later in the day was associated with longer TST (β=.03, 95% CI 0.02-0.04; P<.001) and less variability in TST (β=-.01, 95% CI -0.02 to 0.00; P=.02). Higher intradaily variability in rest activity rhythm was associated with shorter TST (β=-.26, 95% CI -0.29 to -0.23; P<.001), earlier MS (β=-.29, 95% CI -0.33 to -0.26; P<.001), and reduced variability in TST (β=-.16, 95% CI -0.23 to -0.09; P<.001)., Conclusions: Our study provided a comprehensive view of the factors affecting sleep patterns during the late stage of the pandemic. As we navigate the future of work after the pandemic, understanding how work arrangements, lifestyle choices, and sleep quality interact will be crucial for optimizing well-being and performance in the workforce., (©Nguyen Luong, Gloria Mark, Juhi Kulshrestha, Talayeh Aledavood. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 03.09.2024.)

Background: Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio-only) in people with CVD and CVD risk factors. We also assessed their rationale and satisfaction with telehealth visits., Methods and Results: A nationally representative sample of 6252 participants from the 2022 Health Information National Trends Survey 6 was used. We defined the CVD risk categories as having no self-reported CVD (coronary heart disease or heart failure) or CVD risk factors (hypertension, diabetes, obesity, or current smoking), CVD risk factors alone, and CVD. Multivariable logistic regression, adjusting for major sociodemographic factors, assessed the relationship between CVD risk and telehealth uptake. The weighted prevalence of using telehealth was 50% (95% CI, 44%-56%) for individuals with CVD and 40% (95% CI, 37%-43%) for those with CVD risk factors alone. Individuals with CVD had the highest odds of using any telehealth (audio-only or video) (adjusted odds ratio [OR], 2.02 [95% CI, 1.39-2.93]) when compared with those without CVD or CVD risk factors. Notably, 21% (95% CI, 16.3%-25.6%) of patients with CVD used audio-only visits (adjusted OR, 2.38 [95% CI, 1.55-3.64]) compared with patients without CVD or CVD risk factors., Conclusions: In a nationally representative survey, there was high prevalence of any (video or audio-only) telehealth visits in people with CVD, and audio-only visits comprised a significant proportion of telehealth visits in this population.

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Chatbots can effect large-scale behaviour change because they are accessible through social media, flexible, scalable, and gather data automatically. Yet research on the feasibility and effectiveness of chatbot-administered behaviour change interventions is sparse. The effectiveness of established behaviour change interventions when implemented in chatbots is not guaranteed, given the unique human-machine interaction dynamics. We pilot-tested chatbot-based behaviour change through information provision and embedded animations. We evaluated whether the chatbot could increase understanding and intentions to adopt protective behaviours during the pandemic. Fifty-nine culturally and linguistically diverse participants received a compassion intervention, an exponential growth intervention, or no intervention. We measured participants' COVID-19 testing intentions and measured their staying-home attitudes before and after their chatbot interaction. We found reduced uncertainty about protective behaviours. The exponential growth intervention increased participants' testing intentions. This study provides preliminary evidence that chatbots can spark behaviour change, with applications in diverse and underrepresented groups., (© 2024. The Author(s).)

Background: Digital health technologies, such as mobile applications, wearable devices, and electronic health record systems, have significantly enhanced global health security by enabling timely data collection and analysis, identifying infectious disease trends, and reducing infection risk through remote services., Objective: This study assesses the role of digital health in pandemic preparedness and global health security response. It examines the application of digital health to early detection, surveillance, and data management in patient care., Methods: We gathered data from scholarly articles published between 2019 and 2024 (found in PubMed, Science Direct, Google Scholar, and Web of Science), reports from the WHO, and case studies of recent pandemics. Topics discussed include digital health technologies, their use, benefits, and issues. We paid special attention to gathering the informed opinions and perspectives of specialists from various fields, including public health, technology, and government. The commentary synthesises these findings to offer suggestions for incorporating digital health into future pandemic preparedness and response., Results: Digital tools improve communication, combat fake news, and reach the public, but data protection and public health remain challenges. Integration requires extensive research and collaboration between governments and the private sector., Conclusion: The COVID-19 outbreak demonstrated the importance of digital technology in outbreak management, patient care, communication, and data sharing. As the world transitions into the post-pandemic phase, it will be important to build on these innovations and prepare for the challenges ahead in order to strengthen healthcare systems for future pandemics.

The COVID-19 pandemic presented a grave threat to the continuity of health services that UNRWA provides to 5.9 million Palestine Refugees in the Near East. UNRWA runs 140 primary health care clinics, providing approximately nine million medical consultations a year. During the pandemic, UNRWA's e-Health system (and other digital health tools) were crucial in maintaining health services. The e-Health system enabled the identification of at-risk patients and transformed UNRWA's services for sustainability and efficiency. Innovations like telemedicine and two smartphone applications (e-NCD and e-MCH) enhanced service delivery and staff management. To evaluate the effectiveness of digital health integration in UNRWA's services during and after the pandemic, the team analyzed reports, events, and e-Health data from 2019-2022. Results show that digital tools, like e-NCD and e-MCH applications, helped reduce COVID-19 among Palestine Refugees, enabling remote care and continuous access to essential health services. Digital health has now become essential in UNRWA's post-pandemic operations. This paper offers a paradigm for future outbreak responses. By harnessing the power of digital health, UNRWA's e-Health system served as a beacon of hope, demonstrating how innovative approaches can empower patients, enhance health care outcomes, and ensure equitable access to health care services during crisis situations and beyond.

Digital health covers a wide spectrum of applications of digital technologies in the healthcare field. As a new set of tools to support the health system in achieving its goals-improving access to care, quality of care, and system efficiency-digital health has significantly transformed the landscape of modern medicine and health care. This paper examines the role of digital health under Taiwan National Health Insurance, considering the profound impacts of digital health during the COVID-19 pandemic. It focuses specifically on big data management and analytics (MediCloud and My Health Bank/NHI Mobile Easy Access) and innovative service provision models (telemedicine). We discuss two imminent challenges that any health system is likely to encounter: digital trust and digital divide. For the digital divide, we assessed the use of telemedicine and its determinants during the COVID-19 pandemic. Our study shows that high-income levels and the presence of chronic or severe illness were positively correlated with the use of telemedicine. This observation suggests that poor people who have poorer health status were most likely to suffer from unmet needs for telemedicine. Enhancing cybersecurity to safeguard confidentiality, and effective communications with the public are fundamental and essential steps to regaining public trust in the digital era. When calling for more investment in digital technology, policy makers should be mindful of the potential digital divide across the demographic and socioeconomic strata, and specific policies should be devised to provide support to target the socially disadvantaged group.

We examined the associations between the use of different types of media and COVID-19 vaccine hesitancy, as well as risk behaviors of COVID-19 infection, in Japan in late 2021. Cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from February 5 to 7, 2021, and from October 1 to 3, 2021. Each individual's risk of acquiring SARS-CoV-2 infection was calculated using a quantitative assessment tool (the microCOVID). Intention to get vaccinated for COVID-19 was assessed by self-report. Usage of five types of media for obtaining COVID-related information was assessed: (1) newspapers, (2) television or radio, (3) internet or news apps, (4) social network services (SNS) (excluding LINE, a popular messaging app), and (5) other. Reliance on SNS did not show significant associations with either intention to get vaccinated or engaging in risky behavior for acquiring COVID-19. Although users of the internet or news apps were marginally significantly less likely to engage in high-risk behavior, significant associations between vaccine hesitancy and the usage of the internet or news apps were found in the middle age and elderly groups (OR [95% confidence interval (CI)] in middle age: 1.55 [1.07-2.23]; in elderly; 9.24 [3.28-26.02]). The differential associations between different types of media use and COVID-19 prevention behaviors may assist in preparing for future pandemic outbreaks. One implication for public health risk communication is audience segmentation, such as emphasizing vaccine safety and effectiveness for older audiences.

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

Introduction: Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management., Methods: A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre-post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits., Results: The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed., Conclusion: The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Many patients used telehealth services during the COVID-19 pandemic. In this study, we evaluate how different factors have affected telehealth utilization in recent years. Decision makers at the federal and state levels can use the results of this study to inform their healthcare-related policy decisions., Methods: We implemented data analytics techniques to determine the factors that explain the use of telehealth by developing a case study using data from Arkansas. Specifically, we built a random forest regression model which helps us identify the important factors in telehealth utilization. We evaluated how each factor impacts the number of telehealth patients in Arkansas counties., Results: Of the 11 factors evaluated, five are demographic, and six are socioeconomic factors. Socioeconomic factors are relatively easier to influence in the short term. Based on our results, broadband subscription is the most important socioeconomic factor and population density is the most important demographic factor. These two factors were followed by education level , computer use , and disability in terms of their importance as it relates to telehealth use., Discussion: Based on studies in the literature, telehealth has the potential to improve healthcare services by improving doctor utilization, reducing direct and indirect waiting times, and reducing costs. Thus, federal and state decision makers can influence the utilization of telehealth in specific locations by focusing on important factors. For example, investments can be made to increase broadband subscriptions, education levels, and computer use in targeted locations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: There is limited information about how on-line screening tools developed by integrated systems facilitated management of COVID-like illness patients., Methods: Using the Kaiser Permanente Northwest (KPNW) Electronic Health Record, we identified adult plan members who accessed online COVID-19 screening e-visits and enumerated their subsequent medical encounters, tests for SARS-CoV-2, and test outcomes., Results: Between May 2020 and December 2021, members completed 55,139 e-visits, with disproportionate representation among females (65% vs. 53% in the overall membership) and members aged <45 years (61% vs. 39%). Thirty percent of patients (16,953) were managed entirely through e-visits and 70% received subsequent in-person care. The percent of SARS-CoV-2 positive individuals was highest among the 1055 individuals triaged to inpatient care (17.9%), compared to 9.5% among those escalated to additional ambulatory care., Conclusions: The e-visit on-line screening tool helped KPNW assist thousands of patients with COVID-19 symptoms, avoid unnecessary in-person patient encounters, and preserved KPNW infection control and pandemic surge capacity., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic ("COVID-19 mitigation apps"). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people's acceptance of various COVID-19 mitigation apps deployed throughout the pandemic., Objective: This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people's contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people's acceptance of data sharing and data retention practices in various social contexts., Methods: A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents' basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people's acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results., Results: Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents' acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios., Conclusions: This study showed that people's acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations., (©Yuanyuan Feng, Brad Stenger, Shikun Zhang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.08.2024.)

Unlabelled: Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of "virtual-first" care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a "digital determinants of health" (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education., (© Katharine Lawrence, Defne L Levine. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background: Sexually transmitted infections (STIs) are a serious public health issue in many countries. Online postal self-sampling (OPSS) is increasingly used to test for STIs, a trend accelerated by the COVID-19 pandemic. There remains limited understanding of how service users experience OPSS and what leads them to access it over clinic-based services, or vice versa. This research seeks to address these gaps, by undertaking a large qualitative study which sits within the ASSIST study, a mixed-methods, realist evaluation of OPSS., Methods: Participants were recruited via clinic-based and online sexual health services in three case study areas in England. Purposive sampling was used to over-represent populations disproportionately affected by poor sexual health: young people; people of colour; men who have sex with men; and trans and non-binary people. Semi-structured interviews were analysed using Levesque's conceptual framework of access to healthcare., Results: We interviewed 100 service users. Participants typically became aware of OPSS from sexual health services, the internet or word of mouth. Acceptability of OPSS was facilitated by the perceived privacy it offered over clinic-based services, which some participants found embarrassing to access. OPSS also enabled participants to overcome barriers to reaching clinic-based services, such as a lack of appointment availability, although difficulty obtaining OPSS kits in some areas undermined this. As all services in our case study areas were free to use, affordability did not significantly shape access, although OPSS enabled some participants to avoid costs associated with travelling to clinic-based services. Participants were usually able to engage with OPSS, finding it easy to use and reliable, although blood self-sampling was challenging for most. Participants valued the support offered by clinic-based services beyond STI testing, including the opportunity to access contraception or ask staff questions, and felt this was more appropriate when they had specific concerns about their sexual health, such as STI symptoms., Conclusions: Our findings constitute one of the largest qualitative studies to have explored OPSS and offer valuable insights to providers. OPSS shapes access to STI testing in a number of ways, including facilitating access in many circumstances, but users also want to retain access to clinic-based services, particularly for when they believe they need support beyond STI testing., (© 2024. The Author(s).)

Background: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding., Objective: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods., Methods: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders., Results: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002)., Conclusions: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic., (©Smitha Ganeshan, Joshua Goldstein, Young-Jin Sohn, Amie Pollack, Russell S Phillips, Lisa Rotenstein. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.08.2024.)

Background: Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes., Objective: The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes., Methods: We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework., Results: Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework., Conclusions: Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth., (©Sagda Osman, Kate Churruca, Louise A Ellis, Dan Luo, Jeffrey Braithwaite. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.08.2024.)

This study examines the factors influencing users' intention to continue using mobile medical apps within the framework of the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Through a combination of questionnaire surveys and interviews, the research finds that doctor-patient trust, Performance Expectancy (PE), social influence, and facilitating conditions significantly impact users' intention to utilize mobile medical apps. Furthermore, the study reveals the moderating effect of doctor-patient trust on social influence, indicating an increased trust level during the epidemic, attributed to positive media coverage, complimentary medical services, and risk-sharing initiatives. These results provide valuable insights for the field of internet healthcare, COVID-19 response strategies, health information management, and the advancement of digital health technologies, spotlighting the pivotal roles of trust, PE, and social influence in fostering sustained engagement with mobile health apps., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Meng and Guo.)

Background: Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges., Objective: This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations., Methods: An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process., Results: Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted., Conclusions: The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses., (©Manal Kleib, Antonia Arnaert, Lynn M Nagle, Elizabeth Mirekuwaa Darko, Sobia Idrees, Daniel da Costa, Shamsa Ali. Originally published in JMIR Medical Education (https://mededu.jmir.org), 13.08.2024.)

Background: The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents., Methods: A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education., Results: The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice., Conclusions: This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare., (© 2024. The Author(s).)

Caregiving is often associated with negative physical and mental health outcomes, and as the COVID-19 pandemic escalated, caregivers experienced more burden and provided more care with substantially less support. Digital resources may have been one way caregivers managed demands for care and needs for information. This mixed-methods study included surveys and semi-structured interviews with caregivers ( n = 11) to describe experiences and use of digital health resources during the COVID-19 pandemic. Caregivers most often provided significant physical care and experienced reduced or no social support during the pandemic. Caregivers reported the need for improving the quality of telehealth services and digital health resources. COVID-19 will not likely be the last pandemic faced by contemporary society. Measures should be taken to reduce the anticipated negative impacts on caregivers and those receiving care during future pandemics., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how inequalities related to their use were conceptually assessed during and after the pandemic and understand how digital strategies and policies might support digital equity. We used the PRISMA Extension for scoping reviews, identifying 2055 papers through an initial search of 3 databases in 2021 and complementary search in 2022, of which 41 were retained. Analysis was guided by the eHealth equity framework. Results showed that digital inequalities were reported in the U.S. and other high-income countries and were mainly assessed through differences in access and use according to individual sociodemographic characteristics. Health disparities related to technology use and the interaction between context and technology implementation were more rarely documented. Policy recommendations stressed the adoption of an equity lens in strategy development and multilayered and intersectoral collaboration to align interventions with the needs of specific subgroups. Finally, findings suggested that evaluations of health and wellbeing distribution related to the use of digital technologies should inform digital strategies and health policies., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV., Methods and Setting: We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy., Results: We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/μL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments., Conclusion: It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future., (© 2024 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity., (©Maura M Kepper, Lauren A Fowler, Isabelle S Kusters, Jean W Davis, Manal Baqer, Sara Sagui-Henson, Yunyu Xiao, Adati Tarfa, Jean C Yi, Bryan Gibson, Kristin E Heron, Nicole M Alberts, Marissa Burgermaster, Veronica PS Njie-Carr, Lisa M Klesges. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.08.2024.)

Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine., Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases., Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination., Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8% decrease in the duration of the menstrual phase following vaccination., Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care., International Registered Report Identifier (irrid): RR2-10.1186/s13063-021-05241-5., (©Andjela Markovic, Vladimir Kovacevic, Timo B Brakenhoff, Duco Veen, Paul Klaver, Marianna Mitratza, George S Downward, Diederick E Grobbee, Maureen Cronin, Brianna M Goodale, COVID-19 Remote Early Detection (COVID-RED) consortium. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.07.2024.)

Background: The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood., Objective: This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services., Methods: We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes., Results: We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth., Conclusions: The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women's expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols., (©Samuel Knauss, Gracia Andriamiadana, Roxane Leitheiser, Zavaniarivo Rampanjato, Till Bärnighausen, Julius Valentin Emmrich. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 30.07.2024.)

Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs., Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community-based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India., Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods., Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23% (95% CI 3%-45%) and masking was 17% (0%-38%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22% (95% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19-related stigma or discrimination in Pune was 68% (95% CI 0.133-0.191) lower than that in Satara., Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings., (©Saurav Basu, Meghana Desai, Anup Karan, Surbhi Bhardwaj, Himanshu Negandhi, Nitin Jadhav, Amar Maske, Sanjay Zodpey. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 29.07.2024.)

The use of technology in nursing has increased, most notably since the Covid-19 pandemic which highlighted benefits of digital health in nursing practice. Understanding the enablers and barriers associated with nurses' use of digital technology is important as these can impact adoption and engagement. To understand the factors that impacted New Zealand nurses' use of technology a national online survey was undertaken in August 2022. Participants (n=191) came from varied clinical settings across the country. Their responses to the open-ended questions were thematically analyzed and are reported here. Four themes were identified: 1) Knowledge of digital technology, 2) connectivity, 3) devices and systems, and 4) training and education. Understanding the factors that impact nurses use of technology can support actions to build the digital competency of nurses, enhance the nursing workforce and therefore benefit patient care.

Background: Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic., Objective: This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia., Methods: Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health., Results: Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit., Conclusions: This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses., (© Timothy Dotson, Brad Price, Brian Witrick, Sherri Davis, Emily Kemper, Stacey Whanger, Sally Hodder, Brian Hendricks. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Multimedia interventions may play an important role in improving patient care and reducing the time constraints of patient-clinician encounters. The "MyStay Cardiac" multimedia resource is an innovative program designed to be accessed by adult patients undergoing cardiac surgery., Objective: The purpose of this study was to evaluate the uptake of the MyStay Cardiac both during and following the COVID-19 pandemic., Methods: A prospective observational study design was used that involved the evaluation of program usage data available from the digital interface of the multimedia program. Data on usage patterns were analyzed for a 30-month period between August 2020 and January 2023. Usage patterns were compared during and following the lifting of COVID-19 pandemic restrictions. Uptake of the MyStay Cardiac was measured via the type and extent of user activity data captured by the web-based information system., Results: Intensive care unit recovery information was the most accessed information, being viewed in approximately 7 of 10 usage sessions. Ward recovery (n=124/343, 36.2%), goal (n=114/343, 33.2%), and exercise (n=102/343, 29.7%) information were routinely accessed. Most sessions involved users exclusively viewing text-based information (n=210/343, 61.2%). However, in over one-third of sessions (n=132/342, 38.5%), users accessed video information. Most usage sessions occurred during the COVID-19 restriction phase of the study (August 2020-December 2021). Sessions in which video (P=.02, phi=0.124) and audio (P=.006, phi=0.161) media were accessed were significantly more likely to occur in the restriction phase compared to the postrestriction phase., Conclusions: This study found that the use of digital multimedia resources to support patient education was well received and integrated into their practice by cardiac nurses working in acute care during the COVID-19 pandemic. There was a pattern for greater usage of the MyStay Cardiac during the COVID-19 pandemic when access to the health service for nonfrontline, essential workers was limited., (©Anastasia Hutchinson, Damien Khaw, Annika Malmstrom-Zinkel, Natalie Winter, Chantelle Dowling, Mari Botti, Joanne McDonall. Originally published in JMIR Nursing (https://nursing.jmir.org), 18.07.2024.)

Background: The COVID-19 pandemic significantly transformed the landscape of work and collaboration, impacting design research methodologies and techniques. Co-design approaches have been both negatively and positively affected by the pandemic, prompting a need to investigate and understand the extent of these impacts, changes, and adaptations, specifically in the health sector. Despite the challenges that the pandemic imposed on conducting co-design and related projects, it also encouraged a re-evaluation of co-design practices, leading to innovative solutions and techniques. Designers and researchers have explored alternative ways to engage stakeholders and end users, leveraging digital workshops and participatory digital platforms. These adaptations have the potential to enhance inclusivity, allowing for a wider range of individuals to contribute their perspectives and insights through co-design and thus contribute to healthcare change., Objective: This study aims to explore the impacts of the pandemic on co-design and related practices, focusing on co-design practices in healthcare that have been gained, adapted, or enhanced, with a specific focus on issues of equity, diversity, and inclusion., Methods: The study uses a realist synthesis methodology to identify and analyze the effects of the pandemic on co-design approaches in health, drawing on a range of sources including first-person experiences, gray literature, and academic literature. A community of practice in co-design in health will be engaged to support this process., Results: By examining the experiences and insights of professionals, practitioners, and communities who were actively involved in co-design and have navigated the challenges and opportunities of the pandemic, we can gain a deeper understanding of the strategies, tools, and techniques that have facilitated effective co-design during the pandemic, contributing to building resilience and capacity in co-design in health beyond the pandemic., Conclusions: By involving community partners, community of practice (research), and design practitioners, we expect closer proximity to practice with capacity building occurring through the realist process, thus enabling rapid adoption and refinement of new techniques or insights that emerge. Ultimately, this research will contribute to the advancement of co-design methodologies and inform the future of co-design in health., International Registered Report Identifier (irrid): DERR1-10.2196/58318., (©Maryam Mallakin, Joe Langley, Gillian Harvey, Sarah Walker, Caylee Raber, Nadia Beyzaei, Luz A Paczka Giorgi, Paul Holyoke, Kate Sellen. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 17.07.2024.)

Background: Early detection of cancer and provision of appropriate treatment can increase the cancer cure rate and reduce cancer-related deaths. Early detection requires improving the cancer screening quality of each medical institution and enhancing the capabilities of health professionals through tailored education in each field. However, during the COVID-19 pandemic, regional disparities in educational infrastructure emerged, and educational accessibility was restricted. The demand for remote cancer education services to address these issues has increased, and in this study, we considered medical metaverses as a potential means of meeting these needs. In 2022, we used Metaverse Educational Center, developed for the virtual training of health professionals, to train radiologic technologists remotely in mammography positioning., Objective: This study aims to investigate the user experience of the Metaverse Educational Center subplatform and the factors associated with the intention for continuous use by focusing on cases of using the subplatform in a remote mammography positioning training project., Methods: We conducted a multicenter, cross-sectional survey between July and December 2022. We performed a descriptive analysis to examine the Metaverse Educational Center user experience and a logistic regression analysis to clarify factors closely related to the intention to use the subplatform continuously. In addition, a supplementary open-ended question was used to obtain feedback from users to improve Metaverse Educational Center., Results: Responses from 192 Korean participants (male participants: n=16, 8.3%; female participants: n=176, 91.7%) were analyzed. Most participants were satisfied with Metaverse Educational Center (178/192, 92.7%) and wanted to continue using the subplatform in the future (157/192, 81.8%). Less than half of the participants (85/192, 44.3%) had no difficulty in wearing the device. Logistic regression analysis results showed that intention for continuous use was associated with satisfaction (adjusted odds ratio 3.542, 95% CI 1.037-12.097; P=.04), immersion (adjusted odds ratio 2.803, 95% CI 1.201-6.539; P=.02), and no difficulty in wearing the device (adjusted odds ratio 2.020, 95% CI 1.004-4.062; P=.049). However, intention for continuous use was not associated with interest (adjusted odds ratio 0.736, 95% CI 0.303-1.789; P=.50) or perceived ease of use (adjusted odds ratio 1.284, 95% CI 0.614-2.685; P=.51). According to the qualitative feedback, Metaverse Educational Center was useful in cancer education, but the experience of wearing the device and the types and qualities of the content still need to be improved., Conclusions: Our results demonstrate the positive user experience of Metaverse Educational Center by focusing on cases of using the subplatform in a remote mammography positioning training project. Our results also suggest that improving users' satisfaction and immersion and ensuring the lack of difficulty in wearing the device may enhance their intention for continuous use of the subplatform., (©Sunghak Kim, Timothy Jung, Dae Kyung Sohn, Mina Suh, Yoon Jung Chang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.07.2024.)

Digital health has the potential to expand health care and improve outcomes for patients-particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients' needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients' readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hernandez, Khoong, Kanwar, Lopez-Solano, Rodriguez, De Marchis, Nguyen and Casillas.)

Background: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together., Objective: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families., Methods: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented., Results: Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver-care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself., Conclusions: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation., (©Ellen T Welsh, Jennifer E McIntosh, An Vuong, Zoe C G Cloud, Eliza Hartley, James H Boyd. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.07.2024.)