Commercial mHealth Apps and Unjust Value Trade-offs: A Public Health Perspective

A scoping review of Spanish language pediatric digital health interventions

OBJECTIVE

Despite the growing number of Hispanic/Latino families in the United States, major concerns are reported when navigating the healthcare system. Monolingual Spanish-speaking families may experience compounded barriers given the inconsistent availability of Spanish resources and services in traditional healthcare settings. Digital health interventions have the potential to alleviate some barriers in healthcare for these individuals. This scoping review summarizes the state of the literature on the development, adaptation, and implementation of pediatric Spanish-language digital health interventions offered to Spanish-speaking families in the United States to better understand current cultural-sensitivity practices and strategies implemented by researchers.

METHODS

A search in major databases was completed in May 2024. Articles that discussed the development, implementation, or outcome of any digital health intervention primarily oriented to a Spanish-speaking pediatric population in the United States were included. Telephone- and telehealth-only interventions were excluded.

RESULTS

A total of 44 articles were reviewed, representing 30 unique digital health interventions. Most covered preventive health topics, utilized SMS texting, and were intended primarily for parents/caregivers. Only 22 articles discussed specific methods to culturally tailor the intervention. The most common methods implemented were advisory boards and collecting qualitative data from parents/caregivers and youth. About 50% of articles reported results related to efficacy, acceptability, and feasibility.

CONCLUSION

While similar methods are implemented to develop and adapt these interventions, there is ample variation throughout the process. Including and learning directly from intended users in the adaptation and development phases of digital health interventions can help create quality and culturally appropriate digital health programs for families.

Non-empirical methods for ethics research on digital technologies in medicine, health care and public health: a systematic journal review

Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the "empirical turn" in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health.

Healthiness as a Virtue: The Healthism of mHealth and the Challenges to Public Health

Mobile health (mHealth) technologies for self-monitoring health-relevant parameters such as heart frequency, sleeping patterns or exercise regimes aim at fostering healthy behavior change and increasing the individual users to promote and maintain their health. We argue that this aspect of mHealth supports healthism, the increasing shift from institutional responsibility for public health toward individual engagement in maintaining health as well as mitigating health risks. Moreover, this healthist paradigm leads to a shift from understanding health as the absence of illness to regarding health as the performance of certain rituals in order to project healthiness. By drawing from the analogy between healthiness and traditional virtues, we evaluate the promises made by proponents of mHealth technologies for self-monitoring. We argue that the implementation and use of mHealth risk entrenching existing inequalities and, more particularly, tend to exclude populations situated at the losing end of those inequalities from participating in the quasi-virtue of healthiness. Consequently, the implementation and use of mHealth technologies not only present challenges for social justice but also undermine their primary societal goal-to promote public health. Finally, we offer several suggestions on how to realize the potential benefit of mHealth.