Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews

Leveraging artificial intelligence to advance implementation science: potential opportunities and cautions

BACKGROUND

The field of implementation science was developed to address the significant time delay between establishing an evidence-based practice and its widespread use. Although implementation science has contributed much toward bridging this gap, the evidence-to-practice chasm remains a challenge. There are some key aspects of implementation science in which advances are needed, including speed and assessing causality and mechanisms. The increasing availability of artificial intelligence applications offers opportunities to help address specific issues faced by the field of implementation science and expand its methods.

MAIN TEXT

This paper discusses the many ways artificial intelligence can address key challenges in applying implementation science methods while also considering potential pitfalls to the use of artificial intelligence. We answer the questions of "why" the field of implementation science should consider artificial intelligence, for "what" (the purpose and methods), and the "what" (consequences and challenges). We describe specific ways artificial intelligence can address implementation science challenges related to (1) speed, (2) sustainability, (3) equity, (4) generalizability, (5) assessing context and context-outcome relationships, and (6) assessing causality and mechanisms. Examples are provided from global health systems, public health, and precision health that illustrate both potential advantages and hazards of integrating artificial intelligence applications into implementation science methods. We conclude by providing recommendations and resources for implementation researchers and practitioners to leverage artificial intelligence in their work responsibly.

CONCLUSIONS

Artificial intelligence holds promise to advance implementation science methods ("why") and accelerate its goals of closing the evidence-to-practice gap ("purpose"). However, evaluation of artificial intelligence's potential unintended consequences must be considered and proactively monitored. Given the technical nature of artificial intelligence applications as well as their potential impact on the field, transdisciplinary collaboration is needed and may suggest the need for a subset of implementation scientists cross-trained in both fields to ensure artificial intelligence is used optimally and ethically.

Understanding individuals with spinal cord injury's self-care practices: a technology probe study to promote pressure relief adherence

Pressure reliefs (PRs) are self-care practices essential for individuals with spinal cord injury (SCI) to prevent life-threatening pressure injuries (PIs). Despite the benefits, individuals often do not do these exercises at home, leading to increased patient morbidity and mortality. To examine how digital technology could improve this population's adherence to PR exercises, we conducted a technology probe study with five individuals with SCI over ten consecutive business days. A chat-based intervention was created to send user-scheduled PR reminders, which were personalized with visual elements and progress trackers. Participants were interviewed before and after interacting with the probe to better understand their experiences with PIs and PR practices. Results shed light on specific factors that may impact individuals with SCI's behaviours towards PRs and four considerations to design a customisable reminder intervention: (1) easy to use and friendly technology, (2) design-your-own- schedule feature, (3) communication style feature, and (4) dialogue support features. Personalisation supported with gamified visual progress tracking and motivational messages emerged as a strong strategy to increase PR adherence. Both sets of findings expand upon the human-computer interaction (HCI) literature for mobile health tools that encourage self-care practices; in particular, to the specific needs of individuals with SCI and the use of visual elements to increase engagement.

Potential bias and lack of generalizability in electronic health record data: reflections on health equity from the National Institutes of Health Pragmatic Trials Collaboratory

Embedded pragmatic clinical trials (ePCTs) play a vital role in addressing current population health problems, and their use of electronic health record (EHR) systems promises efficiencies that will increase the speed and volume of relevant and generalizable research. However, as the number of ePCTs using EHR-derived data grows, so does the risk that research will become more vulnerable to biases due to differences in data capture and access to care for different subsets of the population, thereby propagating inequities in health and the healthcare system. We identify 3 challenges-incomplete and variable capture of data on social determinants of health, lack of representation of vulnerable populations that do not access or receive treatment, and data loss due to variable use of technology-that exacerbate bias when working with EHR data and offer recommendations and examples of ways to actively mitigate bias.

Health education impact on knowledge and management of arboviral diseases in Kenya: Evidence from randomised control trials

Communities' knowledge and management strategies are crucial for mitigating and controlling the threat of existing and emerging diseases. In this study, we conducted randomised control trials (RCT) to examine the impact of health education on households' knowledge and management of three Arboviral Diseases (ADs); Rift Valley fever, Chikungunya fever, and Dengue fever in Kenya. The study was based on a sample of 629 households drawn from the three of Kenya's AD hotspot counties; Baringo, Kwale, and Kilifi. Employing a difference-in-difference method, our findings indicate that health education intervention significantly improved households' understanding of ADs transmission modes, causes, and prevention strategies. However, this intervention did not sufficiently influence households' disease management behaviour. We recommend the implementation of community engagement and outreach initiatives which have the potential to drive behavioural changes at the household level, thus enhancing the management and control of ADs in Kenya.

A Bibliometric Analysis and Review of Nudge Research Using VOSviewer

With growing demands of decision making in the current era, the impact of the drivers behind individuals' preferences and institutional strategies becomes prominent. Coined in 2008, nudge is used to describe incentives for individuals' choices with foreseeable outcomes but without exclusion of alternative choices or reliance on financial stimuli. Consequently, nudge and its application in real-world situations led to a prosperous surge of studies in multiple disciplines. However, we are still facing a dearth of in-depth understanding of the status quo and future directions of research on nudge in a comprehensive fashion. To address the gap in knowledge, the present study adopted a bibliometric analysis of the existing literature related to the investigation and application of nudge by analyzing 1706 publications retrieved from Web of Science. The results indicated that (a) being a relatively newly developed theory, interest in nudge in academia has expanded both in volume and disciplines, with Western scholars and behavioral economists as the backbones; (b) future studies in nudge-related fields are expected to consolidate its current frontiers in individual behaviors while shedding light on new territories such as the digitalized environment. By incorporating state-of-the-art technologies to investigate extant research, the present study would be pivotal for the holistic understanding of the studies on nudge in recent years. Nevertheless, the inclusiveness and comprehensiveness of the review were limited by the size of the selected literature.

Emojis and Emoticons in Health Care and Dermatology Communication: Narrative Review

Background

Emoticons and emojis have become staple additions to modern-day communication. These graphical icons are now embedded in daily society through the various forms of popular social media and through users’ personal electronic conversations. With ever-increasing use and inclusivity, exploration of the possible health care and dermatology applications of these tools is imperative.

Objective

The goal of this narrative review was to provide and evaluate an up-to-date literature survey examining the utility of emoticons and emojis in medicine. Special attention was paid to their existing and potential uses in the field of dermatology, especially during the COVID-19 pandemic.

Methods

A PubMed search of peer-reviewed publications was performed in mid-2021 to collect articles with emoticon or emoji keywords in combination with other health care–relevant or dermatology-relevant keywords. Screening of publications and described studies was performed by the authors with education and research experience in health care, dermatology, social media, and electronic communication trends. Selected articles were grouped based on common subjects for qualitative analysis and presentation for in-depth discussion.

Results

From this extensive search, researchers were able to identify a wide variety of publications detailing the use of emoticons and emojis in general health care, pediatric health care, public health, and dermatology. Key subject areas that emerged from the investigation included the ability of emoticons and emojis to improve communication within pediatric health care, enhance mood and psychological assessment or mental health screening in adults, develop interventions to improve patient medication adherence, complement novel means of public health and COVID-19 surveillance, and bolster dermatology-specific applications.

Conclusions

This review illuminated the repurposing of emojis and emoticons for a myriad of advantageous functions in health care and public health, with applications studied in many populations and situations. Dermatology-specific uses were relatively sparse in the literature, highlighting potential opportunities for growth in future studies and practices. The importance of diversity and inclusivity has extended to emojis, with the recent introduction of skin color customization and new emojis better representing the comprehensive spectrum of users’ experiences. A continuously evolving and technology-driven population creates a unique niche for emoticons and emojis to ease worldwide communication and understanding, transcending the barriers of age, language, and background. We encourage future studies and innovations to better understand and expand their utility.

Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory

OBJECTIVE

We identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research.

MATERIALS AND METHODS

Since 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements.

RESULTS

We received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data.

DISCUSSION

Based on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries.

CONCLUSION

We are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.