Identifying optimal frameworks to implement or evaluate digital health interventions: a scoping review protocol

Effects of digital health interventions on the psychological outcomes of perinatal women: umbrella review of systematic reviews and meta-analyses

Evidence about the effects of digital health interventions (DHIs) on the psychological outcomes of perinatal women is increasing but remains inconsistent. An umbrella review was conducted to (1) assess the effect of DHIs on depressive, anxiety and stress symptoms and (2) compare the effects of DHIs on different digital platforms and population natures. Ten databases were searched from inception until December 23, 2022. The Hartung-Knapp-Sidik-Jonkman random-effects meta-analyses were utilised. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2). Twenty-four systematic reviews with 41 meta-analyses involving 45,509 perinatal women from 264 primary studies were included. The credibility of the evidence of meta-analyses was rated as highly suggestive (4.88%), suggestive (26.83%), weak (51.22%) or non-significant (17.07%) according to AMSTAR-2. Our findings suggest that DHIs are beneficial for reducing stress symptoms. However, conflicting effects were found on anxiety symptoms. Subgroup and meta-regression analyses suggested that DHIs effectively improve depressive symptoms in postnatal women, and DHIs using the website platform are highly effective in stress reduction. DHIs can be implemented adjuvant to usual obstetric care to improve depressive and stress symptoms. Additional well-designed RCTs with long-term follow-up are warranted.

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

PURPOSEOF REVIEW

Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF.

RECENT FINDINGS

We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.

Delivering Digital Health Solutions that Patients Need: A Call to Action

Digital health solutions have the potential to complement traditional healthcare approaches and deliver improved health outcomes, but there are system-wide challenges that need to be addressed. These include fragmentation of the digital health landscape, regulatory processes that lack the agility to accommodate the fast pace of digital health advances, and inadequate transparency around data sharing and data governance. All of these challenges have led to mistrust, limited understanding and sharing of best practices, a lack of digital education and awareness, and insufficient patient and public engagement and involvement. In this paper, we argue that for digital health solutions to fulfil their potential, there needs to be a significant increase in early, meaningful, and sustained engagement with the people they intend to benefit. The uptake as well as the impact of digital solutions created in partnership with patients for patients are greater and more relevant to the communities they address.

Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review

BACKGROUND

Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations.

OBJECTIVE

This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users.

METHODS

This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid).

RESULTS

A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52).

CONCLUSIONS

As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven.

Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review

BACKGROUND

Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions.

OBJECTIVE

This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities.

METHODS

We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation.

RESULTS

We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%).

CONCLUSIONS

This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.

Implementation of digital health interventions in rehabilitation: A scoping review

OBJECTIVE

Digital health interventions have potential to enhance rehabilitation services by increasing accessibility, affordability and scalability. However, implementation of digital interventions in rehabilitation is poorly understood. This scoping review aims to map current strategies, research designs, frameworks, outcomes and determinants used to support and evaluate the implementation of digital interventions in rehabilitation.

DATA SOURCES

Comprehensive searches from inception until October 2022 of MEDLINE, CINAHL, PsycINFO, PEDro, SpeechBITE, NeuroBITE, REHABDATA, WHO International Clinical Trial Registry and the Cochrane Library.

METHODS

Two reviewers screened studies against the eligibility criteria. Implementation science taxonomies and methods, including Powell et al.'s compilation of implementation strategies, were used to guide analysis and synthesis of findings.

RESULTS

The search retrieved 13,833 papers and 23 studies were included. Only 4 studies were randomised controlled trials and 9 studies (39%) were feasibility studies. Thirty-seven discrete implementation strategies were reported across studies. Strategies related to training and educating clinicians (91%), providing interactive assistance (61%), and developing stakeholder interrelationships (43%) were most frequently reported. Few studies adequately described implementation strategies and methods for selecting strategies. Almost all studies measured implementation outcomes and determinants; most commonly, acceptability, compatibility and dose delivered of digital interventions.

CONCLUSION

The rigour of implementation methods in the field is currently poor. Digital interventions require carefully planned and tailored implementation to facilitate successful adoption into rehabilitation practice. To keep pace with rapidly advancing technology, future rehabilitation research should prioritise using implementation science methods to explore and evaluate implementation while testing effectiveness of digital interventions.

Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review

Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.

Novel behaviour change frameworks for digital health interventions: A critical review

Digital health interventions - interventions delivered over digital media to support the health of users - are becoming increasingly prevalent. Utilising an intervention development framework can increase the efficacy of digital interventions for health-related behaviours. This critical review aims to outline and review novel behaviour change frameworks that guide digital health intervention development. Our comprehensive search for preprints and publications used PubMed, PsycINFO, Scopus, Web of Science and the Open Science Framework repository. Articles were included if they: (1) were peer-reviewed; (2) proposed a behaviour change framework to guide digital health intervention development; (3) were written in English; (4) were published between 1/1/19 and 1/8/2021; and (5) were applicable to chronic diseases. Intervention development frameworks considered the user, intervention elements and theoretical foundations. However, the timing and policy of interventions are not consistently addressed across frameworks. Researchers should deeply consider the digital applicability of behaviour change frameworks to improve intervention success.

One Digital Health Intervention for Monitoring Human and Animal Welfare in Smart Cities: Viewpoint and Use Case

Smart cities and digital public health are closely related. Managing digital transformation in urbanization and living spaces is challenging. It is critical to prioritize the emotional and physical health and well-being of humans and their animals in the dynamic and ever-changing environment they share. Human-animal bonds are continuous as they live together or share urban spaces and have a mutual impact on each other's health as well as the surrounding environment. In addition, sensors embedded in the Internet of Things are everywhere in smart cities. They monitor events and provide appropriate responses. In this regard, accident and emergency informatics (A&EI) offers tools to identify and manage overtime hazards and disruptive events. Such manifold focuses fit with One Digital Health (ODH), which aims to transform health ecosystems with digital technology by proposing a comprehensive framework to manage data and support health-oriented policies. We showed and discussed how, by developing the concept of ODH intervention, the ODH framework can support the comprehensive monitoring and analysis of daily life events of humans and animals in technologically integrated environments such as smart homes and smart cities. We developed an ODH intervention use case in which A&EI mechanisms run in the background. The ODH framework structures the related data collection and analysis to enhance the understanding of human, animal, and environment interactions and associated outcomes. The use case looks at the daily journey of Tracy, a healthy woman aged 27 years, and her dog Mego. Using medical Internet of Things, their activities are continuously monitored and analyzed to prevent or manage any kind of health-related abnormality. We reported and commented on an ODH intervention as an example of a real-life ODH implementation. We gave the reader examples of a "how-to" analysis of Tracy and Mego's daily life activities as part of a timely implementation of the ODH framework. For each activity, relationships to the ODH dimensions were scored, and relevant technical fields were evaluated in light of the Findable, Accessible, Interoperable, and Reusable principles. This "how-to" can be used as a template for further analyses. An ODH intervention is based on Findable, Accessible, Interoperable, and Reusable data and real-time processing for global health monitoring, emergency management, and research. The data should be collected and analyzed continuously in a spatial-temporal domain to detect changes in behavior, trends, and emergencies. The information periodically gathered should serve human, animal, and environmental health interventions by providing professionals and caregivers with inputs and "how-to's" to improve health, welfare, and risk prevention at the individual and population levels. Thus, ODH complementarily combined with A&EI is meant to enhance policies and systems and modernize emergency management.

Physicians' Use of Digital Health Interventions in the Management of Nonalcoholic Fatty Liver Disease

Globally, the use of digital health interventions (DHIs) is expanding, along with growing scientific evidence of their effectiveness. Given the high and increasing prevalence of noncommunicable liver disease, we surveyed 295 physicians across Spain about their knowledge, beliefs, attitudes, practices, and access with regard to DHIs for patient care and in particular for liver diseases, including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Physicians reported high familiarity with DHIs, although most had not recommended them in patient care. Addressing concerns, including limited available time, evidence of effectiveness, education, training, and access may contribute to an increased uptake of these technologies.

Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis

An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

Effectiveness and implementation of an electronic health record-integrated digital health intervention for managing depressive symptoms in ambulatory oncology: The My Well-Being Guide study rationale and protocol

BACKGROUND

Rates of clinically elevated depressive symptoms among ambulatory oncology patients are higher than in the general population and are associated with poorer health-related quality of life. Furthermore, a reduction in depressive symptoms may be associated with improved cancer survival. Several interventions have demonstrated efficacy in reducing oncologic depressive symptoms, including cognitive-behavioral stress management (CBSM). However, more work is needed to understand how to best implement CBSM into practice, such as through stepped-care approaches and digital health interventions linked to electronic health records (EHR). This manuscript presents the protocol of the My Well-Being Guide study, a pragmatic type 1 effectiveness-implementation hybrid study. This trial will test the effectiveness of My Well-Being Guide, a seven-week structured, CBSM-based digital health intervention designed to reduce depressive symptoms. This trial will also evaluate My Well-Being Guide's implementation across two health systems.

METHODS

The final sample (N = 4561) will be oncology patients at Northwestern Medicine or University of Miami Health System who are ≥18 years of age; have a cancer diagnosis; elevated depressive symptoms on the Patient-Reported Outcomes Measurement Information System Depression; and primary language is English or Spanish. Data collection will occur at baseline, and 2-, 6-, and 12-months post baseline. Outcome domains include depressive symptoms and implementation evaluation.

DISCUSSION

This study may provide valuable data on the effectiveness of our depressive symptom management digital health intervention linked to the EHR and the scalability of digital health interventions in general.

Lessons Learned from Natural Disasters around Digital Health Technologies and Delivering Quality Healthcare

As climate change drives increased intensity, duration and severity of weather-related events that can lead to natural disasters and mass casualties, innovative approaches are needed to develop climate-resilient healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas. Digital health technologies are touted as a potential contributor to healthcare climate change adaptation and mitigation, through improved access to healthcare, reduced inefficiencies, reduced costs, and increased portability of patient information. Under normal operating conditions, these systems are employed to deliver personalised healthcare and better patient and consumer involvement in their health and well-being. During the COVID-19 pandemic, digital health technologies were rapidly implemented on a mass scale in many settings to deliver healthcare in compliance with public health interventions, including lockdowns. However, the resilience and effectiveness of digital health technologies in the face of the increasing frequency and severity of natural disasters remain to be determined. In this review, using the mixed-methods review methodology, we seek to map what is known about digital health resilience in the context of natural disasters using case studies to demonstrate what works and what does not and to propose future directions to build climate-resilient digital health interventions.

Researching the hard-to-reach: a scoping review protocol of digital health research in hidden, marginal and excluded populations

INTRODUCTION

There is a significant growth in the use of digital technology and methods in health-related research, further driven by the COVID-19 pandemic. This has offered a potential to apply digital health research in hidden, marginalised and excluded populations who are traditionally not easily reached due to economic, societal and legal barriers. To better inform future digital health studies of these vulnerable populations, we proposed a scoping review to comprehensively map published evidence and guidelines on the applications and challenges of digital health research methods to hard-to-reach communities.

METHODS AND ANALYSIS

This review will follow the Arksey and O' Malley methodological framework for scoping reviews. The framework for the review will employ updated methods developed by the Joanna Briggs Institute including the Preferred Reporting Items for Systematic reviews and Meta-Analysis Scoping Review checklist. PubMed, the Cochrane Library, PsycINFO, Google Scholar and Greenfile are the identified databases for peer-reviewed quantitative and qualitative studies in-scope of the review. Grey literature focused on guidance and best practice in digital health research, and hard-to-reach populations will also be searched following published protocols. The review will focus on literature published between 1 February 2012 and 1 February 2022. Two reviewers are engaged in the review. After screening the title and abstract to determine the eligibility of each article, a thorough full-text review of eligible articles will be conducted using a data extraction framework. Key extracted information will be mapped in tabular and visualised summaries to categorise the breadth of literature and identify key digital methods, including their limitations and potential, for use in hard-to-reach populations.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval. The results of the scoping review will consist of peer-reviewed publications, presentations and knowledge mobilisation activities including a lay summary posted via social media channels and production of a policy brief.

A Systematic Review of Digital Interventions to Improve ART Adherence among Youth Living with HIV in sub-Saharan Africa

An estimated 3.4 million youth aged 15–24 years live with human immunodeficiency virus (HIV), a majority of whom reside in sub-Saharan Africa (SSA). Youth living with HIV (YLHIV) generally maintain lower levels of antiretroviral therapy (ART) adherence compared to other age groups, which has negative impacts on long-term clinical outcomes. Given expanding mobile phone and Internet usage among youth in SSA, and a need for strategies to increase ART adherence, this review systematically assessed whether digital interventions could be used to improve YLHIV ART adherence in SSA. PRISMA 2020 guidelines were followed, and PubMed and Scopus databases were searched using terms to reflect the population of interest and different digital intervention strategies to improve ART adherence. Experimental or quasi-experimental studies in SSA evaluating the quantitative effect of digital interventions on YLHIV ART adherence were included. 3849 articles and abstracts, and 122 full texts were screened by two researchers (KG and RM). A third researcher (AC) resolved conflicts. Data were extracted from six eligible articles published between 2017 and 2021. Interventions from included studies lasted 13–96 weeks and took place in Kenya, Nigeria, Uganda, and Zimbabwe. Two of the six studies found significant intervention-related improvements in viral suppression. Of these two studies, one used short message service (SMS) for appointment and daily adherence reminders, and the other combined weekly SMS reminders with phone calls, support groups, home visits, and clinic-based counseling. The four remaining studies, using SMS and Internet-based interventions, did not find any significant adherence-related improvements. This review provides mixed evidence for using digital interventions to improve ART adherence among YLHIV in SSA. Given the relative novelty of using digital interventions in this context, further research is required to evaluate their effectiveness in improving youth ART adherence.

Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review

Background

Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide.

Objective

The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations.

Methods

This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel.

Results

The review is underway and is anticipated to be completed by September 2022.

Conclusions

The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions.

International Registered Report Identifier (IRRID)

PRR1-10.2196/32538

Development stage of novel digital health interventions for postoperative monitoring: protocol of a systematic review

Introduction

The postoperative period represents a time where patients are at a high-risk of morbidity, which warrants effective surveillance. While digital health interventions (DHIs) for postoperative monitoring are promising, a coordinated, standardized and evidence-based approach regarding their implementation and evaluation is currently lacking. This study aimed to identify DHIs implemented and evaluated in postoperative care to highlight research gaps and assess the readiness for routine implementation.

Methods

A systematic review will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies describing the implementation and evaluation of DHIs for postoperative monitoring published since 2000 (PROSPERO ID: CRD42021264289). This will encompass the Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science and ClinicalTrials.gov databases, and manual search of bibliographies for relevant studies and gray literature. Methodological reporting quality will be evaluated using the Idea, Development, Exploration, Assessment and Long-term Follow-up (IDEAL) reporting guideline relevant to the IDEAL stage of the study, and risk of bias will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Data will be extracted according to the WHO framework for monitoring and evaluating DHIs, and a narrative synthesis will be performed.

Discussion

This review will assess the readiness for implementation of DHIs for routine postoperative monitoring and will include studies describing best practice from service changes already being piloted out of necessity during the COVID-19 pandemic. This will identify interventions with sufficient evidence to progress to the next IDEAL stage, and promote standardized and comprehensive evaluation of future implementational studies.

The Essential Network (TEN): Protocol for an implementation study of a digital-first mental health solution for Australian healthcare workers during COVID-19 (Preprint)

Background

The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement.

Objective

The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN.

Methods

The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy.

Results

The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected.

Conclusions

TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34601

Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review

BACKGROUND

Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs.

OBJECTIVE

This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used.

METHODS

We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain.

RESULTS

We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy.

CONCLUSIONS

Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective.

Benefits of Structured Engagement with Target Audiences of a Health Website: Study Design for a Multi-Case Study

Access to evidence and practice knowledge precedes use, but availability does not guarantee reach and uptake by intended audiences. The CareSearch project provides online palliative care evidence and information to support health and aged care professionals as well as patients, carers and families to make informed decisions about care at the end of life. Already established in the palliative care sector, CareSearch commenced planning to extend its reach, and ensure website use is maximised for different audiences. This paper reports on the development of the Engagement Framework which will be used to guide and deliver an Engagement Project which will actively seek feedback and insights from intended users in a structured process. The process for developing the Engagement Framework commenced with a literature review of approaches used in knowledge translation, implementation science, and social marketing. The Engagement Framework comprising eight steps was then developed. The Engagement Framework outlines the series of tasks to be undertaken by team members when working with three target groups (Aged Care; Allied Health; and Patients, Carers and Families). A process/formative evaluation collecting data using qualitative methods is also described for use in the subsequent Engagement Project. The evaluation will explore the experiences of project participants as well as staff implementing the engagement activities. The three target groups will enable a cross-case comparison of the strengths and weaknesses of the approach. Planning, implementing and evaluating engagement with intended audiences, offers one mechanism to identify ways to increase interaction and integration with knowledge users.