Digital Patient Experience: Umbrella Systematic Review

A System Model and Requirements for Transformation to Human-Centric Digital Health

Digital transformation is widely understood as a process where technology is used to modify an organization's products and services and to create new ones. It is rapidly advancing in all sectors of society. Researchers have shown that it is a multidimensional process determined by human decisions based on ideologies, ideas, beliefs, goals, and the ways in which technology is used. In health care and health, the end result of digital transformation is digital health. In this study, a detailed literature review covering 560 research articles published in major journals was performed, followed by an analysis of ideas, beliefs, and goals guiding digital transformation and their possible consequences for privacy, human rights, dignity, and autonomy in health care and health. Results of literature analyses demonstrated that from the point of view of privacy, dignity, and human rights, the current laws, regulations, and system architectures have major weaknesses. One possible model of digital health is based on the dominant ideas and goals of the business world related to the digital economy and neoliberalism, including privatization of health care services, monetization and commodification of health data, and personal responsibility for health. These ideas represent meaningful risks to human rights, privacy, dignity, and autonomy. In this paper, we present an alternative solution for digital health called human-centric digital health (HCDH). Using system thinking and system modeling methods, we developed a system model for HCDH. It uses 5 views (ideas, health data, principles, regulation, and organizational and technical innovations) to align with human rights and values and support dignity, privacy, and autonomy. To make HCDH future proof, extensions to human rights, the adoption of the principle of restricted informational ownership of health data, and the development of new duties, responsibilities, and laws are needed. Finally, we developed a system-oriented, architecture-centric, ontology-based, and policy-driven approach to represent and manage HCDH ecosystems.

Global Evidence on the Sustainability of Telemedicine in Outpatient and Primary Care During the First 2 Years of the COVID-19 Pandemic: Scoping Review Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework

BACKGROUND

The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level.

OBJECTIVE

This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic's first 2 years, aiming to identify sustainability factors.

METHODS

This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction).

RESULTS

Of the 134 studies that met our criteria, 49.3% (66/134) reported no specific population group. Regarding the concepts, 41.8% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3% (109/134) of the studies referenced the innovation's sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured.

CONCLUSIONS

We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level and in other languages has implications on reproducibility. We did not consider synchronous text-based communication.

TRIAL REGISTRATION

Open Science Framework 4z5ut; https://osf.io/4z5ut/.

Evaluating patient experience in maternity services using a Bayesian belief network model

Pregnancy and childbirth are commonly seen as positive experiences, but they can also pose distinct challenges and risks, especially when care is insufficient. This study investigates the factors influencing maternity patient experience by exploring the complex interactions among these factors. Using data from the 2021 maternity patient survey by the National Health Services (NHS) in England, we implemented a Bayesian Belief Network (BBN) to model these interactions. Three structural learning models were created, namely Bayesian Search (BS), Peter-Clark (PC), and Greedy Thick Thinning (GTT). Further, sensitivity analysis was conducted to quantify interactions among the influencing factors and identify the most influential factor affecting the outcome. The results underscore the importance of recognizing the interdependencies among the eight key domains of the survey, which collectively shape maternity care experiences. These factors include the start of care in pregnancy, antenatal check-ups, care during pregnancy, labour and birth, staff caring, care in the hospital, feeding the baby, and care after birth. These findings can guide healthcare managers and decision-makers in developing proactive strategies to mitigate factors impacting maternity patient experiences. Ultimately, this study contributes to the ongoing efforts to enhance the quality of maternity care and improve outcomes for mothers and their infants.

Patient Experience in Older Adults with Diabetes: A Narrative Review on Interventions to Improve Patient Experience and Research Gaps

Patient experience is a critical healthcare quality indicator, evolving from Patient Satisfaction (PS) and encompassing patients' concrete healthcare experiences. It is increasingly vital in aging societies where collaborative efforts among patients, families, and healthcare professionals are essential. Studies suggest that enhanced patient experience leads to better adherence, outcomes, and patient safety. This paper reviews patient experience evaluations in older adults with diabetes through randomized controlled trial (RCT)-based findings. The author searched PubMed/MEDLINE, Embase, AMED, and CINAHL. The review focused on RCTs examining interventions affecting patient experience and PS in T2D/T1D patients aged ≥65. A total of 13 RCTs were eligible for this review. This review highlights studies on diabetes management in older adults, assessing the impact of health education, diabetes management programs, treatments, mHealth, and advanced insulin delivery systems. Early studies showed that education improved self-care but had a limited impact on glycemic control. Key findings include the effectiveness of experience-based education in improving HbA1c, the benefits of insulin therapy for elderly patients, and the value of structured peer-to-peer diabetes management programs in enhancing satisfaction. Patient adherence, satisfaction, and personalized support emerged as critical factors influencing diabetes management across various interventions. More recent trials involving mHealth demonstrated improvements in glycemic control and PS through automated data sharing and app-based support. Closed-loop insulin delivery studies reported reduced mental strain, improved glycemic control, and better quality of life, despite barriers such as device cost and occasional system limitations. These interventions highlight the potential of advanced technologies to enhance diabetes care, particularly for aging populations. Previous RCTs show that education, structured management programs, effective insulin therapies, and advanced digital treatments improve patient experience, though well-designed studies focusing on patient experience as a primary outcome are lacking. Developing patient experience assessment scales for aging diabetes patients and adapting healthcare systems to maximize patient experience amid digitalization trends are essential, warranting further research.

Patient-Reported Experience Measures in Adult Inpatient Settings: A Systematic Review

Background: Patient-centered ideas have become the key indicator of medical service quality, and patient-reported experience measures are ways to measure how well this idea is being implemented. There are currently numerous adult inpatient experience instruments available, and it is necessary to conduct such systematic reviews to discover any new instruments and help policymakers and researchers increase the likelihood of hearing true patients' voices through appropriate selection of these instruments. Objective: To identify existing adult inpatient experience measures and to critically appraise their development design and psychometric testing results. Methods: EMBASE, PUBMED, Cochrane, CINAHL (EBSCOhost), PsycINFO, and ProQuest were searched from inception to March 2023. A comprehensive review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Studies were identified via specific search terms and inclusion criteria. The methodological quality assessment was evaluated according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results: A total of 29 articles reporting on 23 instruments were included. Each instrument demonstrated both satisfaction and disappointment during the development process and psychometric testing with the recommended criteria of the COSMIN checklist. Pilot tests and cognitive interviews were ignored or not reported in 9 studies. Only 5 studies evaluated the content validity. Among all measurement properties, internal consistency and structural validity were the two most frequently measured attributes. None of the 29 included studies assessed the responsiveness or measurement error of the scales. Conclusion: Among a variety of adult inpatient experience instruments, only a limited number of studies were methodologically sound. Further research still needs to be conducted for the development and validation of patient-reported experience measures. New quality assessments, such as instrument utility, also should be implemented to provide a more complete evaluation of instruments in the information era.

Transitioning Perspectives in Digital Health Through Phenomenology Integration

The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who "speak" different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care.

Designing digital patient experiences: The digital health design framework

BACKGROUND

Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices.

OBJECTIVES

We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx).

METHODS

A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach.

RESULTS

We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges.

CONCLUSIONS

We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.

Impact of digital interventions and online health communities in patient activation: Systematic review and meta-analysis

OBJECTIVE

Study the efficacy of digital health interventions in enhancing patient activation and identify the distinct features of these interventions using the WHO classification system.

METHODS

Asystematic reviewand meta-analysis were carried out according to the PRISMA guidelines. A search was conducted in Scopus, PubMed, and ProQuest. Randomized controlled trials (RCT), quasi-randomized controlled trials, and before-and-after studies enrolling patients ≥ 18 years of age with the Patient Activation Measure (PAM) score measurement and contain digital intervention with any aspects of health education or health-related behavior were included. The Downs and Black quality assessment tool was used to assess the quality of the articles.

RESULTS

In the three different types of meta-analyses, implementing the intervention led to a PAM score increase (Mean Difference (M.D.)), ranging from a minimum of (MD = 0.2014, 95 % CI = 0.0871-0.3158) and a highly significant p-value 0.0006 to a maximum of (MD = 2.7882, 95 % CI = 1.5558-4.0206) and a p-value < .0001. While the M.D. score of 0.2014 may seem relatively low, it is enough to elevate the patient from one activation level to a higher one out of the four activation levels.

CONCLUSION AND PRACTICE IMPLICATIONS

The results suggest the effectiveness of digital health interventions on patient activation across diverse settings and contexts, implying potential generalizability. Using WHO classification, all examined digital interventions addressed the challenges of information, utilization, and efficiency in the health system, but not equity-related challenges. The study recognized online health communities (OHCs) as a subset of digital interventions that enhance patient activation through social support.

Consumer Health Informatics to Advance Precision Prevention

OBJECTIVE

Consumer health informatics (CHI) has the potential to disrupt traditional but unsustainable break-fix models of healthcare and catalyse precision prevention of chronic disease - a preventable global burden. This perspective article reviewed how consumer health informatics can advance precision prevention across four research and practice areas: (1) public health policy and practice (2) individualised disease risk assessment (3) early detection and monitoring of disease (4) tailored intervention of modifiable health determinants.

METHODS

We review and narratively synthesise methods and published recent (2018 onwards) research evidence of interventional studies of consumer health informatics for precision prevention. An analysis of research trends, ethical considerations, and future directions is presented as a guide for consumers, researchers, and practitioners to collectively prioritise advancing two interlinked fields towards high-quality evidence generation to support practice translation. A health consumer co-author provided critical review at all stages of manuscript preparation, moderating the allied health, medical and nursing researcher perspectives represented in the authorship team.

RESULTS

Precision prevention of chronic disease is enabled by consumer health informatics methods and interventions in population health surveillance using real-world data (e.g., genomics) (public health policy and practice), disease prognosis (regression modelling, machine learning) (individualized disease risk assessment), wearable devices and mobile health (mHealth) applications that generate digital phenotypes (early detection and monitoring), and targeted behaviour change interventions based upon personalized risk algorithms (tailored intervention of modifiable health determinants). In our disease case studies, there was mixed evidence for the effectiveness of consumer health informatics to improve risk-stratified or behavioural prevention-related health outcomes. Research trends comprise both consumer-centred and healthcare-centred innovations, with emphasis on inclusive design methodologies, social licence of health data use, and federated learning to preserve data sovereignty and maximise cross-jurisdictional analytical power.

CONCLUSIONS

Together, CHI and precision prevention represent a potential future vanguard in shifting from traditional and inefficient break-fix to predict-prevent models of healthcare. Meaningful researcher, practitioner, and consumer partnerships must focus on generating high-quality evidence from methodologically robust study designs to support consumer health informatics as a core enabler of precision prevention.

Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions

BACKGROUND

Chronic kidney disease affects 10% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients' quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease.

OBJECTIVE

Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution.

METHODS

We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores.

RESULTS

Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients' own health-related goals and fits with the needs of their everyday lives with the disease.

CONCLUSIONS

A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions.

Patient and Staff Experience of Remote Patient Monitoring-What to Measure and How: Systematic Review

BACKGROUND

Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience-measuring methods and tools exists.

OBJECTIVE

This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain.

METHODS

Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By "RPM interventions," we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique.

RESULTS

In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation.

CONCLUSIONS

At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain.

The PICOTS-ComTeC Framework for Defining Digital Health Interventions: An ISPOR Special Interest Group Report

OBJECTIVES

Digital health definitions are abundant, but often lack clarity and precision. We aimed to develop a minimum information framework to define patient-facing digital health interventions (DHIs) for outcomes research.

METHODS

Definitions of digital-health-related terms (DHTs) were systematically reviewed, followed by a content analysis using frameworks, including PICOTS (population, intervention, comparator, outcome, timing, and setting), Shannon-Weaver Model of Communication, Agency for Healthcare Research and Quality Measures, and the World Health Organization's Classification of Digital Health Interventions. Subsequently, we conducted an online Delphi study to establish a minimum information framework, which was pilot tested by 5 experts using hypothetical examples.

RESULTS

After screening 2610 records and 545 full-text articles, we identified 101 unique definitions of 67 secondary DHTs in 76 articles, resulting in 95 different patterns of concepts among the definitions. World Health Organization system (84.5%), message (75.7%), intervention (58.3%), and technology (52.4%) were the most frequently covered concepts. For the Delphi survey, we invited 47 members of the ISPOR Digital Health Special Interest Group, 18 of whom became the Delphi panel. The first, second, and third survey rounds were completed by 18, 11, and 10 respondents, respectively. After consolidating results, the PICOTS-ComTeC acronym emerged, involving 9 domains (population, intervention, comparator, outcome, timing, setting, communication, technology, and context) and 32 optional subcategories.

CONCLUSIONS

Patient-facing DHIs can be specified using PICOTS-ComTeC that facilitates identification of appropriate interventions and comparators for a given decision. PICOTS-ComTeC is a flexible and versatile tool, intended to assist authors in designing and reporting primary studies and evidence syntheses, yielding actionable results for clinicians and other decision makers.

Impact of digital services on healthcare and social welfare: An umbrella review

BACKGROUND

Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare.

METHODS

The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers.

RESULTS

A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management.

CONCLUSIONS

Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.

The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis

BACKGROUND

The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.

OBJECTIVE

This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.

RESULTS

A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.

CONCLUSIONS

Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.

Factors That Influence Patient Satisfaction With the Service Quality of Home-Based Teleconsultation During the COVID-19 Pandemic: Cross-Sectional Survey Study

BACKGROUND

Ontario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences.

OBJECTIVE

This study seeks to understand patient satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction.

METHODS

Using a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services.

RESULTS

The overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills.

CONCLUSIONS

The insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care.

Patients' perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in a Norwegian outpatient clinic: a qualitative study

BACKGROUND

Telemedicine in outpatient services for people living with human immunodeficiency virus (PLHIV) was scaled up during the COVID-19 pandemic as services transitioned to remote care. Many studies have reported on the challenges and advantages of telemedicine care during the pandemic. However, there is limited research on the provision of telemedicine human immunodeficiency virus (HIV) care beyond the COVID-19 pandemic, which entails different telemedicine components and focuses on ways to improve the telemedicine experience for patients. This study aimed to explore PLHIV's perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in an outpatient clinic in Norway. The telemedicine solution included a pre-consultation questionnaire, asynchronous digital messages, and video consultation.

METHODS

Qualitative interviews were conducted with 12 PLHIV. The interviews were analysed using thematic analysis.

RESULTS

We identified four main themes that covered the participants' perceptions, needs, and preferences: (1) perceived usability, (2) maintaining confidentiality, (3) accommodating personal preferences, and (4) perceived usefulness. Some participants had difficulty logging into the telemedicine solution. Other participants suggested additional functionalities, such as picture sharing and access to test result. Telemedicine care enabled the avoidance of stigmatising clinic experiences, although a few participants reported concerns about confidentiality and data security. Accommodating personal preferences and needs in terms of the type of consultations (in-person or video) and frequency of visits was essential to the participants. With telemedicine care, participants felt more in control of their own lives, perceiving that it increased their perceived quality of life and saved them both time and money for travelling to the clinic.

CONCLUSIONS

Our study identified several specific needs and preferences related to the assessed technical solution and the provision of current and future telemedicine care services. Nevertheless, the telemedicine solution was perceived as a usable, flexible, and person-centred approach to HIV care, contributing to accommodating the participants' personal preferences. However, healthcare professionals need to ensure that individual requirements and preferences are consistent with evidence-based follow-up and supported by person-centred care. Thus, the practice of shared decision making is important in telemedicine care.

Digital Maturity as a Strategy for Advancing Patient Experience in US Hospitals

Patient experience is globally recognized as an important indicator of health system performance, linked to health system quality and improving patient outcomes. Post COVID-19, health systems have embraced digital health and advanced digital transformation efforts; however, the relationship between digital health and patient experience outcomes is not well-documented. Using HCAHPS hospital survey data to measure patient experience, and HIMSS EMRAM Maturity Model data to measure digital maturity, a cross-sectional design using multivariate analyses examined the impact of digital maturity on patient experience in US hospitals. Our analysis shows that advanced digital maturity in US hospitals is associated with stronger patient experience outcomes, particularly relative to communication with nurses, doctors, and communication about medicines and therapies. The findings suggest that there are significant differences in patient experience associated with teaching versus nonteaching hospitals, urban versus rural hospitals. As hospitals advance and progress digital transformation initiatives, evidence to inform how transformation efforts can engage and advance patient experience will contribute to health system performance well into the future.

Worldwide Survey on Digital Assistive Technology (DAT) Provision

Occupational therapists have long been involved in assistive technology (AT) provision worldwide. AT is recognized by the World Health Organization (WHO) to enhance functioning, independence, and autonomy and ultimately promote well-being for people living with disabilities. With the digitalisation of societies, the everyday lives and occupations of individuals are changing, becoming more reliant on digital solutions. The development of digital assistive technology (DAT) also offers opportunities for people with disabilities to access, interact, and pilot the digital world. However, we do not know how occupational therapists are involved in DAT provision worldwide. A survey was conducted in the global occupational therapist's community in June 2022 to describe DAT provision and the factors influencing it. Occupational therapy practitioners were included (n = 660) in the analysis. In DAT provision, occupational therapists mostly provide advice to people, assess their needs, provide instruction or training, prescribe DAT, and fit DAT to people and their environment. The clients served through DAT provision are most frequently people with neurological impairments, chronic illnesses, sensory impairments, and older people. The reasons for providing DAT focus on education, work, school, and leisure. It is expected that DAT provision will enhance independence, self-esteem, occupational participation, and social relationships. Issues faced by occupational therapists when providing DAT are costs of product and funding schemes, sufficient knowledge, and access to knowledge sources. Survey respondents are mostly from Western countries with access to the Internet and the digital world, including having digital literacy, highlighting the digital divide that exists between world regions and countries, but also within countries worldwide. There is a need to continue research to better understand the issues related to digitalisation and the digital participation of people living with disabilities.

Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review

BACKGROUND

The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required.

OBJECTIVE

This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation.

METHODS

This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials.

RESULTS

Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx.

CONCLUSIONS

Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx.

Navigating online health information: Insights into consumer influence and decision-making strategies-An overview of reviews

Objective

Communities' use of technology and the internet for online health information (OHI) is increasing exponentially. An understanding of how and why individuals access OHI, and how this information influences decisions on health, medicines and self-care practices is critical. This review aims to: (1) identify the factors influencing OHI-seeking behaviour; (2) evaluate the evidence of OHI on self-care practices; and (3) outline strategies to improve online informed decision-making and assess the impact of these strategies on consumer outcomes.

Methods

A review of systematic reviews was conducted in November of 2023, following the Cochrane Handbook and PRISMA guidelines, and using PubMed, Scopus, Web of Science and EBSCOhost databases. The methodological quality of retrieved reviews was appraised using the AMSTAR 2 tool.

Results

The search retrieved 1725 records. Of these, 943 were screened, and 33 were included in the final analysis. The most frequently identified reasons for seeking OHI were to retrieve diagnostic and treatment information, and well-being and emotional support. Level of education and socio-economic status influenced OHI-seeking. OHI directly influenced self-care decision-making by individuals and their relationships and communication with healthcare providers. Overall, OHI-seeking (and interventions to promote the use of OHI) enhanced individuals' confidence, skills and knowledge.

Conclusions

The findings highlight the benefits of OHI-seeking and its potential influence on self-care decisions. Future research should focus on strategies that would promote the pursuit of high-quality, up-to-date OHI and on the development of interventions for healthcare professionals to improve patients' use of OHI in self-care and self-efficacy.

A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study

BACKGROUND

Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease.

OBJECTIVE

The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education.

METHODS

A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype.

RESULTS

Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design.

CONCLUSIONS

Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life.

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

OBJECTIVE

This paper surveys a subset of the 2022 human and organizational factor (HOF) literature to provide guidance on building a One Digital Health ecosystem.

METHODS

We searched a subset of journals in PubMed/Medline for studies with "human factors" or "organization" in the title or abstract. Papers published in 2022 were eligible for inclusion in the survey. Selected papers were categorized into structural and behavioural aspects to understand digital health enabled interactions across micro, meso, and macro systems.

RESULTS

Our survey of the 2022 HOF literature showed that while we continue to make meaningful progress at digital health enabled interactions across systems levels, there are still challenges that must be overcome. For example, we must continue to grow the breadth of HOF research beyond individual users and systems to assist with the scale up of digital health systems across and beyond organizations. We summarize the findings by providing five HOF considerations to help build a One Digital Health ecosystem.

CONCLUSION

One Digital Health challenges us to improve coordination, communication, and collaboration between the health, environmental and veterinary sectors. Doing so requires us to develop both the structural and behavioural capacity of digital health systems at the organizational level and beyond so that we can develop more robust and integrated systems across health, environmental and veterinary sectors. The HOF community has much to offer and must play a leading role in designing a One Digital Health ecosystem.

Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review

BACKGROUND

Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients' experiences of the advantages and challenges of telehealth in home-based palliative care.

OBJECTIVE

In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients' use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients.

METHODS

This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ≥18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis.

RESULTS

This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth.

CONCLUSIONS

The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process.

Usability of a continuous oxygen saturation device for home telemonitoring

Background

The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients.

Method

The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service.

Results

A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support.

Conclusions

Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients' feedback, are needed to scale up the service.

E-health as a sine qua non for modern healthcare

In each era we need to balance between being able to provide care with our “technical skill, scientific knowledge, and human understanding” (Harrison's Principles of Internal Medicine, 1950) to the individual patient and simultaneously ensure that our healthcare serves all. With the increasing demand of healthcare by an aging population and the lack of specialists, accessible healthcare within a reasonable time frame is not always guaranteed. E-health provides solutions for current situations where we do not meet our own aims of good healthcare, such as restrictions in access to care and a reduction in care availability by a reducing workforce. In addition, telemedicine offers opportunities to improve our healthcare beyond what is possible by in person visits. However, e-health is often viewed as an deficient version of healthcare of low quality. We disagree with this view. In this article we will discuss how to position e-health in the current situation of healthcare, given the continuing rapid development of digital technologies and the changing needs of healthcare professionals and patients. We will address the evolution of e-health towards connected and intelligent systems and the stakeholders perspective, aiming to open up the discussion on e-Health.