The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews

Digital Health Intervention Effect on Older Adults With Chronic Diseases Living Alone: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The incidence of chronic diseases is increasing owing to the aging population; in particular, older adults living alone struggle with self-management and medical expenses. Digital health can contribute to medical cost management and health promotion, but its effectiveness for older adults living alone remains unclear. In a rapidly aging society, it is important to demonstrate the effect of digital health on improving the lives of older adults living alone and reducing the burden of chronic diseases.

OBJECTIVE

This study aims to examine the intervention effects of digital health on self-management, quality of life, and medical factors for older adults living alone with common chronic diseases such as cardiovascular disease, respiratory disease, and musculoskeletal disorders through a systematic literature review and meta-analysis.

METHODS

We searched the literature using 3 databases, including PubMed, CINAHL, and Cochrane CENTRAL, for literature published in overseas academic journals up to October 2024. The final 11 papers were used for analysis based on selection and exclusion criteria. Meta-analysis was used to calculate the mean difference and standardized mean difference (SMD) for the selected literature using RevMan (version 5.4; Cochrane). The effect size and heterogeneity were calculated through 95% CI.

RESULTS

As a result of conducting a meta-analysis of 8 of 11 documents, there was a significant effect of self-management factors on moderate-to-vigorous physical activity (SMD=0.08; z=2.07; P=.04). However, among self-management factors, low-density lipoprotein cholesterol (SMD=-0.04; z=0.91; P=.36) did not show statistically significant results. Among the medical factors, general quality of life (SMD=0.11; z=0.93; P=.35), depression (SMD=-3.95; z=1.59; P=.11), and hospital days (SMD=-1.57; z=0.91; P=.36) also did not show statistically significant results. However, it was confirmed that they improved after a digital health intervention.

CONCLUSIONS

This study demonstrated that digital health interventions are effective in improving physical activity in older adults with chronic diseases living alone. However, owing to the characteristics of older adults living alone, there is a need to further expand digital health to combine care services that can manage diseases at home.

Psychometric Analysis of the eHealth Literacy Scale in Portuguese Older Adults (eHEALS-PT24): Instrument Development and Validation

BACKGROUND

In this era of digitalization, eHealth interventions are used to engage patients in health care and help them manage their health. Previous studies showed that this can be particularly interesting for chronic disease self-management and self-care in older adults. Despite older adults becoming increasingly active on the internet, they continue to struggle in using eHealth information due to inadequate eHealth literacy. Thus, assessing and monitoring eHealth literacy is critical to support eHealth interventions.

OBJECTIVE

This study aimed to describe the translation, adaptation, and validation process of the eHealth Literacy Scale (eHEALS) in Portuguese older adults.

METHODS

The cross-cultural adaption followed the steps of forward and blinded backward translations, evaluation of the translations by a committee of judges, pilot-testing, and full psychometric testing. We tested the psychometric properties of the eHEALS by carrying out two studies: general psychometric analysis (study 1) and confirmatory factor analysis (study 2). Study 1 included 80 older adults conveniently selected from a Health Family Unit. Data were collected by in-person questionnaires between May and July 2022. Study 2 included 301 older adults randomly selected from two distinct Health Family Units. Data were collected by in-person questionnaires between May and July 2023.

RESULTS

We tested stability, reliability, construct validity (exploratory and confirmatory factor analyses and known groups), and model fit. Study 1 had 58.8% (47/80) male and 41.3% (33/80) female respondents (mean age 71.20, SD 5.26 years). Study 2 had 56.5% (170/301) male and 43.5% (131/301) female respondents (mean age 71.77, SD 5.15 years). Moderate and strong correlations were identified in the scale items (study 1: 0.42≤r≤0.91 and study 2: 0.81≤r≤0.96; P<.001). The scale showed good internal consistency for study 1 (α=.92) and study 2 (α=.98), with high correlations between items. The exploratory factor analysis yielded a single-factor structure, explaining 58.3% of the variance in study 1 and 86.4% in study 2. In the confirmatory analysis (study 2), the model fit was mixed (χ²20=265, P<.001; comparative fit index=0.94; Tucker-Lewis Index=0.91; root mean square error of approximation=0.20). Thus, we compared 1-, 2-, and 3-factor structures, deciding on the unidimensional one. In study 1, the eHEALS-PT24 (Portuguese version of the eHealth Literacy Scale for older adults) mean score was 27.25 (SD 5.61), with 43.8% (35/80) and 11.3% (9/80) of participants showing low and high eHealth literacy levels, respectively. In study 2, the eHEALS-PT24 mean score was 23.31 (SD 9.53), with 38.2% (115/301) and 23.6% (71/301) of participants showing low and high eHealth literacy levels, respectively. The known-groups analysis showed statistically significant differences between eHealth literacy and demographic variables (P<.001).

CONCLUSIONS

The findings suggest that the eHEALS-PT24 is a reliable and valid tool to assess eHealth literacy in Portuguese older adults. Therefore, this instrument can be integrated to support the implementation process of eHealth interventions.

Evaluating the cost, cost-effectiveness and survival of an eHealth-facilitated integrated care model for allogeneic stem cell transplantation: Results of the German SMILe randomized, controlled implementation science trial

PURPOSE

eHealth-facilitated integrated care models (eICMs) have proved effective in improving outcomes for chronically ill patients. However, evidence on cost-effectiveness of eICMs is scarce so far. Allogeneic stem cell transplantation (alloSCT) recipients' post-discharge treatment costs and mortality are greatly influenced by complications. Within the international, multicentric SMILe implementation science project, the eHealth-facilitated SMILe integrated care model (SMILe-ICM) was developed to support patients minimize complications' effects within the first year post-alloSCT. Using initial effectiveness findings from the first center that implemented the SMILe-ICM, this study provides a cost and cost-effectiveness evaluation considering one-year and long-term survival effects, post-discharge costs, and patient-related factors.

METHODS

A single-center hybrid effectiveness implementation randomized controlled trial was conducted at a German university hospital from 2/2020 to 8/2022. Eligible alloSCT patients were randomized to the SMILe-ICM or usual care, i.e., one pre-transplant educational nursing visit followed by a physician-led follow-up. The intervention group received usual care plus the SMILe-ICM's four intervention modules (i.e., monitoring of medical/symptom-related parameters, medication adherence, infection prevention, physical activity). All modules were delivered by Advanced Practice Nurses (APNs) in face-to-face visits, combined with continuous online support. Daily, patients entered seventeen medical and symptom-related parameters to the SMILe App, so that APNs could monitor for and investigate possible pre-complication signs. Healthcare utilization costs were assessed at eight time-points (d+30 post-alloSCT-d365) on fourteen self-reported cost indicators and validated against health records. To calculate costs, we applied German standardized unit costs. Cost- and cost-effectiveness were analyzed in five steps: 1.) Calculate total costs, including for the alloSCT inpatient stay and post-discharge follow-up. 2.) Determine life-years gained (survival) as a health benefit unit. 3.) Calculate overall and rehospitalization-free survival estimates. 4.) Calculate the intervention's long-term cost-effectiveness, including extended follow-up, rate of survival until day 1000, and restricted mean survival time. 5.) Contrast these long-term estimates to current post-discharge costs with comparable patient-related factors (age ≥ or < 65, living alone, gender).

RESULTS

Seventy-two patients participated (n = 36/group). Total intergroup healthcare utilization and post-discharge costs differed, but non-significantly. Survival rates improved with the SMILe-ICM (88% vs. 80%) at least until day +1000. Rehospitalization-free survival showed improvement (38% vs. 30%); however, considering this sample size, both findings were nonsignificant. Cost-effectiveness analysis showed an overall post-discharge cost-effectiveness of 35,364.01€/patient and 6,742€/life year gained - a mean of 79.21 additional days of life for an intervention investment of 1.464€/patient in the first year post-alloSCT. One-year cost-effectiveness was highest for patients living alone. Younger age correlated with longer survival but higher costs.

CONCLUSION

The SMILe-ICM appears to offer survival and rehospitalization benefits, particularly for vulnerable groups, e.g., patients living alone. Larger, adequately powered studies are needed to validate these findings.

Exploring online health resources and self-care among irritable bowel syndrome patients: analyzing internet use and AI chatbot interactions

Background

The increasing prevalence of irritable bowel syndrome (IBS) in Saudi Arabia has led to a growing interest in understanding how patients seek health information online. While it is known that digital platforms, such as search engines, social media, and artificial intelligence (AI) chatbots, are commonly used for health information seeking, there is limited knowledge about the specific behaviors of IBS patients in this context and how these behaviors correlate with their self-care activities. This study aimed to explore online health information-seeking behavior and its correlation with self-care activities among patients with IBS in Saudi Arabia, focusing on the use of these digital platforms.

Methods

A cross-sectional survey was conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, from January to July 2023. The survey, available in both English and Arabic, targeted IBS patients aged 16 years or older. The questionnaire covered demographics, general internet usage, online health information-seeking behavior, and IBS knowledge and awareness.

Results

In this study, 451 IBS patients completed the survey. Notably, 95.1% of participants were internet users, primarily accessing health information through mobile phones and search engines. The results highlighted a significant correlation between online health information-seeking behaviors and self-care practices (P=0.009) like exercise and dietary adjustments, despite a moderate basic knowledge [standard deviation (SD) 2.26%] of IBS. Symptomatically, 93.3% experienced abdominal pain weekly, yet 63% did not fully meet the Rome criteria for IBS. Common management strategies included hydration, diet modifications, and exercise. About 28.4% visited the emergency room (ER) for severe symptoms, and 20% regularly consulted doctors every 3-6 months. Surprisingly, 80% were unaware of the FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, often suggested for IBS.

Conclusions

The research indicates a rise in digital health literacy among IBS patients in Saudi Arabia, highlighting the need for accurate and culturally appropriate online resources. It suggests that healthcare professionals and policymakers should direct patients to reliable information and address the digital divide to enhance self-care and IBS management outcomes.

Effects of a Smartphone App-Based Intervention on Rheumatoid Arthritis Self-Management Efficacy: A Randomized Controlled Trial

BACKGROUND

Self-management programs can help patients with rheumatoid arthritis develop strategies to address their disease-related problems. However, accessibility to traditional self-management programs is often limited.

PURPOSE

This study was developed to assess the effectiveness, feasibility, and acceptability of a smartphone-delivered self-management program application (app) for adults with rheumatoid arthritis.

METHODS

A two-arm (intervention vs. control) randomized controlled trial was used. Adult patients with rheumatoid arthritis were recruited from the rheumatology departments of a medical center. Study enrollment capabilities were limited by current pandemic restrictions. The patients who met the inclusion criteria and agreed to participate (N = 46) were enrolled as participants and randomly assigned either to the intervention group (n = 25), which received instructions on the use of a smartphone app designed to facilitate the self-management of rheumatoid arthritis, or to the control group (n = 21), which received instructions on related self-management only. The outcome variables were assessed at baseline and at 8 and 12 weeks. Differences in between-group outcomes over time were analyzed using generalized estimating equations. Feasibility and acceptability were also evaluated. Data were collected between August 1, 2020, and July 31, 2022.

RESULTS

At baseline, no differences were detected between the two groups in terms of the demographic and disease characteristics of concern. Outcome measures for the intervention group improved significantly more than the control group for self-efficacy of pain at 8 weeks (B = 6.39, p < .05) and for both of self-efficacy of pain and self-management behavior at 12 weeks (B = 9.16, p < .05, and B = 4.25, p < .001, respectively). Factors related to app ease of use included limiting pop-ups and windows and having no time restrictions. Most of the participants reported the app as acceptable and easy to use, although challenges relating to using technology limited the usability of the app for some.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The smartphone app was shown to improve self-efficacy of pain and self-management behaviors. However, an accurate assessment of the effectiveness of the app and generalizability of the findings is limited by the smaller-than-desired sample size due to the COVID-19 pandemic and technological challenges. A greater understanding of how to overcome technological challenges is needed to optimize the delivery of self-management programs via smartphone-based apps. Studies reevaluating this app on a larger sample size should be conducted.

Digital health to promote adherence to antiretroviral treatment in patients with HIV/AIDS: Meta review

INTRODUCTION

Digital health or "e-Health" is a set of applications based on Information and Communication Technologies that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-Health interventions to promote adherence to antiretroviral therapy in people living with HIV/AIDS.

METHOD

A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-Health components to promote adherence to antirretroviral therapy, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables.

RESULTS

A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 randomized controlled therapies with different e-Health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-Learning.

CONCLUSIONS

Evidence was found that supports that some e-Health interventions are effective in promoting adherence to antirretroviral therapy and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.

[Translated article] Digital health for promoting adherence to antiretroviral treatment in patients with HIV/AIDS: A meta-review

INTRODUCTION

Digital health or "e-health" is a set of applications based on information and communication technologies (ICTs) that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-health interventions to promote adherence to antiretroviral therapy (ART) in people living with HIV/AIDS.

METHODOLOGY

A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-health components to promote adherence to ART, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables.

RESULTS

A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 RCTs with different e-health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load (VL) measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-learning.

CONCLUSION

Evidence was found that supports that some e-health interventions are effective in promoting adherence to ART and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.

The medical librarian's roles in the patient education process: A scoping review protocol

BACKGROUND

The presence of medical librarians in the patient education team can greatly facilitate the patient education process. Expanding the role of medical librarians in patient education and using them in this process requires understanding the roles and services they can provide. This scoping review aims to identify different traditional and modern services and roles that medical librarians provide specifically in the patient education process.

MATERIALS AND METHODS

A scoping review protocol is reported, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. PubMed, Scopus, Web of Science, and LISTA (Library, Information Science & Technology Abstracts) will be searched. A grey literature search and hand-searching of citations and reference lists of the included studies will also be undertaken. Studies with their full text are not available and are in languages other than English will be excluded. Two independent reviewers will screen titles/abstracts and full text of retrieved articles and eligibility disagreements within a pair will resolve by discussion or a third reviewer. Data charting will be done in accordance with the data extraction tool made in Excel. Findings will be presented as a narrative summary supported by tables and diagrams.

CONCLUSIONS

Identifying the different services that medical librarians provide in the patient education process leads medical librarians to inform about the different services they can provide in the patient education process and to expand their roles as well as policymakers and hospital managers to be aware of these roles and use medical librarians in the patient education process appropriately. It also helps the general public and patients to learn about the services that medical librarians can provide them in this process.

Effects of a nurse-led eHealth programme on functional outcomes and quality of life of patients with stroke: a pooled analysis of randomized controlled trials

BACKGROUND

Stroke remains a leading cause of disability worldwide. Nurse-led eHealth programs have emerged as a potentially effective strategy to improve functional outcomes and quality of life in stroke survivors. However, the variability of study designs and outcomes measured across trials necessitates a pooled analysis to comprehensively assess the efficacy of these interventions. This protocol outlines the methodology for a pooled analysis that aims to synthesize evidence from randomized controlled trials (RCTs) evaluating nurse-led eHealth interventions for stroke patients.

METHODS AND ANALYSIS

This pooled analysis will be conducted according to the PRISMA guidelines. We will include RCTs that evaluate nurse-led eHealth programs and report on functional outcomes or quality of life in stroke patients. Comprehensive searches of electronic databases including Pubmed, EMBASE, the Cochrane Library, CINAHL, and PsycINFO will be conducted with a predefined search strategy. Study selection will involve screening titles and abstracts, followed by full-text review using explicit inclusion and exclusion criteria. Data extraction will be undertaken independently by two reviewers. The risk of bias will be assessed through the Cochrane Risk of Bias tool. Additionally, the quality of evidence for each outcome will be evaluated using the GRADE approach. Meta-analyses will be performed using random-effects models, and heterogeneity will be quantified using the I2 statistic. Subgroup and sensitivity analyses will explore potential sources of heterogeneity.

DISCUSSION AND CONCLUSIONS

This pooled analysis is poised to provide a nuanced understanding of the effectiveness of nurse-led eHealth programs in stroke rehabilitation, leveraging a thorough methodological framework and GRADE tool to ensure robustness and reliability of evidence. The investigation anticipates diverse improvements in patient outcomes, underscoring the potential of personalized, accessible eHealth interventions to enhance patient engagement and treatment adherence. Despite the challenges posed by the heterogeneity of interventions and rapid technological advancements, the findings stand to influence clinical pathways by integrating eHealth into standard care, if substantiated by the evidence. Our study's depth and methodological rigor possess the potential to initiate changes in healthcare policy, advocating for the adoption of eHealth and subsequent investigations into its cost-efficiency. Ultimately, we aim to contribute rich, evidence-based insights into the burgeoning field of digital health, offering a foundational assessment of its applications in stroke care. Our data is expected to have a lasting impact, not only guiding immediate clinical decisions but also shaping the trajectory of future healthcare strategies in stroke recovery.

SYSTEMATIC REVIEW REGISTRATION

Identifier (CRD42024520100: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=520100).

The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study

BACKGROUND

Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication-specifically, short-acting beta2-agonist (SABA) overuse-is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation.

OBJECTIVE

This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined.

METHODS

A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method.

RESULTS

The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist.

CONCLUSIONS

The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.

Health Literacy and Self-Care in Patients with Chronic Illness: A Systematic Review and Meta-Analysis Protocol

Self-care plays a critical role in symptom recognition, management, and risk factor modification for patients with chronic illnesses. Despite its significance, self-care levels in this population are generally poor. Health literacy (HL) is pivotal for promoting effective self-care, yet the association across specific chronic illnesses remains fragmented and conflicting. Therefore, a systematic review and meta-analysis will be conducted. Inclusion criteria encompass quantitative studies involving adult patients with at least one chronic illness reporting on the association between a measure of HL and one or more elements of self-care behaviors as outcomes. Databases to be searched include PubMed, CINAHL, APA PsycINFO, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The studies will undergo risk of bias and certainty of evidence assessment using ROBINS-E and GRADE. Extracted data will include authors, publication date, aim(s), study location, design, sample characteristics, chronic illness type, study length, HL, and self-care measures. Understanding the link between HL and self-care can aid healthcare providers in implementing strategies to enhance health-promoting behaviors, contributing valuable insights to the scientific community and fostering nuanced discussions. This protocol ensures methodological transparency, stimulates discourse, and paves the way for informed interventions to improve overall health outcomes.

The Utilization of e-Health in Lymphedema Care: A Narrative Review

Background: Electronic health (e-Health), refers to technologies that can be utilized to enhance patient care as well as collect and share health information. e-Health comprises several umbrella terms, including telehealth, mobile health, e-Health, wearables, and artificial intelligence. The types of e-Health technologies being utilized in lymphedema (LE) care are unknown. Method: In this narrative review, a search of published research on the utilization of e-Health technologies in LE-related care was conducted. Results: Five different types of e-Health modalities were found (robotics, artificial intelligence, electronic medical records, smart wearable devices, and instructive online information) spanning 14 use cases and 4 phases of care (preventative, diagnostic, assessment, and treatment phases). Broad e-Health utilization examples were found including robotic-assisted surgery to reduce the likelihood of LE after lymphadenectomy, machine learning to predict patients at risk of filarial-related LE, and a novel wearable device prototype designed to provide lymphatic drainage. Conclusions: e-Health has reported merit in the prevention, diagnoses, assessment, and treatment of LE with utilization demonstrating cutting edge applicability of e-Health for achieving optimal patient care and outcomes. As technology continues to advance, additional research into the utilization of e-Health in LE care is warranted.

Virtual assessment and management of chronic cough: A scoping review

Background

Chronic cough is a frequent reason for seeking consultation with primary care providers. The recent widespread adoption of virtual care offers a promising alternative that can be used to optimize the assessment and management of this condition. The objective of this review was to map and identify the strategies used to assess and/or manage chronic cough virtually, and to explore their impact on cough severity and patient satisfaction with virtual care.

Methods

A scoping review was conducted in MEDLINE, EMBASE, and CINAHL in May 2023. Research questions were defined based on the Population, Concept, Context mnemonic, and literature search was conducted using a three-step approach. Study selection involved the steps of identification, screening, eligibility, and inclusion. A descriptive synthesis was performed, and quantitative variables were presented as absolute and relative frequencies.

Results

A total of 4953 studies were identified and seven met the inclusion criteria. The following mHealth and telehealth strategies were identified: diagnostic website, specialized online clinic, online speech language therapy, and remote follow-up to assess the effectiveness of in-person interventions. Results indicated that these virtual strategies can be useful to assess chronic cough, treat, and track chronic cough symptoms. Overall, patients were satisfied with the approaches.

Conclusion

Although literature is scarce, evidence suggests that virtual strategies for the assessment and management of chronic cough may be effective and are well-received by patients. However, further research is needed to identify the type and characteristics of virtual approaches leading to optimize and facilitate the care of patients with this condition. This will also help develop a strong body of evidence to support their incorporation into guidelines and clinical practice.

Exploring the evolution of eHealth in disease management: A bibliometric analysis from 1999 to 2023

Objective

In the digital age, eHealth is vital in modern healthcare, impacting medical services and public health. Despite its potential in disease management, a comprehensive bibliometric analysis is lacking. This study utilizes bibliometric methods to explore the evolution of eHealth in disease management from 1999 to 2023, aiming to discern the research status and trends.

Methods

A literature search was conducted using the Web of Science Core Collection (WOSCC) database. Publications and journals were quantitatively analyzed using Microsoft Office Excel 2023. Country/institution/author collaborations and keyword co-occurrences were analyzed using VOSviewer. CiteSpace was employed to analyze the citation bursts of reference. A global distribution network of publications was constructed and thematic trends were analyzed using R package "bibliometrix."

Results

The study identified 1763 articles on eHealth in disease management. Since 2011, there has been a notable increase in publications, with the United States (n = 391, 22.08%) and the University of Sydney (n = 60, 3.40%) as leading contributors. High-quality journals primarily publish this research. Globally, 9631 authors contributed, with Chavannes, Niels H being the most prolific (n = 23). Author co-citation analysis indicated Eysenbach, G as the most cited (n = 336). Research currently focuses on developing a comprehensive eHealth framework, optimizing mHealth for chronic diseases, improving eHealth intervention trial reporting, assessing social factors in eHealth literacy, and examining telemedicine's role during the Covid-19 pandemic.

Conclusion

This study offers a comprehensive overview of eHealth research in disease management. eHealth's potential in disease prevention and treatment is significant. To enhance eHealth's impact, international collaboration, technological innovation, tailored intervention trials, addressing the digital divide, and solving legal and ethical issues are crucial. This study will guide future research endeavors, with the goal of enhancing eHealth's benefits and expanding its accessibility to a wider patient base.

The effect of digital interventions on related health literacy and skills for individuals living with chronic diseases: A systematic review and meta-analysis

BACKGROUND

Chronic diseases are a leading cause of death and disease burden globally. Digital interventions could be an approach to improve patients' ability to find, evaluate, and use health information.

OBJECTIVES

The main objective was to conduct a systematic review to determine the effect of digital interventions on digital health literacy for patients living with chronic disease. Secondary objectives were to provide an overviewof the design and delivery characteristics of interventions that impact digital health literacy in people with chronic disease.

METHODS

Randomized controlled trials examining digital health literacy (and related components) for individuals with cardiovascular disease, chronic lung disease, osteoarthritis, diabetes, chronic kidney disease, and HIV were identified. This review was conducted following the PRIMSA guidelines. Certainty was assessed using GRADE and the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42022375967).

RESULTS

9386 articles were identified and 17 articles representing 16 unique trials were included. Studies evaluated 5138 individuals with one or more chronic conditions (50% women, ages 42 ± 7-71 ± 12 years). The most targeted conditions were cancer, diabetes, cardiovascular disease, and HIV. Interventions included: skills training, websites, electronic personal health records, remote patient monitoring, and education. The effects of the interventions were related to: (i) digital health literacy, (ii) health literacy, (iii) health information skills, (iv) technology skills and access, and (v) self-management and participation in care. A meta-analysis of three studies identified the effect of digital interventions was better than usual care for eHealth literacy (1.22 [CI 0.55, 1.89], p < 0.001).

CONCLUSIONS

The evidence of the effects of digital interventions on related health literacy is limited. Existing studies reflect the heterogeneity in study design, population, and outcome measures. There is a need for further studies on the effects of digital interventions on related health literacy for individuals with chronic conditions.

Diabetes Health Literacy, Drug Adherence and Factors Associated with Them among Urban Patients in Kerala, India

Aims

The study aimed to assess diabetes health literacy, adherence to diabetes medication, and its associated factors in Kerala, India, the most advanced Indian state in epidemiological transition with the highest literacy level in India.

Materials and methods

We conducted a community-based cross-sectional study among 280 diabetes patients (mean age 62 years, male 42%) selected by multistage cluster sampling. Information on sociodemographic variables was collected using a pretested structured interview schedule. Diabetes health literacy was assessed using the revised Michigan Diabetes Knowledge test. Adherence to diabetes medication was assessed using the Hill-Bone subscale. Binary logistic regression analysis was done to find out the factors associated with diabetes health literacy and medication adherence.

Results

Good diabetes health literacy was reported by 35.7% [95% confidence interval (CI): 30.1-41.6] of the patients. Perfect adherence to diabetes medication was reported by 33.2% of patients (CI: 27.7-39.1). Patients who reported regular newspaper reading [adjusted odds ratio (AOR) 3.16; CI: 1.57-6.30], using the internet (AOR 2.23; CI: 1.11-4.50) and insulin use (AOR 2.60; CI: 1.35-5.00) were more likely to report good diabetes health literacy compared to their counterparts. Patients who reported reading health magazines (AOR 2.75; CI: 1.01-7.60) were more likely to report perfect medication adherence compared to those who did not.

Conclusion

Why diabetes health literacy and medication adherence were low among diabetes patients in the most literate state needs further investigation. Interventions to enhance diabetes health literacy and medication adherence may be undertaken among diabetes patients encouraging them to read newspapers and health magazines regularly and use the internet.

A Deep Dive into the Nexus between Digital Health and Life Sciences Amidst the COVID-19 Pandemic: An Editorial Expedition

I am proposing this editorial to briefly trace the evidences that emerged from the Special Issue (SI)-The Digital Health in the Pandemic Era- [...].