Ethical considerations in the use of GPS-based movement tracking in health research - lessons from a care-seeking study in rural west India

Revisiting public open space and physical activity: What we know, what we still don't, and emerging issues-A decade later

Public open spaces provide settings for physical activity, but research on their role continues to develop. A decade ago, a paper published by Koohsari et al. (2015) in Health & Place identified key conceptual and methodological challenges in public open spaces and physical activity research. Since its publication, the paper has been widely cited, with over 340 citations and a field-weighted citation impact of 10.70 (Scopus). The current interdisciplinary commentary revisits the original study, evaluates progress over the past decade, and discusses emerging issues. While some conceptual and methodological gaps have been addressed, challenges remain. Emerging issues such as intensifying climate change, pandemics, and technological shifts continue to shape how public open spaces influence physical activity. Further interdisciplinary studies among urban designnce, parks and recreation, geography, public health, and other relevant fields are needed to address these challenges.

Validity of Mobility-Based Exposure Assessment of Air Pollution: A Comparative Analysis with Home-Based Exposure Assessment

Air pollution exposure is typically assessed at the front door where people live in large-scale epidemiological studies, overlooking individuals' daily mobility out-of-home. However, there is limited evidence that incorporating mobility data into personal air pollution assessment improves exposure assessment compared to home-based assessments. This study aimed to compare the agreement between mobility-based and home-based assessments with personal exposure measurements. We measured repeatedly particulate matter (PM2.5) and black carbon (BC) using a sample of 41 older adults in the Netherlands. In total, 104 valid 24 h average personal measurements were collected. Home-based exposures were estimated by combining participants' home locations and temporal-adjusted air pollution maps. Mobility-based estimates of air pollution were computed based on smartphone-based tracking data, temporal-adjusted air pollution maps, indoor-outdoor penetration, and travel mode adjustment. Intraclass correlation coefficients (ICC) revealed that mobility-based estimates significantly improved agreement with personal measurements compared to home-based assessments. For PM2.5, agreement increased by 64% (ICC: 0.39-0.64), and for BC, it increased by 21% (ICC: 0.43-0.52). Our findings suggest that adjusting for indoor-outdoor pollutant ratios in mobility-based assessments can provide more valid estimates of air pollution than the commonly used home-based assessments, with no added value observed from travel mode adjustments.

Exploring mobility data for enhancing HIV care engagement in Black/African American and Hispanic/Latinx individuals: a longitudinal observational study protocol

INTRODUCTION

Increasing engagement in HIV care among people living with HIV, especially those from Black/African American and Hispanic/Latinx communities, is an urgent need. Mobility data that measure individuals' movements over time in combination with sociostructural data (eg, crime, census) can potentially identify barriers and facilitators to HIV care engagement and can enhance public health surveillance and inform interventions.

METHODS AND ANALYSIS

The proposed work is a longitudinal observational cohort study aiming to enrol 400 Black/African American and Hispanic/Latinx individuals living with HIV in areas of the USA with high prevalence rates of HIV. Each participant will be asked to share at least 14 consecutive days of mobility data per month through the study app for 1 year and complete surveys at five time points (baseline, 3, 6, 9 and 12 months). The study app will collect Global Positioning System (GPS) data. These GPS data will be merged with other data sets containing information related to HIV care facilities, other healthcare, business and service locations, and sociostructural data. Machine learning and deep learning models will be used for data analysis to identify contextual predictors of HIV care engagement. The study includes interviews with stakeholders to evaluate the implementation and ethical concerns of using mobility data to increase engagement in HIV care. We seek to study the relationship between mobility patterns and HIV care engagement.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Institutional Review Board of the University of California, Irvine (#20205923). Collected data will be deidentified and securely stored. Dissemination of findings will be done through presentations, posters and research papers while collaborating with other research teams.

Green physical activity for leisure connects perceived residential greenspace and mental well-being

Physical activity serves as a pivotal mediator in previous theoretical frameworks that link greenspace and human health. However, it remains unclear whether the domain of physical activity within and around greenspaces can alter the pathway. The present study recruited 668 participants online and examined a conceptual framework that explores the associations between residential greenspace and mental well-being, with a particular focus on the mediation effect of green physical activity (physical activity undertaken in and around greenspaces). Moreover, socio-demographic characteristics, including gender, age, household income, education status, marital status, and student status, were controlled for during the examination. The investigated green physical activities included leisure activities, transportation walking, and transportation cycling, and they were measured by a pre-established questionnaire. Meanwhile, mental well-being was measured by the WHO-5 well-being index, and residential greenspace was indicated by self-reported perceived greenspace and mean Normalized Difference Vegetation Index (NDVI) values within 500 meters (m) of residential radius. We found that both perceived greenspace (B = 1.852, p < 0.001) and NDVI 500 m (B = 3.230, p = 0.038) were positively associated with mental well-being. However, only perceived greenspace, not NDVI 500 m, exhibited positive associations with the three green physical activity items. Furthermore, only green physical activity for leisure (B = 0.223, p < 0.001), not for transportation (p > 0.05), mediated the relationship between perceived greenspace and mental well-being. Our findings reinforce previous studies on "greenspace-health" frameworks and underline the importance of leisure physical activity in promoting mental well-being.

A Framework for Locating Prescribed Medication at Pharmacies

Introduction

Accessibility of available medication at pharmacies is one of the core problems in the health sector of developing countries. The mechanism for optimally accessing the available drugs in pharmacies is unclear. Usually, patients in need are compelled to haphazardly switch between pharmacies in search of their prescription medications due to lack of information about the locations of pharmacies with required drug.

Objective

The primary objective of this study is to develop a framework that will simplify the process of identifying and locating nearest pharmacy when searching for prescribed medications.

Methods

Primary constraints (distance, drug cost, travel time, travel cost, opening and closing hours of pharmacies) in accessing required prescribed medications from pharmacies were identified from literature, and the client's and pharmacies' latitude and longitude coordinates were used to find the nearest pharmacies that have the required prescribed medication in stock.

Results

The framework with web application was developed and tested on simulated patients and pharmacies and was successful in optimizing the identified constraints.

Discussions

The framework will potentially reduce patient expenses and prevent delays in obtaining medication. It will also contribute for future pharmacy and e-Health information systems.

Geolocation, ethics, and HIV research

The HIV epidemic continues to disproportionally affect marginalized populations. Digital tools, including global positioning system and ecologic momentary assessment, have been studied as methods for improving data collection and interventions among HIV-affected communities. Although people living with HIV and populations at high risk have found it acceptable to use digital technologies for HIV research, concerns over privacy and trust have also been expressed. This paper explores and describes the use of geolocation technology data (e.g., location-based social media) in HIV research as well as the ethical and implementation considerations that warrant examination prior to use. Transparent and clear language in consent forms might improve participant trust in the project and investigators' ability to keep participant data secure and private. With respect to institutional review boards, a committee member who is knowledgeable about digital technologies and consumer protections may offer guidance in assessing adequate protections in study protocols. As technology used in research continues to evolve, investigators and the research community must continue to examine the ethical challenges that emerge to address participant concerns.

Conducting community-based pediatric research in rural India: Experience from vadu rural health program

This paper describes unique challenges faced during conduct of community research studies in rural population of Maharashtra at Vadu Rural Health Program, Pune, India. Some of the ethical issues faced include difficulty in comprehending the informed consent by rural families with low education levels and ensuring adequate compensation for study participation without undue inducement, ensuring large number of recruitments during early infancy, ensuring adherence to intervention by care-providers, retention of participants especially in studies having long follow-ups and regulatory compliance for serious adverse event reports are major operational challenges. The delays faced in approvals from the Health Ministry Screening Committee and lack of specific regulatory guidance on community-based conduct of studies pose challenges in terms of study timelines and operational aspect of these studies. Provision of study-related information during prestudy visits, designing patient information sheets in simple language, involving the decision-making member of the family, adequate time for families for decision-making are certain measures that have been useful for effective informed consent administration. Collaboration with accredited social health activists and auxillary nurse midwives for line-listing of pregnancies and births and regular conduction of prestudy visits or community sensitization meetings have been useful for the recruitment of large number of study participants during infancy. Strategies such as provision of universal immunization, selection of field research assistants from the local population, regular home visits, and provision of medical care has been helpful in retention of the study participants. Networking with local health facilities and local government bodies has helped in the provision of medical care to the study participants and in the management of serious adverse events. Our experience can provide important learnings to other investigators from developing countries working in the domain of child health.

Ethical Issues in Democratizing Digital Phenotypes and Machine Learning in the Next Generation of Digital Health Technologies

Digital phenotyping is the term given to the capturing and use of user log data from health and wellbeing technologies used in apps and cloud-based services. This paper explores ethical issues in making use of digital phenotype data in the arena of digital health interventions. Products and services based on digital wellbeing technologies typically include mobile device apps as well as browser-based apps to a lesser extent, and can include telephony-based services, text-based chatbots, and voice-activated chatbots. Many of these digital products and services are simultaneously available across many channels in order to maximize availability for users. Digital wellbeing technologies offer useful methods for real-time data capture of the interactions of users with the products and services. It is possible to design what data are recorded, how and where it may be stored, and, crucially, how it can be analyzed to reveal individual or collective usage patterns. The paper also examines digital phenotyping workflows, before enumerating the ethical concerns pertaining to different types of digital phenotype data, highlighting ethical considerations for collection, storage, and use of the data. A case study of a digital health app is used to illustrate the ethical issues. The case study explores the issues from a perspective of data prospecting and subsequent machine learning. The ethical use of machine learning and artificial intelligence on digital phenotype data and the broader issues in democratizing machine learning and artificial intelligence for digital phenotype data are then explored in detail.

Mandating the Use of Proximity Tracking Apps During Coronavirus Disease 2019: Ethical Justifications

The rise of the coronavirus disease 2019 (COVID-19) in a digital world has expectedly called upon technologies, such as wearables and mobile devices, to work in conjunction with public health interventions to tackle the pandemic. One significant example of this integration is the deployment of proximity tracking apps on smartphones to enhance traditional contact tracing methods. Many countries have adopted proximity tracking apps; however, there is a large degree of global differentiation in the voluntariness of the apps. Further, the concept of a mandatory policy—forcing individuals to use the apps—has been met with ethical concerns (e.g., privacy and liberty). While ethical considerations surrounding deployment have been put forth, such as by the World Health Organization, ethical justifications for a mandatory policy are lacking. Here, we use the Faden–Shebaya framework, which was formed to justify public health interventions, to determine if the compulsory use of proximity tracking apps is ethically appropriate. We show that while theoretically justified, due to the current state of proximity tracking applications and societal factors, it is difficult to defend a mandatory policy in practice.

Innovative Tools for Tourism and Cultural Tourism Impact Assessment

The importance of data and evidence has increased considerably in policy planning, implementation, and evaluation. There is unprecedented availability of open and big data, and there are rapid developments in intelligence gathering and the application of analytical tools. While cultural heritage holds many tangible and intangible values for local communities and society in general, there is a knowledge gap regarding suitable methods and data sources to measure the impacts and develop data-driven policies of cultural tourism. In the tourism sector, rapid developments are particularly taking place around novel uses of mobile positioning data, web scraping, and open application programming interface (API) data, data on sharing, and collaborative economy and passenger data. Based on feedback from 15 European cultural tourism regions, recommendations are developed regarding the use of innovative tools and data sources in tourism management. In terms of potential analytical depth, it is especially advisable to explore the use of mobile positioning data. Yet, there are considerable barriers, especially in terms of privacy protection and ethics, in using such data. User-generated big data from social media, web searches, and website visits constitute another promising data source as it is often publicly available in real time and has low usage barriers. Due to the emergence of new platform-based business models in the travel and tourism sector, special attention should be paid to improving access and usage of data on sharing and collaborative economy.