Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial

BACKGROUND

Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist.

METHODS

This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle.

RESULTS

Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU.

LIMITATIONS

The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low.

CONCLUSIONS

Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.

eHealth literacy in prostate cancer: A systematic review

OBJECTIVE

This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers.

METHODS

8 databases (MEDLINE, SCOPUS, EMBASE, Web Of Science, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL) and grey literature sources (e.g. Google Scholar) were searched from inception to December 2023. Articles were included if assessing eHealth/digital literacy of men with prostate cancer, or their carers', and health outcome associations. Formats such as case reports, and review papers were excluded. Records and full texts underwent independent screening and data extraction. Author disagreements were resolved by discussion. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included literature, with narrative synthesis of results.

RESULTS

21,581 records were retrieved, with 7 articles satisfying inclusion criteria. A heterogenous field was characterised with lack of modern eHealth literacy measurement tools identified. Results suggest novice eHealth literacy using web 1.0 technologies. Non-validated measures of literacy demonstrate mixed results, while health outcome effects limited in scope and reliability.

CONCLUSION

Prostate cancer survivors' eHealth literacy levels is likely novice, and requires further investigation.

PRACTICE IMPLICATIONS

Digital technologies/resources implemented as part of patient communication practices should be vetted for quality, and tailored to patients' eHealth literacy abilities and/or needs.

Quality assessment of health science-related short videos on TikTok: A scoping review

OBJECTIVE

The aims of this review are to clarify the current state of research in terms of assessment tools and assessors of the quality of health science-related short videos on TikTok, to identify limitations in existing research; and to provide a reference for future studies.

METHODS

A scoping review was conducted. The Cochrane Library, PubMed, MEDLINE, Web of Science, Embase, Scopus, EBSCO, CNKI, VIP, Wanfang Data, and CBM databases were searched from September 2016 to November 2022. Manual searching was also performed to identify additional eligible studies. A total of 2620 documents were initially retrieved, and 29 were ultimately included. The literature was screened and collected, and data were extracted and summarized by 2 researchers.

RESULTS

(1) The quality evaluation tools used in the 29 papers included the DISCERN, PEMAT(A/V), GQS, JAMA, HONcode, guidelines and self-developed tools. Twenty-four of the included articles used the DISCERN for quality assessment, which was the most frequently used evaluation tool. However, most of these tools were not developed to assess health science-related short videos, lacked credibility tests, and had poor applicability; therefore, the accuracy of the evaluation results might be biased. (2) The assessors of the quality of health science-related short videos on TikTok were mainly experts in related fields and medical students, with doctors (12/14) being the most common evaluators. Fifteen studies did not report the identity of the evaluators, and 12 studies did not report interrater reliability.

CONCLUSION

This scoping review found that there is a lack of specific quality assessment tools for health science-related short videos on TikTok. Second, the current quality assessors of health science-related short videos on TikTok are limited. Future research should focus on the development of reliable, scientific quality assessment tools for health science-related short videos; unifying the evaluation standards; inviting users with different backgrounds and different health literacy levels to conduct quality assessments; exploring the quality assessment of health science-related short videos on TikTok from different perspectives.

Is it safe to learn about vital pulp capping from YouTube™ videos? A content and quality analysis

AIM

To evaluate YouTube videos on vital pulp capping (VPC) for content, quality, source, usefulness, and reliability.

MATERIALS AND METHODS

This study assessed 249 English-language videos on vital pulp therapy using the Total Content Score (TCS), Video Information and Quality Index (VIQI), Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) score and modified DISCERN score. Videos were categorized based on communication quality, duration, likes and dislikes, views, source, and video type. Of the videos analyzed, 22.1% met the inclusion criteria. Data were analyzed using Shapiro-Wilk, Kruskal-Wallis, and post hoc Bonferroni tests. Sperman's correlation, Kendal tau tests for correlations, and Fisher's exact test were used to assess associations between categorical variables.

RESULTS

The study identified significant correlations between various parameters. A higher TCS was correlated with increased VIQI (p = 0.005) and GQS scores (r = 0.685, p < 0.05). A moderate positive correlation was found between GQS scores and TCSs (r = 0.577, p < 0.05). VIQI scores were significantly and positively correlated with TCS (r = 0.573, p < 0.05) and comment count (r = 0.306, p < 0.05). JAMA scores were positively correlated with upload time (r = 0.304, p < 0.05), comment count (r = 0.337, p < 0.05), and likes (r = 0.301, p = 0.05).

CONCLUSIONS

YouTube videos provided low-to-average quality VPC information and tended to be inaccurate. Therefore, public videos may be incorrect, incomplete, and low-quality. Clinicians and patients should seek reliable information from specialists.

Impact of the COVID-19 Pandemic on People Living with Rheumatoid Arthritis: Experiences and Preferences in Accessing Healthcare Across Five Countries

INTRODUCTION

The global coronavirus 2019 (COVID-19) pandemic created many challenges in healthcare provision. This study aimed to evaluate the global impact of the COVID-19 pandemic on people living with rheumatoid arthritis (RA).

METHODS

The RA Narrative COVID-19 survey was conducted online among people with RA who resided in Brazil, Canada, France, Japan, and the US from August to September 2021. The survey examined disease management, healthcare access and experiences, and participant preferences for interactions with their doctor.

RESULTS

Overall, 500 participants completed the survey: 100 each resided in Brazil, Canada, France, Japan, and the US. Emotional well-being was the aspect of disease management most reported to be negatively impacted by the pandemic (55% of participants); 'having more anxiety and/or stress' during the pandemic was the top factor that made controlling RA symptoms more difficult (49% of participants). In comparison, the top factor that made controlling RA symptoms easier was 'having a less busy schedule' (35% of participants). More participants had virtual appointments during versus pre-pandemic (53% vs. 13%, respectively) and participants were equally satisfied with the overall quality of care received via virtual and in-person appointments (76% of participants were 'satisfied' or 'very satisfied' with both). However, participants generally preferred in-person over virtual appointments, except for prescription refills, for which preferences were similar (39% vs. 36%, respectively).

CONCLUSIONS

This survey suggests that the COVID-19 pandemic did negatively impact some aspects of disease management for people living with RA but had positive impacts on the utilization of virtual care. Although participants generally preferred in-person appointments, these results position virtual care as an appropriate means for routine follow-ups.

Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care

OBJECTIVE

To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only).

DESIGN

A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement.

SETTING

31 primary healthcare centers in Sweden.

SUBJECTS

949 patients treated for hypertension.

MAIN OUTCOME MEASURES

The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression.

RESULTS

At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months.

CONCLUSION

The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.

Understanding university students' attitudes and preferences for internet-based mental health interventions

Internet-based interventions are recognised as a practical approach to address mental health issues. The acceptance and utilisation of such interventions are closely linked to user attitudes and preferences. This study aims to examine the predictors of university students' attitudes towards internet-based interventions. Additionally, it seeks to elucidate students' preferences regarding crucial features of these interventions, such as the format, delivery mode, content type, and structural components, to understand better what makes these interventions appealing and practical for university students. A total of 273 university students (comprising 68 % females and 32 % males) participated in the study. The data collection instruments employed were the Personal Information Form, Internet-Based Intervention Preference Survey, E-therapy Attitude Measure (ETAM), Digital Literacy Scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 (GAD-7). The data were analysed utilising descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis. The multiple regression analysis revealed digital literacy as a predictive factor for attitudes towards internet-based interventions. Demographic variables, such as age and gender, and psychological variables, such as depression and anxiety levels, were found not to be associated with attitudes towards these interventions. While students are actively seeking mental health information online, a significant majority remain unaware of internet-based interventions. They show a preference for interventions offering greater human interaction, including face-to-face guidance and video content featuring people. Participants favour completing one or two sessions of the intervention weekly. Desired features of internet-based interventions include self-assessment scales, relatable characters, voice relaxation exercises, practical daily life activity tasks, and weekly reminders throughout the process. In conclusion, initiatives aimed at enhancing digital literacy levels could foster more positive attitudes towards internet-based interventions among students. Developers creating Internet-Based Interventions (IBI) for university students should consider these preferences.

Assessing patients' needs in the follow-up after treatment for colorectal cancer-a mixed-method study

PURPOSE

The accessibility of cancer care faces challenges due to the rising prevalence of colorectal cancer (CRC) coupled with a shrinkage of healthcare professionals-known as the double aging phenomenon. To ensure sustainable and patient-centred care, innovative solutions are needed. This study aims to assess the needs of CRC patients regarding their follow-up care.

METHODS

This study uses a mixed-method approach divided in three phases. The initial phase involved focus group sessions, followed by semi-structured interviews to identify patients' needs during follow-up. Open analysis was done to define main themes and needs for patients. In the subsequent quantitative phase, a CRC follow-up needs questionnaire was distributed to patients in the follow-up.

RESULTS

After two focus groups (n = 14) and interviews (n = 5), this study identified six main themes. Findings underscore the importance of providing assistance in managing both physical and mental challenges associated with cancer. Participants emphasised the need of a designated contact person and an increased focus on addressing psychological distress. Furthermore, patients desire individualised feedback on quality of life questionnaires, and obtaining tailored information. The subsequent questionnaire (n = 96) revealed the priority of different needs, with the highest priority being the need for simplified radiology results. A possible approach to address a part of the diverse needs could be the implementation of a platform; nearly 70% of patients expressed interest in the proposed platform.

CONCLUSIONS

CRC patients perceive substantial room for improvement of their follow-up care. Findings can help to develop a platform fulfilling the distinct demands of CRC patients during follow-up.

Fostering resilience and well-being in emerging adults with adverse childhood experiences: study protocol for a randomized controlled trial to evaluate the FACE self-help app

BACKGROUND

Adverse childhood experiences (ACE) are linked to an increased risk of psychological disorders and lower psychosocial functioning throughout life. This study aims to evaluate the FACE self-help app, designed to promote resilience and well-being in emerging adults with a history of ACE. The app is based on cognitive-behavioural principles and consists of two thematic components: (1) self- and emotion regulation (SER) and (2) social skills and biases in social information processing (SSIP).

METHODS

The efficacy of the app will be tested through a single-centre, two-arm randomized controlled trial, comparing an active intervention group against a waiting list control group. The active group is divided into two subgroups, in which the two components are delivered in a different order to investigate differential effects in a crossover design. Up to 250 emerging adults aged 18 to 25 years with a history of ACE from a general population cohort study will be recruited. The primary objective is to test the efficacy of the app in improving resilience (primary outcome) and well-being (co-primary outcome) compared to a waiting list control group and to examine the stability of these effects. The secondary objectives include testing the efficacy of the app in improving the secondary outcomes, i.e., self-efficacy in managing emotions, problem solving, fear of evaluation, social avoidance, and self-esteem; examining the differential effects of the two components; and assessing the effect of the app on real-life data on resilience, affective states, distress in social interactions and coping strategies. Furthermore, the study will investigate potential moderators (e.g. ACE severity) and mediators of intervention outcomes (e.g. self-efficacy in managing emotions).

DISCUSSION

The results will provide insights into the efficacy of the self-help intervention as well as mediators and moderators of outcomes. Furthermore, results will extend the existing knowledge by testing the differential effects of the SER and SSIP component on the outcomes. Findings can inform improvements to the FACE app and the development of other interventions for this target group and assess its potential as a scalable, low-threshold intervention to support emerging adults with a history of ACE in their transition to adulthood.

TRIAL REGISTRATION NUMBER

NCT05824182.

The effectiveness of E-health interventions promoting physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

This systematic review and meta-analysis aimed to identify whether E-health interventions effectively improve physical activity (PA) in cancer survivors.

METHODS

PubMed, Web of Science, and Cochrane Library databases were searched from inception to October 21, 2023. Randomized controlled trials reporting the effect of E-health interventions on PA among cancer survivors were included. Random-effect models were used to calculate standardized mean differences (SMD) and the 95% confidence interval (CI).

RESULTS

In total, 15 trials with 2,291 cancer survivors were included in this meta-analysis. The results showed that E-health interventions improved moderate to vigorous physical activity (MVPA) among cancer survivors (SMD = 0.26, 95% CI 0.08, 0.43, N = 8, p < 0.001, I2 = 37%), as well as moderate physical activity (MPA) (SMD = 0.22, 95% CI 0.05, 0.38, N = 9, p < 0.001, I2 = 28%) and vigorous physical activity (VPA) (SMD = 0.34, 95% CI 0.15, 0.54, N = 6, p < 0.001, I2 = 11%).

CONCLUSION

E-health interventions are effective at promoting PA among cancer survivors. As current research primarily focuses on immediate post-intervention measurements with limited follow-up data, further investigation is required to explore the long-term effects of E-health interventions on PA.

Guided versus unguided chatbot-delivered cognitive behavioral intervention for individuals with moderate-risk and problem gambling: A randomized controlled trial (GAMBOT2 study)

BACKGROUND

Internet-based interventions can be a promising option for individuals with problem gambling facing barriers to seeking help. This study aimed to directly compare the effects of therapist-guided Internet interventions with unguided ones on gambling-related behavior, cognition, and stage of change including help-seeking intention.

METHODS

We conducted a participant-blinded randomized controlled trial of therapist-guided versus unguided groups with a 12-week follow-up. Both groups received self-help chatbot-delivered cognitive behavioral therapy. Additionally, at baseline and weeks 1, 2, 3, and 4, the guided group received personalized feedback messages from therapists based on their gambling diary and questionnaire responses. The unguided group received reminders of assessments from research assistants. The primary outcome was the change in scores on the Gambling Symptoms Assessment Scale (G-SAS) over 12 weeks. Secondary outcomes included the stage of change including help-seeking intention, money wagered, gambling frequency, and gambling-related cognitions.

RESULTS

We included 139 participants with a mean Problem Gambling Severity Index total score of 14.6 and a mean G-SAS total score of 27.0 who sought information about gambling problems. Both groups demonstrated substantial decreases in their G-SAS scores from baseline to week 12 (-10.2, 95% CI: -7.67 to -12.7 for the guided group, and 11.7, 95% CI: -9.05 to -14.3 for the unguided group). However, we did not find a significant between-group difference (1.49, 95% CI: -2.20 to 5.17). Regarding the stage of change including help-seeking intention, there were also no between-group differences.

CONCLUSIONS

Minimum therapist support did not have an additive effect on the self-help chatbot intervention on gambling symptoms, behavior, and the stage of change including help-seeking intention.

Sharing Colorectal Cancer Follow-Up Using an E-Care Plan Between Cancer Services and Primary Health Care

High quality, long term follow-up care for cancer patients needs to be coordinated, comprehensive and tailored to the diverse needs of patients. This study implemented shared follow-up care using an interactive e-care plan that provided a collaborative space to schedule and share goals, tasks and information and support the monitoring of care. Qualitative results identified good relational coordination. Increasing communication from the cancer service is important.

Efficacy of Op Koers Online, an online group intervention for parents of children with cancer: Results of a randomized controlled trial

OBJECTIVE

Parents of children with cancer are at risk for developing psychosocial problems. The present study aims to evaluate the effect of an online group intervention (Op Koers Online, in English: On Track Online) on psychosocial wellbeing and coping skills.

METHODS

Parents of a child with cancer (diagnosis <5 years ago) participated in a randomized controlled trial. In six consecutive (and one booster-) protocolled sessions in an online chatroom, trained psychologists and social workers taught coping skills using cognitive behavioral and acceptance and commitment techniques. Questionnaires assessed anxiety, depression, distress, situation-specific emotional reactions and coping skills (Op Koers Questionnaire/Cognitive Coping Strategies Scale Parent Form) and evaluated the intervention. Linear mixed-model analyses were performed to detect differences between the conditions in changes over time; T0-T1 and T0-T2 (6-week and 6-month follow-up), and to detect changes in scores T2-T3 (12-month follow-up) for the intervention group only.

RESULTS

89 parents were included in analyses (mean age 41.9 years, 86% female, 62%/38% post/during treatment of their child). Beneficial intervention effects (p < 0.05) were found at T1 for anxiety, depression, distress, loneliness and relaxation, and at T2 for anxiety, uncertainty and relaxation. In the intervention condition, scores did not change from T2 to T3, except loneliness that decreased and relaxation that improved. All effect sizes were small to medium (β = -0.21 to 0.46). Parents were generally positive about the intervention.

CONCLUSIONS

Op Koers Online for parents of children with cancer has a positive effect on psychosocial wellbeing and the coping skill relaxation. Implementation is recommended to prevent psychosocial problems.

CLINICAL TRIAL REGISTRATION

Dutch Trial Register https://onderzoekmetmensen.nl/en NL73763.041.20.

Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy

OBJECTIVE

Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy.

METHODS

A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach.

RESULTS

The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm.

CONCLUSIONS

The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.

The development of SIBS-ONLINE, a group-based video conference intervention for siblings of children with chronic disorders and their parents

Objective

During the last decade a knowledge-based group intervention called SIBS, aiming to prevent psychological difficulties in siblings of children with chronic disorders, has been developed and empirically evaluated. The results are promising, but SIBS has been difficult to implement in areas with low population density. To address the needs of low-density health regions a video conference-based version of SIBS, "SIBS-ONLINE", was developed.

Method

SIBS-ONLINE was developed in three phases: 1) Gaining experience by delivering five support groups for siblings during the Covid-19 pandemic over video conference; 2) Developing the SIBS-ONLINE intervention based on the experiences of Phase 1; 3) Pilot testing the SIBS-ONLINE intervention with four groups (14 families).

Results

The end-product was SIBS-ONLINE, an intervention for siblings aged 10-16 years and their parents. SIBS-ONLINE consists of three separate sibling and parent groups and three joint sessions delivered over video conference. Intervention materials to enable delivery were developed, such as a manual comprising specification of communication techniques in video conference groups, technical advice, and a detailed description of sessions.

Conclusion

The developmental process resulted in a feasible group-based video conference intervention for families of children with chronic health disorders.

Innovation

A unique group-based video conference intervention is described and general advice for developers and deliverers of future interventions provided.

Role of emergency teleradiology in a mass motorcycle event: the experience of the 2021 International Six Days of Enduro (ISDE)

PURPOSE

Provision of healthcare support at mass gathering sporting events is of paramount importance for the success of the event. Many of such events, like motorsports, have been increasingly taking place in remote and austere environments. In these settings, the use of first-line diagnostic tools, such as point of care ultrasound and portable X-ray, could aid in definitive care on the field for patients with minor trauma while also ensuring fast access to the appropriate level of care for patients requiring hospitalization.

METHODS

As part of the ISDE 2021 medical response plan, a field hospital equipped with portable digital X-ray and telemedicine was established. Data on patient admission, triage, treatments, diagnostics, and outcomes were collected for analysis.

RESULTS

During the 6-day competition, 79 patients sought medical care at the field hospital, with traumatic injuries accounting for 77% of cases. Of these, 47 were athletes and 32 were non-athletes. The majority (91%) arrived spontaneously, while 9% were transported directly. Upon admission, 68 patients were triaged as non-urgent (code 3) and 11 as urgent (code 2). Of those admitted, 69 received treatment and were discharged at the field hospital, while 10 were transferred elsewhere. Notably, four patients had major trauma, two had isolated fractures, and one needed a CT scan after losing consciousness. Overall, 29 missions were conducted on the race field, including 13 primary transports to local hospitals and 6 to the field hospital. Primary transport was primarily due to major trauma. Among 31 patients who had radiological exams, 11 (35.5%) had traumatic injuries. Of these, 5 were treated with braces and casts and discharged without hospitalization, 3 were advised for post-event care, and 3 were hospitalized. In contrast, patients with negative X-rays received on-site treatment, with 7 able to continue competing.

CONCLUSIONS

In summary, the successful implementation of portable X-ray machines and teleradiology at remote and austere high-risk sporting events holds great promise for enhancing on-site medical capabilities, allowing clinicians informed decisions, avoiding unnecessary hospitalization, and allowing athletes to continue with their competition. Provided that challenges related to cost, safety, connectivity, and power supply are effectively addressed.

The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Many people living with HIV reported poor quality of life, which was primarily due to HIV-related stigma and the lack of social support. Compared with face-to-face interventions, e-health interventions are reported to have potential to help people living with HIV improve their adherence to antiretroviral therapy, promote their management of HIV and depressive symptoms. However, in the literature, the effectiveness of e-health interventions in helping people living with HIV reduce stigma, improve social support and quality of life is unclear.

OBJECTIVE

To examine the effectiveness of e-health interventions in reducing stigma and improving social support and quality of life among people living with HIV.

DESIGN

This study is a systematic review and meta-analysis of randomized controlled trials following the Cochrane Handbook guidelines and PRISMA2020.

METHODS

A comprehensive search was conducted from inception to 1st December 2022 in six databases: PubMed, CINAHL Plus with Full Text, PsycINFO (Ovid), Embase, Web of Science, and CENTRAL (Ovid), and an updated search took place on 11st June 2023. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95 % confidence interval (CI) using Review Manager 5.3. A sensitivity analysis was conducted to test the rigor of the pooled results using one-study-out method. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Nine studies met eligibility criteria and were included in this review. The results of the meta-analysis showed that e-health interventions could statistically significantly reduce stigma (SMD: -0.29, 95 % CI: [-0.48, -0.10], p = 0.002) and improve quality of life (SMD = 0.49, 95 % CI: [0.30, 0.68], P < 0.001), but had no significant effects on social support (SMD = -0.01, 95 % CI: [-0.48, 0.46] P = 0.96).

CONCLUSIONS

E-health interventions could reduce stigma and improve quality of life among people living with HIV. More studies are needed to further explore if e-health interventions can improve the social support for people living with HIV and investigate how to integrate e-health interventions into the existing health models to help people living with HIV treat and manage HIV/AIDS.

REGISTRATION

The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42022373299).

Beliefs about medications when treating hypertension in primary health care: results from "PERson-centredness in hypertension management using information Technology (PERHIT)"

PURPOSE

Hypertension is a major global health concern. Despite of efficient antihypertensive medications a low percentage of patients reach a blood pressure (BP) of <140/90. Nonadherence is a great concern in hypertension treatment and patients' beliefs about medications has been shown to have a strong impact on adherence. The objective of this study is to examine beliefs about medications and its impact on BP treatment in a group of Swedish primary healthcare patients treated for hypertension with or without an E-health platform.

MATERIALS AND METHOD

In a randomised unblinded controlled trial, 949 patients with hypertension from Swedish primary health care centres were included. The intervention group used a web-based system to support self-management of hypertension for eight weeks. Beliefs about medication questionnaire (BMQ) were administered to all patients at inclusion, 8-week follow up and 1-year follow up.

RESULTS

Data were collected from the 862 patients who completed the trial. No statistically significant difference was found in BMQ-scores between the intervention and the control group. An association between lower scores in the BMQ subsection 'General-Harm' and achieving target BP of <140/90 mmHg were noted (p = 0.021).

CONCLUSION

This study shows a significant association between beliefs about medication and BP levels, on hypertensive patients in the Swedish primary care setting, in only one out of four subsections of the BMQ. The intervention did not have a significant effect on changing patients' beliefs about medication. Further emphasis on patients' beliefs about medications could be useful in the clinical setting.

Usability and feasibility of E-nergEYEze: a blended vision-specific E-health based cognitive behavioral therapy and self-management intervention to reduce fatigue in adults with visual impairment

BACKGROUND

Over 50% of adults with visual impairment experience severe fatigue. Therefore, we developed a guided E-health intervention based on cognitive behavioral therapy and self-management to reduce fatigue in this population. This pilot study evaluated the usability, feasibility, fidelity and potential effectiveness of E-nergEYEze.

METHODS

E-nergEYEze was developed by a design team and customized by conducting a pilot study using an iterative development strategy. The intervention was first tested in a usability study among adults with visual impairment (n = 5). Participants were asked to think-aloud while exploring the intervention features and a semi-structured interview was performed afterwards. Subsequently, the enhanced intervention was tested in a feasibility study. Adults with visual impairment and severe fatigue (n = 10) followed the intervention partially with guidance from a social worker and one-time computer trainer support. Fatigue severity (Checklist Individual Strength), fatigue impact (Modified Fatigue Impact Scale) and cognitive behavioral therapy skills (Competencies of Cognitive Therapy Scale-Self Report) were measured at baseline and at three months follow-up and analyzed with the Wilcoxon signed-rank test. The intervention was evaluated through evaluation forms.

RESULTS

The usability study resulted in adjustments to content and lay-out with regard to optically shortened text sentences, separate pages for information and assignments with one read-aloud audio and an additional descriptive explanation of page content. Digital challenges were overcome with mandatory computer training and e-platform modifications. The feasibility study showed a positive trend in reducing fatigue severity (Z -6.108; P < .001; SD 8.4), impact of fatigue (Z - 4.451; P < .001; SD 11.4) and cognitive behavioral therapy skills (Z -2.278; P = .023; SD 19.3). Participants gave useful feedback regarding accessibility, content and guidance, with an overall positive experience. The intervention was rated with a median score of 8 (range 7-10).

CONCLUSION

We developed, evaluated and optimized E-nergEYEze by applying a user-centered and iterative approach. E-nergEYEze showed a promising trend to reduce fatigue severity and impact of fatigue and to increase cognitive behavioral therapy skills. The study methods were feasible and the fidelity of the intervention protocol was suitable. Performing a randomized controlled trial is warranted to give insight into whether E-nergEYEze is cost-effective in reducing severe fatigue in adults with visual impairment.

TRIAL REGISTRATION

International Clinical Trial Registry Platform: NL7764. Date registered: 28-05-2019.

Lessons learned from early implementation of the Growing Expertise in E-health Knowledge and Skills (GEEKS) program in Nigeria, 2019 - 2021

Introduction

the Growing Expertise in E-health Knowledge and Skills (GEEKS) program is an applied apprenticeship program that aims to improve informatics capacity at various levels of the national health system and create a sustainable informatics workforce. Nigeria adapted the GEEKS model in 2019 as a mechanism to strengthen data quality and use of routine immunization (RI) and vaccine-preventable disease (VPD) surveillance data among Expanded Programme on Immunization (EPI) staff. Since the start of the GEEKS-EPI program, there has not been a formal assessment conducted to measure the extent to which GEEKS-EPI has been able to build local informatics workforce capacity and strengthen RI and VPD surveillance (VPDS) data quality and use in Nigeria.

Methods

we conducted a qualitative assessment to inform the extent to which GEEKS-EPI has been able to build informatics skillsets to enhance local workforce capacity, foster collaboration across government agencies, and create a sustainable informatics workforce in Nigeria. In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs) were held with GEEKS-EPI supervisors, mentors, and mentees from previous GEEKS-EPI cohorts.

Results

while there were challenges reported during early implementation of the GEEKS-EPI program in Nigeria, particularly early on in the COVID-19 pandemic, participants and supervisors reported that the fellowship provided a framework for building a sustainable RI and VPDS informatics workforce through regular mentorship, peer-to-peer exchanges and Subject Matter Expert (SME)-led trainings.

Conclusion

lessons learned from early implementation of GEEKS-EPI in Nigeria will help to inform its implementation in other countries, where strengthened national RI and VPDS informatics capacity is the primary objective.

Telemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology's Headache Study Group

INTRODUCTION

The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations.

METHOD

The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology's Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain.

RESULTS

COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools.

CONCLUSIONS

The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre's management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

The usability of a digital diary from the perspectives of intensive care patients' relatives: A pilot study

BACKGROUND

Diaries have been used regularly in international settings as an evidence-based and easily applicable intervention following a person-centred approach in the intensive care unit (ICU). In addition, a diary web application known as 'Post-ICU' has been implemented.

AIM

To explore the usability of an innovative digital diary from the perspectives of intensive care patients' relatives.

STUDY DESIGN

A cross-sectional online survey study was applied among a convenience sample of relatives in the ICUs of two hospitals in the Netherlands. The investigator-developed questionnaire included, among other things, items with the appreciation of the layout, user friendliness and functionality of the diary. Relevance and applicability were rated between 1 and 10. Data were analysed with SPSS© software, version 27, and reported as the means (±standard deviation [SD]) and percentages.

RESULTS

Sixty-three relatives with an average age of 51 years (SD ± 14.3) participated in the study; there was a slight predominance of women (57%). All but one participant found using the digital diary easy and were able to upload photos to the diary. The participants had invited other relatives (75%) and nurses (61%) to write in the diary, which they viewed as easily feasible (89%). The relevance and applicability of the diary were rated with mean scores of 8.1 (SD ± 1.9) and 8.3 (SD ± 1.6), respectively.

CONCLUSIONS

The participants found the Post-ICU diary web application highly valuable and easily feasible. Perceived ease of use, perceived usefulness and technophobia were not found to influence the usability of the digital diary.

RELEVANCE TO CLINICAL PRACTICE

The implementation of this new digital tool supports a person-centred ICU policy because of its focus on the personal diary entries of the patient and the collaborative writing process featuring relatives and professionals.

Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis

BACKGROUND

Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care.

METHODS

A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models.

CONCLUSION

Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.

The Impact of Telemedicine during Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic and Future Perspectives: A Systematic Review

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide since December 2019, causing the COVID-19 pandemic. Several measures have taken place in many countries to avoid further spread of the virus and to manage infected people according to disease severity. Notably, telemedicine (TM) was successfully used to manage less severe patients. Our aim was to assess the impact and the edges of using TM in home-isolated or hospitalized patients affected by SARS-CoV-2 infection and its further application.

METHODS

We performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, focusing on randomized controlled trials (RCTs) published in English and available on PubMed database. Full texts were blindly reviewed and then assessed according to PICO model.

RESULTS

Our research identified a total of 1,959 records, of which 24 were potentially eligible through the articles full-text review. Six papers were included for data extraction and 18 articles were excluded: 10 articles were not RCTs and 8 articles did not involve SARS-CoV-2 patients. The TM application showed an improvement in psychological stress, mental disorders, and a significant reduction of general stress in patients affected by SARS-CoV-2 infection. The effectiveness of using TM in rehabilitative respiratory programs has been also reported. Furthermore, the benefits of TM application in tailored monitoring of vital parameters in home-isolated patients helped clinicians to early identify a deterioration of clinical conditions.

CONCLUSION

The use of TM during COVID-19 pandemic represented a novel, intriguing, versatile, and useful tool to support clinical practice. This evidence suggests considering TM in a wider range of clinical applications.

Uptake of signposting to web-based resources: pregnant women's use of a preventive web-based intervention

BACKGROUND

Signposting to web-based interventions is becoming increasingly popular in primary care. Most resources are focused on individuals with clinical problems, but less is known about the uptake of general practice (GP) signposted web-based interventions. GPs in Denmark are responsible for scheduled preventive care during pregnancy and the child's first five years. In the "Family Well-being in General Practice" trial the web-based intervention "Resilientchild.dk" is introduced at these consultations. Resilientchild.dk is designed to improve the capacity of parents to understand the mental state of themselves, their partners, and their children. In this study we assess the uptake and use of this web-based intervention.

OBJECTIVE

To describe participant and practice characteristics associated with the use of a web-based psychoeducational intervention. Eligible participants were pregnant women presenting at their first antenatal assessment, usually around 6-10 gestational weeks.

METHODS

The study was nested in a cluster randomised trial of resilientchild.dk. We conducted a relative importance analysis, which allows for determination of the variables most strongly associated with website use. To assess the direction and magnitude of the influences of the identified variables, we applied multinomial generalized linear mixed modelling. A practice random effect allows us to account for clustering of women within practices.

RESULTS

Parity and the absence of a nurse or midwife in the practice were important factors driving a decrease in the likelihood of using resilientchild.dk. Being a student or living outside the capital city were important factors driving an increase in the likelihood of using resilientchild.dk.

CONCLUSION

The data offer unique opportunities to assess the utilisation of a web-based mental health-promotion intervention following advice from a clinician. This study draws conclusions about which patients are likely to access similar resources and which practice characteristics encourage their use.

TRIAL REGISTRATION

Registered in clinicaltrials.gov, Trial number: NCT04129359 Date of registration: 16/10/2019 ( https://clinicaltrials.gov/ct2/show/NCT04129359 ).

Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers

BACKGROUND

Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy.

METHODS/DESIGN

Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated.

DISCUSSION

This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up.

TRIAL REGISTRATION

Clinical Trials ID NCT05756205.

Exploring colorectal cancer survivors' perspectives on improving care delivery and the role of e-health technology: a qualitative study

PURPOSE

The purpose of this study was to gather insights from colorectal cancer (CRC) survivors on how to improve care for CRC survivors and how e-health technology could be utilized to improve CRC care delivery.

METHODS

Three semi-structured focus groups were held with sixteen CRC survivors. To initiate the discussion, an online registration form and two vignettes were used. The data was analyzed using the framework method.

RESULTS

Based on survivors' experiences, five themes were identified as opportunities for improving CRC care delivery. These themes include better recognition of complaints and faster referrals, more information as part of the care delivery, more guidance and monitoring of health outcomes, more collaboration between practitioners, and more attention for partners and relatives. In addition, survivors expressed opportunities for using e-health to facilitate information provision, improve communication, and monitor survivors' health conditions.

CONCLUSION

Several suggestions for improvement of CRC care delivery were identified. These often translated into possibilities for e-health to support or improve CRC care delivery. The ideas of survivors align with the vast array of existing e-health resources that can be utilized to enhance CRC care delivery. Therefore, the next step involves addressing the implementation gap between the needs of stakeholders, such as CRC survivors and healthcare providers, and the e-health tools currently available in clinical practice.

Effect of e-health interventions on HIV prevention: a protocol of systematic review and meta-analysis

BACKGROUND

Global epidemiological data indicates that despite implementation of multiple interventions and significant financial investment, the HIV/AIDS epidemic remained inadequately controlled as of 2020. E-health presents a novel approach in delivering health information and health care and has gained popularity in HIV prevention worldwide. However, evidence on the effectiveness of e-health interventions on HIV prevention among diverse populations remains inadequate. Our study aims to systematically evaluate the effectiveness of varying e-health interventions on HIV prevention, with the objective of providing data support and guidance for the development of future e-health HIV intervention strategies.

METHODS

A systematic search of electronic English databases, including MEDLINE through PubMed, Embase, Scopus, and Web of Science, along with three Chinese databases, including National Knowledge Infrastructure (CNKI), Chinese Wanfang Digital Periodicals (WANFANG), and Chinese Science and Technology Periodicals (VIP) database, will be conducted for the period of 1 January 1980 to 31 December 2022. Additionally, gray literature and unpublished trials in trial registers will be searched. Studies aimed at HIV prevention through e-health interventions, with full-text publications available in either English or Chinese, will be included. Study types will be limited to RCT, cluster RCT, and quasi-experiment study. The risk of bias in individual studies will be assessed following the guideline highlighted by the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes will cover cognitive, behavioral, psychological, management, and biological measures of individuals involved in e-health interventions. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Ultimately, a systematic review with meta-analysis will be conducted to compare the effectiveness of e-health interventions among diverse populations.

DISCUSSION

This systematic review seeks to establish novel insights into the effectiveness of e-health interventions in diverse populations worldwide. It will inform the design and use of e-health interventions to optimize HIV-related strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022295909.

Beliefs, attitudes and experiences of virtual overdose monitoring services from the perspectives of people who use substances in Canada: a qualitative study

BACKGROUND

Solitary use of substances is a risk factor for substance use-related mortality. Novel e-health harm reduction interventions such as virtual overdose monitoring services (VOMS) have emerged in North America to improve access to emergency overdose support for people who use substances (PWUS). To date, little research has been published, and the perspectives of PWUS are needed to inform evaluation and policy efforts.

OBJECTIVE

To explore the beliefs, values and perceptions of PWUS around using and accessing VOMS in Canada.

METHODS

A qualitative study following grounded theory methodology was conducted. Using existing peer networks, purposive and snowball sampling was conducted to recruit PWUS (≥ 18 years) with previous experience with VOMS. Thematic analysis was used to analyze twenty-three interviews. Several methods were employed to enhance rigor, such as independent data coding and triangulation.

RESULTS

Twenty-three one-on-one telephone interviews of PWUS with previous experience with VOMS were completed and analyzed. The following themes emerged: (1) feelings of optimism around VOMS to save lives; (2) privacy/confidentiality was highly valued due to stigma and fear of arrest; (3) concerns with reliable cell phones negatively impacting VOMS uptake; (4) concerns around emergency response times, specifically in rural/remote communities; (5) desire for trusting relationships with VOMS operators; (6) importance of mental health supports and referrals to psychosocial services; and (7) possible limited uptake due to low public awareness of VOMS.

CONCLUSION

This qualitative study provided novel insights about the VOMS from the perspectives of PWUS. PWUS generally felt optimistic about the potential of VOMS as a suitable harm reduction intervention, but several potential barriers around accessing VOMS were identified that may limit uptake. Future research is warranted.

Why patients diagnosed with bipolar disorder start, continue or discontinue health-related apps supporting their self-management

WHAT IS KNOWN ABOUT THE SUBJECT?: Self-management is essential in the treatment of those who have bipolar disorder. There are many apps to support self-management, but we know that these apps only sometimes cover the users' needs. WHAT IS ADDED TO EXISTING KNOWLEDGE?: In our research, we made an inventory of apps that people with bipolar disorder use to cover their needs in self-management. We also have searched for the reasons to start, continue, switch or quit the use of those apps. We found that 44% (n = 18) of our respondents use health-related apps for self-management purposes. Apps for physical activity, planning and structure and apps for relaxation were most used. In the use of apps, the "freedom of choice" and user-friendliness are the most important in continuing the use of apps, while malfunctioning and "not fitting in individual needs" the main reasons were for quitting the use of apps.

IMPLICATIONS FOR PRACTICE

Various apps can be used for self-management purposes as long as these apps meet the individual user's requirements. Clinicians and patients should have a broad view when looking for suitable apps and not limit the search to just professional apps. In developing new apps, patients, clinicians and developers should collaborate in the development process, requirements and design.

ABSTRACT

INTRODUCTION: Self-management is one of the cornerstones in the treatment of bipolar disorder (BD). Complementing interventions by apps are seen as a good opportunity to support self-management. However, there is insufficient knowledge about understanding the use of health-related applications by consumers with BD for self-management purposes.

AIM

The study aims to gain insight from patients diagnosed with BD about reasons to use, continue or discontinue health-related apps.

METHOD

This study employed a mixed-method design in which 41 participants diagnosed with BD participated in a quantitative survey, and 11 participants also participated in an in-depth interview.

RESULTS

The survey showed that 44% (n = 18) of the participants use health-related apps, and 26.8% (n = 11) use those apps consistently. Interviews revealed that adjustability, usability, trustworthiness and the guarantee of privacy were the main reasons determining whether participants used or terminated the use of a health-related app.

IMPLICATIONS FOR PRACTICE

Although we found that a substantial number of patients diagnosed with BD use one or more apps to support self-management, their use is often discontinued due to content that needs more robust to address their needs. Besides appropriate content, tailoring and persuasive technologies will likely promote the continued use of an app for self-management purposes. Cooperation between those diagnosed with bipolar disorder and health professionals (like mental health nurses) in developing and designing applications that are aimed to support self-management in BD is necessary for successful implementation and adaptation.

Reacting, Sharing, and Commenting: How Many Facebook Users Are Engaging with Posts Related to Dental Caries That Contain Misinformation?

Recent studies have been concerned about the vast amount of misinformation detected on social media that directly hampers the prevention and control of chronic diseases. Based on these facts, the aim of this study was to identify and characterize misinformation about dental caries-related content found on Facebook, regarding the predictive factors of user interaction with posts. Then, CrowdTangle retrieved 2,436 posts published in English, ordered by the total interaction of the highest users. A total of 1,936 posts were selected for inclusion and exclusion criteria to select a sample of 500 posts. Subsequently, two independent investigators characterized the posts by their time of publication, author's profile, motivation, the aim of content, content facticity, and sentiment. The statistical analysis was performed using Mann-Whitney U and χ2 tests and multiple logistic regression models to determine differences and associations between dichotomized characteristics. p values <0.05 were considered significant. In general, posts were predominantly originated from the USA (74.8%), related to business profiles (89%), presented preventive content (58.6%), and noncommercial motivation (91.6%). Furthermore, misinformation was detected in 40.8% of the posts and was positively associated with positive sentiment (OR = 3.43), business profile (OR = 2.22), and treatment of dental caries (OR = 1.60). While the total interaction was only positively associated with misinformation (OR = 1.44), the overperforming score was associated with posts from the business profile (OR = 5.67), older publications (OR = 1.57), and positive sentiment (OR = 0.66). In conclusion, misinformation was the unique predictive factor of increased user interaction with dental caries-related posts on Facebook. However, it did not predict the performance of the diffusion of posts such as business profiles, older publications, and negative/neutral sentiment. Therefore, it is essential to promote the development of specific policies toward good quality information on social media, which includes the production of adequate materials, the increase of the critical sense of consuming health content, and information filtering mediated by digital solutions.

Rationale and development of an e-health application to deliver patient-centered care during treatment for recently diagnosed multiple myeloma patients: pilot study of the MM E-coach

BACKGROUND

Patients with multiple myeloma (MM) increasingly face complicated treatment regimens. E-health may support patients and healthcare providers in enhancing a patient-centered healthcare approach. Therefore, we aimed to develop a patient-centered multi-modality e-health application, to assess the application for usability and end-user experiences.

METHODS

The application was developed following an iterative "action-based" methodology using the design thinking approach. Key end users participated, and relevant stakeholders were consulted in the development process. First, the care pathway was evaluated, the focus of development was determined, and a solution ideated during recurring multidisciplinary meetings. Second, a prototype was tested and improved. Third, a subsequent prototype was evaluated during a pilot study with patients and healthcare professionals on usability, usage, and experiences.

RESULTS

The multi-modality application, named the "MM E-coach," consisted of a newly developed medication module, patient-reported outcome (PRO) questionnaire assessments, a messaging service, alerts, information provision, and a personal care plan. The median system usability score was 60 on a scale of 0-100. Patients appreciated the medication overview, healthcare professionals appreciated the outpatient clinic preparation module, and both appreciated the messaging service. Additional recommendations for improvement mostly revolved around the flexibility of functionalities and look and feel of the application.

CONCLUSIONS

The MM E-coach has the potential to provide patient-centered care by supporting patients and caregivers during MM treatment and is a promising application to be implemented in the MM care pathway. A randomized clinical trial was initiated to study its clinical effectiveness.

The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial

BACKGROUND

Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear.

METHODS

This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.

ETHICS AND DISSEMINATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.

Effects of E-health-based interventions on glycemic control for patients with type 2 diabetes: a Bayesian network meta-analysis

The high disease burden of type 2 diabetes seriously affects the quality of life of patients, and with the deep integration of the Internet and healthcare, the application of electronic tools and information technology to has become a trend for disease management. The aim of this study was to evaluate the effectiveness of different forms and durations of E-health interventions in achieving glycemic control in type 2 diabetes patients. PubMed, Embase, Cochrane, and Clinical Trials.gov were searched for randomized controlled trials reporting different forms of E-health intervention for glycemic control in type 2 diabetes patients, including comprehensive measures (CM), smartphone applications (SA), phone calls (PC), short message service (SMS), websites (W), wearable devices (WD), and usual care. The inclusion criteria were as follows: (1) adults (age≥18) with type 2 diabetes mellitus; (2) intervention period ≥1 month; (3) outcome HbA1c (%); and (4) randomized control of E-health based approaches. Cochrane tools were used to assess the risk of bias. R 4.1.2 was used to conduct the Bayesian network meta-analysis. A total of 88 studies with 13,972 type 2 diabetes patients were included. Compared to the usual care group, the SMS-based intervention was superior in reducing HbA1c levels (mean difference (MD)-0.56, 95% confidence interval (CI): -0.82 to -0.31), followed by SA (MD-0.45, 95% CI: -0.61 to -0.30), CM (MD-0.41, 95% CI: -0.57 to -0.25), W (MD-0.39, 95% CI: -0.60 to -0.18) and PC (MD-0.32, 95% CI: -0.50 to -0.14) (p < 0.05). Subgroup analysis revealed that intervention durations of ≤6 months were most effective. All type of E-health based approaches can improve glycemic control in patients with type 2 diabetes. SMS is a high-frequency, low-barrier technology that achieves the best effect in lowering HbA1c, with ≤6 months being the optimal intervention duration.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42022299896.

Evaluation of mobile applications focused on the care of patients with anxiety disorders: A systematic review in app stores in Brazil

OBJECTIVE

To identify and evaluate the quality of mobile apps available in Brazil focused on the care of patients with anxiety disorders.

METHODS

A comprehensive search was conducted until October 2021 on Play Store (Android) and Apple Store (iOS) in Brazil, using the terms "anxiety," "phobia," "panic attack," and "social phobia." Two independent authors identified the apps and performed data extraction and quality assessment using the Mobile App Rating Scale (MARS). Pearson's correlation was used to analyze the relationship between user star rating and the quality defined by the MARS instrument.

RESULTS

A total of 3,278 potential apps were identified, of which 71 fully met the eligibility criteria. Most apps were made available on the Play Store (91.74%), in English (69.01%), and updated in the last two years (90.14%). Approximately half of the apps (50.70%) did not inform the developer's country and most of them did not report the user star rating (70.42%). The target population was indicated as free by most apps (85.92%), with generalized anxiety disorder being the most addressed disorder (74.65%), followed by panic disorder (33.80%). The three main purposes of the apps were education (83.10%), self-assessment (38.03%), and meditation/breathing (32.39%). Only 31 apps (43.66%) had acceptable quality (above 3.0) and the average total MARS quality score of 2.93 (2.20 to 3.90), with the functionality section receiving the highest score (3.90) and the lowest scoring sections being engagement (2.16). The apps that were rated stars by users (29.58%) showed a negative Pearson correlation (ρ = -0.100), evidencing a difference in the user's evaluation and that performed using the MARS instrument.

CONCLUSION

Gaps in the quality of apps focused on the care of patients with anxiety disorders were evidenced since most were classified as having low quality through the MARS instrument. Thus, users are recommended to use these apps with caution.

Standing up for Myself (STORM): Adapting and piloting a web-delivered psychosocial group intervention for people with intellectual disabilities

BACKGROUND

Our STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic.

AIMS

To adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility.

METHODS AND PROCEDURES

The 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility.

OUTCOMES AND RESULTS

The intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants.

CONCLUSIONS AND IMPLICATIONS

When provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions.

Digital consultations for weight management in the NHS: A qualitative evaluation

Receiving digital healthcare consultations for weight management, in place of in-person appointments, has proliferated in recent years, accelerated by the COVID-19 pandemic. The objective of the present study was to investigate patients' experiences of digital weight management services (DWMS) provided by the National Health Service (NHS). Particular emphasis was placed on examining the perceived benefits and limitations of DWMS so as to identify potential means of improving provision. Sixteen patients (eight male; eight female) accessing digital consultations at one of two West Midlands (UK) NHS trusts, participated in semi-structured interviews. Interviews were transcribed verbatim and analysed via thematic analysis. We identified three overarching themes and associated sub-themes that reflect the perceived benefits and limitations of service provision as identified by patients. These were technology acceptability (sub-themes 'challenges', 'requirements/facilitators', and 'beneficial features'); treatment acceptability (sub-themes 'treatment features', 'patient attributes', and 'practitioner skills'); and treatment efficacy (sub-themes 'treatment features', 'patient attributes', and 'practitioner skills'). Themes identified in this study have informed recommendations intended to enhance acceptability of DWMS technology and treatment, potentially encouraging engagement and increasing treatment efficacy. Limitations of the present study and recommendations for further research are also presented.

AQRS: Anti-quantum ring signature scheme for secure epidemic control with blockchain

Epidemics, such as Corona Virus Disease 2019 (COVID-19), have serious consequences globally, of which the most effective way to control the infection is contact tracing. Nowadays, research related to privacy-preserving epidemic infection control has been conducted, nevertheless, current researchers do not regard the authenticity of records and infection facts as well as poor traceability. Moreover, with the emergence of quantum computing, there is a bottleneck in upholding privacy, security and efficiency. Our paper proposes a privacy-preserving epidemic infection control scheme through lattice-based linkable ring signature in blockchain, called AQRS. Firstly, our scheme adopts a blockchain with three ledgers to store information in a distributed manner, which offers transparency and immunity from the Single Point of Failure (SPoF) and Denial of Service (DoS) attacks. Moreover, we design a lattice-based linkable ring signature scheme to secure privacy-preserving of epidemic infection control. Significantly, we are the first to introduce the lattice-based linkable ring signature into privacy preserving in epidemic control scenario. Security analysis indicates that our scheme ensures unconditional users anonymity, record unforgeability, signature linkability, link non-slanderability and contact traceability. Finally, the comprehensive performance evaluation demonstrates that our scheme has an efficient time-consuming, storage consumption and system communication overhead and is practical for epidemic and future pandemic privacy-preserving.

Telemedicine during the COVID-19 pandemic in Germany: Results from three nationally representative surveys on use, attitudes and barriers among adults affected by depression

Introduction

The COVID-19 pandemic has necessitated a reduction in face-to-face consultations, resulting in significant limitations in healthcare for individuals with depression. To ensure safe and adequate care, e-health services, such as telemedicine, gained a more prominent role. Governments have eased restrictions on the use of telemedicine, enabling healthcare professionals to increasingly offer video and telephone consultations.

Objective

This study examines, 1) possible changes over the course of the pandemic in reported use of video and telephone consultations and intended future use of video consultations with healthcare professionals among adults with diagnosed depression; 2) their attitudes towards video and telephone consultations and perceived barriers towards using e-health after prolonged time of the pandemic; and 3) differences in results between subgroups based on sociodemographic and clinical characteristics.

Methods

Three population-representative online surveys were conducted in Germany at different timepoints (t) during the COVID-19 pandemic. Respondents aged 18-69 years with a professionally diagnosed depression were included in the present analyses (t1: June/July 2020 with n = 1094; t2: February 2021 with n = 1038; t3: September 2021 with n = 1255).

Results

The overall proportion of adults with depression who used video or telephone consultations did not change significantly in the time surveyed (t1: 16.51 %, n = 179; t2: 20.23 %, n = 210; t3: 18.47 %, n = 230). However, among users, reported use of video consultations with a psychotherapist increased significantly from t1 (34.83 %, n = 62) to t3 (44.98 %, n = 102, p = .023). Intended future use of VC for healthcare varied depending on the purpose of the consultation. Significant differences over time were only found for the purpose of using VC to discuss clinical findings, laboratory results and diagnostic analyses with a doctor, with higher intentions reported at t2 during lockdown in Germany. At t3, the majority of adults with depression felt that video and telephone consultations were too impersonal and considered them more as a helpful support rather than an alternative to face-to-face psychotherapy. Key barriers to using e-health were found within the societal context and the lacking support from significant others for using e-health, while knowledge and skills represented facilitators for using e-health.

Conclusion

Despite ambivalent attitudes towards video and telephone consultations among adults with depression, reported use of video consultations with a psychotherapist increased during the COVID-19 pandemic.

Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The pandemic of coronavirus disease 2019 challenged educators to move staff education online and explore innovative ways to motivate learning to support dementia care for patients in geriatric settings. This article presents how the Consolidated Framework for Implementation Research (CFIR) was used to support the adoption of an online dementia education game in Canadian hospitals and long-term care homes (LTC). The dementia education was codeveloped with local staff and patient partners to teach practical person-centered care communication techniques.

RESEARCH DESIGN AND METHODS

CFIR guided our strategy development for overcoming barriers to implementation. Research meetings were conducted with practice leaders, frontline health care workers, and a patient partner. Our analysis examined 4 interactive domains: intervention, inner context, outer settings, and individuals involved and implementation process.

RESULTS

Our analysis identified 5 effective strategies: Easy access, Give extrinsic and intrinsic rewards, Apply implementation science theory, Multiple tools, and Engagement of champion. The CFIR provided a systematic process, a comprehensive understanding of barriers, and possible enabling strategies to implement gamified dementia education. Interdisciplinary staff (n = 3,025) in 10 hospitals and 10 LTC played online games. The evaluation showed positive outcomes in knowledge improvement in person-centered dementia care.

DISCUSSION AND IMPLICATIONS

Gamified education in dementia care offers a social experience and a component of fun to promote adoption. In addition, CFIR is useful for engaging stakeholders to conduct project planning and team reflection for implementation. The real-time discussion and adjustment helped overcome challenges and timely meet the needs of multiple organizations.

Improving the colorectal cancer care pathway via e-health: a qualitative study among Dutch healthcare providers and managers

PURPOSE

This study aims to identify improvement opportunities within the colorectal cancer (CRC) care pathway using e-health and to examine how these opportunities would contribute to the Quadruple Aim.

METHODS

In total, 17 semi-structured interviews were held (i.e., nine healthcare providers and eight managers involved in Dutch CRC care). The Quadruple Aim was used as a conceptual framework to gather and systematically structure the data. A directed content analysis approach was employed to code and analyze the data.

RESULTS

Interviewees believe the available e-health technology could be better exploited in CRC care. Twelve different improvement opportunities were identified to enhance the CRC care pathway. Some opportunities could be applied in one specific phase of the pathway (e.g., digital applications to support patients in the prehabilitation program to enhance the program's effects). Others could be deployed in multiple phases or extended outside the hospital care setting (e.g., digital consultation hours to increase care accessibility). Some opportunities could be easily implemented (e.g., digital communication to facilitate treatment preparation), whereas others require structural, systemic changes (e.g., increasing efficiency in patient data exchanges among healthcare professionals).

CONCLUSION

This study provides insights into how e-health could add value to CRC care and contribute to the Quadruple Aim. It shows that e-health has the potential to contribute to the challenges in cancer care. To take the next step forward, the perspectives of other stakeholders must be examined, the identified opportunities should be prioritized, and the requirements for successful implementation should be mapped out.

What do TikTok videos offer us about dental implants treatment?

OBJECTIVE

To evaluate the quality, source, popularity, visibility and reliability of Tiktok videos on dental implants.

MATERIALS AND METHODS

A Tiktok search for dental implants was performed English language setting. Search hashtags were determined as "#dentalimplants," "#dentalimplantsurgery," "#dentalimplantstreatment," and "#implantdentistry." 148 of the 300 videos watched were included the study. Two periodontologists scored the videos for quality, reliability, utility, visibility and popularity. Videos' quality was evaluated using the Global Quality Scale (GQS) and the DISCERN tools, by categorizing them through quality of communication, duration, likes and dislikes, views, source and video type of each video were recorded.

RESULTS

There was significant positive correlation between "GQS" and "Total DISCERN" (Rho: 0.636) and "Duration in seconds" (Rho: 0.343) (p<0.05). For Total DISCERN, averages of the 31-45 seconds (p=0.010) and 46 seconds and above (p=.018) groups were higher than the averages of the 0-15 seconds group and average of the Educational group was higher than the average of the Testimonial, Product Advertisement and Entertainment groups (p=0.001, p=0.033 and p=0.041). Healthcare professionals mostly upload GQS 2 score videos and Hospital/Universities mostly upload GQS 2 and 3 score videos (p<0.05). Testimonial videos mostly receive GQS2 score videos and the 'Videos rich in supplementary visuals' quality also receives the most GQS4 score videos (p<0.05).

CONCLUSIONS

The results of this study demonstrate that TikTok videos provide low to moderate quality information about dental implants and that TikTok may not provide reliable information about dental implants.

Remote follow-up after cataract surgery (CORE-RCT): study protocol of a randomized controlled trial

BACKGROUND

Cataract surgery has become one of the most performed surgical procedures worldwide. Postoperative management consists of routine clinical examinations to assess post-operative visual function and detect possible adverse events. Due to the low incidence of complications, the majority of clinic visits after cataract surgery are uneventful. Nonetheless, valuable time and hospital resources are consumed. We hypothesize that remote post-operative follow-up involving teleconsultations and self-assessments of visual function and health status, could be a valid alternative to face-to-face clinical examinations in selected patient groups. The practice of remote follow-up after cataract surgery has not yet been evaluated. The aim of this study is to investigate the validity, safety and cost-effectiveness of remote cataract surgery follow-up, and to report on the patients' experiences with remotely self-assessing visual function.

METHODS

This study is a multicenter, open-label, randomized controlled trial. Patients planned for cataract surgery on both eyes, without ocular comorbidities, are eligible for participation. Participants will be allocated (1:1) into one of the two study groups: 'telemonitoring' or 'usual care'. Participants in the 'telemonitoring' group will perform in-home assessments after cataract surgery (remote web-based eye exams and digital questionnaires on their own devices). Participants in the 'usual care' group will have regular post-operative consultations, according to the study site's regular practice. Outcome measures include accuracy of the web-based eye exam for assessing visual acuity and refraction, patient-reported outcome measures (visual function and quality of life), adverse events, and cost aspects.

DISCUSSION

Investigating remote follow-up after cataract surgery fits the current trends of digitization of health care. We believe that remote self-care can be a promising avenue to comply with the increasing demands of cataract care. This randomized controlled trial provides scientific evidence on this unmet need and delivers the desired insights on (cost)effectiveness of remote follow-up after cataract surgery.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04809402. Date of registration: March 22, 2021.

Effect of blended and unguided online delivery of mindfulness-based cognitive therapy versus care as usual on distress among cancer patients and survivors: protocol for the three-arm parallel randomized controlled buddy trial

BACKGROUND

One third of cancer patients and survivors experience psychological distress. Previous studies have shown that online mindfulness-based cognitive therapy (eMBCT) supports cancer patients and survivors in managing distress. Lack of peer support and asynchronicity during online interventions have been reported as barriers for treatment adherence and can result in higher drop-out rates. Considering this, two new formats of eMBCT were created. The primary objective of the Buddy trial is to evaluate the (cost) effectiveness of blended and unguided eMBCT versus care as usual (CAU) on psychological distress among cancer patients and survivors. Secondary objectives include evaluating effects on other psychological outcomes and investigating working mechanisms and treatment effect moderators.

METHODS

The Buddy trial is a parallel three-armed randomized controlled trial. Participants will be randomly assigned to blended therapist-assisted eMBCT, unguided individual eMBCT or CAU. Eligible participants will be Dutch-speaking adult cancer patients or survivors with access to internet. The primary outcome will be psychological distress scores as assessed by the Hospital Anxiety and Depression scale immediately post-treatment. Secondary outcome measures include fear of cancer recurrence (FCRI), fatigue (CIS-F), rumination (RRQ), mindfulness skills (FFMQ), decentering (EQ), self-compassion (SCS-SF), positive mental health (MHCSF), health related quality of life (EQ-5D), and costs associated with psychiatric illness (TiC-P). Outcome measures will be evaluated at baseline, mid-treatment, immediately post-treatment, and three-, six-, and nine-months follow-up. Possible mediators, such as engagement with interventions (TWEETS), and moderators will be also analyzed.

DISCUSSION

There is room to improve eMBCT for cancer patients prior to implementation to ensure adherence and scalability. Blended and unguided eMBCT may reduce psychological distress and improve quality of life and be easily accessible to cancer patients and survivors. Trial registration clinicaltrials.gov, NCT05336916, registered on April 20th, 2022. https://clinicaltrials.gov/ct2/show/NCT05336916 .

Secure data authentication and access control protocol for industrial healthcare system

Because of recent COVID-19 epidemic, the Internet-of-Medical-Things (IoMT) has acquired a significant impetus to diagnose patients remotely, regulate medical equipment, and track quarantined patients via smart electronic devices installed at the patient's end. Nevertheless, the IoMT confronts various security and privacy issues, such as entity authentication, confidentiality, and integrity of health-related data, among others, rendering this technology vulnerable to different attacks. To address these concerns, a number of security procedures based on traditional cryptographic approaches, such as discrete logarithm and integer factorization problems, have been developed. All of these protocols, however, are vulnerable to quantum attacks. This paper, in this context, presents a data authentication and access control protocol for IoMT systems that can withstand quantum attacks. A comprehensive formal security assessment demonstrates that the proposed algorithm can endure both current and future threats. In terms of data computing, transmission, and key storage overheads, it also surpasses other related techniques.

Older patients' experiences of access to and use of e-consultations with the general practitioner in Norway: an interview study

OBJECTIVE

To explore older patients' experiences with accessing and using e-consultations to send text-based clinical inquiries to the general practitioner (GP) online.

DESIGN

Qualitative study based on semi-structured interviews. Results were analysed through a six-phase thematic analysis and interpreted through Levesque's framework of patient-centred access to health care.

SETTING

General practice in Norway.

SUBJECTS

Patients aged over 65 years (n = 16) with experience in using e-consultations.

RESULTS

Respondents considered e-consultations as an integrated part of general practice which helped them achieve better access to health care. We identified four themes describing older patients' access to and use of e-consultations: 1) the importance of digital health literacy to learn about and use the service - and the fear of losing it, 2) the high availability of the service as the main advantage, due to the perceived unavailability of physical GP services, 3) the importance of voluntary use of e-consultations, 4) the importance of a trusting relationship with the GP.

IMPLICATIONS

Information about e-consultations and guidelines for suitable use are recommended to ensure equal access to all patients, regardless of their digital health literacy. Availability problems and high work burdens for the GPs could affect the patients' choice for using e-consultations. If e-consultations are used for triage purposes, caution should be taken to avoid a shift in workload from the health secretary to the GP.Key points of articleThe extended use of e-consultations with the general practitioner has raised concerns that the service may not be accessible and suitable for older patients.For older users, e-consultations can represent a positive addition to physical consultation forms due to the high availability of the service in a general practice setting characterised by long waiting times.Digital health literacy is essential to learn about and use the service. Information about the service and how to use it should be available to all patients to ensure equal access.A trusting relationship with the GP is described as essential for older patients to perceive the outcome of e-consultations as appropriate and safe.

Development and Evaluation of a Self-care Application Based on Herbal Medicine for Skin and Hair Diseases

Background

Self-care applications are effective in the control and treatment of disease symptoms. Today, the mobile phone is used as one of the tools that can help us in this regard. The present study attempts to develop and evaluate a functional self-care mobile-phone application for patients with skin and hair problems using treatment protocols of herbal medicine.

Materials and Methods

This study is a descriptive-applied type. At first, a questionnaire was prepared for data need assessment and also to determine the data items and required capabilities of the application. Based on the results, an application was designed using the Java programing language in the Android software environment. In the next step, the application was installed on the mobile phones of several specialists and patients, and the necessary corrections were made. Then, the final version of the application was evaluated.

Results

The most critical data elements of the mobile application for skin and hair patients included the application's functionality, temperament survey, and clinical information. After considering users' feedback, the screen functionality, the application's information and idiom, and overall functionality of the application were evaluated and approved by the users.

Conclusion

By and large, the developed application could help the patients to receive the best and high-priority treatment protocols based on their own temperament.

The role of e-health on the public knowledge and behavior in preventing COVID-19

Background

Electronic health (e-health) technologies play an important role in improving public knowledge and behavior to control the COVID-19 pandemic. The present study aimed to investigate the role of e-health on the public knowledge and behavior in preventing COVID-19 in Kerman, a city in Iran.

Methods

The present descriptive cross-sectional study used an online survey in Kerman in November 2021. The research instrument was a tripartite questionnaire that included demographic information, the level of respondents' knowledge about COVID-19, the extent of change in respondents' behavior influenced by e-health. Negative binomial regression analysis was run to test the relationship between individual characteristics and the research variables with knowledge and behavior. Spearman correlation test was used to measure the correlation between the two main parts of the survey.

Results

As the negative binomial regression analysis results showed, the relationship between no demographic variable and the public knowledge and behavior was statistically significant (p < 0.001). The mean knowledge and behavior scores were 5.84 ± 2.55 and 11.95 ± 5.09, respectively, showing that people who used e-health had a high level of knowledge, and taking preventive measures was at a high level. The Spearman correlation coefficient test results showed a positive association between knowledge and behavior (r = 0.71).

Conclusion

E-health played a decisive role in increasing knowledge and improving behavior in preventing COVID-19. The results of our research can encourage the use of e-health to improve the public knowledge and behavior in pandemics such as COVID-19.

Application of e-health on neonatal intensive care unit discharged preterm infants and their parents: Protocol for systematic review and meta-analysis

Background

After preterm birth, parents often conformed with difficulties such as negative emotions, lack of care knowledge and skills, and insufficient professional support. As a remote health guidance method, e-health can provide a series of support for premature infants and their parents during the transition period from neonatal intensive care unit (NICU) to home care.

Objectives

To determine the efficacy of e-health interventions in discharged preterm infants as well as their parents, and to describe the process outcomes and elements of these e-health interventions to inform the effective design of future interventions.

Methods

The systematic review of the randomized and non-randomized controlled trials on the follow-up effect of e-health on preterm infants and their parents discharged from NICU between the inception to May 2023 will be electronically searched in the following nine databases: Web of Science, CINAHL Complete (EBSCO), PubMed, Embase, the Cochrane Library, Ovid MEDLINE, China National Knowledge Infrastructure, WANFANG DATA, and SinoMed. Quality will be appraised, respectively, via the revised tool to assess risk of bias (RoB 2) and the tool for risk of bias in non-randomized studies of interventions (ROBINS-I). The main outcome indicators of preterm infants are breastfeeding rate, readmission rate, neurobehavioral development, and premature infant's body mass. The outcome indicators for parents of premature infants are anxiety, depression scale, and parenting competency scale. The RevMan 5.4 software provided by the Cochrane Collaboration will be used for statistical analysis of the data.

Conclusion

The results of this study may provide future development opportunities for e-health follow-up prevention in preterm infants and may support evidence-based decision-making for e-health interventions of post-discharge developmental support in preterm infants.

PROSPERO registration number

CRD42023410334.

Competencies required by patients and health professionals regarding telerehabilitation: A scoping review

Background

Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care.

Objective

The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies.

Methods

We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home.

Results

One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear.

Conclusions

Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.