scholarly journals A research tool for measuring non-participation of older people in research on digital health

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Arianna Poli ◽  
Susanne Kelfve ◽  
Andreas Motel-Klingebiel
Keyword(s):  
Social Participation ◽  
Digital Health ◽  
Relevant Literature ◽  
Healthcare Services ◽  
Survey Questionnaire ◽  
Health Technologies ◽  
Underrepresented Groups ◽  
Self Selection ◽  
Use Of Technology ◽  
Digital Skills

Abstract Background Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research – deriving from the processes of non-recruitment of targeted individuals and self-selection – can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection. Methods Based on a review of the relevant literature, we designed an instrument – the NPART survey questionnaire – for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study. Results Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature. Conclusions The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.

Barriers to and facilitators of the uptake of digital health technology in cardiology: a systematic review

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Whitelaw ◽  
D Pellegrini ◽  
H.G.C Van Spall
Keyword(s):  
Digital Health ◽  
Healthcare Delivery ◽  
Health Technology ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Clinical Workflow ◽  
Eligibility Criteria ◽  
Health Technologies ◽  
Patient Level ◽  
Use Of Technology

Abstract Background Digital health technology has the potential to revolutionize the quality and efficiency of healthcare delivery. However, the uptake of digital health technology has been low in clinical practice. The factors that contribute to the limited adoption of digital health technology, particularly in cardiology, are unclear. Purpose We identified and synthesized the barriers to and facilitators of digital health technology uptake in cardiology, with a focus on provider- and patient- level barriers and facilitators. Methods We searched MEDLINE, EMBASE and CINAHL databases for studies published January 2000 - December 2019 that reported barriers to and/or facilitators of digital health technology adoption in cardiology. Two reviewers screened and extracted data independently. We conducted a thematic analysis to identify major themes pertaining to digital health technology uptake by both providers and patients. Results The search identified 3062 unique studies, of which 23 qualitative studies met eligibility criteria. Seventeen studies included semi-structured interviews and 6 included focus groups. Five (22%) studies reported provider-level facilitators, which included technology usability, integration into clinical workflow, and improved patient outcomes. Eighteen (78%) studies reported patient-level facilitators, which included ongoing technical support, improved access to healthcare services, and improved self-management. Six (26%) studies reported provider-level barriers, which included lack of integration into clinical workflow, increased healthcare costs, and lack of validation and reliability of technology. Finally, 19 (83%) studies reported patient-level barriers which included lack of knowledge about technology, limited internet access, and physical impairments making use of technology difficult. Conclusions Identifying barriers to and facilitators of digital health technology could help improve its uptake in cardiology. The findings of this study can be used to inform researchers, clinicians, and stakeholders who wish to develop and implement digital health technologies that meet the needs of providers and patients. Funding Acknowledgement Type of funding source: None

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia J. Lucas ◽  
Alastair D. Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract Background Type 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aims To gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups. Methods A purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically. Results A diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender. Conclusion This research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2020 ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia Lucas ◽  
Alastair D Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

Abstract P135: The Role Of Digital Health In The Management Of Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Onoriode Kesiena ◽  
Kofi Seffah ◽  
Navin Kumar ◽  
Eunice Hama
Keyword(s):  
Medication Adherence ◽  
Health Information ◽  
Digital Health ◽  
The Internet ◽  
Chi Square ◽  
Health Technologies ◽  
Medical Appointment ◽  
Use Of Technology ◽  
Use Of The Internet ◽  
Chi Square Analysis

Introduction: Digital health involves the use of technology to delivery health care. It is associated with improved clinical outcomes in various populations. We assessed its role in medication adherence in adults with hypertension. Methods: Data from the 2018 National Health Interview Survey data was used. We analyzed 8,224 respondents with hypertension representing about 69 million United States adults. The independent variables were: Use of the internet to (1) to look up health information (2) to fill a prescription and (3) to schedule a medical appointment and use of an email (4) to communicate with a healthcare provider. The dependent variable was anti-hypertensive medication adherence. Chi-square analysis was used to identify group differences and a logistic regression was used to analyze the association between digital health utilization and anti-hypertensive medication adherence. Results: Of the study population, 7,387/8,224 (89.8%) of the respondents reported adherence to anti-hypertensive medications. Those who were adherent were predominantly > 65 years of age, 4141/7387 (47.8%) and earned > $75,000/yearly, 580/2581 (25.2%). The use of internet to look up health information as compared to those who do not, was associated with 30% reduced odds of medication adherence [OR 0.71, 95% CI 0.59, 0.86, p=<.001]. However, this was insignificant after adjusting for covariates [AOR 0.92, 95% CI 0.89, 1.22, p=0.551]. Using the internet to fill up prescription as compared to those who do not, was associated with 47% odds of medication adherence [OR 1.47, CI 1.14,1.90, p=0.003]. This odd increased further after adjusting for covariates [AOR 1.95, CI 1.37,2.78, p=<.001]. No significant association was found in the relationship between medication adherence and scheduling a medical appointment with the internet or communicating with a provider via email even after adjusting for covariates. Conclusion: Increase adherence to anti-hypertensive medications is associated with online refill of prescriptions. This means that the use of digital health technologies in hypertensive populations can lead to better health outcomes. Future studies should evaluate other aspects of digital health use in hypertensive populations.

Inequities in Healthcare Services caused by the Adoption of Digital Health Technologies: A Systematic Review (Preprint)

2021 ◽  
Author(s):  
Rui Yao ◽  
Wenli Zhang ◽  
Richard Evans ◽  
Guang Cao ◽  
Lining Shen
Keyword(s):  
Systematic Review ◽  
Influencing Factors ◽  
Digital Health ◽  
Health Inequities ◽  
Healthcare Services ◽  
The United States ◽  
Future Research ◽  
Unequal Distribution ◽  
Health Technologies ◽  
Starting Point

BACKGROUND Digital health technologies are rapidly adapting to healthcare contexts to provide improved medical services to citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities. OBJECTIVE The aim of this study is to systematically review the inequities of healthcare services brought about by the adoption of digital health technologies. The influencing factors of inequities, as well as corresponding countermeasures to ensure the health equity between different groups of citizens, is also studied. METHODS A systematic review of literature published from 1990 to 2020 was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review process, and the electronic databases of Web of Science Core Collection, PubMed, and Scopus. Search, sorting, and data extraction processes were completed by two authors of the paper using Thomson Endnote. RESULTS In total, 1,895 studies were collected during the search process, of which 40 were identified for analysis. The earliest literature identified was published in 1993, with the number remaining below 2 for a long period of time. The number started to increase until 2016, with a peak thereafter being reached in 2020. The United States, the United Kingdom, and Norway ranked as the top three in terms of publication output. Health inequities caused by digital health technologies were mainly reflected by access and availability of digital technologies and the differences in healthcare outcomes. The factors that influenced inequities included: demographic factors (i.e., gender, age, race, region, economy, and education level), health conditions, and eHealth literacy. Finally, government agencies and medical institutions, digital health technology providers, and healthcare service receivers can all take actions to alleviate inequities, in future. CONCLUSIONS Findings provide a comprehensive starting point for future research allowing for further investigation into how digital health technologies may influence the unequal distribution of healthcare services. The interaction between individual subjective factors, as well as social support, and influencing factors should be included in future studies. In particular, access and availability to digital health technologies by vulnerable groups should be of paramount importance.

scholarly journals “Sometimes I don’t have a pulse … and I’m still alive!” Interviews with healthcare professionals to explore their experiences of and views on population-based digital health technologies

2021 ◽  
Vol 7 ◽  
pp. 205520762110183
Author(s):  
Flavio Tomasella ◽  
Heather May Morgan
Keyword(s):  
Healthcare Professionals ◽  
Digital Health ◽  
Relevant Literature ◽  
Population Based ◽  
Future Research ◽  
Daily Routine ◽  
Structured Interviews ◽  
Clinical Value ◽  
Health Technologies ◽  
Advantages And Disadvantages

Background Digital technologies are increasingly becoming an integral part of our daily routine and professional lives, and the healthcare field is no exception. Commercially available digital health technologies (DHTs – e.g. smartphones, smartwatches and apps) may hold significant potential in healthcare upon successful and constructive implementation. Literature on the topic is split between enthusiasm associated with potential benefits and concerns around privacy, reliability and overall effectiveness. However, little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they perceive as the main advantages and disadvantages of adoption. This study therefore aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public. Methods Nine HCPs volunteered to take part in semi-structured interviews. Related data were thematically analysed, following a deductive approach with the construction of a framework based on expected themes from the relevant literature, and themes identified from the first two interviews. Findings The following main themes in relation to DHTs were identified and explored in detail: HCPs’ experience, knowledge and views; advantages and disadvantages; barriers towards healthcare implementation and potential solutions; future directions. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this were explored, including factors such as time/resources; colleagues’ mindset; lack of evidence of effectiveness for practice; data security concerns. Conclusions The potential advantages of DHTs’ adoption in healthcare are substantial, e.g. patient autonomy, time/resources saving, health and behaviour change promotion, but are presently premature. Therefore, future research is warranted, focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

scholarly journals Prediction of (Non)Participation of Older People in Digital Health Research: Exergame Intervention Study

10.2196/17884 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e17884
Author(s):  
Arianna Poli ◽  
Susanne Kelfve ◽  
Leonie Klompstra ◽  
Anna Strömberg ◽  
Tiny Jaarsma ◽  
...  
Keyword(s):  
Health Care ◽  
Older People ◽  
Symptom Severity ◽  
Health Research ◽  
Intervention Study ◽  
Digital Health ◽  
Gender Effects ◽  
Lower Probability ◽  
Health Technologies ◽  
Self Selection

Background The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care. Objective We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity. Methods A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated. Results Of the 1632 screened patients, 71% did not participate. The nonrecruitment rate was 21%, and based on the eligible sample, the refusal rate was 61%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively. Conclusions Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice. Trial Registration ClinicalTrial.gov NCT01785121, https://clinicaltrials.gov/ct2/show/NCT01785121

scholarly journals Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261145
Author(s):  
Zsuzsa Győrffy ◽  
Sándor Békási ◽  
Bence Döbrössy ◽  
Virág Katalin Bognár ◽  
Nóra Radó ◽  
...  
Keyword(s):  
Underserved Populations ◽  
Reference Group ◽  
Digital Health ◽  
Homeless People ◽  
Healthcare Services ◽  
Homeless Persons ◽  
Homeless Shelters ◽  
Health Technologies ◽  
Vulnerable Patient

Background With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. Methods Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). Results A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. Conclusion Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

scholarly journals Trends beyond the new normal: from remote monitoring to digital connectivity

2020 ◽  
Vol 22 (Supplement_P) ◽  
pp. P8-P12
Author(s):  
Leonardo Calò ◽  
Ermenegildo de Ruvo ◽  
Anna Maria Martino ◽  
Günther Prenner ◽  
Martin Manninger ◽  
...  
Keyword(s):  
Health Services ◽  
Remote Monitoring ◽  
Mobile Apps ◽  
Digital Health ◽  
Healthcare Services ◽  
Digital Tools ◽  
New Normal ◽  
Connected Health ◽  
Use Of Technology

Abstract COVID pandemic emergency has forced changes from traditional in-person visits to application of telemedicine in order to overcome the barriers and to deliver care. COVID-19 has accelerated adoption of digital health. During this time, the distance is itself a prevention tool and the use of technology to deliver healthcare services and information has driven the discovery of mobile and connected health services. Health services should to be prepared to integrate the old model of remote monitoring of CIEDs and adopt new digital tools such as mobile Apps and connected sensors.

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