Challenges of and Solutions for Developing Tailored Video Interventions That Integrate Multiple Digital Assets to Promote Engagement and Improve Health Outcomes: Tutorial

Background Video is a versatile and popular medium for digital health interventions. As mobile device and app technology advances, it is likely that video-based interventions will become increasingly common. Although clinic waiting rooms are complex and busy environments, they offer the opportunity to facilitate engagement with video-based digital interventions as patients wait to see their providers. However, to increase efficiency in public health, leverage the scalability and low cost of implementing digital interventions, and keep up with rapidly advancing technology and user needs, more design and development guidance is needed for video-based tailored interventions. Objective We provide a tutorial for digital intervention researchers and developers to efficiently design and develop video-based tailored digital health interventions. We describe the challenges and solutions encountered with Positive Health Check (PHC), a hybrid app used to deliver a brief, interactive, individually tailored video-based HIV behavioral counseling intervention. PHC uses video clips and multimedia digital assets to deliver intervention content, including interactive tailored messages and graphics, a repurposed animated video, and patient and provider handouts generated in real time by PHC. Methods We chronicle multiple challenges and solutions for the following: (1) using video as a medium to enhance user engagement, (2) navigating the complexity of linking a database of video clips with other digital assets, and (3) identifying the main steps involved in building an app that will seamlessly deliver to users individually tailored messages, graphics, and handouts. Results We leveraged video to enhance user engagement by featuring “video doctors,” full-screen video, storyboards, and streamlined scripts. We developed an approach to link the database of video clips with other digital assets through script coding and flow diagrams of algorithms to deliver a tailored user experience. We identified the steps to app development by using keyframes to design the integration of video and digital assets, using agile development methods to gather iterative feedback from multidisciplinary teams, and creating an intelligent data-driven back-end solution to tailor message delivery to individual users. Conclusions Video-based digital health interventions will continue to play an important role in the future of HIV prevention and treatment, as well as other clinical health practices. However, facilitating the adoption of an HIV video intervention in HIV clinical settings is a work in progress. Our experience in designing and developing PHC presented unique challenges due to the extensive use of a large database of videos tailored individually to each user. Although PHC focuses on promoting the health and well-being of persons with HIV, the challenges and solutions presented in this tutorial are transferable to the design and development of video-based digital health interventions focused on other areas of health.

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A Tutorial on the Challenges and Solutions for Developing Tailored Video Interventions that Integrate Multiple Digital Assets to Promote Engagement and Improve Health Outcomes: The Positive Health Check Example (Preprint)

10.2196/preprints.21128 ◽

2020 ◽

Author(s):

Camilla Harshbarger ◽

Olivia Burrus ◽

Sivakumar Rangarajan ◽

John Bollenbacher ◽

Brittany Zulkiewicz ◽

...

Keyword(s):

Digital Health ◽

Health Interventions ◽

Health Check ◽

Multidisciplinary Teams ◽

Positive Health ◽

Counseling Intervention ◽

Video Clips ◽

Tailored Messages ◽

Digital Interventions ◽

Digital Assets

UNSTRUCTURED Video is a versatile and popular medium for digital health interventions and as the technology behind mobile devices and applications advances, video-based interventions may become increasingly common. Though a complex and busy environment, clinic waiting rooms offer the opportunity for implementing digital interventions to patients waiting to see their providers. However, to increase efficient ways of working in public health, to leverage the scalability and low cost of implementing digital interventions, and to keep up with rapidly advancing technology and user needs, more guidance is needed on the design and development of video-based tailored interventions. Here we provide a tutorial for digital intervention researchers and developers who wish to efficiently design and develop video-based, tailored, digital health interventions by describing our challenges and solutions encountered with Positive Health Check (PHC). PHC, a hybrid app, is a brief, interactive, individually- tailored video-based digital HIV behavioral counseling intervention. Hybrid applications are available from an Internet URL or can be downloaded from Google Play and the Apple Store. PHC uses video clips, and multimedia digital assets to deliver intervention content. These include interactive, tailored messages and graphics, a repurposed animated video and patient and provider handouts generated in real-time by PHC. This tutorial addresses numerous challenges and solutions for (1) using video as a medium to enhance user engagement through “video doctors”, full screen video, storyboards and streamlined scripts; (2) navigating the complexity of linking a database of video clips with other digital assets through script coding and flow diagrams of algorithms for delivering a tailored user experience; and, (3) identifying main steps to building an app that will seamlessly deliver to users individually-tailored messages, graphics and handouts. These steps include using keyframes to design integration of video and digital assets, using agile development methods to gather iterative feedback from multidisciplinary teams, and creating an intelligent data-driven backend solution that will tailor message delivery to individual users. Although PHC focuses on promoting health and well-being among persons with HIV, the challenges and solutions presented here are transferable to video-based digital health interventions focused on other areas of health.

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Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review

JMIR Cancer ◽

10.2196/12071 ◽

2019 ◽

Vol 5 (2) ◽

pp. e12071 ◽

Cited By ~ 10

Author(s):

Lisa McCann ◽

Kathryn Anne McMillan ◽

Gemma Pugh

Keyword(s):

Young Adults ◽

Cancer Diagnosis ◽

Subjective Experience ◽

Emotional Health ◽

Digital Health ◽

Health Interventions ◽

Adolescents And Young Adults ◽

Research Papers ◽

Digital Interventions ◽

Diagnosis Of Cancer

Background The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39%), behavior change (15, 39%), self-care (8, 21%), and emotional health (7, 18%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53% of studies), AYAs’ subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale.

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Effectiveness of digital health interventions for diabetes: systematic review of systematic reviews

10.21203/rs.3.rs-722330/v1 ◽

2021 ◽

Author(s):

Bonkana Maiga ◽

Cheick O Bagayoko ◽

Mohamed Ali Ag Ahmed ◽

Abdrahamane Anne ◽

Marie-Pierre Gagnon ◽

...

Keyword(s):

Systematic Reviews ◽

Digital Health ◽

Scientific Evidence ◽

Relevant Information ◽

Health Interventions ◽

Care Utilization ◽

Clinical Indicators ◽

Health Technologies ◽

Digital Interventions ◽

Effective Interventions

Abstract Background The use of digital health technologies to tackle diabetes has been particularly flourishing in recent years. Previous studies have shown to varying degrees that these technologies can have an impact on diabetes prevention and management. Objective The aim of this review is to summarize the best evidence regarding the effectiveness of digital health interventions to improve one or more diabetes indicators. Methods We included all types of interventions aimed at evaluating the effect of digital health on diabetes. We considered at all types of digital interventions (mobile health, teleconsultations, tele-expertise, electronic health records, decision support systems, e-learning, etc.). We included systematic reviews published in English or French over the last 29 years, from January 1991 to December 2019, that met the inclusion criteria. Two reviewers independently reviewed the titles and abstracts of the studies to assess their eligibility, and extracted relevant information according to a predetermined grid. Any disagreement was resolved by discussion and consensus between the two reviewers, or involved a third author as referee. Results In total in our review of journals, we included 10 reviews. The outcomes of interest were clinical indicators of diabetes that could be influenced by digital interventions. These outcomes had to be objectively measurable indicators related to diabetes surveillance and management that are generally accepted by diabetes experts. Six of the ten reviews showed moderate to large significant reductions in glycated hemoglobin (HBA1c) levels compared to controls. Most reviews reported overall positive results and found that digital health interventions improved health care utilization, behaviours, attitudes, knowledge and skills. Conclusion Based on a large corpus of scientific evidence on digital health interventions, this overview could help identify the most effective interventions to improve diabetes indicators.

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Using digital interventions to improve the cardiometabolic health of populations: a meta-review of reporting quality

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw166 ◽

2017 ◽

Vol 24 (4) ◽

pp. 867-879 ◽

Cited By ~ 7

Author(s):

Adrienne O’Neil ◽

Fiona Cocker ◽

Patricia Rarau ◽

Shaira Baptista ◽

Mandy Cassimatis ◽

...

Keyword(s):

Systematic Reviews ◽

Digital Health ◽

Reporting Quality ◽

Health Interventions ◽

Health Programs ◽

Quality Of Reporting ◽

Digital Interventions ◽

Meta Review ◽

Research Findings

Abstract Objectives. We conducted a meta-review to determine the reporting quality of user-centered digital interventions for the prevention and management of cardiometabolic conditions. Materials and Methods. Using predetermined inclusion criteria, systematic reviews published between 2010 and 2015 were identified from 3 databases. To assess whether current evidence is sufficient to inform wider uptake and implementation of digital health programs, we assessed the quality of reporting of research findings using (1) endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, (2) a quality assessment framework (eg, Cochrane risk of bias assessment tool), and (3) 8 parameters of the Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-eHEALTH) guidelines (developed in 2010). Results. Of the 33 systematic reviews covering social media, Web-based programs, mobile health programs, and composite modalities, 6 reported using the recommended PRISMA guidelines. Seven did not report using a quality assessment framework. Applying the CONSORT-EHEALTH guidelines, reporting was of mild to moderate strength. Discussion. To our knowledge, this is the first meta-review to provide a comprehensive analysis of the quality of reporting of research findings for a range of digital health interventions. Our findings suggest that the evidence base and quality of reporting in this rapidly developing field needs significant improvement in order to inform wider implementation and uptake. Conclusion. The inconsistent quality of reporting of digital health interventions for cardiometabolic outcomes may be a critical impediment to real-world implementation.

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Engagement in Digital Mental Health Interventions: Can Monetary Incentives Help?

Frontiers in Psychology ◽

10.3389/fpsyg.2021.746324 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eliane M. Boucher ◽

Haley E. Ward ◽

Amelia C. Mounts ◽

Acacia C. Parks

Keyword(s):

Mental Health ◽

Financial Incentives ◽

Well Being ◽

Health Interventions ◽

Future Research ◽

User Engagement ◽

Monetary Incentives ◽

Subjective Well Being ◽

Digital Interventions ◽

Mental Health Interventions

Digital mental health interventions (DMHI) are scalable and cost-effective strategies for increasing access to mental health care; however, dropout rates associated with digital interventions are high, particularly for open-access digital interventions. While some studies have focused on predictors of dropout from digital mental health programs, few studies have focused on engagement features that might improve engagement. In this perspective article, we discuss whether monetary incentives (MI) are one avenue to increasing user engagement in DMHI. We begin by reviewing the literature on the effects of MI for behavior change in health domains (e.g., dietary behaviors, substance use, and medication adherence). Then, drawing on a pilot study we conducted to test the effects of different levels of MI on usage and improvement in subjective well-being among users of a DMHI (Happify), we discuss the potential applications of MI for DMHI, the potential drawbacks of financial incentives in this context, and open questions for future research.

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Stakeholder perspectives on evidence for digital mental health interventions: Implications for accreditation systems

Digital Health ◽

10.1177/2055207619878069 ◽

2019 ◽

Vol 5 ◽

pp. 205520761987806

Author(s):

Philip J Batterham ◽

Alison L Calear ◽

Bridianne O’Dea ◽

Mark E Larsen ◽

David J Kavanagh ◽

...

Keyword(s):

Mental Health ◽

Lived Experience ◽

Empirical Evidence ◽

Mental Health Problems ◽

Treatment Guidelines ◽

Routine Care ◽

Health Interventions ◽

User Engagement ◽

Digital Interventions ◽

Mental Health Interventions

Background Digital mental health interventions can be effective for treating mental health problems, but uptake by consumers and clinicians is not optimal. The lack of an accreditation pathway for digital mental health interventions is a barrier to their uptake among clinicians and consumers. However, there are a number of factors that may contribute to whether a digital intervention is suitable for recommendation to the public. The aim of this study was to identify the types of evidence that would support the accreditation of digital interventions. Method An expert workshop was convened, including researcher, clinician, consumer (people with lived experience of a mental health condition) and policymaker representatives. Results Existing methods for assessing the evidence for digital mental health interventions were discussed by the stakeholders present at the workshop. Empirical evidence from randomised controlled trials was identified as a key component for evaluating digital interventions. However, information on the safety of users, data security, user ratings, and fidelity to clinical guidelines, along with data from routine care including adherence, engagement and clinical outcomes, were also identified as important considerations when evaluating an intervention. There are considerable challenges in weighing the evidence for a digital mental health intervention. Conclusions Empirical evidence should be the cornerstone of any accreditation system to identify appropriate digital mental health interventions. However, robust accreditation systems should also account for program and user safety, user engagement and experience, and fidelity to clinical treatment guidelines.

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Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review

Nutrients ◽

10.3390/nu13093281 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3281

Author(s):

Tessa Delaney ◽

Matthew Mclaughlin ◽

Alix Hall ◽

Sze Lin Yoong ◽

Alison Brown ◽

...

Keyword(s):

Dietary Intake ◽

Subjective Experience ◽

Digital Health ◽

Grey Literature ◽

Health Interventions ◽

User Engagement ◽

Narrative Synthesis ◽

Subjective Experiences ◽

Early Evidence ◽

The Relationship

There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.

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Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development

Digital Health ◽

10.1177/2055207619896153 ◽

2019 ◽

Vol 5 ◽

pp. 205520761989615 ◽

Cited By ~ 6

Author(s):

Md Mahbub Hossain ◽

Samia Tasnim ◽

Rachit Sharma ◽

Abida Sultana ◽

Araish Farzana Shaik ◽

...

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Intervention Studies ◽

Digital Health ◽

Communicable Diseases ◽

Health Interventions ◽

Current Evidence ◽

Future Research ◽

Non Communicable Diseases ◽

Digital Interventions

Background A high burden of non-communicable diseases (NCDs) is contributing to high mortality and morbidity in India. Recent advancements in digital health interventions, including mHealth, eHealth, and telemedicine, have facilitated patient-centered care for NCDs. Objective This systematic review aims to evaluate the current evidence on digital interventions for people living with NCDs in India and the outcomes of those interventions. Methods We adopted PRISMA guidelines and systematically reviewed articles from MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following criteria: journal articles presenting digital intervention(s) used by people with at least one of the NCDs, reporting health outcomes following the intervention, studies conducted in India among Indian population. Results Among 1669 articles retrieved from multiple sources, only 13 articles met our criteria. Most ( n = 7) studies were conducted in southern states of India; eight studies included patients with diabetes, followed by neuropsychiatric disorders and other NCDs. Five studies recruited participants from tertiary hospitals; six interventions used text-messaging for delivering health services, and 10 studies reported randomized controlled trials. All the studies reported positive health outcomes following the intervention, including better self-management, increased patient–provider communication, improved medication adherence, and reduced disease symptoms. Most studies scored moderate to high in quality assessment checklist of Downs and Black. Conclusion Current evidence suggests a low number of interventions with positive outcomes. Future research should explore avenues of advanced technologies ensuring equitable and sustainable development of digital health interventions for people living with NCDs in India.

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