A digital self-care intervention for Ugandan patients with heart failure and their clinicians: User-centred design and usability study

Background: The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness, disease management, or empowerment to engage in self-care behaviors. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and to reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. Objective: To develop a digital health intervention that enables improved self-care amongst HF patients in Uganda. Methods: We implemented a user-centred design process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a systematic scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a fully-functional digital health intervention. The evaluation phase involved usability testing of the developed intervention amongst Ugandan patients with HF and their clinicians. Results: Medly Uganda is a digital health intervention that is fully integrated within a government-operated mobile health platform. The system allows patients to report daily HF symptoms, receive tailored treatment advice, and connect with a clinician when showing signs of decompensation. Medly Uganda harnesses Unstructured Supplementary Service Data technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed the system to be accepted by patients, caregivers, and clinicians. Conclusions: Medly Uganda is a fully-functional and well-accepted digital health intervention that enables Ugandan HF patients to better care for themselves. Moving forward, we expect the system to help decongest cardiac clinics and improve self-care efficacy amongst HF patients in Uganda.

The Regeneration of Urban Blue Spaces: A Public Health Intervention? Reviewing the Evidence

Research in recent years has demonstrated that urban surface waters (“urban blue spaces”) can provide beneficial effects on human health and wellbeing. Despite blue spaces prevailing on urban development agendas across the world, little investigation has been done whether and how the regeneration of such spaces is used as a (community-based) public health intervention. Therefore, a review was conducted to analyze urban blue space regeneration projects in terms of their significance for public health. Results show that the regeneration of urban blue spaces displays a diversity of intervention types and follows certain development trends seen in general urban regeneration: Similarities mainly arise in relation to objectives (multi-dimensional goals with increasing focus on environmental sustainability and economic interests), stakeholders (shift to multi-actor governance with a rise of partnerships and community participation), and funding (prevalence of mixed financial schemes and increasing reliance on external funding sources). Although threefold public health effects have been noted across the projects (i. behavioral changes toward healthier lifestyles, ii. healthier urban environments, iii. health policy changes), results of this review indicate that the potential to use urban blue regeneration as a community-based health intervention has yet to be realized.

The Public Health Intervention for International Students at Universiti Malaysia Sabah, Malaysia

Background: COVID-19 pandemic that started in Wuhan, Hubei Province, China, has spread globally, and Sabah is one of the states in Malaysia that is affected by it. The outburst in social media on discrimination against the people from China impacted the international students from China. Thus, University Malaysia Sabah (UMS) had to play a role in mitigating the COVID-19 pandemic and protecting its students. This article aimed to describe the actions taken by UMS for its international student from China during the early phase of the COVID-19 pandemic. Methods: This study used a cross-sectional design where all 379 students from China in UMS were screened from February 2020 until March 2020 during the early phase of COVID 19. Results: During this study period, 0.5% of the students were classified as Persons under Investigation (PUI), while 99.5% were classified as Person under Surveillance (PUS). Conclusion: The public health interventions included surveillance, contact tracing, monitoring, quarantine, isolation, social distancing, mental health support, and mental health intervention activities. These actions to control the pandemic reduce the state health department's health burden and help the students in need.

Suicidal Ideation and Risk Reduction Associated with Participation in a Therapist-Supported Digital Mental Health Intervention

Background Suicide is a significant public health concern with increasing prevalence. Novel interventions that reduce stigma and increase accessibility, such as therapist-supported digital mental health interventions, are urgently needed. Methods This preregistered retrospective cohort, single-arm, and intent-to-treat study with 778 patients examined suicidal ideation (SI) trajectories using multilevel models during and up to 6-months after an 12-week therapist-supported digital mental health intervention (Meru Health Program [MHP]) as assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9). Estimates of associated suicide attempts and deaths by suicide were calculated using published data linking PHQ-9-assessed SI to records of suicide attempts and deaths by suicide. Results MHP participants reporting SI “not at all” significantly increased between baseline and end-of-treatment (78.02–91.00%). Effect sizes of SI changes between baseline and end-of-treatment, 3-month, and 6-month follow-ups were 0.33 (95%CI=0.27-0.38), 0.32 (95%CI=0.27-0.38), and 0.32 (95%CI=0.27-0.438), respectively. Results also indicated an estimated 30.49% reduction (95%CI=25.15%-35.13%) in suicide attempts and death by suicide across treatment. Conclusion This real-world study provides preliminary evidence that participants of the MHP show significant reductions in SI and estimated suicide attempts and deaths by suicide across treatment that are maintained 6-months following treatment. The next steps are to conduct a randomized control trial to confirm these results.

Digital mental health intervention for orthopedic patients with symptoms of depression and/or anxiety: Pilot feasibility study (Preprint)

BACKGROUND Depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. Nevertheless, addressing mental health is not yet a routine part of standard orthopedic treatment, in part due to access related barriers. Digital mental health intervention offers the potential to be a scalable resource that could feasibly be incorporated into orthopedic care. OBJECTIVE The primary purpose of this study was to assess the feasibility of introducing a digital mental health intervention (Wysa) within an outpatient orthopedic setting to patients who endorse coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. METHODS In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a non-surgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and/or Anxiety score ≥ 55). Enrollment was performed face-to-face by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided two months of access to a mobile app called Wysa, which is an established, multi-component digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engaging with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at two-month follow-up between high Wysa users and low Wysa users, defined by a median split. RESULTS The recruitment rate was 61/208 (29%), retention rate was 51/61 (84%), and engagement rate was 44/61 (72%). Compared to low users, high Wysa users achieved greater improvement in PROMIS Anxiety (between-group difference -4.2 points [95% CI -8.1 to -0.2], P=.044) at two-month follow-up. Between-group differences in PROMIS Depression (-3.2 points [-7.5 to 1.2], P=.15) and Pain Interference (-2.3 points [-6.3 to 1.7], P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function were comparable between groups. CONCLUSIONS Delivery of a digital mental health intervention within the context of orthopedic care is feasible and demonstrates potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. CLINICALTRIAL ClinicalTrials.gov NCT202005219

A Review of Digital Health Design Approaches: Challenges Towards Real World Implementation (Preprint)

BACKGROUND Digital health represents an important strategy in the future of healthcare delivery. Over the past decade, mHealth has accelerated the agency of healthcare users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability and patience outcome. This challenge is confounded by two industries, DIGITAL and HEALTH, that have vastly different approaches to research, design, testing and implementation. In this regard, there is a need to examine prevailing design approaches, to weigh their benefits and challenges towards implementation, and to recommend a path forward that synthesises the needs of this complex stakeholder group. OBJECTIVE This review studies prominent digital health intervention (DHI) design approaches mediating the digital health space. In doing so, we seek to examine each methodology’s: origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios. METHODS A narrative synthesis approach to literature review was employed to review existing evidence. We searched indexed scientific literature using keywords relative to different digital health intervention designs. Papers selected after screening were those that discussed the design and implementation of digital health design approaches. RESULTS 120 papers on intervention design were selected for full-text review. We selected the 20 most prominent papers on each design approach, synthesizing findings under the categories of origins, advantages, disadvantages, challenges and cases. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented in order to harmonise the needs of a complex stakeholder group. Whether the primary stakeholder is positioned as the end-user/person/human/patient, the challenge to synthesise the constraints and affordances of both digital design and healthcare, built equally around user satisfaction and clinically efficacy remains paramount. Further research that works towards a transdisciplinarity in digital health may help to break down friction in this field. Until digital health is viewed as a hybridised industry with unique requirements rather than competing interests, the nuances that each design approach posits will be difficult to realise in a real world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, in order to create a better digital health culture and design ethos.