scholarly journals Designing the optimal digital health intervention for orthopedic patients: a qualitative exploration of digital technology design and functionality for patient use before and after elective surgery. (Preprint)

2020 ◽  
Author(s):  
Anna Robinson ◽  
Robert D Slight ◽  
Andrew K Husband ◽  
Sarah P Slight
Keyword(s):  
Behaviour Change ◽  
Health Behaviour ◽  
Digital Health ◽  
Digital Technologies ◽  
Patient Perspectives ◽  
Health Technologies ◽  
Surgical Success ◽  
Orthopaedic Patients ◽  
Behaviour Changes

BACKGROUND Health behaviour changes made by patients during the perioperative period can impact on the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopaedic surgery patients is central to motivating healthier behaviour change, improving recovery and optimizing overall surgical success in the short- and long-term. OBJECTIVE This qualitative investigation explores patient perspectives on the key technology features that would help support them to change their lifestyle behaviours during the pre- and post-operative periods, and that could potentially maintain long-term healthy lifestyles following recovery. METHODS Semi-structured interviews with pre- and post-operative elective orthopaedic patients were conducted between May and June 2020, via telephone and video call-based software. Patient perspectives of using digital technologies to complement current surgical care and support with lifestyle behaviour change were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with NVivo (version 12) software facilitating data management. Ethical approval was obtained from the NHS Health Research Authority. RESULTS Eighteen participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the elective perioperative journey. These center around an intervention’s ability to: 1) deliver both general and specific surgical advice in a timely manner, 2) direct a descriptive and structured recovery, 3) enable customizable, patient-controlled settings, and 4) incorporate interactive, user-centered features. Pre-operative initiation of interventions, and post-operative continuation, were sought after by this cohort. Interventions designed with personalized milestones for patients were found to better guide through a structured recovery. Individualised tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity prior to surgery. Use of apps with personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behaviour change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery. CONCLUSIONS Specific intervention design and functionality features can provide better, structured support for elective orthopaedic patients across the whole perioperative journey, and beyond. This work provides much needed evidence relating to the optimal design and timing of digital interventions for elective orthopaedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behaviour changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored and targeted digital health technologies within modern healthcare settings.

scholarly journals A qualitative study exploring patient suggestions for the design, functionality and implementation of digital health technologies before and after bariatric surgery

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i6-i7
Author(s):  
A Robinson ◽  
A K Husband ◽  
R D Slight ◽  
S P Slight
Keyword(s):  
Bariatric Surgery ◽  
Health Behaviour ◽  
Participatory Design ◽  
Digital Health ◽  
Digital Technologies ◽  
Structured Interviews ◽  
Health Technologies ◽  
Patient Cohort ◽  
Gastric Bypass Procedure ◽  
Behaviour Changes

Abstract Introduction Health behaviour changes made during the pre-operative period can positively impact on post-operative outcomes and the success of bariatric surgery.(1) Digital technologies present an opportunity to support patients with this. Currently, little is known about the optimal design or delivery of digital technologies for this patient cohort. In order to develop useful and effective digital strategies for this unique patient cohort, it is important to first understand how bariatric surgery patients want to be supported.(2) Aim To understand how digital technologies could be designed and delivered to better support patients with surgical health behaviour changes, specifically: 1) what do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented? Methods According to the EQUATOR guidelines, the consolidated criteria for reporting qualitative research (COREQ) checklist was followed. Pre- and post-operative patients attending bariatric surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Participants received an information sheet detailing the study purpose and aims. Written informed consent was obtained before conducting semi-structured interviews. Semi-structured interviews took place between February-March 2020 and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, health behaviour change and perspectives on digital technologies. A reflexive thematic analysis approach enabled the development of themes from the data. NVivo 12 software assisted data organisation. Results Eighteen patients were recruited and interviewed. The average age of participants was 46-years. 55% (n=10) of participants had or were undergoing a gastric bypass procedure. The data analysis enabled the development of four themes which highlighted specific participant desires relating to the design, functionality and implementation of optimal digital technologies to best support them during the pre- and post-operative periods. Specifically, the themes related to an intervention’s ability to: 1) provide structured content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted and usable manner, and 4) meet patient information-seeking and engagement needs (Figure 1). “In the first couple of weeks (following surgery), we need to be told what to do by the technology” Participant 9. Conclusion This patient-informed research highlighted how interventions could be designed, what functionality would be most useful and when they should be implemented within the NHS pathway for bariatric surgical patients. This study is one of the first in this patient cohort to involve pre- and post-operative participants and provides key insights to fill knowledge gaps relating to the design and optimisation of person-centred digital interventions. We acknowledge some limitations with our work. Whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely bariatric surgery and thus findings may not be generalisable to other elective surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings. References 1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology. 2009;28(6):690. 2. Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector. The Design Journal. 2015;18(2):227–48.

Designing digital health technology to support patients before and after bariatric surgery: a qualitative study exploring patient desires, suggestions and reflections to support lifestyle behaviour change. (Preprint)

2021 ◽  
Author(s):  
Anna Robinson ◽  
Andy Husband ◽  
Robert Slight ◽  
Sarah Slight
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Behaviour Change ◽  
Digital Technologies ◽  
Lifestyle Changes ◽  
Lifestyle Behaviour ◽  
Surgical Success ◽  
Before And After ◽  
Surgical Pathway

BACKGROUND A patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. Research has focused on implementing digital technologies and measuring their effectiveness in various surgical cohorts, yet there is limited work concerning the desires, suggestions and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patient perspectives on technology features that would support them to change their lifestyle behaviours during the pre- and post-operative periods, to potentially maintain long-term healthy lifestyles following surgery. OBJECTIVE To understand how digital technologies could be used to better support patients across the perioperative pathway to improve weight-loss outcomes and surgical success. Specifically, the objectives concerned: 1) what do patients want from digital technologies, 2) how do they want to use them, and 3) when would they be of most benefit during their surgical journey? METHODS Patients attending bariatric surgery clinics within one hospital in the North of England were invited to take part. Semi-structured interviews were conducted with purposively sampled pre- and post-operative bariatric surgical patients to discuss lifestyle behaviour change and the use of digital technologies to complement their care. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the NHS Health Research Authority. RESULTS Twenty patients were interviewed. Four overarching themes were developed from the data relating to perspectives of optimised technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal-setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs. Interventions that supported the delivery of personalized feedback and post-operative follow-up were perceived as beneficial. Individualized goal- and target-setting could further support a generation of digitally engaged patients with bariatric conditions. Working towards achievable targets was deemed an effective strategy to successfully motivate behaviour change. The creation of digital ‘package of care’ checklists between patients and clinicians was a novel finding from this research. CONCLUSIONS Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made that relate to the design, content and functionality of digital interventions to best address the needs of this patient cohort. These findings have the potential to influence future co-design and integration of person-centered, perioperative technologies within surgical pathways. CLINICALTRIAL N/A

scholarly journals Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Behaviour Change ◽  
Digital Health ◽  
Self Regulation ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Digital Architecture

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

scholarly journals A technology-assisted life of recovery from psychosis

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Dror Ben-Zeev ◽  
Benjamin Buck ◽  
Sarah Kopelovich ◽  
Suzanne Meller
Keyword(s):  
Early Detection ◽  
Symptom Management ◽  
Digital Health ◽  
Digital Technologies ◽  
Clinical Population ◽  
Illness Management ◽  
Illness Management And Recovery ◽  
Health Technologies ◽  
Health Innovations ◽  
Schizophrenia Spectrum

Abstract Developments in digital health technologies have the potential to expedite and strengthen the path towards recovery for people with psychosis. This perspective piece provides a snapshot of how a range of digital technologies can be deployed to support a young adult’s efforts to cope with schizophrenia-spectrum illness. In conjunction with a day in the life of this individual, we provide examples of innovations in digital health research designed for this clinical population, as well as brief summaries of the evidence supporting the usability, feasibility, or effectiveness of each approach. From early detection to ongoing symptom management and vocational rehabilitation, this day-in-the-life vignette provides an overview of the ways in which digital health innovations could be used in concert to augment, scaffold, and enhance schizophrenia-spectrum illness management and recovery.

Digital health technology enhances resilient behaviour: evidence from the ward

2019 ◽  
Vol 40 (1) ◽  
pp. 34-67 ◽  
Author(s):  
Iacopo Rubbio ◽  
Manfredi Bruccoleri ◽  
Astrid Pietrosi ◽  
Barbara Ragonese
Keyword(s):  
Patient Safety ◽  
Dynamic Capabilities ◽  
Digital Health ◽  
Digital Technologies ◽  
Healthcare Management ◽  
Content Type ◽  
Health Technologies ◽  
Management Domain ◽  
Operational Failure

PurposeIn the healthcare management domain, there is a lack of knowledge concerning the role of resilience practices in improving patient safety. The purpose of this paper is to understand the capabilities that enable healthcare resilience and how digital technologies can support these capabilities.Design/methodology/approachWithin- and cross-case research methodology was used to study resilience mechanisms and capabilities in healthcare and to understand how digital health technologies impact healthcare resilience. The authors analyze data from two Italian hospitals through the lens of the operational failure literature and anchor the findings to the theory of dynamic capabilities.FindingsFive different dynamic capabilities emerged as crucial for managing operational failure. Furthermore, in relation to these capabilities, medical, organizational and patient-related knowledge surfaced as major enablers. Finally, the findings allowed the authors to better explain the role of knowledge in healthcare resilience and how digital technologies boost this role.Practical implicationsWhen trying to promote a culture of patient safety, the research suggests healthcare managers should focus on promoting and enhancing resilience capabilities. Furthermore, when evaluating the role of digital technologies, healthcare managers should consider their importance in enabling these dynamic capabilities.Originality/valueAlthough operations management (OM) research points to resilience as a crucial behavior in the supply chain, this is the first research that investigates the concept of resilience in healthcare systems from an OM perspective, with only a few authors having studied similar concepts, such as “workaround” practices.

scholarly journals Digital Health Platforms in Saudi Arabia: Determinants from the COVID-19 Pandemic Experience

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1517
Author(s):  
Saeed M. Alghamdi ◽  
Abdullah S. Alsulayyim ◽  
Jaber S. Alqahtani ◽  
Abdulelah M. Aldhahir
Keyword(s):  
Saudi Arabia ◽  
Digital Health ◽  
Digital Technologies ◽  
Vital Role ◽  
Future Research ◽  
Narrative Form ◽  
Published Data ◽  
Health Technologies ◽  
Significant Burden ◽  
Mobile Health Applications

COVID-19 poses a significant burden to healthcare systems. Healthcare organisations with better health innovation infrastructures have faced a reduced burden and achieved success in curbing COVID-19. In Saudi Arabia, digital technologies have played a vital role in fighting SARS-CoV-2 transmission. In this paper, we aimed to summarise the experience of optimising digital health technologies in Saudi Arabia as well as to discuss capabilities and opportunities during and beyond the COVID-19 pandemic. A literature search was conducted up to September 2021 to document the experience of using DHTPs in Saudi Arabia in response to the COVID-19 outbreak. We also considered any published data, press briefings, and announcements by the MOH in Saudi Arabia. The findings were synthesised in narrative form. Health officials succeeded in optimising and maintaining a strategy to mitigate the spread of the virus via different digital technologies, such as mobile health applications, artificial intelligence, and machine learning. The quick digital response in Saudi Arabia was facilitated by governmental support and by considering users and technology determinants. Future research must concentrate on establishing and updating the guidelines for using DHTPs.

Supporting mental health during COVID-19 using a digital behaviour change intervention: an open-label, single-arm, pre-post intervention research study (Preprint)

2021 ◽  
Author(s):  
Charlotte Summers ◽  
Philip Wu
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Perceived Stress ◽  
Digital Health ◽  
Mental Wellbeing ◽  
Behaviour Change Intervention ◽  
Open Label ◽  
Post Intervention ◽  
Convenience Sample ◽  
Health Technologies

BACKGROUND COVID-19 is taking its toll on people's mental health, particularly as people are advised to adhere to social distancing, self-isolation measures and government imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and supporting mental health and wellbeing. Particularly in the wake of the COVID-19 pandemic as even before this unprecedented time, mental health and social services were already stretched. OBJECTIVE Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health platform, a digital behaviour change intervention for self-management of mental wellbeing, sleep, activity, and nutrition. METHODS The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. From adults who had joined the intervention and had a complete baseline dataset (GAD-7 Anxiety Test Questionnaire, Perceived Stress Scale, PHQ-9 Patient Health Questionnaire), we followed all users for 12 weeks (N=273), including 33 (12.1%) who reported a positive COVID-19 diagnosis during the study period. Users engagement with the Gro Health platform was tracked by active minutes. RESULTS Of the 347 study participants, 273 (78.67%) completed both baseline and follow up surveys. Change in scores for anxiety, perceived stress and depression was predicted by app engagement with the strongest effect being seen in change perceived stress scores F(1,271)=251.397, p<0.001, with an R2 of .479. CONCLUSIONS A digital behaviour change platform that provides remote mental wellbeing support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. CLINICALTRIAL Approved by Royal Holloway, University of London Ethics Board.

Evolution of Digital Technologies and Use of Virtual Assistants in Drug Development

2019 ◽  
pp. 1-20
Author(s):  
Manu Venugopal
Keyword(s):  
Drug Development ◽  
Digital Health ◽  
Critical Role ◽  
Life Sciences ◽  
Digital Technologies ◽  
Development Phase ◽  
Health Technologies ◽  
Daunting Task ◽  
The World

The drug development phase is one of the most time-consuming and expensive stages in the lifecycle of a drug. Marred by patent expirations, price regulations, complexities in disease conditions, life sciences companies are facing a daunting task to bring new molecular entities into the market. Digital health technologies are playing a critical role in addressing some of the challenges faced during drug development. In this chapter, the author talks about the challenges and key trends in the world of drug development, use of new digital health technologies, and the future of drug development. As an example, the author dives into a specific case study on the use of virtual assistants in clinical trials and the benefits of its usage on patients, healthcare professionals, and life sciences companies.

Queensland Digital Health Clinical Charter: a clinical consensus statement on priorities for digital health in hospitals

2020 ◽  
Vol 44 (5) ◽  
pp. 661
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Keith McNeil ◽  
David Rosengren ◽  
Ian Johnson
Keyword(s):  
Decision Making ◽  
Digital Health ◽  
Digital Technologies ◽  
Executive Leadership ◽  
Digital Transformation ◽  
Decision Making Process ◽  
Health Technologies ◽  
Clinical Community ◽  
Expected Benefits ◽  
High Level

Digital transformation of Australian hospitals is occurring rapidly. Although the clinical community has had limited ability to influence high-level decision making and investments into digital health technologies, as these technologies increasingly transform the way patients are cared for, the clinical community must influence the digital health agenda and be an integral part of the decision-making process. This case study details the process and lessons learnt during the development of the state-wide consensus statement detailing the clinical requirements for digital health initiatives to form the Queensland Digital Health Clinical Charter. To the best of our knowledge, Queensland is the first Australian jurisdiction to create a Digital Clinical Charter to be specifically referenced in the investment in and governance of digital health in hospitals. By developing this clinical charter for digital health, and in articulating the needs of clinicians, a clinical framework will be added to both the decision-making process around the investments in digital health and the definition and realisation of the expected benefits from these sizable investments. What is known about the topic? Digital transformation of healthcare is occurring rapidly. The clinical community has had limited ability to influence high-level decision making and investments into these digital health technologies. Tension currently exists between the clinical community who must use the new digital technologies and the technical groups that govern the introduction of the new technologies. This tension can be manifest as clinicians refusing to adopt new systems, safety concerns and an inability to reach consensus on direction. There are few peer reviewed publications addressing this tension between the clinical community and technical providers. What does this paper add? This paper is the first attempt to create a list of clinical requirements for digital transformation that crosses professional streams and is endorsed by the state-wide executive leadership team to inform the acquisition and governance of digital health technologies. What are the implications for practitioners? Clinicians can feel excluded and marginalised during the decision-making process for new digital technologies, despite the fact that they are often using these technologies to deliver hands-on care to patients. This charter clearly articulates the requirements of clinicians for digital transformation and has been endorsed by the executive leadership team of Queensland Health. The charter adds a clinical framework to be referenced during the decision-making process around the investments in digital health, and the definition and realisation of the expected benefits from these sizable investments. As the digital landscape in public hospitals evolves, clinicians are becoming increasingly reliant upon digital technologies. It is critical that clinicians have a strong effect on technology acquisition and governance to maximise the quality and efficiency of the care they provide.

scholarly journals Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study (Preprint)

2020 ◽  
Author(s):  
Leah Taylor Kelley ◽  
Jamie Fujioka ◽  
Kyle Liang ◽  
Madeline Cooper ◽  
Trevor Jamieson ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Business Models ◽  
Digital Health ◽  
Digital Technologies ◽  
Economic Incentives ◽  
Barriers To Entry ◽  
Health Innovation ◽  
Health Technologies

BACKGROUND Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging. OBJECTIVE This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs. METHODS This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women’s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation. RESULTS A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system’s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs’ business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals. CONCLUSIONS There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients’ well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

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