DIGITAL HEALTH

Wearable activity trackers have been recognised as effective tools for physical activity promotion, leading to their integration in healthcare services. Although, some qualitative literature indicated that device users may experience emotional conflict. The current study is the first of our knowledge to directly examine the conflict faced by wearable activity tracker users. A qualitative, exploratory design was followed, with inductive thematic analysis conducted on semi-structured interview transcripts. The current study consisted of 11 participants (8 female), aged between 18 to 59 years (M= 30.73) who used a wearable activity tracker for a minimum of 3 months. Four themes and nine sub-themes captured participants emotional conflict. Themes were; Who knows best? Whos in charge? Who am I without it? And What is happening to me?. Themes highlighted that device users faced emotional conflict around navigating a data mismatch, how a wearable activity tracker impacted their behaviour, the amount of control a tracker had over them, whether their device use was positive, and how they would act and feel if they no longer used their wearable activity tracker Participants experienced substantial emotional conflict from wearable activity tracker use. The intensity of device-user relationship was clear, suggesting device dependency and perceived device importance. Findings hold crucial implications around the integration of activity trackers in healthcare services, recommendations around healthy use, and the potential long-term negative impact of using these devices on bodily intuition. Theoretical underpinnings remain unclear around wearable activity tracker use; results suggested blurred boundaries between intrinsic and extrinsic motivation - likely due to device embodiment - and highlighted the role of pressure in driving increased physical activity. Author summaryWearable activity trackers allow users to self-track health information. Typically devices are watches, but rings and chest straps are also used. We investigated if individuals using these devices experienced any emotional conflict. Interviews were conducted and data was analysed. We found that users felt emotional conflict for multiple reasons. Many received data from their device that they disagreed with, meaning they had to debate which perspective to adopt. Others felt conflict around how important their device felt to them and how much it impacted their behaviour. These devices were worn consistently by most participants meaning they became dependent on a device and found it difficult to separate what behaviour was for themselves, and what was to please the device. Consistent use meant users felt conflict around who they would feel and act if they stopped using their activity tracker. Conflict was also reported around how these devices changed behaviour; some said a device increased their motivation, but many instead reported feeling pressure to be active. Wearable activity trackers are beginning to be used in healthcare services. These findings stress that we need to recommend them with caution.

BackgroundMild Cognitive Impairment (MCI) is an early stage of cognitive decline and a key risk factor for dementia. Early detection is essential for timely intervention and prevention, so various digital screening tools have been developed recently. However, many of these tools have limitations. Without assistance, users may have difficulty completing the tests, which could result in increased failure rates and reduced accuracy. This study evaluates the usability of Cogscreen, a mobile cognitive screening tool that can be completed independently from start to finish. MethodsA two-step usability evaluation was conducted: a formative evaluation with five physiatrists assessing design clarity and usability issues, and a summative evaluation with 15 participants analyzing task completion rates and System Usability Scale (SUS) scores. ResultsThe formative evaluation identified strengths in interface design and overall usability, while also noting areas for refinement. The summative evaluation showed a 97% task completion rate and an average SUS score of 80.2, indicating strong usability. Minor issues were reported in personal information entry and graphical result interpretation. ConclusionsCogscreen demonstrated high usability as a digital screening tool for MCI, underscoring its promise for supporting early detection of cognitive decline. Future refinements should focus on enhancing error handling and improving demographic guidance. Expanding testing across diverse populations could further validate its potential clinical utility.

There is growing demand for user involvement in health information technology (IT) design to ensure that emerging technologies meet the needs and expectations of end users. This scoping review explored the state of nurses involvement in health IT design, focusing on the: (1) methods, frequency, capacity, and levels of involvement in the design process; (2) types of health IT systems nurses are included in designing; and (3) outcomes of nurses inclusion in the design process. This review followed the Joanna Briggs Institute methodology for scoping reviews. A systematic search was conducted in seven databases: MEDLINE (Ovid), Cumulative Index to Nursing and Applied Health Literature (CINAHL) (EBCOhost), Embase (Ovid), Scopus, Web of Science, Compendex Engineering Village and Institute of Electrical and Electronics Engineers (IEEE) Xplore Digital Library database platforms. A total of 3,364 studies were screened at the title/abstract phase. After initial exclusions, 632 articles were screened for full texts, 495 were excluded, resulting in a final set of 137 eligible articles. Included studies most frequently involved nurses as users or testers of the technologies - usually at the end stages of the design process. Most studies interchangeably used the concepts of human-centred design and user-centred design to guide the design process. Interviews, surveys, observations and think-aloud techniques were the most frequently used design methods to elicit nurses perspectives about health IT systems. However, it was unclear which methods or approaches were most effective in engaging nurses in the design process. No standardized or validated nurse engagement frameworks were reported. These findings highlight the need to explore the nature of nurses involvement in design, their preferences in engagement and specific contributions and roles in order to develop an evidence-based approach to guide nurses participation in the design process. Author summaryNurses are rarely involved in health IT design, particularly in the early design stages. Failure to involve nurses in early stages can lead to IT systems lacking specific nursing contents, functionalities, and technical features, which may affect the use of the systems for nursing work. In this study, we found evidence of nurses being included at the end stages of the design process. Despite majority of the studies focusing on health IT design and development, nurses were mainly involved as users or testers of the technologies. In other words, nurses were mainly engaged in usability testing activities, which typically occur at the end of the design process rather than upstream design phases. We found that the concepts of human-centred design and user-centred design used interchangeably. At the end of the design processes, nurses perceived the IT systems as acceptable and usable, and either integrated or willing to integrate into clinical practice. Nurses perceived satisfaction with the design process resulting from effective technologies highlight the importance of engaging them in every stage of the design process. Our findings suggest that nurses have potential to leverage their clinical expertise and practical understanding of nursing workflows to guide health care technology design processes.

IntroductionMindfulness can positively impact physical and mental health, but face-to-face programmes are limited by poor accessibility, availability, and cost. Virtual reality (VR) offers immersive audio-visual environments that could improve mindfulness practice. AimTo evaluate commercially available VR apps related to mindfulness. MethodsApp stores and relevant online platforms were searched for VR apps related to mindfulness. Results were screened against eligibility criteria and relevant data extracted. Six raters used the Mobile Application Rating Scale (MARS) to assess the quality of VR apps. ResultsFive VR apps related to mindfulness were included i.e., Headspace XR, Hoame, Innerworld, Maloka and TRIPP. These provided access to meditative and mindfulness sessions, guided by virtual instructors in some cases, and situated in a range of virtual landscapes accompanied by sound or music. TRIPP received the highest average MARS score (4.1), followed by Hoame (3.8), Maloka (3.6), Headspace XR (3.4) and Innerworld (3.3). Most VR apps scored the highest on functionality (3.4 to 4.2), while the information category scored the lowest (3.1 to 3.7). The intra-class correlation was moderate. ConclusionThis review provides important insights into VR apps related to mindfulness such as their availability and quality. Only five VR apps were identified related to mindfulness practice with an overall moderate MARS quality score (3.62/5.00). These may provide a convenient and immersive way to access and engage in regular mindfulness practice, particularly for novices. Rigorous scientific research should assess the effectiveness of these VR apps in improving physical and mental health through immersive mindfulness practice.

mHealth apps are increasingly popular, offering tools like health tracking and personalized reminders to support these behaviors. Personalized messaging, tailored to the users profile, has been shown to improve engagement and retention around health topics. Research links personality traits (based on the Big Five model) with preferred app mechanisms, leading to a preference matrix for personalizing health apps. This preference matrix includes 15 mechanisms, categorized by the Behavior Change Technique and gamification elements, guiding developers to optimize app engagement based on user profiles. This study aims to validate this preference matrix by assessing whether the associations between mechanisms and Big Five personality profiles proposed in the preference matrix align with the preferences of our population in an experimental context. This study employs a cross-sectional design. Participants completed an online survey, which collected data on demographic information, mobile health app usage, and personality. The average age of the 214 respondents (118 women, 89 men, 5 others), was 29.42. Logistic regression and logistic ordinal regression analyses, adjusted using the Bonferroni correction, assessed the influence of personality traits on mechanism preferences and motivation levels was statistically significant for three mechanisms. Conscientiousness significantly increased the likelihood of selection for collection (OR = 1.87). For competition, both conscientiousness (OR = 3.22) and altruism (OR = 1.93) emerged as strong predictors. For rewards, conscientiousness (OR = 1.97) and neuroticism (OR = 2.36) also showed a strong predictive value. The study found that four mechanisms--self-monitoring, progression, challenge, and quest--were favored by over half of the participants, suggesting these should be standard features in mHealth applications. Conscientious participants showed a preference for the collection mechanism, while both conscientious and altruistic individuals were drawn to competition. Neurotic and conscientious individuals preferred the reward mechanism. Conscientiousness consistently predicted preferences for all three gamification elements, highlighting its role in influencing engagement with mHealth features. Author summaryThe increasing emphasis on fostering healthy behaviors and mitigating health-related risk factors--such as physical inactivity, a major contributor to mortality--has driven the rapid expansion of mobile health (mHealth) applications. These digital tools are designed to support behavior modification by incorporating functionalities like reminders, goal tracking, and individualized intervention strategies, which have been associated with improved user engagement and sustained adherence. Central to the efficacy of these interventions is personalization, wherein adaptive content is aligned with the unique attributes and preferences of individual users. Empirical findings indicate that customized messages and feedback outperform standardized approaches, particularly in the promotion of physical activity and weight management. Moreover, the integration of gamification elements is a common strategy employed to enhance motivation and user interaction, with preliminary evidence supporting its positive influence. In this study, we seek to enhance the impact of digital health interventions by systematically mapping game mechanics, behavioral change strategies, and application features to user profiles characterized by the Big Five personality dimensions.

Hypertension, a prevalent cardiovascular condition, requires effective management of multimodal health risk factors. This study examines the effectiveness of a digital health tool designed for hypertension management and explores user perspectives on its utility. We analyse a cohort of 5,136 participants who used the digital tool, which provides continuous blood pressure monitoring, real-time feedback, and personalized health recommendations. Our results show that users achieve significant reduction in their blood pressure values and this reduction is positively correlated with the duration for which users report their blood pressure values. Additionally, we obtain high retention rates even after one year of using the digital tool. User feedback was collected through an online survey revealing high satisfaction rates. Participants highlighted the tools ease of use, and felt less anxious. Overall, our study demonstrates the potential of digital health tools in enhancing hypertension management and highlights the importance of user-centred design in developing effective health interventions.

ObjectiveThe aims of this study were to describe the impact of patient engagement on the initial design and content of a mobile health (mHealth) technology that supports enhanced recovery protocols (ERPs) for cardiac surgery. MethodsEngagement occurred at the level of consultation and took the form of an advisory panel. Patients that underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and consented to be contacted about future research, and their caregivers, were approached for participation. A qualitative exploration was undertaken to determine advisory panel members key messages about, and the impact of, patient engagement on mHealth technology design and content. ResultsTen individuals participated in the advisory panel. Key design-specific messages centered around access, tracking, synchronization, and reminders. Key content-specific messages centered around roles of cardiac surgery team members and medical terms, educational videos, information regarding cardiac surgery procedures, travel before/after surgery, nutrition (i.e., what to eat), medications (i.e., drug interactions), resources (i.e., medical devices), and physical activity (i.e., addressing fears and providing information, recommendations, and instructions). These key messages were a rich source of information for mHealth technology developers and were incorporated as supported by the existing capabilities of the underlying technology platform. ConclusionsPatient engagement facilitated the development of a mHealth technology whose design and content were driven by the lived experiences of cardiac surgery patients and caregivers. The result was a detail-oriented and patient-centered mHealth technology that helps to empower and inform patients and their caregivers about the patient journey across the perioperative period of cardiac surgery. KEY QUESTIONS What is already known about this subject?Enhanced recovery protocols (ERPs) have been proposed as a clinical strategy to effectively address complex and multi-system vulnerabilities, like those commonly present in older adults undergoing cardiac surgery. Mobile health (mHealth) technologies have the potential to improve delivery and patient experience with ERPs, but their development in the academic research setting is often limited by a lack of end-user (e.g., i.e., patient and caregiver) involvement. What does this study add?To our knowledge, this is one of the first studies to engage patients and caregivers in the development of a mHealth technology that supports ERPs for cardiac surgery. This study describes a process for engaging patients and caregivers as "co-producers" of a mHealth technology to support delivery of ERPs during the perioperative period of cardiac surgery. It also demonstrates that engaging patients and caregivers in research, through the formation of an advisory panel, yields a rich source of information to guide the design and content of mHealth technologies in cardiac research. How might this impact on clinical practice?In an era in which mHealth technologies are being increasingly looked to for the optimization of healthcare delivery, this study underscores the utility of using patient and caregiver voices to drive the development of patient-centered mHealth technologies to support clinical practice.

IntroductionAdherence is often cited as an important metric to demonstrate sustained engagement of an individual or population with a health technology, but its definition is often ill-defined. Any adherence definition made for digital health interventions must be clearly defined to ensure a consistent approach to measuring sustained use as an indicator of impact. MethodsThis study followed mathematically-defined definitions of distinct aspects of adherence: initial adoption, consistency, duration, and dropout. These were then applied to a digital physiotherapy dataset of older adults (N=56). Participants were assigned 3 sessions a week of exergames (exercise-based videogames) for 12 weeks using MIRA rehab software platform. ResultsThe following adherence characteristics emerged: an initial dropout of 3% (completed [≤]3 sessions), 20% of participants achieving the desired consistency ([≥]3 sessions a week for 12 weeks), 39% of participants passing a duration threshold (completing [≥]20 minutes a week for 12 weeks), and an average dropout at 72.3% (when judged by percentage of sessions completed at dropout). ConclusionThe approach used for measuring and reporting adherence metrics allows readers to draw clear conclusions about the different aspects of engagement that users displayed with the digital health programme. This type of reporting is recommended for all future digital health studies reporting adherence measures to ensure a consistent approach to reporting and comparing digital health interventions and their impact.

ObjectiveTo explore patient and public experiences of and priorities for the use of shared patient health records for advance care planning. MethodsA convergent-parallel mixed method design was used. An online national survey of patients and the public gathered data on experiences and views of sharing health and advance care planning information to support care at the end of life. Descriptive statistics were used to analyse rating scale responses (5 or 10-point scale) and thematic analysis applied to free-text responses. ResultsResponses (N=1728) included participants in 103 UK counties, including people with a terminal condition (n=33), long-term condition (n=442), who provide or have provided care to a person with a long-term or terminal illness (n=229), and who identified as healthy and interested in planning for the future (n=1024). Confidence that recorded care preferences would be accessed when needed was low for carers (median= 2, IQR 1-4) and moderate for patients (median=3, IQR 1-4). Four themes derived from free-text responses included: i) Experience of sharing health information; ii) Preparation, communication and understanding; iii) Concerns, unknowns and assurance seeking, and; iv) Preserving Dignity and Respect: Understanding individual contexts. ConclusionsWhilst recognising the potential of sharing health records, respondents and in particular carers, doubted that patient information would be accessed by relevant health professionals when needed. Future research is required to explore whether patient and carer access to the record influences their confidence in the accuracy of the content and the likelihood of care being delivered in line with their wishes. What is already known on this topicDigital systems can support documentation and sharing of health information, wishes and preferences for the end of life. What this study addsPatients and carers perceive the documentation of advance care plans as a burdensome and complex process, that can lead to confusion about the purpose of documentation. Respondents expressed doubts about the accuracy of documented information, uncertainty about whether health professionals could access their records when needed and concerns that documented wishes and preferences would be ignored. How this study might affect research, practice or policyPatient and public views must be considered in the design and implementation of digital systems. In particular, efforts should be made to build confidence and clarify the expectations of patients and members of the public around the documentation of their wishes and preferences for care alongside the subsequent sharing and use of this information.

The World Health Organization identifies unhealthy behaviors, such as smoking, as significant risk factors contributing to mortality and morbidity, underscoring the necessity to adopt healthier habits. The increasing prevalence of health applications (apps) presents opportunities for promoting healthier lifestyles. Notably, personalized mobile health (mHealth) interventions can enhance user engagement and their effectiveness. Our scoping review aims to contribute to guide the personalization of mHealth interventions for health behavior change by defining which mechanisms should be favored for a given user profile. Online databases were searched to identify articles published between 2008 and 2024 describing the topic of personalization, behavior change apps and mobile app mechanisms. Of 1806 articles identified, 18 articles were retained. We then categorized the mechanisms and user profiles described in the selected articles into existing taxonomies. Finally, the relationship between the user profiles and mechanisms were reported. The four user profiles identified included personality and gamer profiles. Twenty-one mechanisms extracted from the articles were categorized as behavioral change techniques, gamification or mobile app mechanisms, with limited numbers of preference relations between mechanisms and user profiles. The relation matrix was not complete and covered only 51% of possible relations: game mechanisms, 30%; behavioral change techniques, 16%; and app mechanisms, 5%. Two user profiles, the Big Five (18%) and Hexad scale (20%), covered 38% of relations, whereas the two remaining user profiles contributed to the remaining 13%. Social mechanisms, including competition, cooperation and social comparison, exhibit strong connections to user profiles and are pivotal in persuasive system design. Self-efficacy theory links mechanisms such as self-monitoring, social persuasion and rewards to behavior change. However, only 51% of potential relationships between profiles and mechanisms were identified. Adapting mHealth content based on user profiles requires reliable personality assessments and privacy-conscious data collection to enable personalized, profile-specific interventions for improved outcomes. Author SummaryThe promotion of healthy behavior, as well as addressing health risk factors that contribute to mortality, such as sedentary lifestyles, has led to a proliferation of mHealth apps. These apps have the potential to facilitate behavior change and offer a variety of features, including reminders, progress tracking and personalized interventions, which have been demonstrated to enhance user engagement and adherence. Personalization is of critical importance in the process of adapting interventions to align with the specific characteristics and needs of individual user profiles. The use of tailored messages and feedback has been demonstrated to be more effective than the use of generic ones, particularly in the context of promoting physical activity and weight loss. The incorporation of game design elements is also a prevalent feature in health apps, with evidence suggesting that it positively impacts on user engagement and motivation. However, there is a lack of comprehensive frameworks that provide guidance on their implementation in mHealth interventions. Here, we aim to optimize the effectiveness of interventions designed to facilitate health behavior change by defining game mechanisms, behavior change techniques and app mechanisms employed to personalize apps based on user profiles.

Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This rigorous meta-review applied a structured search of 10 databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 unique publications. Most reviews were moderate quality. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making support (13%), information provision or management (13%), and communication (9%). Positive impacts were reported on education, decision-making, information-sharing, communication, and costs. Impacts on symptom management were either positive or showed no harmful effects. However often DHIs were described but not evaluated. Responsive pragmatic research designs are now needed to guide further evaluation, implementation and to inform future service innovation.

Depression is a critical public health issue among women in rural India, with diagnosis and treatment rates being very low. The paper summarizes the development of MITHRA, a user-centred mobile app for depression screening and treatment among women in self-help groups (SHGs) of rural India. The predevelopment phase involved situation analysis and forming participatory design groups of prospective users. The app development phase used an Agile approach for flexibility and rapid adaptation. The post-development phase involved user acceptance testing, training on app usage, data synchronization, accuracy testing and usability evaluation. The study found that only 25% of the women in the participatory design group were digitally literate, despite 63% smartphone ownership. On assessing the cellular connectivity, the average download speed across the eight study sites was 9.81 Mbps, and the average upload speed was 4.6 Mbps. The user tests showed improvement in the task success rate between user testing session 1 and session 2 for all the tested tasks. The app successfully passed user acceptance testing (UAT) and data accuracy testing, demonstrating its readiness for deployment. Heuristic evaluation identified 52 violations with a mean score of 2.3, indicating minor usability issues to be addressed. This description of app development underscores the potential of mHealth apps in addressing mental health issues in underrepresented populations. What is already known on this topicDepression bears a high burden in rural India, particularly among women. Despite high prevalence, diagnosis and treatment rates remain low due to limited resources and stigma. Additionally, lack of awareness contributes to the problem, as many individuals in rural communities may not recognise depression as a treatable condition. Moreover, the scarcity of mental health specialists exacerbates the situation, especially in underserved rural areas. What this study addsThis study underscores the importance of a human-centred app development processes, utilizing a participatory design group approach that places users at the core of every development phase. This study uniquely involved no-to-low literate women and poor digital literacy from rural India as the primary users. By integrating these users before, during, and after the app development phase, the study ensured that the app was intuitive and accessible, specifically catering to the needs of this demographic. The apps design and functionality were directly influenced by the users, enhancing its effectiveness during mental health interventions. This approach improved usability, demonstrating the profound impact of inclusive and user-focused development practices. How this study might affect research, practice or policyThe results from this study reveal that incorporating human-centred design through a participatory approach--where a group of women from the same rural community actively contributed to an app development--leads to the development of an app that is well accepted by the target population. These findings represent a significant advancement in healthcare technology, emphasizing the importance of user engagement and cultural relevance in creating effective solutions. As researchers, policymakers, and practitioners consider these results, they may reshape methodologies, policies, and clinical practices to prioritize user-centric approaches and enhance overall healthcare outcomes. This study also highlights a potential alternative, accessible treatment option for rural communities, partially addressing the mental health workforce shortage.

There is a growing interest to investigate the feasibility of using voice user interfaces as a platform for digital therapeutics in chronic disease management. While mostly deployed as smartphone applications, some demographics struggle when using touch screens and often cannot complete tasks independently. This research aimed to evaluate how heart failure patients interacted with a voice app version of an already existing digital therapeutic, Medly, using a mixed-methods concurrent triangulation approach. The objective was to determine the acceptability and feasibility of the voice app by better understanding who this platform is be best suited for. Quantitative data included engagement levels and accuracy rates. Participants (n=20) used the voice app over a four week period and completed questionnaires and semi-structured interviews relating to acceptability, ease of use, and workload. The average engagement level was 73%, with a 14% decline between week one and four. The difference in engagement levels between the oldest and youngest demographic was the most significant, 84% and 43% respectively. The Medly voice app had an overall accuracy rate of 97.8% and was successful in sending data to the clinic. Users were accepting of the technology (ranking it in the 80th percentile) and felt it did not require a lot of work (2.1 on a 7-point Likert scale). However, 13% of users were less inclined to use the voice app at the end of the study. The following themes and subthemes emerged: (1) feasibility of clinical integration: user adaptation to voice apps conversational style, device unreliability, and (2) voice app acceptability: good device integration within household, users blamed themselves for voice app problems, and voice app missing desirable user features. The voice app proved to be most beneficial to those who: are older, have flexible schedules, are confident with using technology, and are experiencing other medical conditions.

BackgroundWearable activity monitors offer clinicians and researchers accessible, scalable, and cost-effective tools for continuous remote monitoring of functional status. These technologies can complement traditional clinical outcome measures by providing detailed, minute-by-minute remotely collected data on a wide array of biometrics that include, as examples, physical activity and heart rate. There is significant potential for the use of these devices in rehabilitation after stroke if individuals will wear and use the devices; however, the acceptance of these devices by persons with stroke is not well understood. ObjectiveIn this study, we investigated the participant-reported acceptance of a commercially available, wrist-worn wearable activity monitor (the Fitbit Inspire 2) for remote monitoring of physical activity and heart rate in persons with stroke. We also assessed relationships between reported acceptance and adherence to wearing the device. MethodsSixty-five participants with stroke wore a Fitbit Inspire 2 for three months, at which point we assessed the acceptance of wearing the device using the Technology Acceptance Questionnaire (TAQ) inclusive of its seven dimensions (Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Equipment Characteristics (EC), Privacy Concern (PC), Perceived Risk (PR), Facilitating Conditions (FC), and Subjective Norm (SN). We then performed Spearmans correlations to assess relationships between acceptance and adherence to device wear, which we calculated as both the percentage of daily wear time and percentage of valid days the device was worn during the three weeks preceding TAQ administration. ResultsMost participants reported generally agreeable responses with high overall total TAQ scores across all seven dimensions that indicated strong acceptance of the device; "Agree" was the median response to 29 of the 31 TAQ statements. Participants generally found the device beneficial for their health, efficient for monitoring, easy to use and don/doff, and unintrusive to daily life. However, participant responses on the TAQ did not show significant positive correlations with measures of actual device wear time (all p>0.05). ConclusionsThis study demonstrates generally high self-reported acceptance of the Fitbit Inspire 2 among persons with stroke. Participants reported general agreement across all seven TAQ dimensions with minimal concerns interpreted as being directly relatable to post-stroke motor impairment (e.g., donning and doffing devices, using the device independently). However, the high self-reported acceptance scores did not correlate positively with measures of real-world device wear. Accordingly, it should not be assumed that persons with stroke will adhere to wearing these devices simply because they report high acceptability.

BackgroundTwin revolutions in wearable technologies and smartphone-delivered digital health interventions have significantly expanded the accessibility and uptake of personalized interventions in multiple domains of health sciences. Gamification, the application of gaming elements to increase enjoyment and engagement, has the potential to improve the effectiveness of digital health interventions. However, the effectiveness of competition gamification components remains poorly understood, challenging informed decisions on the potential adoption of these components in future studies and trial designs. We aimed to evaluate the effect of smartphone-based gamified team competition intervention on daily step count and sleep duration via a micro-randomized trial. MethodsWe recruited first-year medical residents (interns) in the US, who downloaded the study app, provided consent, wore a wearable device, and completed a baseline survey. Teams were formed based on participating residents institutions and specialties, and subsequently randomized weekly to the competition or non-competition arms. In the competition arm, opponent teams and competition type (step count or sleep duration) were also randomly selected. Competition participants had access to the current competition scoreboard and competition history via the study app; they also received scheduled competition-related push notifications in a competition week. We estimated the main and moderated causal effects of competition on proximal daily step count and sleep duration. This trial is registered with ClinicalTrials.gov (NCT05106439). FindingsBetween April and June 2020, we enrolled 2,286 medical interns from 263 institutions, of whom 1,936 were formed into 191 teams that met the criteria for participation in competitions between July 6 and September 27, 2020. 1,797 participants who had pre-internship baseline information were included in the analysis. Relative to the no competition arm, competition intervention significantly increased the mean daily step count by 111{middle dot}5 steps (SE 40{middle dot}4, p=0{middle dot}01), while competition did not significantly affect the mean daily sleep minutes (p=0{middle dot}69). Secondary moderator analyses indicated that, for each additional week-in-study, the causal effects of competition on daily step count and sleep minutes decreased by 9{middle dot}1 (11{middle dot}6) steps (p=0{middle dot}43) and 1{middle dot}9 (0{middle dot}6) minutes (p=0{middle dot}003), respectively. Intra-institutional competition negatively moderated the causal effect of competition upon daily step count by -114.9 (93{middle dot}7) steps (p=0{middle dot}22). InterpretationGamified competition delivered via mobile app significantly increased daily physical activity which suggests that team competition can function as a mobile health intervention tool to increase short-term physical activity level. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed for studies of mobile health intervention with gamified components: ("mobile health intervention", "mHealth intervention", "mobile health gamification"). We evaluated studies published before November 30, 2021. The search was not limited by language. Previous work affirmed that in mobile health interventions, gamification is effective for improving users physical activity and mental health. Most of previous work used feedback, reward, and progress bar as game mechanics, while none have rigorously examined the effectiveness of gamified team competition. Added value of this studyThis study provides evidence that the gamified team competition has a positive effect on physical activity. The data that was intensively collected as part of this study can be used for further investigation. Implications of all the available evidenceThe results of this study indicate that gamified team competition has the potential to improve the effectiveness of and engagement with mobile health interventions.

Digital health tools may facilitate care continuum. However, enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. The study presents Health Circuit, a digital health tool with an adaptive case management approach and analyses its healthcare impact, as well as its usability (SUS) and acceptability (NPS) by healthcare professionals and patients. In 2018-19, an initial prototype of Health Circuit was tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (Study I). In 2021, a pilot version of Health Circuit was evaluated in 104 high risk patients undergoing prehabilitation before major surgery (Study II). In study I, Health Circuit resulted in reduction of emergency room visits [4 (13%) vs 7 (44%)] and enhanced patients empowerment (p<0.0001) and showed good acceptability/usability scores (NPS 31 and SUS 54/100). In Study II, NPS scored 40 and SUS 85/100. The acceptance rate was also high (mean score of 8.4/10). Health Circuit showed potential for healthcare value generation, good both acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios.

Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive-behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT program for insomnia and anxiety (eCBT+). This randomized controlled trial aimed to assess the usability and acceptability of the eCBT+ program and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomized to the eCBT+ intervention (n=38) or a waitlist (WL) control condition (n=42). Platform usability and program acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary sleep efficiency, were assessed at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS=69.94%). Perceived ease of use, perceived usefulness, and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group (ps< .001). The eCBT+ program was user-friendly and its use was acceptable in older adults with insomnia. The program improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults. (https://www.isrctn.com/ISRCTN15338211) KEYPOINTS{blacksquare} This randomized controlled trial evaluated the feasibility and efficacy of a digital cognitive behavioural therapy program for insomnia and anxiety, delivered through a platform tailored to older adults. {blacksquare}The platform was well accepted and considered user-friendly, with acceptability primarily explained by perceived ease of use, perceived usefulness and demonstrability of results. {blacksquare}The intervention demonstrated efficacy by improving sleep efficiency and reducing insomnia and anxiety symptoms. {blacksquare}This combined digital cognitive behavioural therapy for insomnia and anxiety represents an innovative, clinically relevant and accessible approach for older adults.

BackgroundAnticipatory injectable medications for symptom control are a key end-of-life care intervention. However, ensuring their safe and timely use in the community is a global challenge. The needs and priorities of stakeholders involved in processes for prescribing and administering these medications remain underexplored. We must understand these perspectives to design inclusive and adaptive systems. AimTo identify the needs and priorities of key stakeholders involved in community-based systems for using anticipatory injectable medications. DesignWe adopted a qualitative exploratory design, using an online survey between September and October 2024. Participants provided anonymised demographic information and completed up to four prompts capturing their stakeholder role, needs and priorities. Data were analysed using a combined inductive-deductive framework to produce synthesised shortlists of priorities and needs. Setting/participantsUK-based professional and public participants were recruited through social media, professional networks, charities, and public engagement events. ResultsIn total, 439 participants contributed 729 responses across various stakeholder groups. Findings revealed substantial diversity in stakeholder needs and priorities, both within and between groups. However, most stakeholder groups prioritised timely care, minimising of suffering, and wanted nationally consistent guidance for using injectable medications. Broader societal influences also shaped responses. ConclusionsOur findings highlight wide diversity in priorities and needs between stakeholders for using anticipatory injectable medications in the community. We propose that inclusive system design should include comprehensive assessment of key stakeholders needs and priorities, with the aim of providing better care. Our study demonstrates that stakeholder needs assessment offers a valuable framework to achieve this. What is already known about the topic?O_LIAnticipatory injectable medications are a widely used intervention in several countries to support timely end-of-life symptom control at home. C_LIO_LIThere are ongoing challenges with delays, inconsistent access, and variations in prescribing and governance across regions, indicating that system design influences both timeliness and safety. C_LIO_LIExisting research has primarily focused on the needs of individual professional groups, and no prior work has mapped the differing needs of all stakeholders involved in these systems. C_LI What this paper adds?O_LIOur study demonstrates that stakeholder groups have diverse needs but most share some core priorities -timely care, national consistency in practice guidance, and minimising suffering. C_LIO_LIWider societal factors and concerns shape stakeholder expectations of end-of-life medication systems. C_LIO_LIOur approach to stakeholder needs assessment reveals system requirements that consensus-based or single-perspective approaches often overlook. C_LI Implications for practice, theory, or policyO_LISystem improvements should be tailored to the specific needs of key stakeholder groups rather than assuming uniform priorities. C_LIO_LIStrong cross-stakeholder support exists for national, practical guidance on anticipatory prescribing, equipment, training, and governance. C_LIO_LIStakeholder needs assessment offers a useful method for designing safer, more responsive end-of-life medication systems. C_LI

BackgroundPatients who undergo complex surgery often experience substantial burden of health-related needs (medical, social, and behavioral health). A closed loop digital solution could facilitate the collection and resolution of health-related needs by care team members for patients who undergo complex surgery. A digital solution may facilitate adherence to a clear treatment plan and concomitantly reduce surgical complications and readmissions associated with unmet health-related needs, which remain persistent challenges across health care settings. ObjectivesTo establish a set of user specifications for a digital solution to collect and manage health-related needs, specifically medical, social, and behavioral needs for patients who undergo complex surgery. MethodsWe applied the Double Diamond Framework and organized the study into two phases: (1) qualitative methods to discover patients and care team members perspectives on health-related needs; (2) participatory design sessions to gain feedback about ideal features of a digital solution. We supplemented both phases with analysis of electronic health record data. ResultsExtensive themes emerged from interviews with patients (n=20) and care team members (n=24), capturing their health-related and surgical experiences as well as desired features for a proposed digital solution. A subset of participants from Phase 1 (n=5 patients and n=9 care team members) provided feedback on preferred features, drawing from digital tools currently available in the electronic health record system at our academic medical center. Findings from the qualitative interviews and design sessions were corroborated with documentation in the electronic health record. ConclusionDigital solutions could provide a streamlined approach for collection and management of health-related needs in surgery, with the goal of addressing unmet needs and improving patient activation. This approach is critical to ensure patients, especially patients who undergo complex surgery, have positive health outcomes. We identified preferences for specific features in a proposed digital solution based on our systematic assessment that will inform future work.

The objective of the present study is to evaluate the impact of remote consultations (telemedicine) conducted on a monthly basis, in conjunction with quarterly inpatient follow-ups conducted by a team specialising in palliative care for cancer patients, in terms of anticipating potential deterioration in patients general condition and enhancing their quality of life. The study also investigates whether there is a specific profile of patients who could benefit from teleconsultation and identifies patients expectations and concerns regarding teleconsultation. The study enrolled 36 patients on their initial admission to a palliative care day hospital (HDJ), and they completed a questionnaire regarding their demographics, expectations, and reservations concerning teleconsultation. Patients were then scheduled for two monthly teleconsultations and were advised to return to the HDJ at D = 3 months. However, only 13 out of the 36 patients enrolled were able to benefit from the two teleconsultations and return to the HDJ after 3 months. This finding underscores the critical issue of patients being referred to the mobile palliative care team at a late stage. Our study revealed that factors such as age, gender, socio-economic status, and pathology did not influence patient compliance or the efficacy of the teleconsultations. The study emphasised the benefits of monthly teleconsultations for the clinical and psychological management of patients, highlighting that patients had minimal negative preconceptions upon enrolment and expressed a strong desire to continue these monthly consultations after the initial 3-month period. The findings underscore the significance of leveraging teleconsultations for patients receiving palliative care in oncology, particularly in scenarios where face-to-face consultations are not feasible. Telemedicine holds immense potential to enhance the monitoring of a larger patient population, thereby promoting greater equity in healthcare delivery.