DIGITAL HEALTH

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.

BackgroundHealth information systems are important for health planning and monitoring of progress. Still, data from health facilities are often of limited quality in Low-and-Middle-Income Countries. Quality deficits are partially rooted in the fact that paper-based documentation is still the norm at facility level, leading to mistakes in summarizing and manual copying. Digitalization of data at facility level would allow automatization of these procedural steps. Here we aimed to evaluate the feasibility, usability and acceptability of a scanning innovation called Smart Paper Technology for digital data processing. MethodsWe used a mixed-methods design to understand users engagement with Smart Paper Technology and to identify potential positive and negative effects of this innovation in three health facilities in Southern Tanzania. Eight focus group discussions and 11 in-depth interviews with users were conducted. We quantified time used by health care providers for documentation and patient care using time-motion methods. Thematic analysis was used to analyze qualitative data. Descriptive statistics and multivariable linear models were generated to compare the difference before and after introduction and adjust for confounders. ResultsHealth care providers and health care managers appreciated the forms simple design features and perceived Smart Paper Technology as time-saving and easy to use. The time-motion study with 273.3 and 224.0 hours of observations before and after introduction of Smart Paper Technology, respectively, confirmed that working time spent on documentation did not increase (27.0% at baseline and 26.4% post-introduction; adjusted p=0.763). Time spent on patient care was not negatively impacted (26.9% at baseline and 37.1% at post-intervention; adjusted p=0.001). Health care providers described positive effects on their accountability for data and service provision relating to the fact that individually signed forms were filled. DiscussionHealth care providers perceived Smart Paper Technology as feasible, easy to integrate and acceptable in their setting, particularly as it did not add time to documentation.

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.

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.

More than one third of adults with diabetes can experience diabetes distress due to the demands of daily self-care. As a cognitive therapy, mindfulness can alleviate diabetes distress but face-to-face programmes can be difficult to access and pay for, and apps lack personalisation and feedback. Virtual reality (VR) may support mindfulness practice, but no VR app tailored to people experiencing diabetes distress exists. We interviewed mindfulness practitioners and conducted co-design workshops (using focus groups, questionnaires, artistic methods, generative artificial intelligence tools and prioritization techniques) with adults with type 2 diabetes to gather perspectives on designing a VR mindfulness app. We analysed data using descriptive statistics and the framework approach. Most participants preferred a simple design and layout to use the virtual environment to practice mindfulness, with customisable design options and interactive features that were culturally appropriate. We identified new design features, functionality, and content that informed a software design specific documentation to build a prototype VR mindfulness app for people experiencing diabetes distress. Further research should include more diverse populations to elicit detailed specifications for software design and include safety features to minimise risk when using VR technologies to practice mindfulness.

BackgroundSocial determinants of health (SDOH) affect health outcomes, with unmet social needs like food insecurity, housing instability, and lack of services contributing to poor outcomes, health disparities, and higher healthcare costs. Identifying these needs is vital for improving health and achieving equity. Information technology has emerged as a tool for screening and identifying unmet social needs. ObjectivesThis scoping review examines how information technology is used to screen and identify unmet social needs among vulnerable populations and its impact on the assessment process. MethodsFollowing PRISMA-ScR guidelines, we searched databases including MEDLINE, Embase, Scopus, ACM Digital Library, and Web of Science for studies published from 2010 to 2023. Eligible studies used technology to screen for and identify unmet social needs in populations with health and socioeconomic challenges. Data extraction focused on the types of technology, screening processes, and social needs identified. ResultsOur findings highlight a limited yet evolving landscape of technological applications. We identified 13 studies using tools like self-assessment surveys, tablet-based systems, and electronic portals. These tools were applied across diverse groups, such as refugees and patients in emergency departments. Innovative approaches, such as chatbots and multi-dimensional risk appraisal systems for older adults, showed potential. However, challenges included single-site studies, small samples, and integration issues with medical records. Effectiveness varied. The effectiveness of these tools in screening for unmet social needs shows mixed outcomes. ConclusionsInformation technology plays a pivotal role in improving the identification of unmet social needs. The findings underscore the need for broader, more integrated research to fully understand the impact of technology-based assessments and screening processes for social needs. Future efforts should focus on facilitated screening using technology both within and outside of the visit, ensuring the linkage to appropriate resources and care.

BackgroundAs the COVID-19 global pandemic continues, digital exposure notification systems are increasingly used to support traditional contact tracing and other preventive strategies. Likewise, a plethora of COVID-19 mobile apps have emerged. ObjectiveTo characterize the global landscape of pandemic related mobile apps, including digital exposure notification and contact tracing tools. Data Sources and MethodsThe following queries were entered into the Google search engine: "(*country name* COVID app) OR (COVID app *country name*) OR (COVID app *country name*+) OR (*country name*+ COVID app)". The App Store, Google Play, and official government websites were then accessed to collect descriptive data for each app. Descriptive data were qualified and quantified using standard methods. COVID-19 Exposure Notification Systems (ENS) and non-Exposure Notification products were categorized and summarized to provide a global landscape review. ResultsOur search resulted in a global count of 224 COVID-19 mobile apps, in 127 countries. Of these 224 apps, 128 supported exposure notification, with 75 employing the Google Apple Exposure Notification (GAEN) app programming interface (API). Of the 75 apps using the GAEN API, 15 apps were developed using Exposure Notification Express, a GAEN turnkey solution. COVID-19 apps that did not include exposure notifications (n=96) focused on COVID-19 Self-Assessment (35{middle dot}4%), COVID-19 Statistics and Information (32{middle dot}3%), and COVID-19 Health Advice (29{middle dot}2%). ConclusionsThe digital response to COVID-19 generated diverse and novel solutions to support non-pharmacologic public health interventions. More research is needed to evaluate the extent to which these services and strategies were useful in reducing viral transmission. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSThe COVID-19 pandemic created a role for technology to complement traditional contact tracing and mitigate the spread of disease. How countries responded with technology - specifically, how they utilized mobile apps to support public health was a focus of this research. The search process consisted of searching the Google Search Engine using queries "(*country name* COVID app) OR (COVID app *country name*) OR (COVID app *country name*+) OR (*country name*+ COVID app)." Apps that were found on the App Store, Google Play, and official government format that fit the pre-defined eligibility criteria were included in the Apps list considered in this search. Apps that did not match those criteria were excluded from the process. All 195 countries and associated COVID-19 apps were considered for inclusion if they were official COVID-19 apps adopted by the governments of those countries. Added value of this studyFindings from this research contributes to the literature by providing a synthesis of how technology is being used to support public health authorities in reducing the spread of COVID-19. The results of this global landscape analysis of COVID 19 mobile apps, included both COVID-19 Exposure Notification Apps and non-Exposure Notification Apps. Implications of all the available evidenceThe findings of this research can provide the foundation for future studies to assess adoption rates and, subsequently identify app features that lead to increased adoption of both Exposure Notification and non-Exposure Notification Apps. Only when a product meets the needs of consumers will it be adopted and utilized, and in the case of exposure notification tools, save lives. Eligibility CriteriaThe study eligibility criteria included any COVID-19 mobile applications and COVID-19 Exposure Notification (EN) systems that were downloadable or activated on a mobile device. The search process involved using queries "(*country name* COVID app) OR (COVID app *country name*), OR (COVID app *country name*+) OR (*country name*+ COVID app)" in Google search engine to identify COVID-19 apps in each country. The data included active and inactive apps discovered during the data collection period of June 2021 - July 2021.

BackgroundThe prevalence of diabetes in low- and middle-income countries is rising, and the most important treatment is maintaining a healthy lifestyle. Good diabetes self-care management is associated with better outcomes, but barriers to adhering to its management are knowledge deficits and a lack of social support. Traditionally, diabetes self-care management education and support are conducted by health care workers (HCWs), but limited access to HCWs restricts this activity. Digital health interventions can help overcome some barriers. ObjectiveTo describe type 2 diabetic patients perception of using WhatsApp for diabetes education, as well as the barriers and enablers they experienced in their usage, in the Tigray region of Ethiopia. MethodThis study is a collaboration between researchers from Norway and a researcher from Ethiopia. A qualitative explorative and descriptive approach was adopted. The co-researcher in Ethiopia recruited the participants, and research assistants conducted 17 interviews with a semi-structured interview guide based on the technology acceptance model. The interviews were conducted in Tigrinya, transcribed and translated to English, and de-identified before analysis. The data were analysed using NVIVO 14 with reflexive thematic analysis. ResultsFrom the data, the following four themes were developed: experienced enhanced self-care, digital access to HCWs, digital support, and barriers and enablers. The participants perceived WhatsApp as highly useful. The participants said that they gained new knowledge and experienced social support and increased access to HCWs when using WhatsApp. ConclusionWhatsApp was perceived as easy to use, but some barriers were reported. This study indicates that WhatsApp may contribute to enhancing access to diabetes self-care management education and support.

Heart failure (HF) affects millions worldwide and is associated with high hospital readmission rates. Patients with HF often face challenges such as medication non-adherence, mild cognitive decline, limited healthcare access, and poor knowledge of their condition. Validated digital health tools (DHTs) can help manage HF and prevent symptom worsening. However, it is essential to consider the input of family physicians (FPs) in the development of user-centered DHTs. This study aimed to understand FPs attitudes and needs regarding the feasible and effective use of existing self-care DHTs to support older patients with HF. This qualitative study used a user-centered design framework. Semi-structured interviews with twelve FPs were conducted, using persona-case scenarios. The data were analyzed using NVivo 12 software and Braun and Clarkes thematic analysis method. The following themes were revealed: availability of advice in challenging situations, patient clinical data, digital health tool competencies, patient factors, attitudes and preferences toward digital health technology, and the primary care climate. This study explores family physicians (FPs) needs and expectations in supporting seniors with heart failure (HF) through self-care digital health technologies (DHTs). The findings highlight key challenges FPs face in managing chronic diseases in older adults and emphasize critical considerations for designing HF digital health platforms. Specifically, the study underscores the importance of feasibility and effective integration into primary care, ensuring these platforms align with clinical workflows and enhance patient self-management. These insights can guide the development of user-centered DHTs that support both physicians and patients, ultimately improving HF care in primary care settings. Author SummaryThis study aimed to explore family physicians (FPs) attitudes and needs regarding the feasibility and effectiveness of supporting older patients with heart failure (HF) using a self-care digital health tool (DHT). The DHT used in this study is CorLibra, a medical device designed to promote HF self-management in the home setting. CorLibra helps patients monitor their weight daily and adjust their diuretic medications accordingly. The tool was specifically developed to address the unique needs of older adults based on extensive qualitative research. Our findings provide valuable insights into how FPs can effectively support patients using such tools to manage chronic conditions like HF.

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.

BackgroundUnmet Health-related social needs (HRSNs), such as food insecurity and housing, significantly impact health outcomes and wellbeing. Although screening tools are widely adopted to identify the needs, sustainable linkage to resources remains challenging. Conversational agents (chatbots) offer potential solutions for tailored and personalized feedback, real-time navigation, yet their usability and trustworthiness among populations with high needs require further exploration. MethodsWe conducted a mixed-methods study to evaluate user experiences with the DAPHNE(C) chatbot, which is designed to identify unmet HRSNs and provide personalized resource recommendations. Quantitative and qualitative data were collected from 128 caregivers with at least one dependent child. Online study design combined scenario/ task-based and free form chatbot use, to guide the engagement. Study measures included usability (SUS), task load (NASA-TLX), satisfaction (NPS), and trust. Qualitative analysis involved user feedback and user-chatbot conversation transcripts. We used regression and pairwise analyses to explore associations between demographic characteristics, self-reported unmet HRSNs and user experience outcomes (usability, satisfaction, task load and trust). ResultsMost participants were female (68%), aged 30-49 years (71%), and White (44%) or Black/African American (36%) and Hispanic/Latino (27%), relied on Medicaid/Medicare (83%), and cared for a child with, or had, special healthcare needs (78%). Participants reported high usability (SUS= 84.7, SD=12.4), low task load (NASA-TLX= 6.8, SD=2.8), high satisfaction (NPS= 8.0, SD=2.4), and high trust (Mean= 4.1, SD=0.8). Nearly all participants (98%) reported unmet HRSNs, including food insecurity (76%) and financial limitations (75%). Free-form chatbot conversation sessions averaged 3 minutes and [~]20 turns, with greater use of assistive buttons over typing. Furthermore, DAPHNE (using retrieval-augmented generation to ground every recommendation in a live social-care API) achieved 99 % intent accuracy in 1,523 message turns. Dialogues focused on financial, housing, and food needs. 94% of participants found the tool was helpful, while requesting design features like saved histories, voice interaction, and richer local resource details. Regression analysis showed usability and trust were broadly consistent across most demographic groups, though participants with higher education and lower income showed modest decrements in usability. Several HRSNs, including transportation and utility disruptions, were associated with higher trust and satisfaction, suggesting the assistant may hold particular value for users facing structural these barriers. DiscussionThe DAPHNE chatbot demonstrates potential as a useful tool for addressing HRSNs, with strong usability and trust among diverse populations. Future designs should focus on longitudinal impact assessments and effectiveness to enhance accessibility and address practical implementation challenges.

Digital health technologies are pivotal for strengthening health systems and accelerating progress toward Universal Health Coverage (UHC). In Nigeria, while digital health interventions have been widely introduced, disparities in maturity and effectiveness are evident across different states. This study comprehensively assesses digital health maturity across ten Nigerian states, leveraging the Global Digital Health Index (GDHI) framework and the UN Foundation/ICT4SOML maturity model. Employing a mixed-methods approach that includes key informant interviews, document reviews, and quantitative scoring, the analysis evaluates seven core domains: leadership and governance, strategy and investment, legislation and compliance, standards and interoperability, infrastructure, workforce, and services and applications. The analysis also situates surveyed states along a maturity spectrum from experimentation to mainstreaming. Findings reveal substantial variations in digital health readiness among the ten states. Lagos emerged as the most advanced, demonstrating robust governance structures, interoperability initiatives, and strategic investments in ICT infrastructure. In contrast, states like Gombe, Niger, Bauchi, Sokoto, Borno, Nasarawa and Yobe were the least matured, hindered by weak workforce capacity, poor infrastructure, and a lack of standardized interoperability. The assessment further identifies heavy reliance on donor-driven projects, limited state ownership, and fragmented governance as key barriers to sustainable digital health implementation. To address these gaps, the study recommends establishing a National Digital Health Observatory for benchmarking and peer learning, alongside targeted state-level capacity building and infrastructure investments. The findings highlight the urgent need for stronger political commitment, structured governance, and the domestication of national digital health policies at the sub-national level. By mapping states on a digital health maturity spectrum, this study offers a clear framework for targeted interventions, optimized resource allocation, and accelerated progress toward a resilient, interoperable digital health ecosystem across Nigerias states.

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.

Background: Mobile phone-based tools are increasingly used to collect data on non-communicable disease (NCD) risk factors, particularly in low-resource settings where traditional data collection systems face operational and infrastructural constraints. This study examined stakeholder perspectives on the use of enhanced mobile phone-based capabilities to support the collection of public health surveillance data on NCD risk factors in low-resource settings. Methods: An exploratory qualitative study was conducted between November 2022 and July 2023. Twenty in-depth interviews were conducted with public health specialists, ethicists, NCD researchers, health informaticians, and policy makers in Uganda. Thematic analysis was used to interpret the results. Results: Four themes emerged from the data, including benefits of using mobile phone capabilities for NCD risk factor data collection; ethical, legal, and social implications; perceived challenges of using such mobile phone capabilities; and proposed solutions to improve the utility of phone-based capabilities in data collection on NCD risk factors. Participants recognized the potential of mobile technologies to improve data collection efficiency and expand access to hard-to-reach populations. However, concerns emerged regarding inadequate informed consent, risks to privacy and confidentiality, unclear data ownership, and vulnerabilities created by inconsistent enforcement of data protection laws. Social concerns included low digital literacy, unequal access to mobile devices, and fear of stigmatization. Participants emphasized the need for transparent communication, robust data governance, and community engagement. Conclusion: Mobile phone-based systems can strengthen the collection of NCD risk factor data in low-resource settings; however, their benefits depend on addressing key ethical, legal, and social challenges. To ensure responsible deployment, digital health initiatives must prioritize participant autonomy, data protection, equity, and trust building. Integrating contextualized ethical, legal, and social considerations into design and policy frameworks will be essential to leveraging mobile technologies in ways that support inclusive and effective NCD prevention and control.

ObjectiveThe study sought to investigate the relationship between attitude towards digital health technology and age, gender and frequency of use of digital health technology and to consider whether age, gender and frequency of use present potential barriers to accessing future healthcare in the UK. Differences in technological affinity are likely to lead to differences in the adoption of digital health technology and subsequent inequalities in healthcare between older and younger people and between men and women. DesignThe study represents an example of a technology adoption study employing a survey-based cross sectional correlational design. Attitude towards digital health technology was measured using the 20 item Digital Health Scale. Age, gender, frequency of use of health technology and employment status data were gathered using a demographics questionnaire. The opportunity sample (N = 247) included volunteer participants aged 16-84 years (M = 31.7, SD = 19.35, 156 females and 91 males). ResultsResults indicated a significant negative correlation between age and positive attitude towards digital health technology (r = -0.24, p < .01). Gender differences in attitudes towards digital health technology were non-significant (p > .05). Significant differences in frequency of use were also found, where occasional and frequent use resulted in more positive attitudes than never having used digital health technology (p < 0.05) and participants reporting frequent use were significantly older than those reporting never or occasional use (p < .05) ConclusionFindings identified age, but not gender, as a significant factor in attitude towards digital health technology, suggesting that continued and increased reliance on digital technology in healthcare may lead to age, but not gender, related inequalities in access to healthcare in the UK. That frequent users of digital health technology were also older, highlights the greater demand for healthcare services by older individuals and is further evidence for the potential of digital healthcare to lead to age related inequalities in access to and provision of healthcare. Recommendations for successful application of digital healthcare technology are considered in the light of these findings.

BackgroundTechnologies comprise a broad range of applications with the potential to transform outcomes for the millions of people requiring rehabilitation each year. Despite this potential, many technologies are not successfully implemented into clinical practice. No single consistent approach or model is used to support their implementation into any form of rehabilitation. This study aimed to understand the influences upon rehabilitation technology implementation in the UKs National Health Service and, using this understanding, develop a comprehensive implementation model to support the adoption of rehabilitation technologies. MethodsA multi-methodological approach comprising qualitative enquiry and literature reviews was used to identify, analyse and group key factors that influenced rehabilitation technology implementation. FindingsSeven themes, identified from qualitative enquiry of 48 participants, representing 8 stakeholder groups in the UK, were integrated with published technology and implementation models to generate five key domains that comprise Rehabilitation Technology Implementation Model (RiTe). These domains were: evidence, technology, users, team and organisation. InterpretationThe RiTe model provides a novel and comprehensive understanding of the key factors that influence rehabilitation technology implementation and can be used to plan, support and evaluate implementation efforts. The demands of rehabilitation require repeated, frequent and prolonged participation in interventions by users with variable needs, which means that barriers and facilitators are likely to exert a magnified effect upon the process and success of implementation. Consequently, the key influencers of rehabilitation technology implementation identified in this study provide a critical opportunity to understand factors which could influence technology uptake in other clinical specialties, attesting to the value of the RiTe model to both rehabilitation and wider healthcare.

BackgroundGAI tools are increasingly used informally for health, yet evidence from low- and middle-income countries (LMICs) is limited. This study generates early evidence on such health systems from the fifth most populous country: Pakistan. MethodsWe used a youth-led convergent mixed-methods design among digitally connected urban youth in Pakistan (survey N=1240, 20 interviews). The primary outcome was any GAI use for health. We fitted multivariable logistic regression models and conducted reflexive thematic analysis. FindingsOverall, 69.0% of participants reported using GAI for health. Higher odds of use were observed among women (aOR = 1.57, 95% CI [1.17-2.11], p = 0.003) and youth reporting any mental or physical condition (aOR = 1.82, 95% CI [1.34-2.48], p < .001). Greater trust in AI strongly predicted use (per-level aOR = 4.21, 95% CI [2.98-6.01], p < .001). High confidence using AI (aOR = 1.81, 95% CI [1.11-3.07], p = 0.022), awareness of AI risks (aOR = 1.67, 95% CI [1.20-2.31], p = 0.002), and prior use of other (non-generative) digital health tools (aOR = 4.48, 95% CI [2.59-8.23], p < .001) were also associated with higher likelihood of use. Telemedicine use was significant though weaker in magnitude (aOR = 1.58, 95% CI [1.01-2.54], p = 0.049). Interviews highlighted three themes: (1) access and affordability driving first-line use; (2) emotional safety and informational support, especially for stigmatized concerns; and (3) perceived empowerment in interpreting tests, organizing symptoms, and preparing for clinical visits. ConclusionGiven constrained, stigmatizing, and costly services, GAI may function as an adjunct "first step" for youth health information and emotional support in Pakistans health ecosystem.

BackgroundAlthough there has been an increase in the availability of mobile health (mHealth) tools globally and their potential benefits for both healthcare providers and patients, the adoption of mHealth is still relatively low. Additionally, only a limited number of studies have investigated the intention of individuals to download mHealth apps. ObjectiveWe conducted a study to explore peoples inclination towards using a health app. MethodsWe conducted the study in Nigeria using a discrete choice experiment. The study had a sample size of 2800 participants who were presented with two different attributes and levels. These attributes were price ($20 = N 17932.80 [at a currency exchange rate of $1= N896.64], and free subscription option) and data protection (with options of data protection vs no data protection). The participants were randomly assigned to the different attribute and level options. For the analysis, we used the conditional logistic model. ResultsAccording to the results of the study, the likelihood of downloading a mHealth app is significantly higher when the app is offered for free. The study also found that users tend to ignore data protection specifications, and instead prioritize free subscription offers while showing reluctance towards apps that come with a price tag. ConclusionsThe use of mobile health (mHealth) tools has a high potential in reducing healthcare costs and enhancing the efficacy of traditional health interventions and therapies. The major driving forces behind the increasing adoption of mHealth apps in the future are cost reduction and the establishment of sound business models. It is crucial to establish reliable standards for mHealth apps, which can include information about pricing and legislation regarding data protection, to ensure that potential consumers can make informed decisions.

BackgroundDuring the pandemic in Peru, the COVIDA project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 pandemics led by health student volunteers. However, it has not been described how this interaction is perceived from the users perspective. The aim of this study is to describe the adherence and perceptions of users about COVIDA. MethodsA mixed-method study was conducted to evaluate the adherence and perceptions of COVIDA users. This telehealth intervention implemented in Peru from August to December 2020 involved daily phone-calls by volunteer students to monitor registered users for 14 days or until a warning sign was identified. The volunteers also provided teleorientation to address the users needs and concerns. Quantitative analysis described the characteristics of users and assessed the factors related to adherence to the service. Qualitative analysis trough semi-structured interviews evaluated the users perceptions about the service. ResultsOf the 778 users enrolled in COVIDA, 397 (54.7%) were female and had a mean age of 41 years (SD: 15.3). During the monitoring, 380 users (44.4%) developed symptoms, and 471 (55.5%) showed warning signs for COVID-19. The overall median of adherence was 93% (p25:36%, p75:100%). Among those users who did not develop warning symptoms, a high level of adherence (>66%) was seen predominantly in users that developed symptoms and those with a positive COVID-19 test (p<0.05). Users referred that the information provided by volunteers was clear and valuable and, their accompaniment provided them with emotional support. Communications via phone calls were developed fluently without interruptions. ConclusionsCOVIDA represented an affordable, well-accepted, and perceived alternative model for telemonitoring, teleorientation and emotional support from student volunteers to users with diseases such as COVID-19 in a context of overwhelmed demand for healthcare services.

BackgroundRural districts in Sierra Leone struggle with timely and complete maternal-child health service use. CommCare, a mobile health (mHealth) platform deployed through partnerships with government and NGOs, supports tracking, reminders, and follow-up. MethodsA cross-sectional quantitative study at Falaba CHC (Sulima Chiefdom) assessed CommCares effects on (i) timeliness and frequency of ANC, (ii) PNC follow-up and care quality, and (iii) immunization uptake among children <2 years. Data were collected from n=288 participants using a structured CommCare questionnaire aligned with five sections (A-E) and extracted CommCare indicators; analysis used descriptive statistics and chi square {chi}{superscript 2} tests (=0.05), with effect sizes where applicable. ResultsFirst-trimester ANC initiation increased from 45% to 65% ({chi}{superscript 2}=8.34, p=0.004); completion of [&ge;]4 ANC visits rose 55%[-&gt;]78% ({chi}{superscript 2}=7.72, p=0.009). PNC improved: first-week postpartum follow-up 40%[-&gt;]80% ({chi}{superscript 2}=6.12, p=0.014). Immunization adherence increased 60%[-&gt;]82% ({chi}{superscript 2}=11.34, p=0.002); missed vaccination appointments declined by 24%. CommCare reminders showed strong associations with timely attendance (e.g., PNC {chi}{superscript 2}=28.451, p<0.001) and fewer missed immunization appointments ({chi}{superscript 2}=55.524, p<0.001; {Phi}=-0.439, Cramers V=0.439). ConclusionCommCare substantially improved timeliness and continuity of maternal and child health services at Falaba CHC. Findings support CHW-mediated, reminder-driven mHealth as an effective strategy in similar rural settings. Author SummaryThis study evaluates the role of CommCare, a mobile health (mHealth) platform, in improving maternal and child health service uptake at Falaba Community Health Center in Sierra Leone--a rural district marked by logistical, cultural, and infrastructural barriers to care. Using a cross-sectional quantitative design with 288 participants, the study assessed CommCares effect on antenatal care (ANC), postnatal care (PNC), and immunization adherence. Findings demonstrate consistent and significant gains across the continuum of care. First-trimester ANC initiation improved from 45% to 65%, and completion of at least four visits rose from 55% to 78%. PNC attendance within the first week postpartum doubled from 40% to 80%. Immunization adherence increased from 60% to 82%, while missed appointments declined by nearly a quarter. Strong associations were observed between CommCare reminders and timely service use, with most respondents rating the reminders as "extremely useful." Importantly, the interventions impact was mediated through community health workers (CHWs), meaning phone ownership was not a barrier to equitable reach. These results highlight CommCares potential as a scalable, CHW-mediated digital tool to strengthen rural health systems by enhancing timeliness, continuity, and confidence in maternal-child healthcare. However, persistent gaps such as transport barriers, socio-economic constraints, and limited health system capacity suggest that digital reminders must be complemented by structural supports for sustained impact. The study contributes to the evidence base on mHealth in low-resource settings, underscoring that digital interventions are most effective when embedded into health system workflows and coupled with investments in CHWs, logistics, and culturally attuned communication strategies.