%0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41565 %T Effectiveness of Telegenetic Counseling for Patients and Families With Suspected Hereditary Cancer: Systematic Review %A Shibuya,Yuriko %A Harada,Tomoyo %A Aoki,Mikiko %A Ota,Erika %A Kamei,Tomoko %+ Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-chou, Chuo-ku, Tokyo, Tokyo, Japan, 81 03 3543 6391, 21dn011@slcn.ac.jp %K telegenetics %K genetic counseling %K hereditary cancer: systematic review %D 2023 %7 29.6.2023 %9 Abstract %J iproc %G English %X Background: Telegenetic counseling has attracted attention as a preventive measure against the recent COVID-19 pandemic. This systematic review compared telegenetic counseling using videoconferencing versus face-to-face counseling for hereditary cancer. Objective: This study aimed to evaluate the effectiveness of telegenetic counseling using videoconferencing versus face-to-face counseling for people with suspected hereditary cancer. Methods: A comprehensive literature search was carried out in December 2021 using the databases of the Japan Medical Abstracts Society, PubMed, CINAHL, PsycInfo, EMBASE, and the Cochrane Library. The eligibility criteria were studies in which randomized controlled trials (RCTs) or cluster RCTs were conducted among patients with suspected hereditary cancer and their families, comparing telegenetic counseling using videoconferencing with face-to-face genetic counseling. The Cochrane risk-of-bias tool was used to assess the risk of bias of each RCT study. This study was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Results: Two studies comprising a total of 191 participants were included and used for meta-analysis. Participants were individuals who lived in rural areas or in areas without genetic counselors and were suspected to have breast, colon, ovarian, multiple, or genetic cancer. All outcomes were assessed in only 1 study and their effects could not be discussed explicitly. In one study, there were no significant differences in satisfaction, psychological distress, or a number of genetic tests between face-to-face genetic counseling and telegenetic counseling. The cost per patient for genetic counseling was $106.19 for the telegenetics group and $244.33 for the in-person group. The risk of bias was high in both studies, with a high risk of performance bias, detection bias, and attrition bias. Conclusions: The results of the two RCTs were described qualitatively. However, the evidence is limited because of the small number of RCT studies on telegenetic counseling and the high risk of bias. Further accumulation of studies is needed in the future. Conflicts of Interest: None declared. %R 10.2196/41565 %U https://www.iproc.org/2023/1/e41565 %U https://doi.org/10.2196/41565 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41204 %T Key Enablers to Boost Digital Health Solutions in Latin America %A Morán-Reséndiz,Regina %A Ruiz-Arias,Catalina %+ Facultad de Ingeniería, Universidad Panamericana, Augusto Rodin 498, Ciudad de México, 0390, Mexico, 52 4424653135, contacto@reginamoran.com.mx %K digital health %K Latin America %K health care %K innovation %D 2023 %7 28.6.2023 %9 Abstract %J iproc %G English %X Background: COVID-19 has exposed the fragility of global health systems. However, the pandemic is perceived to have boosted the use of technology and accelerated digital health solutions (DHS). In Latin America, DHS can increase accessibility and provide more efficient health services. Various key players have relevant roles for innovation within the health care systems. For this study, we focused on health-tech start-ups (developers) and health care providers (implementers) who can cocreate and develop new health care solutions. Objective: This research aimed to explore the aspects that boost innovation in the health care ecosystem in Latin America, based on the 5 key aspects of the Innovation Readiness Levels: market, technology, organization, partnerships, and risk. Methods: For this research, a qualitative study was conducted using the 5 key aspects of the Innovation Readiness Levels. Two types of organizations were selected: health-tech start-ups (developers) and health care providers (implementers). A total of 12 professionals from Latin America were interviewed. For each interview, quotes related to the 5 aspects were selected and subclustered to find relationships. Results: Based on the discovered relationships, 7 aspects to boost DHS in Latin America were identified: agility to respond, facilitating collaboration, building and sharing knowledge, creating user-centered solutions, economic resources and sustainability, ease of technological development and adoption, and reaching beyond hospitals. The first 4 aspects could apply to other regions outside Latin America. The last 3 are related to regional challenges in Latin America. Obstacles and calls to action were identified for each aspect. Conclusions: To boost DHS in Latin America, it is necessary to have a complete overview of the patient’s journey and consider all the users involved to understand their needs and identify opportunities to develop new solutions. This will contribute to the improvement of health solutions and patient outreach. Future research is suggested to develop a better understanding of these aspects in the Latin American countries that were not included in this research and to validate whether these are the only key aspects needed. Conflicts of Interest: None declared. %R 10.2196/41204 %U https://www.iproc.org/2023/1/e41204 %U https://doi.org/10.2196/41204 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41724 %T A Survey of Internet Performance During COVID-19 %A Dittmann,Lars %+ Department of Electrical and Photonics Engineering, Technical University of Denmark, Oersteds Plads, 343, 222, Kongens Lyngby, DK-2800, Denmark, 45 45253851, ld@com.dtu.dk %K internet %K security %K eHealth %K COVID-19 %D 2023 %7 27.6.2023 %9 Abstract %J iproc %G English %X Background: Since the beginning of 2020, many societal systems have been used to extend the health care system, which were not planned for, and as such, there is concern for its collapse. Clearly, the collapse of the health care system, primarily hospitals, has been a key concern, and many initiatives, including lockdown and curfew, were taken to avoid such a collapse. The internet was the key platform used to enable people to work from home, provide remote teaching, conduct meetings on the web, etc. However, when it comes to data communication and processing, the risk of collapse is not the only risk, and maybe not even the biggest one. Many systems were not properly adapted for used in such a hurry, which did not allow time (and concern) for a proper risk and privacy assessment. Objective: This paper presents internet performance statistics and analyzes how this knowledge can be used in future designs of internet-based telemedical solutions. Methods: Statistics regarding traffic increases and security attacks on the internet during 2020 and 2021 were analyzed. Results: The internet did not collapse during the COVID pandemic—as many people had predicted. However, the massive use of the internet, in new innovative ways, created a number of new opportunities for cybersecurity breach. Especially, the use videoconferences enabled made-in-middle attacks, phishing, and other classical breaches in new ways due to insufficient authentication and content encryption. Conclusions: Even though a large amount of experience has been gathered with respect to scaling eHealth systems, a minimum amount of improvement with respect to privacy and security has been identified. Conflicts of Interest: None declared. %R 10.2196/41724 %U https://www.iproc.org/2023/1/e41724 %U https://doi.org/10.2196/41724 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41686 %T Improving Telehealth Equity in Response to COVID-19 in California: ACTIVATE and Lighthouse %A Lindeman,David %+ Center for Information Technology Research in the Interest of Society and the Banatao Institute, University of California, Berkeley, 2594 Hearst Ave, Berkeley, CA, 94720, United States, 1 510 666 3677, dlindeman@citris-uc.org %K telehealth %K aging %K underserved populations %D 2023 %7 27.6.2023 %9 Abstract %J iproc %G English %X Background: In response to the significant stressors on health care delivery created by COVID-19, CITRIS Health and partner organizations developed 2 telehealth solutions through a rapid co-design process: Lighthouse and ACTIVATE. These programs were developed to support providers serving underserved and vulnerable populations who lack the tools and resources to support patients with chronic illness or who are isolated. These challenges were exacerbated by the COVID-19 pandemic, which increased the need for resources to support vulnerable patients who could not come into a clinic in person or were isolated and lacked access to services. ACTIVATE and Lighthouse apply 2 different telehealth strategies to reach vulnerable populations. Objective: This paper presents lessons learned from the design, development, and implementation of 2 innovative telehealth programs developed to improve health care delivery, access to care, digital literacy, and patient outcomes: ACTIVATE and Lighthouse. Methods: ACTIVATE is a comprehensive digital health pathway for community health centers that care for those who are medically underserved. ACTIVATE is an innovative, evidence-based, and sustainable telehealth program, designed to benefit vulnerable populations in rural and agricultural communities in the California Central Valley who experience significant health disparities. Lighthouse focuses on connecting older adults in congregate affordable housing, which are settings where residents are particularly vulnerable to isolation, the lack of health care resources, and limited to no access to the internet. Lighthouse provides digital literacy training as well as access to broadband internet with the goal of increasing communication, engagement, and access to health care. Results: This presentation will discuss successful design and implementation strategies as well as organizational and policy barriers to program operations. Conclusions: In addition to reviewing program and implementation outcomes, strategies for replication and sustainability will be discussed. Although developed in response to COVID-19, the ultimate success of Lighthouse and ACTIVATE is dependent upon its successful scaling beyond the pandemic. Conflicts of Interest: None declared. %R 10.2196/41686 %U https://www.iproc.org/2023/1/e41686 %U https://doi.org/10.2196/41686 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41676 %T TELEMED: Database on Evidence-Based Telemedicine in a Hospital Setting %A Wagner Svendsen,Ida %A Kidholm,Kristian %+ Center for Innovative Medical Technology, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 30586477, kristian.kidholm@rsyd.dk %K telemedicine %K hospital %D 2023 %7 27.6.2023 %9 Abstract %J iproc %G English %X Background: The use of telemedicine services has increased worldwide during recent years as a result of national strategies for the digitalization of health care and the COVID-19 pandemic. However, health care professionals often express uncertainty regarding the evidence and effectiveness of telemedicine interventions. Therefore, the Centre for Innovative Medical Technology at Odense University Hospital introduced the TELEMED database, an evidence-based telemedicine database. Objective: This study aimed to ensure that hospital managers, health care professionals, and other stakeholders gain access to information about scientific studies of telemedicine interventions and their effectiveness. Methods: The database constitutes a structured literature search in PubMed for randomized controlled trials or controlled trials on the effect of telemedicine for somatic diseases treated at hospitals. The search was conducted by staff members in the Health Technology Assessment unit at the Centre for Innovative Medical Technology. First, identified studies were sorted by screening titles and abstracts and, subsequently, by reading full-text versions. The data extracted from the studies included the setting, intervention, patient group, type of telemedicine, clinical effect, patient perception, and implementation challenges. Finally, the value of each study was assessed with respect to effectiveness. Results: A total of 518 articles were included for data extraction and assessment. The database provides results from 22 different specialties and can be searched using the following criteria: medical specialty, country, technology, clinical effect, patient experience, and economic effect. The database serves as a platform for the dialogue with clinical departments who wish to implement telemedicine services and has a large potential for supporting the digital transformation during COVID-19 as evidence-based information on patient groups, relevant technologies, and their effect is easily accessible. Conclusions: The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services. The database is freely available and is expected to be continuously improved and broadened over time. Conflicts of Interest: None declared. %R 10.2196/41676 %U https://www.iproc.org/2023/1/e41676 %U https://doi.org/10.2196/41676 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41634 %T Video Consultations in Primary Care Outside Office Hours %A Nebsbjerg,Mette Amalie %A Bomholt,Katrine Bjørnshave %A Vetsergaard,Claus Høstrup %A Christensen,Morten Bondo %A Huibers,Linda %+ Research Unit for General Practice, Aarhus University, Bartholins Allé 2, Aarhus, 8000, Denmark, 45 24647244, man@ph.au.dk %K out-of-hours primary care %K telephone triage %K video consultation %D 2023 %7 27.6.2023 %9 Abstract %J iproc %G English %X Background: Out-of-hours primary care (OOH-PC) is facing increasing demands and workload with many negative consequences, including longer waiting time and increased risk of treatment delay and safety incidents. During the COVID-19 pandemic, video consultation (VC) was introduced as an alternative to face-to-face contact. We hypothesize that VC contributes to sustainable OOH-PC by changing patient flows, decreasing workload, and reducing waiting time. Objective: This study aims to evaluate the use of video in telephone triage in OOH-PC by studying user rate, the effect on contact patterns, and patient characteristics related to receiving a VC. Methods: We conducted a register-based study of VC use in OOH-PC, including all Danish residents contacting OOH-PC in the regions of Central Denmark, Southern Denmark, Northern Denmark, and Zealand. The study population will be followed from birth, immigration, or March 1, 2020 (whichever came last), until death, emigration, or December 31, 2021 (whichever comes first). We will use national registers, linking data with the unique personal identification number. We plan to conduct descriptive analyses, calculating the proportion of VC of all teletriage consultations per month during the study period. We plan to use regression models to measure the association between VC and triage outcome and the association between VC and patient characteristics, calculating risk ratios and 95% CIs. Both crude and mutual adjusted risk ratios for patient characteristics will be presented. Results: Data analyses started in May 2022. Conclusions: A preliminary conclusion will be presented at the conference. Conflicts of Interest: None declared. %R 10.2196/41634 %U https://www.iproc.org/2023/1/e41634 %U https://doi.org/10.2196/41634 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41611 %T Video Counseling and a Safety Planning App to Support Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain During COVID-19 %A Andreasen,Karen %A Linde,Ditte S %A Zapata-Calvente,Antonella Ludmilla %A Martín-de-las-Heras,Stella %A Megías,Jesús López %A Rasch,Vibeke %+ Department of Gynecology and Obstetrics, Odense University Hospital, Sdr.Boulevard 20, Odense, 5000, Denmark, 45 20962973, ostrupvej@gmail.com %K intimate partner violence %K IPV %K pregnancy %K eHealth %K intervention %D 2023 %7 3.4.2023 %9 Abstract %J iproc %G English %X Background: Isolation was a consequence of the COVID-19 lockdowns, which led to increased incidence of intimate partner violence (IPV). During antenatal care, it is possible to screen pregnant women for IPV; this offers a unique opportunity for early intervention. During the pandemic, we designed and implemented a digital IPV intervention tailored to pregnant women in Denmark and Spain. Objective: This study aimed to identify pregnant women exposed to IPV through digital screening and offer video counseling as well as a safety planning app to those who screened positive. Methods: Pregnant women attending antenatal care were screened for IPV through a digital questionnaire. Women who screened positive were offered 6 video consultations with an IPV counselor and provided with access to a dedicated safety planning app. In-depth interviews inspired by the Model for Assessment of Telemedicine Applications were conducted with counselors and participants. The intervention was cocreated with women who have been exposed to IPV, nongovernmental organizations, and health care providers. Results: Despite the COVID-19 shutdowns, more than 15,000 pregnant women have been screened for IPV since January 2021. Qualitative interviews with women who completed the intervention as well as IPV counselors show broad acceptance of the video counseling, particularly the ability to participate from a safe environment and talk to a stranger about sensitive and stigmatizing issues. Preliminary findings show that both women and counselors find the video counseling highly supportive, empowering, and aligned with the needs for safety. The majority indicate improved well-being after the intervention, and neither counselors nor participants see video counseling as a barrier toward talking about sensitive topics such as IPV. The safety app was not perceived as effective. Conclusions: The preliminary results show that video counseling conducted during the COVID-19 pandemic supports pregnant women exposed to IPV and is highly feasible and accepted in both Denmark and Spain. Conflicts of Interest: None declared. %R 10.2196/41611 %U https://www.iproc.org/2023/1/e41611 %U https://doi.org/10.2196/41611 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41562 %T Telehealth Challenges for California Rural Hospitals in Reaching Latino Populations During COVID-19 %A Mauricio,Noemi %A Newhart,Glen %A Herber,Steven %A Ahumada-Newhart,Veronica %+ University of California Davis, School of Medicine, Center for Health and Technology, 4610 X Street, Suite 2347, Sacramento, CA, 95817, United States, 1 916 734 2351, vahumada@ucdavis.edu %K telehealth challenges %K California rural hospitals %K Latino populations %K COVID-19 %D 2023 %7 3.4.2023 %9 Abstract %J iproc %G English %X Background: Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services. Objective: This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers. Methods: We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges. Results: In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population. Conclusions: This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster. Conflicts of Interest: None declared. %R 10.2196/41562 %U https://www.iproc.org/2023/1/e41562 %U https://doi.org/10.2196/41562 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41524 %T Testing the Social Robot LOVOT´s Interaction With Adults With Autism and Mental Impairment: Preliminary Findings %A Gregersen,Lajla Holtebo %A Dalskov Leisted,Sofie %A Samuelsen,Frederik %A Dinesen,Birthe %+ Team Strategy and Development, Jobs and Welfare, Aalborg Municipality, Søndergade, Aalborg, 9000, Denmark, 45 99827420, lgre-jv@aalborg.dk %K telerehabilitation %K artificial intelligence %D 2023 %7 3.4.2023 %9 Abstract %J iproc %G English %X Background: Persons with autism and mental impairment face communicative, social, and behavioral challenges, and there is a need to establish effective interventions to improve the quality of daily life. Social robots working with children with autism have successfully improved their communication and social behavior and reduced stereotypic behavior. However, there is only limited evidence regarding the effectiveness of social robots. Objective: This study aimed to investigate the interactions, effects on well-being, experiences from health care professionals, and ethical aspects of deploying the LOVOT social robot as a tool for adults with autism and mental impairment. Methods: Two social robots have been deployed in 3 residences. A total of 12 adults with autism and mental impairment were recruited. Individual planned sessions on interaction with the social robots are being carried out twice a week for 20-30 minutes over a period of 6 months. Participant observations are carried out every second week during the 6 months on themes such as well-being, interaction with the robot, the level of arousal, eye contact, and communication. Observations have been documented through standardized observation protocols and by video recording. Experiences from health care professionals and ethical aspects have been explored using semistructured interviews. Results: Preliminary results indicate that LOVOT has improved the well-being of participants. Although the participants’ interest in LOVOT varies, the health care professionals report that some participants find great satisfaction interacting with LOVOT, describing LOVOT as a friend, and that LOVOT can provide comfort in stressed situations. Two LOVOTs were damaged by the participants during the study, indicating the importance of robust material in interventions with adults with autism and mental impairment. Conclusions: Preliminary findings indicate that social robots can increase well-being among persons with autism and mental impairment.  Future care of persons with autism and mental impairment might benefit from the use of social robots as part of their care and quality of life. Conflicts of Interest: None declared. %R 10.2196/41524 %U https://www.iproc.org/2023/1/e41524 %U https://doi.org/10.2196/41524 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41571 %T Out of Adversity Comes Opportunity: Smart-Colpo National Program for the Elimination of Carcinoma Cervix in a Post–COVID-19 World %A R,Anjali %A Gowda,Naveen R %A H,Vikas %A Prabhu,Meghana %A Sharma,Jai Bhagwan %A Vakharia,Khyati %A Kumar,Atul %A M V,Akhila %A Gatta,Shilpa %A Sareddy,Madhuri %A K P,Sowmya %A T K,Divya %A Desai,Devashish %A Gopinath,Bharath %A Viswanath,Somanath %A Kini,Ananth %+ All India Institute of Medical Sciences, Ansari nagar, New Delhi, 110029, India, 91 9663502239, drnaveen.nimhans@gmail.com %K Smart-Colpo %K cervical cancer %K screening %K artificial intelligence %K low-resource setting %D 2023 %7 13.3.2023 %9 Abstract %J iproc %G English %X Background: Carcinoma cervix is one of the leading causes of death among women worldwide. The World Health Organization has put forth the 90-70-90 global strategy for the elimination of cervical cancer as a public health problem. It calls for 70% women to be screened at least once in their lifetime. However, this rate is as low as 1.9% for India and even lower for many other countries, making the target insurmountable, especially in resource-constrained settings. The COVID-19 pandemic made this even more challenging. Objective: This study aimed to identify bottlenecks and high leverage points and propose a technology-driven, national-level program for improving the screening of carcinoma cervix. Methods: Detailed process mapping was done to identify potential bottlenecks. A counterfactual approach was used to identify high leverage points for impact using “What if” scenarios. These findings were used to build program theory–based logic models to propose a national-level program for carcinoma cervix prevention. Results: Availability, accessibility, affordability, skewed distribution of infrastructure, cost implications, and limited specialist workforce were identified as bottlenecks. The COVID-19 pandemic put a strain on existing resources and worsened the situation. The existing network of primary health care workers, changes in health-seeking behavior due to COVID-19 with the increasing role of tele-health, conducive political milieu with initiatives such as Digital India Mission, and a booming start-up ecosystem were identified as high leverage points through the counterfactual approach. Using these findings, a national program was designed with program theory–based logic modeling. Conclusions: The journey from <2% of women screened at least once in their lifetime all the way to 70% would need a drastic increase in funding and resource allocation, which is unlikely considering the current conditions. COVID-19 has not only been an adversity but also opened new thinking and opportunities. Artificial intelligence–driven, cost-effective, easy-to-use, and widely acceptable solutions such as “Smart-Colpo” can be a game changer to achieve the World Health Organization targets. Conflicts of Interest: None declared. %R 10.2196/41571 %U https://www.iproc.org/2023/1/e41571 %U https://doi.org/10.2196/41571 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41191 %T Reliable Internet of Things for Health Care Technologies %A Dilip Ballal,Kalpit %A Dittmann,Lars %A Ruepp,Sarah %A Dinesen,Birthe %+ Department of Electronics and Photonics Engineering, Technical University of Denmark, Ørsteds Plads, Bygning 343, Kgs Lyngby, 2800, Denmark, 45 4525 6352, kdiba@dtu.dk %K Internet of Things %K remote health care %K digital health %D 2023 %7 24.2.2023 %9 Abstract %J iproc %G English %X Background: Several at-home monitoring devices are being introduced in the market, which can help individuals, fitness enthusiasts, etc, monitor their health anytime they want. This allows individuals to monitor and collect their health data, reflect upon it, and take necessary action. Such technologies can help enhance the user’s quality of life by motivating and empowering them to improve their health actively. Unfortunately, there are still several challenges to making this transition from in-hospital monitoring to home monitoring smoother. Some of these challenges may include technology readiness and acceptance by patients and their family members, lack of proper privacy measures, security, and lack of reliable internet and communication technology infrastructure. Objective: The objective of this study is to use wireless communication networks to remotely transfer data from various body sensors measuring different vital parameters. Wireless sensors (electrocardiogram monitors, sleep sensors, etc) and Internet of Things devices can allow real-time and relatively cheap at-home health monitoring to provide critical health updates over the internet. Methods: The study will be conducted by means of designing multiple experiments in which data from different sensors will be collected, packaged, and sent to a remote server using the internet. Along with the patient data, different network performance parameters such as delay, information loss, etc, will be calculated to understand and evaluate network performance. Results: The results from the experiment will focus on evaluating network performance parameters such as latency, delay, packet drop, etc, in various indoor as well as outdoor environments. Conclusions: We hope the results obtained from these experiment can be used for making various technological design choices and serve as a good starting point while building Internet of Things health care technologies. Conflicts of Interest: None declared. %R 10.2196/41191 %U https://www.iproc.org/2023/1/e41191 %U https://doi.org/10.2196/41191 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41461 %T Promoting Healthy Aging in a Digital World %A Young,Heather M %A Nesbitt,Thomas S %+ Betty Irene Moore School of Nursing, University of California Davis, Betty Irene Moore Hall, 2570-48th St, Sacramento, CA, 95817, United States, 1 541 261 0395, hmyoung@ucdavis.edu %K technology %K mobile health %K mHealth %K sensors %K older adults %K healthy aging %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: The aging of the population is a global phenomenon, with growing numbers of persons over the age of 65 years, greater diversity of aging societies, and fewer younger people available to provide care and support for older adults. At the same time, enabling technology offers new solutions for aging well, including self-management of chronic conditions, communication with family and the health care team, passive monitoring, and enriching the home and community environments. Objective: This keynote address highlights the demand characteristics for healthy aging and identifies potential solutions and challenges with enabling technology. Methods: This presentation is based on literature review and engagement with diverse scientific collaborators. Results: Major societal trends include the following: the growth of the older population with associated increases in the prevalence of chronic conditions and functional and cognitive disability; increased demand for both health and social services; increased demands on family caregivers at a time when there are fewer caregivers available; explosion of health information and desire to self-manage chronic conditions while remaining at home; widespread workforce shortages; and escalating costs of care. The COVID-19 pandemic exposed the urgency of these demands and exacerbated health needs and workforce shortages while accelerating systematic change to address emergent challenges. New solutions are required to promote health, well-being, and health equity that entail both care model redesign and deployment of enabling technology. Optimal care for the future will place the older adult at the center; assure that information is available to all for good decision-making; and deploy human resources in the most effective way possible, providing the right person at the right time for the right task. Conclusions: Technology has the potential to collect and make meaningful use of everyday data to inform plans for care; engage and optimize communication among the older adult, family, and care team; and enhance function and well-being. Actualizing this future requires appropriate policy, training, and leadership. Conflicts of Interest: None declared. %R 10.2196/41461 %U https://www.iproc.org/2023/1/e41461 %U https://doi.org/10.2196/41461 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41347 %T Implementation Challenges for Danish Hospitals in Digital Transformation %A Kidholm,Kristian %+ Center for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Sdr Boulevard 29, Odense C, 5000, Denmark, 45 30586477, kristian.kidholm@rsyd.dk %K implementation %K digital transformation %K hospitals %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: Increased digitalization of hospitals is a goal for national and regional health strategies. Since 2019, it has been an explicit goal to increase the use of virtual consultation with hospital patients. Two years after the start of the pandemic, virtual consultation for hospital patients has increased. At Odense University Hospital (OUH), we have seen a 30% and 337% increase in the annual number of telephone and video consultations with patients, respectively. However, the annual number of video consultations is still below 1% of the total number of outpatient visits. Objective: This presentation describes challenges that may explain the slow implementation of telemedicine at OUH and how these challenges are handled in practice. Methods: The description is based on 12 meetings with hospital managers and staff at OUH. Analysis of the content of the meetings has been condensed into the major themes specified in the results. Results: Three main challenges have been found: (1) uncertainty regarding the quality of telemedicine interventions, (2) uncertainty regarding the technical and communicative skills needed to do video consultation, and (3) misunderstandings regarding the economic consequences of telemedicine. To address the uncertainty among our staff toward the clinical quality of telemedicine, a database including randomized trials of telemedicine interventions described in the PubMed database from 2010-2022 was produced. The database shows that more than 96% of interventions results in similar or improved clinical outcomes for selected patient groups. To ensure the skills needed by the hospital staff to do video consultation, we have offered courses in the technical and communicative aspects of video consultation to interested departments. Finally, some members of our staff believe that reducing the number of physical visits may reduce the hospital budget, which is contrary to the actual financial agreements with capitation payment. To address this misunderstanding, information about the true economic consequences of implementing telemedicine has been provided. Conclusions: Successful implementation of telemedicine requires more than solid evidence; it also requires initiatives focusing on the challenges among the hospital staff. Conflicts of Interest: None declared. %R 10.2196/41347 %U https://www.iproc.org/2023/1/e41347 %U https://doi.org/10.2196/41347 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41285 %T Challenges and Opportunities of the Use and Adoption of Telemedicine for Diabetes Care and Management During the COVID-19 Pandemic and Beyond %A Altabtabaei,Rabab %A Alhuwail,Dari %+ Information Science Department, Kuwait University, College of Life Sciences, PO Box 5969, Sabah AlSalem University City, 13060, Kuwait, 965 24633214, dari.alhuwail@ku.edu.kw %K telemedicine %K informatics %K kuwait %K public health informatics %K COVID19 %K diabetes %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: More than half of the world’s population deals with noncommunicable diseases causing premature death. Leveraging digital solutions like telemedicine, health care providers (HCPs) can provide medical care remotely. Yet, there is little known about the contextual challenges and opportunities of leveraging telemedicine solutions in varying socioeconomic and cultural contexts, including Kuwait. Objective: The aims of this paper were as follows: (1) uncover the challenges and opportunities of adopting and using telemedicine for diabetes care and management from the viewpoints of HCPs and patients with diabetes; (2) explore nonfunctional requirements for telemedicine applications for diabetes care and management; and (3) offer recommendations to improve the adoption of telemedicine in Kuwait’s health care system for diabetes care and management. Methods: Through semistructured interviews, this study employed a qualitative and exploratory design to uncover rich context-specific findings. Participants were recruited via social media platforms. The analysis followed a thematic analysis approach and used the framework method. Researchers used the “diffusion of innovation” model as a lens to guide the analysis and interpretation of the results. Results: A total of 20 interviews were conducted—10 (50%) HCPs and 10 (50%) patients with diabetes. The participants were familiar with and interested in adopting telemedicine. Challenges included a lack of telemedicine infrastructure and how to increase patients’ technology awareness. Patients with diabetes mentioned that telemedicine would save time and effort. The participants suggested developing a secure, user-friendly telemedicine solution. They stated the importance of telemedicine during the pandemic, as many diabetes cases can be followed up online, which reduces virus spread and increases patients’ safety. Conclusions: The findings from this study can give a better understanding of what HCPs and patients with diabetes need to accept the adoption of telemedicine in resource-rich countries like Kuwait. The COVID-19 pandemic impacted the ways HCPs deliver medical care to patients and encouraged both HCPs and patients to explore the digital platform for continuous care and management of diabetes. Conflicts of Interest: None declared. %R 10.2196/41285 %U https://www.iproc.org/2023/1/e41285 %U https://doi.org/10.2196/41285 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41242 %T Exoskeletons in the Digital Era: A Way to Improve the Level of Physical Activity Among Older Citizens %A Madeleine,Pascal %A Christensen,Daniel J R %A Franch,Jesper %A Svendsen,Lone %A Hansen,Ernst A %A Hostrup,Hanne %A Pirscoveanu,Cristina-Ioana %+ Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers vej 7, Aalborg, 9220, Denmark, 45 99408833, pm@hst.aau.dk %K gait %K ageing %K walking aid %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: The COVID-19 pandemic has had a negative impact on the level of physical activity among older citizens. Objective: The aim of this short paper is to set focus on the potential benefits of assistive walking devices for older citizens. Methods: In this feasibility study, 24 older citizens aged >65 years participated in the study. The participants answered to the following questionnaires after fulfilling a consent form: Tilburg Frailty Indicator, International Physical Activity Questionnaire, and Quality of Life. Then, physiological and biomechanical assessments were made in a laboratory setting with and without wearing an exoskeleton (aLQ, IMASEN Electrical Industrial Co). The aLQ is a passive-assistive lower-limb walking exoskeleton activated by a cam spring system designed to improve gait. After the tests, the participants were asked to answer the following questions: “Do you feel the exoskeleton is helping you to walk?” and “What is your opinion on the device?”. Results: The participants were community-dwelling older individuals, aged 72.6 (SD 4.5) years, and were characterized by an overall high level of physical activity of 3069 (SD 2847) metabolic equivalent–minutes per week. Their Tilburg Frailty Indicator indicated an overall frailty score of 3.5 (SD 2.5). The participants reported a Quality of Life score of 6.7 (SD 1.6) and an overall health score of 76.4 (SD 17.1). Moreover, of the 24 participants, 7 (29%) reported that carrying the tested exoskeleton did not induce any noticeable changes, and 3 (10%) reported that they walked better with the device than without. Conclusions: These findings are of importance in our current digital era where the COVID-19 pandemic forced municipalities and hospitals to cancel or postpone the training and rehabilitation of older citizens, resulting in a degradation of the level of physical activity and health in general. The use of assistive walking devices can be a way to improve or maintain their level of physical activity. Future studies using a prospective design should confirm that. Conflicts of Interest: None declared. %R 10.2196/41242 %U https://www.iproc.org/2023/1/e41242 %U https://doi.org/10.2196/41242 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41066 %T Telenursing and Telemonitoring During and Beyond the COVID-19 Pandemic %A Kamei,Tomoko %+ St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan, 81 3 5550 2283, kamei@slcn.ac.jp %K telenursing %K telemonitoring %K COVID-19 %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: The presenter will be discussing home monitoring–based telenursing for people with chronic conditions. This technology has been implemented in home-care individuals with chronic obstructive pulmonary disease, type 2 diabetes, congestive heart failure, lung cancer, and amyotrophic lateral sclerosis, who are treated at home, including during the COVID-19 pandemic. The pandemic, which began in late 2019, has limited our everyday activities and opportunities to connect with people. Older adults with chronic conditions are most especially affected. While telenursing practice is not so familiar in the Japanese context, the Japan Academy of Home Care (2021) first defined telenursing as “information and communication technologies involving telecommunication provided by nurses.” Furthermore, we are providing seminars for the nurses and expanding their capacity on how to provide efficient telenursing support for people receiving home care. Objective: This study aims to present effective telenursing practice examples, as well as the challenges surrounding the use of technology in care for older adults with chronic conditions during and beyond the COVID-19 pandemic. Methods: A fully longitudinal mixed methods design was used to evaluate the physical and emotional fluctuations of people from qualitative and quantitative strands, and we integrated the results and meta-inferences. Results: The patients showed a continuous change over time in terms of their physical and psychological status. Living with symptoms, the patients were constantly reminded of the reality of their disease and the activity limitations the pandemic brought. At times, they were able to find hope for the future by actively controlling and managing their disease, maintaining their health and physical function, and realizing that they could live a normal life. On the other hand, they experienced a loss of activity, a decline in physical function, and anxiety about the future, brought about by the pandemic. Thus, people who receive telenursing are on a dynamic disease trajectory that vacillates between hope and despair, and telenursing can help them. Conclusions: Performing telemonitoring and telerehabilitation of older adults throughout the pandemic, as well as adapting to their physical and emotional fluctuations, will improve their quality of life. Conflicts of Interest: None declared. %R 10.2196/41066 %U https://www.iproc.org/2023/1/e41066 %U https://doi.org/10.2196/41066 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41064 %T Clinical Outcomes After Viewing Video Education on Danger Signs and Symptoms of Worsening Heart Failure and Self-care Actions %A Albert,Nancy %A Babcock,Carol %A Gray-Leyko,Anna Maria %A Bena,James %A Morrison,Shannon %A Sayler,Dorothy %A Levay,Michelle %+ Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland, OH, 44195, United States, 1 2164447028, albertn@ccf.org %K heart failure %K video education %K danger signs %D 2023 %7 15.2.2023 %9 Abstract %J iproc %G English %X Background: Patients with heart failure (HF) must understand subtle escalation in fatigue, dyspnea, and edema before they are triggered to control worsening status. Objective: The aim of this paper is to examine if video education of HF danger signs or symptoms recognition and control, developed using symbolic modeling (social cognitive theory), leads to between-group differences in functional status, symptoms, and self-efficacy for managing symptoms at 30-days, all-cause, and HF-related hospitalization, emergency department visits, and death at 30, 90, and 180 days. Methods: Using a 2-group, randomized controlled, multicenter, single-blind design, patients received video education (VE) plus usual care (UC) or UC alone before hospital discharge. VE patients also had access to content post discharge. Thirty-day functional status, fatigue, dyspnea, and self-efficacy for managing symptoms were assessed using valid, reliable tools. In the analysis, multivariable models were created to compare changes in patient-reported outcomes from baseline to 30-days post discharge and morbidity or mortality outcomes up to 180 days. Results: Of 369 VE and 377 UC patients enrolled from 7 sites, mean age was 68.0 (SD 12.4) years, and 206 (55.9%) were male. At 30 days, there were no between-group differences in the change in functional status, fatigue, dyspnea, and self-efficacy from baseline. In multivariable analyses, between-group outcomes did not differ at 30 or 90 days. At 180 days, HF-related events and HF-related hospitalization were higher in the video group—odds ratios (95% CI): 1.42 (1.04, 1.94), P=.03; and 1.44 (1.05, 1.97), P=.03, respectively. In time-to-event adjusted analyses, video patients had earlier HF-related hospitalization, compared to UC patients—hazard ratio (95% CI) 1.32 (1.02, 1.72), P=.04. Conclusions: Video education on recognition and control of danger signs or symptoms paradoxically increased HF-related events and hospitalization and decreased time to first HF-related hospitalization. Increased recognition of subtle HF signs or symptoms via video education is valuable but must be connected to patient or family self-care actions that reduce HF signs or symptoms. Trial Registration: ClinicalTrials.gov NCT03657459; https://clinicaltrials.gov/ct2/show/NCT03657459 Conflicts of Interest: None declared. %R 10.2196/41064 %U https://www.iproc.org/2023/1/e41064 %U https://doi.org/10.2196/41064 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 9 %N %P e41340 %T Experiences of Using a Telepresence Robot During the COVID-19 Pandemic %A Diaby,Lahila Fanta %A Dinesen,Birthe %+ Laboratory for Welfare Technology – Digital Health & Rehabilitation, Sport Sciences – Performance and Technology, Department of Health Science and Technology, Aalborg University, Niels Jernes vej 12, A5-203, Aalborg, 9220, Denmark, 45 72691034, lahila.diaby@outlook.com %K telepresence %K COVID-19 %K school absenteeism %K primary school %K user experience %K social robot %D 2023 %7 14.2.2023 %9 Abstract %J iproc %G English %X Background: School absenteeism due to mental disorders and physical disabilities is an international problem. When children are absent from primary school, they do not receive the fundamental educational foundation they are entitled to. This affects their further opportunities to receive higher education later in their life. Studies show that telepresence robots can include absent students in the teachings and social life at school. Objective: The purpose of this project was therefore to investigate the opportunities and limitations of using an OriHime telepresence robot to teach absent primary school students during the COVID-19 pandemic. Methods: This project was a case study from a primary school in Denmark. The study included primary school students (n=3), teachers (n=5), parents (n=2), a school principal, a pedagogue, a school absentee consultant, and a psychologist. The 14 participants were interviewed based on interview guides. In all, 20 hours of observation of OriHime have been made in the classroom conducting in the pilot test. Afterward, OriHime was tested by an absent primary school student for a 2-month period during the COVID-19 pandemic. Results: The absent students found that OriHime was useful and a good alternative for them to be able to attend class. Teachers and pupils found that OriHime was useful in a class setting but not when conducting outdoor activities. The parents found that OriHime could include the absent students in the teachings and social life in class. Conclusions: The absent students experienced that OriHime could function as an educational and social tool during COVID-19 and that it was possible to participate in the indoor teachings while being physically absent. The absent students, teachers, and parents found OriHime useful with opportunities but stated some limitations. Based on the results, a guideline for the implementation of OriHime in Danish primary schools was produced. Conflicts of Interest: None declared. %R 10.2196/41340 %U https://www.iproc.org/2023/1/e41340 %U https://doi.org/10.2196/41340 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41129 %T Telepalliation Facilitates a Sense of Security for Patients With Terminal Illnesses %A Sigaard,Jarl Voss Andersen %A Christensen,Hanne Aagaard %A Skov,Sanne Broch %A Petrini,Laura %A Henneberg,Nanna Celina %A Nielsen,Celine Bejstrup %A Dinesen,Birthe %+ Palliative Team, South West Jutland Hospital, Finsensgade 35, Esbjerg, DK-6700, Denmark, 45 23832739, Jarl.Sigaard@rsyd.dk %K telepalliation %K COVID-19 %D 2022 %7 25.8.2022 %9 Abstract %J iproc %G English %X Background: Each year, an estimated 20 million people worldwide are in need of palliative care. The main diagnosis of people needing palliative care is cancer, followed by cardiovascular disease and chronical obstructive lung disease. The web-based telepalliation program and digital platform (offering video consultation, treatment planning, patient-reported outcomes, chat forum, and information on palliation) was developed through a participatory design process involving patients, their relatives, health care professionals, and researchers. Objective: This study aimed to pilot-test the telepalliation program during the COVID-19 pandemic. Methods: The case study is used as the overall method for the study. The theoretical framework is the Antonovsky “Sense of Coherence” theory. A triangulation of data collection techniques was used: documents (home pages and documents on palliative care) were studied; participant observation was carried out in patients’ homes (n=16 hours); and semistructured qualitative interviews were carried out with 3 women (ages 46-73 years) and 3 men (aged 64-80 years). Of the 6 patients, 4 were diagnosed with cancer and 2 with cardiovascular diseases. The interviews were recorded and analyzed. We followed 7 subjects and conducted 6 interviews; 1 patient dropped out due fatigue. Results: Patients participating in the telepalliation program articulated their experiences in terms of the following themes: a sense of security; a sense of coherence; a feeling that the telepalliation platform facilitates continuity and better communication with health care professionals across sectors; a sense of easier access to the palliative team; and a feeling that their spouse and family were more integrated into the care process, because they could participate in difficult dialogues with the palliative team via video link. Conclusions: Preliminary findings indicate that patients participating in a telepalliation program experience a sense of security, coherence in their care process, and integrated care across sectors for the individual patients. Further research is needed on the potential benefits and drawbacks of telepalliation. %R 10.2196/41129 %U https://www.iproc.org/2022/1/e41129 %U https://doi.org/10.2196/41129 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41105 %T A Combination of Web-based and In-Person Training Reduced Fall Accidents in Older Adults During the COVID-19 Pandemic %A Thomsen,Mikkel Jacobi %A Liston,Matthew %A Christensen,Merete Grothe %A Vestergaard,Peter %A Hirata,Rogerio %+ Department of Health Science and Technology, Faculty of Medicine, Aalborg Univeristy, Fredrik Bajers Vej 7D, Aalborg, 9220, Denmark, 45 4531423258, rirata@hst.aau.dk %K falls %K older adults %K training %K dance %K web-based training %D 2022 %7 24.8.2022 %9 Abstract %J iproc %G English %X Background: Fall accidents in older adults are associated with reduced quality of life, personal health issues, and earlier deaths. Previous studies have found that both physical and cognitive parameters influence the risk of falling in older adults. During the COVID-19 pandemic lockdown (2020-2021) in Denmark, web-based training was the safest option for training, although its effectiveness was uncertain. Objective: The purpose of this stratified, block randomized trial was to examine the effect of two types of web-based and in-person training—salsa dance and regular fitness circuit—in two training groups in comparison with a control group. Methods: A total of 78 older adults (9 male and 69 female; mean age 70.4, SD 4.4 years; mean height 165.2, SD 6.8 cm; and mean weight 65.7, SD 11.9 kg) completed the 6-months training period: dance (n=25), fitness (n=23), and control group (n=30). Accidental falls were registered during the follow-up test. Participants in the two training groups were assigned to 1-hour training sessions twice a week for 6 months. Prior to the pandemic, training was administered by a skilled instructor at an activity center in the municipality or a dance studio. Following the pandemic, dance training was administered through a web-based meeting platform, whereas fitness training was guided by a video. Adherence to the training was collected weekly. Participants in the control group were encouraged to continue their everyday life. Results: Both intervention groups had fewer accidental falls during the 6 months intervention compared with the control group (control group: 9 falls; dance: 4 falls, fitness: 0 falls; chi-square: P<.05). In total, adherence to fitness training was 72.6%, and it was 86.9% for dance. However, adherence to the web-based dance training was 95% (342 dance training hours of possible 360 dance training hours). Conclusions: A combination of a 6-months web-based and in-person training (for dance and fitness) reduced the number of accidental falls in older adults. Trial Registration: ClinicalTrials.gov NCT03683849; https://clinicaltrials.gov/ct2/show/NCT03683849 %R 10.2196/41105 %U https://www.iproc.org/2022/1/e41105 %U https://doi.org/10.2196/41105 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41061 %T Telemedicine and Remote Rehabilitation for Patients with Cardiac Disease Post COVID-19 Era %A Daida,Hiroyuki %A Kagiyama,Nobuyuki %A Kasai,Takatoshi %A Takahashi,Tetsuya %+ Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 03, Japan, 81 338133111 ext 3900, daida@juntendo.ac.jp %K telemedicine %K remote cardiac rehabilitation %K digital device %K post COVID-19 %D 2022 %7 24.8.2022 %9 Abstract %J iproc %G English %X Background: The COVID-19 pandemic has accelerated the changes of daily practice in medical care worldwide. Telemedicine is one of the most stimulated fields among these changes, even in the cardiovascular disease care. In the past decade, remote monitoring has become an important tool that provides valuable clinical information via respiratory assist devices and implantable pacemakers from patients at home. Objective: The objective of our study was to investigate whether these remote monitoring approaches could include a broader spectrum of patients with cardiac disease with the development of noninvasive monitoring devices. Methods: Several pilot studies of telemedicine-based monitoring systems using commercially available digital devices were conducted in the infectious disease wards and other clinical settings during the COVID-19 pandemic. We evaluated the effectiveness of a remote heart monitoring system that provides real-time electrocardiogram and other vital signs monitoring in patients with cardiovascular disease. A newly developed remote cardiac rehabilitation system was also evaluated. Results: We found that current remote monitoring technology could provide sufficient monitoring of vital signs, suggesting a potential to predict a worsening of heart failure in advance. Remote cardiac rehabilitation could be effectively and safely provided in patients with low to medium risk. Conclusions: Telemedicine and remote cardiac rehabilitation possess a great potential in the cardiovascular disease practice post COVID-19 era; however, there are several unsolved issues regarding their implementation in the real-world clinical practice. %R 10.2196/41061 %U https://www.iproc.org/2022/1/e41061 %U https://doi.org/10.2196/41061 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41680 %T Sundhed.dk and MyHealth During the Corona Storm %A Elbæk Petersen,Morten %+ Social Sciences, Sundhed.dk, Dampfærgevej 22, København Ø, Denmark, 45 44222080, mep@sundhed.dk %K e-learning %K eHealth %K medical records %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: The Danish eHealth portal, sundhed.dk, pioneers open access to medical records since 2003 and is, in this regard, unique worldwide. As part of the Danish health care sector, sundhed.dk supports transparency and patient empowerment and provides health professionals with the possibility to access patient health data outside of local systems and across sectors and boundaries. Sundhed.dk and the MyHealth app have played a crucial role during the COVID-19 pandemic in Denmark, not least due to the development of the corona passport. Objective: The overall purpose during the COVID-19 pandemic has been to assist the health authorities handling the pandemic and to support patient empowerment. Sundhed.dk provided new digital services to support monitoring the spread of the virus and telemedicine solutions to support the Danish citizens both during isolation and as the society was gradually reopening. Methods: By exploiting sundhed.dk’s known and widespread position in the society and the already existing digital building blocks, sundhed.dk and MyHealth managed to provide fast and easy access to COVID-19 laboratory responses and, on top of that, to develop the corona passport, which was the result of accelerated IT development and fast scaling of the required server with the users. Results: The many digital services accessible through sundhed.dk or MyHealth made it possible for Danish citizens to continue to see their doctor or physiotherapist during lockdown. Moreover, the corona passport made the safe and efficient reopening of Denmark possible. Conclusions: The story of sundhed.dk during the COVID-19 pandemic is a story of success, a result of its close interdisciplinary and cross-sectoral cooperation with Danish health authorities and private IT vendors. It illustrates what can be achieved when there is a unified blueprint and overall purpose to overcome barriers in order to ensure development and progress for both the individual and the society. This has also drawn global attention, as reflected in a report by the World Health Organization. %R 10.2196/41680 %U https://www.iproc.org/2022/1/e41680 %U https://doi.org/10.2196/41680 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41561 %T Impact of Digital Literacy Levels of Health Care Professionals on Perceived Quality of Care %A Khare,Amitesh %A Jain,Kanika %A Laxmi,Vijay %A Khanna,Puneet %+ Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, Ansari Nagar, New Delhi, 110029, India, 91 9958961924, dramiteshk@gmail.com %K digital health literacy %K technology acceptance model %K quality of care %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: Multiple digital technologies were used during and after the COVID-19 pandemic with an intent to improve quality of patient care. It has been seen that the perception of patients toward the use of digital solutions in clinical care varies significantly. This has also been attributed to varying levels of digital literacy among the health care professionals (HCP) involved in patient care. Objective: Our paper aims to study the impact of digital literacy levels of HCPs, including hospital attendants and support staff who were involved in a clinical care team of COVID-19 patients, so that barriers toward the implementation of digital health solutions could be identified. Methods: A standardized survey using responses based on Likert scale was developed, which measured the confidence levels of HCPs and their attitudes toward digital technologies. The survey consisted of questions from the Technology Acceptance Model as well as the unified theory of acceptancy and use of technology to assess the attitude of HCPs. A total of 100 Hospital attendants directly employed in patient care were enrolled in the study. They were also asked to respond to feedback received from patients on the perceived quality of care. Results: Around 60% of the HCPs showed high digital literacy levels. Most respondents showed confidence in the use of technology. Moreover, around 20% of HCPs showed apprehension toward using digital solutions for direct patient care. A significant difference was found between study population with high digital literacy and perceived quality of care. Conclusions: Our study found that poor digital literacy in HCPs adversely affects the safety and quality of patient care. It is important that institutions provide targeted education and training to not only doctors and nursing staff but also other support staff with low digital literacy levels and to boost their confidence in providing clinical care. %R 10.2196/41561 %U https://www.iproc.org/2022/1/e41561 %U https://doi.org/10.2196/41561 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41530 %T Video Consultations in General Practice: Tendencies and Lessons Learned From the First COVID-19 Lockdown Period %A Assing Hvidt,Elisabeth %A Grønning,Anette %A Lüchau,Elle %A Nordtug,Maja %A Bavngaard,Martin %A Søndergaard,Jens %+ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, Odense, 5000, Denmark, 45 65504247, ehvidt@health.sdu.dk %K video consultation %K general practice %K Denmark %K COVID-19 %K qualitative research %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: Video consultation was urgently introduced in general practice in connection with the COVID-19 pandemic, where a rapid implementation ensured patients’ continued access to their general practitioner (GP). With the Danish lockdown in March 2020, the use of video consultations in general practice increased drastically and then declined significantly shortly after as society gradually reopened. Today, only a small proportion of the total number of consultations in general practice is made up of video consultations, and there is great variation in the scope and use of video consultation among GPs and practice staff. Objective: The aim of this paper is to present research findings from a qualitative, interdisciplinary project, investigating GP and patient experiences with video consultations during the first lockdown period in 2020, which might help explain the abovementioned tendencies in relation to scope and implementation variances. Methods: The data corpus includes data generated through semistructured interviews with 27 patients and 15 GPs, as well as 8 video recordings of video consultations between GP and patient. Results: The patients reported positive experiences with consulting their GP through video, valuing increased convenience and spatial flexibility and wishing for future use of video consultation as either a supplement or an alternative to physical consultation. Video consultation furthermore presented a new communicative context in which both patients and GPs enacted distinct forms of technologically facilitated participation. Conclusions: To further the best use of video consultation in future general practice, organizational and individual factors such as renumeration, task delegation, time pressure, and professional identity need to be considered. %R 10.2196/41530 %U https://www.iproc.org/2022/1/e41530 %U https://doi.org/10.2196/41530 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41491 %T Future Patient: Telerehabilitation of Patients With Heart Failure Empower Patients %A Dinesen,Birthe %A Spindler,Helle %A Refsgaard,Jens %A Hollingdal,Malene %+ Laboratory for Welfare Technologies - Telehealth & Telerehabilitation, Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, Aalborg, 9220, Denmark, 45 20515944, bid@hst.aau.dk %K telerehabilitation %K heart failure %K cardiovascular disease %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: Heart failure is one of the most common cardiovascular diseases that causes mortality, and patients’ participation in rehabilitation programs is often low. During the COVID-19 pandemic, the Future Patient Telerehabilitation Program developed for patients with heart failure offered a new approach. The aim of the Future Patient program has been to increase the quality of life and educate patients to monitor any worsening of their symptoms. Patients used self-tracking devices for monitoring their physical activity, blood pressure, sleep, respiration, and pulse, with their data transmitted to a shared web platform (called the Heart Portal), which could be accessed by patients, their relatives, and health care professionals across sectors. Objective: The aim of this paper is to determine whether the Future Patient Telerehabilitation Program has increased the quality of life of patients with heart failure and to empower them to manage their own disease. Methods: A randomized controlled trial (n=140) was conducted. Data from the intervention group (n=70, 50%) on patient-reported outcomes were collected and analyzed using the Kansas City Cardiomyopathy Questionnaire and Spiegel Sleep Questionnaire. Semistructured interviews with 12 patients (n=6, 50% men and n=6, 50% women) were conducted and analyzed. Results: The patients participating in the Future Patient program experienced a significant increase in clinical and social well-being as well as in quality of life. The patients participating in the program articulated their experiences in terms of the following themes: a sense of security and an increased sense of empowerment in managing their disease using the Heart Portal. The Heart Portal proved to be a valuable tool for remote monitoring and better communication with health care professionals across sectors. Conclusions: Telerehabilitation of patients with heart failure can improve their quality of life and empower them to manage their own disease remotely. %R 10.2196/41491 %U https://www.iproc.org/2022/1/e41491 %U https://doi.org/10.2196/41491 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41472 %T Measuring Client Satisfaction With Digital Services: Validity and Reliability of a Short-Form Digital Tool %A Pedersen,Henrik %A Havnen,Audun %A Lara-Cabrera,Mariela Loreto %+ Department of Mental Health, Norges teknisk-naturvitenskapelige universitet - NTNU, Olav Kyrres gate 9, Trondheim, Norway, 47 91697343, henrik.pedersen@ntnu.no %K digital mental health services %K patient satisfaction %K telehealth %K reliability %K validity %K patient-reported experience %K digital health care %K scale development %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: Because of the COVID-19 pandemic’s preventive measures, mental health care services were forced to reorganize and develop remote telehealth services. This led to newer modes of receiving treatment, both internet-based and video-based therapies, to meet patients’ need for help, while at the same time keeping the COVID-19 pandemic under control. This shift calls for an evaluation of the patient experience during times of increased use of novel approaches of receiving treatment. Brief evaluation forms are ideal for this purpose. Objective: As there are no validated brief measurement tools to evaluate patient-reported experiences in Norwegian mental health settings, we aimed to explore the internal consistency and factor validity of the 4-item self-administrated Client Satisfaction Questionnaire (CSQ-4). Methods: We examined the internal consistency and factor structure of a brief digitally administrated patient satisfaction measure in a sample of 145 outpatients in Norwegian mental health settings during the COVID-19 pandemic. Results: The internal consistency of a digital Norwegian CSQ-4 was high, with a Cronbach α of .92. A clear unidimensional structure (eigenvalue=3.22), which explained 80.4% of the variance, emerged from our data. A Mann-Whitney U test found a nonsignificant difference in satisfaction between genders (U=2546.5; P=.17). A Spearman rank correlation between satisfaction and age in our data was not statistically significant (r144=.110, P=.19). Conclusions: A measurement tool such as the CSQ-4 would be a valuable resource to improve the development and application of digital mental health services. Our results may support the use of the Norwegian CSQ-4 as a valid and reliable measure of satisfaction with mental health care services. In addition, as the CSQ-4 is a short-form and generic tool, it can be implemented in a wide range of routine evaluations of patient-reported satisfaction with telehealth services. %R 10.2196/41472 %U https://www.iproc.org/2022/1/e41472 %U https://doi.org/10.2196/41472 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41109 %T The Heart Game: A New Tool for Digital Patient Education for Patients With Heart Failure %A Hamborg,Lisbeth Gade %A Petersen,Rikke Jankuhn %A Spindler,Helle %A Dinesen,Birthe %+ Laboratory for Welfare Technology- Digital Health & Rehabilitation, Sport Sciences- Performance and Technology, Department for Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D, Aalborg, Denmark, 45 50820076, Lghamborg@hotmail.com %K telehealth %K digital patient education %K heart failure %K game prototype %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: The COVID-19 pandemic has shown the need for new ways to perform remote patient education. Patients with heart failure are associated with a high readmission rate. Rehabilitation can prevent hospital readmissions, but there is poor participation in rehabilitation of patients with heart failure. Based on user-driven innovation in the Future Patient research project, we have developed the prototype of the digital Heart Game. The Heart Game is a new approach to digital patient education, where patients can access a digital board game via an app; through the board game, they can be presented with quizzes, activities, and reflection questions, all related to heart failure. Objective: The objective of our study was to assess the usability of the Heart Game prototype app. Methods: A total of 6 patients with heart failure were recruited. Think-aloud test, where participants were observed during play and sound and iPad screens were recorded, was conducted, followed by a questionnaire immediately after playing. Finally, an interview (n=6) was carried out. Qualitative data were analyzed in NVivo software (version 12.0). Results: In total, 6 patients with heart failure (83% male; mean age 66 years) participated in the think-aloud tests. One participant did not complete the game. The game duration was from 9 minutes and 14 seconds to 16 minutes and 13 seconds. Findings from the think-aloud tests were shown in themes: digital games are a new world; practice makes perfect; the Heart Game is illogical; tasks are not generalizable, in understandable formulations, or entertaining; and the Heart Game is relevant, fun, and entertaining to play. Conclusions: The usability of the Heart Game shows opportunities for digital patient education. However, there are some challenges in the prototype with illogical game structures in the board game. Further test and development of the prototype needs to be performed. %R 10.2196/41109 %U https://www.iproc.org/2022/1/e41109 %U https://doi.org/10.2196/41109 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41075 %T Integrating Psychosocial Aspects in Digital Solutions %A Spindler,Helle %+ Department of Psychology and Behavioral Sciences, Business and Social Sciences, Aarhus University, Bartholins Allé11, Aarhus C, 8000, Denmark, 45 87165829, hellesp@psy.au.dk %K digital health %K psychology %K psychosocial %K digital solutions %D 2022 %7 23.8.2022 %9 Abstract %J iproc %G English %X Background: The design and development of digital health platforms do not routinely incorporate psychosocial aspects and theory that may increase engagement and motivation for using the digital solution. However, emerging evidence suggests that when integrating both theory and psychosocial aspects in the design process, the resulting digital health platforms may be superior in engaging and motivating patients to use them. Objective: The objective of our study was to give an overview of how and why integrating psychosocial aspects in digital solutions may be essential to engaging and motivating patients to use digital solutions. Methods: We conducted a brief narrative review of studies integrating psychosocial aspects and theory in the design and development of digital solutions for telerehabilitation. Results: In the studies identified, self-determination theory, incorporating the patient’s perspective, and using behavioral or psychological interventions on digital platforms are among some of the theoretical and psychosocial aspects that have already been used to design and develop digital solutions for telerehabilitation. Conclusions: Based on the literature, it is argued that integrating psychosocial aspects and theory in the design and development of digital solutions for telerehabilitation may result in platforms of increased value to both health providers and patients. %R 10.2196/41075 %U https://www.iproc.org/2022/1/e41075 %U https://doi.org/10.2196/41075 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41469 %T Identifying Parental Needs When Caring for a Child or Adolescent With Cancer: Participatory Design Study %A Nielsen,Camilla Littau %A Clemensen,Jane %A Holm,Kristina Garne %A Jensen,Claus Sixtus %A Callesen,Michael Thude %+ Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, Odense C, 5000, Denmark, 45 27502561, camilla.littau.nielsen@rsyd.dk %K pediatric cancer %K parental caregiving %K participatory design %D 2022 %7 22.8.2022 %9 Abstract %J iproc %G English %X Background: Survival possibilities among children and adolescents (referred to as “children”) with cancer have increased, resulting in more children and parents living with sequelae and psychological distress, respectively. Childhood cancer treatment is intensive and long term and affects the everyday life and functioning of the whole family, including daily and social life restrictions and hospitalizations, which force the parents to split up between the hospital and home to care for both the ill child and siblings and manage their jobs and homelife routines. Adequate parental coping strategies are essential for family adjustment and the child’s coping ability. Parenting a child with cancer, however, is challenging and stressful. Objective: This study aimed to identify parental needs when caring for a child with cancer. Methods: Using a participatory design approach, we generated data through field studies and semistructured interviews with parents of children receiving treatment at Odense or Aarhus University Hospital and focus group interviews with parents of children who have completed treatment within the past 2 years. Results: The parents felt trapped in an endless, emotional roller-coaster ride of fear, hope, grief, and mental and emotional exhaustion and had very limited resources for self-care. The presence of support from peers, health care providers, and relatives was a facilitator of successfully coping with the illness. In contrast, full-time isolation in the hospital, due to COVID-19 restrictions, was a barrier and linked with feelings of loneliness. Loneliness was also experienced as navigating difficult emotions when responding differently from the spouse or not feeling understood by relatives. Conclusions: Parents of children with cancer face many stressors that may become a psychological burden. New innovative approaches to provide psychosocial support, taking into account that the families are periodically isolated, are needed. For this goal, technological solutions may be useful and should be the focal point of this study’s experimental design phase. %R 10.2196/41469 %U https://www.iproc.org/2022/1/e41469 %U https://doi.org/10.2196/41469 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41310 %T Digital Communication Between Patients and Health Care Professionals Across Disciplines and Sectors After Hospital Discharge: Facilitators, Barriers, and Effects %A Jensen,Lili Worre Høpfner %A Dinesen,Birthe %A Kold,Søren %A Rahbek,Ole %+ Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K text messaging %K communication %K postoperative care %K continuity of patient care %D 2022 %7 22.8.2022 %9 Abstract %J iproc %G English %X Background: Over the past decade, hospital admissions for patients undergoing orthopedic surgery have been shortened, and the time for informing and educating patients prior to discharge has been compromised. The transition of care from hospital to home poses a substantial risk of adverse events. Patients have difficulty remembering information and struggle to assess the severity of symptoms after discharge, leading to unplanned telephone contacts and clinic visits. These inquiries are frequent and pose a substantial burden on the health care system and patients. The COVID-19 pandemic showed an emerging need to implement new communication technologies. Asynchronous digital communication (DC) may provide easy access to health care and seamless communication across sectors. Objective: This study aimed to investigate how DC can facilitate easy communication between patients and health care professionals (HCPs) across sectors and the effects of DC on patient-initiated telephone contacts after discharge. Methods: The overall theoretical approach was inspired by Continuity of Care and the Consolidated Framework for Implementation Research. Substudy I was a scoping review on DC between patients and HCPs after hospital discharge. Substudy II explored DC in an orthopedic surgery setting and through a triangulation of qualitative data collection techniques. Substudy III investigated the effect of DC on patient-initiated telephone contacts after discharge. Results: Preliminary findings from substudy I show that DC is increasingly used to support patient-provider communication after discharge. In substudy II, preliminary findings show that DC is feasible in a real-life setting, providing patients with easy access to HCPs, who accept and adapt DC to existing cross-sectoral workflows. However, barriers exist related to the technological integration between systems and individuals’ hesitation to use DC. In substudy III, DC is to be tested in a randomized controlled trial. Conclusions: This study generates new knowledge of asynchronous DC that may guide future implementations across the health care system. %R 10.2196/41310 %U https://www.iproc.org/2022/1/e41310 %U https://doi.org/10.2196/41310 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41184 %T Design and Development of an e-Learning Patient Education Program for Self-management Support in Patients With Rheumatoid Arthritis %A Raunsbæk Knudsen,Line %A Lomborg,Kirsten %A de Thurah,Annette %+ Department of Rheumatology, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, Aarhus N, 8200, Denmark, 45 30375716, linknuds@rm.dk %K rheumatoid arthritis %K web-based patient education %K e-learning %K digital health tools %K self-management %D 2022 %7 22.8.2022 %9 Abstract %J iproc %G English %X Background: Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Furthermore, change is taking place in the organization of health care systems because of a demographic shift toward aging populations and advancements in digital technologies, allowing for new interventions. However, evidence on how to provide web-based patient education within arthritis is limited. Objective: This study aimed to develop an e-learning education program targeting patients with rheumatoid arthritis. Methods: The development involved content specification and creative design with contributions from the investigators, patient research partners, and experts in communication, digital design, and e-learning. It was theoretically framed within theories of self-management and behavior change, multimedia learning, and entertainment education and empirically based on the evidence of patient education in rheumatoid arthritis and focus group discussions with patients, nurses, and rheumatologists. Finally, we conducted a feasibility test among 10 patients to assess the acceptability and usability of the program to identify areas to be adjusted. Results: The 5 following themes for educational needs were found in focus group discussions: “Knowledge of rheumatoid arthritis,” “The disease course and prognosis,” “Medical treatment,” “A new life situation,” and “Daily life with rheumatoid arthritis.” Based on these themes, a didactic and entertaining e-learning program with a simple user interface was created. It consists of 3 modules covering the disease course, examinations, treatment, and daily life with rheumatoid arthritis. It combines animations, videos, podcasts, text, speech, and tests. The patients who tested the program found it to be feasible—that is, clear in content and easy to understand with a suitable pace and coherence between graphics, speech, and text. Conclusions: This e-learning program is based on solid theoretical knowledge that meets users’ needs and is easy to use. Our study describes possible elements integrated in the development of web-based educational tools that can guide future development processes. %R 10.2196/41184 %U https://www.iproc.org/2022/1/e41184 %U https://doi.org/10.2196/41184 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41060 %T Telehealth Frontiers: Social Telerobots in Developmental and Behavioral Pediatrics %A Ahumada-Newhart,Veronica %A Marcin,James %+ Department of Pediatrics, Center for Health and Technology, University of California Davis Health, 4610 X St, Suite 2347, Sacramento, CA, 95817, United States, 1 916 734 2351, vahumada@ucdavis.edu %K telehealth %K social robots %K technology %K human development %K health equity %D 2022 %7 22.8.2022 %9 Abstract %J iproc %G English %X Background: COVID-19 has severely impacted health in vulnerable demographics. As communities transition back to in-person work, learning, and social activities, pediatric patients who are restricted to their homes due to medical conditions face unprecedented isolation. Prior to the pandemic, it was estimated that each year, over 2.5 million US children remained at home due to medical conditions. Confronting gaps in health and technical resources is central to addressing the challenges faced by children who remain at home. Having children use mobile telemedicine units (telerobots) to interact with their outside environment (eg, school and play, etc) is increasingly recognized for its potential to support children’s development. Additionally, social telerobots are emerging as a novel form of telehealth. A social telerobot is a tele-operated unit with a mobile base, 2-way audio/video capabilities, and some semiautonomous features. Objective: In this paper, we aimed to provide a critical review of studies focused on the use of social telerobots for pediatric populations. Methods: To examine the evidence on telerobots as a telehealth intervention, we conducted electronic and full-text searches of private and public databases from 2010 onward. We included studies with the pediatric personal use of interactive telehealth technologies and telerobot studies that explored effects on child development. We excluded telehealth and telerobot studies with adult (aged >18 years) participants. Results: In addition to telehealth and telerobot advantages, evidence from the literature suggests 3 promising robot-mediated supports that contribute to optimal child development—belonging, competence, and autonomy. These robot-mediated supports may be leveraged for improved pediatric patient socioemotional development, well-being, and quality-of-life activities that transfer traditional developmental and behavioral experiences from organic local environments to the remote child. Conclusions: This review contributes to the creation of the first pediatric telehealth taxonomy of care that includes the personal use of telehealth technologies as a compelling form of telehealth care. %R 10.2196/41060 %U https://www.iproc.org/2022/1/e41060 %U https://doi.org/10.2196/41060 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41096 %T Digital Health for Vulnerable Populations: From Co-design to Scaling and Replication %A Berkowitz,Gale %+ Center for Information Technology Research in the Interest of Society and the Banatao Institute, University of California, 356G Sutardja Dai Hall, Berkeley, CA, 94720, United States, 1 5102604586, gberkowitz@gmail.com %K telehealth %K co-design %K health outcomes %D 2022 %7 19.8.2022 %9 Abstract %J iproc %G English %X Background: The COVID-19 pandemic has made it clear that technology access, digital literacy, and telehealth access have become more crucial than ever before. At the Center for Information Technology Research in the Interest of Society (CITRIS) at the University of California, 2 projects are focused on communities have the least access to quality health care services, including low-income workers in rural areas as well as low-income older adults in their community. Objective: Co-designed technology innovation is a core competency of CITRIS Health. This presentation will focus on 2 of CITRIS Health’s co-designed signature programs: ACTIVATE and Lighthouse. Co-designed innovations have the intended outcomes of improving access to technology, increasing technology literacy, and ultimately improving health outcomes. Methods: Co-design refers to a participatory approach to designing solutions, in which community members are treated as equal collaborators in the design process—they give feedback, and they try out devices. It is part of an innovation process. Key components of a co-design process involve the following: intentionally involving users in designing solutions, postponing design decisions until after gathering feedback, synthesizing feedback from participants into insights, and developing solutions based on feedback. Results: Both projects have undergone formal evaluations to assess the process of implementation as well as outcomes. Additionally, each project has a systematic process for monitoring its own implementation and key metrics. Common near-term outcomes include positive feedback from co-designers about the inclusivity of the design progress and optimism that technology selections, training, and interventions will lead to the intended outcomes. Conclusions: Ultimately, the intention of these co-designed innovations is to create models that are feasible and sustainable. They will provide a roadmap for both public and private partners, setting a gold standard in California and across the nation. %R 10.2196/41096 %U https://www.iproc.org/2022/1/e41096 %U https://doi.org/10.2196/41096 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e41059 %T Systematic Approaches for Telemedicine and Data Coordination for COVID-19 in Baja California, Mexico %A Castillo Olea Jr,Cristian %A Vera Hernandez Sr,Carlos %A Mendias Alarcon,Amellaly %A Conte Galvan Sr,Roberto %+ School of Medicine and Psychology, Autonomous University of Baja California, Paque Industrial Tijuana, Tijuana, 22420, Mexico, 52 5574302237, castillo.cristian@uabc.edu.mx %K telemedicine %K COVID-19 %K systems design %K digital health %D 2022 %7 19.8.2022 %9 Abstract %J iproc %G English %X Background: In 2019, the State of Baja California had a total population of 3,682,063 inhabitants; in the city of Tijuana, there were only 13 Red Cross ambulances and 1 fire department ambulance to attend to the prehospital emergencies of almost 2 million inhabitants. Objective: This study aimed to provide information to the public; evaluate COVID-19 in real time; and track regional, municipal, and state-wide data in real time that inform supply chains and resource allocation with the anticipation of a surge in COVID-19 cases. Methods: Our model is based on human-centric design factors and cross-disciplinary collaborations for the scalable, data-driven enablement of smartphone teleconsultation technologies to link hospitals, clinics, and emergency medical services for point-of-care assessments of COVID-19 testing and subsequent treatment and quarantine decisions. Results: The Telehealth System handled 28,964 telephone calls in the period from April 1, 2020, to January 30, 2022, and accumulated 20,287 working hours. In total, 13,721 follow-up calls were made to quarantined patients, providing medical and psychological counseling, and 12,643 calls were received and transferred from the 911 system, of which 4964 calls from patients with respiratory symptoms required urgent ambulance dispatch. Conclusions: Telehealth offers capabilities for remote detection, care, and treatment to help with supervision, surveillance, discovery, and prevention, as well as to mitigate the effects of health care indirectly related to COVID-19. %R 10.2196/41059 %U https://www.iproc.org/2022/1/e41059 %U https://doi.org/10.2196/41059 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e40954 %T Technology-Based Innovative Health Care Solutions for Improving Maternal and Child Health Outcomes in Low- and Middle-Income Countries: Systematic Review and Network Meta-analysis %A Rahman,Md Obaidur %A Yamaji,Noyuri %A Suzuki,Daichi %A Sasayama,Kiriko %A Yoneoka,Daisuke %A Ota,Erika %+ Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 3543 6391 ext 4990, obaidur006@gmail.com %K technology-based interventions %K mobile health %K digital health %K telehealth %K eHealth %K maternal and child health %K systematic review %K network meta-analysis %K low- and middle-income countries %D 2022 %7 19.8.2022 %9 Abstract %J iproc %G English %X Background: Technology-based health care interventions (TBIs) are being considered as a promising solution to effectively strengthen maternal and child health (MCH) service uptake in resource-limited settings. Objective: This study aimed to identify the most effective TBIs that could achieve the best functional MCH outcomes in low- and middle-income countries (LMICs). Methods: A comprehensive search was performed in January 2021. In all, 2 independent researchers identified randomized controlled trials (RCTs) implemented in LMICs using the Population, Intervention, Comparison, Outcomes framework: Population: healthy pregnant women; Intervention: TBIs; Comparison: usual care or non-TBIs; and Outcomes: MCH outcomes. We estimated the direct, indirect, and relative effects, with their certainty based on the Grading of Recommendations, Assessments, Development, and Evaluations approach, for a wide range of MCH outcomes. Results: In total, 30 trials with 70,807 participants were included, and 80% had low risk of bias. Our network meta-analysis (NMA) estimates indicated that TBIs, particularly SMS text messaging or phone call with mobile voucher interventions, were likely to be effective in improving MCH outcomes. The 1-way communication intervention was likely to be the most effective for the uptake of ≥4 antenatal care visits (relative risk [RR] 1.81, 95% CI 1.33-2.45; moderate certainty), facility delivery (RR 1.45, 95% CI 1.10-1.91; moderate certainty), early breastfeeding initiation (RR 1.18, 95% CI 1.02-1.37; moderate certainty), and caesarean delivery (RR 0.87, 95% CI 0.84-0.91; low certainty) outcomes; however, 2-way communication intervention was likely to be the most effective for the skilled birth attendance (RR 1.36, 95% CI 1.14-1.63; low certainty), maternal (RR 2.04, 95% CI 1.05-3.96; very low certainty) and infant’s postnatal care use (RR 1.55, 95% CI 1.19-2.04; low certainty), exclusive breastfeeding practice (RR 1.53, 95% CI 1.14-2.05; moderate certainty), and perinatal death (RR 0.51, 95% CI 0.32-0.83; low certainty) outcomes. There was no substantial inconsistency between direct and indirect evidence, but small study effects were detected in the NMA. Conclusions: Different forms of TBIs have a possibility to improve MCH outcomes in LMICs and can be integrated into the existing health systems based on their priorities. This study suggests the implementation of large-scale, well-designed RCTs in low-income countries due to the limited number of RCTs in the NMA. Trial Registration: PROSPERO CRD42021239185; https://tinyurl.com/yuvmp35x %R 10.2196/40954 %U https://www.iproc.org/2022/1/e40954 %U https://doi.org/10.2196/40954 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e40911 %T Evaluation of a Tailored Digital Literacy Intervention in Affordable Older-Adult Housing: Case Study %A DeLange Martinez,Pauline %A Espinoza Giacinto,Rebeca %A Henderson,Stuart %A Lindeman,David %+ Public Health Sciences Department, University of California, One Shields Ave, MS1C, Davis, CA, 95616, United States, 1 530 752 2793, pdmartinez@ucdavis.edu %K technology acceptance %K digital literacy %K digital divide %K low-income %K gerontology %K gerontechnology %K aged %K emigrants and immigrants %K poverty %K computer literacy %K evaluation %K low English proficiency %K information communication technologies %K ICT use %D 2022 %7 19.8.2022 %9 Abstract %J iproc %G English %X Background: Older age, low socioeconomic status, living alone, and low English proficiency are independent factors associated with low information communication technology (ICT) use. Evidence-based interventions are needed to increase digital access and literacy among underrepresented groups. Objective: This study aimed to increase the understanding of factors influencing ICT adoption and sustainable resources for training and support in affordable older-adult housing. Methods: Broadband, tablet computers, training, and support were offered at 1 affordable older-adult housing community. Three 60-minute classes covered device basics, Google Translate, YouTube, and Zoom; in-language user guides were provided. Resident Ambassadors offered weekly in-language tech support. Mixed methods evaluation included surveys at entry, 30 days, and 90 days and key informant interviews. Results: Overall, 72% (N=76) of residents participated. The average age was 78 (SD 8) years, and the participants were primarily Asian (62%), lived alone (68%), and had low English proficiency (65%). About half (49%) of the participants had less than a high school degree. Reasons to decline initial participation included: already owned another device, visual or cognitive challenges, or unwillingness to complete surveys. Of the participants, 89% attended at least 1 class and 37% attended all 3 classes. Over 90% of participants found the classes helpful, 87% found the user guide helpful, and 49% received help from a neighbor. At 30 and 90 days, 82% of the participants reported using their tablet at least twice per week for various activities. However, over half of participants reported the tablet was difficult to learn, and from 30 to 90 days, confusion and the fear of making mistakes when using the tablet slightly increased. Conclusions: Overall, participants reported high satisfaction with the devices and tech support, although the decreasing comfort with technology over time indicates a need for additional training and ongoing support. This case study provides a model to increase ICT use among older adults in affordable older-adult housing communities. %R 10.2196/40911 %U https://www.iproc.org/2022/1/e40911 %U https://doi.org/10.2196/40911 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 8 %N 1 %P e40906 %T Keeping Telehealth an Equalizer in the Age of COVID-19 %A Marcin,James %+ Center for Health and Technology, University of California Davis Health, 2516 Stockton Blvd, Sacramento, CA, 95817, United States, 1 9167344726, Jpmarcin@ucdavis.edu %K telehealth %K equity %D 2022 %7 19.8.2022 %9 Abstract %J iproc %G English %X Background: Telehealth has historically been used to increase access to care for marginalized populations living in rural and underserved communities and those who require frequent medical care. Video visits have been used to address distance barriers for routine and specialty care, and remote patient monitoring has been used to help those with chronic medical conditions. However, following the COVID-19 pandemic, telehealth has become standard and is less likely to be used by the populations who could benefit most from its use. Objective: This review aimed to evaluate whether telemedicine use is lower among patients without insurance, racial/ethnic minority individuals, and non–English-speaking patients. Methods: From reviews of the literature and US data, comparisons of telehealth use between different populations were conducted. Utilization rates were compared between racial/ethnic groups (Black, Asian, and White; Hispanic and non-Hispanic) and among different telehealth use cases: on-demand, direct-to-consumer care; scheduled ambulatory video visits; and remote patient monitoring applications. Results: Among telehealth users in the United States, the highest share of visits that used video services occurred among young adults aged 18-24 years (72.5%), those earning at least US $100,000 (68.8%), those with private insurance (65.9%), and White individuals (61.9%). Video telehealth rates were lowest among those without a high school diploma (38.1%); adults aged ≥65 years (43.5%); and Hispanic (50.7%), Asian (51.3%), and Black individuals (53.6%). Conclusions: Telehealth use increased dramatically during the COVID-19 pandemic, but research suggests that access to telehealth was not equitable across different population subgroups. Following the pandemic, the use of telehealth has gone from a tool that was used to primarily address barriers in access among minority populations to a model of care that serves those who are better insured, English-speaking, and White. Interventions to address inequities involve payment policies, ambulatory operations, and investments in making telehealth more accessible by underserved populations. %R 10.2196/40906 %U https://www.iproc.org/2022/1/e40906 %U https://doi.org/10.2196/40906