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Digital Health Intervention Design and Evaluation for Public Health Promotion

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 23491

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Special Issue Editors

Dr. Panos Balatsoukas

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Guest Editor

1. Design School, Loughborough University, Loughborough, LE11 3TU, UK
2. Population Health and Environmental Sciences, King’s College London, Guy’s, London, SE1 1UL, UK
Interests: digital health; public health; design

Dr. Isabel Sassoon

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Guest Editor

1. Department of Computer Science, Brunel University London, UB8 3PN, London, UK
2. Department of Informatics, King’s College London, Strand, WC2R 2LS, London, UK
Interests: digital health; health data science

Special Issue Information

Dear Colleagues,

Digital health interventions have the potential to promote healthy behaviors among the public (e.g., increase physical activity, support healthier eating habits, encourage responsible use of antibiotics, promote smoking cessation or safe sex). While there is an abundance literature on the application of such interventions (e.g., mobile apps, websites, or social networking technologies have been frequently used) the majority of this literature, as expected, tends to focus on the evaluation of their effectiveness on health outcomes rather than the documentation of the design process itself. In addition, when evaluating effectiveness, the true effect of digital health interventions is frequently hindered because a) in many cases, digital technologies form part of larger interventions that involve also face to face counselling or other methods of health promotion; b) digital health interventions can consist of several design components (that serve different purposes ranging from behavior change and social interaction to group support and information sharing), making it difficult to understand the individual and systemic/collective effect of these components on health outcomes or the intervention’s usability, safety, and sustainability. Papers addressing these challenges are invited for this Special Issue. Submitted manuscripts should report original work combining empirical research with a practical focus on aspects related to the design and evaluation of digital health interventions for public health promotion.

Dr. Panos Balatsoukas
Dr. Isabel Sassoon
Guest Editors

Manuscript Submission Information

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Keywords

digital health
eHealth
health promotion
design
behavior change
social networking technologies
mobile apps
health interventions
healthy behaviors

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Published Papers (7 papers)

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Research

14 pages, 7135 KiB

Open AccessArticle

Fact or Fiction? The Development and Evaluation of a Tobacco Virtual Health Tool

by Geneviève Jessiman-Perreault, Rachel Dunn, Angela Erza, Candace Kratchmer, Ameera Memon, Howie Thomson and Lisa Allen Scott

Int. J. Environ. Res. Public Health 2023, 20(2), 1397; https://doi.org/10.3390/ijerph20021397 - 12 Jan 2023

Viewed by 1448

Abstract

The virtual setting is an important setting for health promotion as individuals increasingly go online for health information and support. Yet, users can have difficulty finding valid, trustworthy, and user-friendly health information online. In 2022, we launched an interactive Fact or Fiction Tobacco virtual health tool. The virtual health tool uses evidence-informed tailored content to engage users and refer them to local tobacco cessation resources. The present paper describes the development, user testing, and evaluation of this tool. The Fact or Fiction virtual health tool was designed by tobacco cessation and health marketing experts and informed by health behaviour theories of change. The tool captures data on who is seeking health information, the user’s stage of readiness to quit tobacco products, and whether they act by accessing referred resources. In 2021, we conducted two phases of user testing prior to marketing the tool publicly. After 7 weeks of marketing, we collected data on user interactions with the tool and evaluated the reach of the tool. Results from user testing found the tool to be engaging, easy to use, and quick to complete. Adaptations were made to simplify and condense text and include additional animations. During the first seven weeks of the tool being live, it reached 2306 users, and 38.7% of those users were current or occasional tobacco users. Users were classified based on their intention to quit. Bivariate analysis found that the tool was successful in driving tobacco users towards action as 21.2% tobacco users who were looking to quit and 8.8% of tobacco users who were not looking to quit clicked on local tobacco cessation resources. This virtual health tool is reaching the targeted population and providing tailored information needed at each stage of the continuum of health behaviour change. Among tobacco users looking to quit, this virtual health tool acts as a quick referral to local tobacco cessation resources. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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15 pages, 1114 KiB

Open AccessArticle

Exploring the Black Box of an mHealth Intervention (LIFE4YOUth): A Qualitative Process and Outcome Evaluation of End-User Engagement

by Anna Seiterö, Kristin Thomas, Marie Löf and Ulrika Müssener

Int. J. Environ. Res. Public Health 2022, 19(21), 14022; https://doi.org/10.3390/ijerph192114022 - 28 Oct 2022

Viewed by 1898

Abstract

The effectiveness of mHealth interventions rely on whether the content successfully activate mechanisms necessary for behavior change. These mechanisms may be affected by end-users’ experience of the intervention content. The aim of this study was to explore how the content of a novel mHealth intervention (LIFE4YOUth) was understood, interpreted, and applied by high school students, and the consequences of engaging with the content. Qualitative content analysis was used inductively and deductively to analyze interview data (n = 16) based on think-aloud techniques with Swedish high school students aged 16–19 years. Theoretical constructs from social cognitive theory framed the deductive analysis. The analysis resulted in four categories which describe central activities of intervention engagement among end-users: defining, considering, centralizing, and personalizing. End-users engaged in these activities to different degrees as illustrated by four typologies: Literal, Vague, Rigid, and Creative engagement. Most informants knew about the risks and benefits of health behaviors, but engagement with intervention content generally increased informants’ awareness. In conclusion, this study provides in-depth knowledge on the cognitive process when engaging with mHealth content and suggests that deliberate and flexible engagement most likely deepens end-users’ understanding of why and how health behavior change can be managed. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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10 pages, 1498 KiB

Open AccessArticle

Covidseeker: A Geospatial Temporal Surveillance Tool

by Yulin Hswen, Elad Yom-Tov, Vaidhy Murti, Nicholas Narsing, Siona Prasad, George W. Rutherford and Kirsten Bibbins-Domingo

Int. J. Environ. Res. Public Health 2022, 19(3), 1410; https://doi.org/10.3390/ijerph19031410 - 27 Jan 2022

Cited by 1 | Viewed by 2483

Abstract

Introduction: Geospatial temporal data derived from smartphones traditionally used for purposes of navigation may offer valuable information for public health surveillance and locational hot spotting. Our objective was to develop a web-based application, called Covidseeker, that captures continuous fine-grained geospatial temporal data from smartphones and leverages these data to study transmission patterns of COVID-19. Methods: This report describes the development of Covidseeker and the process by which it utilizes geospatial temporal data from smartphones and processes it into a usable format to study geospatial temporal patterns of COVID-19. We provide an overview of the design process, the principles, the software architecture, and the dashboard of the Covidseeker application and consider key challenges and strategic uses of capturing geospatial temporal data and the potential for future applications in outbreak surveillance. Results: A resource such as Covidseeker can support situational awareness by providing information about the location and timing of transmission of diseases such as COVID-19. Geospatial temporal data housed in smartphones hold tremendous potential to capture more depth about where and when transmission occurs and the patterns of human mobility that lead to increases in risk of COVID-19. Conclusion: An enormous and highly rich source of geospatial temporal information about human mobility can be used to provide highly localized discrete information that is difficult to capture by traditional sources. The architecture of Covidseeker can be applied to help track COVID-19 and should be integrated with traditional disease surveillance practices. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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17 pages, 1710 KiB

Open AccessArticle

Reviewing the User-Centered Design Process for a Comprehensive Gastroesophageal Reflux Disease (GERD) App

by Min Ji Kim, Sarah Schroeder, Shuan Chan, Kyle Hickerson and Yi-Ching Lee

Int. J. Environ. Res. Public Health 2022, 19(3), 1128; https://doi.org/10.3390/ijerph19031128 - 20 Jan 2022

Cited by 3 | Viewed by 3021

Abstract

The objective of this study was to design a user-centered mobile health (mHealth) application for individuals with gastroesophageal reflux disease (GERD) and evaluate its design features and effectiveness for use by doctors. Prior to designing, our team undertook a discovery process that involved creating personas, conducting a competitor analysis and heuristic evaluation of existing apps, along with interviews with acid reflux patients. Then, we created a low-fidelity prototype, which was revised on the basis of several rounds of user testing. During the design phase, each round of user testing included a mix of surveys, concurrent think-alouds, and interviews to gather user feedback on the prototypes. Lastly, an evaluation phase consisting of gathering feedback on the user-centered design approach from user experience experts and medical doctors specialized in GERD was conducted. Overall, the final GERD app includes important features for tracking symptoms and triggers, analytics, data export, and community information, while promoting individualization, accessibility, and usability. The documentation of the design process of this app serves as a reference point for future medical app developers as it followed an empirically supported user-centered design strategy and resulted in an app which received positive feedback from users and human factors experts. We also intend to share some of the limitations due to the constrained resources, as well as potential ways to strengthen the design process for mHealth applications. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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15 pages, 1266 KiB

Open AccessArticle

Co-Creation of Massive Open Online Courses to Improve Digital Health Literacy in Pregnant and Lactating Women

by Yolanda Álvarez-Pérez, Lilisbeth Perestelo-Pérez, Amado Rivero-Santanta, Alezandra Torres-Castaño, Ana Toledo-Chávarri, Andrea Duarte-Díaz, Vinita Mahtani-Chugani, María Dolores Marrero-Díaz, Alessia Montanari, Sabina Tangerini, Carina González-González, Michelle Perello, Pedro Serrano-Aguilar and on behalf of the IC-Health Project Consortium

Int. J. Environ. Res. Public Health 2022, 19(2), 913; https://doi.org/10.3390/ijerph19020913 - 14 Jan 2022

Cited by 12 | Viewed by 3804

Abstract

Background: Digital health literacy (DHL) increases the self-efficacy and empowerment of pregnant and lactating women (PLW) in using the Internet for health issues. The European project IC-Health aimed to improve DHL among PLW, through the co-creation of Massive Open Online Courses (MOOCs). Methods: The co-creation of the MOOCs included focus groups and the creation of communities of practice (CoPs) with PLW and healthcare professionals aimed to co-design the MOOCs. The quantitative measures of MOOCs’ acceptability, experience in the co-creation process and increase in DHL (dimensions of finding, understanding and appraisal) were assessed. Results: 17 PLW participated in focus groups, 113 participants were included in CoPs and 68 participants evaluated the acceptability of MOOCs. A total of 6 MOOCs aimed at improving PLW’s DHL were co-designed. There was a significant improvement in self-perceived DHL after using MOOCs (p-value < 0.001). The acceptability of MOOCs and co-creation experience were positively valued. Conclusions: The preliminary results of the quantitative assessment showed a higher self-perceived DHL after the IC-Health MOOCs. These results suggest that IC-Health MOOCs and the co-creation methodology appear to be a viable process to carry out an intervention aimed to improve DHL levels in European PLW. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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19 pages, 7938 KiB

Open AccessArticle

Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach

by Mirjam Ekstedt, Marie Kirsebom, Gunilla Lindqvist, Åsa Kneck, Oscar Frykholm, Maria Flink and Carolina Wannheden

Int. J. Environ. Res. Public Health 2022, 19(1), 391; https://doi.org/10.3390/ijerph19010391 - 30 Dec 2021

Cited by 14 | Viewed by 4320

Abstract

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients’ engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application—ePATH (electronic Patient Activation in Treatment at Home)—with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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15 pages, 1544 KiB

Open AccessArticle

Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women

by Melissa A. Napolitano, Cherise B. Harrington, Loral Patchen, Lindsey P. Ellis, Tony Ma, Katie Chang, Azar Gaminian, Caitlin P. Bailey and W. Douglas Evans

Int. J. Environ. Res. Public Health 2021, 18(4), 2178; https://doi.org/10.3390/ijerph18042178 - 23 Feb 2021

Cited by 14 | Viewed by 3875

Abstract

The study aim was to implement and evaluate the feasibility of a culturally informed (“BeFAB”) app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions. Full article

(This article belongs to the Special Issue Digital Health Intervention Design and Evaluation for Public Health Promotion)

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