bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies to advancing digital health equity: perspectives from underserved groups
Authors: Wilson S , Tolley C , Mc Ardle R , Slight R , Hassan N , Slight S 
Published: October 2024

Abstract

Digital Health Technologies (DHTs) are revolutionizing healthcare. However, there is a lack of demonstrable health benefits across all populations. To advance digital health equity, we explored the perspectives of underserved groups on strategies to support digital inclusivity. Participants belonged to two or more CLEARS (Culture (ethnicity, language, religion), Limiting conditions (visual or hearing), low Educational attainment, older Age, Residence (rural, deprived or no fixed address), low Socioeconomic status) groups. This framework encompassed sociodemographic factors associated with digital exclusion and recognizes the role of intersectionality.(1) Twenty-nine individuals participated in focus groups (n = 4) or interviews (n = 11) and shared their perspectives on the barriers to DHTs, innovative ideas to improve inclusivity, and perceived feasibility of implementing changes. An inductive reflective thematic analysis was used to analyze the transcripts, assisted by N-Vivo. Participants experienced fragmented communication with healthcare providers when using DHTs, explaining how they received a no-reply SMS message asking them to confirm an appointment via a link but were unable to access the link. Current solutions to overcoming such barriers included using non-digital routes (e.g., visiting a pharmacy) or calling non-emergency healthcare services. Many participants expressed the need for DHT support services to be implemented to provide educational support and access to devices. However, some participants raised concerns about the financial strain this might place on healthcare systems. Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.
(1)Wilson et al. (2023). Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review. Alzheimer’s & Dementia.

Key messages
• Strategies to mitigating digital exclusion within healthcare should be designed with underserved groups.
• Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.
Accessibility engineering in the mhealth industry - A multi-case study
Authors: Hasenlust K , Reinschluessel A V , Rother M 
Published: October 2024

Abstract

Medical apps, i.e. apps that fall under the EU Medical Device Regulation (MDR), are increasingly becoming a relevant part of healthcare in European countries. This is particularly evident in the numerous partnerships between app vendors and insurers as well as in the launches of national reimbursement programs. However, when it comes to enabling as many patients as possible to benefit from the medical advantages associated with the use of these apps, funding is only one part of the equation. It is up to the app vendors to develop barrier-free user interfaces so that people - regardless of individual characteristics such as cognitive abilities, physical limitations or language skills - can interact successfully with the app. Little is known about how these companies approach the topic of accessibility, what challenges they face and how big the impact of medical device legislation and other regulations on accessibility is. Against this background, we are undertaking a case study in several companies offering apps on the German market that are certified as medical devices and targeted at patients. Through interviews with employees with various roles (e.g. business, engineering, design) we are aiming at reconstructing the development processes of the apps with a focus on accessibility. We plan to expand the results by interviews with experts, e.g., in the area of MDR conformity assessment. 20 interviews in four companies have revealed that accessibility only plays a minor role during development. As a result, the topic is not systematically addressed, but only a few features are implemented. The app’s compatibility with screen reader or voice control was not explicitly addressed in any of the companies. There was also no deliberate involvement of people with disabilities in user studies. The preliminary results also indicate that the influence of medical device legislation on the implementation of accessibility is negligible.

Key messages
• User interface accessibility has a very low priority in the mhealth companies we have examined so far.
• The current regulations are not sufficient in enforcing the basic implementation of accessibility features requiring more guidance and detailed regulations, given our sample of companies.
Assessment of digital literacy and user experience in patients with cochlear implants
Authors: Werminghaus M , Thyson S , Schatton D , Richter J G , Klenzner T 
Published: October 2024

Abstract

Introduction
The cochlear implant (CI) is the treatment of choice for people affected by deafness or profound hearing loss. Patients with cochlear implants (PwCIs) can enhance their hearing outcomes using digital hearing training programs (dHTPs). Current technological trends leans towards personalized, AI-driven dHTPs, aiming to optimize user experience (UX) and adherence. This study aims to investigate the digital literacy skills and UX of PwCI before and after testing a prototype of a dHTP with an AI-driven design (TraiCI).

Methods
Two research-specific questionnaires developed by the Hearing Center Düsseldorf (QDL and QUX) were used to assess digital literacy skills and user experience in TraiCI. Additionally, the User Experience Questionnaire (UEQ) was employed to evaluate general user experience. The UEQ assesses software quality across dimensions such as transparency and stimulation using paired opposites.

Results
22 outpatient PwCIs the Hearing Center Düsseldorf with unilateral or bilateral CI (mean age 54 years; SD = 15) were included. In QDL, PmCI demonstrated high levels of digital literacy skills. The majority of PmCI (80.6%) reported prior experience with dHTP. Usage of these programs occurred daily to multiple times per week within the first six months after CI treatment, with session durations predominantly ranging from 10 to 30 minutes. QUX data indicated a smooth initiation process (70.8%) and seamless login experience (95.5%). The UEQ addressed various aspects of user experience, with ‘transparency’ receiving the highest scores (MW = 1.9; SD = 0.6), while ‘stimulation’ received the least positive ratings (MW = 0.0; SD = 2.1).

Conclusions
The results show a high degree of digital literacy among PwCIs. They encountered minimal challenges in operating hardware and software components. Further refinement is necessary to align with PwCI’s expectations and maximize benefits. Early and iterative involvement of PwCIs in future projects could optimize outcomes.

Key messages
• The study highlights the proficient digital literacy skills of cochlear implant patients (PwCIs).
• Further refinement of dHTPs is needed to better align with PwCIs’ expectations and maximize benefits, emphasizing the importance of iterative involvement for optimized outcomes.
Patients’ trust in health information sources as an antecedent of novel healthcare technology usage
Authors: Gur A , Avidar R 
Published: October 2024

Abstract

Background
As professional health information sources, healthcare maintenance organizations (HMOs) need to convince patients of the necessity, efficiency, and reliability of technology-based services to increase and optimize their usage. It raises the question of whether patients’ trust in health information sources shapes the use of technology-based services and, in return, increases their willingness to use novel healthcare services in the future.

Methods
Data were collected through an online close-ended survey among 668 adult Israeli citizens insured with Israeli health insurance (85% of them Jewish, 52.5% female, and in their early 40s, with half holding an academic degree). The survey explored actual use and willingness to use innovative healthcare technologies and the trust respondents attributed to various sources of health information. Data were analyzed by SPSS 28.

Results
Participants generally use healthcare technology primarily to schedule appointments, search for medical information, and make health-related requests. To quite an extent, they are willing to be treated with innovative healthcare technologies (e.g., for radiological purposes and personally tailored medication). Preliminary results suggest that trust in the measured formal health information sources (i.e., formal health providers, HMO, HMO online services) was positively associated with technology-based healthcare services usage (r=.14 - .20, p&lt;.001). A positive association also emerged between the current use of healthcare technology and the willingness to use innovative medical technologies in the future (r=.23, p&lt;.001).

Conclusions
HMOs, as key players, have the power to maximize the usage of advanced health services by establishing trusting relationships with their patients. This will increase the usage of healthcare technology-based services and generate positive patient experiences, which will result in the willingness to experience novel types of health services in the future.

Key messages
• Encouraging patients to use technology-based health services will maximize the potential inherent in the use of innovative health services and treatments in the future.
• Nurturing trusting relationships with patients at any level in the health system will increase their compliance with health providers’ recommendations to use advanced health services.
Debuting an innovative model for integrated child health care in the Southeast region, Bulgaria
Authors: Vankova D , Nikolov D 
Published: October 2024

Abstract

Background
Demographic indicators are fundamental drivers for health policy action. The Southeast Region (SER) is the largest statistical region (NUTS 2) in Bulgaria (BG), distinguished by the highest Infant mortality rates (IMR) and teenage crude fertility rates across the European Union (EU). For instance, the 2022 statistics reveal an IMR of 8.2 per 1000 live births in SER, notably higher than Bulgaria’s average of 4.8 and the EU’s average of 3.3. This disparity highlights the critical need for region-specific health initiatives aimed at curtailing IMR and harmonizing health outcomes throughout the EU territories. This report outlines such an initiative under the project code BG16FFPR003-2.001-012, recently funded by the EU. The novel SER initiative: This is the first presentation of the concept of integrated territory investments (CITI) and the innovative model for integrated child health care in SER, BG. The project impacts child health care across the four districts of SER - Burgas, Sliven, Yambol, Stara Zagora. The municipalities have collaboratively submitted 24 project proposals with educational bodies, NGOs, public institutions, and the Ministry of Health. The theoretical frame of the project’s model is underpinned by three foundational pillars: 1) Prevention in primary healthcare; 2) Child health care in hospitals; 3) Development of human resources, providers of health care. The forthcoming infrastructural, organisational, and capacity-building interventions will remain adaptable yet aligned with the overarching CITI framework.

Conclusions
A current phase of public discourse on the CITI concept and the innovative integrated model in SER is underway. Stakeholders are actively encouraged to provide input either through discussions or by participating in designated online surveys. Community engagement is instrumental in evaluating and prioritizing these initiatives, which aim to fundamentally transform the SER by leveraging its unique territorial potential.

Key messages
• Demographic indicators drive health policy. Project BG16FFPR003-2.001-012 targets EU disparities, lowering IMR and balancing fertility rates.
• This is the first presentation of the “Innovative model for integrated child health care in SER”. The EPH Conference provides an ideal platform for sharing and discussion.
Intergenerational Transmission of Overweight and Obesity among Preschool Children in Sweden
Authors: Kodagoda H , Lindkvist M , Ivarsson A , Silfverdal S-A , Vaezghasemi M 
Published: October 2024

Abstract

Background
Child overweight including obesity (OWOB) has quadrupled globally, since 1975. It affects a third of European children and even higher rates persist among expectant parents. Parental pre-pregnancy body mass index (BMI) and health behaviours are known to influence offspring health. Thus, this study aimed to investigate the link between parental and children’s OWOB, alongside parental socio-economic and other factors.

Methods
This is a population-based repeated cross-sectional study utilized data from the Salut Programme in Västerbotten, Sweden, and Swedish national registers, including 5,937 of 3-year-olds and their parents. Logistic regression analyses were used to examine the association of child BMI with prenatal BMI and other factors. Further, the Relative Excess Risk due to Interaction (RERI) arising from the interplay between parent’s OWOB status in relation to their children’s OWOB was calculated.

Results
OWOB prevalence rates for 3-year-olds, expectant mothers, and their partners were 15.1%, 29.1%, and 53.5%, respectively. Both parent’s OWOB significantly affected children’s BMI (with strongest association for mothers). The Relative Excess Risk due to interaction (RERI) was positive for children’s OWOB if both parents were obese, showing an additive interaction effect of individual parental obesity status. The odds for a child to be OWOB was 2.88 (1.83-4.43) if both parents were obese compared to if none of them were obese.

Conclusions
OWOB among preschool children remain an important public health concern in Sweden. Based on the study findings, Sweden’s regional and national public health initiatives should prioritize targeting parental overweight and obesity as a key strategy to reduce the burden of OWOB among children. Furthermore, the resemblance of these results with comparable studies across the world, emphasizing the importance of initiating interventions with parents before pregnancy or even earlier.

Key messages
• Parental combined obesity status significantly increase the odds of childhood overweight and obesity.
• The importance of initiating interventions with parents before pregnancy for better health outcomes related to child BMI.
Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients
Authors: Singh M K , Mahapatra A , Kandpal S D , Salah H , Sharma K 
Published: October 2024

Abstract

Background
Malnutrition & Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY

Methods
In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services.

Results
Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision & collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc.

Conclusions
NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden

Key messages
• Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives.
• Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.
Health in Germany – A new panel infrastructure for Public Health Research in Germany: study design
Authors: Öztürk I , Lemcke J , Damerow S , Hintze M , Kuttig T , Heller T , Wetzstein M , Allen J , Schmich P 
Published: October 2024

Abstract

Background
The Robert Koch Institute (RKI) is developing a new panel infrastructure, ‘Health in Germany,’ to enhance public health research through continuous, rapid data collection from questionnaire surveys, measurements, and laboratory analyses. Using online and offline collection methods (CAWI and PAPI), the project aims to have 30,000 registered panelists by Spring 2024.

Methods
The sample of the recruitment study is based on address data from Germany’s local registration offices, whereby a mixed-mode design is used for data collection. Individuals aged 16-69 receive an initial online-only invitation, followed by postal reminders that include a paper questionnaire. For those aged 70 and above, both online and paper options are available from the outset. Incentives include an unconditional €5 cash payment for all invitees and an additional €10 for successful registration into the panel infrastructure.

Results
The initial response rate of the recruitment study is 35%. Of the CAWI participants, approx. 90% expressed willingness to participate again, with approx. 80% completing the online registration. To date, over 42,000 panelists have been recruited. Further detailed results on response rates, non-response bias, and sample composition will be presented at the conference.

Conclusions
RKI’s ‘Health in Germany’ is one of the largest probability panels in public health research, effectively gathering and analyzing data. The recruitment success and strong participant engagement highlight the infrastructure’s efficiency and its significant contribution to epidemiological research in Germany.

Key messages
• Successful recruitment of over 42,000 panelists demonstrates robust engagement and effective implementation.
• The push-to-web strategy (or web-push strategy) underscores the infrastructure’s adaptability and efficiency.
Tobacco Free Advent Calendar: Evaluating innovative strategies in Public Health digital campaigns
Authors: Lotrean D , Sargsyan Z , Bonarrio T , Antinozzi M , Mocanu K , Radu-Loghin C 
Published: October 2024

Abstract

Introduction
Two editions, 2022 and 2023, of the Tobacco Free Advent Calendar (TFAC) built a large network of Organizations, Universities, Institutions, individual experts and medical students across Europe, coordinated by ENSPNext (European Network for Smoking and Tobacco Prevention Youth Group), to advocate for Youth and for Public Health. This study has 2 objectives: 1. Monitor the performance of TFAC 2023 vs TFAC 2022 for 31 days 2. Evaluate improvements in reach and engagement made for TFAC 2023.

Methods
For 24 days, TFAC 2023 featured thematic messages, embedded fact sheets, quizzes, videos and call-to-action buttons. New content was accessible daily starting on the first day of advent, ending on Christmas. TFAC was available in English and Armenian. AI was used to assist for various tasks and challenges during development and research. Comparative and Time Series Analysis were conducted in Excel and IBM SPSS26.

Results
TFAC 2023 was accessed 3764 times (8.8% increase), the doors were opened 1506 times (3.9% decrease), Call to action buttons were clicked 261 times (169% increase). For english version a strong variation in reach was observed, but not in engagement which remained relatively constant. In Armenian version both reach and engagement varied in 2023 vs 2022. A seasonal component was identified for both versions, particularly an increase at weekends and a decrease on weekdays. Similar to 2022, the reach and engagement were higher at the start and lower as time passed, although in 2023 the reach and engagement remained higher and more constant over time. Completion rates of interactive materials ranged between 21.4% to 100% in the English version and from 7.1% to 100% in the Armenian version. No interactive material remained unanswered.

Conclusions
Decrease of translations didn’t lower the reach and engagement of TFAC. Engagement with TFAC 2023 was higher, possibly due to the implication of students organizations and collaboration with influencers.

Key messages
• Targeted dissemination increased the reach and engagement of TFAC 2023 versus TFAC 2022.
• Members of the target group should be recruited for being members in the projects affecting them to increase engagement and impact of the campaign.
How stop smoking outreach works: a co-inquiry informed, complex intervention model
Authors: Mills T , Dawkins L , Dean R , Lewis E , Wills J , Sykes S 
Published: October 2024

Abstract

Background
Across Europe, smoking prevalence is concentrating in underserved communities with high levels of deprivation. And yet, there is little research on how stop smoking services (SSS) can engage these communities. This study presents the findings of a 12-month collaboration involving an external public health research team and staff of an English SSS. Staff worked with community partners (e.g., schools) to raise awareness of the service, which included a newly introduced e-cigarette offer.

Methods
A complex intervention model was developed and refined through 6 facilitated co-inquiry sessions involving 13 SSS staff. Staff also completed 32 reflection forms on outreach events and rapid ethnography was conducted, by the research team, to evaluate staff’s working assumptions. This included 8 observations of outreach events and interviews with 10 SSS staff and 8 community members, from the service target groups. Data were organised into themes.

Findings
The model presents a picture of stop smoking outreach as challenging, unpredictable and resource intensive yet often having great impact. The themes enrich this to highlight 1) the appreciation for yet unpredictability of outreach referrals for people disconnected from health services; 2) the importance of staff adopting a person-centred approach; 3) the challenges and opportunities presented by e-cigarettes; and 4) the role of strategic community partnerships in optimising staff time on outreach.

Conclusions
Stop smoking outreach can generate considerable interest in SSS, particularly when delivered in combination with an e-cigarette offer. Future research should explore the economic and social return on investment in community outreach: while time consuming, referrals generated proactively may become more important for SSS as smoking concentrates in underserved communities.

Key messages
• Stop smoking outreach is an effective way to raise awareness and generate referrals but must be done non-judgementally and via effective community partnerships.
• Staff’s careful discussion of an e-cigarette offer can change the perception of SSS without contributing to recreational normalization.