BACKGROUND: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees.
OBJECTIVE: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees.
METHODS: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up.
RESULTS: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=-0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=-11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group.
CONCLUSIONS: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors.

OBJECTIVE: In this observational study, we determined the distribution of mHealth applications (apps) in Germany using data from the FeverApp registry.
METHODS: The registry data were processed to assess general monthly trends in app distribution, and a seasonal autoregressive integrated moving average model was decomposed to investigate time series. A sample comparison was made matching data from cold-called against self-registered distributers of the FeverApp.
RESULTS: Among 881 pediatric and adolescent medical practices, 27,300 app users were recruited between 2019 and August 2023. The number of monthly recruited users increased steadily. A seasonal trend was observed, showing a higher distribution in winter months. Self-registered pediatric practices did not recruit significantly more app users than cold-called practices, with approximately every 25th family recruited in both groups.
CONCLUSIONS: The trend of more app sign-ups during winter is likely related to the flu season in Germany. Intrinsic and extrinsic motivational factors of the practices seem to have a large impact on the distribution. We observed a positive trend in the app distribution. Seasonal febrile infections and individual distribution methods among practices influence the distribution of the FeverApp in Germany. Family factors may have a greater influence than the motivation of distributing practices.

Digital mental health interventions are routinely integrated into mental health services internationally and can contribute to reducing the global mental health treatment gap identified by the World Health Organization. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience with digital mental health intervention design and evaluation to identify 8 of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These include: (1) harm caused by online recruitment work; (2) monitoring of intervention safety; (3) exclusion of specific demographic or clinical groups; (4) inadequate robustness of effectiveness and cost-effectiveness findings; (5) adequately conceptualizing and supporting engagement and adherence; (6) structural barriers to implementation; (7) data protection and intellectual property; and (8) regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device (SaMD) are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges we have identified highlight a substantial body of required knowledge and expertise, either within the team or through access to external experts. Ensuring access to knowledge requires careful planning and adequate financial resources (for example, paying public contributors to engage in debate on critical ethical issues or paying for legal opinions on regulatory issues). Access to such resources can be planned for on a per-study basis and enabled through funding proposals. However, organizations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups that can retain necessary competencies, such as in medical device regulation.

The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence.

BACKGROUND: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply.
OBJECTIVE: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis.
METHODS: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately.
RESULTS: A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions.
CONCLUSIONS: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls.
BACKGROUND: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.

BACKGROUND: Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD.
METHODS: The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent-child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open-ended questions. Data analysis of the interview transcripts and open-ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data.
RESULTS: Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals (\"Nutrition Ninja\") were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application.
CONCLUSIONS: Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention.

UNASSIGNED: The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients\' intention to use the EHR.
UNASSIGNED: This study aims to validate the privacy calculus model (PCM) regarding EHRs and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions.
UNASSIGNED: An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with N = 241 participants, aged 18 years and older residing in Germany with no previous experience with the diseases mentioned in the respective medical reports. Participants were randomized (single-blinded) into four groups in parallel: high stigma and acute time course (n = 74), high stigma and chronic time course (n = 56), low stigma and acute time course (n = 62) and low stigma and chronic time course (n = 49). The data were analyzed using structural equation modeling with partial least squares.
UNASSIGNED: The model explains R² = 71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease\'s time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention.
UNASSIGNED: The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. The need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts.

The rise of mHealth has transformed maternal healthcare in low- and middle-income countries, enhancing care and women\'s access to quality services. The \"Kapasia Model,\" launched in 2017 in Bangladesh, aims to connect beneficiaries with healthcare providers, improve antenatal care (ANC) and reduce maternal mortality. This study aimed to explore healthcare providers\' perspective on digitalized ANC services within the Kapasia model. Conducted from January to July 2022, it involved 30 in-depth interviews with community-level healthcare providers across 17 facilities in Kapasia Upazila, Gazipur. A thematic analysis was performed to analyze data. The findings revealed that healthcare providers emphasized the Kapasia Model\'s role in raising awareness and knowledge of pregnancy care and increasing antenatal care attendance. They viewed digitalized service as means of improving connectivity and access to healthcare for pregnant women. However, providers also discussed challenges such as women\'s limited access to mobile phones and the time-consuming nature of completing information forms. Overall, healthcare providers supported integration of digital tools and endorsed digitalization in their workflow. Addressing these challenges is essential for optimizing ANC delivery and improving quality of services. Insights from this study will inform evidence-based decisions for future scaling-up and replication by policymakers and stakeholders in similar settings.

BACKGROUND: The potential benefits of eHealth support in enhancing patient care, satisfaction, and cancer outcomes are well-established; however, its integration into routine care has been gradual. The emergence of the COVID-19 pandemic in 2020 dramatically affected cancer patients, imposing multifaceted challenges that impede traditional doctor-patient interactions. Consequently, there has been a surge in the adoption of eHealth for supporting oncological therapies. This study investigates the fundamental prerequisites for transitioning to a more digitally oriented routine care, focusing on the availability of appropriate technical equipment and the cultivation of a positive mindset towards eHealth among breast cancer patients.
METHODS: In 2013, 2016, and 2020, breast cancer patients participated in surveys utilizing a comprehensive paper questionnaire encompassing 29 inquiries about their health status, technical equipment, and attitudes toward digital therapy support.
RESULTS: A total of 959 patients participated in the interviews. Comparative analyses between the 2013, 2016, and 2020 surveys revealed a widespread increase in internet access and device ownership across various age groups. By 2020, 3 quarters of patients were utilizing the internet for health-related topics. Notably, there has been a considerable improvement in patients\' personal attitudes towards eHealth and their expectations for future digital therapy support.
CONCLUSIONS: Over the seven years spanned by the surveys, there has been a substantial positive shift in the attitudes of breast cancer patients towards eHealth, accompanied by a marked improvement in their technical equipment. This study reveals that the essential prerequisites for digital therapy support now appear to be prevalent among breast cancer patients.

The main objectives of the pre-anaesthesia consultation are to establish the patient\'s anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies - e-Health - has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit. The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.