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Digital health technology (DHT) plays an increasingly vital role in managing chronic diseases by enabling patients to actively manage their health. These tools have been shown to improve self-management and adherence to medical advice. However, for DHT to be fully effective, patients with chronic conditions must be digitally literate. The eHealth Literacy Scale (eHEALS), an 8‑item tool with scores ranging from 8 to 40, was developed to assess individuals' perceived ability to find, evaluate, and apply digital health information. Assessing patients' digital health literacy (DHL) and understanding the factors influencing it are essential for improving the accessibility and usability of health resources. This study aimed to assess DHL in patients with diabetes mellitus (DM), hypertension, and rheumatoid arthritis (RA) through a systematic review and meta‑analysis using eHEALS. We sought to determine average DHL scores, examine demographic and socioeconomic factors influencing DHL, and explore its impact on disease management to inform future strategies for enhancing DHL and improving chronic disease outcomes. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review across 7 databases (PubMed, SCOPUS, Embase, ERIC, CINAHL, Library Literature and Information Science Index, and Google Scholar) from inception to August 14, 2022, with an updated search in October 2024. Eligible studies included adults (≥18 years) with DM, hypertension, or RA who reported DHL data using eHEALS (8-40) and were original research published in English. Exclusion criteria included studies involving participants younger than 18 years, reviews, meta‑analyses, studies not addressing the target diseases, or non‑English publications. Study quality was evaluated using the Newcastle‑Ottawa Scale (NOS). Eight studies involving 2527 participants were included. The pooled mean eHEALS score was 27.03 (95% CI 25.08-28.98), indicating high overall DHL. Stratified by disease, scores were higher for DM (27.79) and hypertension (28.48) but lower for RA (24.74). Quality assessment indicated a high standard of included studies. Factors influencing DHL included age, education, employment, and perception of the internet as a health resource. Due to the limited number of studies, meta‑regression analysis could not be performed. DHL is critical for individuals with chronic conditions, empowering them to make informed decisions and manage their health effectively. However, the scarcity of studies limits comprehensive analysis of DHL determinants. While the internet offers abundant health information, unequal DHL and health skills remain barriers. More inclusive research is needed to fully understand DHL's impact on health outcomes and mitigate disparities, ensuring equitable access to digital health resources and improving disease management.

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. This study aims to evaluate the usability of InteractiveClinics among children with JIA. As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7%) and 1 parent for each child (n=12; female: n=8, 66.7%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care.

Pediatric asthma is the most common chronic respiratory disease of childhood. Caregivers often report lacking knowledge in several aspects of asthma management at home. Although the use of mobile health (mHealth) tools, such as mobile apps, could facilitate asthma self-management and, simultaneously, the collection of data for research, few studies have explored the features that caregivers would like to see in such a tool and their perceptions on data sharing. This study evaluates caregivers' perceived knowledge gaps in asthma management; their perceptions of certain features and resources that should be included in a potential mobile app; and any concerns that they may have regarding data sharing for research, including privacy and security concerns. In this cross-sectional study, we surveyed 200 caregivers of children (aged 1-13 y) with asthma who were followed at a pediatric tertiary care center in Montreal, Canada. Anonymous data were collected through the institutional web-based survey platform. We collected the participants' answers by using a 5-category Likert scale (\"completely agree,\" \"agree,\" \"neither agree nor disagree,\" \"disagree,\" and \"completely disagree\"), multiple-choice questions, and free-text questions on the abovementioned topics. Descriptive statistics were performed, and answers were compared between caregivers of preschool-aged children and caregivers of school-aged children. Participating children's mean age was 5.9 (SD 3.4) years, with 54% (108/200) aged ≤5 years and 46% (92/200) aged >6 years. Overall, caregivers reported having adequate knowledge about asthma and asthma self-management. Nonetheless, they identified several desirable features for a mobile app focused on asthma self-management. The most frequently identified features included receiving alerts about environmental triggers of asthma (153/199, 76.9%), having videos that demonstrate symptoms of asthma (133/199, 66.8%), and being able to log children's asthma action plans in the app (133/199, 66.8%). Interestingly, more caregivers of preschool-aged children preferred textual information when compared to caregivers of school-aged children (textual information for explaining asthma: P=.008; textual information for the symptoms of asthma: P=.005). Caregivers were generally highly in favor of sharing data collected through a mobile app for research. Caregivers of children with asthma in our study identified several desirable educational and interactive features that they wanted to have in a mobile app for asthma self-management. These findings provide a foundation for designing and developing mHealth tools that are relevant to caregivers of children with asthma.

The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the \"Internet Plus Healthcare\" technology model is not implemented throughout the patient consultation process. The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case. A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019-2020) and after (2021-2022) implementation of the chronic disease management information system. Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2%, the achievement rate of the pulmonary function test increased by 26.2%, the awareness rate of chronic respiratory disease knowledge increased by 20.1%, the retention rate increased by 16.3%, and the patient satisfaction rate increased by 9.6% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4% (P<.001) after use of the chronic disease management information system. Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases.

Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ≥8 days showed a more significant decrease in severity scores compared to those who used it for ≤7 days, or did not use it at all. Participants who used the app for ≥8 days had a median SCORAD of 6.25 (95% CI 4.6-14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95% CI 13.9-24.0; IQR 13.9-24; P=.03) and those using it ≤7 days (13, 95% CI 9.35-27; IQR 7.2-27; P=.04). Their median POEM of 2 (95% CI 1.0-4.5; IQR 1-5.3) was also significantly lower than those using the app ≤7 days (9, 95% CI 2-12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95% CI 1-9; IQR 1-9; P=.14). Additionally, using the Atopic App for ≥8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management.

Wearable devices (WDs) have evolved beyond simple fitness trackers to sophisticated health monitors capable of measuring vital signs, such as heart rate and blood oxygen levels. Their application in health care, particularly medication management, is an emerging field poised to significantly enhance patient adherence to treatment regimens. Despite their widespread use and increasing incorporation into clinical trials, a comprehensive review of WDs in terms of medication adherence has not been conducted. This study aimed to conduct a comprehensive scoping review to evaluate the impact of WDs on medication adherence across a variety of diseases, summarizing key research findings, outcomes, and challenges encountered. Adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, a structured search was conducted across MEDLINE, Web of Science, and Embase databases, covering the literature from January 1, 2010, to September 30, 2022. The search strategy was based on terms related to WDs and medication adherence, specifically focusing on empirical studies to ensure the inclusion of original research findings. Studies were selected based on their relevance to medication adherence, usage of WDs in detecting medication-taking actions, and their role in integrated medication management systems. We screened 657 articles and identified 18 articles. The identified studies demonstrated the diverse applications of WDs in enhancing medication adherence across diseases such as Parkinson disease, diabetes, and cardiovascular conditions. The geographical distribution and publication years of these studies indicate a growing interest in this research area. The studies were divided into three types: (1) studies reporting a correlation between data from WDs or their usage and medication adherence or drug usage as outcomes, (2) studies using WDs to detect the act of medication-taking itself, and (3) studies proposing an integrated medication management system that uses WDs in managing medication. WDs are increasingly being recognized for their potential to enhance medication management and adherence. This review underscores the need for further empirical research to validate the effectiveness of WDs in real-life settings and explore their use in predicting adherence based on activity rhythms and activities. Despite technological advancements, challenges remain regarding the integration of WDs into routine clinical practice. Future research should focus on leveraging the comprehensive data provided by WDs to develop personalized medication management strategies that can improve patient outcomes.

Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. Adolescents in both groups reported high levels of satisfaction with the study, with 95% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5% of intervention messages, and their caregivers responded to 88.5% of messages. There were no significant differences in rates of engagement related to adolescents' sex, age, device use, or race/ethnicity. A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination.

Medication adherence is crucial for managing chronic conditions. Mobile apps may have the potential, through a wide variety of features, to support and improve medication adherence. The purpose of this systematic review was to evaluate the effectiveness of mobile apps in promoting medication adherence for patients managing chronic conditions. MEDLINE (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) evaluating the effectiveness of mobile app interventions in improving medication adherence in patients with chronic conditions. Study design and app features were qualitatively described. Meta-analyses were performed on studies, grouped by medication adherence measurement scale, on the mean differences in medication adherence scores between intervention and control groups, using random effects models. If baseline medication adherence data were available, a difference in differences meta-analysis with a random effects model was also conducted. Bias assessment was conducted using the Cochrane Risk of Bias tool. This review included 14 RCTs published between 2014 and 2022, with sample sizes between 57 and 412 participants and the length of interventions ranging from 30 days to 12 months. A range of patient populations was evaluated, including those with Parkinson disease, coronary heart disease, psoriasis, and hypertension, with hypertension being the most common condition. All 14 studies reported that app interventions improved medication adherence, and 10 RCTs demonstrated statistically significant improvement in medication adherence. Three separate sets of meta-analyses, categorized by the medication adherence measurement scales, were conducted on the mean difference between medication adherence scores between the control and intervention groups: the 8-item Morisky Medication Adherence Scale (MMAS-8; 0.57, 95% CI 0.33-0.80; P<.001, I2=0%, τ2=0, P value for heterogeneity test=.94), 4-item Morisky Medication Adherence Scale (MMAS-4; 0.15, 95% CI -0.12 to 0.42; P=.28, I2=0%, τ2=0, P value for heterogeneity test=.54) and a percentage medication adherence scale (18.85, 95% CI 2.17-35.53; P=.03, I2=63%, τ2=94.89, P value for heterogeneity test=.10). Additionally, with available baseline adherence scores, difference in differences meta-analyses were conducted for studies using the MMAS-8 scale (0.38, 95% CI 0.15-0.62; P=.001, I2=0%, τ2=0, P value for heterogeneity test=.51) and for studies using the MMAS-4 scale (0.55, 95% CI 0.17 to 0.93; P=.005, I2=33%, τ2=0.03, P value for heterogeneity test=.22). The meta-analysis of the MMAS-8 scale, percentage medication adherence scale, and both difference-in-differences meta-analyses demonstrated that app-based interventions improved medication adherence. From the studies included in this review, mobile apps, designed for a wide variety of chronic conditions with a range of features, were shown to improve medication adherence and may be a tool to successfully manage chronic conditions.

The demographic shift toward older populations is placing increasing pressure on health care systems, and only 20% of patients with chronic issues in the industrial world's rural areas have guaranteed access to adequate health care services. This stresses the health care systems, emphasizing the need for innovative solutions. The Horizon 2020 Pre-Commercial Procurement (PCP) project, Crane, addresses these needs by facilitating the procurement of a digital self-management system for treating patients with chronic issues at home. Three rural European regions are participating in the project: Västerbotten (Sweden), Extremadura (Spain), and Agder (Norway). This study aims to explore and identify key design criteria and value-based key performance indicators (VB-KPIs) to support the development and evaluation of digital health care solutions for patients with chronic issues in rural areas within the Crane PCP process. A 3-iteration process was used to identify and prioritize the VB-KPIs in the Crane project. First, user needs were investigated based on stakeholder analyses in the participating rural regions. The early health technology assessment tool, Step Up, was used in 5 workshops (2 in Agder, 2 in Extremadura, and 1 in Västerbotten). Participants included patients and health care professionals. Second, post workshop, stakeholders were asked to comment on the summarized results, which were accordingly adjusted. Third, following the workshops, VB-KPIs were identified and prioritized, and discussions among representatives from the 3 buyer regions were conducted. Thirty-five VB-KPIs across 5 domains were identified. User-related (9 VB-KPIs), employee-related (9 key performance indicators), clinical (4 VB-KPIs), organizational (6 VB-KPIs), and economic (8 VB-KPIs) outcomes from the workshops and the subsequent discussions emphasized regional differences in terms of user needs and priorities. While Agder (Norway) and Västerbotten (Sweden) emphasized privacy, digital trust, and physical interaction as important, Extremadura (Spain) prioritized negotiation and shared decision-making. Despite differences, shared values were identified, including empowerment, flexibility, preventative care, and improved quality of life. The identified and prioritized VB-KPIs are likely to provide a need-based foundation for the development and subsequent evaluation of the digital PCP, Crane, although regional socioeconomic and cultural differences may necessitate local adaptations.