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Summary Persuasive health technology
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eHealth Development in Context
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eHealth Research, Theory and Development
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Summary: Digital Health Communication Summary 2023 (Master: CIS/CIW/NMD/BDM)
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Summary eHealthChapter 1; Introducing eHealth
Why eHealth?
Multi-morbidity having more than one chronic diseases.
Problem: more people are getting older, more health problems, less people to care for them,
because birth rates are low.
Trend in the world today informal caregivers are more in the lead of their own healthcare.
Serious future options: de-hospitalization, organizing healthcare into regional networks,
adequate homecare, and the concentration of highly specialized, complex care in one
location.
Ways of looking at using technology to support health
Influential paper by Eysenbach (What is eHealth) started a discussion which resulted in
many views and definitions.
Beyond the emerge of several definitions, different taxonomies appeared which represent
different ways of looking at eHealth:
- Categorizing eHealth technologies according to their place in the healthcare
continuum: describing services to support care delivery, to manage care or to
promote prevention and education as part of public health self-management
programmes.
- Categorizing eHealth technologies according to the characteristics of the technology:
describing the capacities of devices and systems to support human-computer
interactions, to monitor and coach people and to develop tailored and personalized
health interventions.
- Categorizing eHealth technologies according to their influence on the healthcare
system: describing the infrastructure for healthcare, emphasizing the possibilities of
technologies to innovate or disrupt healthcare.
eHealth the use of technology to support health, well-being and healthcare.
eHealth technology the actual technological instrument via which health, well-being, and
healthcare are supported, often information or communication technology.
eHealth intervention an eHealth technology specifically focused on intervening in an
existing context by changing behaviour and/or cognitions.
Health informatics the interdisciplinary study of the design, development, adoption, and
application of IT-based innovations in healthcare services delivery, management and
planning. Also called ‘medical informatics’.
Behaviour change interventions behavioural change interventions are interventions
designed to affect the actions that individuals take with regard to their health.
eHealth: technology and psychology
Technology should fit the way people live and work, their socio-economic backgrounds and
the way they make decisions about their health and well-being. This is important for
concepts like user engagement, adherence, trust and involvement.
Benefits of eHealth:
- Access to care; available independent of time and place. Lower threshold to
healthcare, which entails that more people have a possibility to access healthcare.
, - Empowerment; empower people by giving them the opportunity to take more
control of their own healthcare. Can also be empowered when they are educated
about their health and more aware of their own health data. Patient-centredness is
another advantage, people feel like they are becoming experts on their own health.
Care professionals can be empowered as well. Technology can provide tailored
support on medical decision making, among other things, via data-driven diagnosis
support and artificial intelligence.
- Innovation; technology has the ability to change the way healthcare is delivered by
stimulating all involved stakeholders to critically think about how they deliver or
receive care. This opens up new ways of thinking, which can in turn stimulate
innovation.
- Quality of care; improved via highly efficient, innovative systems and by effective
interventions that lower costs and increase safety by reducing human errors.
Effectiveness can be improved by using the possibilities of technology to improve
traditional interventions and treatments. Efficiency is an important benefit, eHealth
can require fewer resources to achieve the same quality of care and effects on health
and well-being. Teledermatology the use of audio and video communication in the
assessment and treatment of skin conditions and tumours can decrease the
number of doctor visits, saving costs and time.
eHealth in practice
- Self-care and prevention; the patient or health consumer is in the lead: technology
can be used to foster self-management in an easy and convenient way. Self-care and
prevention technologies can be employed to provide information on health and well-
being. In addition, technology can support interaction with others in multiple ways.
Another form of self-care and prevention can be found in technologies that support
(self)-monitoring of health-related information. Another example of self-care and
prevention are online (self-help) treatments.
Blended care online interventions used in combination with face-to-face therapies.
- Supportive care; more involvement of the healthcare professionals and, ideally,
healthcare professionals and patients work together to manage or improve the health
of the patient or client. An example is telemedicine, by images give other
dermatologists more reliable advice, instead of over phone. Another example is
electronic personal health records (PHRs), this is an electronic application through
which individuals can access, manage and share their health information and that of
others for whom they are authorized, in a private, secure and confidential
environment.
- Societal health; focuses on broad health-related issues that might affect individuals.
Societal health issues demand that governments play a vital role in creating policies
and regulations. In turn, healthcare inspectorates must implement and maintain
these policies and regulations. First, eHealth can influence the attitude or awareness
of individuals about societal health issues. Second, it can be used to support
behaviour that is compliant with guidelines that are required to manage broad
health-related issues. Finally, technology can support communication between health
professionals about societal health issues.
,eHealth barriers
- Implementation barriers; implementation is not only the introduction but also the
dissemination and long-term use. First of all, a lack of incentives to use technology
can result in a resistance to use it. Most of the times it is not financially attractive.
Also, a lack of eSkills can hinder the uptake of eHealth technologies. Furthermore,
there often is a lack of motivation to start or continue using an eHealth technology
among users and other stakeholders. Another barrier is lack of confidence, people
might fear that they will be substituted by technology. Next, interoperability is low;
sometimes it is difficult or impossible to communicate information from one system
to another. Finally, unclear regulations can hinder successful use of eHealth
technologies in practice.
- Ethical barriers; privacy and security are obstacles people perceive when using
technologies to share health or medical information. The lack of transparency is not a
new phenomenon per se compared to traditional care, but the difference is that the
‘clinical eye’ of a caregiver is missing. The quality of information is another aspect. To
what extent can we trust the information that is provided by the internet?
- Evidence barriers; the limited large-scale evidence of the cost-effectiveness of
eHealth interventions and the little information on long-term effects on health and
healthcare is a critique. The main barrier is that in study designs that are used to
evaluate many eHealth interventions, don’t always address the full picture. In
general, the effect of web-based interventions are measured with the golden
standards for clinical interventions. Another barrier is that we do not have enough
knowledge on the process of adherence, which refers to the question of whether
people are not adherent: they stop using technology prematurely, or do not use all of
its different possibilities, which might have a negative influence on the intervention’s
impact. Furthermore, mere information on effectiveness on specific outcome
measures doesn’t suffice for eHealth. Matters such as adoption, answering questions
about when and how people started using the technology and the implementation
process should be studied as well to get a holistic view of the impact of the eHealth
technology. Another issue is related to the way evaluation studies are reported. Many
studies have a rather myopic view, meaning that they do not provide enough
information about matters that need to be reported to ensure replicability of studies
and interventions. To overcome this problem a CONSORT checklist was developed to
guide how ‘eHealth and mHealth trials should be reported, in particular related to
reporting sufficient details of the intervention to allow replication and theory-
building. Finally, eHealth technology is not fixed: it can be tailored to different user
profiles, and can be constantly updated and adapted by developers or users.
Agile science development and evaluation occur in parallel, iteratively, until the
eHealth technology has been optimized to fit the complex context in which behaviour
occurs. Advanced methods such as time series and log data can be used to provide
ongoing information about the use of technology and its impact on the context and
people. This kind of information is necessary to take eHealth evaluation to the next
level and overcome evidence barriers.
- To overcome these barriers we need both applied and fundamental research.
Applied research focuses on matters such as good design, implementation, use of
in practice and effectiveness of an intervention, all within specific contexts.
, Fundamental research aims to make generic claims about constructs such as
adherence, behaviour change theories, persuasive elements or tailoring.
A holistic approach towards eHealth development and evaluation
Holistic approach can be used to overcome the barriers. Holism refers to the notion that
individual elements in a complex system are determined by the relations they bear to the
other elements. This means that all aspects of a lager whole are interrelated, and separate
analysis of its parts should be avoided.
CeHRes Roadmap combines the approaches participatory development, human-centred
design, business modelling, and persuasive design, and provides a framework to develop a
technology that fits the human and contextual perspective.
eHealth development is a participatory development process
Participatory development stakeholder are involved during the entire development and
evaluation process.
eHealth development is intertwined with implementation
Implementation plays an important role from the start. If potential issues can be detected at
the early stages, then they can be addressed before the actual implementation starts. The
better the fit and interrelationship, the higher the chances of successful implementation in
practice.
eHealth development is coupled with persuasive design
eHealth can be used for multiple purposes: to support self-management behaviour, to
educate, to share personal information, to influence attitudes or to facilitate communication
between people.
Persuasive technology aimed at influencing behaviour and attitudes.
Formative evaluation starts at the beginning of the development and continues during
every development activity.
Summary:
- eHealth has many actual and potential advantages for health, well-being and
healthcare and can be divided into self-care and prevention; supportive care
and societal health.
- In practice, many barriers of eHealth are experienced with regard to implementation
in practice, ethics and evidence.
- A holistic vision of eHealth is advocated: the technology, people and their contexts
are all intertwined.
- A holistic development, design, implementation and evaluation process can
create eHealth technologies that overcome the barriers and achieve the
benefits.
- The CeHRes Roadmap can support holistic eHealth development and is based
on approaches such as participatory development, human-centred design,
business modelling and persuasive design.
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