AIoT-Driven Health Behavioral Security: Vision and Challenges

BackgroundThe potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized.ObjectiveThis study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived.MethodsWe conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework.ResultsWe interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were “not for them.” We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care.ConclusionsWe identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity.

Health Technology Assessment for Cardiovascular Digital Health Technologies and Artificial Intelligence: Why Is It Different?

Previously, most mammalian auditory systems research has concentrated on human sensory perception whose frequencies are lower than 20 kHz. The implementations almost always used analog VLSI design. Due to the complexity of the model, it is difficult to implement these algorithms using current digital technology. This paper introduces a simplified model of biosonic reception system in bats and its implementation in the ‘‘Chiroptera Inspired Robotic CEphaloid’’ (CIRCE) project. This model consists of bandpass filters, a half-wave rectifier, low-pass filters, automatic gain control, and spike generation with thresholds. Due to the real-time requirements of the system, the system employs Butterworth filters and advanced field programmable gate array (FPGA) architectures to provide a viable solution. The ultrasonic signal processing is implemented on a Xilinx FPGA Virtex II device in real time. In the system, 12-bit input echo signals from receivers are sampled at 1 M samples per second for a signal frequency range from 20 to 200 kHz. The system performs a 704-channel per ear auditory pipeline operating in real time. The output of the system is a coded time series of threshold crossing points. Comparing hardware implementation with fixed-point software, the system shows significant performance gains with no loss of accuracy.

Digital health is typically driven, in part, by the principle of personalised care. However, the underlying values and associated ethical design considerations at the intersection of personalised care, youth mental health, and digital technology are underexplored. Through a value sensitive design lens, this work aims to contribute a prototype conceptual framework for the ethical design and evaluation of personalised youth digital mental health technology, which comprises three values–personalisation, empowerment, and autonomy–and 15 design norms as fundamental yet non-exhaustive ethical criteria. Furthermore, it provides illustrative applications of the framework by applying it to (1) the proactive design of two exemplary digital mental health technologies to draw out emerging ethical considerations and (2) the retrospective evaluation of three existing technologies to assess whether they are designed to support personalisation, empowerment, and autonomy. This work creates an understanding of personalised care and related values in this socio-technical context, with key design recommendations going forward for youth digital mental health research, practice, and associated policy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10676-025-09866-x.

This research follows a trajectory of work in the field of women’s studies and learning with digital technologies. The research is undertaken by the DIME HUM 833 research group from University of Seville (Spain). Extensive research projects have basically focused on: (a) characterize the processes of digital inclusion and know how women (with different profiles professionals, entrepreneurs, unemployed, students ...) learn with technologies and overcome digital divides (MAIA Project), (b) to value the processes of participation and learning in social networks and their influence on the subjective and emotional well-being of women (RURAL WOMEN Project). A third research in process is presented on the line (ALCMENA Project). The aim of this project is (c) describe the situation of middle-aged and older women in the Andalusian Digital Society and learn about their experiences with digital technologies. Mixed-type research has been developed from a survey studies and qualitative studies based on techno-autobiographical interviews and thinking aloud protocols. The final sample was made up of 1340 women for the MAIA Project and specifically 478 in rural areas for the RURAL WOMEN Project. The results show a moderate degree of digital inclusion of women. The results point to the research offers a detailed knowledge of the role that current digital technologies are playing in the lives of a wide diversity of women. The results show different learning ecologies from the women with different profiles. The results are shown in detail in the book Jiménez-Cortés et al. (2016). At the same time, the research shows that participation in democratic processes online has the potential to improve the quality of life of women and gives them greater control over their lives and satisfaction. This knowledge allows women to prepare for an active and full digital citizenship, which brings them well-being. The results are shown in detail in other papers (Jiménez-Cortés, 2015; 2016). The expected results of the ALCMENA Project will show processes of digital empowerment and strategies of middle-aged and older women that serve as a reference to guide the actions of interested social agents and institutions.

Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system. The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system. A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process. The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results. The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. PRR1-10.2196/46595.

This study sought to investigate digital health tools and technologies dimensions for equitable access to health, including Universal Health Coverage in developing economies. Universal Health Coverage (UHC) is a promise of accessible and high-quality healthcare, which addresses coverage of essential health services and catastrophic health spending, in line with goal 3 of the United Nations Sustainable Development Goals (SDGs). However, the problem of inequitable access to health, including UHC, continues to plague the entire endeavour, even with notable technological advancements among the population and within the health sector. This study uses a narrative literature review methodology to investigate the dimensions of digital health tools and technologies for equitable access to health, including UHC. The findings from this study identify internet access, availability of internet, availability of a smart device, and device access to digital content as key dimensions for equitable access to health, including UHC in developing economies, and in line with digital health tools and technologies. Considering these dimensions will ensure that developed and deployed interventions are available and accessible to the majority of the population. Ultimately promoting digital health and equitable access to health, as well as ensuring that key dimensions of digital health tools and technologies are not assumed.

Engagements with personal digital data are growing in recent decades, as many digital technologies offer any interested user the opportunity to track their habits and practices. Yet, far from being objective and neutral conduits of knowledge, digital data is often politicised, invested with particular values, norms, and assumptions about human experiences. Digital health technologies, in particular, are often found to be coded through biomedical understandings of health and the individualism of Western ethics. Such politics of data knowledge inevitably has implications on the ways people in different socio-cultural contexts make sense of their health, bodies, and correspondingly, experience spaces of health through engagements with digital data. Drawing on diaries and diary-interviews with users of digital food-tracking devices in Singapore, this paper develops the idea of ‘epistemological tensions’ to theorise the socio-cultural differences in digital practices beyond the dominant focus on Anglo-American experiences. The findings suggest that people’s engagements with digital health technologies can be experienced as ‘glitchy’ and fraught with epistemological tensions, as they constantly position their healthy eating practices between algorithmic advice offered by these technologies, and the socio-cultural norms of health and eating that they subscribe to. In negotiating such tensions, people are also found to express agency that has spatial and temporal implications on their health practices. In sum, this paper underscores the importance of critically situating, instead of simply scrutinising, everyday geographies of datafication. Doing so can yield more contextually nuanced insight into the potential and limits of digital technologies in mediating health geographies in different social and cultural contexts.

Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: a systematic review

BackgroundDigital technologies could contribute to health promotion and disease prevention. It is unclear if and how such digital technologies address the health needs of older people in nonclinical settings (ie, daily life).ObjectiveThis study aims to identify digital technologies for health promotion and disease prevention that target the needs of older people in nonclinical settings by performing a scoping review of the published literature. The scoping review is guided by the framework of Arksey and O’Malley.MethodsOur scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The information sources are bibliographic databases (MEDLINE, PsycINFO, CINAHL, and SCOPUS) and bibliographies of any included systematic reviews. Manual searches for additional studies will be performed in Google Scholar and most relevant journals. The electronic search strategy was developed in collaboration with a librarian who performed the search for studies on digital technologies for health promotion and disease prevention targeting the needs of older people. Study selection and data coding will be performed independently by 2 authors. Consensus will be reached by discussion. Eligibility is based on the PCC (Population, Concept, and Context) criteria as follows: (1) older people (population); (2) any digital (health) technology, such as websites, smartphone apps, or wearables (concept); and (3) health promotion and disease prevention in nonclinical (daily life, home, or community) settings (context). Primary studies with any design or reviews with a systematic methodology published in peer-reviewed academic journals will be included. Data items will address study designs, PCC criteria, benefits or barriers related to digital technology use by older people, and evidence gaps. Data will be synthesized using descriptive statistics or narratively described by identifying common themes. Quality appraisal will be performed for any included systematic reviews, using a validated instrument for this study type (A Measurement Tool to Assess Systematic Reviews, version 2 [AMSTAR2]).ResultsFollowing preliminary literature searches to test and calibrate the search syntax, the electronic literature search was performed in March 2022 and manual searches were completed in June 2022. Study selection based on titles and abstracts was completed in July 2022, and the full-text screen was initiated in July 2022.ConclusionsOur scoping review will identify the types of digital technologies, health targets in the context of health promotion and disease prevention, and health benefits or barriers associated with the use of such technologies for older people in nonclinical settings. This knowledge could guide further research on how digital technologies can support healthy aging.International Registered Report Identifier (IRRID)PRR1-10.2196/37729

Biopharma Is Going Digital … Bit by Bit

Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status

Multiple sclerosis (MS) is a prevalent neurological disorder worldwide, leading to significant disability and impacting the quality of life and healthcare costs. The complex nature of MS necessitates a multidisciplinary approach involving various healthcare professionals to address its physical, cognitive, and psychological symptoms. Patient-centered care and digital technologies are becoming more relevant and embedded in disease management. Patient journeys are useful to understand pain points and opportunities for digital health interventions. This study aims to explore the journey of people with MS (pwMS) from the perspective of healthcare professionals in Finland and provide insights for digital health developers. A mixed methods approach was employed, conducting individual interviews with healthcare professionals and a narrative review of the current state of MS services. Thematic analysis of the interviews identified key stages of the patient journey and potential digital health touchpoints. The Finnish healthcare system offers various support services for MS patients, including medical, social, psychological, and rehabilitation aspects. Digital health technologies have the potential to enhance MS care at different stages of the patient journey. This study provides valuable insights into the MS patient journey and identifies opportunities for digital health interventions in Finland. Further research is warranted to validate and expand these findings to other settings and involve the perspectives of pwMS themselves.

In clinical practice, assessing digital health literacy is important to identify patients who may encounter difficulties adapting to digital health using digital technology and service. We developed the Digital Health Technology Literacy Assessment Questionnaire (DHTL-AQ) to assess the ability to use digital health technology, services, and data. The DHTL-AQ was developed in three phases. In the first phase, the conceptual framework and domains and items were generated from a systematic literature review using relevant theory and surveys. In the second phase, a cross-sectional survey with 590 adults age ≥ 18 years was conducted at an academic hospital in Seoul, Korea in January and February 2020 to test face validity of the items. Then, psychometric validation was conducted to determine the final items and cut-off scores of the DHTL-AQ. The eHealth literacy scale, the Newest Vital Sign, and 10 mobile app task ability assessments were examined to test validity. The final DHTL-AQ includes 34 items in two domains (digital functional and digital critical literacy) and 4 categories (Information and Communications Technology terms, Information and Communications Technology icons, use of an app, evaluating reliability and relevance of health information). The DHTL-AQ had excellent internal consistency (overall Cronbach’s α = 0.95; 0.87–0.94 for subtotals) and acceptable model fit (CFI = 0.821, TLI = 0.807, SRMR = 0.065, RMSEA = 0.090). The DHTL-AQ was highly correlated with task ability assessment (r = 0.7591), and moderately correlated with the eHealth literacy scale (r = 0.5265) and the Newest Vital Sign (r = 0.5929). The DHTL-AQ is a reliable and valid instrument to measure digital health technology literacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10916-022-01800-8.

Increasing age and rurality are associated with decreased care coordination. There is a growing interest in the role of digital tools in improving care across the care continuum for rural and older adult groups. Still, little is known about the best practices of rural older adults and digital health tool usability. Guided by a user-centered design approach, we 1) describe multiple strategies to meaningfully engage rural older adults in the development of a digital health tool to improve telehealth navigation and 2) report best practices assessed from our multi-modal iterative design approach. We engaged key informants, including rural older adults, their caregivers, providers, healthcare administrators, and an advisory board. Our mixed methods user-centered design approach triangulated findings through semi-structured interviews, a systematic literature review, tool usability testing, and a MyChart usability analysis using eye-tracking technology. Lessons learned from our analysis reveal that rural older adults readily engage with digital technology and often sustain use after their introduction. Digital health technologies were most commonly associated with relieving access to care and transportation barriers. Reduced internet access and challenges with using the equipment were common usability barriers. Useful strategies to overcome usability barriers include in-person or telephone tutorials and knowledgeable caregivers. Tools to assist rural older adults with technology barriers were limited. As digital health technologies increasingly integrate into rural care coordination, barriers faced by rural older adults must be considered. Research that aims to elevate the voices of rural older adults in digital health tool design is imperative.