Social and digital determinants of health are increasingly recognized as critical drivers of health outcomes, particularly in Africa, where economic disparities, geographic divides, and evolving digital infrastructures present unique challenges. Addressing these determinants is crucial for reducing health inequities and improving access to healthcare across the continent. This review synthesizes the current understanding of social and digital determinants of health within the African context, emphasizing their regional variations, research gaps, and potential interventions. A narrative review approach was adopted, conducting a targeted search of literature from databases such as PubMed and Google Scholar, alongside grey literature from organizations like the World Health Organization (WHO). The review focused on studies published between 2000 and 2023, covering social determinants like socioeconomic status, education, and healthcare access, as well as emerging digital determinants such as digital literacy and mobile technology use. Thematic analysis was performed to categorize findings and identify regional variations, particularly in North, sub-Saharan, Eastern, Western, and Central Africa. The review highlights significant disparities in both social and digital determinants across African regions. Urban-rural divides, economic inequalities, and limited healthcare infrastructure pose persistent challenges. Digital determinants are increasingly influencing health outcomes, with countries like Kenya leading in mobile health innovations, while others, particularly in rural areas, struggle with poor internet penetration. Research gaps were identified, particularly the need for longitudinal data and integration of digital determinants into health surveillance systems like health and demographic surveillance systems (HDSS). Social and digital determinants of health significantly impact health outcomes in Africa. Addressing these disparities through targeted interventions, improved infrastructure, and digital health innovations is essential for reducing inequities. Further research, particularly longitudinal studies, is critical for understanding the evolving role of digital determinants in African healthcare systems and shaping effective public health policies.

Parents learning about their children with medical complexity often use numerous health-related resources, including mobile health applications (mHealth apps). mHealth apps could provide broad access to key information and support, lower healthcare costs, and improve care. The quality of mHealth apps for this population has been a concern, but is currently unknown. The objective of this systematic review was to identify and evaluate the quality of publicly available mHealth apps designed for parents who are preparing or caring for medically complex infants. A systematic search strategy was applied to identify mHealth apps in the Apple and Google Play app stores in November 2022 and replicated in August 2024. Apps with no cost, in English, designed for parents of infants with perinatal medical complexity requiring hospitalization were included. Apps for healthy pregnancies, children >1 year, non-parental caregivers or healthcare professionals, primarily for tracking/monitoring, or unrelated activities/products were excluded. Independent raters used the Mobile Application Rating Scale (MARS) subscales of Engagement, Functionality, Aesthetics, and Information to evaluate quality for each app. Mean ratings were calculated by subscale and for overall app quality. From 1,917 identified apps, 32 apps were downloaded and fully screened. The final sample of 15 unique apps were available on the Apple App Store, with six also available on the Google Play Store. Most apps focused on prematurity (n=6), followed by the neonatal intensive care experience (n=4), congenital heart disease (n=4), and hypoxic-ischemic encephalopathy (n=1). MARS ratings of the overall sample (mean =3.61, median =3.58; range, 2.65-4.68) indicated 20% (3/15) were of good quality and 67% (10/15) were of acceptable quality. Apps showed strengths in Functionality and Information and performed worst in Engagement. The poorest quality found in Engagement suggests that most of these apps do not effectively target users' interests or needs. Notably, many suffered from a lack of recent updates or became unavailable. This decline appears to parallel the increasing integration of digital health technologies within healthcare systems, which could prompt testing of mHealth apps on health outcomes. High-quality mHealth apps that are valued by parents and offer evidence-based information and support are needed to extend care.

More than 50% of individuals admitted to hospital with a right hemisphere (RH) stroke may present with a cognitive communication disorder (CCD). However, there is a critical absence of evidence-based screening tools available for speech-language pathologists (SLPs) to identify this disorder. We developed and beta tested a new mobile health (mHealth) application to screen for CCD after an RH stroke, the Right Hemisphere Cognitive Communication Screener (RECOGNISE). Participants with RH stroke and SLPs evaluated RECOGNISE, accessible via an Android operating system. Both participant groups completed user acceptance surveys. Six participants with RH stroke and three SLPs beta tested RECOGNISE. All participants with RH stroke reported that RECOGNISE was easy and enjoyable to use. Qualitative content analysis revealed three main themes: content of test items, user interface and accessibility. SLPs identified several positive features of RECOGNISE including its evidence-based grounding, capabilities unique to the app and ability to engage patients. User interface issues included challenges with app navigation, layout of images, and scoring inconsistencies. RECOGNISE is the first mHealth application developed to identify CCD after RH stroke. Findings suggest that with some user interface improvements, RECOGNISE has the potential to offer SLPs with an evidence-based tool to screen for CCD after RH stroke. Future research will establish the reliability and validity of RECOGNISE.

The increasing prevalence of irritable bowel syndrome (IBS) in Saudi Arabia has led to a growing interest in understanding how patients seek health information online. While it is known that digital platforms, such as search engines, social media, and artificial intelligence (AI) chatbots, are commonly used for health information seeking, there is limited knowledge about the specific behaviors of IBS patients in this context and how these behaviors correlate with their self-care activities. This study aimed to explore online health information-seeking behavior and its correlation with self-care activities among patients with IBS in Saudi Arabia, focusing on the use of these digital platforms. A cross-sectional survey was conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, from January to July 2023. The survey, available in both English and Arabic, targeted IBS patients aged 16 years or older. The questionnaire covered demographics, general internet usage, online health information-seeking behavior, and IBS knowledge and awareness. In this study, 451 IBS patients completed the survey. Notably, 95.1% of participants were internet users, primarily accessing health information through mobile phones and search engines. The results highlighted a significant correlation between online health information-seeking behaviors and self-care practices (P=0.009) like exercise and dietary adjustments, despite a moderate basic knowledge [standard deviation (SD) 2.26%] of IBS. Symptomatically, 93.3% experienced abdominal pain weekly, yet 63% did not fully meet the Rome criteria for IBS. Common management strategies included hydration, diet modifications, and exercise. About 28.4% visited the emergency room (ER) for severe symptoms, and 20% regularly consulted doctors every 3-6 months. Surprisingly, 80% were unaware of the FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, often suggested for IBS. The research indicates a rise in digital health literacy among IBS patients in Saudi Arabia, highlighting the need for accurate and culturally appropriate online resources. It suggests that healthcare professionals and policymakers should direct patients to reliable information and address the digital divide to enhance self-care and IBS management outcomes.

Mobile health (mHealth) apps are becoming a promising tool to motivate sustainable lifestyle and behavior changes, including modifications to diet and exercise. However, most current mHealth apps do not have meaningful, and sustained user acceptance, particularly, among adolescents. They perceive mHealth apps designed for adults to be tedious and visually unexciting, which discourage adolescent usage. Researchers and adolescent mHealth app developers would benefit from a foundational understanding of which functions and features adolescents feel would most motivate app use. Capturing caregivers' and health care providers' inputs are also important as both groups play an integral role in adolescent health care decision-making. The purpose of the study is to explore and analyze mHealth app features identified by adolescents, caregivers, and health care providers that have the potential to inspire continued use, thereby resulting in sustained health behavior changes in adolescents. We used inductive thematic analysis of qualitative data obtained from semi-structured focus groups conducted via Zoom©. Important features of mHealth apps that encourage adoption and continued use were explored with 25 participants, including adolescents, their caregivers, and health care providers. Common features facilitating continual usage of mHealth apps that were identified as significant by participating adolescents, their caregivers and health care providers were: look and feel of the app, customization, educational information/recommendations, and integration with electronic health record. Features such as gamification and social interaction that are usually lacking in current adolescent mHealth apps were well recognized as meaningful for motivational purposes. The findings suggest that adolescents and caregivers identify an app as valuable when it is user-friendly and intuitive and appreciate features that are motivating and can engage users in positive behaviors. Health care providers prefer mHealth apps that are user-friendly and can be effectively integrated into the cycle of care, thereby enabling delivery of efficient and value-based health care. Thus, mHealth app designs that are informed by health care providers' clinical experience and needs, in combination with app features that are desired and supported by both adolescents and their caregivers, have the potential to motivate widespread adoption and long-term use, which could result in improved health behaviors and outcomes among adolescents.

Mobile health (m-Health) is widely acknowledged as a pivotal domain for improving global healthcare and driving its digital health transformation. Despite the vast amount of literature published in recent years, bibliometric studies on m-Health remain limited in scope and coverage. This study presents a comprehensive review of m-Health literature extracted from Scopus and PubMed databases, spanning the period from 1997 to 2023, including publications during the coronavirus disease 2019 (COVID-19) pandemic. The combined Scopus and PubMed databases were used in this study. The search formula for the literature retrieval used the most appropriate and relevant keywords to m-Health. The bibliometric data importation, extraction and analysis of authors, titles, publication date, publication place, publisher, volume number, issue number, citation count, document type, author keywords, affiliation were all carried out using the 'Biblioshiny', 'EndNote X9®', 'Microsoft Excel®' and 'Microsoft Access®' software tools. Duplicate records were manually identified and removed. Visualization maps illustrating the recurrent keywords, collaboration patterns, and prolific publishing countries were generated using 'VOSviewer®'. A total of 37,470 (20,703 from Scopus and 16,767 from PubMed) publications were selected for the literature analysis. The results provided the definitive literature evidence on the origin of the concept of m-Health in 2003. Significant increase in the publications followed the global surge of smart phones usage in 2007, and the emergence of m-Health applications (Apps) and their global markets and ecosystems. The number of the publications peaked between 2013 and 2022 with most citations in 2022. There was noticeable spike in m-Health literature during the COVID-19 pandemic. The results also showed that most of the highly cited publications, leading institutions, and most prolific authors were predominantly from the developed countries. The USA has the highest number of publications followed by the UK, Australia, Germany, Canada and China, with most of the prolific authors originating from these countries. In conclusion, while there has been a remarkable increase in global m-Health publications since 2003, most of the impactful literature and publications in this area originated from selected countries in the developed world. The study indicates a significant disparity between the published literature from developed compared to the developing countries. Addressing this disparity, further bibliographical studies are required to address these and other literature gaps.

Mobile health (mHealth) applications (apps) are crucial in delivering health information and services to older adults. Despite their importance, blind and visually impaired (BVI) older individuals often face significant challenges in app accessibility and usability. This study delves into the design preferences and expectations of BVI older users and underscores the necessity of user-centered design for inclusive mHealth apps. Conducted in September 2023, the study comprised six focus group interviews. Each session involved two to four participants who began with self-introductions, followed by discussions centered on three open-ended interview questions. The study involved 14 participants: four with severe low vision and 10 totally blind. The primary design principles highlighted were "customizability" and "simplicity". The participants stressed the importance of intuitively designed main pages aligning with user patterns. Further, the participants articulated the following mHealth app feature or menu recommendations: editable profiles, emergency contact access, adaptable data presentation, data exportation, audible color details, customizable colors for varying visual needs, audible error feedback, feasible data input methods, toolbars, and habit-establishing reminders. Discussions also touched on the vital role of clear health data visualizations and comprehensible app-based health information. The findings illuminate paths for software developers and health scientists working towards more inclusive mHealth solutions. It is essential during the development phase to prioritize app learnability to accommodate a broad range of users, ensuring that even those with disabilities can effectively use technological innovations to address health disparities.

Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention. English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed. Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences. Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.

Depression is more common in youth with type 1 diabetes (T1D) compared to youth without diabetes. This study aims to assess the efficacy of Competent Adulthood Transition with Cognitive Humanistic and Interpersonal Teaching (CATCH-IT), an internet-based cognitive behavioral therapy (CBT) intervention, in adolescents with T1D and depressive symptoms. Adolescents (13 to 17 years old) with T1D and mild (score 5-9) or moderate (score 10-14) depressive symptoms on Patient Health Questionnaire-Adolescent (PHQ-A) screening assessment were recruited to participate and received online access to the CATCH-IT modules for 6 months (requested to complete in 12 weeks). Statistical analyses included paired t-test for changes in Center for Epidemiologic Studies Depression Scale (CES-D), PHQ-A, Problem Areas in Diabetes-Teen version (PAID-T), and hemoglobin A1c (HbA1c). Nineteen patients were consented, 15 met inclusion criteria and received the intervention. In the seven participants that completed the modules, there was a trend towards improvements in PHQ-A, CES-D and HbA1c. Participants provided robust qualitative feedback on the modules and areas for improvement in subsequent iterations, such as inclusion of diabetes-related content. Given the prevalence of depression in diabetes, feasible, low resource interventions are needed. Internet programs such as CATCH-IT can serve as an effective first line intervention in this high-risk population. A modified version of CATCH-IT tailored for adolescents with T1D may be beneficial in this patient population.