A Value Framework to Assess Patient-Facing Digital Health Technologies That Aim to Improve Chronic Disease Management: A Delphi Approach.

OBJECTIVES: Digital health technologies (DHTs) can optimise healthcare costs and improve quality and efficiency of care. However, the fast-paced rate of innovation and varying evidence standards can make it difficult for decision-makers to assess these technologies in an efficient and evidence-based manner. We sought to develop a comprehensive framework to assess the value of novel patient-facing DHTs used to manage chronic diseases by eliciting stakeholder value preferences. METHODS: Literature review and primary data collection from a three-round web-Delphi exercise was utilized. 79 participants from 5 stakeholder groups (patients, physicians, industry, decision makers, and influencers) and 3 countries (United States of America, United Kingdom, and Germany) took part. Likert scale data were statistically analyzed to determine intergroup differences in both country and stakeholder groups, stability of results, and overall consensus. RESULTS: The resulting co-created framework comprised 33 stable indicators with consensus from quantitative value judgments across domains: health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics, and user preferences. Lack of stakeholder consensus was observed on the importance of value-based care models, optimizing resources for sustainable systems, and stakeholder involvement in DHT design, development, and implementation; however, this was because of high rates of neutrality and not negative judgments. Supply-side actors and academic experts were the most unstable stakeholder groups. CONCLUSION: Stakeholder value judgments revealed a need for a coordinated regulatory and health technology assessment policy response that updates laws to meet technological innovations, offers a pragmatic approach to evidence standards to assess DHTs, and involves stakeholders to understand and meet their needs.

Assessing the Value of Provider-Facing Digital Health Technologies Used in Chronic Disease Management: Toward a Value Framework Based on Multistakeholder Perceptions.

OBJECTIVES: Hardly any value frameworks exist that are focused on provider-facing digital health technologies (DHTs) for managing chronic disease with diverse stakeholder participation in their creation. Our study aimed to 1) understanding different stakeholder opinions on where value lies in provider-facing technologies and 2) create a comprehensive value assessment framework for DHT assessment. METHODS: Mixed-methods comprising both primary and secondary evidence were used. A scoping review enabled a greater understanding of the evidence base and generated the initial indicators. Thirty-four indicators were proposed within 6 value domains: health inequalities (3), data rights and governance (6), technical and security characteristics (6), clinical characteristics (7), economic characteristics (9), and user preferences (3). Subsequently, a 3-round Web-Delphi was conducted to rate the indicators' importance in the context of technology assessment and determine whether there was consensus. RESULTS: The framework was adapted to 45 indicators based on participant contributions in round 1 and delivered 16 stable indicators with consensus after rounds 2 and 3. Twenty-nine indicators showed instability and/or dissensus, particularly the data rights domain, in which all 5 indicators were unstable, showcasing the novelty of the concept of data rights. Significant instability between important and very important ratings was present within stakeholder groups, particularly clinicians and policy experts, indicating they were unsure how different aspects should be valued. CONCLUSIONS: Our study provides a comprehensive value assessment framework for assessing provider-facing DHTs incorporating diverse stakeholder perspectives. Instability for specific indicators was expected due to the novelty of data and analytics integration in health technologies and their assessment. Further work is needed to ensure that, across all types of stakeholders, there is a clear understanding of the potential impacts of provider-facing DHTs. HIGHLIGHTS: Current health technology assessment (HTA) methods may not be well suited for evaluating digital health technologies (DHTs) because of their complexity and wide-ranging impact on the health system.This article adds to the literature by exploring a wide range of stakeholder opinions on the value of provider-facing DHTs, creating a holistic value framework for these technologies, and highlighting areas in which further discussions are needed to align stakeholders on DHTs' value attributes.A Web-based Delphi co-creation approach was used involving key stakeholders from throughout the digital health space to generate a widely applicable value framework for assessing provider-facing DHTs. The stakeholders include patients, health care professionals, supply-side actors, decision makers, and academia from the United States, United Kingdom, and Germany.High levels of instability among stakeholders and value domains are demonstrated, indicating the novelty of assessing provider-facing DHTs and their impact on the health system.

Dance Intervention Affects Social Connections and Body Appreciation Among Older Adults in the Long Term Despite COVID-19 Social Isolation: A Mixed Methods Pilot Study.

The ability of dance to address social isolation is argued, but there is a lack of both evidence of such an effect and interventions designed for the purpose. An interdisciplinary research team at University of Calgary partnered with Kaeja d'Dance to pilot test the effects of an intervention designed to facilitate embodied social connections among older adults. Within a mixed methods study design, pre and post behavioral tests and qualitative surveys about experiences of the body and connecting were administered to thirteen participants along with test instruments of loneliness and body appreciation. In the short-term, no significant changes were found on quantitative tests. Exploratory analysis revealed intervention improvements on individual body appreciation questions only. This indication of change was strongly supported by converging qualitative data and identified as relating to: increased connection through task-based collaboration, increased awareness of interpersonal boundaries, and a shift to experiencing the body as responsive. These indications of increased relational capacity were deemed likely to cause further impact in the long term. Examining this possibility and the subsequently arisen factor of COVID-19 risks and restrictions, test instruments were administered again to 10 participants 4 and 5 months after the intervention. A significant increase in loneliness was found. Despite this negative impact of COVID-19 isolation, several positive intervention changes remained detectable and some continued to increase over time. Seventy percent of the participants, who made new social contacts during the intervention and later sought continued contact, improved significantly across all body appreciation measures over the full study. The qualitative data from the last two time-points revealed both consistent values and new, negative changes. While these preliminary findings speak to the durability of intervention changes, they also identify areas of urgent priority to help older adults restore embodied relational capacity that has declined during COVID-19. Within the limitations of a small-sample pilot study, converging mixed methods results support the hypothesis that dance interventions designed for the purpose can positively affect the social inclusion of older adults. Although we recommend further study, these promising results also indicate that dance interventions can help older adults recover from pandemic isolation.