An acceptance analysis of a sexual health education digital tool in resource-poor regions of Kenya: an UTAUT based survey study.

BACKGROUND: Unplanned pregnancies and sexually transmitted diseases are a concern in Sub-Saharan Africa, particularly in low-income areas. Access to sexual health information is limited, partly due to the absence of comprehensive sex education in the national school curriculum and social taboos. In response to these challenges, this study introduces a web-based prototype, designed to provide essential sexual health information, targeting 18 to 35-year-old Kenyans, focusing on contraception, menstruation, and female genital mutilation. METHOD: Aiming to investigate young adults' behavioral intention to use a digital tool for sexuality education, by analyzing factors affecting acceptance and usability in low-income and resource-poor regions in Kenya. To explore the acceptability and use of the developed digital tool, this study used a modified version of the Unified Theory of Acceptance and Use of Technology (UTAUT), complemented by the System Usability Scale (SUS) questionnaire. For statistical analysis, a Structural Equation Model (SEM) including Confirmatory Factor Analysis (CFA) and Linear Regression was used. Regarding the reporting of the E-survey results, the Checklist for Reporting Results of Internet E-surveys (CHERRIES), was considered. RESULTS: Survey information from 77 persons (69 female, 7 male, 1 diverse) were collected. A modified UTAUT appears as an appropriate model for measuring the constructs and integrating evidence-based approaches to advanced and safe sexual healthcare information. Results from the SEM showed perceived usefulness, attitude towards healthcare integrated evidence technology, and usability as well as having a significant positive impact on the acceptance, the intention to use as well as wellbeing. Having the resources and knowledge necessary for the usage of a digital tool turns out to have a significant negative impact. A SUS score of 67.3 indicates the usability of the tool for sexual health information, assessed as okay. CONCLUSIONS: The study adopts validated methods to assess the acceptability and usability of a digital sexual health education tool in Kenya. Emphasizing its potential effectiveness and highlighting the influence of cultural and contextual factors on technology adoption.

Artificial Intelligence Bias in Health Care: Web-Based Survey.

BACKGROUND: Resources are increasingly spent on artificial intelligence (AI) solutions for medical applications aiming to improve diagnosis, treatment, and prevention of diseases. While the need for transparency and reduction of bias in data and algorithm development has been addressed in past studies, little is known about the knowledge and perception of bias among AI developers. OBJECTIVE: This study's objective was to survey AI specialists in health care to investigate developers' perceptions of bias in AI algorithms for health care applications and their awareness and use of preventative measures. METHODS: A web-based survey was provided in both German and English language, comprising a maximum of 41 questions using branching logic within the REDCap web application. Only the results of participants with experience in the field of medical AI applications and complete questionnaires were included for analysis. Demographic data, technical expertise, and perceptions of fairness, as well as knowledge of biases in AI, were analyzed, and variations among gender, age, and work environment were assessed. RESULTS: A total of 151 AI specialists completed the web-based survey. The median age was 30 (IQR 26-39) years, and 67% (101/151) of respondents were male. One-third rated their AI development projects as fair (47/151, 31%) or moderately fair (51/151, 34%), 12% (18/151) reported their AI to be barely fair, and 1% (2/151) not fair at all. One participant identifying as diverse rated AI developments as barely fair, and among the 2 undefined gender participants, AI developments were rated as barely fair or moderately fair, respectively. Reasons for biases selected by respondents were lack of fair data (90/132, 68%), guidelines or recommendations (65/132, 49%), or knowledge (60/132, 45%). Half of the respondents worked with image data (83/151, 55%) from 1 center only (76/151, 50%), and 35% (53/151) worked with national data exclusively. CONCLUSIONS: This study shows that the perception of biases in AI overall is moderately fair. Gender minorities did not once rate their AI development as fair or very fair. Therefore, further studies need to focus on minorities and women and their perceptions of AI. The results highlight the need to strengthen knowledge about bias in AI and provide guidelines on preventing biases in AI health care applications.

Praxis der Teledermatologie.

HINTERGRUND: Teledermatologische Anwendungen werden im deutschen Versorgungssystem in den nächsten Jahren erheblich an Bedeutung gewinnen. Das vorliegende Empfehlungspapier wurde als Expertenkonsens auf der Basis einer qualifizierten Literaturrecherche und eines strukturierten Entscheidungsprozesses der Autorengruppe entwickelt. ZIELSETZUNG: a) die IST-Analyse zum Einsatz der Telemedizin in der Dermatologie, b) die Bewertung der Evidenz ihres Nutzens und ihrer Sicherheit und, c) die Entwicklung von Verfahrensstandards für die ärztliche Praxis in den deutschsprachigen Ländern. Auf der Basis dieser Erkenntnisse soll durch einen Expertenkonsens eine Handlungsorientierung für den Einsatz der Teledermatologie gegeben werden. METHODEN: Dreistufiges Vorgehen: 1) Systematische Literaturrecherche in den internationalen medizinischen Onlinedatenbanken Pubmed und Embase, 2) Weitere, teils manuelle Recherchen, 3) Expertenkonsens mit einem systematischen Entscheidungsverfahren mit 21 Teilnehmern. ERGEBNISSE: In der strukturierten Literaturrecherche fanden sich 204 wissenschaftliche Originalarbeiten, in denen Anwendungen der Telemedizin bei Hautkrankheiten thematisiert wurden. Diese wurden systematisch aufgearbeitet, analysiert und bewertet. In der zweiten Stufe wurden in einer Handsuche zusätzliche relevante Schriften identifiziert und ebenfalls ausgewertet. Das Expertengremium entwickelte dann auf der Basis der externen Evidenz sowie der internen Diskussion Handlungsempfehlungen für die Praxis. Schlussfolgerung der wissenschaftlichen Studienlage ist, dass die telemedizinische Unterstützung der dermatologischen Behandlung und Prävention bei Einsatz leistungsfähiger Systeme, Kenntnis ihrer Anwendung sowie Beachtung der Indikationen und Kontrainidikationen einen erheblichen Mehrnutzen darstellt. SCHLUSSFOLGERUNGEN: Die Teledermatologie hat in den deutschsprachigen Ländern wie auch weltweit einen zunehmenden Stellenwert und bietet aufgrund des hohen Innovationsgrades eine Vorreiter- und Vorbildfunktion für weitere telemedizinische Anwendungen anderer Fachrichtungen. Eine qualitätsgesicherte teledermatologische Behandlung ist in den deutschsprachigen Ländern praktikabel und kann zu einem relevanten Mehrnutzen in der Versorgung führen. Ihr Einsatz ist immer dann in Erwägung zu ziehen, wenn relevante Zusatznutzen für die Patienten ohne relevante Nachteile für sie und für die Versorgenden zu erwarten sind. Für die teledermatologische Behandlung wurden mit dem vorliegenden Konsensuspapier praxisrelevante Maßgaben festgelegt. Etwaige situationsabhängige Limitationen in der Versorgung sind stets zu beachten.

A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model.

BACKGROUND: Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. OBJECTIVE: This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. METHODS: The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. RESULTS: Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. CONCLUSIONS: The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12905-023-02839-6.

Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study.

BACKGROUND: Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures. OBJECTIVE: The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle. METHODS: This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle. RESULTS: The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458). CONCLUSIONS: We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.

Going digital in Germany: An exploration of physicians' attitudes towards the introduction of electronic prescriptions - A mixed methods approach.

PURPOSE: Digitalization of medical prescriptions is a core element for the digitalization of healthcare. While some countries have introduced electronic prescriptions over 20 years ago and nearly reached 100 % penetration, physicians in Germany have only been able to use electronic prescriptions since mid-2021 and currently only 0.1 % of prescriptions are transmitted electronically. This study investigates German physicians' viewpoint towards electronic prescriptions as a potential reason for the low penetration and investigates levers to drive adoption. BASIC PROCEDURES: We conducted a two-stage sequential mixed methods study consisting of semi-structured interviews followed by an online survey among 1136 physicians testing the main dimensions of the Unified Theory of Acceptance and Use of Technology model. MAIN FINDINGS: Our initial interviews suggested that there was a high technology acceptance by physicians, but due to technical barriers, they were not able to use the system, explaining the low penetration. However, with the larger sample size of the survey, we identified, that while physicians see barriers for introducing electronic prescriptions, such as unclear cost reimbursement or lack of time to deal with the implementation, the majority believes these can be overcome within twelve months. Furthermore, we found that only one third of physicians is in favor of replacing paper-based prescriptions with electronic prescriptions and most physicians considers it unlikely that they will issue more than half of their prescriptions electronically within the next twelve month. Additionally, respondents perceived limited usefulness and expect high effort for using electronic prescriptions. PRINCIPAL CONCLUSION: Low electronic prescription penetration in Germany seems to be driven by low technology acceptance, not technical barriers. This can be linked to low perceived usefulness, high effort expectancy and low perceived patient demand. Improving technical stability, system functionality and increasing physicians' level of information were seen as main levers to drive electronic prescription adoption.

Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis.

BACKGROUND: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. OBJECTIVE: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. METHODS: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. RESULTS: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. CONCLUSIONS: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution.

Digital Health meets Hamburg integrated medical degree program iMED: concept and introduction of the new interdisciplinary 2nd track Digital Health.

Digitalization in medicine is transforming the everyday work and the environment of current and future physicians - and thereby brings new competencies required by the medical profession. The necessity for a curricular integration of related digital medicine and, in more general, digital health topics is mostly undisputed; however, few specific concepts and experience reports are available. Therefore, the present article reports on the aims, the implementation, and the initial experiences of the integration of the topic Digital Health as a longitudinal elective course (2nd track) into the integrated medical degree program iMED in Hamburg.