Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study.

BACKGROUND: Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). OBJECTIVE: The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. METHODS: Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. RESULTS: In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information-seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. CONCLUSIONS: Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services.

Creating work-life balance among physicians in the age of digitalization: the role of self-consciousness and communication - a qualitative study.

BACKGROUND: Besides the positive effects of using digital health solutions, digitalization can affect the healthcare worker burnout. The ability to coordinate different aspects of life (WLB) also plays a significant role in the development of burnout among medical workers. The aim of our study is to show, through qualitative interviews, the impact of digitalization on work-life balance in Hungarian physicians. METHODS: 62 semi-structured interviews were conducted between October 2021 and June 2022, of which, a total of 31 interviews were used for the analysis, which were all related to the theme of work-life balance. Purposive sampling and inductive thematic approach were used to collect and analyse the data and identify patterns of the themes. RESULTS: Based on this analysis, 5 main themes emerged: (1) the use of digital health tools, (2) Impact of digital tools on everyday work, (3) Work-life balance, (4) Setting and maintaining work-life boundaries, (5) Potential solutions. With the spread of digital communication, most of the respondents feel that their working hours increased even at the expense of their private life. The majority considers constant availability as a serious problem, however, several physicians indicated that as a result of a learning curve, they are able to change and set the necessary boundaries. Respondents were divided on whether or not they were successful in setting and maintaining boundaries. The 2 most important factors of establishing WLB in a digital age are self-consciousness and communication. However, these skills are not self-evident: the responses also show that in many cases there is a need for external support, but also for health professionals to actively reflect from time to time on their role as healers and their relationship with technology. CONCLUSION: Basic principles and tools for establishing successful digital work-life balance in healthcare should be involved in the training curriculum of future physicians and healthcare professionals, while institutions should elaborate specific policies to include digital work-life balance in the institutional setting, as part of the preventive measures against burnout.

State of vulnerable populations in the techquity framework in Hungary.

Digital health solutions could alleviate the needs of vulnerable populations in the recent period of the permacrisis, however, there are several barriers that limit their use for certain individuals. We use the four-pillar model of the novel concept of techquity to provide original evidence of the discrepancy in the willingness to try and the ability to harness healthtech in Hungary. We identified three underserved segments of society: older adults, people with long-term activity-limiting conditions, and people experiencing homelessness who could greatly benefit from digital technologies and yet use them less than the general population. We also discuss potential strategic considerations in order to promote techquity and digital inclusion among people living in vulnerable situations.

Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey.

BACKGROUND: In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. OBJECTIVE: However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. METHODS: Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. RESULTS: The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. CONCLUSIONS: Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.

Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust.

BACKGROUND: With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. METHODS: Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). RESULTS: A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. CONCLUSION: Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.

Digitally engaged physicians about the digital health transition.

BACKGROUND: Digitalisation affects 90% of healthcare. Digital health, however, does not only refer to technological transformation but also has considerable cultural and social consequences. It fundamentally reshapes the roles of physicians and patients, as well as their relationship. Moreover, from the second half of the 20th century, the growing number of chronic patients and the increase in life expectancy have posed new challenges to the medical workforce. OBJECTIVES: To explore the digitally engaged physician's knowledge and attitudes towards digital health technologies and the transformation of the doctor-patient relationship. METHODS: A qualitative interview study analysed with Interpretative Phenomenological Analysis (IPA). The study is based on qualitative, semi-structured interviews with 11 digitally engaged physicians from 9 countries. We identified four main themes emerging from e-physicians' responses and experience: 1) the past: intentions and experiences of change, 2) the present: the role of digital health and technology in the medical practice and their everyday challenges, 3) the present: the practical and ideal physician-patient relationship, and 4) the future: skills and competencies needed for working with e-patients and visions about the future of the medical practice. RESULTS: The interviewed physicians state that digital health solutions could create a deeper doctor-patient relationship: knowledgeable patients are a huge help in the joint work effort and technology is the main tool for creating a more involved and responsible patient. Medical professionals in the future might rather get a role as a translator between technical data and the patient; as a guide in the jungle of digital health. However, the interviewed physicians also noted that digital transition today is more beneficial to patients than to their doctors. CONCLUSIONS: We state that digitally engaged physicians are characterized by a kind of dichotomy: they use digital opportunities enthusiastically, but they also feel the difficulties related to digital health.

Opinion leader empowered patients about the era of digital health: a qualitative study.

OBJECTIVES: We aimed to explore the opinion leader empowered patients' relationship with their medical professionals, their experiences and beliefs about technologies, and how they see the future. We also attempted to determine whether technologies, the access to it or patient empowerment are the main driving forces behind these changes. DESIGN: A qualitative interview study analysed with interpretative phenomenological analysis. SETTING: All interviews were conducted and recorded individually with the same trained interviewer via a Skype call. PARTICIPANTS: The study is based on qualitative, semistructured interviews with 11 opinion leader empowered patients from six countries including UK, USA, Australia, Sweden, South Africa and Ireland. RESULTS: We identified four superordinate themes emerging from e-patients' experiences: (1) impact of technology, (2) the meaning of empowerment, (3) the changing physician-patient relationship and (4) expectations for the future. The relationship e-patients have with their physicians is based on efficient communication, proactivity, the desire for asking questions and the use of technologies. The interviews have shown that the rapid development of technology has fundamentally changed the lives of these e-patients, and technology eventually is transforming the physician-patient relationship into a partnership. Regarding the future of the physician-patient partnership, e-patients emphasised that change will rather be cultural than technological. CONCLUSIONS: The interviews have shown that cooperation between technology and healthcare is not enough on its own: the most decisive factor is the return of the human touch and reciprocal communication. All of these suggest that technology is an important ally in the 'renaissance of medicine' that starts to treat patients as it should have always had.