Effectiveness of Public Health Digital Surveillance Systems for Infectious Disease Prevention and Control at Mass Gatherings: Systematic Review.

BACKGROUND: Mass gatherings (MGs; eg, religious, sporting, musical, sociocultural, and other occasions that draw large crowds) pose public health challenges and concerns related to global health. A leading global concern regarding MGs is the possible importation and exportation of infectious diseases as they spread from the attendees to the general population, resulting in epidemic outbreaks. Governments and health authorities use technological interventions to support public health surveillance and prevent and control infectious diseases. OBJECTIVE: This study aims to review the evidence on the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MG events. METHODS: A systematic literature search was conducted in January 2022 using the Ovid MEDLINE, Embase, CINAHL, and Scopus databases to examine relevant articles published in English up to January 2022. Interventional studies describing or evaluating the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs were included in the analysis. Owing to the lack of appraisal tools for interventional studies describing and evaluating public health digital surveillance systems at MGs, a critical appraisal tool was developed and used to assess the quality of the included studies. RESULTS: In total, 8 articles were included in the review, and 3 types of MGs were identified: religious (the Hajj and Prayagraj Kumbh), sporting (the Olympic and Paralympic Games, the Federation International Football Association World Cup, and the Micronesian Games), and cultural (the Festival of Pacific Arts) events. In total, 88% (7/8) of the studies described surveillance systems implemented at MG events, and 12% (1/8) of the studies described and evaluated an enhanced surveillance system that was implemented for an event. In total, 4 studies reported the implementation of a surveillance system: 2 (50%) described the enhancement of the system that was implemented for an event, 1 (25%) reported a pilot implementation of a surveillance system, and 1 (25%) reported an evaluation of an enhanced system. The types of systems investigated were 2 syndromic, 1 participatory, 1 syndromic and event-based, 1 indicator- and event-based, and 1 event-based surveillance system. In total, 62% (5/8) of the studies reported timeliness as an outcome generated after implementing or enhancing the system without measuring its effectiveness. Only 12% (1/8) of the studies followed the Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems and the outcomes of enhanced systems based on the systems' attributes to measure their effectiveness. CONCLUSIONS: On the basis of the review of the literature and the analysis of the included studies, there is limited evidence of the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs because of the absence of evaluation studies.

Interventions Aimed at Enhancing Health Care Providers' Behavior Toward the Prescription of Mobile Health Apps: Systematic Review.

BACKGROUND: Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients. OBJECTIVE: This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps. METHODS: A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The "National Institute of Health's quality assessment tool for before-and-after (pretest-posttest design) studies with no control group" and "the mixed methods appraisal tool (MMAT)" were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions. RESULTS: In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up. CONCLUSIONS: This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption.