Together towards tomorrow: partnerships powering the digital transformation of the health sector

This editorial presents a collective vision of unity, innovation and collaboration, and a shared desire for resilient and more equitable health systems worldwide, urging the global health community to harness the collective strength of alliances and international collaboration to guide the health sector into a new era of digital transformation and innovation.

Emotional and psychological safety in the context of digital transformation in healthcare: a mixed-method strategic foresight study.

BACKGROUND: Perceived safety has received attention in the digital transformation of healthcare. However, the impact of perceived safety on the future of digital transformation has not been fully elucidated. AIM: To investigate perceived safety in the context of the digital transformation of healthcare while considering relevant needs, influencing factors and impacts, including crisis events, to provide recommendations for action based on a participatory, multiperspective, strategic 5-year foresight viewpoint. METHODS: A strategic foresight study is conducted via a participatory mixed-methods design to understand the present related factors that are likely to be relevant to future developments in the digital transformation of healthcare. RESULTS: We observed that feeling safe plays a complex role in the digital transformation of healthcare. How perceived safety is considered has and will continue to impact the individual, organisational and system levels. Regarding a potential crisis event, controversial consequences have been observed. At its core, digital (health) literacy related to equity of access and human support is one of the crucial aspects in the context of perceived safety related to the successful implementation of digital technologies in healthcare. CONCLUSIONS: The scenarios showed that a continuation of the current situation over the next 5 years may result in partly desirable and partly undesirable outcomes. Concrete key factors should be used in practice to support both education and healthcare quality development and research. The essence of the scenarios should serve as a starting point for research agenda setting and political decision-making in the future. However, additional research is needed to quantify the correlations among the relevant factors.

Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey.

BACKGROUND: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. OBJECTIVE: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. METHODS: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. RESULTS: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. CONCLUSIONS: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status.

Challenges and Needs in Digital Health Practice and Nursing Education Curricula: Gap Analysis Study.

Background: Australian nursing programs aim to introduce students to digital health requirements for practice. However, innovation in digital health is more dynamic than education providers' ability to respond. It is uncertain whether what is taught and demonstrated in nursing programs meets the needs and expectations of clinicians with regard to the capability of the nurse graduates. Objective: This study aims to identify gaps in the National Nursing and Midwifery Digital Health Capability Framework , based on the perspectives of clinical nurses, and in nurse educators' confidence and knowledge to teach. The findings will direct a future co-design process. Methods: This study triangulated the findings from 2 studies of the Digital Awareness in Simulated Health project and the National Nursing and Midwifery Digital Capability Framework. The first was a qualitative study that considered the experiences of nurses with digital health technologies during the COVID-19 pandemic, and the second was a survey of nurse educators who identified their confidence and knowledge to teach and demonstrate digital health concepts. Results: The results were categorized by and presented from the perspectives of nurse clinicians, nurse graduates, and nurse educators. Findings were listed against each of the framework capabilities, and omissions from the framework were identified. A series of statements and questions were formulated from the gap analysis to direct a future co-design process with nursing stakeholders to develop a digital health capability curriculum for nurse educators. Conclusions: Further work to evaluate nursing digital health opportunities for nurse educators is indicated by the gaps identified in this study.

Academic background of senior executives and enterprise digital transformation.

With the application of digital technology and its promotion of business model innovation, digital transformation has increasingly become an important strategic issue for enterprises. In this context, based on imprinting theory, we select all A-share listed enterprises in China from 2008 to 2022 as samples and study the relationship between the academic background of senior executives and the digital transformation of enterprises. The study results show that senior executives with academic backgrounds can significantly promote the digital transformation of enterprises. A test of the action mechanism shows that the academic background of senior executives plays a role in the promotion of the digital transformation of enterprises by improving enterprise innovation, and the degree of industry competition moderates the relationship between the academic background of senior executives and the digital transformation of enterprises. This paper applies imprint theory to explore the relationship between the academic background of executives and corporate digital transformation, expanding the research on how imprints affect corporate decision-making and the scope of imprint theory research, while also providing evidence to support government departments in formulating policies to encourage talented individuals with academic backgrounds to participate in corporate management.

Emotional and Psychological Safety in Healthcare Digitalization: A Design Ethnographic Study.

Objectives: Emotional and psychological safety is important during the use of digital technologies in healthcare. We aimed to gain comprehensive insight into needs, influencing factors and outcomes in the context of perceived safety and digital technologies in healthcare. Methods: We employed a participatory, design ethnographic research approach with 16 participants in 10 use cases. The methods included in an iterative process were, think-aloud, guideline-based interviews, process mapping, storyboard creation, and photo documentation. A qualitative, primarily inductive data analysis and synthesis was performed. Results: Perceived safety is influenced by various factors and unmet needs. Increased perceived safety can positively support the use of digital technologies, whereas low perceived safety can limit or even hinder its use. Conclusion: The needs of the different target groups should be considered throughout the entire process of digital technology development and healthcare provision to support their implementation. These findings support further research by providing specific aspects of emotional and psychological safety regarding target groups, settings, and ages and those with different levels of affinity for digital technologies.

Can digital technology innovation contribute to firms' market value?

With the rapid development of digital technology, digital technology innovation has become a core driver of China's economic development. Thus, this study uses A-share listed companies from 2003 to 2021 as the research sample. The digital patents of firms are identified to portray the level of digital technology innovation by matching the digital economy industry classification code, national economy industry classification code, and IPC number. Considers the economic effect of digital technology innovation from the perspective of firm market value. It is found that digital technology innovation significantly contributes to the increase in firm market value, and this finding still holds when robustness tests are performed. Mechanistic tests have shown that digital technology innovation affects firm market value by driving digital transformation, promoting productivity, and enhancing market profitability. Further analysis reveals that digital technology innovation has a more significant effect on increasing firm market value for large, non-state, capital-intensive, technology-intensive and low internal control costs firms. This study verifies the enabling effect of digital technology innovation on the development of the real economy at the micro level, and provides insights for the optimization of China's digital technology innovation policies and the formulation of firms' digital development strategies.

Community nursing and the digital technology revolution: the past, present and future.

While very much in its infancy in terms of becoming an established tool, the use of digital technology in community nursing is steadily growing, despite the persistent barriers to, and challenges encountered in its uptake and implementation. The mobile nature and high workload of a community nurse's daily practice should facilitate the rapid uptake of time-saving technology. However, there are indications that technology may not be the panacea it was originally proclaimed to be. Francesca Ramadan elaborates on the past and present applications of digital technology in community nursing and delves into the principles that should shape the future potential of tools such as artificial intelligence, automation technologies and clinical decision support systems.

Identify the digitalization technology opportunity of low-carbon energy technologies: Using the patent data and collaborative filtering.

The digitalization of low-carbon energy technologies (LCET) provides important technical support for the transition to a greener energy system. Digitalization addresses the phenomenon of the growing application of information and communications technologies (ICT) across the economy, which is regarded as the technology convergence between ICT and other technologies. Scholars have revealed the signs that LCET and ICT are becoming increasingly interlinked, which raises the challenges for predicting and identifying the technology opportunities for innovations in the converged technology area. To address the challenges, this paper proposes a collaborative filtering approach to identify the digitalization technology opportunity of low-carbon energy technologies using patent classification and patent citation information. We applied the proposed collaborative filtering approach using a large LCET patent dataset derived from the United States Patent and Trademark Office (USPTO). The results indicate that the proposed method can effectively identify digitalization technology opportunities of LCET, and the current LCET digitalization technology opportunities identified based on this approach are mainly concentrated in the Energy storage field. The advantages of the proposed approach are that its underlying data are more readily available and its technical complexity is relatively lower, and thus, more replicable for other technology fields.

An analysis of the impact of digital technology adoption on the income of high quality farmers in production and operating.

Digital technology is shaping our traditional agriculture in unprecedented ways. As a new engine to empower farmers and promote common prosperity in rural areas, the development of the digital economy can help revitalize rural industries, providing strong support for increasing industrial value-added income and farmers' income levels. Based on 676 pooled cross-section data of high-quality farmers in China Guangdong Province from 2020-2021, the article empirically examines the impact of digital technology adoption on the production and business income of high-quality farmers and explores its mechanism of action, based on theoretical analysis and using the ERM model. It is found that the use of digital technology helps to increase the income of high quality farmers in production and business, but effects vary for different income levels and different types of high quality farmers. In addition, tests of the mechanism of action suggest that the introduction of digital technologies can mitigate the negative impact of market distance on the income of high quality farmers in production and business. After applying variable substitution, model replacement, and propensity score matching (PSM) for robustness checks, the research findings still hold true. Therefore, efforts should be made to speed up the upgrading of rural digital technology and other infrastructure, increase training for high quality farmers to improve their digital literacy through multiple channels, for the better marketing of agricultural products.

A landscape analysis of digital health technology in medical schools: preparing students for the future of health care.

Although Digital Health Technology is increasingly implemented in hospitals and clinics, physicians are not sufficiently equipped with the competencies needed to optimize technology utilization. Medical schools seem to be the most appropriate channel to better prepare future physicians for this development. The purpose of this research study is to investigate the extent to which top-ranked medical schools equip future physicians with the competencies necessary for them to leverage Digital Health Technology in the provision of care. This research work relied on a descriptive landscape analysis, and was composed of two phases: Phase I aimed at investigating the articulation of the direction of the selected universities and medical schools to identify any expressed inclination towards teaching innovation or Digital Health Technology. In phase II, medical schools' websites were analyzed to discover how innovation and Digital Health Technology are integrated in their curricula. Among the 60 medical schools that were analyzed, none mentioned any type of Digital Health Technology in their mission statements (that of the universities, in general, and medical schools, specifically). When investigating the medical schools' curricula to determine how universities nurture their learners in relation to Digital Health Technology, four universities covering different Digital Health Technology areas were identified. The results of the current study shed light on the untapped potential of working towards better equipping medical students with competencies that will enable them to leverage Digital Health Technology in their future practice and in turn enhance the quality of care.

How does the Chinese digital transformation of enterprises affect the auditor switch?

The digital transformation of enterprises has brought great changes to the audit service demand of enterprises and the audit service supply of auditors. Therefore, there is a pressing need to study the digital transformation of enterprises and its impact on auditor switch. This paper aims to explore the influence of enterprise digital transformation on auditor switch and its potential implications for improving auditor efficiency. Using Python's machine learning tools and text analysis methods, This paper measure the digital transformation of Chinese listed companies and study the impact of digital transformation on the frequency of auditors witches. Our findings suggest that companies that have undergone digital transformation have reduced the frequency of changing auditors by alleviating information asymmetry, enhancing the effectiveness of companies' internal controls and increasing audit fees. This unique measurement mode of digital transformation provides new evidence for the relationship between the audit service demand of enterprises and the audit service supply of auditors under the digital transformation environment. The research can assist businesses in understanding how digital transformation affects auditing professionally and in improving their audit processes accordingly.

Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies.

BACKGROUND: Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. OBJECTIVE: The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. METHODS: Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. RESULTS: The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. CONCLUSIONS: Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

The Digital Platform and Its Emerging Role in Decentralized Clinical Trials.

Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.

User profiles in digitalized healthcare: active, potential, and rejecting - a cross-sectional study using latent class analysis.

BACKGROUND: There is evidence of different use by different groups of people for general health-related applications. Yet, these findings are lacking for digitalized healthcare services. It is also unclear whether typical use patterns can be found and how user types can be characterized. METHODS: The analyses are based on data from 1 821 respondents to the Health Related Beliefs and Health Care Experiences in Germany panel (HeReCa). Digitalized healthcare services, that were used to determine the user types, include for example sick notes before/after examination and disease related training. User types were determined by latent class analysis. Individual groups were characterized using multinomial logistic regressions, taking into account socioeconomic and demographic factors as well as individual attitudes towards digitalization in the healthcare system. RESULTS: Three types were identified: rejecting (27.9%), potential (53.8%) and active (18.3%). Active participants were less likely to be employed, less likely to be highly educated and less skeptical of digital technologies. Potential users were the youngest, most highly-educated and most frequently employed group, with less skepticism than those who rejected. Rejecters were the oldest group, more likely to be female and of higher socio-economic status. CONCLUSIONS: Socio-demographic and socio-economic differences were identified among three user types. It can therefore be assumed that not all population groups will benefit from the trend towards digitalization in healthcare. Steps should be taken to enhance access to innovations and ensure that everyone benefits from them.

Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study.

BACKGROUND: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a "digital divide," inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. OBJECTIVE: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. METHODS: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. RESULTS: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70% (1580/2258) to 82.5% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. CONCLUSIONS: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services.

Digital technology and self-care in sexual health.

This Collection highlights some recent publications in Sexual Health on using technology to optimise sexual health. By leveraging innovations such as rapid diagnostic tools, mobile health (mHealth), self-testing and artificial-intelligence-powered tools, we can empower individuals to take control of their sexual health, reducing risks and enhancing accessibility.