Despite legal and technological advances, women still face barriers to abortion care in legally restricted or low-resource settings. The advent of medication abortion using misoprostol with or without mifepristone, has enabled women to self-manage their abortions outside of the formal healthcare system. Self-managed abortions are often assisted by telemedicine services, which provide women with evidence-based guidance on managing the abortion process on their own. This thesis explores two separate abortion telemedicine services operating in legally restricted and/or low resource settings – a global online telemedicine service and an abortion support hotline in Venezuela – and evaluates the outcomes associated with each. By interviewing counsellors at a Venezuelan abortion support hotline and the women who used the service, we gained a stronger understanding of the hotline’s successes, barriers, and areas for improvement. We conclude that abortion telemedicine services provide effective and acceptable care, in general, and we recommend greater access to misoprostol in Venezuela.

The aim of the study is to explore three healthcare apps, Numa, Ella, and Leia Health, and their affordances in digital healthcare. By applying discourse analysis and discursive interface analysis as primary methods, the study investigates reward and motivation features within these apps, aiming to uncover the norms and assumptions embedded in their interfaces. Theoretical concepts such as motivation affordance, technology affordances, and sociomaterialism are used as frameworks to understand and analyze the results. The interface analysis provides insights into how various affordances, such as functional, cognitive, sensory, and collaborative, shape the user experience in healthcare apps. The results offer an overview and understanding of how user behaviors are influenced by the structure, design, and features of health apps through their digital interfaces, illustrating how the apps provide users with support and information.

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Background: Maternal and child health initiatives are embracing the use of electronic or mobile technology, a branch of digital health popularly referred to as eHealth or mHealth. While digital health can offer extensive benefits, it has raised various challenges. For instance, digital health programs are not often designed with a focus on equity in distribution nor are they designed from a gender equity standpoint. Although digital health interventions for maternal healthcare focuses predominantly on women as beneficiaries, few studies explore gendered power relations and how they impact the success of maternal and child health projects in African contexts such as Nigeria. This gap in literature risks excluding women from engaging in the digital space and can worsen the negative and unintended consequences of participating in digital health. This thesis examines the impact and implications of digital health interventions for maternal health in sub-Saharan Africa. -- Method: Two secondary and three primary studies described the various implications of digital health in sub-Saharan Africa more broadly and in rural Edo State, Nigeria, specifically. The secondary studies involved a review and a systematic review of the literature, the primary studies involved focus group discussions and in-depth interviews with pregnant or postpartum women who were beneficiaries of a digital health program and their community members. -- Results: The first paper illustrated exclusionary practices of digital health programs in sub-Saharan Africa, the second paper showed how digital health programs can challenge and redress harmful and unequal gender norms, roles, and power relations that privilege men over women. Observations from the third paper indicate that while mHealth programs are helpful to women in many ways, they are not enough on their own to undo entrenched systems of power through which men control women's reproductive lives. The fourth paper affirms that a community-centered approach to implementing digital health programs enhances women's acceptance and sustained use of digital health. The fifth paper shows how women navigate patriarchal environments through negotiation, collaboration and maneuvering to yield the best possible maternal health outcomes. -- Conclusion: At the core of all the studies was the need to understand and redress overarching factors contributing to ill health and exacerbating health inequities in maternal health through gender transformative approaches. Potentially unintended consequences, side effects, and negative effects of digital health impedes its many benefits, therefore, to achieve meaningful impact, gender and digital inclusion must remain a priority in the development, implementation, and evaluation of digital health. This thesis illuminated the needs of those with the greatest barriers to health technologies for maternal health thereby contributing to the discussion on digital health social justice with overarching themes on how to achieve equitable opportunities for all women and girls to access, use and benefit from digital health for maternal health.

Den digitala vården i Sverige är i ständig utveckling och består av ett flertal moderna teknologier som kan hjälpa samhället. Enligt populära tidskrifter och myndigheter står Sverige inför ett problem, den fysiska primärvården i Sverige är överbelastad och samhället har svårt att hinna med. Sverige har som mål att bli bäst i världen på att använda digitala verktyg för att utveckla vården, att E-hälsa skall frodas både för samhälle och individ. När sådana stora projekt startas är det viktigt att det finns en underliggande acceptans hos samhället, är projektet ett bra förslag eller kommer det att undantryckas av samhället. Syftet med studien är att undersöka yngre vuxnas åsikter om E-hälsa med en inriktning på den digitala vårdcentralen. För att kunna besvara syftet med hjälp av undersökningen kommer studien redogöra för vilka faktorer som påverkar yngre vuxnas acceptans av digitala vårdcentraler. Undersökningen har genomförts med hjälp av det teoretiska ramverket UTAUT (Unified Theory of Acceptance and Use of Technology) som är en modell för att mäta acceptans. Ramverket har varit grunden för att analysera den insamlade empirin. Studien har identifierat fyra faktorer som har inverkan på acceptansen för den digitala vårdcentralen. De fyra faktorerna är erfarenhet, frivillighet, smidighet och effektivitet och måluppfyllelse. / Digital healthcare in Sweden is constantly evolving and consists of several modern technologies that can help the society. According to popular magazines and authorities, Sweden is facing a problem, the physical primary care in Sweden is overloaded and the society is struggling to keep up. Sweden aims to become the best in the world at using digital tools to develop healthcare, that e-health will flourish for both the society and the individual. When such large projects are started, it is important that there is an underlying acceptance by the society, is this project a good proposal or will it be pushed aside by the society. The aim of this study is to investigate younger adults' acceptance on e-health with a focus on the digital health centre. In order to answer this purpose through the survey, the study will outline the factors that influence younger adults' acceptance of digital health centers. The study was conducted using the theoretical framework UTAUT (Unified Theory of Acceptance and Use of Technology) which is a model to measure acceptance. This framework has been the basis for analyzing the collected empirical data. The study has identified four factors that have an impact on the acceptance of the digital health centre. The four factors are experience, voluntariness, agility and efficiency and goal achievement.

Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire; 2) Review the current literature on the availability and effectiveness of mobile phone interventions targeting sugar-sweetened beverage (SSB) consumption; and 3) Use the updated BEVQ-15 to conduct the Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The Healthy Beverage Habits study was an online randomized controlled pilot trial with an 8-week intervention and a 4-week maintenance period delivered through Instagram. The materials were adapted from the in-person SIPsmartER SSB reduction intervention. Data analysis included RM-ANOVAs to test for differences in beverage intake between the Instagram intervention group and the E-mail control group. Results: For the Healthy Beverage Habits trial, no significant between group over time differences were found. However, the Instagram group demonstrated a significant reduction in total beverage kcal (mean difference±SE=-156±48; p=0.049), and increase in total HBI scores (mean difference±SE= 11.9±2.3; p=0.025) from baseline to the end of the maintenance period. No within group differences were demonstrated for the E-mail control group over the intervention or maintenance period. The study retention rate was 38%, with 39 participants initially enrolled and 15 participants completing all study visits through maintenance. Results for the validity and reproducibility of the updated BEVQ-15 and a review of the availability and effectiveness of mobile phone interventions targeting SSB consumption are presented. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions. / Doctor of Philosophy / Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire which estimates habitual average daily intake of 15 beverage categories as well as total sugar-sweetened beverages (SSB) and total beverages. 2) Review the current literature of the availability and effectiveness of mobile phone interventions targeting SSB consumption. 3) Use the updated BEVQ-15 to conduct The Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The updated BEVQ-15 was assessed for agreement between the BEVQ-15 and dietary recalls. Researchers compared beverage intake between two BEVQ-15 administrations. The Healthy Beverage Habits pilot study was an 8-week intervention with a 4-week maintenance period. Data analysis included testing for differences in beverage intake between the Instagram group and the E-mail group. Results: The updated BEVQ-15 demonstrated moderate agreement between the BEVQ-15 and dietary recalls for total SSB intake and total beverage intake. All beverage variables were significantly correlated. For the systematic review, 11 of the 17 studies (65%) were successful in reducing SSB consumption through mobile phone delivery. The successful studies used multiple types of technology. There were no significant differences for any beverage variable between the Instagram and E-mail groups over time. However, for within group changes, Instagram significantly reduced total beverage kcals and improved total HBI score, while the E-mail group did not demonstrate any significant changes. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits pilot trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions.

Yes / Introduction The role of digital health in providing psychological treatment and support for the prevention of suicide is well documented. Particular emphasis has been placed on digital health technologies during the COVID-19 pandemic. Providing psychological support reduces the burden of mental health conditions. The challenge is to provide support in the context of patient isolation, which highlights the role of digital technology (video conferencing, smartphone apps and social media). There is, however, a dearth of literature where experts by experience have been involved in the end-to-end process of developing digital health tools for suicide prevention. Methods and analysis This study aims to codesign a digital health tool for suicide prevention focusing on the enablers and barriers. The scoping review protocol is phase I within a three-phase study. The protocol will inform the second phase of the study which is the scoping review. The results of the review will inform a funding application to National Institute for Health and Care Research to codesign a digital health tool for suicide prevention (the third phase). The search strategy will follow the Joanna Briggs Institute Reviewer’s Manual for Scoping Reviews and incorporates the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist to ensure reporting standards are maintained. The methodology will be supplemented by frameworks by Arksey and O’Malley and Levac et al. The search strategy dates for screening are from November 2022 to March 2023. Five databases will be searched: Medline, Scopus, CINAHL, PsycInfo and Cochrane Database of Systematic Reviews. Grey literature searches include government and non-government health websites, Google and Google Scholar. The data will be extracted and organised into relevant categories. The results will be synthesised into themes and inform phase II of the study. Ethics and dissemination Ethics granted by the University of Bradford on 15 August 2022, reference E995. The project team will design a digital health tool, results will be published in a peer-review journal and disseminated through conferences. Study registration number Safety (Mental Health) Innovation Challenge Fund 2022–2023 Protocol RM0223/42079 Ver 0.1. / This research was funded by the National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). Project Reference: SICF 2022-02.

Background: The digitalization is increasing in healthcare and also in physiotherapy, making it possible to meet patients through digital healthcare visits in an accessible and efficient way. More research is needed about physiotherapeutic digital care visits and  physiotherapists’ thoughts about conducting the first visit over a digital platform as their insights can contribute to future development. Aim: The aim of the study was to explore physiotherapists’ thoughts about conducting the first visit over a digital platform within the primary health care. Method: A qualitative descriptive study was conducted with semi-structured interviews. Six physiotherapistst working in primary care participated in individual interviews and were recruited through purposive and snowball sampling. The interview material was analyzed using qualitative content analysis with an inductive approach. Result: The data analysis resulted in ten subcategories sorted into four categories: The digital format, The influence of factors related to the patient, Areas of use and development and The physiotherapeutic work.  Conclusion: The physiotherapists had a positive attitude towards digital first visits, however they felt that it was not suitable for all patients and therefore a combination of digital and physical visits were preferred. They also believed that more education and guidelines are required to implement digital new visits to a greater extent. / Bakgrund: Digitaliseringen inom vården ökar och även så inom fysioterapin, där man genom digitala vårdbesök kan träffa patienter på ett lättillgängligt och effektivt sätt. Det behövs dock mer forskning kring digitala vårdbesök inom fysioterapi och fysioterapeuters tankar kring ämnet då deras insikter kan bidra till framtida utveckling.  Syfte: Syftet med studien var att undersöka fysioterapeuters tankar om digitala nybesök inom primärvården. Metod: En kvalitativ beskrivande studie genomfördes med semistrukturerade intervjuer. Sex fysioterapeuter som arbetar inom primärvården deltog i enskilda intervjuer och rekryterades genom ändamålsenligt-och snöbollsurval. Intervjumaterialet analyserades med kvalitativ innehållsanalys med en induktiv ansats. Resultat: Dataanalysen resulterade i tio underkategorier sorterade i fyra kategorier: Det digitala formatet, Patientrelaterade faktorer påverkar, Användnings-och utvecklingsområden och Det fysioterapeutiska arbetet. Slutsats: Fysioterapeuterna hade en positiv inställning till att använda sig av digitala nybesök, men ansåg att det inte lämpade sig för alla patienter och att möjligheten till både digitala och fysiska besök var att föredra. De menade även att det krävs mer utbildning och tydligare riktlinjer för att implementera digitala nybesök i större utsträckning.

Yes / Polypharmacy is often needed for the management of cardiovascular diseases and is associated with poor adherence to treatment. Hence, highly flexible and adaptable systems are in high demand to accommodate complex therapeutic regimens. A novel design approach is employed to fabricate highly modular 3D printed “polypill” capsules with bespoke release patterns for multiple drugs. Complex structures are devised using combined fused deposition modeling 3D printing aligned with hot-filling syringes. Two unibody highly modular capsule skeletons with four separate compartments are devised: i) concentric format: two external compartments for early release while two inner compartments for delayed release, or ii) parallel format: where nondissolving capsule shells with free-pass corridors and dissolution rate-limiting pores are used to achieve immediate and extended drug releases, respectively. Controlling drug release is achieved through digital manipulation of shell thickness in the concentric format or the size of the rate limiting pores in the parallel format. Target drug release profiles are achieved with variable orders and configurations, hence confirming the modular nature with capacity to accommodate therapeutics of different properties. Projection of the pharmacokinetic profile of this digital system capsules reveal how the developed approach can be applied in dose individualization and achieving multiple desired pharmacokinetic profiles.

Digital Health relates to “health information systems which enable the merging of social-care and healthcare systems. This would impact on the organisation, service delivery as well as the technological infrastructure” (Herselman & Botha, 2016, p.10). However, with relatively sparse research publications emanating from within the Namibian Health domain, and the concept of Namibian Digital Health as an emergent phenomenon, a Namibian Digital Health Innovation Ecosystem Framework would provide a start to conceptualising, developing and implementing such an ecosystem for Namibia and thus unlocking the potential of Digital Health in this country. The purpose of this study is to develop a Namibian Digital Health Innovation Ecosystem Framework based on literature reviews and the feedback from knowledgeable professionals (KPs) in Namibia, as well as global experts. The methodology which was applied in this study to address the purpose, and to answer the research questions, was Design Science Research Methodology and the Design Science Research Methodology (DSRM) process of Peffers, Tuunanen, Rothenberger and Chatterjee (2008), was adopted. Pragmatism is the overall philosophy guiding the study, as proposed by Ackoff’s theory regarding the hierarchy of human understanding (1989) and Shneiderman’s visual information seeking mantra (1996). During Phases 2 and 3 of the study interpretivism and positivism were applied as philosophies, guided by hermeneutics and triangulation, towards understanding the feedback of Knowledgeable Professionals (KPs) in Namibia, as well as the global experts. The study was divided into three phases. The first phase entailed a literature study which identified the components of Digital Health, Innovation and Digital Ecosystems as well as related research of Digital health, Innovation and Digital Ecosystems in developed and developing countries. This process led to the compilation of the initial Namibian Digital Health Innovation Ecosystem Framework using a conceptual approach. In the second phase of the study, the initial Namibian Digital Health Innovation Ecosystem was evaluated by KPs in Namibia using the Delphi method and interviews. Phase 2 adopted both quantitative and qualitative approaches. The findings from Phase 2 resulted in the development of the intermediate Namibian Digital Health Innovation Ecosystem Framework. In Phase 3 of the study, the intermediate framework was validated by global experts. Feedback was collected from global experts through questionnaires which were analysed through qualitative content analysis. The findings, from Phase 3 led to the development of the final Namibian Digital Health Innovation Ecosystems Framework. The guidelines, which can be used by the Namibian government to implement the suggested digital health innovation ecosystem framework, were also provided. / Information Science / D. Litt. et Phil. (Information Systems)