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)

Introduktion: Psykisk sjukdom är en växande samhällsutmaning. Individer som lider av psykisk sjukdom har olika grader av allvarlighet och varaktighet, och får vanligtvis stöd från kommunen och/eller regionen, inklusive boende med särskilt service och boendestöd. Boendestödet utvecklas kontinuerligt och blir alltmer digitaliserat för att möta dagens behov och förbättra tillgängligheten och effektiviteten i tjänsterna. Syfte: Syftet med studien var att undersöka boendestödjarnas upplevelser av utmaningar och fördelar med att använda digitala verktyg inom boendestöd för personer med psykisk sjukdom. Metod: En semistrukturerad intervjustudie genomfördes med sex boendestödjare från tre olika boenden i en storstadsregion. Metoden involverade ett tvåstegsurval. Rekrytering av boendestödjarna skedde genom fysiska informationsträffar. Intervjuerna spelades in och transkriberades sedan. Genom en noggrann innehållsanalys bröts texten ner i meningsenheter, vilka sedan kodades och kategoriserades för att identifiera mönster och kategorier. Därefter analyserades resultatet med hjälp av teorin om digital health literacy. Resultat: Genom innehållsanalys framkom tre huvudkategorier: teknik, utbildning och säkerhet. Inom dessa kategorier identifierades sex underkategorier som inkluderade fördelar och utmaningar relaterade till digitala verktyg inom boendestöd. Resultaten visade att boendestödjarna ser potentialen i digitala verktyg för att förbättra boendestödet, samtidigt identifierades utmaningar kring säkerhet, integritet och hantering av personuppgifter. För att hantera dessa utmaningar och utnyttja fördelarna fullt ut krävs att de olika kompetensnivåerna inom digital health literacy beaktas. / Introduction: Mental illness is a growing societal challenge. Individuals with mental illness experience varying degrees of severity and duration, and typically receive support from municipalities and regions, including housing support. Housing support is evolving and becoming increasingly digitalized to improve accessibility and efficiency. Aim: This study aimed to investigate housing support workers' experiences of the challenges and benefits of using digital tools in housing support for individuals with mental illness. Methods: A semi-structured interview study was conducted with six housing support workers from three different residences in a metropolitan area. Participants were recruited through physical information meetings. Interviews were recorded, transcribed, and analyzed using content analysis to identify patterns and categories. The results were then analyzed using the theory of digital health literacy. Results: Three main categories emerged from the content analysis: technology, education, and security. Six subcategories were identified within these categories, highlighting benefits and challenges related to digital tools in housing support. Housing support workers recognized the potential of digital tools to enhance support, but challenges regarding security, privacy, and handling of personal data were noted. Addressing these challenges requires considering various competency levels in digital health literacy. Conclusion: Successful implementation of digital tools in housing support requires continued investment in education and fostering a culture of knowledge sharing, taking into account the experiences of housing support workers

O Brasil é um país emergente de dimensões continentais, que ainda apresenta amplas desigualdades econômicas e sociais. Particularmente, o país apresenta muitas assimetrias na oferta e qualidade de atenção à saúde. Apesar dos bons avanços nos últimos anos na área de saúde do país obtidos pelo Sistema Único de Saúde (SUS), ainda não se consegue atender de maneira adequada muitas das demandas de serviços de saúde do nosso país. Adicionalmente, com o processo de envelhecimento da população brasileira, haverá a necessidade de um aumento de gastos com a atenção doenças crônicas nos próximos anos, o que poderá inviabilizar o financiamento da área de saúde. Além disso, a precariedade do acesso das informações da saúde no Brasil acaba dificultando a gestão da atenção à saúde, bem como a identificação das reais necessidades da área e de suas prioridades. Diante destes desafios, a Saúde Digital (ou e-Saúde) torna-se uma opção tecnológica para o país procurar inovações para minimizar as assimetrias e viabilizar uma melhora da qualidade e oferta dos seus serviços de saúde. A convergência e a evolução tecnológica e ampliação do acesso a internet, está permitindo a integração de informações e a colaboração médica junto a diversas instituições em saúde remotamente localizadas. Este cenário permite o estabelecimento de sistemas amplos de registros de pacientes nacional, eliminando as ilhas de informação, que constituem em instrumento essenciais para gestão da qualidade da atenção de saúde, vigilância epidemiológica, pesquisa médica, medicina preventiva e na definição de políticas públicas. Este trabalho tem por objetivo a proposição de modelos voltados à Saúde digital, bem como estudos de caso de desenvolvimentos direcionados à atenção da Saúde e a sua gestão, principalmente de doenças crônicas, particularmente para Câncer e Fibrose Cística, além do serviço de identificação única de pacientes dentro do contexto da saúde brasileira. / Brazil is an emerging country of continental dimensions, which still has large economic and social inequalities. Particularly, the country has many imbalances in supply and quality of health care. Despite good progress made in the country\'s health by Sistema Único de Saúde (SUS), nevertheless the country can not meet many of the demands of health services in our country. Additionally, with the aging of the population, and higher spending on chronic disease care, the funding could derail this area in the near future. Additionally, with the aging of the population, and higher spending on chronic disease care, the funding of health area could be derailed in the near future. Furthermore, the poor access health information in Brazil makes it difficult to manage health care and define the real needs of the area and its priorities. Faced with these challenges, the Digital Health (or e-Health) becomes a technological option for the country looking for innovations to minimize disparities and enable an improvement in the quality of their health services, which together with the convergence and the evolution technological, and the expanding access to internet, is enabling the integration of information and collaboration with various medical institutions in health remotely located. This scenario allows the establishment of systems of national patient records, eliminating the isolated islands of information, which constitute essential tool for quality management in health care, surveillance, medical research, and the definition of public policies and preventive medicine, as well as integration of other services and applications for health care. This paper aims to propose models focused on digital health, as well as case studies of developments directed to the attention of Health and its management, especially of chronic diseases, particularly cancer and cystic fibrosis, in addition to service of identification of patients within the context of the Brazilian health.

O Brasil é um país emergente de dimensões continentais, que ainda apresenta amplas desigualdades econômicas e sociais. Particularmente, o país apresenta muitas assimetrias na oferta e qualidade de atenção à saúde. Apesar dos bons avanços nos últimos anos na área de saúde do país obtidos pelo Sistema Único de Saúde (SUS), ainda não se consegue atender de maneira adequada muitas das demandas de serviços de saúde do nosso país. Adicionalmente, com o processo de envelhecimento da população brasileira, haverá a necessidade de um aumento de gastos com a atenção doenças crônicas nos próximos anos, o que poderá inviabilizar o financiamento da área de saúde. Além disso, a precariedade do acesso das informações da saúde no Brasil acaba dificultando a gestão da atenção à saúde, bem como a identificação das reais necessidades da área e de suas prioridades. Diante destes desafios, a Saúde Digital (ou e-Saúde) torna-se uma opção tecnológica para o país procurar inovações para minimizar as assimetrias e viabilizar uma melhora da qualidade e oferta dos seus serviços de saúde. A convergência e a evolução tecnológica e ampliação do acesso a internet, está permitindo a integração de informações e a colaboração médica junto a diversas instituições em saúde remotamente localizadas. Este cenário permite o estabelecimento de sistemas amplos de registros de pacientes nacional, eliminando as ilhas de informação, que constituem em instrumento essenciais para gestão da qualidade da atenção de saúde, vigilância epidemiológica, pesquisa médica, medicina preventiva e na definição de políticas públicas. Este trabalho tem por objetivo a proposição de modelos voltados à Saúde digital, bem como estudos de caso de desenvolvimentos direcionados à atenção da Saúde e a sua gestão, principalmente de doenças crônicas, particularmente para Câncer e Fibrose Cística, além do serviço de identificação única de pacientes dentro do contexto da saúde brasileira. / Brazil is an emerging country of continental dimensions, which still has large economic and social inequalities. Particularly, the country has many imbalances in supply and quality of health care. Despite good progress made in the country\'s health by Sistema Único de Saúde (SUS), nevertheless the country can not meet many of the demands of health services in our country. Additionally, with the aging of the population, and higher spending on chronic disease care, the funding could derail this area in the near future. Additionally, with the aging of the population, and higher spending on chronic disease care, the funding of health area could be derailed in the near future. Furthermore, the poor access health information in Brazil makes it difficult to manage health care and define the real needs of the area and its priorities. Faced with these challenges, the Digital Health (or e-Health) becomes a technological option for the country looking for innovations to minimize disparities and enable an improvement in the quality of their health services, which together with the convergence and the evolution technological, and the expanding access to internet, is enabling the integration of information and collaboration with various medical institutions in health remotely located. This scenario allows the establishment of systems of national patient records, eliminating the isolated islands of information, which constitute essential tool for quality management in health care, surveillance, medical research, and the definition of public policies and preventive medicine, as well as integration of other services and applications for health care. This paper aims to propose models focused on digital health, as well as case studies of developments directed to the attention of Health and its management, especially of chronic diseases, particularly cancer and cystic fibrosis, in addition to service of identification of patients within the context of the Brazilian health.

Increasing prevalence of non-communicable diseases, aging, and population growth pose significant sustainability challenges to health systems. Especially the health systems of low- and middle-income countries are more vulnerable to the risks related to non-communicable diseases and demographic changes. As the Covid-19 pandemic demonstrates, the quality of health systems is vital to save lives, and even the most developed countries are not immune to the consequences of global health crises. The World Health Organization estimates that non-communicable diseases such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes cause around 40 million deaths in a year, and 15 million people aged between 30 and 69 suffer from premature deaths mostly in low- and middle-income countries. The United Nations aim to address this problem through the Sustainable Development Goal 3.4 that stresses to reduce by one third premature mortality from non-communicable diseases through prevention and promote mental health and well-being until 2030. Poor quality health systems and inadequate access to healthcare services by the most vulnerable groups are some of the main reasons for premature deaths. Improving the quality of health systems through innovation and digitalisation is strategic to deliver essential healthcare services to the most vulnerable people. Digital health technologies such as mobile health applications for chronic disease self-management play a key role in improving the health status of individuals and the accessibility of healthcare services. Type 2 Diabetes Mellitus (‘T2DM’) is one of the most prevalent non-communicable diseases suffered by almost half a billion people, and current developments in digital health technologies offer innovative methods for its treatment. Hence, this study investigates the effectiveness of a T2DM self-management smartphone application called DiaWatch and its potential benefits for the Sustainable Development Goals in terms of addressing the challenges of health systems. Methodology: Using the Technology Acceptance Model as an overall conceptual framework, a comprehensive literature review was performed to clearly define the objectives and methods for the study. Based on these findings, two sets of semi-structured qualitative interview questions have been prepared for collecting empirical data. Ten healthcare professionals working at a university hospital in Istanbul, Turkey, and ten T2DM patients using a T2DM self-management app called DiaWatch have been interviewed from mid-February to early-March. A thematic analysis has been carried out to analyse the empirical data collected through the semi-structured interviews. Results: Firstly, the results of the interviews with T2DM patients using the DiaWatch app suggest that the health status and chronic condition self-management experience of the majority of the interviewees improved since using the app and they adopted behavioural changes, such as being more adherent to the treatment, increased physical activity, having a healthier diet and measuring blood glucose level more regularly. The interviewees reported less dependency on healthcare facilities and increased accessibility of healthcare services, as they are tele-monitored by their physicians. Secondly, the results of the interviews with healthcare professionals highlight the benefits of digital health technologies for the health systems in terms of facilitating the job of healthcare staff, reducing the costs, and saving time. The interviewees state that tele-monitoring helps to decrease the number of redundant hospital admissions and screenings; however, data privacy and irreplaceability of face-to-face medical examinations are the main concerns before the acceptance of these technologies.

This study explores the digitalization of healthcare phenomenon in relation to patient empowerment. Because digital environments change the way individuals interact with healthcare providers, there are consequences for patients’ ability to act and determine their health outcomes in a digital health ecosystem. An assessment of the mediatization of healthcare was therefore conducted through a critical phenomenological analysis of patients’ lived experiences. This methodology facilitated an investigation of their descriptive and subjective reflections on health structures and the means of entering into capabilities that can, but not necessarily do, emerge from specific technical artifacts. Through in-depth interviews, I accessed patients’ perspectives and narratives to phenomenologically enter into their consciousness intentionalities. These revealed that mediatized healthcare certainly affects, possibly enables, and risks constraining health agency. In theoretical terms, this study was based on structural dimensions within the theories of mediatization (Couldry & Hepp, 2017) and health lifestyles (Cookerham, 2005), combined with the individual dimensions of patients’ capabilities (Oosterlaken, 2015) represented by empowerment constructs (Palumbo, 2017), where it elaborates on matters of structure and agency as interrelated and negotiated concepts. The thesis concludes with a critical discussion of the avoidance of technological determinism of the phenomenon: digital tools were incorporated in some of the capabilities of participants, and indeed sometimes contribute to their empowerment, but not always and not for everything. Empowerment must be seen as a process rather than an outcome and, concerning digitalization processes, must be investigated by scrutinizing individual initiatives embedded in a long chain of interconnectedness.

Background: To ensure a sustainable future in the maritime industry; new measures of employee well-being are needed. Digital health solutions have proven to possess great potential to ensure employee well-being regardless of location, with opportunities for a proactive instead of a reactive approach where health and safety issues can be avoided.  Research Problem: Despite the potential benefits of using digital health solutions, the acceptance and impact of such solutions remain unexplored in the maritime industry, which is essential for achieving improvements.   Purpose: This study aims to explore what influences the acceptance of digital health solutions for improving seafarer well-being to understand how the maritime industry accepts digital health solutions and, more importantly, the potential impact this acceptance has on seafarer well-being. Research Question: How does the acceptance of digital health solutions in the maritime industry impact the employee well-being of seafarers?  Methodology and Method: This is a qualitative and inductive study, with a relativist view of reality and a social constructionist view of knowledge, that aims to build new theories through semi-structured interviews and Gioia’s analysis method.  Conclusion: Our findings focus on what influences the acceptance of digital health solutions and how these solutions impact employee well-being. With the aid of the Technology Acceptance Model (TAM), we find that there are levels of acceptance dependent on the nature of different influential factors. Furthermore, we discover that digital health solutions can influence physical, mental, and social well-being. From this, we develop a framework explaining the impact acceptance has on employee well-being. As a result, we illustrate that acceptance is a crucial aspect of improving employee well-being with digital health solutions.

Sweden has a high rate of unintended pregnancies (UP) despite being a rather open society regarding sexual health education. New technology provides new possibilities to improve access by providing contraceptive consultations online, but will that lower the rate of UP? Very few studies have been done on the people working with the young women to find out what can be done to improve the quality of the contraceptive counseling. That is why this study involved two midwives practicing at a youth center at an early stage of the design process. Cultural Probes was used as method to better understand what needs midwives experience in their daily work. Three key findings stating the needs of the midwives were knowledge, missed appointments and trust. In addition, a service evaluation was done to investigate when and how midwives and young women interact. Making the contraceptive consultations available online with a digital care provider would make it more accessible for the young women and the results of this study do not contradict that hypothesis. However, availability is not the sole influencing factor on contraceptive usage. This study shows that encouragement for young women to seek general knowledge and information about contraceptives prior to the consultation is an important factor in order to improve the quality of contraceptive counselling. / Trots Sveriges relativt öppna samhälle gällande sex och sexualundervisning så har vi en väldigt hög frekvens av oönskade graviditeter. Ny teknik möjliggör att hålla preventivmedel konsultationer online vilket leder bättre tillgänglighet, men frågan är om det räcker för att sänka frekvensen oönskade graviditeter? Väldigt få studier har gjort på barnmorskorna som jobbar med de unga kvinnorna för att får reda på vad mer som kan göras för att höja kvaliteten på preventivmedelsrådgivningen. Därför har denna studie, i ett tidigt stadie av designprocessen, involverat två barnmorskor praktiserande på en ungdomsmottagning. Cultural Probes användes som metod för att bättre förstå vilka behov barnmorskor upplever i deras dagliga arbete. Det främsta resultatet summeras i tre teman: kunskap, missade besök och förtroende. Dessutom utfördes en serviceutvärdering av hela kundresan för att ta reda på när och hur barnmorskor och unga kvinnor interagerar. Genom att möjliggöra preventivmedelsrådgivning online genom digital vård så skulle tillgängligheten förbättras för de unga kvinnorna och denna hypotes är inget som denna studie motsätter sig. Men tillgänglighet är inte den enda faktorn som påverkar användandet av preventivmedel. Denna studie visar att uppmuntran till att få unga kvinnor att söka kunskap och information om preventivmedel innan själva besöket är en viktig del som skulle kunna förbättra kvaliteten på preventivmedelsrådgivningen

Background: Consumer smartwatches have gained attention as mobile health (mHealth) tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement artifacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead signal and is limited in asymptomatic cases. Objective: DoubleCheck-AF is a validation study of a wrist-worn device dedicated to providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with particular emphasis on the challenge of frequent premature beats. Methods and Results: We performed a prospective, non-randomized study of 344 participants including 121 patients in AF. To challenge the specificity of the device two control groups were selected: 95 patients in stable SR and 128 patients in SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG tracings were labeled by two independent diagnosis-blinded cardiologists as “AF,” “SR” or “Cannot be concluded.” In case of disagreement, a third cardiologist was consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACs per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the wearable and combination of both yielded sensitivity and specificity of 94.2 and 96.9%; 99.2 and 99.1%; 94.2 and 99.6%, respectively. All seven false-positive PPGbased cases were from the frequent PVCs/PACs group compared to none from the stable SR group (P < 0.001). In the majority of these cases (6/7) cardiologists were able to correct the diagnosis to SR with the help of the ECG of the device (P = 0.012). Conclusions: This is the first wearable combining PPG-based AF detection algorithm for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm confirmation. The system maintained high specificity despite a remarkable amount of frequent single or multiple premature contractions

Objective: Increased prenatal care satisfaction is associated with positive clinical and business outcomes. Despite a link between pre-visit preparation interventions and patient satisfaction, little is known about the development of digital pre-visit interventions to improve prenatal patient satisfaction. Methods: A two-phase approach was employed. In the first phase, a mixed-methods survey was deployed to establish determinants of patient satisfaction, to identify unmet patient needs, determine current preparation practices and determine what visit patients felt the least prepared for. A convenience sample of 87 prenatal patients completed a self-administered survey on a tablet within 4 weeks of their estimated due date. In the second phase, a combination of participant interviews and staff workshops followed a Design Thinking methodology to co-design a prototype intervention to help patients prepare for their visit. Results: Of the participants surveyed, 94.1% reported feeling satisfied with their prenatal care. Visit preparedness was found to be a statistically significant predictor of overall satisfaction. Preparedness was lowest in early pregnancy and for primigravida patients. Patients reported a mismatch between high informational needs and low visit frequency in early pregnancy. To fulfill their information needs, participants conducted frequent research on their pregnancy, often using digital resources such as websites, peer-forums, mobile applications and social media. Participants reported low satisfaction with system characteristics of their care, citing the wait time needed to see their provider, time spent in the waiting room and a lack of flexibility in appointment scheduling as pain points in their care. Utilizing a Design Thinking approach, a prototype digital on-boarding package was co-developed with patients and clinic staff. Conclusions for Practice: Implementation of a digital on-boarding package for patients ahead of their first visit has the potential to fulfill informational needs and set expectations for their care journey, which in turn can increase preparedness and satisfaction. / Thesis / Master of Science (MSc) / Satisfied patients are more likely to have better health outcomes, are more likely to provide a positive review about their care provider and are less likely to pursue malpractice claims. One possible way to make patients more satisfied is to better prepare them for visits with their doctor. This study explored the current pregnancy experience of patients at an obstetrics clinic in Niagara and combined patient and staff input to come up with potential ways to help them prepare. Most patients were satisfied with their care, especially ones who said they felt well prepared for their visits. Patients in their first pregnancy felt least prepared for their visits. Patients in early pregnancy shared that they had many questions and that they wished they could have seen their physician earlier. To help patients, a digital on-boarding package was designed to answer patients’ questions and connect them with trustworthy resources.