Digital Health Week is an opportunity for anyone interested in digital health to participate in a program of virtual events and share research and ideas. It is designed to be both informative, provocative, and a showcase of the innovative work being undertaken in digital health across the University of Sydney, the University of Melbourne, and beyond. Digital Health Week 2022 will bring together researchers, health services, industry, and the community to build person-centred eHealth collaborations. This Open Journal displays abstracts for oral presentations and ePosters that were accepted for inclusion at the event. All abstracts included in this journal underwent blinded peer-review.
The SAGE yoga trial: Online delivery during COVID19
Background: Challenging balance can prevent falls. Yoga practice can be a source for it, although the effect of yoga on falls has not been evaluated. Aims: The NHMRC-funded Successful AGEing (SAGE) yoga trial aims to establish the effect of two distinct yoga exercise programs on falls rate of community-dwelling people aged 60 years+. This presentation outlines the key learnings from transitioning to online classes once the COVID19 pandemic interrupted face-to-face interactions. Methods: Participants were randomised to either: (1) the SAGE yoga exercise program, 40 weeks of twice-weekly supervised classes focussed on standing balance-challenging; or (2) a seated yoga relaxation program, 2 supervised classes followed by unsupervised practice. Primary outcome is the rate of falls in the 12 months post randomisation via self-reported surveys and follow-up phone calls. Results: 700 participants were recruited from September/2019 to October/2021. Since April/2020 face-to-face classes were delivered online via Zoom. The new classes started after were completely delivered online. The change to online classes expanded recruitment locations and offered people in regional and remote settings the possibility to participate. The public response to this was outstanding, showing that access to supervised online physical activity is indeed valued. Providing technology support, an initial one-on-one online introduction to the yoga instructor and access to class-specific Whatsapp groups to promote social connection, have contributed to the success of the online delivery format. Conclusions: Considering the impact of COVID19 on our ways of living, further exploration of online fall prevention exercise programs is crucial and can be an inclusive practice to be scaled up.
Digital health startups in the time of the COVID-19 crisis
The digital health industry has focused on designing and developing various technological solutions, such as digital health applications, wireless medical devices, cybersecurity, AI/ML in medical software, robotics assist surgery, logistics, clinicians training, and personalized medicine. Within this industry, the role of digital health startups is rapidly growing. The COVID-19 global pandemic has been a catalyst for the increased use of digital health within healthcare services. The role of digital health startups during the pandemic cannot be understated. This study aimed to fill the gap. Scopus, IEEE Xplore, and ACM digital library were scanned between 2020 and 2021. The data were also collected from research-based business magazines (Harvard Business Review, MIT Sloan Management Review, etc.). In addition, 25 digital health startup founders were interviewed. An inductive approach was used to analyze the data using Braun and Clarke’s thematic analysis approach. Out of 795 identified articles, eighteen studies were relevant to the topic. Startups’ stakeholders (entrepreneurs, providers, regulators, and investors) perspectives have been changed towards digital healthcare in COVID-19. Some startups showed adaptive behavior, strategic development, and established million-dollar businesses, while some exhibited malfunctions and had to shut their services. Four themes have emerged from the triangulation of the data- market orientation approach, developing dynamic capabilities, bringing competitive advantage, and improving business performance. Digital health startups altered their ways of survival and serving during the COVID-19 crisis. Understanding the new norm in business transformation aids startups in implementing digital health services successfully.
“I hate messages that have nothing to do with me”: Co-design of text messages to engage adolescents with health apps
Background: Engagement with ehealth interventions is often low, even among adolescents. To be effective, development of strategies to better engage adolescents with eHealth approaches must involve adolescents themselves. Aims: This study aimed to meaningfully engage young people in the production of text messages to prompt adolescents to engage with a healthy lifestyles app (Health4Life). Methods: With assistance from a senior researcher, two Young Person Research Assistants developed and conducted an online consultation via Zoom with Adolescent Expert Advisors. They then used advisors’ feedback to generate text messages designed to engage adolescents with the Health4Life app. Results: Twenty-five adolescents attended the online consultation. While none of the adolescents chose to speak or share video during the consultation, they were highly engaged with online activities and provided detailed feedback via the chat. Adolescents expressed preferences for: relatable and personable quotes; positive, relatable messages including health facts; and delivery at 6-8am or 8-9pm. A final library of 20 text messages was produced that will be implemented in upcoming studies examining adolescents’ health app engagement. Conclusions: Employing Young Person Research Assistants to lead this research, in addition to engaging Adolescent Expert Advisors, meant young people were meaningfully involved in every stage of this research and resulted in a library of engaging and relevant text messages to prompt adolescent engagement with health apps. This study also generated important insights regarding how to effectively engage adolescents with research. For example researchers might consider using asynchronous methods for gaining feedback from this population (e.g. group chats).
Acceptability and feasibility of CIRCUS: An online Cognitive Behaviour Therapy intervention for multiple health behaviours in women
Background: Australian women have experienced increased stress recently due to competing roles that women fulfill, exacerbated by the COVID-19 pandemic. Women who experience higher stress levels are more likely to engage in sub-optimal health behaviours. By providing support to manage stress, low mood, and the realities facing women, we aim to reduce reliance on unhelpful coping strategies such as alcohol use, sedentary behaviour, and poor nutrition. eHealth is an ideal platform for deploying such support as it overcomes the structural, geographical and social barriers to accessing health care. CIRCUS is a 7-module eHealth intervention developed in consultation with Australian women and has been tailored to their needs. Aims: This study evaluates the acceptability and feasibility of the CIRCUS intervention for use by Australian women. Methods: Women aged over 18-years completed an online baseline assessment of multiple health behaviours and then trialled CIRCUS for 3-weeks. Participants provided feedback on elements of the intervention content, design and presentation at a 3-week follow-up. Website analytics also recorded number of visits to the CIRCUS site. Results: 190 women consented to the study with 73 completing the baseline assessment and 44 accessing the CIRCUS intervention online. 15 completed the 3-week follow-up assessment. Satisfaction and usage data will be reported. Conclusions: The majority of those who accessed CIRCUS were satisfied with its content and format, however, the low transition of participants from baseline assessment to use of the intervention and to follow-up suggest modifications to the methodology are necessary.
The impact of app engagement in an intervention addressing parents’ fussy eating concerns
Background: Although fussy eating is a developmentally normal behaviour, it is a source of anxiety and concern for up to half of parents of young children. Concern for fussy eating mediates parents’ use of nonresponsive feeding practises, which have poor, long-term health outcomes for children. However, few interventions have been developed for this population. Aims: This randomised controlled feasibility trial evaluated a web app to improve feeding practices of parents concerned for fussy eating. Methods: A web app was co-designed with parents of toddlers concerned about fussy eating. The final app included a food offer tracker, information about fussy eating/feeding strategies, recipes, and SMS. Participants were recruited via Facebook and randomised to intervention (n=25, received app access for 6 weeks) or control (n=26, wait-listed). T-tests evaluated pre/post differences in parent feeding practices and child eating behaviours; app engagement impact on outcomes was investigated with linear regression. Results: No pre/post differences were found in the control group. Parents in the intervention reported significant decreases in children’s food fussiness (p = 0.04, Cohen D = 0.40) and aggressive mealtime behaviours (p = 0.01, Cohen D = .55). Higher app engagement predicted decreased parental concern for fussy eating (R2 = 0.77, F = 24.48, p = 0.03) and increased structured parent feeding practises (R2 = 0.52, F = 6.71, p = 0.0004). Conclusions: A web app co-designed with parents to address their fussy eating concerns has potential to improve their feeding practices. A larger trial is warranted to examine long-term impacts.
Chronic pain prevalence, opioid use, and primary care provider prescription patterns
Background: Opioid medications are one of the most common approaches adopted by primary care providers for chronic pain management but are usually not recommended beyond 3 months. Research studies in chronic pain management at primary care settings remains lacking, and the usual investigations relying majorly on large surveys or questionnaires can lead to bias by missing a large proportion of population. Aims: Our study aims to provide an overview of chronic pain patients and the primary health care they’ve received using a novel artificial intelligence based machine learning algorithm. Methods: This study used observational U.S. Medicaid claims data (n>7 million) among 6 geographically different states to identify chronic pain patients in primary care between January 2017 to December 2019. The performance of 8 different machine learning classification algorithms were evaluated to model the risk factors of chronic pain patients prescribed opioids by primary care providers. Results: Our study demonstrated a prevalence of 25.9% (average age 33.0±19.7 years, 64.0% female) of chronic pain among Medicaid claimants, and 6.5% (average age 37.5±19.4 years, 67.5% female) were considered as high-impact chronic pain. The top 3 performing algorithms for accuracy were XG Boost (0.814), Random Forest (0.810) and Ada Boost (0.806). Conclusions: With machine learning algorithms, our study yielded a previously under-recognized vulnerable age group of children and adolescents under 18 years old as one of the major risk factors of having an opioid prescription from a primary care provider.
The use of digital health to communicate medication and health-related goals of care for older people with polypharmacy
Background: Identifying goals of care of older people can optimise health and medication management, however these conversations are often sidelined due to several barriers. Digital health has the potential to allow individuals to communicate their goals of care to their healthcare practitioners, however little is known about the preferences of older adults. Aim: To explore digital technologies that older people would prefer to use to document and communicate their health and medication-related goals of care. Methods: A questionnaire was developed to explore the preferences and types of digital technologies older people (≥65 years) would use to communicate their goals of care. Questions included exploring older adults’ willingness to use digital technologies and their preferred options. The questionnaire was administered within two settings: a) hospitalised older adults admitted to Royal North Shore Hospital, and b) community-dwelling older adults. Responses were analysed descriptively. Results: Currently, the questionnaire has been completed by 24 hospitalised and 70 community-dwelling older adults, mean(SD) age 76.4(7.3) and 74.7(7.0), respectively. Community-dwelling older people (n=44, 63.9%) were more willing to using digital health to document goals of care compared with hospitalised older adults (n=13, 54.2%). Both community-dwelling and hospitalised older adults expressed that Email (n=25(43.9%), n=5(15.6%)) and Websites (n=11(19.3%), n=8(25%)) were the preferred options to communicate goals of care to their healthcare practitioners. Conclusions: Preliminary results suggests that older people are willing to document and communicate their goals of care using digital health technologies.
Translation of findings from a randomised controlled trial to real-world implementation of an online self-help program in an Australian youth mental health service
Background: Despite the availability of evidence-based treatments for bulimia nervosa (BN), there exist numerous barriers in being able to these treatments. Developing new cost-effective and accessible delivery mechanisms is essential to ensure early receipt of treatment. This has been further emphasized as a result of the COVID-19 pandemic, which has increased demands for flexible, by-distance treatment options. Binge Eating eTherapy (BEeT) is one of the first online CBT programs for eating disorders in Australia. Aims: The trial aims to compare the effectiveness of engaging in the BEeT program in a purely independent manner to use of BEeT in conjunction with regular support from a non-specialist clinician (30 min videoconferencing session per week) to waitlist control. Methods: BEeT consists of ten one-hour interactive, multi-media sessions and includes an inbuilt calendar with self-monitoring tools. This presentation will deliver key findings from a multisite, three-arm randomised controlled trial (RCT) of BEeT involving 114 participants with full or sub-threshold bulimia nervosa. Results: The trial aimed to compare the effectiveness of pure self-help BEeT vs clinician-supported BEeT vs WLC. Baseline to post-treatment decreases in objective binge episode (OBE) frequency was greater for clinician supported as compared to WLC (d: 0.74, p= .004), however this was not the case for pure self-help (d: 0.40, p = .349). Pure self-help participants did display a further decrease in OBEs at follow up and as a result outperformed WLC when analysed as an overall rate of change across three timepoints of baseline, post-treatment and follow up. This presentation will also provide an overview of our progress in collaborative effort with “headspace”, a nation-wide youth mental health service in Australia, to provide a brief, four-week version of the BEeT intervention to children and young people (12-25 years old) experiencing mild to moderate symptoms of binge-eating or compensatory behaviour. Conclusions: When considered alongside the largely equal number of participants who no longer met criteria full threshold BN at post-treatment and follow-up, these findings challenge the long-standing assumption held by the field that clinician supported interventions are more effective than pure self-help and suggest a unique benefit of unsupported use.
Broadening the concept of ‘engagement’ in mHealth interventions for equity of access
Background: Part of the appeal of digital health solutions and mHealth interventions (mobile/wireless technologies to support health) is their potential to overcome traditional barriers to health information including socio-economic status, region and gender. Aims: Whilst the ‘digital divide’ has been recognised as a barrier to equity in mHealth interventions, this presentation explores how those without direct access to digital technology can engage with and benefit from mHealth interventions. Methods: As part of an evaluation of a parenting app to promote socioemotional and cognitive development in early childhood in Indonesia, we conducted qualitative interviews and workshops with a variety of users and stakeholders [parents and caregivers (n=47), local experts on early childhood development (n=6) and funders (n=4)]. Results: ‘Engagement’ with the mHealth intervention did not necessarily involve interaction with the app itself. Many users were informally disseminating app content through non-digital networks in the community. We found engagement and enthusiasm for simple messages derived from the app content (e.g. advice on handwashing) was sometimes more pronounced and impactful through these non-digital dissemination channels. This was particularly evident in rural areas, where mobile phone usage and literacy were low. Conclusions: Understanding non-digital modes of engagement in relation to mHealth interventions has implications for measuring reach, uptake and impact, particularly in disadvantaged communities and areas with limited access to digital technology. We argue that broadening the concept of ‘engagement’ in mHealth is crucial for realising goals of universal access.
Co-designing the user experience of a parenting and early childhood development mHealth app in lower- and middle-income countries
Background: The ubiquity of mobile phones globally presents an opportunity to deliver parenting and early childhood development information to promote and optimise the socio-emotional and cognitive development of children during the first five years of life. However, it is crucial to ensure that mobile health (mHealth) solutions appreciate, among other things, cultural and linguistic diversity, especially in lower- and middle-income countries (LMICs). To that end, co-design is one way forward. Aims: Overall, this work aims to co-create a parenting app “Thrive by Five” to ensure usability, acceptability, and cultural appropriateness in LMICs. Here, findings from nine countries in Asia and Africa relating to the user experience are presented. Methods: Thematic analysis was applied to co-design workshops conducted with 174 parents and caregivers and 58 in-country subject matter experts from Afghanistan, Indonesia, Namibia, Kenya, Kyrgyzstan, Uzbekistan, The Democratic Republic of the Congo, Cameroon, and Ethiopia. To best inform user experience design, workshop participants were given a walkthrough of the app prototype or a period of hands-on user testing, when possible. Results: Key feedback on the app user experience indicated several necessary changes, including simplifying and localising language, including short videos, adding more bright colours, illustrations, and animations, and numerous improvements to the app features and functionality. Conclusions: Using co-design, vital feedback on user experience was elicited to further the ongoing co-creation of a parenting app with and for nine select LMICs.
Digital Health as a silver lining: exploring pregnancy digital health usage amidst the COVID-19 pandemic
Background: Digital health tools such as apps are being increasingly used by women to access pregnancy-related information. Aims: Conducted during the COVID-19 pandemic, this study investigated pregnant women’s usage of digital health tools and self-monitoring behaviours. In addition, views and interest in theoretical pregnancy app features: (1) a direct patient-to-healthcare-professional communication tool and (2) a novel body measurement tool was assessed. Methods: Using a mixed methods approach, 108 pregnant women were surveyed and 15 currently or recently pregnant women were interviewed online between November 2020 to May 2022. Results: We found that the COVID-19 pandemic had far-reaching impacts on the experiences of pregnant women – from their experiences with healthcare to their relationships with themselves and their social circle. Most participants said that they would use the theoretical app features we described and also identified a gap in the availability of evidence-based educational information. Other features that they would include in a pregnancy app were a “Digital Wallet” and a desire for a holistic pregnancy app that allowed for more continuous and personalised care. The main factor that influenced how likely participants were to use pregnancy apps were concerns about data privacy and security. Conclusions: This study highlights the gaps and needs of pregnant women and should inform all stakeholders designing pregnancy digital healthcare. This study offers a unique insight into the experiences of pregnant women during a very particular and unique period in human history.
Evaluating single-sample Google Trends research studies: What’s hype and what’s not
Background: Digital health studies using Google Trends (GT) have increased exponentially since the release of the first GT paper in 2009. However, the recommendations of two systematic reviews (Nuti et al, 2014; Mavragani et al, 2018) have largely been ignored. Also, only a handful of several thousand studies have used multiple sampling techniques to improve their estimates. The impact of inadequate sampling is unknown. Aims: To re-examine published studies using multiple sampling from GT and estimate the impact of inadequate sampling. Methods: We identified four studies with published data: Lazer et al (2014), Gamma et al (2016), Husnayain et al (2019), Schneider et al (2020). We replicated the methods of each study using their own data, confirming their results. We extracted 130 samples of GT data using the same specifications (time, region, terms) as the authors. We repeated the four article analyses on each sample and tallied the impact on the results. Results: Each study showed some variation in its results across multiple samples, from minor, but noticeable, to significantly different outcomes. As expected, the best estimate was obtained using the mean series across all 130 samples. Conclusions: Research using GT needs to take multiple samples of data to obtain accurate estimates before analysis. The number of samples needed appear to be related to the time frame (earlier data require more samples). The four studies all used different methods of analysis, and more research is needed to determine the extent to which different analysis methods are impacted by inadequate sampling.
Evaluation, quantifying and minimising the carbon footprint of inhalational anaesthesia in operation theatres at the Children’s Hospital at Westmead.
Background: Inhalational anaesthetic agents, particularly Nitrous, have significant global warming effects. We are uniquely positioned to minimise our carbon footprint through the change of conduct of practice. To quantify the local significance, we undertook an audit of CHW’s inhalational anaesthetic usage over the past 12 months to quantify both the carbon footprint (in equivalent tonnes of CO2) and the monetary cost of our inhalational anaesthetics. The Nitrous carbon footprint was significantly greater than that of the volatile agents, and the financial cost was not insignificant. This data highlights the potential for significantly reducing our department’s carbon footprint by minimising Nitrous use and limiting fresh gas flows. A significant portion of this consumption likely occurs at the point of gas induction which creates a point of practice change that could have significant reductions in overall gas usage. Aims: Minimising the carbon footprint of inhalational anaesthesia at the Children’s Hospital at Westmead (CHW), Creating a database (DB) for ongoing access to anaesthesia/surgical data for future research purposes. Methods: Physiological data, anaesthetic volatiles, Nitrous, and medical air used in all anaesthesia-induced operations were captured, anonymised and restored in a DB using anaesthetic machines and electronic monitors in surgical wards at CHW from 15.10.2021-15.10.2022. Results: Recent rationalisation in volatile anaesthetic consumption at Royal North Shore Hospital (RNS) achieved a 12-month change of 66% reduction in eCO2 and $82000 reduction in the direct cost of volatiles (39.3). For comparison, RNS does ~20000 cases per year (baseline ~1200 tonnes eCO2 footprint), and CHW does ~15000 cases per year (baseline ~2300 tonne eCO2 footprint). Conclusions: Similar changes implemented at CHW would be equivalent to an over 1,500-tonne reduction in eCO2 and over $165,000 in direct cost savings each year.
‘I'm glad my bub has just weaned so I don't have to make that decision!’: Preliminary results from an online social listening study on breastfeeding and COVID-19 information
Background: The COVID-19 pandemic has dominated global attention since early 2020 and the approval of vaccines was a welcome milestone. The exclusion of breastfeeding and pregnant women from clinical trials meant evidence-based advice for this group lagged and has at times been contradictory and confusing. Breastfeeding is an important public health issue and health professionals were concerned that this confusion could impact poorly on breastfeeding outcomes. Aim: This study aimed to understand breastfeeding-related COVID-19 information sharing and reactions on social media during the Australian vaccine roll-out. Methods: The CrowdTangle platform was used to source data. Posts were categorised to both intent and source, and mapped with a timeline of related events and announcements. Descriptive analysis was used to understand data distribution patterns and qualitative analysis is under way. Results: A total of 945 posts were included for analysis. Interactions per post ranged from 0-6,500. Vaccine-related posts were the highest in number and increased over time. Non-profit organisations shared the highest number of posts (n=241), but interactions per posts were highest from personal accounts. Peaks in posts and interactions mapped to key announcements and pandemic events. Preliminary qualitative analysis shows changes in intent over time with full analysis currently underway.
Linked health data: Dealing with demographic data discrepancies
Background: Data linkage custodians tolerate error rates of ≤0.5%, which still represent 10,000s of records in large datasets. Demographic variables are important covariates in digital health studies, and discrepancies can influence analysis. It is inadequate to simply discard cases with errors, as errors may not arise from the linkage process, but may be inherent in data prior to linkage, and may thus exceed the error rate. Also, removing cases from multiple datasets compounds the impact. Aims: Develop an approach to detecting, classifying, and correcting demographic data discrepancies in large linked datasets. Methods: Using demographic variables sex, birthdate, death date from two data linkage studies (ASHLi and PAVLOVA) as examples, methods are presented for defining within- and between-dataset discrepancies in single-record-per-case and multiple-record-per-case datasets. The difference in dealing with categorical (e.g., sex) and date data is illustrated. Methods are presented for resolving: - partially missing data - choosing most common option from a value set - resolving date boundary errors - using surrounding date information to resolve date conflicts Results: Our methods minimise the impact of data errors, retaining a significant proportion of cases (depending on the nature of the variables and the number of variables). A SAS macro which automates the work is presented. Conclusions: While these strategies are not applicable to all demographic variables, our work shows that researchers can improve the quality of their data without having to discard all discrepant cases. Our automation of these processes will further improve access of these strategies to researchers.
Using Incrementalism and Legitimacy to Ensure Ethical Use of Digital Health Data to Provide Accelerated Access to Medicines
Background: Provisional marketing approval and funding schemes allow medicines to be approved or funded on the basis of earlier data, with post-market data collection—including use of digital health data—to confirm their safety, effectiveness and cost-effectiveness. Ethical and responsible use of digital health data is necessary for both initiatives. Aims: To explore the beliefs of patients and physicians from Sydney, NSW regarding post-market data collection, including of digital health data, as a component of accelerated access. Methods: Semi-structured interviews were conducted with 18 Australian physicians and 13 patients and patient advocates; two focus groups were conducted with patients. Both patients and consumers were from medical specialties and disease areas in which accelerated access is most actively discussed. These were transcribed verbatim and analysed thematically. Results: There was significant diversity in stakeholder opinion. Although all acknowledged potential risks and benefits of increased reliance on post-market collection and use of digital health data, they disagreed on their magnitude and extent and how these should be balanced in both policy formation and clinical practice. Robust data collection, coupled with swift and decisive action by regulators and funders, were seen as necessary to address risks, but not all participants were confident this could be achieved. Conclusions: Stakeholder analysis shows a range of reasonable views on how to respond to calls for increased reliance on post-market collection and use of digital health data as part of accelerated access. Incremental policy change can maintain the protections of current systems while providing faster access to new medicines where this is needed most. However, not all substantive positions can be accommodated. A focus on fair procedures will increase legitimacy and acceptability of decisions about accelerated access to medicines. I offer a number of practical suggestions to achieve both legitimate and incremental policy making in regards use of post-market collection and use of digital health data in decisions about access to medicines.
How do health professionals use online communities to engage with their peers?
Background: Online communities have emerged as popular technologies for connecting individuals in health. Research on these communities to date has centred on how these digital health tools support patient to patient peer interactions and professional-patient interactions. Our research instead focuses on how health professionals use online communities (including Facebook, Twitter, Instagram, LinkedIn, WhatsApp) to engage with their peers. Aims: To investigate how health professionals use online communities for peer education, information exchange, support, and social connection across different online platforms. Methods: Our study included an international sample of health professionals from medical, nursing, and allied health disciplines including physiotherapy, psychology, speech pathology, and podiatry. Participants completed an online survey that included demographics, engagement and participation in online communities, and instruments including the Social Media in Healthcare Scale and the Physician Well-Being Index. The qualitative interviews centred on experiences, identities and roles in online community participation. Results: Our participants detailed numerous aspects of their online community participation. This included reports of their use of multiple platforms and distinguishing different ways of presenting themselves and engaging with each platform. Participants described benefits of online community participation as allowing them to communicate with leaders in their fields and developing collaborations that they would otherwise not have access to. Conclusions: Our initial findings indicate that health professionals use a variety of social media technologies to engage with their peers. They find these technologies to be useful for forming and maintaining peer networks and keeping up with current research in their disciplines.
Headspace Demand Management Strategy: Including lived experience voices to optimise digital solutions in youth mental health
Background: At Headspace Bondi Junction a surge in referrals followed COVID-19 lockdowns in 2020, causing longer wait times for young people accessing mental health support. In response, a clinical redesign project was initiated. Key solutions were the implementation of the health technology platform ‘Innowell’ to guide intake and assessment, and a peer worker acting as a digital navigator in young people’s mental health care journeys. Aims: · Decrease wait times: o Intake triage within 2 days compared to 8 days o Assessment within 2 weeks compared to 8 weeks o Psychological treatment within 1 month compared to 3 months · Reduce young people reporting ‘waiting too long’ for psychological treatment from 82% to 30% · Increase scores on an experience of service survey in domains of participation in care and the impact of care: o Participation: improve to 95% from 91% o Impact: improve to 70% from 65% Methods: The project adopted a 5-stage implementation methodology with each stage co-designed with young people. Evaluation is mixed-methods, incorporating qualitative interviews with staff, young people and carers. Results: Preliminary results demonstrate positive trends: · Wait times: o Intake within 4 days o Assessment within 2.14 weeks o Psychological treatment within 1.13 months · 30% of young people reporting ‘waiting too long’ · Experience of service: o Participation: 89% o Impact: 68% Conclusions: Including lived experience voices in digital youth mental health interventions is vital and impactful. However, refinement is needed to optimise integration of a peer workforce.
The InsideOut eClinic: the development and public release of a self-led, self-signup eTherapy platform for eating disorders
Digitally delivered guided self-help programs for eating disorders can reduce treatment barriers like cost, stigma, geography, and availability of clinicians. Digital eating disorder treatments also provide a unique opportunity for innovative enhancements such as self-monitoring tools, clinician dashboards, clinician pairing/monitoring and supported self-help options. Binge Eating eTherapy (BEeT) was one of the first online CBT programs for eating disorders in Australia. Clinical trials of ‘BEeT’ and a re-formatted four-week version of ‘Brief BEeT’ showed promising baseline to post-treatment decreases in objective binge eating frequency. After developing and evaluating these programs, InsideOut Institute has built an eating disorder digital therapy treatment platform (‘the InsideOut eClinic’), which allows us to deliver eTherapies and self-monitoring. The InsideOut eClinic enables the authoring and delivery of new eTherapies without further digital development. The self-monitoring capabilities allow for food, thought, and behaviour monitoring, goal setting, and Cognitive Behavioural Therapy tools such as exposure and thought challenges, also available as a mobile application. The platform allows for further innovative therapeutic options including the connection of users to clinicians, clinical monitoring or support and patient led or guided experiences. This presentation will explore the conversion of digital tools from research studies into operationalised, publicly available treatments, the building of a sustainable and considered platform that survives outside a particular grant or study, and the use of codesign and research learnings to inform continuous improvement valuing lived and living experience voices.
How does collaboration support sexual health organisations to successfully navigate Meta’s content moderation policies?
Background: Since the start of the COVID-19 pandemic, sexual health organisations increasingly use social media platforms (particularly Instagram) to distribute sexual health content to young people. However, Meta’s content moderation policies severely restrict the distribution of ‘sexual’ content that is ‘sexual’, which restricts the ability of sexual health organisations to distribute content that reflects peoples’ lived experiences. Aims: This study examines how sexual health organisations resist and creatively navigate Meta’s content moderation policies to ensure that their distributed content reaches young people. Methods: This exploratory study involved semi-structured interviews with producers of best-practice digital sexual health promotion employed by 12 sexual health organisations in Australia and the United Kingdom. Interviews focused on understanding professional experiences of producing and distributing social media content. Themes were developed using abductive analysis. Results: Many of the sexual health organisations collaborated with content creators and organisations, who hold similar values to that organisation. These relationships are used to distribute content to new networks, prioritise content within Instagram’s algorithm and share experiences of content moderation. Collaboration supports organisations to better understand the nuances of the algorithm and produce content that more effectively flies under the radar of content moderation. Conclusions: While Meta’s content moderation policies restrict the type of sexual health content shared, sexual health organisations use collaboration to increase their visibility with young people on Instagram. These strategies can be used to increase the visibility of digital health content, that resonates with young people’s lived experiences, across a variety of social media platforms.
Offering disadvantaged adolescents hope for a better future through eHealth interventions targeting poor diet, alcohol use, tobacco smoking and vaping: Findings from a systematic review
Introduction: Chronic disease burden disproportionately affects disadvantaged adolescent populations. Preventing chronic disease risk behaviours including poor diet, alcohol use, tobacco smoking and vaping in adolescence is critical. Universal eHealth interventions provide effective prevention, and are a potentially viable option to reach disadvantaged adolescents. However, it is unclear whether they adequately serve disadvantaged adolescents, including those from lower socioeconomic and geographically remote contexts. Aims: We aimed to synthesise evidence for the effectiveness of eHealth interventions targeting disadvantaged adolescents in preventing poor diet, alcohol use, tobacco smoking and vaping. Methods: Seven electronic databases were systematically searched. Eligible studies were randomised controlled trials and quasi-experimental trials of eHealth interventions targeting diet, alcohol use, tobacco smoking and vaping among adolescents, that reported at least one marker of socioeconomic status or geographical remoteness. Two reviewers screened, extracted data, and assessed risk of bias. Results: 3278 articles were identified and fifteen were included for extraction. Nine trials were among adolescents of low socioeconomic status (targeting poor diet [n=6]; alcohol use [n=2], and tobacco smoking [n=1]), four were among adolescents living in geographically remote areas (targeting poor diet [n=3], and alcohol use [n=1]), and one study focused on adolescents of low socioeconomic and geographically remote backgrounds (targeting alcohol and tobacco smoking). No studies targeted vaping. Conclusions: There is a lack of eHealth interventions targeting adolescents from disadvantaged backgrounds in preventing poor diet, alcohol use, tobacco smoking and vaping. Addressing these risk behaviours among disadvantaged adolescents has the potential to improve future health and narrow health inequities.
The quality of training data for mammographic AI systems: investigating factors to reduce hype and increase clinical translation
Background: Breast cancer is one of leading causes of female cancer-related death, with 25-30% of the total new cancer cases in women annually and AI breast screening has demonstrated promising detection results. High quality digital health data are required to train a reliable and effective AI model for breast cancer however different radiologists have different experience in lesion segmentation and levels of agreement for lesion location. Aims: This study aims to evaluate the AI systems by analyzing the quality of data with concordance between annotations of radiologists. Methods: MIAS Mammography Dataset (320 images, 33% cancer cases, 1 radiologist annotating cancers) and Lifepool (856 images, 2 radiologists) were used with data from overlapped annotations using Lin’s concordance correlation coefficient (CCC) ‘almost perfect’ category. An AI system which applied deep convolutional neural networks to detect breast cancer was implemented. Results: The validation accuracy for training and testing the AI system with data from the combination of MIAS and ‘almost perfect’ Lifepool datasets is higher (0.95 versus 0.9 training; 0.97 versus 0.9 testing). In addition, the training process of the AI system from the combination datasets outputs higher validation accuracy in an earlier epoch, which indicates less training computation time to train the accurate AI system. Conclusions: AI system performance is affected by the concordance within the training data, with ‘almost perfect’ data yielding more accurate cancer detection and reduce training time. Future work will investigate other training data in the level of ‘substantial’, ‘moderate’ and ‘poor’ for AI performance to map the noise within the system.
Co-design of a digital workplace wellness intervention in Malaysia
Background: Malaysia is currently experiencing high, and growing, rates of chronic disease. Lifestyle risk factors, such as obesity, lack of physical activity, smoking, and poor diet all contribute to the onset of these conditions and to worse outcomes. Previous studies suggest that workplace wellness initiatives can benefit both individuals and employers (e.g., through lower healthcare costs and reductions in absenteeism). Aims: This abstract outlines phase one of the study, which aims to co-design a socially-driven digital health intervention to promote healthy behavior in a workplace in Malaysia. Methods: In this co-design phase, a total of 12 interviews were completed with employees to understand the barriers and facilitators to healthy behaviors in the workplace, including social factors (drawing on social cognitive theory and other social influence theories). Next, co-design workshops were developed, based on the findings from the interviews, and conducted with employees to design workplace wellness activities that fit the company culture and constraints. Results: The employee interviews uncovered barriers to healthy behaviors, such as limited availability of healthy food options, and facilitators, such as co-workers participating together in activities. Co-design workshops explored how these factors could be leveraged or addressed in the design of wellness activities for the company. While not an initial focus of the study, an additional theme that emerged from both interviews and co-design workshops was the need for more mental health support for employees. Conclusions: The co-design process uncovered important barriers, facilitators, and ideas while designing a culturally-relevant digital workplace wellness intervention in Malaysia.
Getting off the Universal Serial Bus (USB) – An Innovative Approach to Nursing and Midwifery Recruitment
Background: In 2020, an application for funding was successful for the development of a digital solution, building on a pilot at the Prince of Wales Hospital (POWH). Given the current pandemic response environment, there is a critical need to develop an industry leading Nursing and Midwifery skills development approach, enabled by emerging technology. Currently Nursing orientation and information on-boarding processes at SESLHD are not standardized. Med App is an offline-accessible, mobile-first tool for accessing clinical and hospital guidelines, communicating with clinicians, and facilitating education and training. It offers an innovative digital solution to support not only Orientation, but also staff education, quality improvement, real-time clinical decision support and communication. Across SESLHD the tool has been trialed in a COVID-19 testing clinic, Vaccination Hub, with Nursing and Midwifery Graduates and most recently, with a nursing and midwifery casual staffing office. Aims: To address the growing healthcare system pressures requiring remote and innovative ways of delivering education and information to clinicians, enhancing access to information and education in a way that provides an alternate medium to interact with educators, teams and colleagues. Methods: Rollout via New Graduate coordinators to 2021 new Graduate Nurses and Midwives prior to commencement of graduate program. Mixed method evaluation focusing on a time in motion study, interviews, focus groups and surveys will explore the experiences of participants. Results: To date, over 300 users across 7 SESLHD facilities with 859 hours of productive time returned to practice. Next steps include the launch of a Falls Quality Improvement project and a Wellbeing Initiative using a Wellbeing Index. Conclusions: With a formal evaluation underway, early data shows strong engagement with the platform by both users and coordinators with anecdotal data further demonstrating the value of timely access to information in a rapidly changing world.
How Do Online Actors Navigate Facebook In Communicating Vaccination Messages
Background: Factually, health information is important to tackle issues around vaccination. The distribution of false information from online actors about the efficacy of vaccination online and on social media platforms has also been on the rise. This paper examines how various vaccination activists use Facebook to communicate critical messages about vaccination in Australia. Aims: This paper argues that online actors leverage and negotiate the affordances of Facebook in different ways to communicate vaccination messages. Social media affordances are platform features that enhance, promote, or encourage communication practices and social interactions (Bucher & Helmond, 2017). It is also a relationship between the technology and the users and the possible or actual outcomes from the user's interactions with that platform (Evans, Pearce, Vitak, & Treem, 2017). Methods: As this paper focuses on vaccination contents produced by online anti-vaccination groups, data was gathered using semi-structured interviews to identify specific techniques and practices used to communicate messages about childhood vaccination in Australia Results: This paper offers an understanding of the specificity and complexity of communication techniques and practices of online actors on Facebook and how that influences the understanding of vaccination in Australia. Conclusions: Findings from this paper significantly show an understanding of the evolving nature of social media platforms. Additionally, understanding online users' communication techniques, practices, and communities have uncovered some novel strategies for navigating Facebook.
The ethics of sextech – is design justice compatible with market demands?
Background: While many sextech projects involve researchers, to date these partnerships have primarily focused on the biomedical or sexological aspects of sexuality and tech use. This paper explores sociotechnical insights drawn from an online 'public interest sextech' research hackathon, which featured presentations from representatives of marginalised communities disproportionally impacted by the collection, regulation, aggregation and commercialisation of sexual and/or intimate data – including Aboriginal and Torres Strait Islander people, people living with HIV, people with disabilities, trans people and sex workers. Aims: Hackathon participants (including sexuality educators, design professionals and technologists) were asked to consider how the values of designers become embedded in the technologies; and invited to create speculative designs for innovative sextech informed by design justice approaches (Costanza-Chock 2020). Methods: Hackathons typically involve a series of intensive design sprints. We followed this model, supporting participants via expert presentations, and access to industry mentors over a 3-day period. Participants then ‘pitched’ their design to judges with broad expertise in sextech and public interest technologies. They also shared reflections on speculative sextech design (and the broader hackathon experience) in facilitated small group sessions. Results: Throughout the hackathon, panellists (and activist participants) focused on local, collective approaches – focusing on cultural protocols, counter-surveillance and building community partnerships. In contrast, market-focused participants prioritised opportunities for commercialisation and global scaleability. Conclusions: While co-design is a core element of ethical and inclusive practice, there are significant tensions between the market demands of start-up tech cultures, and the more collective approaches favoured by stakeholders from marginalised sexual communities.
An AI-powered virtual online platform to enhance clinical genetic service provision
Background: Escalation in genetic testing is identifying increasing numbers of individuals with high-risk mutations who require life-long, risk-mitigation programs. Adherence to optimal risk-management programs saves lives, empowers life choices and is cost-effective. However, some individuals experience psychological, socio-economic, geographic, and health system-based barriers to care without specialist support. These result in preventable morbidity and mortality and reduce the personal and clinical benefits of testing. Some clinical genetic services (CGS) offer telephone or survey-based follow-up programs, but these are inconsistent, and cost- and time-intensive. Aims: The goal of this study is to develop the first generation of “GenCare”: an AI-powered virtual online platform functioning as a multidimensional CGS champion to enhance personalised care for patients living with genetic disorders. GenCare will support: 1) Bidirectional responsive communication between the CGS and patients, including collecting and integrating patient data into CGS databases, 2) Incorporate AI-based algorithms that will use these data to automatically assess and identify patients at risk, to optimise and enhance care delivery. Methods: GenCare is being co-designed and development from experiences and preferences captured through iterative focus groups with all stakeholders. The first stage of eliciting GenCare attributes determined by stakeholders is complete. The paper prototype assessment is underway. Conclusions: This proposal is currently focussed on individuals with a high familial cancer or cardiac disease risk. GenCare will be a highly scalable digital solution to optimise clinical wellbeing of people living with a high-risk disease predisposition and support CGS to respond quickly to individuals’ needs
Who’s Keeping It Real: Social Media Use, Authenticity and Online Self-Expression and the association with Eysenck’s Personality Superfactors
Background: People frequently utilise social media platforms in order to express themselves online and do so in a way that that is reflective of the real “authentic” self, yet flexible enough to test different aspects of the self. For those who do experiment with different forms of self-expression, individual characteristics such as personality traits have been thought to play an important role. In addition, the nature of content shared appears to also share a relationship with personality and authenticity of online self-expression. Aims: This study seeks to explore the role of individual characteristics in driving certain approaches to self-expression on social media platforms, specifically through examining how Eysenck’s structure of personality relates to self-expression in the context of social media. Methods: A total of 489 participants completed a number of online surveys, measuring overall social media use, authenticity of self-presentation on social media (real, ideal, false), self-expression styles (depth, breadth, positivity & authenticity) and Eysenck’s revised short scale personality questionnaire. Results: Findings demonstrated that extroversion predicts the sharing of one’s authentic self, as well as the sharing of a greater breadth and depth of content on social media. Neuroticism is negatively correlated with sharing an authentic self on SM and with sharing positively-valenced content. Neuroticism positively correlates with the depiction of a false or ideal self on SM. Conclusions: Overall, the greater authenticity of content shared predicts increased display of SM users’ real self, and a decrease in content intended to impress or portray ones idealised or false self.
Embedding Digital Therapeutics into Primary Care: A New Era of Prescribing and Dispensing
Background: The current practice and resource constraints in primary care make the management of mental health and sleep disturbances amenable to digital health interventions (DHIs). However, the enablers and barriers for practice translation has not been concurrently explored across key primary care healthcare professionals (HCPs) Aims: To explore primary care HCPs attitudes towards DHIs and perceived readiness for practice integration. Methods: Secondary analysis of two qualitative datasets collected from HCPs enrolled in a clinical trial evaluating SleepFix, an app-based intervention for insomnia. Interviews were guided by a schedule of questions focusing on HCPs’ current use of DHIs, perceived practice barriers/enablers of implementation, user experience of SleepFix and potential models of care for integrating DHIs into practice. Interviews were transcribed verbatim and thematically analysed. Results: 45 HCP participants (GP=17, nurse =14, pharmacist=14) were interviewed pre-intervention and 15 (GP=6, nurses=2, pharmacist=1) at post-intervention. While participants appeared more receptive towards using DHIs post-pandemic, they did not feel primary care was ready for embedding DHIs, especially sleep-based interventions, into mainstream care. Participants reiterated the need for reliable point-of-care formularies for DHIs to guide practice. Further, in response to the lack of clarity for how DHIs mapped to the respective professions’ scope of practice and reimbursement structures alternative care models were articulated. Conclusions: While DHIs show promise for improving patient care, establishing a robust evidence-base and revising the respective professions’ scope of practice scope and reimbursement are necessary.
Parents’ practices and perspectives of accessing health-related information for their young children
Background: Digital technology (DT) is ubiquitous in the lives of families with young children and a concern for many parents, who find guidelines unrealistic. Research around accessing health-related information frequently focuses on specific health conditions rather than children’s health more broadly, and there is a lack of research surrounding parents of young children’s access to health-related information, including DT use. Aims: To explore the practices and perspectives of parents of young children accessing health-related information for their children, especially DT use. Methods: Parents of children aged 0-36 months (n=20, 16 female) completed a sociodemographic survey and participated in an online semi-structured interview on the type of health-related information they seek, from whom and where they seek information, and why they choose these sources. Inductive thematic analysis was completed on the transcribed interview data. Results: Parents most commonly accessed information about non-urgent health issues. Practices and perspectives were guided by information accessibility, relatability, and trustworthiness, and were impacted by geographical location, number of children and Covid19 restrictions. Online sources were frequently used for sourcing health-related information, specifically government/ organisational websites, and social media. DT use information was less commonly sought, with parents relying on personal values and experiences, and mainstream media messaging, to make decisions about their child’s DT use. Conclusions: Findings indicate a need for a shift towards broader sources and strategies to allow effective research translation to help inform parents’ perspectives and practices surrounding DT use.