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TitleThe Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis.
AuthorsKim, K; Shin, S; Kim, S; Lee, E
JournalJournal of medical Internet research
Publication Date30 Jan 2023
Date Added to PubMed31 Jan 2023
AbstractWith widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors. To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis. The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale. Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors. Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.
Linkhttp://doi.org/10.2196/40778
TitleDigital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review.
AuthorsLattie, EG; Adkins, EC; Winquist, N; Stiles-Shields, C; Wafford, QE; Graham, AK
JournalJournal of medical Internet research
Publication Date22 Jul 2019
Date Added to PubMed25 Jul 2019
AbstractCollege students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
Linkhttp://doi.org/10.2196/12869
TitleDigital health and telehealth in cancer care: a scoping review of reviews.
AuthorsShaffer, KM; Turner, KL; Siwik, C; Gonzalez, BD; Upasani, R; Glazer, JV; Ferguson, RJ; Joshua, C; Low, CA
JournalThe Lancet. Digital health
Publication Date1 May 2023
Date Added to PubMed27 Apr 2023
AbstractThe COVID-19 pandemic necessitated remote cancer care delivery via the internet and telephone, rapidly accelerating an already growing care delivery model and associated research. This scoping review of reviews characterised the peer-reviewed literature reviews on digital health and telehealth interventions in cancer published from database inception up to May 1, 2022, from PubMed, Cumulated Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Reviews, and Web of Science. Eligible reviews conducted a systematic literature search. Data were extracted in duplicate via a pre-defined online survey. Following screening, 134 reviews met the eligibility criteria. 77 of those reviews were published since 2020. 128 reviews summarised interventions intended for patients, 18 addressed family caregivers, and five addressed health-care providers. 56 reviews did not target a specific phase of the cancer continuum, whereas 48 reviews tended to address the active treatment phase. 29 reviews included a meta-analysis, with results showing positive effects on quality of life, psychological outcomes, and screening behaviours. 83 reviews did not report intervention implementation outcomes but when reported, 36 reported acceptability, 32 feasibility, and 29 fidelity outcomes. Several notable gaps were identified in these literature reviews on digital health and telehealth in cancer care. No reviews specifically addressed older adults, bereavement, or sustainability of interventions and only two reviews focused on comparing telehealth to in-person interventions. Addressing these gaps with rigorous systematic reviews might help guide continued innovation in remote cancer care, particularly for older adults and bereaved families, and integrate and sustain these interventions within oncology.
Linkhttp://doi.org/10.1016/S2589-7500(23)00049-3
TitleDevelopment of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills.
Authorsvan der Vaart, R; Drossaert, C
JournalJournal of medical Internet research
Publication Date24 Jan 2017
Date Added to PubMed26 Jan 2017
AbstractWith the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI's self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=-.41, P<.001), education (ρ=.14, P=.047), Internet use (ρ=.39, P<.001), health-related Internet use (ρ=.27, P<.001), health status (ρ range .17-.27, P<.001), health literacy (ρ=.31, P<.001), and the eHEALS (ρ=.51, P<.001). This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations.
Linkhttp://doi.org/10.2196/jmir.6709
TitleAnnual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review.
AuthorsHollis, C; Falconer, CJ; Martin, JL; Whittington, C; Stockton, S; Glazebrook, C; Davies, EB
JournalJournal of child psychology and psychiatry, and allied disciplines
Publication Date1 Apr 2017
Date Added to PubMed13 Dec 2016
AbstractDigital health interventions (DHIs), including computer-assisted therapy, smartphone apps and wearable technologies, are heralded as having enormous potential to improve uptake and accessibility, efficiency, clinical effectiveness and personalisation of mental health interventions. It is generally assumed that DHIs will be preferred by children and young people (CYP) given their ubiquitous digital activity. However, it remains uncertain whether: DHIs for CYP are clinically and cost-effective, CYP prefer DHIs to traditional services, DHIs widen access and how they should be evaluated and adopted by mental health services. This review evaluates the evidence-base for DHIs and considers the key research questions and approaches to evaluation and implementation. We conducted a meta-review of scoping, narrative, systematic or meta-analytical reviews investigating the effectiveness of DHIs for mental health problems in CYP. We also updated a systematic review of randomised controlled trials (RCTs) of DHIs for CYP published in the last 3 years. Twenty-one reviews were included in the meta-review. The findings provide some support for the clinical benefit of DHIs, particularly computerised cognitive behavioural therapy (cCBT), for depression and anxiety in adolescents and young adults. The systematic review identified 30 new RCTs evaluating DHIs for attention deficit/hyperactivity disorder (ADHD), autism, anxiety, depression, psychosis, eating disorders and PTSD. The benefits of DHIs in managing ADHD, autism, psychosis and eating disorders are uncertain, and evidence is lacking regarding the cost-effectiveness of DHIs. Key methodological limitations make it difficult to draw definitive conclusions from existing clinical trials of DHIs. Issues include variable uptake and engagement with DHIs, lack of an agreed typology/taxonomy for DHIs, small sample sizes, lack of blinded outcome assessment, combining different comparators, short-term follow-up and poor specification of the level of human support. Research and practice recommendations are presented that address the key research questions and methodological issues for the evaluation and clinical implementation of DHIs for CYP.
Linkhttp://doi.org/10.1111/jcpp.12663
TitleMethods of usability testing in the development of eHealth applications: A scoping review.
AuthorsMaramba, I; Chatterjee, A; Newman, C
JournalInternational journal of medical informatics
Publication Date1 Jun 2019
Date Added to PubMed29 Apr 2019
AbstractThe number of eHealth applications has exponentially increased in recent years, with over 325,000 health apps now available on all major app stores. This is in addition to other eHealth applications available on other platforms such as PC software, web sites and even gaming consoles. As with other digital applications, usability is one of the key factors in the successful implementation of eHealth apps. Reviews of the literature on empirical methods of usability testing in eHealth were last published in 2015. In the context of an exponentially increasing rate of App development year on year, an updated review is warranted. To identify, explore, and summarize the current methods used in the usability testing of eHealth applications. A scoping review was conducted on literature available from April 2014 up to October 2017. Four databases were searched. Literature was considered for inclusion if it was (1) focused on an eHealth application (which includes websites, PC software, smartphone and tablet applications), (2) provided information about usability of the application, (3) provided empirical results of the usability testing, (4) a full or short paper (not an abstract) published in English after March 2014. We then extracted data pertaining to the usability evaluation processes described in the selected studies. 133 articles met the inclusion criteria. The methods used for usability testing, in decreasing order of frequency were: questionnaires (n = 105), task completion (n = 57), 'Think-Aloud' (n = 45), interviews (n = 37), heuristic testing (n = 18) and focus groups (n = 13). Majority of the studies used one (n = 45) or two (n = 46) methods of testing. The rest used a combination of three (n = 30) or four (n = 12) methods of testing usability. None of the studies used automated mechanisms to test usability. The System Usability Scale (SUS) was the most frequently used questionnaire (n = 44). The ten most frequent health conditions or diseases where eHealth apps were being evaluated for usability were the following: mental health (n = 12), cancer (n = 10), nutrition (n = 10), child health (n = 9), diabetes (n = 9), telemedicine (n = 8), cardiovascular disease (n = 6), HIV (n = 4), health information systems (n = 4) and smoking (n = 4). Further iterations of the app were reported in a minority of the studies (n = 41). The use of the 'Think-Aloud' (Pearson Chi-squared test: χ2 = 11.15, p < 0.05) and heuristic walkthrough (Pearson Chi-squared test: χ2 = 4.48, p < 0.05) were significantly associated with at least one further iteration of the app being developed. Although there has been an exponential increase in the number of eHealth apps, the number of studies that have been published that report the results of usability testing on these apps has not increased at an equivalent rate. The number of digital health applications that publish their usability evaluation results remains only a small fraction. Questionnaires are the most prevalent method of evaluating usability in eHealth applications, which provide an overall measure of usability but do not pinpoint the problems that need to be addressed. Qualitative methods may be more useful in this regard. The use of multiple evaluation methods has increased. Automated methods such as eye tracking have not gained traction in evaluating health apps. Further research is needed into which methods are best suited for the different types of eHealth applications, according to their target users and the health conditions being addressed.
Linkhttp://doi.org/10.1016/j.ijmedinf.2019.03.018
TitleDigital Health Behavior Change Technology: Bibliometric and Scoping Review of Two Decades of Research.
AuthorsTaj, F; Klein, MCA; van Halteren, A
JournalJMIR mHealth and uHealth
Publication Date13 Dec 2019
Date Added to PubMed14 Dec 2019
AbstractResearch on digital technology to change health behavior has increased enormously in recent decades. Due to the interdisciplinary nature of this topic, knowledge and technologies from different research areas are required. Up to now, it is not clear how the knowledge from those fields is combined in actual applications. A comprehensive analysis that systematically maps and explores the use of knowledge within this emerging interdisciplinary field is required. This study aims to provide an overview of the research area around the design and development of digital technologies for health behavior change and to explore trends and patterns. A bibliometric analysis is used to provide an overview of the field, and a scoping review is presented to identify the trends and possible gaps. The study is based on the publications related to persuasive technologies and health behavior change in the last 18 years, as indexed by the Web of Science and Scopus (317 and 314 articles, respectively). In the first part, regional and time-based publishing trends; research fields and keyword co-occurrence networks; influential journals; and collaboration network between influential authors, countries, and institutions are examined. In the second part, the behavioral domains, technological means and theoretical foundations are investigated via a scoping review. The literature reviewed shows a clear and emerging trend after 2001 in technology-based behavior change, which grew exponentially after the introduction of the smartphone around 2009. Authors from the United States, Europe, and Australia have the highest number of publications in the field. The three most active research areas are computer science, public and occupational health, and psychology. The keyword "mhealth" was the dominant term and predominantly used together with the term "physical activity" and "ehealth". A total of three strong clusters of coauthors have been found. Nearly half of the total reported papers were published in three journals. The United States, the United Kingdom, and the Netherlands have the highest degree of author collaboration and a strong institutional network. Mobile phones were most often used as a technology platform, regardless of the targeted behavioral domain. Physical activity and healthy eating were the most frequently targeted behavioral domains. Most articles did not report about the behavior change techniques that were applied. Among the reported behavior change techniques, goal setting and self-management were the most frequently reported. Closer cooperation and interaction between behavioral sciences and technological areas is needed, so that theoretical knowledge and new technological advancements are better connected in actual applications. Eventually, this could result in a larger societal impact, an increase of the effectiveness of digital technologies for health behavioral change, and more insight in the relationship between behavioral change strategies and persuasive technologies' effectiveness.
Linkhttp://doi.org/10.2196/13311
TitleTelepsychiatry Today.
AuthorsChan, S; Parish, M; Yellowlees, P
JournalCurrent psychiatry reports
Publication Date1 Nov 2015
Date Added to PubMed19 Sep 2015
AbstractThe use of video-based telepsychiatry is increasing in response to consumer demand for convenient, inexpensive, and readily accessible services; improved financial reimbursement; and a robust body of evidence-based literature. Telepsychiatry leads to high patient and provider satisfaction ratings, and outcomes equivalent to in-person care, while younger generations often prefer telepsychiatry over face-to-face encounters. The evidence base for telepsychiatry is especially strong with respect to the treatment of post-traumatic stress disorder (PTSD), depression, and ADHD, while its use in underserved ethnic groups is well described in the American Indian, Hispanic, and Asian populations. Despite this, telepsychiatry barriers still persist. These include personal bias-especially in leadership-and insufficient training; the challenging business environment and legislative processes; and inconsistent reimbursement, licensing, and prescription policies. Technology is now less of a barrier, and it is clear that telepsychiatry overall is flourishing and changing the way that providers are working and patients are being treated.
Linkhttp://doi.org/10.1007/s11920-015-0630-9
TitleDigital health, gender and health equity: invisible imperatives.
AuthorsSinha, C; Schryer-Roy, AM
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed18 Oct 2018
AbstractA growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind. SinhaChaitaliCInternational Development Research Centre (IDRC), Ottawa, Canada.Schryer-RoyAnne-MarieAMNairobi, Kenya.engIntroductory Journal ArticleEnglandJ Public Health (Oxf)1011886381741-3842IMDeveloping CountriesFemaleHealth EquityHumansMaleSex FactorsSexismTelemedicineUna cantidad creciente de evidencia muestra que el uso de las tecnologías digitales en la salud, ya sea eSalud (eHealth), mSalud (mHealth) o "salud digital", está mejorando y salvando vidas en países de ingresos bajos y medios. A pesar de esta descripción frecuente y persistente, muy pocos estudios analizan sus efectos en la igualdad en materia de salud y las dinámicas de género y de poder. Este suplemento informativo aborda estos imperativos invisibles al ir más allá de las medidas de cobertura tradicionales, la eficiencia y la eficacia en función de los costos asociadas con las intervenciones de salud digital, para desentrañar las diferentes experiencias de los beneficiarios y trabajadores de la salud. Este conjunto de trabajos presenta resultados de una cohorte de aplicación de proyectos de investigación en África, Asia, América Latina y el Medio Oriente; y dos comentarios ofrecen observaciones de actividades de evaluación orientadas en el aprendizaje en toda la cohorte. La historia que surge de esta cohorte comprende tres temas: (i) la salud digital puede influenciar positivamente la igualdad en materia de salud; (ii) los análisis de género y de poder son esenciales; y (iii) la salud digital puede usarse para fortalecer la rendición de cuentas ascendente y descendente. Estos resultados, a nivel de proyecto individual y al nivel de la cohorte, brindan recomendaciones alentadoras acerca de cómo abordar el diseño, la aplicación y la evaluación de las intervenciones de salud digital para examinar la agenda de los Objetivos de Desarrollo Sostenible de no dejar a nadie atrás. Palabras clave: m-Salud, mSalud, eSalud, salud digital, género, igualdad en materia de salud, mujeres, ODS, rendición de cuentas, sistemas de salud De plus en plus d’études révèlent que le recours aux technologies numériques en santé – désignées par les termes cybersanté, santé mobile ou santé numérique – permet de sauver des vies dans les pays à revenu faible ou moyen et d’en améliorer la qualité. Malgré la prévalence et la constance des données, très peu d’études traitent de ses répercussions sur l’équité en santé, la sexospécificité et la dynamique de pouvoir. Le présent supplément se penche sur ces impératifs invisibles et va au-delà des mesures traditionnelles de couverture, d’efficacité et de rentabilité associées aux interventions numériques en santé, afin de lever le voile sur les différentes expériences que vivent les travailleurs de la santé et les bénéficiaires de soins de santé. Ce recueil de textes présente les résultats d’une cohorte de projets de recherche sur la mise en oeuvre menés en Afrique, en Asie, en Amérique latine et au Moyen-Orient, et deux commentaires font part d’observations tirées d’activités d’évaluation axées sur l’apprentissage réalisées dans toute la cohorte. L’analyse des résultats de la cohorte aboutit à trois constats : (i) la santé numérique peut exercer une influence positive sur l’équité en santé; (ii) l’analyse comparative entre les sexospécificités et l’analyse de la dynamique de pouvoir sont essentielles; (iii) la santé numérique peut être utilisée pour renforcer la responsabilisation vers le haut et vers le bas. Ces constats, qu’ils soient liés à chacun des projets ou à l’ensemble de la cohorte, donnent lieu à des recommandations encourageantes quant à la manière d’aborder la conception, la mise en oeuvre et l’évaluation d’interventions numériques en santé, de sorte à réaliser le programme et les objectifs de développement durable consistant à ne laisser personne de côté. Mots clés: santé mobile, cybersanté, santé numérique, sexospécificité, équité en santé, femmes, ODD, responsabilisation, systèmes de santé
Linkhttp://doi.org/10.1093/pubmed/fdy171
TitleDigital Health Readiness: Making Digital Health Care More Inclusive.
AuthorsBober, T; Rollman, BL; Handler, S; Watson, A; Nelson, LA; Faieta, J; Rosland, AM
JournalJMIR mHealth and uHealth
Publication Date9 Oct 2024
Date Added to PubMed9 Oct 2024
AbstractThis paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person's stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person's goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care.
Linkhttp://doi.org/10.2196/58035
MNCHFPRHHIV/AIDSMalariaNoncommunicable diseaseCOVID-19Decision-makingEducation & trainingBehavior changeGovernancePrivacy & securityEquityCHWsYouth & adolescentsSystematic reviewsProtocols & research designMedical RecordsLaboratoryPharmacyHuman ResourcesmHealthSMSChatbotsAI