Botswana is developing its eHealth capacity using a National eHealth Strategy. However, that Strategy overlooks telemedicine, a potential solution for many healthcare challenges. For telemedicine to benefit Botswana, a telemedicine-specific strategy is required. While establishing a national strategy is a sovereign responsibility, guidance and recommendations can be provided. Using published resources specific to Botswana, key health-related issues were identified. These issues were matched with suitable telemedicine activities and delivery approaches. Recommendations were then derived from these for use in an effective telemedicine-specific strategy for Botswana. From 28 health-related issues, six were prioritised. Three telemedicine activities were identified (clinical services, education, and behaviour change), and one delivery approach was chosen (store-and-forward) because they align well with current needs, infrastructure, and mobile phone user capabilities. Since telemedicine has been proven to be effective, efficient, and cost-effective when implemented correctly this knowledge and experience, plus a recognised strategy development framework, has led to evidence-based recommendations. Specific telemedicine options were identified as examples. As confidence grows, telemedicine options can be expanded to address additional clinical needs and explore alternative activities and delivery options. The recommendations can help the Government develop a telemedicine-specific strategy that aligns with the National eHealth Strategy while actively promoting and supporting the adoption and system integration of straightforward telemedicine interventions. This foundation will facilitate the future expansion of telemedicine initiatives for the benefit of all Batswana.

The adoption of eHealth has not made great strides in Uganda especially among patients despite its potential in improving patient outcomes through access to care, patient engagement and its ability to reduce unnecessary hospital visits. Previous studies have focused on barriers and facilitators of eHealth in general. None has examined the adoption of eHealth among patients. Therefore, this study set out to investigate the barriers and facilitators of eHealth adoption among patients in Uganda. A cross-sectional survey was conducted in four districts across the country. A total of 292 patients of 18 years and above participated in the study and their selection was through simple random sampling. The bivariate analysis results revealed that education level (χ2 = 14.9, ρ<0.05), gender (χ2 = 4.95, ρ<0.05) and location (χ2 = 85.9, ρ<0.05) have a statistical significant relationship with eHealth adoption. The logistic regression model further revealed that male patients (OR=2.662), those with master’s degree and above (OR=2.2797) and those residing in Kampala (OR=.012) were more likely to use eHealth systems than their counterparts. The success of eHealth requires players in the health sector to ardently focus on the socio-demographic factors of the users, technological and hospital conditions if eHealth adoption is to ensue.

Background: The study investigates patients' use of eHealth services, awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence their use. Methods: A cross-sectional design using questionnaire were conducted. Based on the unified theory of acceptance and use of technology (UTAUT), participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. Simple linear regression was conducted identify factors influencing participants' intention to use eHealth services. Results: 1203 participants were surveyed and their’ ages averaged 43.7 years. Participants usage rates varied, with the lowest at 2.4% for measuring vital signs and the highest at 47.4% for booking appointments. Intentions to use services ranged from 22.5% for video consultations to 46.6% for prescription refill requests. Approximately 20% of respondents were unaware of each service's availability. Positive associations were found between all constructs and the intention to use online services, with younger age being the most significant factor. Conclusions: Use of and intentions to use eHealth services varied greatly. Participants were often unaware of the availability of services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.

Introduction: This study aimed to validate the psychometric properties of the German eHealth Impact Questionnaire (eHIQ-G), which is divided into two independently administered and scored parts. Methods: 162 people with MS browsed one of two possible websites containing information on MS and completed an online survey. Internal consistency was assessed by Cronbach’s alpha and structural validity by Confirmatory Factor Analysis. Construct validity was examined by assessing correlations with the eHealth Literacy Questionnaire and the General Self-Efficacy Scale. Moreover, the mean difference of the eHIQ-G score between the two websites was investigated. Results: Cronbach’s alpha for the eHIQ-G subscales ranged from .833 to .885. The eHIQ-G part 1 achieved acceptable levels of goodness-of-fit indices, whereas the fit for the eHIQ-G part 2 was poor and likewise for the alternative modified models. The correlations with the reference instruments were 0.08 – 0.62 and as expected. Older age was related with lower eHIQ-G part 1 score, whereas no significant effect was found for education. Although not significant, the website ‘AMSEL’ reached higher mean scores on eHIQ part 2. Conclusion: The eHIQ-G has good internal consistency, and sufficient structural and construct validity. It will facilitate the measurement of the impact of websites providing health information.

Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or who cannot access in-person MBIs in their communities. The objective of this study was to determine if eHealth is a viable platform to increase accessibility to MBIs for teens with chronic illnesses. This study reports the qualitative results of a mixed method randomized trial describing the experience of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program, an 8-week MBI, delivered either in person or via eHealth. Participants were adolescents between the ages of 13 and 18 with a chronic illness recruited at a tertiary pediatric hospital in Toronto, Canada. Individual semi-structured post-participation audio-video interviews were conducted by a research assistant. A multiple-pass inductive process was used to review interview transcripts and interpret emergent themes from the participants’ lived experiences. Fifteen participants completed post-participation interviews. Four distinct themes emerged from participants in both the in-person and eHealth groups: creation of a safe space, fostering peer support and connection, integration of mindfulness skills into daily life and improved well-being through the application of mindfulness. Results from this study suggest that eHealth may be an acceptable and feasible mode of delivery for MBIs in adolescents with chronic illnesses. EHealth should be considered in future studies as a promising avenue to increase access to MBIs in this population.

Objective: This study aimed to determine impact of eHealth literacy on health promotion activities and preventive health practice among adolescents. Methods: This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face to face questionnaire form including socio demographic characteristics, preventive health practices, eHealth Literacy scale and Adolescent Health Promotion Scale were used. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis and multiple regression analysis were used in the analyzes. The p<0.05 value was considered statistically significant in the evaluations. Results: In the study, 55.8% were female and the mean age of the whole group was 16.09±2.63 years. The mean score of eHealth Literacy scale was 29.40±6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97±21.87. Among the adolescents 96.0% didn’t use alcohol and 81% didn’t smoke. The rate of annual weight measure was 68.8%. Measurements of annual blood pressure, annual blood iron, annual cholesterol, annual dental examination and regular exercise rate were below 50%. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p<0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy was positively and significantly predicts health promotion behaviors (β= 0.27, t (695)= 7.54, p<0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β=0.13), the annual blood iron measurement by more than 0.16 (β=0.16), annual dental examination by more than 0.11 (β=0.11). Conclusions: Adolescents ehealth literacy was high and effected via health promotion activities and preventive health practices. Developing eHealth litracy interventions will be important for environments with a high concentration of adolescents (schools, courses). Also, primary health care services should be entegrated with school environment.

Worldwide, it is estimated that at least 1 in 4 adults suffers from hypertension, and this number is expected to increase as populations grow and age. Blood pressure (BP) possesses substantial heritability, but is also heavily modulated by lifestyle factors. As such, digital, lifestyle-based in-terventions are a promising alternative to standard care for hypertension prevention and man-agement. In this study we assessed the prevalence of elevated and high BP in a Dutch general pop-ulation cohort undergoing a health screening, and observed the effects of a subsequent self-initiated, digitally-enabled lifestyle program on BP regulation. Baseline data were available for 348 participants, of which 56 had partaken in a BP-focused lifestyle program and got re-measured 10 months after the intervention. Participants with elevated SBP and DBP at baseline showed a mean decrease of 7.2 mmHg and 5.4 mmHg, respectively. Additionally, 70% and 72.5% of participants showed an improvement in systolic and diastolic BP at remeasurement. These improvements in BP are superior to those seen in other recent studies. The long-term sustainability and the efficacy of this and similar digital lifestyle interventions will need to be estab-lished in additional, larger studies.

Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educative counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasability study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone unsupervised during their daily routine over a period of 4 months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in the tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of .408, while the improvements on the THI were much smaller with an effect size of .168. Analysis on the user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively, reported a stronger improvement of the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.

The global need for rapid diagnostic methods for pathogen identification and antimicrobial susceptibility testing (AST) is underscored by the increasing bacterial resistance and limited therapeutic options, especially critical in sepsis management. The evolution from traditional phenotype-based methods to rapid molecular and mass spectrometry techniques has significantly decreased result turnaround times, improving patient outcomes. Despite advancements, the complex decision-making in antimicrobial therapy often exceeds the capacity of many clinicians, highlighting the importance of antimicrobial stewardship programs (ASP). These programs, integrating mHealth and eHealth, leverage technology to enhance healthcare services and patient outcomes, particularly in remote or resource-limited settings. However, the application of such technologies in antimicrobial management remains underexplored in hospitals. The development of platforms combining antimicrobial prescription data with pharmacotherapeutic algorithms and laboratory integration can significantly reduce costs and improve hospitalization times and mortality rates. Yet, the effectiveness of empirical antibiotic therapy, influenced by rapid diagnostic tests, becomes cost-effective when error rates exceed 20%, emphasizing the need for technological integration in ASPs to combat the rising challenge of antimicrobial resistance (AMR) and healthcare sustainability.

eHealth applications are an essential component in achieving Universal Health Coverage. (1) Background: The lack of skilled healthcare personnel has hindered successful integration and use, especially in developing and low and middle-income countries. (2) Methods: A descriptive study was conducted using an online survey to collect quantitative data from 37 organizations to address this issue. (3) Results: The findings showed that there are limited training opportunities available for policymakers and eHealth specialists. Additionally, obstacles such as insufficient funds, inadequate infrastructure, poor leadership, and governance were identified and found to be context specific. To mitigate these challenges, the study proposed continuous in-service training, the implementation of computer-based systems, and the integration of academic modules. The importance of strong eHealth policies and committed leaders was also emphasized. (4) Conclusions: The results of this study support previous research and emphasize the importance of implementing practical and uncomplicated solutions to overcome eHealth barriers to capacity building in low- and middle-income countries. It is essential to recognize that the data collected for this study only pertains to BETTEReHEALTH.

Critically the paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. The paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating both the health system to move towards more socially inclusive e-health solutions.

Data collection and analysis are becoming more and more important in a variety of application domains as long as the novel technologies advance. At the same time, we are experiencing a growing need for human-machine interaction with expert systems pushing research through new knowledge representation models and interaction paradigms. In particular, in the last years eHealth - that indicates all the health-care practices supported by electronic elaboration and remote communications - calls for the availability of smart environment and big computational resources. The aim of this paper is to introduce the HOLMeS (Health On-Line Medical Suggestions) framework. The introduced system proposes to change the eHealth paradigm where a trained machine learning algorithm, deployed on a cluster-computing environment, provides medical suggestion via both chat-bot and web-app modules. The chat-bot, based on deep learning approaches, is able to overcome the limitation of biased interaction between users and software, exhibiting a human-like behavior. Results demonstrate the effectiveness of the machine learning algorithms showing 74.65% of Area Under ROC Curve (AUC) when first-level features are used to assess the occurrence of different prevention pathways. When disease-specific features are added, HOLMeS shows 86.78% of AUC achieving a more specific prevention pathway evaluation.

New digital interventions have shown potential in managing asthma and improving patients' quality of life compared with conventional interventions. Our objective was to conduct an exhaustive survey of the application of digital health technologies in evaluating, treating, and self-managing psychological and psychopathological elements linked to asthma. We analyzed a compendium of research papers and systematic reviews pertaining to asthma, encompassing themes such as outdoor air pollution, early life wheezing disorders, atopic dermatitis, digital strategies for asthma self-management, psychiatric conditions and asthma, familial impacts on pediatric asthma, and the utilization of mobile health apps for managing asthma. We scrutinized eight chosen studies to evaluate the capacity of digital health technologies to enhance the man-agement and treatment outcomes of psychological factors related to asthma. The studies under review indicate that eHealth interventions, mixed reality instruments, mHealth technolo-gy-augmented nurse-led interventions, and smartphone apps incorporating Bluetooth-enabled sensors for asthma inhalers can markedly enhance self-management of symptoms, quality of life, and mental health outcomes, particularly in children and adolescents with asthma. Nonetheless, additional research is required to ascertain their efficacy and practicability across diverse populations and environments. Customized interventions that cater to the unique needs and preferences of asthma patients and associated psychological elements are vital to ensure the persistent and equitable adoption of these technologies. We underscore the significance of addressing psychological elements in the management and treatment of asthma and advocate for ongoing research and development in this domain.

The worldwide population is undergoing a fundamental change in its age structure, which challenges the health and social services system. The need to migrate towards a more person-centered and coordinated model of care that supports the optimization of abilities and capacities for older people has to be matched. In this sense, eHealth technologies can play a fundamental role. In this paper, through a questionnaire-based data collection on 30 primary (older people) and 32 secondary (informal caregivers) end-users, we share the sustainable way to develop a product optimizing the user experience and ensuring adoption. Both older adults and caregivers consider the use of smartphone and smartwatch to be very important, but also the use of digital devices for healthcare can be helpful. Seniors care about self-monitoring of health parameters using wearable devices, regardless of their health status, and would like to be included in the process of making good health decisions, because they need to feel in control of their healthcare process. Digital solutions in health and care can support the wellbeing of older adults in many areas of their daily lives at home and in their communities, but only if such innovation is designed around the natural voice of the intended target.

Amid to the COVID-19 pandemic, digital health literacy (DHL) has become a significant public health concern. This research aims to assess information seeking behavior, as well as the ability to find relevant information and deal with DHL among university students in Pakistan. An online-based cross-sectional survey, using a web-based interviewing technique, was conducted to collect data on DHL. Simple bivariate and multivariate linear regression was performed to assess the association of key characteristics with DHL. The results show a high DHL related to COVID-19 in 54.3% of students. Most of the Pakistani students demonstrated ~50% DHL in all dimensions, except of reliability. Multivariate findings showed that gender, sense of coherence and importance of information were found to be significantly associated with DHL. However, a negative association was observed with students’ satisfaction with information. This led to the conclusion that critical operational and navigations skills are essential to achieve COVID-19 DHL and cope with stress, particularly to promote both personal and community health. Focused interventions and strategies should be designed to enhance DHL amongst university students to combat the pandemic.

Based on the demographic shift and the related challenges resulting from the growing number of elderly and persons with chronic diseases, the idea of smart home that supports its inhabitants in the daily life, gains importance. The purpose of this paper was to examine in a prototypic Ambient Assisted Living environment if users after interaction with different health-supporting applications intend to use such in the future. Two experimental studies exemplary show possible applications of home-integrated technology that can support, assist and accompany the target group in different contexts, and examine to what extent participants are willing to future use such sophisticated technology at home. The results show that people in general, but especially the old and chronically ill ones are quite fascinated of health-supporting ambient technology and the majority intends to use such ambient assistance in the future (study I). Moreover, serious games for healthcare are shown as a hedonic use of technology in smart homes that have a great potential to retain or improve the physical health, mobility and the overall well-being of the inhabitants (study II). The article provides two examples of ambient technology to leverage the demographic change and presents important user factors for facilitating high user acceptance.

Health literacy describes skills and competencies that enable people to gain access to, understand and apply health information to positively influence their own health and the health of those in the social environment. In an increasingly media saturated and digitized world, these skill sets are necessary for accessing and navigating sources of health information and tools, such as television, the Internet, and mobile apps. The concepts of Media Health Literacy (MHL) and eHealth Literacy (eHL) describe the specific competencies such tasks require. This article introduces the two concepts, and then reviews findings on the associations of MHL and eHL with several contextual variables in the social environment such as socio-demographics, social support, and system complexity, as a structural variable. As eHL and MHL are crucial for empowering people to actively engage in their own health, a growing body of literature reports of the potential and the effectiveness of intervention initiatives to positively influence these competencies. From an ethical standpoint, equity is emphasized, stressing the importance of accessible media environments for all - including those at risk of exclusion from (digital) media sources. Alignment of micro and macro contextual spheres will ultimately facilitate both non-digital and digital media to effectively support and promote public health.

This paper outlines the ongoing development of a specialised mobile application to address the mental health needs of vulnerable populations in the European Union (EU). Conducted as a mixed-methods research within two EU Science and Technology Cooperation Actions, the study prioritises stakeholder feedback to identify features for initial testing and strategies to improve application uptake, using critical digital health analysis. With a focus on marginalised groups such as refugees, migrants and socio-economically disadvantaged individuals, the application aims to provide an accessible and culturally sensitive platform for mental health support, integrating evidence-based interventions such as cognitive behavioural techniques and mindfulness exercises. Key features include multilingual support, habit tracking, personalised recommendations for support and services, and real-time crisis intervention. Collaboration with stakeholders and ongoing rigorous usability testing are driving the refinement process to ensure usability, acceptability and effectiveness, underscoring the importance of user engagement in technology-based mental health interventions in the EU context and highlighting the importance of collaborative science and technology for societal benefit.