Background Digital health technology (DHT) has the potential to revolutionize health care delivery. However, the uptake of DHT has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular care, are unclear. Objective We identified and synthesized the barriers to and facilitators of DHT uptake in cardiovascular care, with a focus on patient-, clinician-, and researcher-, level barriers and facilitators. Methods We searched MEDLINE, EMBASE and CINAHL databases for studies published from inception to May 2020 that reported barriers to and/or facilitators of DHT adoption in cardiovascular care. We conducted a thematic analysis to identify major themes pertaining to DHT uptake by patients, clinicians and researchers. Results The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Twenty-five (86.2%) studies reported patient-level barriers, which included difficult to use technology (n = 7), and poor internet connection (n = 7). Twenty-four (82.7%) studies reported patient-level facilitators, which included improved connection and communication with clinicians (n = 10), and personalized components within the technology (n = 6). Six (20.7%) studies reported clinician-level barriers, which included increased work and responsibilities (n = 4) and lack of integration with electronic medical records (n = 3). Four (13.8%) studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that were found to improve efficiency (n = 3). No studies reported researcher-level barriers or facilitators. Conclusion Identifying barriers to and facilitators of DHT could help improve its uptake in cardiovascular care. The findings of this study can be used to inform clinicians, and stakeholders who wish to develop and implement DHTs that meet the needs of clinicians and patients.

Objective The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. Methods Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. Results Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. Conclusions Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.

Background Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier. Methods Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18–25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review. Results Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns. Conclusions The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone—like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

Background: Among social media (SoMe) platforms, Twitter and YouTube have gained popularity, facilitating communication between cardiovascular professionals and patients. Objective: This mixed method systematic review aimed to assess the source profile and content of Twitter and YouTube posts about heart failure (HF). Methods: We searched PubMed, Embase and Medline using the terms “cardiology,” “social media,” and “heart failure.” We included full-text manuscripts published between January 1, 1999 and April 14, 2019. We searched Twitter and YouTube for posts using the hashtags “#heartfailure”, “#HF”, “#CHF” on May 15, 2019 and July 6, 2019. We performed a descriptive analysis of the data. Results:: Three publications met inclusion criteria, providing 677 tweets for source profile analysis; institutions (54.8%), health professionals (26.6%), and patients (19.4%) were the most common sources profiles. The publications provided 1194 tweets for content analysis: 83.3% were on education of professionals; 33.7% on patient empowerment; and 22.3% on research promotion. Our search of Twitter and YouTube generated 2,252 tweets and >400 videos, of which we analyzed 260 tweets and 260 videos. Sources included institutions (53.5% Twitter, 64.2% YouTube), health professionals (42.3%, 28.5%), and patients (4.2%, 7.3%). Content included education of professionals (39.2% Twitter, 62.3% YouTube), patient empowerment (20.4%, 21.9%), research promotion (28.8%, 13.1%), advocacy of professionals (5.8%, 2.7%), and research collaboration (5.8%, 0%). Conclusions: Twitter and YouTube are platforms for knowledge translation in HF, with contributions from institutions, health professionals, and less commonly, patients. Both focus largely on education of professionals and less commonly, on patient empowerment. Twitter includes more research promotion, research collaboration, and professional advocacy than YouTube.