Background Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.
Background The process of designing a digital health intervention (DHI)—also referred to as mobile health or eHealth—spans needs assessments, technical functionality and feasibility, user satisfaction, effectiveness, impact, and value. These interventions are causing a rapid evolution in the landscape of health care. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI design is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries, both of which approach, understand, and involve end users differently in the framing of a DHI. Objective The objective of this systematic review is to assess the challenges to incorporating end users in the design stage of digital health interventions, to identify key pain points, and to identify limitations and gaps for areas of future investigation. Methods The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist will be used to structure this protocol. A systematic search of the PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Scopus, and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results As of February 2021, we have completed a preliminary literature search examining challenges to the incorporation of end users in the design stage of DHIs. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by December 2021. Conclusions This systematic review aims to provide an effective summary of key pain points toward incorporating end users in DHIs. Results from this review will provide an evidence base for a better approach to end user involvement in the interest of improving efficacy and uptake of DHIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238164 International Registered Report Identifier (IRRID) PRR1-10.2196/28083
BACKGROUND Digital Health Interventions (DHIs) are rapidly evolving the landscape of healthcare. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI development is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries respectively, which approach, understand and involve end users differently in the framing of a DHI. OBJECTIVE The objective of this systematic review is to assess the challenges to incorporate end users in the development of digital health interventions, to identify emerging hybridised solutions, and to identify limitations and gaps for areas of future investigation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) will be used to structure this protocol. A systematic search of the PsycInfo, PubMed (Medline), Web of Science, CINAHL and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardised form and conduct quality appraisal. RESULTS As of February 2020, we have completed a preliminary literature search examining challenges to incorporate end users in the development of DHI. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by August 2021. CONCLUSIONS This systematic review aims to provide an effective summary of challenges to incorporate end users in the development of DHIs. Results from this review will provide an evidence base for a more harmonised approach to end users that satisfies the needs of healthcare outcomes and digital design and development respectively.
BACKGROUND Digital health represents an important strategy in the future of healthcare delivery. Over the past decade, mHealth has accelerated the agency of healthcare users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability and patience outcome. This challenge is confounded by two industries, DIGITAL and HEALTH, that have vastly different approaches to research, design, testing and implementation. In this regard, there is a need to examine prevailing design approaches, to weigh their benefits and challenges towards implementation, and to recommend a path forward that synthesises the needs of this complex stakeholder group. OBJECTIVE This review studies prominent digital health intervention (DHI) design approaches mediating the digital health space. In doing so, we seek to examine each methodology’s: origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios. METHODS A narrative synthesis approach to literature review was employed to review existing evidence. We searched indexed scientific literature using keywords relative to different digital health intervention designs. Papers selected after screening were those that discussed the design and implementation of digital health design approaches. RESULTS 120 papers on intervention design were selected for full-text review. We selected the 20 most prominent papers on each design approach, synthesizing findings under the categories of origins, advantages, disadvantages, challenges and cases. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented in order to harmonise the needs of a complex stakeholder group. Whether the primary stakeholder is positioned as the end-user/person/human/patient, the challenge to synthesise the constraints and affordances of both digital design and healthcare, built equally around user satisfaction and clinically efficacy remains paramount. Further research that works towards a transdisciplinarity in digital health may help to break down friction in this field. Until digital health is viewed as a hybridised industry with unique requirements rather than competing interests, the nuances that each design approach posits will be difficult to realise in a real world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, in order to create a better digital health culture and design ethos.
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