Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.
Department of Nursing, School of Health and Welfare, Jönköping Academy, Jönköping University, Jönköping, Sweden.
Front Public Health. 2022 Jul 22;10:883315. doi: 10.3389/fpubh.2022.883315. eCollection 2022.
Digital health interventions (DHIs) have become essential complementary solutions in health care to enhance support and communication at a distance, with evidence of improving patient outcomes. Improving clinical outcomes is a major determinant of success in any health intervention, influencing its funding, development, adoption and implementation in real-world practice. In this article we explore our experiences of developing and testing DHIs to identify and discuss complexity challenges along their intervention research lifecycle. Informed by the case study research approach, we selected three individual DHIs aimed at satisfying the supportive and educational needs of people living with cancer. The Care Expert, the Digi-Do and the Gatapp were underpinned on different complexity frameworks i.e., the Medical Research Council framework and the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework. This variance on the methodological underpinning was expected to prompt a multifaceted discussion on the complexity dimensions endorsed by each of the frameworks. Our discussion endorses the adoption of mixed-methods research designs, to gather the perspectives of stakeholders and end-users, as well as pragmatic evaluation approaches that value effectiveness outcomes as much as process outcomes. Furthermore, the dissemination and sustainability agenda of DHIs needs to be considered from early-stage development with the inclusion of a business model. This business plan should be worked in partnership with healthcare services, regulatory bodies and industry, aiming to assure the management of the DHI throughout time.
数字健康干预（DHIs）已成为医疗保健中必不可少的补充解决方案，可增强远程支持和沟通，并有证据表明可改善患者的治疗效果。改善临床治疗效果是任何健康干预措施取得成功的主要决定因素，影响其资金、开发、采用和在实际实践中的实施。在本文中，我们探讨了我们开发和测试 DHIs 的经验，以确定并讨论其干预研究生命周期中的复杂性挑战。我们采用案例研究方法，选择了三种旨在满足癌症患者支持和教育需求的个体数字健康干预措施。Care Expert、Digi-Do 和 Gatapp 分别基于不同的复杂性框架，即医学研究委员会框架和不采用、放弃、扩展、传播和可持续性框架。这种方法基础上的差异预计将引发关于每个框架所支持的复杂性维度的多方面讨论。我们的讨论支持采用混合方法研究设计，以收集利益相关者和最终用户的观点，以及重视效果结果与过程结果的实用评估方法。此外，DHIs 的传播和可持续性议程需要从早期开发阶段考虑，纳入商业模式。该商业模式应与医疗保健服务、监管机构和行业合作制定，旨在确保整个数字健康干预的管理。
