Janssen Ricky, Engel Nora, Krumeich Anja, Esmail Aliasgar, Dheda Keertan, Thomas Réjean, Pant Pai Nitika
Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Mental Health and Neuroscience Research Institute (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
PLOS Glob Public Health. 2025 Sep 10;5(9):e0005034. doi: 10.1371/journal.pgph.0005034. eCollection 2025.
For digital health interventions, the "gold standard" of evaluating effectiveness is the randomized control trial (RCT). Yet, RCT methodology presents issues such as precluding changes to the technology during the study period as well as the use of study settings that do not reflect "real world" contexts. In this paper, we draw on empirical material from our ethnographic research on an app-based program called HIVSmart!, which is a digital strategy designed to support people in the process of HIV self-testing. We explore how this digital health approach was made to work in different contexts, and what this means for monitoring and evaluation of digital health interventions. Our analysis reveals that making technology which is "ease to use" depends on various user practices developed over time and the multiple, shifting users who define this ease of use. Furthermore, it shows that asking whether an app is "working" provides different answers at different moments, as the technology, as well as the human and physical supports around it, change and adapt over time. Therefore, questions around the feasibility of the technology, as well as ongoing monitoring efforts, need to be developed in a way that capture this fluctuation in the technology and its surroundings. Based on our insights, we contribute to implementation science approaches in the field of digital health by putting forward recommendations regarding how we can assess the effectiveness of digital health tools.
对于数字健康干预措施而言，评估有效性的“黄金标准”是随机对照试验（RCT）。然而，随机对照试验方法存在一些问题，比如在研究期间不允许对技术进行更改，以及使用的研究环境不能反映“现实世界”的情况。在本文中，我们借鉴了对一款名为HIVSmart!的基于应用程序的项目进行人种志研究的实证材料，该项目是一项旨在支持人们进行HIV自我检测的数字策略。我们探讨了这种数字健康方法是如何在不同背景下发挥作用的，以及这对数字健康干预措施的监测和评估意味着什么。我们的分析表明，使技术“易于使用”取决于随着时间推移形成的各种用户实践以及定义这种易用性的众多、不断变化的用户。此外，分析还表明，询问一款应用程序是否“有效”在不同时刻会得到不同答案，因为技术以及其周围的人力和物质支持会随着时间变化和调整。因此，围绕技术可行性以及持续监测工作的问题，需要以能够捕捉技术及其周围环境这种波动的方式来提出。基于我们的见解，我们通过就如何评估数字健康工具的有效性提出建议，为数字健康领域的实施科学方法做出贡献。
