Publications
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Tudor Car L, 2022, Digital education for health professionals: An evidence map, conceptual framework and research agenda, Journal of Medical Internet Research, Vol: 24, Pages: 1-21, ISSN: 1438-8871
BackgroundHealth professions education has undergone major changes with the advent and adoption of digital technologies worldwide. To enable robust and relevant research in digital health professions education, it is essential to map the existing evidence, identify gaps and research priorities.MethodsWe searched for systematic reviews on digital education of practicing and student healthcare professionals. We searched Medline, Embase, Cochrane Library, ERIC, CINAHL, and grey literature sources from January 2014 to July 2020. Two authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empiric findings and research recommendations against a newly developed conceptual framework. ResultsWe identified 77 eligible systematic reviews. All included experimental studies and evaluated the effectiveness of digital education interventions in different healthcare disciplines or of different digital education modalities. Most reviews included studies on various digital education modalities (N=22), virtual reality (N=19) and online education (N=10). Most reviews focused on health professions education in general (N=36), surgery (N=13) and nursing (N=11). The reviews mainly assessed participants’ skills (N=51) and knowledge (N=49) and included data from high-income countries (N=53). Our novel conceptual framework of digital health professions education comprises six key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified in these reviews 61 unique questions for future research; these mapped to framework domains of education (29 recommendations), context (17), infrastructure (9), learners (3), and research (3). Conclusions We have identified a large number of research questions regarding digital educat
Martinengo L, Stona A-C, Car LT, et al., 2022, Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871
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- Citations: 6
Cousin E, Duncan BB, Stein C, et al., 2022, Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019, The Lancet Diabetes & Endocrinology, Vol: 10, Pages: 177-192, ISSN: 2213-8587
BackgroundDiabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals.FindingsIn 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−
Haowen J, Vimalesvaran S, King Wang J, et al., 2022, Virtual reality in medical students’ education: a scoping review, JMIR Medical Education, Vol: 8, Pages: 1-24, ISSN: 2369-3762
Purpose: Virtual reality (VR) is a digital education modality that produces a virtual manifestation of the real world and it has been increasingly used in medical education. As VR encompasses different modalities, tools and applications, there is a need to explore how VR has been employed in medical education. The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.Method: We performed a search of 4 bibliographic databases in December 2020, with data extracted using a standardized data extraction form. The data was narratively synthesized and reported in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Results: Of 114 included studies, 69 studies (61%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15 [14%]) and virtual worlds (20 [18%]), mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68 [60%]) and of high interactivity (79 [70%]). There is limited evidence on the use of more novel VR modalities such as mobile VR and virtual dissection tables (8 [7%]), as well as the use of VR for training of non-surgical and non-psychomotor skills (20 [18%]) or in group setting (16 [14%]). Only 3 studies reported the use conceptual frameworks or theories in the design of VR.Conclusion: Despite extensive research available on VR in medical education, there continues to be important gaps in the evidence. Future studies should explore the use of VR for the development of non-psychomotor skills and in areas other than surgery and anatomy.
Keller R, Hartmann S, Teepe GW, et al., 2022, Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871
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- Citations: 7
Soon MKS, Martinengo L, Lu J, et al., 2021, Telegram Education for Surgical Learning and Application (TESLA): An exploratory study (Preprint)
<sec> <title>BACKGROUND</title> <p>The COVID-19 pandemic disrupted medical education, shifting a huge portion of learning online. Social media platforms have long been well-integrated into medical education. However, Telegram’s role in medical education remains relatively unexplored. A Telegram channel titled “Telegram Education for Surgery Learning and Application (TESLA)” focusing on General Surgery education was created to supplement medical students’ learning. It encompassed weekly multiple-choice questions and resources such as illustrations and journal articles.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study explored students’ experience of TESLA and their views on the role of messaging apps in medical education.</p> </sec> <sec> <title>METHODS</title> <p>We invited thirteen medical students from Lee Kong Chian School of Medicine, Singapore who were in the TESLA channel for at least a month to participate in individual semi-structured interviews. The interviews were conducted via video conference using an interview guide. Interviews were transcribed and analysed by two researchers using inductive thematic content analysis.</p> </sec> <sec> <title>RESULTS</title> <p>Three themes were identified: (1) Learning as a medical student, (2) The role of mobile learning in medical education and (3) TESLA for surgical education. Students shared that pandemic-related safety measures such as reduced clinic allocations and the inability to cross between wards led to a decrease in clinical exposure. Student
Tan BY, Thach T, Munro YL, et al., 2021, Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 18
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- Citations: 4
Ollier J, Neff S, Dworschak C, et al., 2021, Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol (vol 9, 625640,2021), FRONTIERS IN PUBLIC HEALTH, Vol: 9
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- Citations: 1
Car LT, Teng YS, How JW, et al., 2021, Priorities for family physician and general practitioner recruitment and retention in Singapore: a PRIORITIZE study, BMC FAMILY PRACTICE, Vol: 22
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- Citations: 2
Jiang H, Vimalesvaran S, Wang JK, et al., 2021, Virtual Reality in Medical Students’ Education: Scoping Review (Preprint)
<sec> <title>BACKGROUND</title> <p>Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.</p> </sec> <sec> <title>METHODS</title> <p>We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.</p> </sec> <sec> <title>RESULTS</title> <p>Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or
Dhinagaran DA, Sathish T, Kowatsch T, et al., 2021, Public perceptions of diabetes, healthy living and conversational agents in Singapore: a needs assessment, JMIR Formative Research, Vol: 5, Pages: 1-15, ISSN: 2561-326X
Background:The incidence of chronic diseases such as type 2 diabetes is on the rise in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. Yet ongoing personalised guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology such as conversational agents are a potential alternative for delivery of healthy lifestyle change behavioural interventions to the public.Objective:We explored Singaporeans’ perceptions on and experience of healthy living, diabetes and mobile health interventions (apps and conversational agents). This survey was done to help inform the design and development of a conversational agent focusing on healthy lifestyle change.Methods:This qualitative study was conducted over Aug and Sept 2019. 20 participants were recruited from relevant healthy living Facebook pages and groups. Semi-structured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analysed in parallel by two researchers using Burnard’s method, a structured approach for thematic content analysis.Results:The collected data was organised into four main themes: (1) use of conversational agents, (2) ubiquity of smartphone applications, (3) understanding of diabetes and (4) barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile applications as well as conversational agents unrelated to healthcare. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. In terms of barriers to healthy living, frequent dining out, high stress levels, lack of work-life balance and dearth of free time to engage in physical activity were mentioned. In contrast, discipline, pre
Ward JL, Azzopardi PS, Francis KL, et al., 2021, Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 1593-1618, ISSN: 0140-6736
BackgroundDocumentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).FindingsIn 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or mater
Ollier J, Neff S, Dworschak C, et al., 2021, Elena plus Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol, FRONTIERS IN PUBLIC HEALTH, Vol: 9
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- Citations: 7
Micah AE, Cogswell IE, Cunningham B, et al., 2021, Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050, The Lancet, Vol: 398, Pages: 1317-1343, ISSN: 0140-6736
BackgroundThe rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.MethodsWe estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.FindingsIn 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geogra
Teepe GW, Da Fonseca A, Kleim B, et al., 2021, Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871
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- Citations: 16
Keller R, Hartmann S, Teepe GW, et al., 2021, Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis (Preprint)
<sec> <title>BACKGROUND</title> <p>Advancements in technology offer new opportunities for the prevention and management of type 2 diabetes. Venture capital companies have been investing in digital diabetes companies that offer digital behavior change interventions (DBCIs). However, little is known about the scientific evidence underpinning such interventions or the degree to which these interventions leverage novel technology-driven automated developments such as conversational agents (CAs) or just-in-time adaptive intervention (JITAI) approaches.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our objectives were to identify the top-funded companies offering DBCIs for type 2 diabetes management and prevention, review the level of scientific evidence underpinning the DBCIs, identify which DBCIs are recognized as evidence-based programs by quality assurance authorities, and examine the degree to which these DBCIs include novel automated approaches such as CAs and JITAI mechanisms.</p> </sec> <sec> <title>METHODS</title> <p>A systematic search was conducted using 2 venture capital databases (Crunchbase Pro and Pitchbook) to identify the top-funded companies offering interventions for type 2 diabetes prevention and management. Scientific publications relating to the identified DBCIs were identified via PubMed, Google Scholar, and the DBCIs’ websites, and data regarding intervention effectiveness were extracted. The Diabetes Prevention Recognition Program (DPRP) of the Center for Disease Control and Prevention in the United States was used to identify the recognition status. The DBCIs’ publications, websites, and mobile apps were reviewed with regard to
Paulson KR, Kamath AM, Alam T, et al., 2021, Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 870-905, ISSN: 0140-6736
BackgroundSustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.MethodsWe completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.FindingsGlobal U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019.
Tudor Car L, Myint Kyaw B, Nannan Panday RS, et al., 2021, Digital health training programs for medical students: a scoping review, Journal of Medical Internet Research, Vol: 7, Pages: 1-11, ISSN: 1438-8871
Background: Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. This review collated and analyzed the literature evaluating digital health education for medical students to inform development of future courses and identify areas where curricula may need to be strengthened.Methods: We carried out a scoping review following the Joanna Briggs Institute’s guidance and reported in line with PRISMA-ScR guidelines. We searched six major bibliographic databases and grey literature sources for the articles published from January 2000 to November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussion between the authors. The findings were analyzed using thematic analysis and presented narratively.Results: A total of 34 studies focusing on different digital courses were included in this review. Most (n=22) were published from 2010 to 2019 and originated from the US (n=20). The reported digital health courses were mostly elective (n=20), integrated into the existing curriculum (n=24) and focused mainly on medical informatics (n=17). Most of the courses targeted medical students from first to third year (n=17) and the duration of the courses ranged from an hour to three academic years. Most (n=22) reported the use of blended education. Six of 34 delivered courses entirely digitally using online modules, offline learning, Massive Open Online Courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in person observations and/or online-based assessment. Thirty studies evaluated courses mostly using uncontrolled before and after design and generally reported improvements in students’ learning outcomes. ConclusionsDigital health courses reported in the literature were mostly elective, focused on a single area of digital health and lac
Tudor Car L, 2021, The choice of behavioral change techniques in conversational agents in healthcare: a scoping review protocol, JMIR Research Protocols, Vol: 10, Pages: 1-5, ISSN: 1929-0748
Background:Conversational agents or chatbots are computer programs that simulate conversations with users. Conversational agents are increasingly used for delivery of behavior change interventions in health care. Behavior change is complex and comprises the use of one or several components collectively known as behavioral change techniques (BCTs).Objective:The objective of this scoping review is to identify the BCTs that are used in behavior change–focused interventions delivered via conversational agents in health care.Methods:This scoping review will be performed in line with the Joanna Briggs Institute methodology and will be reported according to the PRISMA extension for scoping reviews guidelines. We will perform a comprehensive search of electronic databases and grey literature sources, and will check the reference lists of included studies for additional relevant studies. The screening and data extraction will be performed independently and in parallel by two review authors. Discrepancies will be resolved through consensus or discussion with a third review author. We will use a data extraction form congruent with the key themes and aims of this scoping review. BCTs employed in the included studies will be coded in line with BCT Taxonomy v1. We will analyze the data qualitatively and present it in diagrammatic or tabular form, alongside a narrative summary.Results:To date, we have designed the search strategy and performed the search on April 26, 2021. The first round of screening of retrieved articles is planned to begin soon.Conclusions:Using appropriate BCTs in the design and delivery of health care interventions via conversational agents is essential to improve long-term outcomes. Our findings will serve to inform the development of future interventions in this area.International Registered Report Identifier (IRRID):PRR1-10.2196/30166JMIR Res Protoc 2021;10(7):e30166
See YKC, Smith HE, Car LT, et al., 2021, Health literacy and health outcomes in patients with low back pain: a scoping review, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol: 21
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- Citations: 4
Tudor Car L, Kyaw BM, Nannan Panday RS, et al., 2021, Digital Health Training Programs for Medical Students: Scoping Review (Preprint), DH
<sec> <title>BACKGROUND</title> <p>Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened.</p> </sec> <sec> <title>METHODS</title> <p>We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) wer
Tudor Car L, 2021, Virtual reality in medical students’ education: A scoping review protocol, BMJ Open, Vol: ``, Pages: 1-5, ISSN: 2044-6055
Background Virtual reality (VR) is a technology that produces a virtual manifestation of the real world. In recent years, VR has been increasingly used as a tool in medical education. The use of VR in medical education has large potential, as it allows for distance learning and training which may be challenging to deliver in real life. VR encompasses different tools and applications. There is a need to explore how VR has been employed in medical education to date.Objective The objective of this scoping review is to conceptualise the VR tools available and the applications of VR in undergraduate medical education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research.Methods and analysis The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping studies. A comprehensive search from a total of six electronic databases and grey literature sources will be performed. The reference list of included studies will be screened for additional studies. The screening and data extraction will be done in parallel and independently by two review authors. Any discrepancies will be resolved through consensus or discussion with a third review author. A data extraction form has been developed using key themes from the research questions. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews reporting guidelines.Ethics and dissemination All data will be collected from published and grey literature. Ethics approval is therefore not a requirement. We will present our findings at relevant conferences and submit them for publications in peer-reviewed journals.
Ng DY, Tudor Car L, Ng MJM, et al., 2021, Identifying barriers to early presentation in patients with locally advanced breast cancer (LABC) in Northern Singapore: qualitative study, PLoS One, Vol: 16, ISSN: 1932-6203
Introduction:Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC).Materials & methods:A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis.Results:Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme.Conclusions:Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.
Dhinagaran DA, Sathish T, Kowatsch T, et al., 2021, Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment (Preprint)
<sec> <title>BACKGROUND</title> <p>The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public.</p> </sec> <sec> <title>OBJECTIVE</title> <p>We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes.</p> </sec> <sec> <title>METHODS</title> <p>This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis.</p> </sec> <sec> <title>RESULTS</title> <p>The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of
Martinengo L, Lo NYW, Goh WIWT, et al., 2021, Choice of Behavioral Change Techniques in Health Care Conversational Agents: Protocol for a Scoping Review (Preprint)
<sec> <title>BACKGROUND</title> <p>Conversational agents or chatbots are computer programs that simulate conversations with users. Conversational agents are increasingly used for delivery of behavior change interventions in health care. Behavior change is complex and comprises the use of one or several components collectively known as behavioral change techniques (BCTs).</p> </sec> <sec> <title>OBJECTIVE</title> <p>The objective of this scoping review is to identify the BCTs that are used in behavior change–focused interventions delivered via conversational agents in health care.</p> </sec> <sec> <title>METHODS</title> <p>This scoping review will be performed in line with the Joanna Briggs Institute methodology and will be reported according to the PRISMA extension for scoping reviews guidelines. We will perform a comprehensive search of electronic databases and grey literature sources, and will check the reference lists of included studies for additional relevant studies. The screening and data extraction will be performed independently and in parallel by two review authors. Discrepancies will be resolved through consensus or discussion with a third review author. We will use a data extraction form congruent with the key themes and aims of this scoping review. BCTs employed in the included studies will be coded in line with BCT Taxonomy v1. We will analyze the data qualitatively and present it in diagrammatic or tabular form, alongside a narrative summary.</p> </sec> <sec> <title>RESULTS</title> <p>To date, we have designed the s
Moenninghoff A, Kramer JN, Hess AJ, et al., 2021, Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871
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- Citations: 34
Tudor Car L, Kyaw BM, Teo A, et al., 2021, Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review (Preprint)
<sec> <title>BACKGROUND</title> <p>Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.</p> </sec> <sec> <title>METHODS</title> <p>We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.</p> </sec> <sec> <title>RESULTS</title> <p>Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (10
Teepe GW, Da Fonseca A, Kleim B, et al., 2021, Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review (Preprint)
<sec> <title>BACKGROUND</title> <p>The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual’s burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression.</p> </sec> <sec> <title>METHODS</title> <p>We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app’s website, information on the app’s website, and the app itself. All types of measurements (eg, open questions, cl
Martinengo L, Stona A-C, Tudor Car L, et al., 2021, Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines (Preprint)
<sec> <title>BACKGROUND</title> <p>Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores.</p> </sec> <sec> <title>METHODS</title> <p>A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics.</p> </sec>
Dhinagaran DA, Sathish T, Soong A, et al., 2021, Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study (Preprint)
<sec> <title>BACKGROUND</title> <p>The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore.</p> </sec> <sec> <title>METHODS</title> <p>We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants’ knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants’ satisfaction with, and usability of, the conversationa
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