Summer Listening Series

The Moderating Effect of Health Literacy on the Impact of a Mobile Remote Monitoring Intervention with Tailored Messages for Breast Cancer Survivors: A Post Hoc Analysis of a Randomized Controlled Trial

Women with breast cancer starting adjuvant endocrine therapy were randomized to an app-based remote monitoring intervention with and without tailored educational messages versus enhanced usual care. Among participants with low health literacy randomized to the remote monitoring app with tailored messages, 80% had high AET adherence over 12 months compared with 42.1% in enhanced usual care (p=0.01); there were no significant differences by study arm for those with high health literacy.

Learning Outcomes

• Understand the moderating effect of health literacy on the efficacy of a remote monitoring intervention on one-year adjuvant endocrine therapy adherence among women with early-stage breast cancer.

Speakers

• Ilana Graetz, Emory University

Key considerations regarding usability and effective mobile app integration into two electronic health record systems

Substitutable Medical Applications and Reusable Technology (SMART)® Applications (app) that are compatible with the Fast Healthcare Interoperability Resources (FHIR)® are the standard for integrating mobile apps and electronic health records (EHR). Our team developed a SMART on FHIR mobile application, Info Viz for Health®, to support clinical HIV-related communication with diverse persons with HIV. Unfortunately, relatively little is known regarding clinician perspectives and preferences of mobile app integration with EHRs, which if not obtained, could render apps integrated into EHRs useless. Our study objectives were to explore the perceptions of clinical EHR users from both a developed (United States (US)) and a developing (Dominican Republic (DR)) setting regarding the usability of our app and identify key factors that researchers and designers should consider when creating apps to integrate with EHRs. We conducted semi-structured in-depth interviews with n=26 clinicians (n=13 per site) who provide HIV-related health education. Interviews were led with rigorously developed guides that contained questions based on Davis’s technology acceptance model and questions to explore characteristics of effective app integration. Interviews were analyzed using qualitative content analysis. Findings indicated high perceived usability of the Info Viz for Health app and several important considerations for effective integration of apps with EHRs were identified. Namely, apps integrated with EHRs must be easy and intuitive to access/use, and must leverage commonly used features of EHRs. These findings will provide valuable information for researchers, organizations, and/or other professionals designing health-related apps for EHR integration.

Learning Outcomes

• Identify and describe several important considerations while designing mobile applications for future integrations with EHR.

Speakers

• Samantha Stonbraker, PhD, MPH, RNz, University of Colorado College of Nursing

Examining Barriers to the Adoption of a Digital Mental Health Intervention: A Mixed-Methods Study using Thematic Analysis and Machine Learning

In our mixed-methods study, we examine barriers to the adoption of Digital Mental Health intervention (DMH) among young adults. We identified digital literacy, access, in-person interaction, and a need for personalization as barriers to DMH adoption. Machine learning insights highlight significant factors influencing engagement, including illegal drug use, and suicide ideation. We recommend integrating AI and real-time support into DMH services, tailored to young adults’ socio-cultural context, to enhance engagement and effectiveness.

Learning Outcomes

• Understand the underlying reason for college students' early dropout on digital mental health intervention (DMHI).

Speakers

• Ha Na Cho, Ph.D, University of California, Irvine

Computationally-guided Qualitative Analysis of User-Generated Data for Different Models of Mobile-Personal Health Records Apps

Mobile Personal Health Records (mPHR) are smartphone apps granting patients portable and continuous access to their medical records on the go, thereby increasing their potential to play an active role in managing their healthcare. An extensive body of literature has focused on understanding user(s) experiences with web-based tethered PHRs (i.e., Patient Portals) offered by healthcare organizations. However, patients' opinions of smartphone-based PHRs have received less attention. Our study aims to understand this gap. We used a computationally-guided qualitative analysis approach to identify latent topics indicating dimensions of user experiences present in app reviews left on popular m-PHR apps available on Google Play and Apple app stores. After following a detailed app selection process, 10 m-PHR, including tethered (n=6) and interconnected (n=4) apps, were selected for analysis. Our findings show similarities in user experiences for HCO-tethered PHRs and HCO-independent interconnected PHRs, and we discuss the design implications concerning the differences.

Learning Outcomes

• Identify the three levels of PHR integration.

Speakers

• Zainab Balogun, University of Maryland Baltimore County

Getting people access to services is also getting them access to a phone: Clarifying digital divide dynamics and their consequences in Community Mental Health Care

Access to mental healthcare is increasingly technologically-mediated. People with low socioeconomic status (SES) and serious mental illness (SMI) face lower rates of tech ownership and may lack technological skills, called digital divides. Yet, little is known about how digital divides may impact mental healthcare access. Therefore, a qualitative study (ethnographic observations and interviews) was conducted with staff working with low-SES SMI patients using community mental health care (CMH) (N=14). Findings showed that consumers struggled to maintain consistent internet—and thus mental healthcare—access despite owning smartphones. Consumers frequently faced care disruptions due to broken, lost, or uncharged phones. Staff and patients created effortful but ad-hoc workarounds to restore access during technological access disruptions. These solutions frequently occurred after healthcare appointments were missed. Digital divide concepts should accommodate the work necessary to maintain technology access even after ownership and its impact on care access—especially among low-SES SMI patients.

Learning Outcomes

• Understand how technology access and technology skills impact care access for low SES individuals with SMI.
• Identify ways consumers and care workers can accommodate technological disruptions to enable care access.

Speakers

• Alicia Williamson, School of Information, University of Michigan

Barriers and Facilitators of Digital Health Use for Self-Management of Hypertensive Disorders by Black Pregnant Women

Digital health is popular for managing health conditions; however, these applications are often developed with few considerations of the differences across user populations. Tailoring such applications to include cultural considerations could lead to better adoption and adherence in such programs, but a reproducible framework is needed. This study aims to capture Black women’s barriers and facilitators in self-managing hypertensive disorders of pregnancy (HDP) using digital health products. One-on-one interviews were conducted with 17 Black pregnant women with HDP using a semi-structured interview guide. Qualitative data obtained was analyzed using grounded theory and 38 codes were mapped within the four levels of the socioecological model of health. Themes were created that identified barriers and facilitators of the women’s pregnancy experiences and used to influence the feature development of a digital health intervention. Future work will instantiate and validate a framework that provides theoretical constructs for developing culturally tailored digital health interventions.

Learning Outcomes

• Understand the importance of considering cultural differences in their digital health and informatics took development.

Speakers

• Morgan Foreman, PhD Candidate, UTHealth Houston McWilliams SBMI & IBM Research

The rapid integration of Generative Artificial Intelligence (GenAI) into daily living has sent shockwaves throughout the world. Healthcare has seen an upsurge in the development of AI-enabled algorithms that have led to improvements in medical education, research, and practice. For example, remote exam proctors, patient-facing chatbots, EHR search engines, and practice management tools have been adopted by major health systems and academic institutions across the United States. These innovations are compelling us to adapt, adopt, and regulate swiftly. Although the potential and promise of integrating GenAI in healthcare are immense, there are some inherent risks and challenges, which require awareness and regulations. This panel will discuss the various applications of Gen AI in dentistry, especially as it relates to dental education, research, and practice. Dr. Sepideh Banava will discuss the applications of GenAI in dental education and clinical practice. Dr. Jay Patel will discuss its applications in dental research, specifically, developing, testing, and validating prediction models for dental diseases using large electronic dental record datasets. Dr. Enihomo Obadan-Udoh will discuss its potential applications in dental public health. This engaging and informative panel will sketch a realistic picture of GenAI use in academia and its potential to improve population health while suggesting intelligent strategies to make informed decisions.

Learning Outcomes

• List GenAI uses in dental education and practice.
• Outline the risks and challenges with the adoption of GenAI in dental education and practice.
• Discuss ethical issues in using GenAI in dental education and practice.
• Describe the uses of AI in various aspects of dental public health. 5. Discuss the ethical considerations for using AI in dental public health.

Speakers

• Enihomo Obadan-Udoh, DDS, MPH, Dr. Med. Sc., University of California San Francisco
• Sepideh Banava, DDS, MSc, MBA, DABDPH, Nationwide Children's Hospital

Climate change is a growing threat to global health, driving more frequent and intense heat waves, wildfires, disease shifts, and extreme weather. An estimated 3.6 billion people live in high-risk areas, with climate-related deaths projected to rise by 250,000 annually by 2030–2050, especially in low- and middle-income countries. This panel will explore how global health informatics can support data-driven decision-making, improve preparedness, and address data challenges to mitigate climate-related health impacts.

Speakers

• Felix Holl, PhD, MPH, M.Sc., FAMIA, Neu-Ulm University of Applied Sciences
• James Tcheng, MD, Duke University Health System
• Elizabeth Campbell, MS, MSPH, PhD, Columbia University Department of Biomedical Informatics
• Farah Magrabi, PhD, Macquarie University, Australian Institute of Health Innovation

This panel features six distinct discussions exploring how innovative technologies and data-driven approaches are advancing patient care and health system efficiency. Topics include blockchain-based self-sovereign identity and NFTs for secure, patient-controlled data sharing; improved classification of wearable sensor data using novel image representations and augmentation techniques; and a voice-activated self-monitoring app designed to aid individuals managing both diabetes and hypertension. Additional presentations examine integrating remote patient monitoring data with EHRs to predict emergency department visits, the use of wearable sensors to detect short-form video addiction through multi-modal domain adaptation, and barriers to adoption of a clinical decision support tool for emergency department discharge decisions in acute heart failure cases. Together, these sessions highlight emerging tools and frameworks aimed at enhancing health outcomes, patient autonomy, and system-level decision-making. 

Speakers

• Mohammad Arif Ul Alam, PhD, University of Massachusetts Lowell
• Matthew Christensen, MD, Vanderbilt University Medical Center
• Ashika Farzana, MS, Geisinger
• Mahmudur Rahman, PhD, University of Wisconsin-Madison
• Li Yang, MSM, University of Wisconsin-Milwaukee
• Yan Zhuang, PhD, Indiana University