Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: · NCT02603536 – November 11, 2015· NCT01549457 – March 9, 2012

Background Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mobile Health (mHealth) Research Group modified the existing consolidated framework for implementation research (CFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. The objective is to identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methods Both qualitative and descriptive quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders. The mCFIR tool consists of 5 Domains and 25 constructs and was distributed through Qualtrics Experience Management (XM). “Performance” and “Importance” scores were valued on a scale of 0 to 10 (Mean ± SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Results We observed a parallel trend in the scores of Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 ± 0.5 and 8.6 ± 0.6, respectively) and Performance (7.6 ± 0.7 and 7.2 ± 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 ± 0.4 and 5.6 ± 1.8). The thematic analysis produced the following themes: for areas of strengths, the themes brought up were timely diagnosis and response, cost-effectiveness, and user-friendliness. As for areas for improvement, the themes discussed were training, phone accessibility, stakeholder engagement, and literacy. Conclusion The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Amongst several important findings, we observed the value of bringing the perspectives of both end users (HCPs and patients) to the table across Domains. Trial Registration: NCT02603536 – November 11, 2015: WelTelOAKTREE: Text Messaging to Support Patients With HIV/AIDS in British Columbia (WelTelOAKTREE). NCT01549457 – March 9, 2012: TB mHealth Study—Use of Cell Phones to Improve Compliance in Patients on LTBI Treatment.

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BACKGROUND As a result of the novel coronavirus 2019 (COVID-19) pandemic, fewer patients are able to communicate with their health care professionals due to widely encouraged physical distancing. This provides a unique opportunity to evaluate and test the effectiveness of virtual care globally, especially mobile phone facilitated health interventions, called mHealth. This review evaluates how this rapidly growing field of virtual care could be effective in a pandemic situation by using mHealth interventions to manage chronic diseases, in addition to filling gaps within the health care system that have arisen due to COVID-19. OBJECTIVE To synthesize the published information regarding mobile phone-based virtual care technologies for mHealth interventions implemented in previous pandemics and chronic care. This information can provide an evidence-base to the patient experience and public health virtual care approaches toward COVID-19 control and health services beyond the pandemic. METHODS For this rapid review, we included systematic reviews (restricted within the past 2 years), randomized control trials, controlled non-randomized clinical trials, prospective and retrospective cohort studies, and case control studies reporting on mHealth and telehealth technologies on chronic, non-communicable diseases and infectious disease outbreaks and patient centered clinical decision support tools (symptom checkers, chatbots, digital self-triage technologies). PubMed and Cochrane Systematic Libraries were searched for studies dated between 1973 (when the first mobile phone was invented) and August 10, 2020. AMSTAR2 was used to evaluate the quality of systematic reviews. RESULTS Of 4083 potentially relevant records, 130 meeting our inclusion criteria for this review. For virtual care and mHealth technologies managing patient care, the general consensus among systematic reviews was that there is mixed evidence evaluating its efficacy in improving overall health outcomes. Clinical trials assessing adherence to chronic diseases management strategies were the most promising. The inconsistency observed regarding the efficacy of mHealth and virtual care interventions stems from research study bias, dependence on self-reporting, small samples sizes, among many other factors. This noted inconsistency extended to mHealth and virtual care interventions used during pandemics, predominantly focusing on HIV. There have been no evaluations investigating the effectiveness of digitalized case contact tracing during a pandemic or support for isolated individuals and/or health care workers. CONCLUSIONS Virtual care technologies could be effective in communicating crucial health care support and advice to patients managing chronic and infectious diseases, as well as individuals in self-isolation. There is no direct evidence regarding the use of virtual care technologies during a respiratory disease-based pandemic; however, reviewing available literature can provide insights into effective virtual care interventions for implementation during a pandemic such as COVID-19. CLINICALTRIAL N/A

Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012