The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review

Abstract

Background Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.

The Current Status of Secondary Use of Claims, Electronic Medical Records, and Electronic Health Records in Epidemiology in Japan: Narrative Literature Review

“…A total of 620 eligible articles were identified for this narrative literature review. Figure 2 [ 13 - 18 ] illustrates the selection process and the results of each screening step. We also illustrate the publication years of these articles in Multimedia Appendix 3 .…”

“… Search and screening process [ 13 - 18 ]. EHR: electronic health record; EMR: electronic medical record.…”

“…This is a comprehensive narrative literature review that investigated the secondary use of claims data, EMRs, and EHRs in epidemiology in Japan. Referring to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 13 ] and procedures used in previous review studies [ 14 - 18 ], we conducted this review by searching for biomedical articles in PubMed.…”

Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study

“…Finally, continued emphasis on the rigorous evaluation of digital innovations, especially in routine health service delivery settings, will strengthen the evidence base for mHealth optimization and expansion [ 8 ]. A comprehensive digital health monitoring and evaluation (M&E) process is critical for finding the right innovation for bridging an identified gap, with consistent and iterative assessment of progress to scale or discontinue activities [ 9 ].…”

“…There is also broad recognition that diverse users must be engaged in the design, development, delivery, and optimization of digital health innovations. User- or human-centered design (HCD) should better amplify the perspectives of HCWs [ 8 ]. Giving HCWs a strong voice in the development of apps designed to help them overcome challenges in health care delivery may offer solutions that contribute to sustained improvements in the quality of health care in LMICs [ 9 ], including those in SSA [ 10 , 11 ].…”