JMIR Publications

ABSTRACT

Background:

With advances in digital health technologies, the concept of well-being has evolved. Understanding the values constituting well-being and addressing them in both design and evaluation processes is key to ensure a positive impact of digital health on well-being. Yet, often well-being is understood differently in these processes and this could limit the successful implementation of digital health. To increase the success rate of digital health, it is important to align the concept of well-being in the design and evaluation processes.

Objective:

A systematic scoping review was conducted to obtain insight into (1) the concept of well-being in digital health, (2) current practices and differences within design and evaluation of digital health (e.g., scope, target user), and (3) how practice deals with theory on well-being. We also aimed to (4) provide recommendations for future practitioners to optimize digital health for well-being by aligning design with evaluation.

Methods:

We followed Preferred Reporting Items for Systematic reviews and MetaAnalyses extension for Scoping Reviews. Papers were extracted from six databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patients’ well-being as their purpose. Data were divided into design and evaluation papers and extracted guided by a theoretical framework on four problems in technology for well-being: the epistemological problem, the scope problem, the specification problem, and the aggregation problem.

Results:

A total of 117 studies were eligible for analysis (46 design, 71 evaluation papers). Epistemological problem: the thematic analysis resulted in various definitions of well-being grouped into seven values: Healthy Body, Functional Me, Healthy Mind, Happy Me, Social Me, Self-managing Me, and External Conditions. Design papers mostly considered well-being as Healthy Body and Self-Managing Me while evaluation papers considered the values of Healthy Mind and Happy Me. Users were rarely involved in defining well-being. Scope problem: Patients with chronic care needs were commonly considered as main users. Design papers also regularly involved other users such as caregivers and relatives. These were not often involved in evaluation papers. Specification problem: Most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods. Evaluation papers mostly considered pre-post measurements or randomized controlled trials. Aggregation problem: Value conflicts were rarely described.

Conclusions:

Major differences exist between design and evaluation of digital health, particularly in their considered intended digital health outcomes, research methodologies, and involved users. Recommendations were provided for aligning these processes. The same concept of well-being should be shared in both processes as an intervention outcome. Evaluation should enlarge its study scope into the subjective effects of digital health on a variety of users. Also, design outcomes should be used as input for evaluation and vice versa.