Hsiu-Ju Chang

Background: Digital sexually transmitted and blood-borne infection (STBBIs) testing services are used to improve testing access, but might replicate existing social inequities. Previous research has shown that the digital STBBI testing service GetCheckedOnline has improved access to testing in British Columbia (BC), Canada. As part of the program’s continuous evaluation, we examined awareness and use of the service in 5 urban, suburban, and rural communities where the program has expanded. Objective: This study aimed to determine if social location is associated with differences in awareness and use of the service in 5 communities outside Vancouver, BC. Methods: From July to September 2022, we conducted a cross-sectional survey recruiting (in-person and online) sexually active people aged 16 years or older in 5 urban, suburban, and rural communities where GetCheckedOnline had sample collection sites available at the time. We examined differences in awareness and use by age, gender identity, sexual identity, race/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework. Results: Of the 1658 participants (n=1058, 63.8% in-person and n=600, 36.2% online), 35.3% (586/1658) were aware of GetCheckedOnline and 19.5% (324/1658) had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (>38 years: awareness odds ratio [OR] 0.23, 95% CI 0.17‐0.32; use OR 0.19, 95% CI 0.12‐0.28; GetCheckedOnline is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.

Background: Digital technologies are reshaping health care, making digital health literacy (DHL) a critical competency for navigating online health information. Although widely conceived and measured as a unidimensional measure of DHL, the literature increasingly supports a multidimensional framing of the eHealth Literacy Scale (eHEALS). Studies propose alternative factor structures that can better inform population-level interventions, but these studies have not accounted for the ordinal nature of eHEALS response data. Objective: This study aimed to identify and validate an alternate multidimensional structure of eHEALS accounting for its ordinal response scale. Methods: Data were drawn from the 2022 GetCheckedOnline community survey of consenting English-speaking British Columbia residents aged ≥16 years who reported sexual activity in the past 12 months. Participants were recruited through geo-targeted digital advertisements, community outreach, and in-person recruitment at public events, and community locations. DHL was measured using eHEALS, with responses collected on a 5-point Likert scale. Descriptive statistics summarized eHEALS responses using means, medians, and IQRs. Exploratory and confirmatory factor analyses were used to assess the scale’s structure using polychoric correlations and standard model fit indices. Reliability and validity were evaluated using polychoric ordinal alpha, average variance extracted, and composite reliability, with missing data addressed via multiple imputation. Results: Overall, 1657 participants met inclusion criteria with a mean age of 33.0 (SD 11.77, 95% CI 32.4-33.6) years. Among these 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) identified as racialized minorities, 80.5% (95% CI 78.5%–82.3%) reported easy internet access, and 32.2% (95% CI 30.0%-34.5%) had a bachelor’s degree or higher. Across eHEALS items, median scores were 4.0 (IQR 1.0-2.0) with excellent internal consistency (polychoric ordinal α=.92). Exploratory factor analysis supported a 3-factor solution explaining 65.7% of the variance, demonstrated through confirmatory factor analysis (χ²17=71.7, P<.001, root-mean-square error of approximation=0.059, standardized root-mean-square residual=0.026, comparative fit index=0.969, Tucker-Lewis Index=0.948). The final model included Information Navigation (standardized loadings=0.765-0.917), Resource Appraisal (0.825-0.892), and Confidence in Use (0.803 for both items), with composite reliability (0.784-0.900), and average variance extracted (0.503-0.738) supporting construct validity. Conclusions: This study confirms a multidimensional structure of eHEALS, identifying Information Navigation, Resource Appraisal, and Confidence in Use as key dimensions of DHL. This revised model enhances measurement precision, enabling more accurate identification of populations with limited DHL and informing the development of targeted, equity-oriented interventions. Future research should aim to confirm this multidimensional structure in more diverse populations and explore how distinct DHL domains influence access to digital health services in various contexts. Additionally, ongoing scale development must adapt to account for the role of emerging technologies, including artificial intelligence and social media algorithms in health care.

BACKGROUND Digital technologies are reshaping health care, making digital health literacy (DHL) a critical competency for navigating online health information. Although widely conceived and measured as a unidimensional measure of DHL, the literature increasingly supports a multidimensional framing of the eHealth Literacy Scale (eHEALS). Studies propose alternative factor structures that can better inform population-level interventions, but these studies have not accounted for the ordinal nature of eHEALS response data. OBJECTIVE This study aimed to identify and validate an alternate multidimensional structure of eHEALS accounting for its ordinal response scale. METHODS Data were drawn from the 2022 GetCheckedOnline community survey of consenting English-speaking British Columbia residents aged ≥16 years who reported sexual activity in the past 12 months. Participants were recruited through geo-targeted digital advertisements, community outreach, and in-person recruitment at public events, and community locations. DHL was measured using eHEALS, with responses collected on a 5-point Likert scale. Descriptive statistics summarized eHEALS responses using means, medians, and IQRs. Exploratory and confirmatory factor analyses were used to assess the scale’s structure using polychoric correlations and standard model fit indices. Reliability and validity were evaluated using polychoric ordinal alpha, average variance extracted, and composite reliability, with missing data addressed via multiple imputation. RESULTS Overall, 1657 participants met inclusion criteria with a mean age of 33.0 (SD 11.77, 95% CI 32.4-33.6) years. Among these 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) identified as racialized minorities, 80.5% (95% CI 78.5%–82.3%) reported easy internet access, and 32.2% (95% CI 30.0%-34.5%) had a bachelor’s degree or higher. Across eHEALS items, median scores were 4.0 (IQR 1.0-2.0) with excellent internal consistency (polychoric ordinal α=.92). Exploratory factor analysis supported a 3-factor solution explaining 65.7% of the variance, demonstrated through confirmatory factor analysis (χ²17=71.7, P<.001, root-mean-square error of approximation=0.059, standardized root-mean-square residual=0.026, comparative fit index=0.969, Tucker-Lewis Index=0.948). The final model included Information Navigation (standardized loadings=0.765-0.917), Resource Appraisal (0.825-0.892), and Confidence in Use (0.803 for both items), with composite reliability (0.784-0.900), and average variance extracted (0.503-0.738) supporting construct validity. CONCLUSIONS This study confirms a multidimensional structure of eHEALS, identifying Information Navigation, Resource Appraisal, and Confidence in Use as key dimensions of DHL. This revised model enhances measurement precision, enabling more accurate identification of populations with limited DHL and informing the development of targeted, equity-oriented interventions. Future research should aim to confirm this multidimensional structure in more diverse populations and explore how distinct DHL domains influence access to digital health services in various contexts. Additionally, ongoing scale development must adapt to account for the role of emerging technologies, including artificial intelligence and social media algorithms in health care.

Background: Digital testing services for sexually transmitted and blood-borne infections (STBBI) are becoming more common in Canada. There is little evidence supporting the assumption that these services reduce healthcare system burden. To explore this further, we described patterns of provider-based testing among repeat users of a digital STBBI testing service, and their association with access barriers. Methods: We conducted a cross-sectional survey in November 2022 of repeat GetCheckedOnline.com users (≥2 tests, with 1 test between April and October 2022). We stratified participants into three use patterns of GetCheckedOnline for testing, using ordinal logistic regression to examine associations with barriers reflecting availability, accessibility, acceptability and appropriateness of health services (applying weights to adjust for non-responders). Results: Of 798 participants (17.2% of 4633 eligible), 52.6% only and 35.8% mostly tested through GetCheckedOnline; 14.5% tested more often/equally through healthcare providers. Availability was associated with greater use of GetCheckedOnline (e.g., not having a primary care provider, OR 2.03, 95% CI [1.52–2.73]), and appropriateness with lower use (getting tested part of clinical care, OR 0.07 95% CI [0.05–0.11]). Participants < 25 years, high school educated or less or born outside Canada reported greater use of GetCheckedOnline for testing while 2S/LGBTQ+ and full-time employed participants reported lower use. Most participants (88.0%) would have tested through a provider if GetCheckedOnline were not available. Conclusion: GetCheckedOnline use was associated with barriers to the availability of provider-based testing. Digital STBBI testing services may improve access to testing and reduce demands on healthcare providers for testing.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The digital transformation of public health highlights the growing need for new digital competencies to tackle evolving and contemporary public health challenges. While some public health institutions and schools worldwide have begun addressing this need through various approaches, many in Canada have yet to do so. To support systematic competency and curriculum development, we mapped and explored existing digital public health (DPH) training programs, identifying common curricula content, approaches and disciplinary perspectives. Objective: To support systematic competency and curriculum development, we mapped and explored existing digital public health (DPH) training programs, identifying common curricula content, approaches and disciplinary perspectives. Methods: This two-stage environmental scan included a systematic search of DPH training programs and interviews with select program directors, emphasizing a transdisciplinary approach. Between March and May 2023, we conducted a search on Google and public health association directories to identify degree programs and courses (as part of degree awarding programs) focused on building capacity for using digital technologies in public health. We then conducted semi-structured interviews with four directors of identified programs exploring program characteristics and the inter/transdisciplinary partnerships essential to their design. Search data was summarized using narrative synthesis, while content analysis was applied to the interview data. Results: Overall, 58 DPH training programs were identified, categorized into three groups: public health data science (29/58, 50%); public health informatics (16/58, 28%); and a mix of programs exploring digital competencies (13/58, 22%) related to project management and addressing the digital determinants of health. Interviews focused on four key categories: (1) Motivation for interdisciplinary DPH programs, highlighting the need to align with current job market demands for practitioners skilled in interdisciplinary practice and addressing pressures for curricular updates from professional bodies; (2) Design and delivery of interdisciplinary programs, emphasizing academic-industry partnerships aimed at developing professionals with depth in public health and breadth in DPH knowledge; (3) Characteristics of inter- and transdisciplinary partnerships, showcasing the involvement of diverse disciplinary perspectives from academia, public, and private sectors in program design and delivery; and (4) Challenges in implementing these partnerships, including difficulties in negotiating shared commitments, reconciling differing perspectives, and securing sustainable funding for such programs. Conclusions: This global scan of DPH training programs found a strong focus on data-centric competencies, with less emphasis on digital skills for health promotion, leadership, and addressing digital determinants of health. Bridging these gaps requires a stepwise approach: integrating digital competencies into curricula, offering standalone programs for specialized skills, and strengthening partnerships to navigate funding and administrative barriers while promoting equity-driven, interdisciplinary collaboration.

Background: The COVID-19 pandemic highlighted gaps in the public health workforce’s capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners’ capacity to support the digital transformation of public health. Methods: Following the World Health Organization’s (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development.

Background Evidence of long-term impacts of COVID-19 related public health restrictions on digital sexually transmitted and blood borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). Methods Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, testers’ sociodemographic and sexual risk profiles, for the pre-pandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analysed. Each outcome was modelled using segmented generalized least squared regression. Results Overall, 17,215 and 22,646 test episodes were conducted in the pre-pandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021(end of pandemic period), monthly GetCheckedOnline testing increased 21.24 test episodes per million BC residents (95%CI: -11.88, 54.84) and GetCheckedOnline tests per 100 tests in corresponding BC regions increased 1.10 (95%CI: 0.02, 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, while monthly GetCheckedOnline testing increased among people ≥40 years, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. Conclusions Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.

Background: The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. Objective: In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. Methods: We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. Results: Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. Conclusions: The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.27686

Background: There has been rapid development and application of digital technologies in public health domains, which are considered to have the potential to transform public health. However, this growing interest in digital technologies in public health has not been accompanied by a clarity of scope to guide policy, practice, and research in this rapidly emergent field. Objective: This scoping review seeks to determine the scope of digital health as described by public health researchers and practitioners and to consolidate a conceptual framework of digital public health. Methods: The review follows Arksey and O’Malley’s framework for conducting scoping reviews with improvements as suggested by Levac et al. The search strategy will be applied to Embase, Medline, and Google Scholar. A grey literature search will be conducted on intergovernmental agency websites and country-specific websites. Titles and abstracts will be reviewed by independent reviewers, while full-text reviews will be conducted by 2 reviewers to determine eligibility based on prespecified inclusion and exclusion criteria. The data will be coded in an iterative approach using the best-fit framework analysis methodology. Results: This research project received funding from the British Columbia Centre for Disease Control Foundation for Population and Public Health on January 1, 2020. The initial search was conducted on June 1, 2020 and returned 6953 articles in total. After deduplication, 4523 abstracts were reviewed, and 227 articles have been included in the review. Ethical approval is not required for this review as it uses publicly available data. Conclusions: We anticipate that the findings of the scoping review will contribute relevant evidence to health policy makers and public health practitioners involved in planning, funding, and delivering health services that leverage digital technologies. Results of the review will be strategically disseminated through publications in scientific journals, conferences, and engagement with relevant stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/27686

BACKGROUND The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. OBJECTIVE In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. METHODS We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. RESULTS Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. CONCLUSIONS The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.27686