impact of technology on health essay

Essay on the Impact of Technology on Health Care

Technology has grown to become an integral part of health. Healthcare organizations in different parts of the world are using technology to monitor their patients’ progress while others are using technology to store patients’ data (Bonato 37). Patient outcomes have improved due to technology, and health organizations that sought profits have significantly increased their income because of technology. It is no doubt that technology has influenced medical services in varied ways. Therefore, it would be fair to conclude that technology has positively affected healthcare.

First, technology has improved access to medical information and data (Mettler 33). One of the most significant advantages triggered by technology is the ability to store and access patient data. Medical professionals can now track patients’ progress by retrieving data from anywhere. At the same time, the internet has allowed doctors to share medical information rapidly amongst themselves, an instance that leads to more efficient patient care.

Second, technology has allowed clinicians to gather big data in a limited time (Chen et al. 72). Digital technology allows instant data collection for professionals engaged in epidemiological studies, clinical trials, and those in research. The collection of data, in this case, allows for meta-analysis and permits healthcare organizations to stay on top of cutting edge technological trends.

In addition to allowing quick access to medical data and big data technology has improved medical communication (Free et al. 54). Communication is a critical part of healthcare; nurses and doctors must communicate in real-time, and technology allows this instance to happen. Also, healthcare professionals can today make their videos, webinars and use online platforms to communicate with other professionals in different parts of the globe.

Technology has revolutionized how health care services are rendered. But apart from improving healthcare, critics argue that technology has increased or added extra jobs for medical professionals (de Belvis et al. 11). Physicians need to have excellent clinical skills and knowledge of the human body. Today, they are forced to have knowledge of both the human body and technology, which makes it challenging for others. Technology has also improved access to data, and this has allowed physicians to study and understand patients’ medical history. Nevertheless, these instances have opened doors to unethical activities such as computer hacking (de Belvis et al. 13). Today patients risk losing their medical information, including their social security numbers, address and other critical information.

Despite the improvements that have come with adopting technology, there is always the possibility that digital technological gadgets might fail. If makers of a given technology do not have a sustainable business process or a good track record, their technologies might fail. Many people, including patients and doctors who solely rely on technology, might be affected when it does. Apart from equipment failure, technology has created the space for laziness within hospitals.

Doctors and patients heavily rely on medical technology for problem-solving. In like manner, medical technologies that use machine learning have removed decision-making in different hospitals; today, medical tools are solving people’s problems. Technology has been great for our hospitals, but the speed at which different hospitals are adapting to technological processes is alarming. Technology often fails, and when it does, health care may be significantly affected. Doctors and patients who use technology may be forced to go back to traditional methods of health care services.

Bonato, P. “Advances in Wearable Technology and Its Medical Applications.”  2010 Annual International Conference of The IEEE Engineering in Medicine and Biology , 2010, pp. 33-45.

Chen, Min et al. “Disease Prediction by Machine Learning Over Big Data from Healthcare Communities.”  IEEE Access , vol. 5, 2017, pp. 69-79.

De Belvis, Antonio Giulio et al. “The Financial Crisis in Italy: Implications for The Healthcare Sector.”  Health Policy , vol. 106, no. 1, 2012, pp. 10-16.

Free, Caroline et al. “The Effectiveness of M-Health Technologies for Improving Health and Health Services: A Systematic Review Protocol.”  BMC Research Notes , vol. 3, no. 1, 2010, pp. 42-78.

Mettler, Matthias. “Blockchain Technology in Healthcare: The Revolution Starts Here.”  2016 IEEE 18Th International Conference On E-Health Networking, Applications and Services (Healthcom) , 2016, pp. 23-78.

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• NEWS & VIEWS FORUM
• 10 February 2020

Scrutinizing the effects of digital technology on mental health

• Jonathan Haidt &

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The topic in brief

• There is an ongoing debate about whether social media and the use of digital devices are detrimental to mental health.

• Adolescents tend to be heavy users of these devices, and especially of social media.

• Rates of teenage depression began to rise around 2012, when adolescent use of social media became common (Fig. 1).

• Some evidence indicates that frequent users of social media have higher rates of depression and anxiety than do light users.

• But perhaps digital devices could provide a way of gathering data about mental health in a systematic way, and make interventions more timely.

Figure 1 | Depression on the rise. Rates of depression among teenagers in the United States have increased steadily since 2012. Rates are higher and are increasing more rapidly for girls than for boys. Some researchers think that social media is the cause of this increase, whereas others see social media as a way of tackling it. (Data taken from the US National Survey on Drug Use and Health, Table 11.2b; go.nature.com/3ayjaww )

JONATHAN HAIDT: A guilty verdict

A sudden increase in the rates of depression, anxiety and self-harm was seen in adolescents — particularly girls — in the United States and the United Kingdom around 2012 or 2013 (see go.nature.com/2up38hw ). Only one suspect was in the right place at the right time to account for this sudden change: social media. Its use by teenagers increased most quickly between 2009 and 2011, by which point two-thirds of 15–17-year-olds were using it on a daily basis 1 . Some researchers defend social media, arguing that there is only circumstantial evidence for its role in mental-health problems 2 , 3 . And, indeed, several studies 2 , 3 show that there is only a small correlation between time spent on screens and bad mental-health outcomes. However, I present three arguments against this defence.

First, the papers that report small or null effects usually focus on ‘screen time’, but it is not films or video chats with friends that damage mental health. When research papers allow us to zoom in on social media, rather than looking at screen time as a whole, the correlations with depression are larger, and they are larger still when we look specifically at girls ( go.nature.com/2u74der ). The sex difference is robust, and there are several likely causes for it. Girls use social media much more than do boys (who, in turn, spend more of their time gaming). And, for girls more than boys, social life and status tend to revolve around intimacy and inclusion versus exclusion 4 , making them more vulnerable to both the ‘fear of missing out’ and the relational aggression that social media facilitates.

Second, although correlational studies can provide only circumstantial evidence, most of the experiments published in recent years have found evidence of causation ( go.nature.com/2u74der ). In these studies, people are randomly assigned to groups that are asked to continue using social media or to reduce their use substantially. After a few weeks, people who reduce their use generally report an improvement in mood or a reduction in loneliness or symptoms of depression.

The best way forward

Third, many researchers seem to be thinking about social media as if it were sugar: safe in small to moderate quantities, and harmful only if teenagers consume large quantities. But, unlike sugar, social media does not act just on those who consume it. It has radically transformed the nature of peer relationships, family relationships and daily activities 5 . When most of the 11-year-olds in a class are on Instagram (as was the case in my son’s school), there can be pervasive effects on everyone. Children who opt out can find themselves isolated. A simple dose–response model cannot capture the full effects of social media, yet nearly all of the debate among researchers so far has been over the size of the dose–response effect. To cite just one suggestive finding of what lies beyond that model: network effects for depression and anxiety are large, and bad mental health spreads more contagiously between women than between men 6 .

In conclusion, digital media in general undoubtedly has many beneficial uses, including the treatment of mental illness. But if you focus on social media, you’ll find stronger evidence of harm, and less exculpatory evidence, especially for its millions of under-age users.

What should we do while researchers hash out the meaning of these conflicting findings? I would urge a focus on middle schools (roughly 11–13-year-olds in the United States), both for researchers and policymakers. Any US state could quickly conduct an informative experiment beginning this September: randomly assign a portion of school districts to ban smartphone access for students in middle school, while strongly encouraging parents to prevent their children from opening social-media accounts until they begin high school (at around 14). Within 2 years, we would know whether the policy reversed the otherwise steady rise of mental-health problems among middle-school students, and whether it also improved classroom dynamics (as rated by teachers) and test scores. Such system-wide and cross-school interventions would be an excellent way to study the emergent effects of social media on the social lives and mental health of today’s adolescents.

NICK ALLEN: Use digital technology to our advantage

It is appealing to condemn social media out of hand on the basis of the — generally rather poor-quality and inconsistent — evidence suggesting that its use is associated with mental-health problems 7 . But focusing only on its potential harmful effects is comparable to proposing that the only question to ask about cars is whether people can die driving them. The harmful effects might be real, but they don’t tell the full story. The task of research should be to understand what patterns of digital-device and social-media use can lead to beneficial versus harmful effects 7 , and to inform evidence-based approaches to policy, education and regulation.

Long-standing problems have hampered our efforts to improve access to, and the quality of, mental-health services and support. Digital technology has the potential to address some of these challenges. For instance, consider the challenges associated with collecting data on human behaviour. Assessment in mental-health care and research relies almost exclusively on self-reporting, but the resulting data are subjective and burdensome to collect. As a result, assessments are conducted so infrequently that they do not provide insights into the temporal dynamics of symptoms, which can be crucial for both diagnosis and treatment planning.

By contrast, mobile phones and other Internet-connected devices provide an opportunity to continuously collect objective information on behaviour in the context of people’s real lives, generating a rich data set that can provide insight into the extent and timing of mental-health needs in individuals 8 , 9 . By building apps that can track our digital exhaust (the data generated by our everyday digital lives, including our social-media use), we can gain insights into aspects of behaviour that are well-established building blocks of mental health and illness, such as mood, social communication, sleep and physical activity.

Stress and the city

These data can, in turn, be used to empower individuals, by giving them actionable insights into patterns of behaviour that might otherwise have remained unseen. For example, subtle shifts in patterns of sleep or social communication can provide early warning signs of deteriorating mental health. Data on these patterns can be used to alert people to the need for self-management before the patterns — and the associated symptoms — become more severe. Individuals can also choose to share these data with health professionals or researchers. For instance, in the Our Data Helps initiative, individuals who have experienced a suicidal crisis, or the relatives of those who have died by suicide, can donate their digital data to research into suicide risk.

Because mobile devices are ever-present in people’s lives, they offer an opportunity to provide interventions that are timely, personalized and scalable. Currently, mental-health services are mainly provided through a century-old model in which they are made available at times chosen by the mental-health practitioner, rather than at the person’s time of greatest need. But Internet-connected devices are facilitating the development of a wave of ‘just-in-time’ interventions 10 for mental-health care and support.

A compelling example of these interventions involves short-term risk for suicide 9 , 11 — for which early detection could save many lives. Most of the effective approaches to suicide prevention work by interrupting suicidal actions and supporting alternative methods of coping at the moment of greatest risk. If these moments can be detected in an individual’s digital exhaust, a wide range of intervention options become available, from providing information about coping skills and social support, to the initiation of crisis responses. So far, just-in-time approaches have been applied mainly to behaviours such as eating or substance abuse 8 . But with the development of an appropriate research base, these approaches have the potential to provide a major advance in our ability to respond to, and prevent, mental-health crises.

These advantages are particularly relevant to teenagers. Because of their extensive use of digital devices, adolescents are especially vulnerable to the devices’ risks and burdens. And, given the increases in mental-health problems in this age group, teens would also benefit most from improvements in mental-health prevention and treatment. If we use the social and data-gathering functions of Internet-connected devices in the right ways, we might achieve breakthroughs in our ability to improve mental health and well-being.

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Competing Interests

N.A. has an equity interest in Ksana Health, a company he co-founded and which has the sole commercial licence for certain versions of the Effortless Assessment of Risk States (EARS) mobile-phone application and some related EARS tools. This intellectual property was developed as part of his research at the University of Oregon’s Center for Digital Mental Health (CDMH).

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The rise of health technology

July 11, 2021 When it comes to the digital transformation of healthcare, one area deserves particular attention: health technology. It continues to push the boundaries of how healthcare is delivered and could drive breakthroughs in how we understand disease. Explore a special collection  to understand its evolving role in the life-sciences sector, or go deeper with articles from it to discover:

• How digital tools can help improve well-being, address sleep loss, and support mental-health needs
• What medtech and healthcare players more broadly can do to capture more value from digital health
• How it could help companies build new business or reinvent themselves
• What executives think could lie ahead for digital therapeutics and healthcare innovation

Leap to the future of healthcare: Reinvent through business building

How the medtech industry can capture value from digital health

Moving digital health forward: Lessons on business building

Telehealth: A quarter-trillion-dollar post-COVID-19 reality?

Using digital tech to support employees’ mental health and resilience

Sleep on it: Addressing the sleep-loss epidemic through technology

Digital therapeutics and pharma: A blueprint for success from Sanofi’s Bozidar Jovicevic

‘Test and listen’: Microsoft’s Jim Weinstein on healthcare tech

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For Better or Worse, Technology Is Taking Over the Health World

Sarah Fielding is a freelance writer covering a range of topics with a focus on mental health and women's issues.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content. He keeps a DSM-5 on hand just in case.

For many people over the past year and a half, the world has existed primarily through a screen. With social distancing measures in place to protect individuals from becoming infected with the coronavirus, technology has stepped in to fill the void of physical connections. It’s also become a space for navigating existing and new mental health conditions through virtual therapy sessions, meditation apps, mental health influencers, and beyond.

“Over the years, mental health and technology have started touching each other more and more, and the pandemic accelerated that in an unprecedented way,” says Naomi Torres-Mackie, PhD , the head of research at The Mental Health Coalition , a clinical psychologist at Lenox Hill Hospital, and an adjunct professor at Columbia University. “This is especially the case because the pandemic has highlighted the importance of mental health for everyone as we struggle to make sense of an overwhelming new world and can find mental health information and services online.” 

This shift is especially critical, with a tremendous spike occurring in mental health conditions. In the period between January and June 2019, 11% of US adults reported experiencing symptoms of an anxiety or depressive disorder. In January 2021, 10 months into the pandemic, in one survey that number increased to 41.1%. Research also points to a potential connection for some between having COVID-19 and developing a mental health condition—whether or not you previously had one.

The pandemic’s bridge between mental health and technology has helped to “meet the needs of many suffering from depression, anxiety, life transition, grief, family conflict, and addiction,” says Miyume McKinley, MSW, LCSW , a psychotherapist and founder of Epiphany Counseling, Consulting & Treatment Services.

Naomi Torres-Mackie, PhD

The risk of greater access is that the floodgates are open for anyone to say anything about mental health, and there’s no vetting process or way to truly check credibility.

This increased reliance on technology to facilitate mental health care and support appears to be a permanent one. Torres-Mackie has witnessed mental health clinicians drop their apprehension around virtual services throughout the pandemic and believes they will continue for good.

“Almost all therapists seem to be at least offering virtual sessions, and a good portion have transitioned their practices to be entirely virtual, giving up their traditional in-person offices,” adds Carrie Torn, MSW, LCSW , a licensed clinical social worker and psychotherapist in private practice in Charlotte, North Carolina.

The general public is also more receptive to technology’s expanded role in mental health care. “The pandemic has created a lasting relationship between technology, and it has helped increase access to mental health services across the world,” says McKinley. “There are lots of people seeking help who would not have done so prior to the pandemic, either due to the discomfort or because they simply didn’t know it was possible to obtain such services via technology.”

Accessibility Is a Tremendous Benefit of Technology

Every expert interviewed agreed: Accessibility is an undeniable and indispensable benefit of mental health’s increasing presence online. Torn points out, “We can access information, including mental health information and treatment like never before, and it’s low cost.”

A 2018 study found that, at the time, 74% of Americans didn’t view mental health as accessible to everyone. Participants cited long wait times, a lack of affordable options, low awareness, and social stigma as barriers to mental health care. The evolution of mental health and technology has alleviated some of these issues—whether it be through influencers creating open discussions around mental health and normalizing it or low-cost therapy apps . In addition, wait times may reduce when people are no longer tied to seeing a therapist in their immediate area.

While some people may still be apprehensive about trying digital therapy, research has shown that it is an effective strategy for managing your mental health. A 2020 review of 17 studies published in EClinicalMedicine found that online cognitive-behavioral therapy sessions were at least as effective at reducing the severity of depression symptoms than in-person sessions. There wasn’t a significant difference in participant satisfaction between the two options.

There Are Limitations to Mental Health and Technology’s Increasing Closeness

One of the most prevalent limitations of technology-fueled mental health care and awareness is the possibility of misleading or inaccurate information.  

If you’re attending digital sessions with a therapist, it’s easy to check their qualifications and reviews. However, for most other online mental health resources, it can be more challenging but remains just as critical to verify their expertise and benefits. “The risk of greater access is that the floodgates are open for anyone to say anything about mental health, and there’s no vetting process or way to truly check credibility,” says Torres-Mackle.

To that point, James Giordano, PhD, MPhil , professor of neurology and ethics at Georgetown University Medical Center and author of the book “Neurotechnology: Premises, Potential, and Problems,” cautions that, while there are guiding institutions, the market still contains “unregulated products, resources, and services, many of which are available via the internet. Thus, it’s very important to engage due diligence when considering the use of any mental health technology .” 

 Verywell / Alison Czinkota 

McKinley raises another valuable point: A person’s home is not always a space they can securely explore their mental health. “For many individuals, home is not a safe place due to abuse, addiction, toxic family, or unhealthy living environments,” she says. “Despite technology offering a means of support, if the home is not a safe place, many people won’t seek the help or mental health treatment that they need. For some, the therapy office is the only safe place they have.” Due to the pandemic and a general limit on private places outside of the home to dive into your personal feelings, someone in this situation may struggle to find opportunities for help.

Miyume McKinley, MSW, LCSW

There are lots of people seeking help that would not have done so prior to the pandemic, either due to the discomfort or because they simply didn’t know it was possible to obtain such services via technology.

Torn explains that therapists who work for tech platforms can also suffer due to burnout and low pay. She claims that some of these platforms prioritize seeing new clients instead of providing time for existing clients to grow their relationship. “I’ve heard about clients having to jump from one therapist to the next, or therapists who can’t even leave stops open for their existing clients, and instead their schedule gets filled with new clients,” she says. “Therapists are burning out in general right now, and especially on these platforms, which leads to a lower quality of care for clients.”

Screen Time Can Also Have a Negative Impact

As mental health care continues to spread into online platforms, clinicians and individuals must contend with society’s growing addiction to tech and extended screen time’s negative aspects.

Social media, in particular, has been shown to impact an individual’s mental health negatively. A 2019 study looked at how social media affected feelings of social isolation in 1,178 students aged 18 to 30. While having a positive experience on social media didn’t improve it, each 10% increase in negative experiences elevated social isolation feelings by 13%.

Verywell / Alison Czinkota

While certain aspects like Zoom therapy and mental health influencers require looking at a screen, you can use other digital options such as meditation apps without constantly staring at your device.

What to Be Mindful of as You Explore Mental Health Within Technology

Nothing is all bad or all good and that stands true for mental health’s increased presence within technology. What’s critical is being aware that “technology is a tool, and just like any tool, its impact depends on how it's used,” says Torres-Mackie.

For example, technology can produce positive results if you use the digital space to access treatment that you may have struggled to otherwise, support your mental well-being, or gather helpful—and credible—information about mental health. In contrast, she explains that diving into social media or other avenues only to compare yourself with others and avoid your responsibilities can have negative repercussions on your mental health and relationships. 

Giordano expresses the importance of staying vigilant about your relationship with and reliance on tech and your power to control it. 

With that in mind, pay attention to how much time you spend online. “We are spending less time outside, and more time glued to our screens. People are constantly comparing their lives to someone else's on social media, making it harder to be present in the moment and actually live our lives,” says Torn. 

Between the increase in necessary services moving online and trying to connect with people through a screen, it’s critical to take time away from your devices. According to a 2018 study, changing your social media habits, in particular, can improve your overall well-being . Participants limited Instagram, Facebook, and Snapchat use to 10 minutes a day per platform for three weeks. At the end of the study, they showed significant reductions in depression and loneliness compared to the control group. However, even the increased awareness of their social media use appeared to help the control group lower feelings of anxiety and fear of missing out.

“Remember, it’s okay to turn your phone off. It’s okay to turn notifications off for news, apps, and emails,” says McKinley. Take opportunities to step outside, spend time with loved ones, and explore screen-free self-care activities. She adds, “Most of the things in life that make life worthwhile cannot be found on our devices, apps, or through technology—it’s found within ourselves and each other.”

Kaiser Family Foundation. The implications of COVID-19 for mental health and substance use .

Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA . Lancet Psychiatry . 2021;8(2):130-140. doi:10.1016/S2215-0366(20)30462-4

Luo C, Sanger N, Singhal N, et al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: a systematic review and meta-analysis . EClinicalMedicine . 2020;24:100442. doi:10.1016/j.eclinm.2020.100442

Primack BA, Karim SA, Shensa A, Bowman N, Knight J, Sidani JE. Positive and negative experiences on social media and perceived social isolation . Am J Health Promot . 2019;33(6):859-868. doi:10.1177/0890117118824196

Hunt MG, Marx R, Lipson C, Young J. No more FOMO: Limiting social media decreases loneliness and depression . J Soc Clin Psychol . 2018;37(10):751-768. doi:10.1521/jscp.2018.37.10.751

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Promises and Pitfalls of Technology

Politics and privacy, private-sector influence and big tech, state competition and conflict, author biography, how is technology changing the world, and how should the world change technology.

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Technologies are becoming increasingly complicated and increasingly interconnected. Cars, airplanes, medical devices, financial transactions, and electricity systems all rely on more computer software than they ever have before, making them seem both harder to understand and, in some cases, harder to control. Government and corporate surveillance of individuals and information processing relies largely on digital technologies and artificial intelligence, and therefore involves less human-to-human contact than ever before and more opportunities for biases to be embedded and codified in our technological systems in ways we may not even be able to identify or recognize. Bioengineering advances are opening up new terrain for challenging philosophical, political, and economic questions regarding human-natural relations. Additionally, the management of these large and small devices and systems is increasingly done through the cloud, so that control over them is both very remote and removed from direct human or social control. The study of how to make technologies like artificial intelligence or the Internet of Things “explainable” has become its own area of research because it is so difficult to understand how they work or what is at fault when something goes wrong (Gunning and Aha 2019) .

This growing complexity makes it more difficult than ever—and more imperative than ever—for scholars to probe how technological advancements are altering life around the world in both positive and negative ways and what social, political, and legal tools are needed to help shape the development and design of technology in beneficial directions. This can seem like an impossible task in light of the rapid pace of technological change and the sense that its continued advancement is inevitable, but many countries around the world are only just beginning to take significant steps toward regulating computer technologies and are still in the process of radically rethinking the rules governing global data flows and exchange of technology across borders.

These are exciting times not just for technological development but also for technology policy—our technologies may be more advanced and complicated than ever but so, too, are our understandings of how they can best be leveraged, protected, and even constrained. The structures of technological systems as determined largely by government and institutional policies and those structures have tremendous implications for social organization and agency, ranging from open source, open systems that are highly distributed and decentralized, to those that are tightly controlled and closed, structured according to stricter and more hierarchical models. And just as our understanding of the governance of technology is developing in new and interesting ways, so, too, is our understanding of the social, cultural, environmental, and political dimensions of emerging technologies. We are realizing both the challenges and the importance of mapping out the full range of ways that technology is changing our society, what we want those changes to look like, and what tools we have to try to influence and guide those shifts.

Technology can be a source of tremendous optimism. It can help overcome some of the greatest challenges our society faces, including climate change, famine, and disease. For those who believe in the power of innovation and the promise of creative destruction to advance economic development and lead to better quality of life, technology is a vital economic driver (Schumpeter 1942) . But it can also be a tool of tremendous fear and oppression, embedding biases in automated decision-making processes and information-processing algorithms, exacerbating economic and social inequalities within and between countries to a staggering degree, or creating new weapons and avenues for attack unlike any we have had to face in the past. Scholars have even contended that the emergence of the term technology in the nineteenth and twentieth centuries marked a shift from viewing individual pieces of machinery as a means to achieving political and social progress to the more dangerous, or hazardous, view that larger-scale, more complex technological systems were a semiautonomous form of progress in and of themselves (Marx 2010) . More recently, technologists have sharply criticized what they view as a wave of new Luddites, people intent on slowing the development of technology and turning back the clock on innovation as a means of mitigating the societal impacts of technological change (Marlowe 1970) .

At the heart of fights over new technologies and their resulting global changes are often two conflicting visions of technology: a fundamentally optimistic one that believes humans use it as a tool to achieve greater goals, and a fundamentally pessimistic one that holds that technological systems have reached a point beyond our control. Technology philosophers have argued that neither of these views is wholly accurate and that a purely optimistic or pessimistic view of technology is insufficient to capture the nuances and complexity of our relationship to technology (Oberdiek and Tiles 1995) . Understanding technology and how we can make better decisions about designing, deploying, and refining it requires capturing that nuance and complexity through in-depth analysis of the impacts of different technological advancements and the ways they have played out in all their complicated and controversial messiness across the world.

These impacts are often unpredictable as technologies are adopted in new contexts and come to be used in ways that sometimes diverge significantly from the use cases envisioned by their designers. The internet, designed to help transmit information between computer networks, became a crucial vehicle for commerce, introducing unexpected avenues for crime and financial fraud. Social media platforms like Facebook and Twitter, designed to connect friends and families through sharing photographs and life updates, became focal points of election controversies and political influence. Cryptocurrencies, originally intended as a means of decentralized digital cash, have become a significant environmental hazard as more and more computing resources are devoted to mining these forms of virtual money. One of the crucial challenges in this area is therefore recognizing, documenting, and even anticipating some of these unexpected consequences and providing mechanisms to technologists for how to think through the impacts of their work, as well as possible other paths to different outcomes (Verbeek 2006) . And just as technological innovations can cause unexpected harm, they can also bring about extraordinary benefits—new vaccines and medicines to address global pandemics and save thousands of lives, new sources of energy that can drastically reduce emissions and help combat climate change, new modes of education that can reach people who would otherwise have no access to schooling. Regulating technology therefore requires a careful balance of mitigating risks without overly restricting potentially beneficial innovations.

Nations around the world have taken very different approaches to governing emerging technologies and have adopted a range of different technologies themselves in pursuit of more modern governance structures and processes (Braman 2009) . In Europe, the precautionary principle has guided much more anticipatory regulation aimed at addressing the risks presented by technologies even before they are fully realized. For instance, the European Union’s General Data Protection Regulation focuses on the responsibilities of data controllers and processors to provide individuals with access to their data and information about how that data is being used not just as a means of addressing existing security and privacy threats, such as data breaches, but also to protect against future developments and uses of that data for artificial intelligence and automated decision-making purposes. In Germany, Technische Überwachungsvereine, or TÜVs, perform regular tests and inspections of technological systems to assess and minimize risks over time, as the tech landscape evolves. In the United States, by contrast, there is much greater reliance on litigation and liability regimes to address safety and security failings after-the-fact. These different approaches reflect not just the different legal and regulatory mechanisms and philosophies of different nations but also the different ways those nations prioritize rapid development of the technology industry versus safety, security, and individual control. Typically, governance innovations move much more slowly than technological innovations, and regulations can lag years, or even decades, behind the technologies they aim to govern.

In addition to this varied set of national regulatory approaches, a variety of international and nongovernmental organizations also contribute to the process of developing standards, rules, and norms for new technologies, including the International Organization for Standardization­ and the International Telecommunication Union. These multilateral and NGO actors play an especially important role in trying to define appropriate boundaries for the use of new technologies by governments as instruments of control for the state.

At the same time that policymakers are under scrutiny both for their decisions about how to regulate technology as well as their decisions about how and when to adopt technologies like facial recognition themselves, technology firms and designers have also come under increasing criticism. Growing recognition that the design of technologies can have far-reaching social and political implications means that there is more pressure on technologists to take into consideration the consequences of their decisions early on in the design process (Vincenti 1993; Winner 1980) . The question of how technologists should incorporate these social dimensions into their design and development processes is an old one, and debate on these issues dates back to the 1970s, but it remains an urgent and often overlooked part of the puzzle because so many of the supposedly systematic mechanisms for assessing the impacts of new technologies in both the private and public sectors are primarily bureaucratic, symbolic processes rather than carrying any real weight or influence.

Technologists are often ill-equipped or unwilling to respond to the sorts of social problems that their creations have—often unwittingly—exacerbated, and instead point to governments and lawmakers to address those problems (Zuckerberg 2019) . But governments often have few incentives to engage in this area. This is because setting clear standards and rules for an ever-evolving technological landscape can be extremely challenging, because enforcement of those rules can be a significant undertaking requiring considerable expertise, and because the tech sector is a major source of jobs and revenue for many countries that may fear losing those benefits if they constrain companies too much. This indicates not just a need for clearer incentives and better policies for both private- and public-sector entities but also a need for new mechanisms whereby the technology development and design process can be influenced and assessed by people with a wider range of experiences and expertise. If we want technologies to be designed with an eye to their impacts, who is responsible for predicting, measuring, and mitigating those impacts throughout the design process? Involving policymakers in that process in a more meaningful way will also require training them to have the analytic and technical capacity to more fully engage with technologists and understand more fully the implications of their decisions.

At the same time that tech companies seem unwilling or unable to rein in their creations, many also fear they wield too much power, in some cases all but replacing governments and international organizations in their ability to make decisions that affect millions of people worldwide and control access to information, platforms, and audiences (Kilovaty 2020) . Regulators around the world have begun considering whether some of these companies have become so powerful that they violate the tenets of antitrust laws, but it can be difficult for governments to identify exactly what those violations are, especially in the context of an industry where the largest players often provide their customers with free services. And the platforms and services developed by tech companies are often wielded most powerfully and dangerously not directly by their private-sector creators and operators but instead by states themselves for widespread misinformation campaigns that serve political purposes (Nye 2018) .

Since the largest private entities in the tech sector operate in many countries, they are often better poised to implement global changes to the technological ecosystem than individual states or regulatory bodies, creating new challenges to existing governance structures and hierarchies. Just as it can be challenging to provide oversight for government use of technologies, so, too, oversight of the biggest tech companies, which have more resources, reach, and power than many nations, can prove to be a daunting task. The rise of network forms of organization and the growing gig economy have added to these challenges, making it even harder for regulators to fully address the breadth of these companies’ operations (Powell 1990) . The private-public partnerships that have emerged around energy, transportation, medical, and cyber technologies further complicate this picture, blurring the line between the public and private sectors and raising critical questions about the role of each in providing critical infrastructure, health care, and security. How can and should private tech companies operating in these different sectors be governed, and what types of influence do they exert over regulators? How feasible are different policy proposals aimed at technological innovation, and what potential unintended consequences might they have?

Conflict between countries has also spilled over significantly into the private sector in recent years, most notably in the case of tensions between the United States and China over which technologies developed in each country will be permitted by the other and which will be purchased by other customers, outside those two countries. Countries competing to develop the best technology is not a new phenomenon, but the current conflicts have major international ramifications and will influence the infrastructure that is installed and used around the world for years to come. Untangling the different factors that feed into these tussles as well as whom they benefit and whom they leave at a disadvantage is crucial for understanding how governments can most effectively foster technological innovation and invention domestically as well as the global consequences of those efforts. As much of the world is forced to choose between buying technology from the United States or from China, how should we understand the long-term impacts of those choices and the options available to people in countries without robust domestic tech industries? Does the global spread of technologies help fuel further innovation in countries with smaller tech markets, or does it reinforce the dominance of the states that are already most prominent in this sector? How can research universities maintain global collaborations and research communities in light of these national competitions, and what role does government research and development spending play in fostering innovation within its own borders and worldwide? How should intellectual property protections evolve to meet the demands of the technology industry, and how can those protections be enforced globally?

These conflicts between countries sometimes appear to challenge the feasibility of truly global technologies and networks that operate across all countries through standardized protocols and design features. Organizations like the International Organization for Standardization, the World Intellectual Property Organization, the United Nations Industrial Development Organization, and many others have tried to harmonize these policies and protocols across different countries for years, but have met with limited success when it comes to resolving the issues of greatest tension and disagreement among nations. For technology to operate in a global environment, there is a need for a much greater degree of coordination among countries and the development of common standards and norms, but governments continue to struggle to agree not just on those norms themselves but even the appropriate venue and processes for developing them. Without greater global cooperation, is it possible to maintain a global network like the internet or to promote the spread of new technologies around the world to address challenges of sustainability? What might help incentivize that cooperation moving forward, and what could new structures and process for governance of global technologies look like? Why has the tech industry’s self-regulation culture persisted? Do the same traditional drivers for public policy, such as politics of harmonization and path dependency in policy-making, still sufficiently explain policy outcomes in this space? As new technologies and their applications spread across the globe in uneven ways, how and when do they create forces of change from unexpected places?

These are some of the questions that we hope to address in the Technology and Global Change section through articles that tackle new dimensions of the global landscape of designing, developing, deploying, and assessing new technologies to address major challenges the world faces. Understanding these processes requires synthesizing knowledge from a range of different fields, including sociology, political science, economics, and history, as well as technical fields such as engineering, climate science, and computer science. A crucial part of understanding how technology has created global change and, in turn, how global changes have influenced the development of new technologies is understanding the technologies themselves in all their richness and complexity—how they work, the limits of what they can do, what they were designed to do, how they are actually used. Just as technologies themselves are becoming more complicated, so are their embeddings and relationships to the larger social, political, and legal contexts in which they exist. Scholars across all disciplines are encouraged to join us in untangling those complexities.

Josephine Wolff is an associate professor of cybersecurity policy at the Fletcher School of Law and Diplomacy at Tufts University. Her book You’ll See This Message When It Is Too Late: The Legal and Economic Aftermath of Cybersecurity Breaches was published by MIT Press in 2018.

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Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

• The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
• The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
• The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

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How does technology affect your physical health?

With tens of billions of internet-connected devices around the world, technology surrounds us like never before. There are many positive aspects to technology – not least, helping us stay connected to others, which has been a lifeline throughout the pandemic – but alongside the benefits, there are also potential health consequences that should be considered. In this overview, we explore the effects of technology overuse and the negative and positive impacts of technology on health.

Negative impacts of technology on health

Some of the health problems caused by technology include:

Musculoskeletal issues

Looking down at an electronic gadget for long periods can lead to neck and back pain, as well as pains in elbows, wrists, and hands. In addition, laptop and smartphone usage can involve people sitting in positions consistent with poor ergonomic function and poor ergonomic positioning. As well as back pain from computer use, often caused by poor gaming posture or computer posture, there have also been reports of “selfie elbow” or “texting thumb” caused by technology overuse.

How to minimize musculoskeletal issues:

• Ensure proper sitting posture at the computer by ensuring that your desk, seat, and screen set-up is optimized – the UK's NHS has detailed guidance on achieving this here .
• Instead of holding your phone in your lap, you can minimize neck problems by holding it out in front of you. Positioning the device so it is in front of your face with your head sitting squarely on your shoulders is helpful to your neck.
• Consider using a body-standing desk. These make staring straight at your computer screen possible and help you avoid the health dangers of sitting all day.
• If texting with your thumbs causes pain, you may need to use other fingers to text or use a stylus.
• Regular screen breaks – allowing you to walk around, stand up, or stretch – will help relieve muscle pain and stress.

Digital eye strain

Constant exposure to digital devices can be harmful to our eyes. Digital eye strain, sometimes called Computer Vision Syndrome (CVS), is one of the most commonly reported symptoms of too much screen time. For example, one study suggested over 60% of Americans were affected by it . Symptoms of digital eye strain include dry eyes, redness around the eyes, headaches, blurred vision, plus neck and shoulder pain.

How to reduce digital eye strain:

• Practice the 20-20-20 rule for healthy digital device usage – i.e., take a 20-second break from the screen every 20 minutes and look at something 20 feet away. You could set a timer every 20 minutes to act as a reminder.
• Reduce overhead lighting to minimize screen glare.
• Increase text size on devices so you can read comfortably.
• Make sure you are blinking – when we stare at digital devices, we can blink less frequently, leading to dry eyes. If dry eyes are bothering you, using eye drops could help.
• Get regular eye check-ups. Poor eyesight contributes to eye strain. Regular check-ups will help ensure timely prescriptions when you need them.

Disrupted sleep

Getting enough sleep is vital for almost every bodily function. But using a laptop, tablet, or smartphone shortly before going to bed can affect your ability to fall asleep. This is because the so-called blue light from devices can lead to heightened alertness and disrupt your body clock. In addition, activities on digital devices can be stimulating and make us much less ready for sleep. As a result, people can become absorbed and continue using the technology past their bedtime.

It’s important to distinguish between interactive and passive technological devices. Passive devices are those which require little or no input from users. Examples include listening to music, reading an e-book, or watching TV or a movie. With interactive devices, what is viewed on-screen changes with input from the user. For example, playing a video game is interactive, as is chatting on social media. Interactive activities are more likely to disrupt sleep than passive activities.

How to avoid disrupted sleep:

• Avoid using your smartphone, laptop, and tablet for at least an hour before going to sleep every night. Reading a book is more likely to relax you than scrolling through social media feeds.
• Dim the screen as much as possible for evening use. In many e-readers, you can also invert the screen color (i.e., white font on black background). Many devices now come with a 'night-time mode,' which is easier on the eye before bed.
• You could consider using a software program for PCs and laptops which decreases the amount of blue light in computer screens – which affects melatonin levels – and increases orange tones instead. An example is a program called f.lux which is available here .
• If you can, consider making your bedroom a screen-free zone.
• Establish a relaxing bedtime routine that doesn’t involve screens, to help you relax before going to sleep.

Physical inactivity

Excessive use of smartphones, laptops, and tablets can lead to physical inactivity. For example, according to one study , 38% of parents worried that their children weren’t getting enough physical exercise due to excessive screen time.

Too much sedentary time has been linked to an increased risk of a range of health conditions, including obesity, heart disease, cancer, and diabetes. The Covid-19 pandemic – which kept people at home, increased reliance on digital technology, and saw sporting events around the world canceled – didn't help. Still, even before Covid, it’s estimated that physical inactivity was costing 5.3 million lives a year globally .

How to stay active:

• The World Health Organization recommends at least 150 minutes of moderate activity or 75 minutes of vigorous activity a week for adults. Health organizations around the world advise against prolonged sitting for all age groups.
• Get up and stretch every 20 to 30 minutes. Walk around, take restroom breaks, carry out simple stretches to pump fresh blood and oxygen through your body.
• Find a physical activity you enjoy – whether that’s walking, cycling, swimming, or a team sport.
• Certain apps and wearable technologies can help keep you active – for example, by sending push notifications telling you it's time to move or by helping you set and track fitness goals.

Psychological issues

Excessive screen time can negatively affect mental and emotional wellbeing. For example, by inducing anxiety because someone hasn’t replied quickly enough to your WhatsApp or text message, or constantly checking your social media feeds to see how many likes your last post received. It’s easy for both adults and children to compare themselves unfavorably to others on social media, which in turn can lead to feelings of anxiety.

Then there’s ‘doom scrolling’ – 1 in 5 Americans now obtain their news from social media , which is a more significant proportion than those who read traditional print media. Social media users who log in multiple times a day can be exposed to non-stop news, typically bad news such as natural disasters, terrorist events, political division, high-profile crimes, etc. Bingeing on bad news via social media or other online sources is known as doom scrolling, which can adversely affect mental health.

How to minimize psychological effects:

• Limit the amount of time you spend on social media – one study found that the less people used social media, the less depressed and lonely they felt . You can use a timer or app to track how long you are spending on social networking sites.
• Use real-world activities to help you focus on your immediate surroundings and circumstances. For example, you can read a book, watch a movie, go for a walk, do some baking, or phone a friend.
• Remember that social media is not a true reflection of reality – user feeds are often highly curated and show only a small proportion of real life.

Negative effects on kids

Technology overuse can have a significant impact on children and teenagers. This is because children’s brains are still developing, which means they can be more sensitive to the effects of technology overuse than adults. For example, some studies suggest that excessive screen time and social media use among kids and teens can impact social skills, creativity, attention spans , and language and emotional development delays. In addition, the same issues described above – poor posture, eye strain, disrupted sleep, and lack of physical activity leading to obesity – also apply to children.

How to minimize the impact on kids:

• It’s important for parents and caregivers to monitor screen time. The American Academy of Pediatrics recommends children under 18 months old avoid screen time altogether, except for video chat , while 2-5 years old should have no more than 1 hour a day of supervised viewing. For older children, the Academy no longer provides a specific recommended time limit (previously, it recommended no more than 2 hours per day, but this was seen as unrealistic given how pervasive technology has become). Instead, the Academy encourages parents and caregivers to set sensible screen limits based on their own circumstances.
• To help your children get better sleep, talk to them about how digital devices can disrupt sleep and encourage them to avoid screens for at least an hour before bedtime.
• Set aside time without technology – for example, by turning off electronics at specific times or set days of the week.
• Model good behaviors for your children by avoiding technology overuse and ensuring your own healthy screen time per day.

Impact on hearing

Prolonged use of earphones, headphones, or earbuds at high volumes can cause hearing loss. The World Health Organization  estimates  that 1.1 billion young people worldwide are at risk of hearing loss due to unsafe listening practices, in part from listening to music via headphones or earbuds. Noise exposure is one of the most  common causes of hearing loss.

How to minimize the impact on hearing:

• Outside-the-ear headphones are considered a better option because, unlike earbuds which deliver music directly into the ear, they provide a buffering space between the music and the ear canal.
• Better quality headphones are likely to improve both your listening experience and protect your hearing.
• You could also consider using noise-canceling headphones, which work by using inverse waves to cancel out the incoming sound. Another option is noise-isolating headphones, which create a seal around the ear that creates a physical barrier between the ear and the outside noise.
• Experts recommend listening at no more than 85 decibels (dB) for no more than 8 hours per day.

Positive effects of technology on health

It’s not all bad: there are many ways in which technology can also positively impact our health. For example, digital devices or apps can help to improve our diets, track our fitness activities, act as a reminder to get up and move or take our medication. There is a wealth of well-sourced and credible medical information online, which allows people to research their own health conditions (although it's important to note that misinformation also exists, and looking up information about health symptoms online can sometimes be a double-edged sword, causing needless worry).

In addition, technology helps medical providers ensure better patient care, improve relationships with patients, and deliver medical results direct to patients’ phones. Examples include:

• Online medical records that give patients access to test results and allow them to fill prescriptions.
• Apps that track chronic illnesses and communicate essential information to doctors.
• Virtual medical appointments – through video and phone consultations – especially during and post-Covid.

Tips for using technology in a healthy way

Some tips for ensuring healthy screen time include:

• Remove unnecessary apps from your phone to prevent you from constantly checking them for updates.
• Set screen time limits and stick to them.
• Log off and take regular breaks.
• Review and maximize your privacy settings on social media. Be selective about what you want to post and who you want to see it.
• Keep mealtimes gadget-free.
• Keep electronic devices out of your bedroom. Turn clocks and other glowing devices towards the wall at bedtime. Avoid using digital devices for at least an hour before going to bed.
• Use the internet to stay connected but prioritize real-world relationships over virtual ones.

If you are a parent or caregiver, many of the same principles apply:

• Set limits on screen time and restrict it before bedtimes and during mealtimes.
• Encourage in-person interactions over online interactions.
• Encourage children to have technology-free playtime.
• Make sure you're aware of what programs, games, and apps they are spending time on – you can read our article on apps and websites parents need to know about here .
• Explore technology together with your children.
• Use a parental control app like Kaspersky Safe Kids – as well as minimizing their exposure to inappropriate content, it also helps you manage their screen time and includes expert advice and tips from child psychologists on online topics.

In summary: technology is an integral aspect of modern life, and there are both positive and negative effects of computer use on human health. Taking sensible steps – such as setting limits on screen time, ensuring correct posture, taking regular breaks, and keeping active – can help minimize the impacts of technology on health.

Related articles:

• Internet safety – guidelines for kids and teens
• How to find the best antivirus for gaming
• What are the effects of cyberbullying
• How to deal with trolling, bots and fake accounts
• https://www.kaspersky.com/blog/secure-futures-magazine/it-health-work/37690/

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The Impact of Technology on Mental Health

In the contemporary world, symptoms of depression, stress, anxiety, and other mental disorders have become more prevalent among university students. Researchers have proven that time spent on social media, videos, and Instant messaging is directly associated with psychological distress. This bibliography examines different literature discussing how technology affects mental wellness.

The scope of this research is to uncover the consequences of technology use on mental health. The research question above will help examine the relationship between technology use and how this action results in mental illnesses such as anxiety and depression. Information used in this study includes both primary and secondary sources focusing on their observational and experimental data analysis.

The article explores how web-based social networking is a significant limitation to mental health. Deepa and Priya (2020) introduce a concept of time whereby they explain that the hours spent on social networking platforms promote depression and anxiety (Deepa & Priya, 2020). Some of the digital technology students use are Instagram, Facebook, Twitter, YouTube, and other web-based sites platforms, which have become a threat to mental health (Deepa & Priya, 2020). The authors explain that researchers discovered that excessive social media use was linked to mental illnesses during schooling. However, it may be alleviated by dialectical thinking, positivity, meditation, and active coping.

The authors used descriptive research using simple sampling questionnaires and ANOVA to study different groups of students and the social media platforms they use. This system provided mixed results based on these groups and examinations (Deepa & Priya, 2020). The research findings revealed a relationship between being active on social media and depression. The authors contradict a study done by Gordon et al. (2007) that mentions that the time spent on the internet has nothing to do with depression (Deepa & Priya, 2020). Instead, it is what students engage in when they are active online. This study is credible because it is not outdated and involved many participants, which helped strengthen the hypothesis created. This source will be integral in answering the types of technology students use and their consequences on mental wellness. Additionally, the journal’s credibility is guaranteed, considering that the article is an international publication. This title indicates that the journal has been peer-reviewed by many other scholars to ensure the information provided is accurate.

The article examines how internet use affects well-being by analyzing the rate of internet use among college students. Gordon et al. (2007) mention that technology use is triggered by self-expression, consumptive motives, and sharing information. In this study, Gordon et al. (2007) posit that frequency of internet use does not affect mental illness. Instead, they mention that what students do on those platforms is the factor that contributes to mental illness.

First, they mention that the internet has provided ways for students to get new acquaintances, find intimate partners, and conduct research for their college assignments, among other things. This factor indicates that these students’ daily life has become increasingly reliant on the internet (Gordon et al., 2007). Therefore, increased internet use has formed a new environment, full of peer pressure. This explanation is an indication of what they do on the internet. The reason is that they see, admire, and adopt new habits which increase stress and depressive symptoms. Additionally, overdependence on technology has affected family cohesion and social connectedness.

The article provides similar ideologies as Junco et al. (2011) that technology causes social isolation by keeping students from the realities in their environment. It explains that students live a fictional life by actively engaging in technology to hide their true selves (Gordon et al., 2007). The research is valid considering it applies rationales from different authors to justify their deduction that technology use has become an avenue for peer pressure among students. This article is essential since it explains the negative impact of technology on mental health, which is explored in this research. It is also a scholarly article considering that these authors have doctors of philosophy in education, indicating vast knowledge and command to undertake this research.

These researchers use unique survey data to investigate the adverse effects of instant messaging on academic achievement. They explain that instant messaging is not destructive since it can provide company when needed. However, excessive use of instant messaging reduces concentration by diverting the mind’s attention away from the facts of the surroundings. Students lose focus when multitasking activities like chatting while studying (Junco & Cotten, 2011). It also impacts the essential, incidental, and representational processing systems, the foundation for learning and memory. When they fail their tests, they become withdrawn with significant effects, such as anxiety and depression.

Additionally, the authors mention that students using IM become socially disengaged since IM becomes their point of contact with others. Considering all these effects, it is evident that IM can cause anxiety, depression, and social isolation if not regulated. Unlike Gordon et al. (2007), who mention only the detrimental effects of using technology, these authors mention that IM, an example of technology, helps students manage stress (Junco & Cotten, 2011). They explain that through a survey of a target group whereby students reported that IM and other online platforms such as video games had provided contact with the outside world, which relieves stress.

This article’s viability is uncertain because most arguments presented are derived from other researchers’ work (Junco & Cotten, 2011). However, the article is helpful for my research because it provides the negative and positive effects of using technology. The position of this research is that IM can help deal with stress. The viability of this research is verified considering the research has been reviewed by Mendeley Company which generates citations for scholarly articles.

Karim et al. (2020) explore how social media impacts mental health. They begin by conducting a qualitative analysis of 16 different studies provided by various researchers on the topic (Karim et al., 2020). First, they listed different types of social media platforms, including Twitter, Linkedin, Facebook, Instagram, and Snapchat, to be the most widely used social media platforms among the youth. They also mention that social media has become an influential technology in the contemporary world (Karim et al., 2020). Although social media has incredible benefits, it is linked to various mental health issues such as depression and anxiety. Some works agreed that social media use is detrimental to mental well-being, and the timing does not matter (Karim et al., 2020). In contrast, other studies suggested that no evidence justifies the maximum time one should be active on social media. None of the research provided the limit of time recommended for anyone to be active on social media.

The credibility of the piece is jeopardized because the researchers did not conduct their study to identify the correlation between mental health and technology (Karim et al., 2020). However, it provides substantial ideas drawn from other credible sources, which are essential in providing information addressing this topic. For example, their position is that long hours of social media use contribute to depression and anxiety (Karim et al., 2020). This focus is integral in my research since it addresses the impact of technology on mental health by explaining the possible avenues for mental health crises.

Lattie et al. (2019) investigate how the rise in mental disorders such as anxiety and depression correlates with computing technologies. According to these authors, personal computing technologies such as smartphones have become the source of mental health crises since they provide access to social media (Lattie et al., 2019). This platform has promoted harmful ideas that make people experience peer comparison. For instance, “fear of missing out (FOMO) is a pressure promoted by media which dictates how people interact, behave and talk within these platforms” (Lattie et al., 2019, para. 8). FOMO is when people feel the need to fit in with a specific trend by emulating verbatim how their internet friends behave, dress or talk. For instance, if all the girls on social media put on branded clothes for attention, every girl on the platform would also want to be like them. This pressure will result in stress to keep up with the standards set, promoting mental health disorders. These authors conclude that the pressure to feel accepted has increased the number of students negatively affected by technology.

However, the authors also mention that this digital platform has played a significant role in promoting mental health wellness. In addition, some of the interventions available such as the Headspace and Pacifica applications, are technology-enabled and provide coping skills when students face a crisis (Lattie et al., 2019). Lattie et al. (2019) provide similar sentiments as Junco et al. (2011), who also stated that technology is not entirely to blame for mental crises considering that activities such as assimilation of culture affect well-being. Additionally, this article is relevant since it has applied different up-to-date scholarly reasoning to create a hypothesis (Lattie et al., 2019). Finally, the article’s position is that social media promotes mental health by providing coping skills while also deteriorating it by contributing to disorders such as depression. However, this information is contrary to what Junco et al. (2011) mention that technology has the power to relieve stress by providing a coping mechanism.

The article provides informative discussions on the risks that digital presence has promoted. Skillbred-Fjeld et al. (2020) mention that many people have experienced harassment online based on their appearance, ethnicity, age, race, and religion. This exposure to bullying has resulted in psychological distress such as depression and suicidal thoughts. The authors indicate that most students spend more hours on digital media than how they spend with families and friends while also being more exposed to harassment. This disconnect is also a challenge to maintaining mental health, considering it breaks the bond between families and friends.

These authors stress that cyberbullying is a prevalent occurrence in online engagement and has detrimental effects on individuals. This article does not share similar rationales with other articles in this search since it focuses on proving how cyberbullying results in mental illness. The article answers the proposed research question, and its position is that cyberbullying affects most students using digital communication systems (Skilbred-Fjeld et al., 2020). The article is credible for this research since the author engaged in intensive searches, which enhanced the viability of the information provided.

In her article “Cyberspace and Identity,” Turkle (1999) posits that the development of cyberspace interactions has extended the range of identities. The author establishes her case with four essential points. Her first observation is that digital presence is based on fiction and not reality. Second, she claims that digital profile results from a digital exhibition that does not last. The third point made by Turkle (1999) is that online identity affects real self-considering the fact that it affects thoughts and behaviors). Finally, she claims that online identity exemplifies a cultural conception of diversity.

This author introduces the aspect of role-playing promoted by digital presence. She mentions that people are given a chance to portray themselves in a different light from reality on digital platforms considering the anonymity established when altering self-image through textual construction (Turkle, 1999). The research by Gordon et al. (2007) reinforced this claim when they mentioned that digital engagement does not cause mental illness. Instead, what students do on those platforms is the primary factor contributing to mental illness (Turkle, 1999). This factor is relatable in the current digital world since people share their adventurous moments, making others who cannot enjoy such things feel unworthy, posing a significant threat to mental wellness. The article’s position is that images portrayed on digital platforms are illusions, and they have promoted peer pressure, anxiety, and depression in people who believe them to be true (Turkle, 1999). The same sentiments are shared by Skilbred-Fjeld et al. (2020) since they mention that social media has become a site to dehumanize others who are less privileged. This occurrence promotes fear, self-hate, and depression, indicating a match in reasoning among these authors.

Deepa, M., & Priya, K. (2020). Impact of social media on mental health of students. International Journal of Scientific & Technology Research , 9 (03). Web.

Gordon, C., Juang, L., & Syed, M. (2007). Internet use and well-being among college students: Beyond frequency of use. Journal of College Student Development , 48( 6), 674-688. Web.

Junco, R., & Cotten, S. R. (2011). Perceived academic effects of instant messaging use.

Computer & Education , 56 (2), 370-378. Web.

Karim, F., Oyewande, A. A., Abdalla, L. F., Ehsanullah, R. C., & Khan, S. (2020). Social media use and its connection to mental health: A systematic review. Cureus , 12 (6). Web.

Lattie, E. G., Lipson, S. K., & Eisenberg, D. (2019). Technology and college student mental health: Challenges and opportunities. Frontiers in psychiatry , (10) , 246. Web.

Skilbred-Fjeld, S., Reme, S. E., & Mossige, S. (2020). Cyberbullying involvement and mental health problems among late adolescents. Cyberpsychology: Journal of Psychosocial Research on Cyberspace , 14 (1). Web.

Turkle, S. (1999). Looking toward cyberspace: Beyond grounded sociology. Cyberspace and identity. Contemporary Sociology , 28 (6), Web.

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The use and impact of surveillance-based technology initiatives in inpatient and acute mental health settings: A systematic review

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Background: The use of surveillance technologies is becoming increasingly common in inpatient mental health settings, commonly justified as efforts to improve safety and cost-effectiveness. However, the use of these technologies has been questioned in light of limited research conducted and the sensitivities, ethical concerns and potential harms of surveillance. This systematic review aims to: 1) map how surveillance technologies have been employed in inpatient mental health settings, 2) identify any best practice guidance, 3) explore how they are experienced by patients, staff and carers, and 4) examine evidence regarding their impact. Methods: We searched five academic databases (Embase, MEDLINE, PsycInfo, PubMed and Scopus), one grey literature database (HMIC) and two pre-print servers (medRxiv and PsyArXiv) to identify relevant papers published up to 18/09/2023. We also conducted backwards and forwards citation tracking and contacted experts to identify relevant literature. Quality was assessed using the Mixed Methods Appraisal Tool. Data were synthesised using a narrative approach. Results: A total of 27 studies were identified as meeting the inclusion criteria. Included studies reported on CCTV/video monitoring (n = 13), Vision-Based Patient Monitoring and Management (VBPMM) (n = 6), Body Worn Cameras (BWCs) (n = 4), GPS electronic monitoring (n = 2) and wearable sensors (n = 2). Twelve papers (44.4%) were rated as low quality, five (18.5%) medium quality, and ten (37.0%) high quality. Five studies (18.5%) declared a conflict of interest. We identified minimal best practice guidance. Qualitative findings indicate that patient, staff and carer perceptions and experiences of surveillance technologies are mixed and complex. Quantitative findings regarding the impact of surveillance on outcomes such as self-harm, violence, aggression, care quality and cost-effectiveness were inconsistent or weak. Discussion: There is currently insufficient evidence to suggest that surveillance technologies in inpatient mental health settings are achieving the outcomes they are employed to achieve, such as improving safety and reducing costs. The studies were generally of low methodological quality, lacked lived experience involvement, and a substantial proportion (18.5%) declared conflicts of interest. Further independent coproduced research is needed to more comprehensively evaluate the impact of surveillance technologies in inpatient settings, including harms and benefits. If surveillance technologies are to be implemented, it will be important to engage all key stakeholders in the development of policies, procedures and best practice guidance to regulate their use, with a particular emphasis on prioritising the perspectives of patients.

Competing Interest Statement

AS and UF have undertaken and published research on BWCs. We have received no financial support from BWC or any other surveillance technology companies. All other authors declare no competing interests.

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https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463993

Funding Statement

This study is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (grant no. PR-PRU-0916-22003). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ARG was supported by the Ramon y Cajal programme (RYC2022-038556-I), funded by the Spanish Ministry of Science, Innovation and Universities.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Data Availability

The template data extraction form is available in Supplementary 1. MMAT quality appraisal ratings for each included study are available in Supplementary 2. All data used is publicly available in the published papers included in this review.

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How Technology Affects Our Lives – Essay

Do you wish to explore the use of information technology in daily life? Essays like the one below discuss this topic in depth. Read on to find out more.

Introduction

Technology in communication, technology in healthcare, technology in government, technology in education, technology in business, negative impact of technology.

Technology is a vital component of life in the modern world. People are so dependent on technology that they cannot live without it. Technology is important and useful in all areas of human life today. It has made life easy and comfortable by making communication and transport faster and easier (Harrington, 2011, p.35).

It has made education accessible to all and has improved healthcare services. Technology has made the world smaller and a better place to live. Without technology, fulfilling human needs would be a difficult task. Before the advent of technology, human beings were still fulfilling their needs. However, with technology, fulfillment of needs has become easier and faster.

It is unimaginable how life would be without technology. Technology is useful in the following areas: transport, communication, interaction, education, healthcare, and business (Harrington, 2011, p.35). Despite its benefits, technology has negative impacts on society. Examples of negative impacts of technology include the development of controversial medical practices such as stem cell research and the embracement of solitude due to changes in interaction methods. For example, social media has changed the way people interact.

Technology has led to the introduction of cloning, which is highly controversial because of its ethical and moral implications. The growth of technology has changed the world significantly and has influenced life in a great way. Technology is changing every day and continuing to influence areas of communication, healthcare, governance, education, and business.

Technology has contributed fundamentally in improving people’s lifestyles. It has improved communication by incorporating the Internet and devices such as mobile phones into people’s lives. The first technological invention to have an impact on communication was the discovery of the telephone by Graham Bell in 1875.

Since then, other inventions such as the Internet and the mobile phone have made communication faster and easier. For example, the Internet has improved ways through which people exchange views, opinions, and ideas through online discussions (Harrington, 2011, p.38). Unlike in the past when people who were in different geographical regions could not easily communicate, technology has eradicated that communication barrier. People in different geographical regions can send and receive messages within seconds.

Online discussions have made it easy for people to keep in touch. In addition, they have made socializing easy. Through online discussions, people find better solutions to problems by exchanging opinions and ideas (Harrington, 2011, p.39). Examples of technological inventions that facilitate online discussions include emails, online forums, dating websites, and social media sites.

Another technological invention that changed communication was the mobile phone. In the past, people relied on letters to send messages to people who were far away. Mobile phones have made communication efficient and reliable. They facilitate both local and international communication.

In addition, they enable people to respond to emergencies and other situations that require quick responses. Other uses of cell phones include the transfer of data through applications such as infrared and Bluetooth, entertainment, and their use as miniature personal computers (Harrington, 2011, p.40).

The latest versions of mobile phones are fitted with applications that enable them to access the Internet. This provides loads of information in diverse fields for mobile phone users. For business owners, mobile phones enhance the efficiency of their business operations because they are able to keep in touch with their employees and suppliers (Harrington, 2011, p.41). In addition, they are able to receive any information about the progress of their business in a short period of time.

Technology has contributed significantly to the healthcare sector. For example, it has made vital contributions in the fields of disease prevention and health promotion. Technology has aided in the understanding of the pathophysiology of diseases, which has led to the prevention of many diseases. For example, understanding the pathophysiology of the gastrointestinal tract and blood diseases has aided in their effective management (Harrington, 2011, p.49).

Technology has enabled practitioners in the medical field to make discoveries that have changed the healthcare sector. These include the discovery that peptic ulceration is caused by a bacterial infection and the development of drugs to treat schizophrenia and depressive disorders that afflict a greater portion of the population (Harrington, 2011, p.53). The development of vaccines against polio and measles led to their total eradication.

Children who are vaccinated against these diseases are not at risk of contracting the diseases. The development of vaccines was facilitated by technology, without which certain diseases would still be causing deaths in great numbers. Vaccines play a significant role in disease prevention.

Technology is used in health promotion in different ways. First, health practitioners use various technological methods to improve health care. eHealth refers to the use of information technology to improve healthcare by providing information on the Internet to people. In this field, technology is used in three main ways.

These include its use as an intervention tool, its use in conducting research studies, and its use for professional development (Lintonen et al, 2008, p. 560). According to Lintonenet al (2008), “e-health is the use of emerging information and communications technology, especially the internet, to improve or enable health and healthcare.” (p.560). It is largely used to support health care interventions that are mainly directed towards individual persons. Secondly, it is used to improve the well-being of patients during recovery.

Bedside technology has contributed significantly in helping patients recover. For example, medical professionals have started using the Xbox computer technology to develop a revolutionary process that measures limb movements in stroke patients (Tanja-Dijkstra, 2011, p.48). This helps them recover their manual competencies. The main aim of this technology is to help stroke patients do more exercises to increase their recovery rate and reduce the frequency of visits to the hospital (Lintonen et al, 2008, p. 560).

The government has utilized technology in two main areas. These include the facilitation of the delivery of citizen services and the improvement of defense and national security (Scholl, 2010, p.62). The government is spending large sums of money on wireless technologies, mobile gadgets, and technological applications. This is in an effort to improve their operations and ensure that the needs of citizens are fulfilled.

For example, in order to enhance safety and improve service delivery, Cisco developed a networking approach known as Connected Communities. This networking system connects citizens with the government and the community. The system was developed to improve the safety and security of citizens, improve service delivery by the government, empower citizens, and encourage economic development.

The government uses technology to provide information and services to citizens. This encourages economic development and fosters social inclusion (Scholl, 2010, p.62). Technology is also useful in improving national security and the safety of citizens. It integrates several wireless technologies and applications that make it easy for security agencies to access and share important information effectively. Technology is widely used by security agencies to reduce vulnerability to terrorism.

Technologically advanced gadgets are used in airports, hospitals, shopping malls, and public buildings to screen people for explosives and potentially dangerous materials or gadgets that may compromise the safety of citizens (Bonvillian and Sharp, 2001, par2). In addition, security agencies use surveillance systems to restrict access to certain areas. They also use technologically advanced screening and tracking methods to improve security in places that are prone to terrorist attacks (Bonvillian and Sharp, 2001, par3).

Technology has made significant contributions in the education sector. It is used to enhance teaching and learning through the use of different technological methods and resources. These include classrooms with digital tools such as computers that facilitate learning, online learning schools, blended learning, and a wide variety of online learning resources (Barnett, 1997, p.74). Digital learning tools that are used in classrooms facilitate learning in different ways. They expand the scope of learning materials and experiences for students, improve student participation in learning, make learning easier and quick, and reduce the cost of education (Barnett, 1997, p.75). For example, online schools and free learning materials reduce the costs that are incurred in purchasing learning materials. They are readily available online. In addition, they reduce the expenses that are incurred in program delivery.

Technology has improved the process of teaching by introducing new methods that facilitate connected teaching. These methods virtually connect teachers to their students. Teachers are able to provide learning materials and the course content to students effectively. In addition, teachers are able to give students an opportunity to personalize learning and access all learning materials that they provide. Technology enables teachers to serve the academic needs of different students.

In addition, it enhances learning because the problem of distance is eradicated, and students can contact their teachers easily (Barnett, 1997, p.76). Technology plays a significant role in changing how teachers teach. It enables educators to evaluate the learning abilities of different students in order to devise teaching methods that are most efficient in the achievement of learning objectives.

Through technology, teachers are able to relate well with their students, and they are able to help and guide them. Educators assume the role of coaches, advisors, and experts in their areas of teaching. Technology helps make teaching and learning enjoyable and gives it meaning that goes beyond the traditional classroom set-up system (Barnett, 1997, p.81).

Technology is used in the business world to improve efficiency and increase productivity. Most important, technology is used as a tool to foster innovation and creativity (Ray, 2004, p.62). Other benefits of technology to businesses include the reduction of injury risk to employees and improved competitiveness in the markets. For example, many manufacturing businesses use automated systems instead of manual systems. These systems eliminate the costs of hiring employees to oversee manufacturing processes.

They also increase productivity and improve the accuracy of the processes because of the reduction of errors (Ray, 2004, p.63). Technology improves productivity due to Computer-aided Manufacturing (CAM), Computer-integrated Manufacturing (CIM), and Computer-aided Design (CAD). CAM reduces labor costs, increases the speed of production, and ensures a higher level of accuracy (Hunt, 2008, p.44). CIM reduces labor costs, while CAD improves the quality and standards of products and reduces the cost of production.

Another example of the use of technology in improving productivity and output is the use of database systems to store data and information. Many businesses store their data and other information in database systems that make accessibility of information fast, easy, and reliable (Pages, 2010, p.44).

Technology has changed how international business is conducted. With the advent of e-commerce, businesses became able to trade through the Internet on the international market (Ray, 2004, p.69). This means that there is a large market for products and services. In addition, it implies that most markets are open 24 hours a day.

For example, customers can shop for books or music on Amazon.com at any time of the day. E-commerce has given businesses the opportunity to expand and operate internationally. Countries such as China and Brazil are taking advantage of opportunities presented by technology to grow their economy.

E-commerce reduces the complexities involved in conducting international trade (Ray, 2004, p.71). Its many components make international trade easy and fast. For example, a BOES system allows merchants to execute trade transactions in any language or currency, monitor all steps involved in transactions, and calculate all costs involved, such as taxes and freight costs (Yates, 2006, p.426).

Financial researchers claim that a BOES system is capable of reducing the cost of an international transaction by approximately 30% (Ray, 2004, p.74). BOES enables businesses to import and export different products through the Internet. This system of trade is efficient and creates a fair environment in which small and medium-sized companies can compete with large companies that dominate the market.

Despite its many benefits, technology has negative impacts. It has negative impacts on society because it affects communication and has changed the way people view social life. First, people have become more anti-social because of changes in methods of socializing (Harrington, 2008, p.103). Today, one does not need to interact physically with another person in order to establish a relationship.

The Internet is awash with dating sites that are full of people looking for partners and friends. The ease of forming friendships and relationships through the Internet has discouraged many people from engaging in traditional socializing activities. Secondly, technology has affected the economic statuses of many families because of high rates of unemployment. People lose jobs when organizations and businesses embrace technology (Harrington, 2008, p.105).

For example, many employees lose their jobs when manufacturing companies replace them with automated machines that are more efficient and cost-effective. Many families are struggling because of the lack of a constant stream of income. On the other hand, technology has led to the closure of certain companies because the world does not need their services. This is prompted by technological advancements.

For example, the invention of digital cameras forced Kodak to close down because people no longer needed analog cameras. Digital cameras replaced analog cameras because they are easy to use and efficient. Many people lost their jobs due to changes in technology. Thirdly, technology has made people lazy and unwilling to engage in strenuous activities (Harrington, 2008, p.113).

For example, video games have replaced physical activities that are vital in improving the health of young people. Children spend a lot of time watching television and playing video games such that they have little or no time for physical activities. This has encouraged the proliferation of unhealthy eating habits that lead to conditions such as diabetes.

Technology has elicited heated debates in the healthcare sector. Technology has led to medical practices such as stem cell research, implant embryos, and assisted reproduction. Even though these practices have been proven viable, they are highly criticized on the grounds of their moral implications on society.

There are many controversial medical technologies, such as gene therapy, pharmacogenomics, and stem cell research (Hunt, 2008, p.113). The use of genetic research in finding new cures for diseases is imperative and laudable. However, the medical implications of these disease treatment methods and the ethical and moral issues associated with the treatment methods are critical. Gene therapy is mostly rejected by religious people.

They claim that it is against natural law to alter the gene composition of a person in any way (Hunt, 2008, p.114). The use of embryonic stem cells in research is highly controversial, unlike the use of adult stem cells. The controversy exists because of the source of the stem cells. The cells are obtained from embryos. There is a belief among many people that life starts after conception.

Therefore, using embryos in research means killing them to obtain their cells for research. The use of embryo cells in research is considered in the same light as abortion: eliminating a life (Hunt, 2008, p.119). These issues have led to disagreements between the science and the religious worlds.

Technology is a vital component of life in the modern world. People are so dependent on technology that they cannot live without it. Technology is important and useful in all areas of human life today.

It has made life easy and comfortable by making communication faster and travel faster, making movements between places easier, making actions quick, and easing interactions. Technology is useful in the following areas of life: transport, communication, interaction, education, healthcare, and business. Despite its benefits, technology has negative impacts on society.

Technology has eased communication and transport. The discovery of the telephone and the later invention of the mobile phone changed the face of communication entirely. People in different geographical regions can communicate easily and in record time. In the field of health care, technology has made significant contributions in disease prevention and health promotion. The development of vaccines has eradicated certain diseases, and the use of the Internet is vital in promoting health and health care.

The government uses technology to enhance the delivery of services to citizens and the improvement of defense and security. In the education sector, teaching and learning processes have undergone significant changes owing to the impact of technology. Teachers are able to relate to different types of learners, and the learners have access to various resources and learning materials. Businesses benefit from technology through the reduction of costs and increased efficiency of business operations.

Despite the benefits, technology has certain disadvantages. It has negatively affected human interactions and socialization and has led to widespread unemployment. In addition, its application in the healthcare sector has elicited controversies due to certain medical practices such as stem cell research and gene therapy. Technology is very important and has made life easier and more comfortable than it was in the past.

Barnett, L. (1997). Using Technology in Teaching and Learning . New York: Routledge.

Bonvillian, W., and Sharp, K. (2011). Homeland Security Technology . Retrieved from https://issues.org/bonvillian/ .

Harrington, J. (2011). Technology and Society . New York: Jones & Bartlett Publishers.

Hunt, S. (2008). Controversies in Treatment Approaches: Gene Therapy, IVF, Stem Cells and Pharmagenomics. Nature Education , 19(1), 112-134.

Lintonen, P., Konu, A., and Seedhouse, D. (2008). Information Technology in Health Promotion. Health Education Research , 23(3), 560-566.

Pages, J., Bikifalvi, A., and De Castro Vila, R. (2010). The Use and Impact of Technology in Factory Environments: Evidence from a Survey of Manufacturing Industry in Spain. International Journal of Advanced Manufacturing Technology , 47(1), 182-190.

Ray, R. (2004). Technology Solutions for Growing Businesses . New York: AMACOM Div American Management Association.

Scholl, H. (2010). E-government: Information, Technology and Transformation . New York: M.E. Sharpe.

Tanja-Dijkstra, K. (2011). The Impact of Bedside Technology on Patients’ Well-Being. Health Environments Research & Design Journal (HERD) , 5(1), 43-51.

Yates, J. (2006). How Business Enterprises use Technology: Extending the Demand-Side Turn. Enterprise and Society , 7(3), 422-425.

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Home — Essay Samples — Information Science and Technology — Disadvantages of Technology — The Impact of Technology on Our Lives

The Impact of Technology on Our Lives

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Published: Jan 29, 2024

Words: 799 | Pages: 2 | 4 min read

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Impact on communication, effects on education, influence on work and productivity, influence on health and well-being, impact on society.

• Anderson, M., & Perrin, A. (2017, May 19). Tech Adoption Climbs Among Older Adults. Pew Research Center - Internet and Technology. https://www.pewresearch.org/internet/2017/05/17/technology-use-among-seniors/
• Brown, A. E., & Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women’s mood and body image. Body Image, 19, 37-43. https://doi.org/10.1016/j.bodyim.2016.09.008
• Chen, Q., Liang, Y., & Deng, C. (2019). The effects of WeChat use on mental health among college students in China. Cyberpsychology, Behavior, and Social Networking, 22(12), 724-730. https://doi.org/10.1089/cyber.2019.0216
• Kim, L. E., & Caine, K. E. (2014). Help-seeking behavior in the context of suicidal ideation: A study of Facebook users. Journal of Affective Disorders, 155, 49-53. https://doi.org/10.1016/j.jad.2013.10.043

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Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews

Associated data.

Background: Research increasingly shows how selective and targeted use of technology within care and welfare can have several advantages including improved quality of care and active user involvement.

Purpose: The current overview of reviews aims to summarize the research on the effectiveness of technology for mental health and wellbeing. The goal is to highlight and structure the diverse combinations of technologies and interventions used so far, rather than to summarize the effectiveness of singular approaches.

Methods: The current overview includes reviews published in the past five years with a focus on effectiveness of digital and technological interventions targeting mental health and wellbeing.

Results: A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. A combination of two taxonomies was created through qualitative analysis, based on the retrieved interventions and technologies in the reviews. Review classification shows a predominance of reviews on psychotherapeutic interventions using computers and smartphones. It is furthermore shown that when smartphone applications as stand-alone technology are researched, the primary focus is on self-help, and that extended reality is the most researched emerging technology to date.

Conclusion: This overview of reviews shows that a wide range of interventions and technologies, with varying focus and target populations, have been studied in the field of care and wellbeing. The current overview of reviews is a first step to add structure to this rapidly changing field and may guide both researchers and clinicians in further exploring the evidence-base of particular approaches.

Introduction

Within the broad field of healthcare and welfare a wide range of services are offered which are aimed at promoting the wellbeing and mental health of individuals. While the context and target populations can vary substantially, professionals in this field share many interventions which often rely on face-to-face interactions. However, digital technologies can also support these services, either stand-alone or in combination with an existing service offer. New technologies can allow for more flexibility, can offer interventions in the natural context, can reach a larger population without risk of stigma, and can be more cost-effective as compared to existing services ( 1 , 2 ). Research increasingly shows how selective and targeted use of technology can have a meaningful impact on the quality of care and the role users can take in the organization and delivery of services ( 3 ). For example, users may be able to have more control over their care, especially in the context of chronic illness ( 4 ).

Nevertheless, there is a sharp contrast between what is technically possible and the amount of research that has actually been done so far. As a result, there are an overwhelming number of options, which hampers overview. To address this, attempts have already been made to structure parts of the field, for example for specific technologies, e.g., internet-supported mental health interventions ( 5 , 6 ), smartphone apps ( 7 ) or for particular domains, e.g., for emotion regulation in clinical psychology ( 8 ). The current overview of reviews aims to extend those previous endeavors by expanding the scope to all technologies applied to the broad domain of mental health and wellbeing. The goal is to structure existing technologies and interventions which have been the focus of reviews, rather than to summarize the effectiveness of singular approaches. By summarizing the large body of research to date and by highlighting both similarities and differences across approaches and settings, we hope to further structure this domain and to inform about gaps in research that currently still exists.

Materials and Methods

This review was preregistered in the Open Science Framework as part of a larger study ( https://osf.io/hdxky ).

Search Strategy

The databases Scopus and Web of Sciences were searched on 4 January 2021 for reviews written in English and published in the past five years with a focus on effectiveness of digital and technological interventions in the field of care and welfare. A combination of two sets of search terms was used, one with a focus on technological interventions and the other on wellbeing. The search string was as follows: (websites OR “smartphone app * ” OR wearable OR “virtual reality” OR “augmented reality” OR “immersive technology” OR platform OR mhealth OR “mobile health” OR ehealth OR “e-mental health” OR e-health OR internet OR mail OR chat) AND (“mental health * ” OR “mental wellbeing” OR “social support” OR “psychological support” OR psycholog * OR psychiatr * OR “mental illness” OR “mental disorder” OR “quality of life”).

Inclusion and Exclusion Criteria

Articles were included if they were systematic reviews, meta-analyses, scoping reviews, or overviews of reviews with an exclusive focus on the efficacy of technological tools or interventions in the context of mental health, wellbeing, or quality of life. No limitations were placed on the setting, control condition, or population, which could consist of participants of all ages of the general population, at-risk groups or individuals with underlying conditions. Studies were excluded if the focus was on strictly medical applications, lab research, assistive technology for disability, mere feasibility of technology, and if research took place among low- and middle-income countries.

Literature Screening and Data Extraction

The online review platform Covidence ( https://www.covidence.org ) was used, which aims to facilitate screening and data extraction with multiple reviewers. Titles, abstracts and full texts were screened by two independent reviewers in each phase. Conflicts were resolved through discussion. A data extraction template was designed to extract the characteristics of each included study. Reviews were categorized regarding:

• (1) Focus: prevention, treatment, or relapse prevention.
• (2) Target population, or the intended audience of the reviewed interventions: general population, at-risk population, somatic disorders, pain or neurological disorders, substance use, mental illness, or other.
• (3) Age: children and young adults, adults, or elderly.
• (4) Setting: home, outpatient, or residential.
• (5) Integration with conventional care: online, blended.

The included reviews were also labeled according to the intervention(s) and implemented technology(/ies) through inductive qualitative analysis with the goal of creating a taxonomy. Three authors independently developed an intervention and technology taxonomy based on 50 included reviews. These categorizations were subsequently compared, and the final matrix combining interventions and technologies was developed through discussion. All reviews were subsequently labeled according to these taxonomies. A review could load on multiple interventions and technologies simultaneously. After data extraction was complete, each entry was checked for errors in extraction by the first author.

For a number of combinations of interventions and technologies a review was selected and its focus described, to briefly illustrate what each combination might. Three criteria for selection were put forward: (1) the review is the most recent available, (2) the review is of high-quality, as determined by the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses [a maximum of four negative evaluations; ( 9 )], and (3) the review focuses on the combination of a single methodology and technology.

Study Identification

The systematic search strategy yielded 6,113 results. The selection process is visually summarized in a PRISMA flowchart ( 10 ) in Figure 1 . A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. The reviews were diverse in scope and the quality of the studies they retrieved varied greatly (cfr. supra, review illustrations). Each review included an average of 16 studies, with outliers ranging from 1 to 111 studies.

PRISMA flowchart.

Characteristics of Reviews

A detailed overview of the characteristics of each review can be found in Supplementary Table 1 . Results show that most reviews focused on treatment ( N = 196). Prevention was also fairly common ( N = 107), but only a limited number of reviews examined applications for relapse prevention or maintenance of treatment effects ( N = 20). In line with the focus on treatment or, in this context, psychotherapy, the largest subset of reviews had an (exclusive) focus on individuals with mental illness ( N = 142; Figure 2 ). This was followed by the general population ( N = 58) and somatic conditions ( N = 56). The “other” category of Figure 2 consisted of informal caregivers ( N = 22) and perinatal women ( N = 9). A third of the studies focused on more than one target group in their review (e.g., both general population and at risk populations). In terms of age group, most studies focus primarily on adults ( N = 203). However, there are also several studies that focus on children to young adults ( N = 81). The age group that is currently understudied in systematic reviews is the older population ( N = 23). Since most reviews do not clearly indicate the setting in which the studies took place (e.g., outpatient or residential), it was not possible to formally categorize reviews on this behalf. In general, however, many interventions were offered in the home setting. Additionally, interventions also took place in outpatient care, residential care, school/university setting, and the work context. Finally, there were only three reviews that clearly and explicitly examined blended care (a combination of online and face-to-face contact). Most reviews examined interventions that were entirely digital or did not clearly report whether complementary face-to-face contact was provided.

Target groups of the included reviews. Each review could be assigned multiple categories.

The taxonomy concerning interventions consists of 9 types, which are described in Table 1 and can be considered as an operationalization of the mental health intervention spectrum of mental disorders, developed by Mrazek and Haggerty ( 23 ).

Taxonomy of interventions determined through inductive qualitative analysis, and their description.

Three broad clusters of technologies can be distinguished: a first is technologies taking conventional care online. A second is technology to be used as (stand-alone) interventions. Finally, there are emerging technologies, on which there may already be substantial research evidence, but which have not necessarily been (frequently) implemented in clinical practice up to now. Table 2 provides an overview of the taxonomy of technologies.

Taxonomy of implemented technologies, determined through inductive qualitative analysis, and their description.

Technological and digital interventions rely on the combination of a technical component and an intervention. The retrieved reviews can thereby be categorized under several interventions and/or technology forms. The matrix in Table 3 should therefore not be viewed as an exhaustive overview of possible combinations of interventions and technologies. What can be derived from it are common and less common combinations of technologies and interventions and the relative difference in weight of the various possible combinations.

Overview of the number of studies retrieved in the reviews for combinations of interventions and technologies.

ACT, acceptance and commitment therapy; CBT, cognitive behavioral therapy; XR, extended reality .

The overview in Table 3 shows that the focal point of research into technological and digital interventions for mental health and wellbeing is on interventions offered through computer, smartphone, or a combination of both.

Programs can be offered in the form of mere self-help or can include some form of (mainly digital) support from a professional. Table 4 provides an overview of the number of studies included in the reviews that discuss pure self-help in relation to studies that (also) include interventions that are supported by a professional. While the majority of studies on smartphone applications are limited to self-help, studies exploring computerized programs do more commonly include professional support. Conventional services delivered online are less represented. In terms of emerging technologies, studies using VR and wearables are most common. When inspecting the interventions, and in line with the predominance of samples with mental disorders, psychotherapeutic interventions are strongly represented in the literature. Supportive interventions are also common and mostly target informal caregivers and individuals with somatic conditions.

Overview of the number of studies retrieved in the reviews for combinations focusing on interventions and self-help.

ACT, acceptance and commitment therapy; CBT, cognitive behavioral therapy .

Illustrations of Reviews Within the Combination of Both Taxonomies

Discussing each of the 246 studies would lead us to far. To nevertheless offer some insight into both taxonomies, we briefly describe the most common combinations of technologies and interventions. For that purpose, we choose the most frequent combinations within the three technological clusters defined earlier and selected the review meeting all three criteria defined earlier. The JBI quality assessments of all retrieved studies can be found in Supplementary Table 2 .

Conventional Approach Using (a)Synchronous Technologies

Corry et al. ( 28 ) focused on synchronous technology and supportive interventions . They conducted a systematic review on telephone interventions delivered by healthcare professionals, for providing education and psychosocial support to informal caregivers of adults with diagnosed illnesses. The combination of asynchronous technology and psychotherapeutic interventions was reviewed by Senanayake et al. ( 29 ). In text messaging interventions for the management of depression, texts were being used for various purposes: therapeutic, motivational and supportive.

Programs Supported by Technology

Digital programs were explored in combination with a wide variety of interventions, for example with preventive interventions in the context of technology-enhanced youth suicide prevention and interventions ( 30 ). Others were combined with measurement and follow-up , using digital interventions for routine outcome monitoring (ROM) and measurement-based care (MBC), the routine use of outcome measurement to guide treatment decisions of patients receiving face-to-face psychotherapy ( 31 ). Leng et al. ( 32 ) furthermore focused on the potential of combing digital programs and supportive interventions , more specifically the use of digital interventions to support informal caregivers of people with dementia. Victorson et al. ( 33 ), finally, explored the combination with psychotherapeutic interventions—ACT and mindfulness when looking into technology-enabled mindfulness-based programs.

Self-help smartphone programs were either most commonly combined with behavioral interventions or with psychotherapeutic interventions . On the one hand, a systematic review by Milne-Ives et al. ( 34 ) focused for example on the effectiveness of smartphone apps for health behavior change, in physical activity, diet, drug and alcohol use, and mental health. On the other hand, Ilagan et al. ( 35 ) looked into psychotherapeutic interventions targeting borderline personality disorder (BDP) symptoms like anger, suicidality and self-harm, using smartphone apps. These apps were used to set up safety plans, to help patients track their mood, or to facilitate emotion regulation exercises.

Computer programs often looked into psychotherapeutic interventions, both general or CBT , but were also used in the context of skills training . Dugdale et al. ( 36 ) summarized current evidence on the potential of computer-based treatment programs to reduce symptoms of substance misuse and mental health difficulties in adults with a dual diagnosis. Following an initial screening, users could for example access an interactive coping strategy training, which helped them to address the lifestyle factors which are maintaining their harmful alcohol consumption. Eilert et al. ( 37 ) conducted a systematic review and meta-analysis on the effectiveness of computer-based treatment for generalized anxiety disorder. All but one of the online interventions included some form of human support alongside the intervention and most were primarily based on CBT. To be more specific, interventions relied on (a combination of) psychoeducation, case examples, mindfulness and/or relaxation exercises, notification and/or reminder emails, homework, summaries, and relapse prevention and maintenance. Finally, a scoping review by Zhang et al. ( 38 ) assessed the potential of computer-based cognitive bias modification interventions. These interventions, for which evidence initially emerged from experimental psychology, aim to retrain automatic attention to stimuli that are either harmful (e.g., in the context of substance abuse) or threatening (e.g., in the context of social anxiety disorder). In order to do so, participants for example completed online series of modified Stroop tasks. In these tasks, the computer presented them with series of threatening and neutral words, in varying colors. Every time, participants were asked to name the color of these words, while ignoring their semantic content.

Emerging Technologies

XR was most commonly used in combination with psychotherapeutic interventions—CBT . Kothgassner and Felnhofer ( 39 ) examined the effectiveness of virtual reality exposure therapy (VRET) for the treatment of anxiety disorders in children and adolescents. Social media , in turn was most frequently combined with supportive interventions . Ridout and Campbell ( 40 ) conducted a systematic review on the current evidence base for using social networking sites as a means to deliver mental health interventions for young people up to the age of 25, particularly for sharing knowledge and providing peer-to-peer support. Wearables were often used for measurement and follow-up and were for example used to unobtrusively measure and monitor depressive symptoms in children and adolescents ( 41 ). Chatbots were applied in the context of pychotherapeutic interventions , for example in the review by Abd-Alrazaq et al. ( 26 ) who explored to what extent chatbots might meet the needs of people with mental health conditions, in particular people with symptoms of depression, anxiety and stress and acrophobia. Emerging technologies which are less frequent in current literature are digital phenotyping and robots. Cornet and Holden ( 13 ) looked into the potential of digital phenotyping for health and wellbeing and found that smartphones were most commonly used to capture accelerometery, location, audio, and usage data, for example with patients with bipolar disorder or schizophrenia. The obtained data were primarily used for unobtrusive monitoring. Finally, Scoglio et al. ( 42 ) was the only review with an exclusive focus on robots , but found only a very limited number of studies to date.

The current overview of reviews on technological and digital interventions in the field of care and welfare shows that there is a large diversity, both in terms of interventions and technologies used. Although the focus is mainly on treatment, a relevant portion of the reviews also consider a preventive approach. Furthermore, both in the case of young people and adults, the reviews focus on a wide variety of target groups. No clear-cut differences regarding these target groups were found amongst the diversity of retrieved reviews, aside from the fact that supportive interventions mostly targeted informal caregivers and individuals with somatic conditions. Technologies most frequently researched are programs, both on computers, smartphones, or cross-platform digital environments (74% of all study categorizations). Not only emerging technologies (e.g., XR), but also technologies that allow conventional therapy to take place online (e.g., video calling) have been the focus of research far less often. Remarkably, an explicit focus on blended interventions is largely absent from the reviews. Combining online and face-to-face offerings is often cited as the most promising avenue for technological and digital interventions in care and welfare ( 43 ). However, only three of the 246 reviews appear to explicitly focus on this.

A classification matrix focusing on the type of technology and the content of the activity or intervention was created through qualitative analysis. This proved challenging as many reviews included a wide range of interventions. While the current solution can help to understand the variety of possible interventions and gaps in research and practice, other ways of classification are also possible and have been proposed. The list of treatment elements and definitions for the classification of smartphone apps by Wasil et al. ( 7 ) for example demonstrated that psychoeducation, relaxation and medication were the three most common elements in smartphone apps. Since our study goes beyond smartphone apps and focuses on reviews that each include a broad range of treatment elements, a categorization at a higher level was warranted. Fernandez-Álvarez et al. ( 8 ) recently made a similar attempt to structure current research on digital technologies for the intervention of emotion regulation, in which a distinction was made between three distinct categories: digital technologies (1) to understand process and outcome (e.g., (bio)sensors, (2) to create new interventions (e.g., bio- and neurofeedback and XR) and (3) to disseminate psychological treatments [e.g., (un)guided interventions and videoconferencing psychotherapy]. Although their categorization is solely focused on emotion regulation, the structuring does show similarities to the current overview of review. However, as our study took a more systematic approach and looked at combinations of technologies and interventions in a broader field, it might offer better insights in current gaps and potential opportunities. The potential of XR is for example not limited to creating new interventions, but might very well also be used to understand process and outcome. A structuring of the field using the combination of two taxonomies therefore seems to better allow for a flexible categorization of (future) studies.

The focus of future research can be twofold. Firstly, it can further explore novel combinations of interventions and technologies, as combining both taxonomies resulted in a 9 x 9 matrix. This implies that, theoretically, 81 combinations could be made of different technologies and interventions. However, no studies were retrieved for 31 of those combinations (38%). This might lead one to conclude that the different forms of technology have only been used rather one-sided so far. However, not every technology is necessarily suitable for every intervention. Nevertheless, there are various technologies included in the matrix that are still recent: research on these paradigms has therefore only recently started developing. Those emerging technologies have currently been relatively understudied, except for XR, where virtual reality already has an extensive and long-standing research tradition, but is only now gradually making its way into practice. Secondly, even more established combinations need further strengthening, especially those who already see strong uptake in clinical practice. To be more specific, this overview for example shows that (self-help) smartphone apps and programs, which are currently already frequently disseminated in practice, have not been the focus of as much research as often might be thought.

There are also limitations to the current study. Given the broad scope of our overview and the large number of reviews retrieved, we opted to rely on the count of studies within reviews as an indication for the amount of research that has been conducted to date. This obviously does not provide a proper indication of the actual evidence-base for particular combinations of technologies and interventions. We are therefore cautious in our interpretations and see the current overview primarily as a way to provide a structuring of a very broad field, which is currently still in the midst of expanding. Also important to note is that this overview was set up in the context of a broader study on the potential of technological and digital interventions for Flanders, a region and community in Belgium. To assure sufficient local relevance of the literature overview, it was therefore limited to only include reviews with a focus on high-income countries. In the initial abstract screening process several articles were excluded focusing on low to middle income countries. Digital interventions seem (also) most prevalent there as well, although the number of studies specifically taking these contexts into account are still limited ( 44 ).

Taken together, the current overview shows that technological and digital interventions in the field of care and welfare can vary substantially in terms of the aims for which they are used, their focus, and target population. Overall, reviews focusing on effectiveness of such applications do appear to have mostly concentrated on psychotherapeutic interventions for mental illness offered through computers and smartphones. Regardless of the underlying rationale, however, adding structure to this diverse and rapidly expanding field helps to offer some insights in current (lack) of evidence-base of certain technologies and interventions that rely on them.

Author Contributions

EV, SJ, and ND created the taxonomy. All authors contributed to the screening process and participated in the data extraction and the writing of the manuscript.

The funding for this overview was provided by the Policy Research Centre Welfare, Public Health and Family of the Flemish Government (Project EF73).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

We would like to thank the reviewers, as well as the members of the project's advisory board and particularly the chair of the board, Loes Houthuys, for their reflections and constructive input.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fdgth.2021.754337/full#supplementary-material