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      Democratizing Global Health Care Through Scalable Emergent (Beyond the Mobile) Wireless Technologies

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          Abstract

          Advances in mobile phone technologies coupled with the availability of modern wireless networks are beginning to have a marked impact on digital health through the growing array of apps and connected devices. That said, limited deployment outside of developed nations will require additional approaches to collectively reach the 8 billion people on earth. Another consideration for development of digital health centered around mobile devices lies in the need for pairing steps, firmware updates, and a variety of user inputs, which can increase friction for the patient. An alternate, so-called Beyond the Mobile approach where medicaments, devices, and health services communicate directly to the cloud offers an attractive means to expand and fully realize our connected health utopia. In addition to offering highly personalized experiences, such approaches could address cost, security, and convenience concerns associated with smartphone-based systems, translating to improved engagement and adherence rates among patients. Furthermore, connecting these Internet of Medical Things instruments through next-generation networks offers the potential to reach patients with acute needs in nonurban regions of developing nations. Herein, we outline how deployment of Beyond the Mobile technologies through low-power wide-area networks could offer a scalable means to democratize digital health and contribute to improved patient outcomes globally.

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          Most cited references55

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          The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective

          The Lancet, 383(9921), 999-1008
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            Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop

            Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom’s Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key conclusion was that sustained engagement is not always required and that for each intervention it is useful to establish what constitutes “effective engagement,” that is, sufficient engagement to achieve the intended outcomes. The potential of digital interventions for testing and advancing theories of behavior change by generating ecologically valid, real-time objective data was recognized. Evaluations should include all phases of the development cycle, designed for generalizability, and consider new experimental designs to make the best use of rich data streams. Future health economics analyses need to recognize and model the complex and potentially far-reaching costs and benefits of digital interventions. In terms of governance, developers of digital behavior interventions should comply with existing regulatory frameworks, but with consideration for emerging standards around information governance, ethics, and interoperability.
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              Renovating the Pyramid of Needs: Contemporary Extensions Built Upon Ancient Foundations.

              Maslow's pyramid of human needs, proposed in 1943, has been one of the most cognitively contagious ideas in the behavioral sciences. Anticipating later evolutionary views of human motivation and cognition, Maslow viewed human motives as based in innate and universal predispositions. We revisit the idea of a motivational hierarchy in light of theoretical developments at the interface of evolutionary biology, anthropology, and psychology. After considering motives at three different levels of analysis, we argue that the basic foundational structure of the pyramid is worth preserving, but that it should be buttressed with a few architectural extensions. By adding a contemporary design feature, connections between fundamental motives and immediate situational threats and opportunities should be highlighted. By incorporating a classical element, these connections can be strengthened by anchoring the hierarchy of human motives more firmly in the bedrock of modern evolutionary theory. We propose a renovated hierarchy of fundamental motives that serves as both an integrative framework and a generative foundation for future empirical research.
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                Author and article information

                Contributors
                Journal
                JMIR Biomed Eng
                JMIR Biomed Eng
                JMBE
                JMIR biomedical engineering
                JMIR Publications (Toronto, Canada )
                2561-3278
                Jan-Jun 2022
                11 February 2022
                : 7
                : 1
                : e31079
                Affiliations
                [1 ] Technical Research and Development Novartis Pharmaceuticals East Hanover, NJ United States
                [2 ] Technical Research and Development Novartis AG Basel Switzerland
                [3 ] Global Drug Development Connected Health Novartis Pharmaceuticals East Hanover, NJ United States
                Author notes
                Corresponding Author: Graham B Jones graham.jones@ 123456novartis.com
                Author information
                https://orcid.org/0000-0003-2195-3567
                https://orcid.org/0000-0003-2155-7898
                https://orcid.org/0000-0001-6076-0771
                Article
                v7i1e31079
                10.2196/31079
                11041427
                da366b40-460c-47db-b541-f99000f91f3a
                ©Graham B Jones, Andrew Bryant, Justin Wright. Originally published in JMIR Biomedical Engineering (http://biomsedeng.jmir.org), 11.02.2022.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Biomedical Engineering, is properly cited. The complete bibliographic information, a link to the original publication on https://biomedeng.jmir.org/, as well as this copyright and license information must be included.

                History
                : 8 June 2021
                : 21 July 2021
                : 22 July 2021
                : 20 December 2021
                Categories
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                lpwan,wireless communication,global health,mobile technology,mhealth,wireless,cloud-based,personalization,cost,security,convenience,iot,internet of things

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