Abstract
Digital technology has the potential to create a wide range of opportunities for motivating physical activity and a healthy lifestyle, implementing programs, and improving health indicators. This chapter presents an overview as to how digitization of physical health data can become the basis of helpful information for implementing and prioritizing physical activity actions in low-and middle-income countries (LMICs). The digitized data can be helpful to policymakers and stakeholders involved in promoting physical activities and physical health at the individual, local, national, regional, and global levels. In addition, digitizing physical health data will be an essential basis for a research program on the economic aspects of physical activity in LMICs. This will be a valuable guide for researchers to plan research in economics and physical health using a reliable methodology focused on the LMICs research needs. In addition, the information obtained from digitalization will help funding agencies allocate and monitor resources efficiently.
“Physical health is defined as the state of the body while considering everything from the absence of diseases to the level of physical fitness.”
EUPATI—European Patients Academy on Therapeutic Innovation.
You have full access to this open access chapter, Download chapter PDF
Keywords
1 Introduction
Globally, it is widely accepted that the physical health of the young generation is continuously declining, which remains unnoticed in many countries (Fan 2021). The twenties of the twenty-first century are marked by digital transformation. Digital technologies are being actively introduced into all spheres of life and are becoming an indispensable component of business plans. Medicine is not left out. A study from Deloitte showed that 92% of medical institutions consider increased customer satisfaction and engagement as the main result that can be achieved due to digital transformation (Deloitte Center for Health Solutions 2021). In recent years, there have been innovations in physical health tools and health applications designed to manage and promote physical health and fitness among the general population (Sawyer et al. 2023).
Several wearable devices on the market are suitable for monitoring a person’s physical health. The growth of technological innovation is rapidly redefining the right to the highest attainable standard of physical health. In a growing number of countries, this has strengthened the ability of governments to protect and fulfill this fundamental human right by ensuring accessibility, acceptability, and good quality of medical facilities, goods, and services. The 2030 Agenda for Sustainable Development emphasizes that spreading information and communication technologies and global connectivity have enormous potential to accelerate human progress, bridge the digital divide and develop (United Nations General Assembly resolution 2015).
Digitalization research is still in its early stages but is expanding. The widespread use of digital technologies in the healthcare sector includes the search for medical knowledge resources, monitoring the quality of patient care, and improving clinical support (Paul et al. 2023).The availability of digital devices with integrated sensors has caused a growing interest in their use in health care systems and sports science (Antunes et al. 2018; Botilias et al. 2020). In addition, digital devices have become a promising tool for improving the regular collection of health data, disease monitoring, and support for public health surveillance (Ravalli et al. 2022).
Digital technologies allow patients and doctors to both inform and control the treatment process. However, this technology complements physical consultation and in no way replaces physical consultation (Haleem et al. 2021). Multicomponent health promotion programs with digital components are increasingly being implemented in the workplace to assess and promote employees’ health and reduce the risk of chronic diseases (Thai et al. 2023). Regular physical activity (PA) and good physical health reduce the risk of developing diseases such as heart disease, stroke, and some cancers. Also, it helps to cope with life problems, protecting against fatigue, injury, and illness (National Center for Chronic Disease Prevention and Health Promotion 2023; Booth et al. 2012). Since the positive impact of regular PA on a person’s physical health is well known and is an essential prerequisite for healthy aging, digital technologies are also increasingly being used to encourage unstructured and structured forms of PA (Herold et al. 2022). The World Health Organization (WHO) is drafting the ‘Global action plan on physical activity (GAPPA) to be implemented from 2018 to 2030 (WHO 2018).
Mobile and wireless technologies, such as mobile phones and wearable devices, have the potential to reach millions of people and can help promote and increase PA and reduce sedentary behaviors. WHO is working with scientific partners and industry to find out what works and scale the reach and impact of applications and programs aimed at helping people of all ages to be more active (World Health Organization 2023). In 2017 the World Confederation for Physical Therapy (WCPT) launched a collaboration to develop initiatives for the global practice and regulations of digital physical therapy practice through a Joint WCPT/INPTRA digital physical therapy Practice Task Force (Task Force). The variety of technologies encompassing digital and physical therapy may include telemonitoring, tele-education, telemedicine, teleassistance, and mobile health, and each field has its subset of technologies and specificities (World confederation for physiotherapy 2017–2019).
2 Focusing on LMICs
Health issues in low- and middle-income countries (LMICs) have been the focus of many digital initiatives to ensure the sustainability of these services. Policymakers should take into account the issues of utility, usability, integration, and infrastructure in order to improve digital health functions (Duggal et al. 2023). Digital technologies can increase the availability of technologically advanced treatment for individuals living in countries where such treatment may be unavailable (Pagliari 2021), e.g., LMICs. Due to recent regulatory changes, the LMICs are just starting to discuss digital practice. Healthcare challenges in LMICs have been the focus of many digital initiatives that have aimed to ensure consistent implementation of these services (Duggal et al. 2023). Digital health can support health care in LMICs by overcoming distance problems, poor infrastructure, and the need to provide community practitioners with specialist support (Hui et al. 2022).
Remote treatment can reduce the need for physical examination and strengthen the human resources of healthcare. Digital medicine can help healthcare systems overcome barriers such as the shortage of healthcare providers in LMICs due to “brain drain” (Human Rights Council Fifty-third session 2023). The COVID-19 pandemic has accelerated the introduction of innovations in the field of digital healthcare due to the availability of various technologies and the urgent need for medical care for treatment and prevention (Abdolkhani et al. 2022). COVID-19 is the first global pandemic of the digital age, and there are numerous examples of how digital health solutions have helped a lot during the pandemic (Aisyah et al. 2022). Perhaps the most notable acceleration in both the United States and other parts of the world has been due to the rapid adoption of telemedicine. In many ways, the response to COVID-19 has led to years of progress in just a few months (Lee et al. 2022).
In just a few weeks in March and April 2020, telemedicine applications and services, health sensors, 3D-printed protective equipment, and laboratory tests at home became part of everyday life (Meskó 2022). For example, in Catalonia, Spain, telemedicine replaced personal visits to primary health care doctors in less than a month. Compared to the beginning of March 2020, telemedicine visits increased by 5.5 times just four weeks later, and personal visits decreased by seven times (Pol et al. 2020).
The COVID-19 crisis considered the possibility of developing telemedicine in several countries. Australia, England, and the USA face several challenges. However, a few years ago, they incorporated digital practice into the healthcare system, and recently their associations have developed recommendations for helping specialists during the COVID-19 outbreak (Dantas et al. 2020).
3 Armenia as a Case Study
Physical inactivity accounts for over three million deaths yearly, mostly from non-communicable diseases in low-income and middle-income countries (Pratt et al. 2012). An essential component for improving physical health and reducing premature mortality by one-third is an increase in the level of PA. To achieve this goal, research is needed in LMICs to support evidence-based policy development, identify barriers, and motivate people to PA (Liu 2022).Our recent research conducted in Armenia, one of the LMICs, showed the effects of PA on some parameters of physical health. According to the results of studies, the indicators of body composition and stress resistance are on the border between the norm and violation, and the relationship of body composition with stress resistance, endothelial function, and well-being in the population varies depending on the degree of physical activity and gender (Muradyan et al. 2021; Macheiner et al. 2022).
Based on the literature data on practice, we initially hypothesized that regular PA classes would improve stress resistance and wellness indicators. For this purpose, we selected participants according to the method. The change was detected by a comparative analysis of the study’s results before and after the inclusion of clients in the PA program. The study showed significant changes in stress and wellness indicators in the group of supporters of PA two to four times a week. This proves that the regularity of fitness programs is an essential criterion for improving indicators, reducing what leads to stress, and increasing the indicators of health (Muradyan et al. 2022).
We also conducted research before the COVID-19 pandemic (from May 2018 to September 2019) and during the pandemic (November 2020 to December 2021). We evaluated the correlation and infrastructure of some physical health indicators before and during the COVID-19 pandemic in the Armenian population. In conclusion, during COVID-19 pandemic significantly decreased stress resistance, endothelium function, and wellness indicators (Muradyan 2022).
Our current study showed that a high level of PA improves the indicator of body composition and increases stress resistance. We have also identified that the probability of getting infected with COVID-19 was higher among people with low levels of PA. Thus, our research indicates the need to develop and implement health programs, including PA. The application and subsequent analysis of the effectiveness of these programs can be monitored with the help of digital technologies not yet widely used in Armenia.
4 Challenges and Opportunities in PA-Related Research in LMICs
There are many social barriers to encouraging PA in LMICs, including a lack of resources and amenities, which should be the attention of researchers. The most significant barriers are cost and reimbursement, legal liability, and ethical issues such as confidentiality, infrastructure, equipment, Internet, age and level of education of patients, computer literacy, bandwidth range, and internet speed (Pratt et al. 2012; Liu 2022; Kaboré et al. 2022). For example, for pregnant women in South Africa, the lack of prenatal PA can be associated with insufficient relevant information, work commitment, discomfort, lack of time, tiredness and low energy, inadequate or conflicting information about prenatal physical activity, and lack of financial resources (Okafor and Goon 2022). Thus, more profound research and support for introducing digital technologies such as wearables, websites, and mobile applications can help people in LMICs benefit from PA. Moreover, increased access to information technology, even among the most vulnerable people, has led to digital interventions being promoted as a tool to reduce inequalities in health promotion.
Research using mobile devices is gaining popularity. A meta-analysis of electronic databases (PubMed, PsychINFO, SCOPUS) that provided raw data and aimed to influence PA through the distribution or collection of intervention materials using a mobile device suggests that this platform is an effective means of influencing PA behavior, and harnessing the potential of smartphone technology could provide researchers with an effective tool to increase PA (Fanning et al. 2012). Using a systematic search strategy to identify relevant studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library published between January 1990 and March 2020 suggests that the opposite is true in the context of PA, that is, the people who will benefit most from these interventions are left behind. The authors recommend that in the future when developing digital interventions to improve the PA, more efforts will be made to meet the needs of people with low socioeconomic status (SES) (Western et al. 2021). The review that maps and describes the impact of digital workplace wellness measures in LMICs revealed that digital workplace wellness measures are feasible, cost-effective, and acceptable. However, no long-term and consistent effects were found in this review, and further studies are needed to obtain additional evidence (Thai et al. 2023).
A review of Ovid MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Scopus, and Cochrane Library for peer-reviewed articles, emphasized the advantages of wearable devices for physical activity and also urged people with chronic diseases to maximize the effectiveness of wearable devices. The authors suggest that wearable devices may develop some special functions in combination with the treatment of chronic diseases. It is necessary to formulate targeted strategies of PA per the specific characteristics of the disease (Yu et al. 2023). A systematic search in PubMed of studies evaluating the impact of the Internet, personal sensors, mobile phone or autonomous computer software on a diet, PA, obesity, tobacco or alcohol use has shown that interventions using the Internet and mobile devices improve important lifestyle habits up to 1 year and supports the effectiveness of Internet and mobile interventions for improving lifestyle and reducing risk factors for non-communicable diseases (NCDs) (Afshin et al. 2016). A systematic review of mobile health and PA was conducted in October 2017 using CINAHL, ERIC, EMBASE, MEDLINE, and PsycINFO databases, and identified two mechanisms by which mobile health use promotes PA: increased motivation and changes in self-awareness and strategizing (Carter et al. 2018). The study was conducted on 46 LMICs; people with chronic diseases and multimorbidity are significantly less physically active (especially the elderly), and it is essential to study the effectiveness and efficacy of PA in treating chronic diseases in LMICs (Vancampfort et al. 2017). Thus, one of the main factors in improving the population’s physical health is PA.
5 Conclusion
Considering that digital technology opens up a wide range of opportunities for motivating PA and a healthy lifestyle, implementing programs, and improving health indicators, it is essential to emphasize the use of digital technology in healthcare institutions at LMICs. The digitization of physical health data can become the basis of helpful information for implementing and prioritizing GAPA actions in LMICs. The digitized data will be helpful to policymakers and stakeholders involved in promoting PA and physical health at the individual, local, national, regional, and global levels, with a particular focus on LMICs. In addition, digitizing physical health data will be an essential basis for a research program on the economic aspects of PA in LMICs. This will be a valuable guide for researchers to plan research in economics and physical health using a reliable methodology focused on the LMICs research needs. In addition, the information obtained from digitalization will help funding agencies allocate and monitor resources efficiently.
References
Abdolkhani R, Petersen S, Walter R, Zhao L, Butler-Henderson K, Livesay K (2022) The impact of digital health transformation driven by COVID-19 on nursing practice: systematic literature review. JMIR Nurs 5(1):e40348
Afshin A, Babalola D, Mclean M, Yu Z, Ma W, Chen CY, Arabi M, Mozaffarian D (2016) Information technology and lifestyle: a systematic evaluation of internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use. J Am Heart Assoc 5(9):e003058
Aisyah DN, Manikam L, Kiasatina T, Naman M, Adisasmito W, Kozlakidis Z (2022) The use of a health compliance monitoring system during the COVID-19 pandemic in Indonesia: evaluation study. JMIR Public Health Surveill 8(11):e40089
Antunes RS, Seewald LA, Rodrigues VF, Costa LG, Righi RR et al (2018).Article 42) A survey of sensors in healthcare workflow monitoring. J ACM Comput Surv 51(2):1–37
Booth FW, Roberts CK, Laye MJ (2012) Lack of exercise is a major cause of chronic diseases. Compr Physiol 2(2):1143–1211. https://doi.org/10.1002/cphy.c110025
Botilias G, Papoutsis A, Karvelis P, Stylios C (2020) Track my health: an IoT approach for data acquisition and activity recognition. Stud Health Technol Inform 273:266–271. Epub 2020/10/23
Carter DD, Robinson K, Forbes J, Hayes S (2018) Experiences of mobile health in promoting physical activity: a qualitative systematic review and meta-ethnography. PLoS One 13(12):e0208759
Dantas LO, Barreto RPG, Ferreira CHJ (2020) Digital physical therapy in the COVID-19 pandemic. Braz J Phys Ther 24(5):381–383
Deloitte Center for Health Solutions, Digital transformation in healthcare, from a buzzword to an imperative for health systems (2021)
Duggal M, El Ayadi A, Duggal B, Reynolds N, Bascaran C (2023) Editorial: challenges in implementing digital health in public health settings in low and middle income countries. Front Public Health 10:1090303
Fan C (2021) The physical health evaluation of adolescent students based on big data. Mob Inf Syst 2021:2356869
Fanning J, Mullen SP, McAuley E (2012) Increasing physical activity with mobile devices: a meta-analysis. J Med Internet Res 14(6):e161
Haleem A, Javaid M, Singh RP, Suman R (2021) Telemedicine for healthcare: capabilities, features, barriers, and applications. Sens Int 2:100117. https://doi.org/10.1016/j.sintl.2021.100117
Herold F, Theobald P, Gronwald T et al (2022) Going digital—a commentary on the terminology used at the intersection of physical activity and digital health. Eur Rev Aging Phys Act 19:17
Hui CY, Abdulla A, Ahmed Z, Goel H, Monsur Habib GM, RESPIRE Group et al (2022) Mapping national information and communication technology (ICT) infrastructure to the requirements of potential digital health interventions in low- and middle-income countries. J Glob Health 12:04094. https://doi.org/10.7189/jogh.12.04094
Human Rights Council Fifty-third session, A/HRC/53/65, Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development Digital innovation, technologies and the right to health, 19 June–14 July 2023, Agenda item 3
Kaboré SS, Ngangue P, Soubeiga D, Barro A, Pilabré AH, Bationo N, Pafadnam Y, Drabo KM, Hien H, Savadogo GBL (2022) Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: a systematic review. Front Digit Health 4:1014375
Lee P, Abernethy A, Shaywitz D, Gundlapalli AV, Weinstein J, Doraiswamy PM, Schulman K, Madhavan S (2022) Digital health COVID-19 impact assessment: lessons learned and compelling needs. NAM Perspect 2022. https://doi.org/10.31478/202201c
Liu W (2022) Editorial: barriers to promoting physical activity in low- and middle-income countries: alignment with the sustainable development goals. Front Public Health 10:943428
Macheiner T, Muradyan A, Mardiyan M, Sekoyan E, Sargsyan K (2022) Evaluation of body composition influence on stress resistance, endothelial function and wellness indicators according to physical activity level and gender in Yerevan. Georgian Med News 324:112–121
Meskó B (2022) COVID-19’s impact on digital health adoption: the growing gap between a technological and a cultural transformation. JMIR Hum Factors 9(3):e38926
Muradyan A (2022) Correlation and infrastructure of some physical health indicators before and during COVID-19 pandemic. Georgian Med News 330:65–69
Muradyan A, Mardian M, Mkrtchyan S, Sekoyan E (2021) Peculiarities of relationship between some physiological indicators of physical health among the population of Armenia. Georgian Med News 319:118–124
Muradyan A, Macheiner T, Mardiyan M, Sekoyan E, Sargsyan K (2022) The evaluation of biomarkers of physical activity on stress resistance and wellness. Appl Psychophysiol Biofeedback 47(2):121–129
National Center for Chronic Disease Prevention and Health Promotion, Physical Activity Helps Prevent Chronic Diseases (2023)
Okafor UB, Goon DT (2022) Uncovering barriers to prenatal physical activity and exercise among south African pregnant women: a cross-sectional, mixed-method analysis. Front Public Health 10:697386
Pagliari C (2021) Digital health and primary care: past, pandemic and prospects. J Glob Health 11
Paul M, Maglaras L, Ferrag MA, Almomani I (2023) Digitization of healthcare sector: a study on privacy and security concerns. ICT Express 9:571–588
Pol PS, Solans O, Fajardo J, Manuel MP, Rodenas P, Jordi G, Luis GE, Adrià C, César VM, Josuè SR, Rosa RM, Jordi P-J (2020) Turning the crisis into an opportunity: digital health strategies deployed during the COVID-19 outbreak. JMIR Public Health Surveill 6(2):e19106
Pratt M, Sarmiento OL, Montes F, Ogilvie D, Marcus BH, Perez LG, Brownson RC, Lancet Physical Activity Series Working Group (2012) The implications of megatrends in information and communication technology and transportation for changes in global physical activity. Lancet 380(9838):282–293
Ravalli S, Roggio F, Lauretta G et al (2022) Exploiting real-world data to monitor physical activity in patients with osteoarthritis: the opportunity of digital epidemiology. Heliyon 8(2):e08991
Sawyer C, Hassan L, Sainsbury J, Carney R, Bucci S, Burgess H, Lovell K, Torous J, Firth J (2023) Using digital technology to promote physical health in mental healthcare: a sequential mixed-methods study of clinicians’ views. Early Interv Psychiatry 18:140–152. https://doi.org/10.1111/eip.13441
Thai YC, Sim D, McCaffrey TA, Ramadas A, Malini H, Watterson JL (2023) A scoping review of digital workplace wellness interventions in low- and middle-income countries. PLoS One 18(2):e0282118
United Nations General Assembly resolution, Transforming our world: the 2030 Agenda for Sustainable Development, Adopted in 70/1 (2015)
Vancampfort D, Koyanagi A, Ward PB, Rosenbaum S, Schuch FB, Mugisha J, Richards J, Firth J, Stubbs B (2017) Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. Int J Behav Nutr Phys Act 14(1):6
Western MJ, Armstrong MEG, Islam I et al (2021) The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 18:148
WHO (2018) Global action plan on physical activity 2018–2030: more active people for a healthier world ISBN 978-92-4-151418-7
World confederation for physiotherapy, REPORT OF THE WCPT/INPTRA, Digital Physical Therapy Task Force, 2017–2019
World Health Organization, Digital solutions for promoting physical activity (2023)
Yu S, Chen Z, Wu X (2023) The impact of wearable devices on physical activity for chronic disease patients: findings from the 2019 health information National Trends Survey. Int J Environ Res Public Health 20(1):887
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Copyright information
© 2024 The Author(s)
About this chapter
Cite this chapter
Muradyan, A., Sargsyan, K. (2024). Digitization of Physical Health Data in Low- and Middle-Income Countries. In: Kozlakidis, Z., Muradyan, A., Sargsyan, K. (eds) Digitalization of Medicine in Low- and Middle-Income Countries. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-031-62332-5_21
Download citation
DOI: https://doi.org/10.1007/978-3-031-62332-5_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-62331-8
Online ISBN: 978-3-031-62332-5
eBook Packages: MedicineMedicine (R0)