DDEA Visiting Researcher, Professor Brian Oldenburg, explores the challenges and opportunities of implementing digital health innovations for chronic conditions.

The rise of digital health solutions promises to transform the management of chronic diseases, offering new pathways for prevention and care. Although ripe with opportunities, the path to real-world implementation has its challenges.

DDEA Visiting Researcher Brian Oldenburg is working on these challenges by advancing digital health implementation research in collaboration with his colleagues at the Steno Diabetes Centre Copenhagen (SDCC).

Not About the Technology

Being Professor of Public Health and Implementation Science at La Trobe University and the Baker Heart and Diabetes Institute and Director of Australia’s National Centre of Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, Brian Oldenburg is uniquely positioned to tackle the challenges with digital health innovations.

His research focuses on one crucial question:
How do we implement digital solutions at scale to improve the lives of people with long-term conditions like diabetes?

As Professor Oldenburg shared in his expert talk, Digital Innovations in Diabetes Care – How do we assess the effects and how do we move from research to practice? at the SDCC, it is clear that the success of digital health innovations does not rest solely on the technology itself.

“It’s not about the technology,” Brian Oldenburg emphasizes, “it’s about all the other issues surrounding its implementation and integration into routine care delivery. The success of digital health innovations hinges on integrating these technologies into healthcare systems and aligning them with the specific needs of different populations, especially vulnerable and disadvantaged groups.”

Professor Brian Oldenburg also points out that while technology continue to evolve, newer is not always better.

“Just because you have smarter technology doesn’t mean the effects are greater if we don’t use the technology smartly,” he says.

Importance of Cultural Factors

Professor Brian Oldenburg has been part of many technology-based health intervention trials in Australia and other countries over the last 30 years, comprising web-based programs, telephone coaching programs, and more recently, apps and wearables of various kinds, in order to help people with diabetes, heart disease, and other conditions.

About half of the research that Professor Oldenburg and his team does involves lower-middle-income countries, particularly in South Asia and India, as well as countries in sub-Saharan Africa.

“Cultural factors play a central role in determining the success of digital health innovations. Factors such as healthcare access, education, and the level of technological infrastructure vary widely across countries and regions,” Oldenburg adds.

“For example, we’ve run a program for diabetes prevention in Southern India, and a lot of that program is delivered through WhatsApp. It’s one of the most commonly used media platforms in India, so it made sense to use it for our program delivery, because people were already familiar with it and using it in their daily lives,” explains Brian Oldenburg.

The DIY Movement by People with Type 1 diabetes

Sometimes, people take charge of their own healthcare using technology. 10 years ago, a group of tech-savvy people with type 1 diabetes got tired of waiting for solutions from health services and pioneered the development of user-driven open-source diabetes technology. The #WeAreNotWaiting DIY movement sparked innovative solutions like an open-source artificial pancreas system.

“This is a great example of how people, by taking an active role in development, can create tools that may be more effective for monitoring and managing their conditions than those provided by traditional health services. Health professionals are crucial, but the majority of the time, people manage their conditions themselves, making them experts on their own needs,” says Brian Oldenburg.

A Burgeoning Field of Research

Implementation science is a field of research steadily coming into its own, but its methods often vary from more traditional science methods.

“Traditionally, as with clinical trials, you conduct a trial for a certain time, often a couple of years, evaluate the outcomes and then recommend what to implement. However, the approach to implementation research is different—we can’t afford to wait years to identify what to recommend if there is already good evidence for implementation. Instead, we continuously assess outcomes with people with chronic conditions, determining what works and what doesn’t, and make rapid adjustments, as needed. We employ both qualitative and quantitative methods, integrating various disciplines including the clinical sciences, social and behavioural sciences, and psychology to create a more comprehensive approach,” explains Professor Brian Oldenburg.

As Brian Oldenburg described in his expert talk at SDCC, there is much yet to explore about how to co-design, implement, and integrate digital health programs into routine care delivery. The successful implementation of digital health innovations at scale is about connecting many dots, including financial models of delivery, sustainability, level of support, equity issues, etc.

“Addressing these factors is also essential to achieving meaningful outcomes with digital health innovations at both individual and population levels,” says Professor Oldenburg.