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      Digital tools for youth health promotion: principles, policies and practices in sub-Saharan Africa

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          Abstract

          Although digital health promotion (DHP) technologies for young people are increasingly available in low- and middle-income countries (LMICs), there has been insufficient research investigating whether existing ethical and policy frameworks are adequate to address the challenges and promote the technological opportunities in these settings. In an effort to fill this gap and as part of a larger research project, in November 2022, we conducted a workshop in Cape Town, South Africa, entitled ‘Unlocking the Potential of Digital Health Promotion for Young People in Low- and Middle-Income Countries’. The workshop brought together 25 experts from the areas of digital health ethics, youth health and engagement, health policy and promotion and technology development, predominantly from sub-Saharan Africa (SSA), to explore their views on the ethics and governance and potential policy pathways of DHP for young people in LMICs. Using the World Café method, participants contributed their views on (i) the advantages and barriers associated with DHP for youth in LMICs, (ii) the availability and relevance of ethical and regulatory frameworks for DHP and (iii) the translation of ethical principles into policies and implementation practices required by these policies, within the context of SSA. Our thematic analysis of the ensuing discussion revealed a willingness to foster such technologies if they prove safe, do not exacerbate inequalities, put youth at the center and are subject to appropriate oversight. In addition, our work has led to the potential translation of fundamental ethical principles into the form of a policy roadmap for ethically aligned DHP for youth in SSA.

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          Most cited references39

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          Digital health: a path to validation

          Digital health solutions continue to grow in both number and capabilities. Despite these advances, the confidence of the various stakeholders — from patients and clinicians to payers, industry and regulators — in medicine remains quite low. As a result, there is a need for objective, transparent, and standards-based evaluation of digital health products that can bring greater clarity to the digital health marketplace. We believe an approach that is guided by end-user requirements and formal assessment across technical, clinical, usability, and cost domains is one possible solution. For digital health solutions to have greater impact, quality and value must be easier to distinguish. To that end, we review the existing landscape and gaps, highlight the evolving responses and approaches, and detail one pragmatic framework that addresses the current limitations in the marketplace with a path toward implementation.
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            Good collaborative practice: reforming capacity building governance of international health research partnerships

            In line with the policy objectives of the United Nations Sustainable Development Goals, this commentary seeks to examine the extent to which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. Our evaluation finds that governance of collaborative research partnerships, and in particular capacity building, in resource-constrained settings is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health-related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS) (2016). However, more clarity is needed in national legislation, industry and ethics guidelines, and regulatory provisions to address the structural inequities and power imbalances inherent in international health research partnerships. Most notably, ethical partnership governance is not supported by the principal industry ethics guidelines – the International Conference on Harmonization Technical Requirements for Registration of Pharmaceutical for Human Use (ICH) Good Clinical Practice (ICH-GCP). Given the strategic value of ICH-GCP guidelines in defining the role and responsibility of global health research partners, we conclude that such governance should stipulate the minimal requirements for creating an equitable environment of inclusion, mutual learning, transparency and accountability. Procedurally, this can be supported by i) shared research agenda setting with local leadership, ii) capacity assessments, and iii) construction of a memorandum of understanding (MoU). Moreover, the requirement of capacity building needs to be coordinated amongst partners to support good collaborative practice and deliver on the public health goals of the research enterprise; improving local conditions of health and reducing global health inequality. In this respect, and in order to develop consistency between sources of research governance, ICH-GCP should reference CIOMS ethical guidelines as the established standard for collaborative partnership. Moreover, greater commitment and support should be given to co-ordinate, strengthen and enforce local laws requiring equitable research partnerships and health system strengthening.
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              A framework for digital health equity

              We present a comprehensive Framework for Digital Health Equity, detailing key digital determinants of health (DDoH), to support the work of digital health tool creators in industry, health systems operations, and academia. The rapid digitization of healthcare may widen health disparities if solutions are not developed with these determinants in mind. Our framework builds on the leading health disparities framework, incorporating a digital environment domain. We examine DDoHs at the individual, interpersonal, community, and societal levels, discuss the importance of a root cause, multi-level approach, and offer a pragmatic case study that applies our framework.
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                Author and article information

                Contributors
                Journal
                Health Promot Int
                Health Promot Int
                heapro
                Health Promotion International
                Oxford University Press (US )
                0957-4824
                1460-2245
                April 2024
                01 April 2024
                01 April 2024
                : 39
                : 2
                : daae030
                Affiliations
                Health Ethics and Policy Lab, ETH Zurich , Hottingerstrasse 10, 8092 Zurich, Switzerland
                Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Ghana
                Berman Institute of Bioethics, Johns Hopkins University , 1809 Ashland Avenue, Baltimore, MD 21205, USA
                Bloomberg School of Public Health, Johns Hopkins University , Baltimore, 615 North Wolfe Street, Baltimore, MD 21205, USA
                Department of Philosophy and Classics, University of Ghana , MR26+9PV, W.E.B. Dubois Road, Accra, Ghana
                Nuffield Department of Medicine, University of Oxford , Old Road Campus, Oxford, OX3 7BN, UK
                Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea , 574W+49W, Buea, Cameroon
                United Nations Population Fund, West and Central Africa Regional Office , PFQM+RVF, Route des Almadies, Dakar, Senegal
                Centre for Social Science Research, University of Cape Town , 12 University Avenue South, Rondebosch, Cape Town 7700, South Africa
                Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University , Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
                Department of Radiology and Imaging Sciences, Emory University School of Medicine , 1364 Clifton Rd, Atlanta, GA 30322, USA
                African Center of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University , 8HMC+PF5, Kampala, Uganda
                Healthy Brains Global Initiative , Rutherford, CA, USA
                Faculty of Medicine and Health Science, Stellenbosch University , Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
                Wellcome Trust , 215 Euston Road, London WC1E 6BP, UK
                Health Ethics & Governance Unit, Research for Health Department, Science Division, WHO , Avenue Appia 20, 1202 Geneva, Switzerland
                Department of Bioethics, Genetics & Genome Biology, SickKids Research Institute, The Hospital for Sick Children , 555 University Avenue, Toronto, ON M5G 1X8, Canada
                Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea , 574W+49W, Buea, Cameroon
                Howard College, School of Law, University of KwaZulu-Natal , King George V Avenue, Durban 4041, South Africa
                Desmond Tutu Health Foundation , 3 Woodlands Road, Woodstock, Cape Town 7915, South Africa
                Children and Youth in Broadcasting—Curious Minds , 3 Damba Close, Chaban-Sakaman, Accra, Ghana
                Genesis Analytics, Health Practice Area , 50 6th Road, Hyde Park, Johannesburg 2196, South Africa
                Office of Research and Development, University of Botswana , 4775 Notwane Road, Gaborone, Botswana
                Faculty of Humanities, Centre for Social Science Research, University of Cape Town , 12 University Avenue, Rondebosch, Cape Town 7700, South Africa
                African Population and Health Research Center , APHRC Headquarters, Kitisuru, Nairobi, Kenya
                Faculty of Medicine and Health Science, Stellenbosch University , Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
                Health Ethics and Policy Lab, ETH Zurich , Hottingerstrasse 10, 8092 Zurich, Switzerland
                Author notes
                Corresponding author. E-mail: agata.ferretti@ 123456hest.ethz.ch
                Author information
                https://orcid.org/0000-0001-6716-5713
                https://orcid.org/0000-0002-6476-2165
                Article
                daae030
                10.1093/heapro/daae030
                10983781
                38558241
                46244ce4-883f-4a0d-95c2-cd117e723c53
                © The Author(s) 2024. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 11
                Funding
                Funded by: Fondation Botnar, DOI 10.13039/501100011318;
                Award ID: OOG-20-024
                Categories
                Perspective
                Children and Young People's Health
                AcademicSubjects/MED00860

                Public health
                digital health,young people,adolescents health,lmics,sub-saharan africa,ethics,policy roadmap

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