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Public wellness policy-making for hearing loss: stakeholders' evaluation of a novel eHealth tool

  • Lyubov Trenkova2,
  • Mariola Śliwińska-Kowalska3,
  • Dario Brdarić4,5,
  • Niels Henrik Pontoppidan6,
  • Panagiotis Katrakazasseven &
  • Doris-Eva Bamiou ORCID: orcid.org/0000-0001-7486-4264 1,8

Wellness Research Policy and Systems volume 18, Commodity number:125 (2020) Cite this article

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  • 1 Citations

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Abstract

Groundwork

Hearing loss (HL) affects 466 meg people of all ages worldwide, with a chop-chop increasing prevalence, and therefore requires appropriate public health policies. Multi-disciplinary approaches that make use of eHealth services can build the testify to influence public policy. The European union-funded project EVOTION developed a platform that is fed with real-time data from hearing aids, a smartphone, and additional clinical data and makes public health policy recommendations based on hypothetical public health policy-making models, a big data engine and decision support organisation. The nowadays written report aimed to evaluate this platform as a new tool to back up policy-making for HL.

Methods

A total of 23 key stakeholders in the United kingdom, Croatia, Bulgaria and Poland evaluated the platform co-ordinate to the Strengths, Weaknesses, Opportunities and Threats methodology.

Results

There was consensus that the platform, with its avant-garde applied science also as the corporeality and multifariousness of data that it can collect, has huge potential to inform commissioning decisions, public health regulations and touch healthcare equally a whole. To achieve this, several limitations and external risks demand to be addressed and mitigated. Differences between countries highlighted that the EVOTION tool should be used and managed co-ordinate to local constraints to maximise success.

Determination

Overall, the EVOTION platform tin can equip HL policy-makers with a novel data-driven tool that tin can support public health policy-making for HL in the hereafter.

Peer Review reports

Introduction

Hearing loss every bit a public health issue

Hearing loss (HL) affects approximately 466 million people worldwide, i.due east. 6.one% of the globe's population, with the total number of people with HL estimated to rise to over 900 million past 2050 [i]. It is the fifth leading crusade of years lived with inability, college than diabetes and visual harm [ii]. It has been associated with a college risk of dementia, mental affliction, and depression and with an agin overall upshot on general health [three]. It also has important economic consequences, including work discrimination, reduced productivity, unemployment and early retirement and, every bit a issue, loss of income [4, 5]. The most common causes of HL are ageing, dissonance exposure, complications at nascency, genetic causes, infectious diseases, chronic ear infections or ototoxicity. Some types of HL are preventable, and thus amenable to public health (PH) policy-making and legislation. For case, lx% of childhood HL is due to preventable causes, where 1.i billion young people are at chance from exposure to loud sounds on personal audio devices and in noisy amusement venues [half dozen]. People with HL can benefit from early identification and from the use of assistive devices such as hearing aids (HAs) or cochlear implants, captioning, and other forms of educational or social support. Even so, HA users all the same face significant challenges such equally listening in noisy environments, poor sound quality and difficulties in selecting among predefined settings. Equally a result, many adults, especially elderly, practise not accustom to their HAs and practice not use them, with huge cost implications for health systems [vii]. It has been reported that up to 40% of people fitted with a HA either fail to apply it or practice not do good from it [8]. In the Uk, the almanac cost of unsuccessful HA use has been estimated to be over £40 million of NHS funding [9]. Moreover, it is unclear whether HAs are as effective for adults with different degrees of severity of HL [10]. Interdisciplinary, holistic approaches for the management of HL tin can yield valuable insights into HA uptake, apply and outcomes, so that changes tin be made at the population and PH policy-making level [11]. Information technology is crucial that countries develop long-term bear witness-based PH programmes and policies to heighten awareness for HL and for HL prevention, early on diagnosis and effective interventions in order to support healthcare systems and to ultimately promote the social inclusion of the hearing-impaired population.

Policy-making challenges and eHealth

In the last decade, in health policy-making there has been a transition from traditional methods (e.g. utilise of skilful opinion or data from single randomised controlled trials) towards more evidence-based approaches at the population level. Such techniques currently used are systematic reviews, national routine data monitoring and skillful groups [12,xiii,14,15]. Even though these techniques overcome previous limitations, their validity and reliability is non always clear and information are likely to be out of engagement and therefore not sufficient for clinical or PH action [xvi]. Collaborative approaches equally a whole pose boosted challenges every bit PH policy-makers may non be able to engage effectively with clinicians, healthcare professionals or other experts who could support the decision-making process, for example, due to the use of unlike terminology [17].

Currently, at that place is an increasing involvement in and apply of eHealth services, such as databases, big information analytics or mobile applications, to help healthcare professionals communicate ameliorate, enable patients to admission the care they demand rapidly and easily, and strengthen wellness systems worldwide [xviii]. The use of eHealth can as well benefit public policy-making by improving planning and resource allocation, cost-efficiency, health service delivery, real-fourth dimension monitoring, personalised services and preventive measures [19]. A number of policy modelling and formation techniques, processes and guidelines already exists such as ontology models or assessment tools for health services, technologies and impact (e.thousand. [20,21,22]). Still, to our knowledge, no online policy-making tools supporting the specification of policies or policy-making processes are available to engagement. In order to make employ of the tremendous potential of eHealth for policy, we need to overcome several challenges with regards to awareness, quality of the tools, access and costs. For developing countries in particular, cultural and educational problems have been reported as huge obstacles towards the utilize of eHealth applications [23]. On the other mitt, well established healthcare systems may take the ability to integrate eHealth services more than hands [24]. The field of audiology, in detail, can massively benefit by the use of new technologies such as smart HAs and mobile applications linked to them, HA data logging or population databases [25, 26]. Even so, we are not enlightened of any tools that incorporate data analysis capabilities and PH decision support for HL. With the rapid increase in the number of people affected by HL and in view of several gaps in current noesis in the field (as sated above), building dynamic data-driven systems that are linked to hearing devices, existing clinical databases and other tools may generate bear witness to not only ameliorate hearing care but also to inform decisions at the population level.

The EVOTION approach

The collaborative European Matrimony-funded EVOTION projection has built an integrated platform to support the conception of PH policies related to HL prevention, diagnosis and rehabilitation with the use of big data [28, 29]. EVOTION'southward overarching ambition is to promote bear witness-informed policy-making in hearing healthcare, in line with the increasing utilize of eHealth applications worldwide. The EVOTION platform enables, among others, (1) static and real-time information from HA users to exist collected from diverse sources and continuously fed into a data repository and (ii) the application of large data analytics (BDA) techniques via a BDA engine and based on pre-defined public wellness policy conclusion-making (PHPDM) models. A PHPDM model is a mathematical structure that processes two or more sources of testify and projects out the health outcomes associated with alternative policies [30]. The EVOTION PHPDM models exercise non define PH policies as such, just rather the statistical analyses and the data required to back up policy decisions and, based on these, plausible decisions for dissimilar scenarios within the context of the EVOTION project [31]. Subsequently, the results of the BDA tasks can yield policy recommendations that tin and so be used by relevant stakeholders through a decision support system. The EVOTION decision support system enhances and refines the PHPDM models [32]. To enable the validation of the EVOTION platform, a multi-heart clinical study with 1080 HA users has nerveless big data, including information from smart HAs and a mobile application too as audiological, demographic, cognitive and quality of life data [33]. All information were hosted in the EVOTION Information Repository (EDR). The total amount of data at the end of the project was 60,939,630 data points. Analytics are performed through a dashboard of the platform where the end-user can select the type of assay they desire to run and then the EVOTION information on which they want to run the assay. Figure 1 is a schematic view of the architecture of the EVOTION platform, with the cardinal components explained.

Fig. 1
figure 1

Schematic representation of the EVOTION platform. Middle: the EVOTION Data Repository collecting data from various sources. Left: Hearing help users transmitting data via smart hearing aids, smartphones and potentially via smartwatches if bachelor using a Bluetooth connection. Lesser right: healthcare professional person inbound data from the clinic either straight through a dashboard of the platform or through existing clinical databases connected to the EVOTION Data Repository. Peak correct: policy-maker running queries on the EVOTION database through the dashboard in social club to respond specific public health problems. Source: Pontoppidan 2019 [27]. Used with permission

Total size image

Aim

The aim of the present report was to evaluate the EVOTION platform equally a novel innovative tool to support PH policy-making in the domain of HL from the point of view of central stakeholders, who are potential time to come end-users of the platform.

Methods

In club to demonstrate the functionalities of the EVOTION platform to relevant stakeholders and collect evaluation feedback, a series of workshops were conducted between April and September 2019 by 4 dissimilar project partners in their home countries, as follows:

  • London, Great britain, organised by University Higher London

  • Osijek, Croatia, organised by the Institute of Public Health for the Osijek-Baranya County

  • Sofia, Bulgaria, organised by Pazardzhik Regional Assistants

  • Warsaw, Poland, organised by Nofer Institute of Occupational Medicine

Workshops were hosted by these four specific organisations because they were the partners of the EVOTION project responsible for delivering the PH policy evaluation of the platform and had the necessary expertise and resources. The choice of these countries enabled the evaluation of the platform in wellness systems and populations with different demographic and economic characteristics, budgets, PH priorities and other constrains with regards to public policy decisions. The post-obit department describes electric current PH policy-making local methods in each state.

The workshops

All iv workshops included the following fundamental components:

  1. 1.

    Presentation 1: Overview of the project and policy-making evaluation

  2. ii.

    Presentation 2: Insights from preliminary data assay

  3. three.

    Sit-in of the EVOTION platform

  4. 4.

    Focus group word

Presentation 1 provided background to the EVOTION projection and its aims, explained the clinical study and described the different components of the platform as well as the types of data that were collected [33]. Presentation ii focused on preliminary results from analysing a sub-sample of the EVOTION dynamic data, i.e. data describing the use of HAs in different acoustic environments by different HA users. We demonstrated the analytical methods nosotros had and so far applied to the data and how these methods are beingness implemented in the EVOTION BDA engine. More specifically, nosotros presented how much HAs were used over time by the participants of the EVOTION clinical study and the acoustic environmental context (i.eastward. how sound characteristics varied) over the same fourth dimension period; this is illustrated in Fig. 2. Our findings showed a positive correlation between HA usage and overall sound level and multifariousness and a negative correlation between HA usage and overall signal-to-dissonance ratio [34]. We also presented preliminary findings suggesting how the EVOTION HA data tin can be used to predict temporary threshold shifts and noise-induced hearing loss for individuals and the general public [35, 36].

Fig. two
figure 2

Preliminary results from EVOTION dynamic data analysis. Average hearing aid usage over time (left) and how the sound level, sound diversity and signal quality, i.e. signal-to-noise ratio, draw the acoustic environment (right). Source: Christensen et al. [34]. Used with permission

Full size prototype

The EVOTION platform demonstration (item 3) included the user interface of the dashboard, how to perform queries in the EDR, use of analytic tools (including the creation of tasks, workflows and policies) and results visualisation [38]. The demonstration focused on how the end-user can run analytics in iii steps – (one) the cosmos of a policy specifying which PHPDM model it should be linked to, (2) the creation of a workflow within that policy specifying the statistical techniques to be used and (3) the creation of a data analytics task within the workflow by specifying the types of data from the EDR to be used (Fig. 3). This demonstration enabled stakeholders to come across the bodily process and the functionalities of the platform. It should be noted that, at the time of the workshops, these components had not been finalised and therefore participants were not able to see the whole ready of functionalities or get whatever easily-on experience with the tool. The focus group discussion part of the workshops was facilitated by a set of questions used across all workshops and is detailed below.

Fig. three
figure 3

Snapshots of the EVOTION dashboard. Elevation: cosmos of a policy using pre-defined Public Health Policy Decision-making models. Center: creation of a workflow within that policy specifying the statistical techniques to be used. Bottom: Cosmos of a data analytics task within the workflow by specifying the types of information from the EVOTION Data Repository to be used. Source: Basdekis et al. [37]. Used with permission

Full size image

Participants

Purposive sampling was employed by each of the 4 institutions to select professionals that would be potentially involved in making, executing, recommending or discussing policy decision in the area of HL such every bit PH, policy or audiology experts. In full, 23 professionals participated in the evaluation across the 4 countries with v to vii attendees per workshop. Participants represented a wide range of expertise. In the workshop in London, they were mainly high-profile national HL experts with informational roles in policy-making (due north = 5). In Croatia, they were experts in implementing regional-level PH policies (n = seven). The workshop in Republic of bulgaria was attended past national-level full general (just not HL) PH policy experts advising on PH policies, who were a representative sample of experts from all key quadruple-helix stakeholders of the policy-making procedure (n = 6). In Poland, attendees were once more national and governmental PH experts involved in drafting PH policy legislation/regulations focused on racket exposure and HA distribution and financing (northward = v) (Additional file 1). Engaging such a range of stakeholders ensured that the assessment of the platform was based on different perspectives depending on the expertise of each of the partners and institutions hosting the workshops. Keeping the workshops relatively small-scale ensured an in-depth discussion and gave all attendees the opportunity to provide detailed feedback.

Focus grouping discussion

Following the EVOTION platform demonstration (stride 3 to a higher place), we conducted a semi-structured focus group discussion to explore the stakeholders' views on the platform following the Strengths, Weaknesses, Opportunities and Threats (SWOT) approach. SWOT is a method originally adult to systematically analyse an system'due south strategic position in relation to its competitors or for the purposes of project planning [39]. It consists of identifying external opportunities and threats too as the internal strengths and weaknesses of a company or a project. Based on the interaction betwixt these factors, strategic plans can be developed. SWOT has grown in popularity and has been used in multiple fields, including the healthcare sector [40, 41]. The SWOT methodology was chosen because the EVOTION platform was developed as a novel tool in the marketplace and, even though there is no other tool to compare information technology directly with, it was necessary for the tool to exist assessed for its advantages and disadvantages in the context of health policy-making as a whole.

In order to prompt word, the focus grouping facilitator in each country asked questions such equally:

  • Please tell united states of america about the strengths or advantages of the EVOTION tool. What exercise you think is better or unique compared to other similar tools?

  • Please tell us nearly the weaknesses of the EVOTION tool. What practice y'all recollect could be improved or avoided?

  • Please tell u.s. about the opportunities that the EVOTION tool creates.

  • What may be the obstacles in the utilise of EVOTION as a PH policy-making tool for HL in the future?

  • Would you be willing to utilise it yourself or recommend information technology to others in the hereafter if it was finalised and available to use?

The last question was not strictly related to the SWOT methodology but was central to the aim of the study. The discussions were audio-recorded and transcribed. Based on each recording, a country-specific SWOT was drafted and, based on these four SWOTs, common SWOT themes were identified.

Workshop discussion data analysis

The focus grouping information was analysed thematically according to the SWOT methodology. Specifically, in the context of the present report, the following definitions were used:

  • Strengths: internal features of the EVOTION platform that give it an advantage over other similar tools in the field.

  • Weaknesses: internal limitations or disadvantages of the tools over other like ones.

  • Opportunities: characteristics of the tool that give it a future potential in relation to the broader surroundings. This is in dissimilarity to the traditional definition as elements of the external surroundings that an organisation or project could exploit for their own benefit.

  • Threats: the interaction between the platform and external factors that could pose a take a chance to the tool reaching its total potential, in contrast to the traditional definition of elements of the environment external to the platform that can cause issues.

The country-specific SWOTs were created by ii members (at least one of which had participated in the workshop) of each of the four enquiry teams. Initially, themes were identified in the data of each of the four workshops within each of the above SWOT domains by one member of each squad, broadly post-obit the steps by Braun and Clark [42] and using as a priori domains the four SWOT categories. For each SWOT, themes were then reviewed past the 2nd member of the team, discussed and concluding SWOTs were developed. The themes from the iv SWOTs were then compared to each other for similarities and differences and an overall framework with common themes was produced (see beneath) too as themes brought up to a unmarried country only (see below). This process involved merging, splitting, renaming themes and moving them across domains. The process was led by the first author just involved discussion with all co-authors. Comments regarding the potential future apply of the tool were also extracted separately from the SWOTs from each research team, summarised by the first author and are presented in section 3.3.

Results

Common SWOT themes

The SWOTs of the EVOTION platform that were identified in more than than ane of the workshops are summarized in Fig. 4 and explained here in detail with examples. The letters in the brackets bespeak the countries in whose SWOT each theme was identified, i.e. United kingdom of great britain and northern ireland for the United Kingdom, C for Republic of croatia, B for Bulgaria and P for Poland.

Fig. 4
figure 4

EVOTION evaluation results. Summary of common themes from all iv workshops produced after identifying themes in the SWOT analysis of each of the workshops and then comparing themes from the four countries to each other

Full size epitome

Strengths

  1. one.

    Size of database and corporeality of collected data [UK, P, B]

  2. two.

    Technologically advanced solution and high level of technical integration [C, B]

  3. 3.

    The platform has potential to exist developed (east.chiliad. by simplifying/automating processes, collecting data from other sources) [Britain, B, P]

    "Potential to embed more than analyses." (Great britain)

  4. 4.

    Collection of data from sources where measurements are difficult, e.chiliad. real-time information [United kingdom of great britain and northern ireland, P, B]

    "Capability to obtain statistics concerning the effect of staying in racket-exposed environment for users of HAs. Thus far, these statistics were not as easily attainable." (Poland)

  5. five.

    Empowers patients by offering increased capabilities, e.thou. HA controls [Britain, P, C, B]

    " …giving increased capabilities equally compared to hitherto used devices, including the capability to customize hearing aids." (Poland)

Weaknesses

  1. 1.

    The platform requires loftier tech and expensive technology and equipment, e.yard. smart HAs [UK, P]

    "Requires advanced technologies, thus might be rejected by individuals not accepted to novel technical and advisory solutions, particularly elderly people." (Poland)

  2. ii.

    Not convenient, complicated machinery [U.k., P, B]

    "Currently the mechanism of data collection and analysis is overcomplicated. The operational model is difficult to explain and is not fully understood by representatives of governmental and non-governmental entities which do non come in direct contact with hearing-impaired individuals." (Poland)

  3. three.

    Limitations of collected information, due east.g. more detail needed regarding the listening/acoustic environments, noise exposure or qualitative/meaning other data [UK, P, B]

    "We need qualitative and significant others' data … We demand more particular re specific listening environments." (United Kingdom)

  4. 4.

    Limited power to engage, communicate or be merged with other tools or databases [U.k., P, C]

  5. five.

    Limitation of available analytics, eastward.g. tool not fully functional at the fourth dimension of workshop, lacks major analytic capabilities required for PH policy decision-making [C, P, B]

    "Not enough emphasis on PH policy-making processes, e.g. no economic evaluation included." (Republic of bulgaria)

  6. half dozen.

    Limited interaction between different levels of platform, e.g. limited access to database [UK, P]

Opportunities

  1. 1.

    Potential to affect healthcare [UK, P]

    "Faster response to trouble … tin provide a quick response to HL problems as they ascend." (United kingdom of great britain and northern ireland)

  2. 2.

    Data can exist used for scientific research [UK, C]

    "Can testify how HA compliance translates to existent life do good. Compared to other wellness interventions hearing intendance has better compliance, convincing prove of 60–80%. How does that translate in real world do good, how does it impact on residue of healthcare, does it relieve money?" (U.k.)

  3. iii.

    Can influence commissioning decisions, e.g. facilitate control over land budget'due south expenditures on HA refunds by better fitting [United kingdom of great britain and northern ireland, C, P]

    "[Could use the platform to] lower end costs in healthcare … improve integration, reduction of handling costs resulting from bad hearing care regulation." (Croatia)

  4. four.

    Potential to inform occupational health regulations and law in the future, due east.g. limits on permissible dissonance volume in personal electronic devices or implementation of Temporary Threshold Shift model in new generation HAs [Great britain, C, P, B]

    " … could take into business relationship prediction of noise exposure in irresolute occupational health requirements." (Bulgaria)

  5. 5.

    Tin potentially be applied to other populations or specialties, given that various sources of PH data are more and more readily available [UK, B, C, P]

    "Inclusion of children in platform usage … user-friendly app in the grade of a game?" (Croatia)

    "Opportunity to use EVOTION engineering science and PH data collection methods to other areas beyond HL." (Bulgaria)

Threats

  1. 1.

    Challenges regarding information management, retention and security, due east.g. compliance with data protection regulations or hacking risk [Great britain, C, B, P]

    "Security risks, due east.thou. result with Bluetooth connection between HA and mobile phone" (Bulgaria)

  2. ii.

    Hard to implement due to limitations of IT systems in different countries [C, P, B]

    "Unsatisfactory quality of data in healthcare IT system … Bad inter-sector and healthcare It connexion in different institutions in healthcare." (Croatia)

  3. 3.

    Cannot extrapolate information from ane country to another due to differences between countries [UK, B]

    "Not possible to validate the statistical representativeness of the cohorts on a national scale [equally the] clinical study [was] carried out in several countries." (Bulgaria)

  4. iv.

    Potentially high price due to complication, etc., e.chiliad. challenge of financing of platform due to tight public budgets [UK, P, C]

    "Ensuring continuous financing of [the] EVOTION platform implementation [is a weakness] … Limited national health insurance funds." (Croatia)

  5. 5.

    Range of economic power, Information technology literacy or cognition, or analytic skills of patients and potential end users, e.thou. elderly people [C, P, B]

    "Unequal availability for users regarding economical power and skills … especially the elderly." (Croatia)

    "Insufficient technical infrastructure and capabilities at the end user side could limit the applicability and exploitation of the system's functionalities to its total potential. Insufficient noesis of end users about analytics, neural networks, etc. A constraint for the applicability and exploitation of the platform." (Bulgaria)

Country-specific SWOT themes

In add-on to the to a higher place common themes, certain themes were specific to ane land only. This was possibly related to the different expertise of the stakeholders who participated in each of the workshops.

In the United Kingdom, participants raised the potential to place problems with the information drove process itself as an opportunity but besides highlighted that the fact that the population the information were collected from was skewed and difficulties to utilize the tool towards HL prevention as weaknesses.

"Potential at data conquering level…redefining goals, considering why you collect these specific data." (U.k.)

In Croatia, the development of the platform was seen as an opportunity that brought together experts from unlike institutions and disciplines and trained them with avant-garde It tools.

"Beingness of adequate experts for work on the platform." (Croatia)

In Bulgaria, professionals brought upwardly the opportunity to employ commonly adopted user-feel conventions to help improve the user experience with the platform but also recognised that EVOTION is a very specialised tool in a very small area of the marketplace.

"The tool could be considered equally intended for a very tight market segment of the PH area whereas other PH areas, e.g. control and policies in the areas of coronary diseases, or handling and long-term care for diabetics are considered of higher priority in national healthcare – upgrading the current tool for such areas could necessitate a significant modification for information collection." (Bulgaria)

Finally, Polish policy-makers acknowledged that other tools currently beingness developed by HA manufacturers may surpass EVOTION but too thought that the platform can benefit people with normal hearing as well equally the hearing impaired through prevention programmes.

"The production might also be beneficial for persons with right hearing, through prevention programs." (Poland)

Future apply of the EVOTION tool

In addition to the SWOT analysis to a higher place, professionals commented on whether they would exist willing to utilise the EVOTION tool in the future and how. All stakeholders were mostly very positive about using the platform in the future and gave examples but also mentioned sure obstacles or prerequisites.

Specifically, feedback from Poland involved the potential apply of the platform (1) as function of campaigns and prevention programmes for HL, (2) to develop guidelines for employers or people with HL with regards to noise protection at work, or (3) at a college level use past ministries for specifying the criteria for the provision and refund of HAs.

"Apply by the Ministry of Health for specifying regulations on required weather condition for selecting and refund criteria of hearing aids…for specifying regulations on hiring persons with hearing loss using hearing aids, for positions exposed to noise." (Poland)

Along the same lines, data from Bulgaria involved the potential accommodation of the tool to monitor the occupational surroundings for racket command just as well in integration with other eHealth information repositories or past patients' organisations to collect feedback. On the other paw, Britain stakeholders stressed the need to clearly define the intended audience and use of the EVOTION platform. Use by governments or charities was mentioned only as one way to change policy.

"Need to ascertain which policies we are trying to influence." (U.k.)

Farther to this, Bulgarian participants suggested that a number of functionalities should be added to enhance the tool, including the cess of the affect of the recommended policy decisions peculiarly with economic measures (cost-do good, toll-effectiveness, incremental cost analysis) and brusque- and long-term monitoring and evaluation of these policies overall. They also suggested that analyses of budgetary implications and the consistency of the recommended policies with existing ones in the aforementioned expanse may add to improvements of the tool.

Discussion

Summary of findings

The nowadays study collected feedback from a range of professionals involved in PH policy-making in four dissimilar countries on the SWOTs of the EVOTION platform as a tool that tin can back up policy-making for HL. Participants were generally very enthusiastic about the capabilities and potential of the tool. Among its advantages were the amount of collected data (Fig. iv, Forcefulness 1), the high-terminate technology implemented (Forcefulness 2) and the drove of real-fourth dimension data (Strength 4). At that place was consensus that the platform tin use such capabilities to influence commissioning decisions (Opportunity three), inform occupational health regulations and laws in the future (Opportunity 4), and benefit healthcare as a whole (Opportunity 1). For case, as highlighted by a participant of the London workshop, in the context of HL treatment in item, the tool could be used to show how HA compliance translates to real-world benefit, how it impacts on the balance of healthcare and if information technology is cost-efficient. Given the lack of other available eHealth tools, these strengths and future potential make the EVOTION platform a promising new entry in the market that could generate data to inform the field of HL but also PH policy decisions at a higher level.

On the other hand, stakeholders highlighted a number of limitations of the tool itself such as the high requirements for the end-user (Weakness 2) or the difficulty in accessing various levels of the platform (Weakness 6). Risks that need to be considered for the successful future use of the tool were also identified, including challenges regarding data management (Threat 1), the potential high maintenance cost (Threat 4), and difficulties in across land use due to differences in Information technology systems (Threat 2) or the Information technology skills of the population (Threat 5). These limitations and risks stress the fact that in that location is still work to exist done for the EVOTION tool to exist properly exploited and to accomplish its full potential. This is not surprising for an innovation incorporating a number of different components and implementing such advanced technology. Some of the weaknesses and threats were addressed in the finalisation of the platform after the workshops (east.g. additional analytics) or are ongoing work (eastward.grand. data management and maintenance). Other considerations are related to the different needs, health systems mechanisms and resources available in unlike European Union countries and would need to be addressed in a country-specific and setting-specific (e.g. national versus regional) way for the successful implementation of the platform and adoption in the future. However, the platform's flexibility to modify and further develop in response to evolving stakeholder needs in the future was demonstrated to the stakeholders and appreciated by them (Force 3). For instance, after the workshops, a new simulation functionality was added that allows the enhancement of the PHPDM models depending on user requirements and, in this way, it complements the BDA results and supports even further the policy recommendation process [31].

State-specific considerations

The EVOTION evaluation workshops included stakeholders with a wide range of expertise who represented countries with unlike socioeconomic characteristics and PH systems in terms of resources, arrangement and approach. Certain themes identified in the SWOT analyses reflect different PH resource available across the 4 countries, such as the "express power of the platform to appoint with other tools" brought up mainly in the London workshop (Weakness 4). In the United Kingdom, there are other NHS databases that the EVOTION platform may need to communicate with, while in Bulgaria, for instance, this may exist less of an issue as the platform may provide a health database for HL or the use of HAs where none currently exists.

If we consider the results of the SWOT analysis in the context of the electric current PH policy-making arrangement of each country, we can encounter an additional advantage of the use of platforms like EVOTION, that of raising awareness inside the policy-makers likewise as shaping policy for the benefit of the population. For instance, the bulk of the Croation stakeholders who participated in the workshops reported a lower level of HL awareness compared to the United kingdom of great britain and northern ireland or Poland, which have more organised HL services. In this instance, use of a system like EVOTION would help increase awareness among professionals for HL in particular. Additionally, Croation stakeholders reported as strengths of the EVOTION project overall the fact that it trained experts from different institutions to piece of work with specific IT tools and this way it generated ideas for the establishment of new departments for international collaboration at unlike institutions in the future. This is fifty-fifty more important given that it has been previously reported that PH stakeholders accept difficulty liaising with other relevant stakeholders such as non-governmental organisations and regional authorities and that they may not be appropriately equipped and familiar with the employ of new technologies and services for policy-making in the area of wellness [17].

Future use of the EVOTION tool

Generally, PH policy-making stakeholders at a national and local level who participated in the nowadays report are open to welcoming such a technological approach to their traditional activities but indicated that either they were non the ones who would be using the tool or that a number of bug demand to be addressed until they can actually utilize information technology in decision-making. The Croation stakeholders stressed the uniqueness of the tool in the area of policy-making and participants in Poland and Bulgaria mentioned specific examples of how the tool could be used and for what purpose. Moreover, some of them, every bit explicitly reported in Republic of bulgaria, already have knowledge of neural networks and big data technologies or are willing to learn, which is an advantage given the complication of the tool. In addition, specific campaigns and awareness-raising approaches will have to be adopted for stakeholders at the higher level of controlling to recognise the advantages and, hence, exist willing to dedicate public funding and result guidelines for using such platforms as part of the routine policy-making practice. However, United kingdom of great britain and northern ireland stakeholders did report that they themselves were not in a position to use it and that the target time to come users of the tool and the ways in which information technology can shape policy should exist specified. This comment may reverberate the dissimilar ways policy-making is made beyond countries and the different roles of stakeholders across workshops. For instance, in the U.k., health policy-making is done at a loftier governmental level and none of the United Kingdom workshop participants held such an executive position to utilize the EVOTION tool for actual decision-making. The potential future costs, for Croatia and Bulgaria in particular, were also reported to exist a crucial gene both for purchasing the platform and for the assessment of potential policy decisions offered by the platform. Sure improvements could aid the uptake of the tool by potential users. For instance, integrating health economic science analytics in time to come versions would be important in gild to fully run across the needs of PH policy stakeholders. Additionally, the provision of a complimentary trial or an open-source version could give future stop-users the chance to test the tool and facilitate take-up. In order to assist future users, a comprehensive guide is also being prepared and will be made publicly available for futurity reference and use past any interested potential user [43].

Evaluation methodology

The nowadays study obtained feedback from a range of potential future users of the EVOTION tool based in 3 European regions with distinctly different constraints with regards to PH decision-making (Western Europe, Balkan region, Eastern Europe). The stakeholders seemed to understand and appreciate the various components and capabilities of the platform. Their feedback has valuable implications for the improvement and exploitation of the EVOTION technologies towards evidence-based policy-making for HL. A major limitation of the evaluation procedure used in the present study was the fact that, at the fourth dimension of the workshops, the platform was non complete and did not permit stakeholders to have hands-on experience with the tool. This was due to practical reasons, related to the timeframe of the commitment of the EVOTION project as a whole. Nosotros likewise admit that this evaluation represents a very small number of professionals from only iv countries selected on the footing of their participation in the EVOTION consortium and it is unclear if the results are generalisable.

Conclusions

The EVOTION platform is an innovative eHealth tool developed at an opportune moment for national and international strategies to harness technologies to improve healthcare delivery and PH policies. Primal stakeholders from unlike PH settings in iv European countries agreed that the implementation of the tool would atomic number 82 to substantial benefits for the formulation of PH decisions for HL past providing highly relevant and extensive show and by facilitating timely decisions in response to emerging situations and needs in the hereafter. All the same, a number of improvements demand to be made in the platform, risks to be carefully considered, and the intended apply and target audience need to be specified. As long equally we tin can overcome these obstacles, stakeholders expressed an interest to utilize the EVOTION tool in their respective office and field of piece of work to generate evidence-based, high-quality policy recommendations.

Availability of data and materials

The workshop discussions transcripts and SWOT analysis tables from the iv individual workshops are bachelor.

Abbreviations

BDA:

Big data analytics

EDR:

EVOTION Data Repository

HA:

Hearing assist

HL:

Hearing loss

PH:

Public wellness

PHPDM:

Public Wellness Policy Decision-making model

SWOT:

Strengths, Weaknesses, Opportunities, Threats

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Acknowledgements

Nosotros would like to thank the EVOTION consortium (https://h2020evotion.eu/the-evotion-consortium/) every bit a whole for their work throughout the EVOTION project and in item Konstantin Pozdniakov, Ioannis Basdekis (Metropolis Academy London) and Jeppe H. Christensen (Eriksholm Research Centre) for their contribution in the workshops. We would also like to thank all the participants of our workshops for their omnipresence and valuable feedback.

Funding

The EVOTION project received funding from the Eu's Horizon 2020 enquiry and innovation programme nether grant agreement No 727521.

Writer data

Affiliations

  1. Academy College London, Ear Institute, London, United Kingdom

    Giorgos Dritsakis & Doris-Eva Bamiou

  2. Pazardzhik Regional Assistants, Pazardzhik, Bulgaria

    Lyubov Trenkova

  3. Department of Audiology and Phoniatrics, Lodz, Poland

    Mariola Śliwińska-Kowalska

  4. Institute of Public Health for the Osijek-Baranja Canton, Osijek, Croatia

    Dario Brdarić

  5. University of Osijek, Faculty of Dental Medicine and Wellness, Osijek, Republic of croatia

    Dario Brdarić

  6. Eriksholm Inquiry Centre, Oticon A/Due south, Snekkersten, Denmark

    Niels Henrik Pontoppidan

  7. Biomedical Engineering Laboratory, Establish of Communication and Reckoner Systems, Athens, Greece

    Panagiotis Katrakazas

  8. Biomedical Research Centre, National Institute for Health Research, London, Britain

    Doris-Eva Bamiou

Contributions

GD, LT, MSK, DEB and NHP organised, hosted, facilitated and/or presented at the workshops. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Doris-Eva Bamiou.

Ethics declarations

Ethics approval and consent to participate

The study has been canonical by the London Southeast Enquiry Ethics Commission (ref: 17/LO/0789). Consent was sought by participants earlier the workshops and their participation was completely voluntary and anonymous.

Consent for publication

No personal information was collected. Participants consented to anonymised verbatim quotations to be used for enquiry purposes prior to the workshops.

Competing interests

The authors have no competing interests to report.

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Supplementary information

Additional file 1.

Part of the workshop participants and their relation to policy-making per country.

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Dritsakis, G., Trenkova, 50., Śliwińska-Kowalska, G. et al. Public health policy-making for hearing loss: stakeholders' evaluation of a novel eHealth tool. Health Res Policy Sys 18, 125 (2020). https://doi.org/ten.1186/s12961-020-00637-2

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Keywords

  • hearing loss
  • public wellness
  • policy-making
  • EVOTION platform
  • big data
  • SWOT

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