Anja Yvonne Bischof
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Item type:Publication, Long-Term Usage of Breeze, a Gamified Breathing Training App, and Its Effect on Momentary Relaxation in People With Cancer: Cohort Study(JMIR Publications Inc., 2025-12-16); Scopus© Citations 4 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Leveraging Influencers to Reach and Engage Vulnerable Individuals With a Digital Health Intervention: Quasi-Experimental Field Study(JMIR Publications Inc., 2025-09-05); ; Theresa SchachnerBackground: Noncommunicable diseases are the leading cause of death, present economic challenges to health care systems worldwide, and disproportionally affect vulnerable individuals with low socioeconomic status (SES). While digital health interventions (DHIs) offer scalable and cost-effective solutions to promote health literacy and encourage behavior change, key challenges concern how to effectively reach and engage vulnerable individuals. To this end, social media influencers provide a unique opportunity to reach millions, and lasting engagement can be ensured through the design of DHIs in a manner that specifically appeals to low-SES individuals through alignment with their social background. Objective: The objectives of this study were 2-fold: to assess the effectiveness of leveraging influencers to reach vulnerable individuals (as measured via app downloads per stream viewers) and evaluate how the design of a DHI can improve engagement among this group (as measured via completion of the intervention). Methods: This study used a cross-sectional, quasi-experimental field design to assess both (1) the effectiveness of influencers in reaching vulnerable individuals and (2) the impact of specific design elements—such as gamification and storytelling—on user engagement using a stress management DHI featuring a slow-paced breathing exercise. In total, 3 differently designed versions of this DHI were developed following a fractional factorial design (StressLess, Breeze, and TragicKingdom). Reach was calculated as the number of downloads per viewers per stream and influencer. Engagement with the DHI was measured via number of conversational turns and milestone and intervention completion rates. Participants’ SES and technology acceptance were evaluated through a postintervention survey. Descriptive statistics, chi-square tests, and ANOVAs were used to examine the effects of the DHI design on reach and engagement metrics. Results: The recruitment via 8 influencers (total streams=25; total viewers=12,667) generated 220 downloads. The average reach ratio across streams amounted to 16.2% (SD 15.5%), with significant differences between conditions (ꭓ22=8.0, P=.02; StressLess: 8.1%, SD 9.3%; Breeze: 14%, SD 10.5%; TragicKingdom: 28.4%, SD 17.6%). The intervention completion rate across all DHI versions amounted to 7.7% (17/220), with no significant differences between conditions (P=.48). Conclusions: This work provides the first evidence that recruitment via influencers yields high reach ratios, moving far beyond the reach of traditional social media platforms. Nonetheless, based on the data collected, the ability to leverage such platforms to recruit vulnerable individuals remains unclear. In addition, while engagement with the promoted interventions was initially high, the completion rate of the full breathing exercise was comparably low, indicating that the influencer promotion strategy cannot fully overcome the well-documented adherence barriers in digital health.Type:journal articleJournal:Journal of Medical Internet ResearchVolume:27DOI:10.2196/67174Scopus© Citations 5 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Medication adherence halves COPD patients' hospitalization risk - Evidence from Swiss health insurance data(2024); ; Medication adherence is vital for patients suffering from Chronic Obstructive Pulmonary Disease (COPD) to mitigate long-term consequences. The impact of poor medication adherence on inferior outcomes like exacerbations leading to hospital admissions is yet to be studied using real-world data. Using Swiss claims data from 2015-2020, we group patients into five categories according to their medication possession ratio. By employing a logistic regression, we quantify each category’s average treatment effect of the medication possession ratio on hospitalized exacerbations. 13,557 COPD patients are included in the analysis. Patients with high medication adherence (daily medication reserve of 80% to 100%) are 51% less likely to incur exacerbation following a hospital stay than patients with the lowest medication adherence (daily medication reserve of 0% to 20%). The study shows that medication adherence varies strongly among Swiss COPD patients. Furthermore, high medication adherence immensely decreases the risk of hospitalized exacerbations.Type:journal articleScopus© Citations 19 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A Collection of Components to Design Clinical Dashboards Incorporating Patient-Reported Outcome Measures: Qualitative Study(2024); ; ; Scopus© Citations 9 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, How to interpret patient-reported outcomes? - Stratified adjusted minimal important changes for the EQ-5D-3L in hip and knee replacement patients(Springer Science and Business Media LLC, 2024-11-25); ; ; ; Abstract Background As one of the main goals of hip and knee replacements is to improve patients’ health-related quality of life, a meaningful evaluation can be achieved by calculating minimal important changes (MICs) for improvements in patient-reported outcome measures (PROMs). This study aims at providing MICs adjusted for patient characteristics for EQ-5D-3L index score improvements after hip and knee replacements. It adds to existing literature by relying on a large national sample and precise clustering algorithms, and by employing a state-of-the-art methodology for the calculation of improved adjusted MICs. Methodology A retrospective observational study was conducted using the publicly available National Health Service (NHS) PROMs dataset for primary hip and knee replacements. We used information on 252,331 hip replacements and 279,668 knee replacements from all NHS-funded providers in England between 2013 and 2020. Clusters of patients were created based on pre-operative EQ-VAS, depression status, and sex. Unstratified and stratified estimates for meaningful EQ-5D-3L improvements were obtained through anchor-based predictive MICs corrected for the proportion of improved patients and the reliability of transition ratings Results Stratifying patients showed that MICs varied across subgroups based on pre-operative EQ-VAS, depression status, and sex. MICs were larger for patients with worse pre-operative EQ-VAS scores, while patients with better pre-operative scores required smaller MICs to achieve a meaningful change. We show how after stratification the percentage of patients achieving their stratified MIC was better in line with the actual share of improved patients. Larger MICs were found for patients with depression and for female patients. MICs calculated for knee replacements were consistently lower than those for hip replacements. Conclusions Our findings show the importance of adjusting MICs for patients’ characteristics and should be considered for quality-related choices and policy initiatives.Type:journal articleJournal:Journal of Patient-Reported OutcomesVolume:8Issue:1Scopus© Citations 3 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Gender health gap pre- and post-joint arthroplasty: Identifying affected patient-reported health domains(2024-02-27); Scopus© Citations 9 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, What is the association between gender and self-perceived health status when controlling for disease-specific conditions? A retrospective data analysis of pre- and post-operative EQ-5D-5L differences in total hip and knee arthroplasty(2023-11-27); ; Scopus© Citations 9 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth(2023); Background: In the absence of medical necessity, opting for caesarean sections exposes mothers and neonates to increased risks of enduring long-term health problems and mortality. This ultimately results in greater economic burden when compared to the outcomes of spontaneous vaginal births. In Switzerland around 33% of all births are by caesarean section. However, the rate of caesarean sections without medical indication is still unknown. Therefore, we devise an identification strategy to differentiate caesarean sections without medical indication using routine data. In addition, we aim to categorize the influencing factors for women who undergo spontaneous vaginal births as opposed to those with caesarean sections without medical indication. Method: We use Swiss Federal Statistics data including 98.3% of all women giving birth from 2014 to 2018. To determine non-medically indicated caesarean sections in our dataset, we base our identification strategy on diagnosis-related groups, diagnosis codes, and procedure classifications. Subsequently, we compare characteristics of women who give birth by non-medically CS and external factors such as the density of practicing midwives to women with spontaneous vaginal birth. Logistic regression analysis measures the effect of factors, such as age, insurance class, income, or density of practicing midwives on non-medically indicated caesarean sections. Results: Around 8% of all Swiss caesarean sections have no medical indication. The regression analysis shows that higher age, supplemental insurance, higher income, and living in urban areas are associated with non-medically indicated caesarean sections, whereas a higher density of midwives decreases the likelihood of caesarean sections without medical indication. Conclusions: By identifying non-medically indicated caesarean sections using routine data, it becomes feasible to gain insights into the characteristics of impacted mothers as well as the external factors involved. Illustrating these results, our recommendation is to revise the incentive policies directed towards healthcare professionals. Among others, future research may investigate the potential of midwife-assisted pregnancy programs on strengthening spontaneous vaginal births in absence of medical complications.Type:journal articleJournal:BMC Pregnancy and ChildbirthVolume:23Issue:1Scopus© Citations 8 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Advocating for Harnessing the Power of Ecosystems in Healthcare: The Case of an Ecosystem in the Realm of Parkinson's Disease -A Position Paper(2024); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, What kind of self-management works and what patients need to better self-manage in case of COPD - Evidence from Swiss survey dataObjective: We aim to understand what self-management interventions and capabilities are associated with a better health status of COPD patients and what kind of support individuals with COPD need to enhance disease self-management. Methods: We obtained self-reported data from 195 COPD patients using a web-based survey. We employed OLS regressions to examine the association between health status of COPD patients measured by reversed CAT score and two self-management capabilities, i.e. smoking cessation and feeling secure in medication intake, and four self-management interventions, i.e. exchange with other COPD patients, annual flu vaccination, participation in the “Living well with COPD” education program and usage of digital health interventions. We used patient characteristics, i.e. age, gender, education, body mass index (BMI), hospitalized exacerbations in the past and number of comorbidities, as controls. For self-management indicators which showed a significant impact on patients’ health status, we conducted subgroup analyses to identify the differences in patients’ support needs. Results: Not feeling “very secure” in medication intake was associated with a lower reversed CAT score, denoting a worse health status (3.61 points lower for “Secure” (p<0.05), 5.69 points lower for “Neutral” (p<0.01), and 4.94 points lower for “Insecure” (p<0.05)). Successful smoking cessation was associated with 3.63 points higher reversed CAT score (p<0.05), denoting a better health status. The subgroups analyses showed that respondents who are not very secure in medication intake had a significantly higher need for regular tips and information on dealing with COPD and support for smoking cessation. The subgroup of current smokers expressed a significantly higher need for support for smoking cessation than former smokers. Discussion: Our study shows that smoking cessation and medication adherence are effective self-management approaches in case of COPD. Our results suggest that self-management should be personalized according to the needs of COPD patients of different subgroups.Type:conference contribution