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Editorial article, editorial: doing critical health communication: a forum on methods.

• 1 Department of Communication, University of Cincinnati, Cincinnati, OH, United States
• 2 Department of Communication, University of South Florida, Tampa, FL, United States

Editorial on the Research Topic “Doing” Critical Health Communication. A Forum on Methods

The assumed premise of health communication research is straightforward: improving communication processes across all health-related domains. Communication between providers and patients, public health messaging, health literacy training, culturally competent healthcare, health status sharing in families, workplaces, and small groups can all fit within the broad definition of health communication. However, philosophical differences in what communication means–or for that matter, what health means–result in a complex, multi-paradigmatic field of study. For instance, viewing communication primarily as information transfer leads to a different trajectory of research and scholarship than a view of communication as the constitutive process of meaning making. Similarly, conceptualizing health as a means of achieving social concordance or even control vs. as a site of social struggle leads us different places.

Within the well-established field of health communication, a preponderance of published research continues to be rooted in communication models that derive from social psychology and information science. Consequently, emerging issues, new theoretical and methodological directions, and ethical challenges define the landscape of the field. For instance, we have witnessed a significant rise in interpretive research focusing on the social construction of meaning. However, we believe there is more work to do in nurturing critical health communication [CHC] perspectives.

The primary rationale for this research topic was to describe multiple ways to engage in CHC methodologies through a set of short, “how-to” articles. The original impetus were two roundtable panels (convened at successive National Communication Association conventions) to gauge the trajectory of CHC in the decade after Zoller and Kline’s review of the contributions of interpretive/critical health communication research in the Annals of Communication (then called Communication Yearbook). One of the things we recognized in those panel discussions was that CHC was still considered a niche sub-discipline or area within health communication, and consequently, students and young scholars who were interested in CHC often did not receive formal guidance in this area, notwithstanding the dramatic increases in CHC-fueled work being published in our disciplinary journals, and/or presented at conferences. Even for scholars familiar with the intellectual terrains of poststructuralism, postcolonialism, the “linguistic turn,” hermeneutics, phenomenology and critical theory, there was a gap in documenting these theoretical concepts into concrete ways of “doing” health communication research.

In calling for papers, we urged potential authors to ask, “What makes your work critical?” How do methodological practices illuminate the role of critique? What are the ontological and epistemological implications of doing CHC? How is CHC related to critical praxis? How does “doing” critical work engage with/deviate from the broader interpretive move toward discourses/texts? What do recent provocations around the “return to the material” in Communication scholarship mean for CHC researchers? How is CHC situated to respond to widening racial, gendered and other social disparities in health across the globe? Finally, how do CHC researchers situate their own privilege and conceptualize embodied risk through their work? The fourteen articles that comprise this collection, selected from the 30 + abstracts submitted for consideration, and shortlisted from 19 full-text article submissions) respond to this prompt in unique, individual ways.

Of the fourteen articles, five report on new/original research, four offer ‘Conceptual Analysis’ or brief essays on a particular concept. Another four are short “Perspectives” on varying issues concerning CHC, and one is a Brief Research Report. As to our remit of a “how to” for CHC, the articles offer pedagogical insights on CHC methods in a variety of ways.

Zoller and Kline’s 2008 drew attention to both shared attributes and key points of difference in interpretive and critical health communication. One of our goals for this topic was to theorize their differences as well as their “blurry edges.” Anne Kerber’s essay addresses longstanding conflicts between a critical “hermeneutic” of suspicion that interrogates relations of power and an affirmative stance that seeks positive models of critical social change.

A second rationale for this collection was to re-establish the disciplinary history of the efforts of CHC scholars. At the abovementioned conference panel discussions and through our own anecdotal experience, we have learnt that the multi-decade project to critique, de-parochialize, globalize and queer the body of the discipline (and consequently, its journals and editorial boards), led by women, scholars of color, LGBTQ scholars, and scholars from the Global South, has not been documented or set into the received intellectual history of the field (in contrast to cognate areas, like critical organizational or critical management studies). This absence influences the diffusion of our work. It also makes it possible for other scholarly collectives, notably our colleagues who coalesce under the “Rhetoric of Health and Medicine” or RHM, whose work we admire, review and support, to largely ignore this history and the contributions of CHC scholars in opening up space for critical/humanist inquiry in this area. In that sense, we seek to make explicit the politics, the pragmatics and the real-life implications of doing CHC work. As a foundational scholar in the area, Heather Zoller’s essay derives from her extensive work in the field, and outlines how the politics of academic training, visibility, and publishing intersect in pursuing a trajectory of critical health communication research. This essay is an excellent entry point for this research topic.

Essays in this collection model different forms of critical analysis. For instance, Carter and Alexander’s original research is an exemplar for connecting race, class, historical positioning, and health communication practices. Their interview-based original research highlights the voices of African American farmers, revealing how their issues and interests have been silenced in discussions about United States farming. They connect these erasures with broader political discourses about diet and health disparities.

Khan et al model critical ethnographic analysis through their study of Ashodaya Samithi , a sex worker collective in Mysore, India. They offer narratives that highlight resistance and alliance building that are imperative in order to invert dominant discriminatory notions of nationhood and citizenship that have and continue to violate health and rights of marginalized communities. Much of the critical work in health communication has emerged from the global South, espousing a critique of the West-dominated nature of communication theorizing and global health policies.

Dutta and his team provide a primer in a Marxist approach to critical theorizing, with attention to the global subaltern. The authors draw from their embodied culture-centered research engaging in activist interventions that aim to disrupt Whiteness and associated capitalist and colonial logics. The authors challenge us to consider what counts as resistance organizing in ways that provide an interesting counterpoint to Kerber’s essay. Such tensions in what counts as “critical” research in health communication continues to be an important fault line in our field. Metatheoretical differences in conceptualizing the role of the critic in health communication manifest in methodological and pragmatic differences in what research looks like. One such difference is in the practice of what some scholas call ‘critical reflexivity’

Critical reflexivity–or the continual introspection of how analysis reveals the motivations of the analyst as much as it says something about that which is analyzed–is a governing principle guiding the ethical conduct of critical research. Rebecca de Souza’s essay interrogates how the literature on critical reflexivity–what she calls the “self-other” hyphen—predicates a white researcher introspecting on their ethical analytical practices as they work in communities of color. However, flipping the trope, de Souza’s essay offers a fascinating look at what happens when a person of color navigates analysis of predominantly white spaces. Through an analysis of the responses and challenges to her work by peer reviewers, commentators and colleagues, de Souza offers a window into the “micro-politics” of knowledge production. Her work offers practical suggestions for scholars of color to challenge the hegemonic assumptions that emerge from working in white spaces.

Similarly, Leandra Hernandez and Sarah De Los Santos Upton provide an exemplar of the power of critical reflexivity and the need for critical praxis through social justice activism. The essay blends discussion of their research and activist work, describing the intersectional approach they have taken to health communication research at the United States-Mexico border. Situated as Chicana feminists, they have investigated gendered, racial and class constructions in the context of reproductive justice, violence, and immigration. The authors describe how their work has necessitated a blending of theoretical and methodological approaches.

Critical reflexivity is also an important tool in Smita Misra’s essay , which centers around the concept of migrant trauma. As encapsulated by their experiences in a participatory theater project that purportedly allowed for refugees to cope with trauma, Misra offers a critical reflexive account of how well-meaning, “participatory”/critical projects can offer limited/constraining understanding of the lives of the vulnerable populations they serve.

Nicole Hudak’s essay discusses challenges in publishing research that does not fit within post-positivism, calling for more advocacy of qualitative and critical research. In addition, the essay challenges all of us to interrogate reviewer practices that reinforce heteronormativity and create barriers to research addressing LGBTQ + health care experiences. This turn to embodied identity is further crystallized in Ellingson’s work, which theorizes embodiment more centrally.

Embodiment becomes sensorial in Laura Ellingson’s essay. Sensual intersubjectivities that blend the senses, the motors, and the material, Ellingson explains, are crucial to critical health communication research methods because interrupting discourses on/of what makes certain bodies/citizens ‘healthy’ and ‘normal’ calls for a sustained practice of sensorial reflexivity.

If critical reflexivity is one way to redefine the “blurry edges” between interpretive and critical approaches, then Sastry and Basu’s essay offers a methodological warrant to use critical reflexivity as a practicable method for analysis in health communication. The essay elucidates an approach blending culture-centered analysis, abductive analysis, and critical reflexivity in a post-COVID world. Departing from their ethnographic work in the culture-centered tradition, the authors offer a framework to analyze health discourses using the early responses to COVID-19 as an exemplar.

Several essays offer methodological innovations in the doing of critical health research. Sarah MacLean and Simon Hatcher write about the walkthrough method in their essay. The walkthrough method offers a viable process to scrutinize the architecture of a health technology tools –- the BEACON Rx Platform in their case –in terms of expected use and consequent implications of access and equity. This method also creates spaces for questioning the discourses inherent in health technologies that frame dominant understandings of how to be in “good” health.

Wendy Pringle provides a new methodological tool for critical health communication scholars, particularly those interested in textual/rhetorical analysis and policy discourses. She adapts the “What's the Problem Represented to be?” (WPR) approach from the field of discursive policy analysis. The paper uses the illustrative example of the legalization of medical assistance in dying in Canada. The WPR method facilitates attention to evolving discourses of problem constructions, and she describes the implications for people with disabilities, including what is said and what is left unspoken. The method addresses social change, including policy critique, and advocacy as a form of resistance.

In our call for papers, we hoped to collectively articulate (and complicate) what exactly we mean by “critical” in CHC. In addition to the models we have discussed, Kim Kline and Shamshad Khan call attention to the need for CHC scholars to speak to both internal and external stakeholders. Their essay signposts the possibilities and challenges for CHC scholars to engage in “transdisciplinary” collaborations within and without the discipline of health communication.

Speaking of collaborations, this research topic would not have been realized without the collaborative efforts between the contributing authors, the editorial team, and most importantly, the large number of reviewers who volunteered their time and intellectual commitment to this cause–not to mention adapting their reviewing practices for Frontiers. While open-access, transparency, and publication of reviewers’ names with published articles signals the timely democratization of the publication process, the concomitant “bot-tification” of the process was a learning curve for several Communication scholars–us included.

As we conclude this editorial, the United States has more than 13 million confirmed cases of COVID-19, and some estimates suggest that the death toll might reach 5,00,000 by the summer of 2021. Debates around masks, vaccines, technology transfers, economic impacts and racial and income inequalities related to the pandemic continue, painfully demonstrate the need for more research in how mechanisms of power/control/inequality shape individual and collective experiences of health and illness.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Keywords: health communication, critical health studies, research methods, reflexivity, critical health communication

Citation: Sastry S, Zoller HM and Basu A (2021) Editorial: Doing Critical Health Communication: A Forum on Methods. Front. Commun. 5:637579. doi: 10.3389/fcomm.2020.637579

Received: 03 December 2020; Accepted: 24 December 2020; Published: 25 January 2021.

Edited and reviewed by:

Copyright © 2021 Sastry, Zoller and Basu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Shaunak Sastry, [email protected]

This article is part of the Research Topic

'Doing' Critical Health Communication: A Forum on Methods

Health Communication Research Paper Topics

Community Health Issues

• Change Agency
• Collective Efficacy
• Community Mobilization
• Community Organizing as a Research Approach
• Community Participation
• Community-Based Participatory Research
• Comprehensive Community Initiatives
• Conflict Management: Health Professionals
• Cultural Differences
• Health Activism and Public Health
• Immigrant Families
• Media Literacy
• Nature, Environment, and Sustainability
• Organizational and Public Policy Barriers
• Readiness Assessments
• Rural Health Communication
• Sex Workers
• Social Action, Types of
• Social Aggregates
• Social Capital
• Social Determinants of Health
• University–Community Relationships

End-of-Life Issues

• Advance Directives
• Advanced Aging Communities
• Bereavement
• Communicating Bad News
• Death and Dying
• Family Communication and End of Life
• Final Conversations
• Palliative Care
• Pediatric Hospice Care
• Rhetoric: Death with Dignity
• Staff Communication in Nursing Homes
• Terminality

Evaluation of Health Intervention, Education, and Communication

• Content Analysis
• Data Mining
• Focus Groups
• Logic Models and Program Evaluation
• Measurement Problems
• Message Quality Measurement
• Mixed Methods of Evaluation
• Modeling Development and Testing
• New Technologies and Intervention Evaluation Methodology
• Qualitative Methods of Evaluation
• Quantitative Methods of Evaluation
• Risk Communication
• Risk Society
• Setting Objectives in Health Communication and Intervention
• Statistical Challenges in Evaluation

Everyday and Family Health Communication Issues

• Adolescent Substance Abuse Prevention
• Alcohol and Health Decision Making
• Childhood Injury Prevention
• Communication with Families
• Consequences of Health Literacy
• Consequences of Stigmatization
• Coping with Stigmatization
• Courtesy Stigma
• Cross-Generational Health Communication
• Decision Making
• Disabilities and Family Relationships
• Everyday Health Communication
• Familial Roles in Health Communication
• Family Caregiving
• Family Meeting
• Family Planning
• Family Relationship to Health
• Grief and Loss
• Health Communication with Children
• Health Education
• Health Literacy and Numeracy
• Health Transition and Family Communication
• Illness Identity
• Improving Health Literacy
• Integrating Health Literacy into Health Care Systems
• Measurement of Health Literacy
• Model of Health Literacy
• Mother–Daughter Dyad Communication
• Online Health Literacy
• Religion and Spirituality
• Social Construction of Disability
• Social Identity
• Social Influence of Everyday Health Communication
• Social Norms
• Social Support and Cardiovascular Health
• Social Support and Health
• Social Support and Support Groups
• Social Support Interventions
• Stigma Reduction
• Stigmatization
• Stigmatization, Labels, Marks, and Peril
• Surrogate Decision Makers
• Teen Pregnancy
• Types of Social Support
• Unintended Effects of Health Communication
• Health Campaigns
• Advertising of Dietary Supplements
• Advertising of Food
• Advertising of Over-the-Counter Drugs
• Advertising of Prescription Drugs
• Affordable Care Act
• Assessment of Health Campaigns
• Awareness and Instruction Strategies
• Campaign Effects Versus Effectiveness
• Campaigns in Developing Countries
• Channels and Formats
• Communication Complex
• Communication for Behavioral Impact
• Crisis Communication
• Disease Prevention
• Dissemination
• Emotion Appraisals Regarding Risk
• Evidence Role in Health Campaigns
• Formative Evaluation
• Governmental Regulation of Advertising
• Incentive Appeals
• Influential Source Messengers
• Integrated Marketing Mix
• Interpersonal Communication and Mass Media Health Campaigns
• Message Design
• Message Sidedness
• Message Tailoring
• Optimistic Bias
• Perceived Threat
• Program Strategies: Campaigns
• Public Service Announcements
• Risk Communication and Food Safety
• Risk Perceptions
• Risk-Taking Behavior
• Segmentation of Health Campaigns
• Sensation-Seeking Targeting
• Social Marketing

International and Diversity Issues in Health Communication

• Conflict and Negative Health Effects
• Cultural Sensitivity
• Discrimination or Bias in Health Care
• Disenfranchised Populations
• Ethnic Diversity in Health Care Settings
• Health Disparities in Clinical Interactions
• Health Disparities on Communal Level
• Human Rights
• Immigrant Populations
• Intercultural Health Communication
• Islamic Healing
• LGBT Issues
• Marginalized Populations
• Overall Health Disparities
• Personal Influences on Health Disparities
• Public Health Intervention in Multicultural Communities
• Relational Influences on Health Disparities
• Solutions for Health Disparities
• Structure-Centered Approach

Health Information

• Defensive Reactions to Health Messages
• Digital Divide
• Disclosure and Family Health History
• Disclosure and Medical Errors
• Disclosure and Providers and Patients
• Emotion and Information Seeking
• Explaining Illness
• Expressive Writing and Health
• Health Citizenship
• Health Communication Curricula
• Information Nonseeking
• Information Seeking
• Information Sharing
• Need for Explaining Illness
• Online Health Information Seeking
• Online Health Information Sharing
• Opinion Leaders
• Psychosocial Determinants of Health Information-Seeking Behavior
• Social Determinants of Health Information-Seeking Behavior
• History of Health Communication
• Basic Concepts of Communication
• Communication Across the Lifespan
• Communication Networks
• E-Health Defined
• Evolution of Medicine as Business
• Health Information Channels
• Patient and Relationship-Centered Communication and Medicine
• Personalized Medicine
• Postcolonial Studies and Health
• Premises of Health Communication
• Science Communication
• Translational Research

Media Content

• Advertising Unhealthy Foods to Children
• Body Images and Portrayals
• Celebrity Cancer Announcements
• Celebrity Endorsements
• Critical Analysis of Media and Health
• Digital Media
• Entertainment–Education
• European Approach to Entertainment–Education
• Health Blogging
• Health Consequences of Pornography
• Health Journalism
• Health Promotion
• Hollywood and Public Relations Approach to Entertainment–Education
• Ideological Hegemony
• Impact of Media Content
• Institutional Processes and Competing Agendas
• Interpretation and Effects of Disclaimers
• Media and Health Disparities
• Media and Quality of Health Information
• Media Content: Magazines
• Media Content: Newspapers
• Media Content: Other Print
• Media Content: Televised Entertainment
• Media Content: Televised News
• Media Coverage of Genetically Modified Organisms
• Media Depictions of Disability
• Media Depictions of Medical Workers
• Media Depictions of Mental Illnesses
• Moderating Variables and Audience Effects
• Music in Health Behavior
• Obesity and Mass Media
• Pathways to Change Tool
• Public Relations and Health Journalism
• Public Relations and Health Promotion
• Public Relations and Social Media
• Reaching Audiences
• Role of Involvement in Entertainment–Education
• Social Marketing and Community Change Perspective
• Twitter and Public Health

Organizational Issues and Health Policy

• Adult Children of Alcoholics
• American Medical Association
• Conflict Management and Health Professionals
• Department of Health and Human Services
• Health Care Teams
• Health Policy
• Healthy People Initiative
• Hospital Governance Culture
• Informed Consent
• Interdisciplinary Health Services Research
• Mediated Health Campaigns
• Multicultural Campaigns
• National Action Plan to Improve Health Literacy
• National Cancer Institute
• National Institutes of Health
• National Library of Medicine
• National Medical Association
• Organizations and Health
• Patient Privacy
• Politics and Political Complexities
• Public Relations and Health Care Organizations
• Role Stress
• Segmentation and Public Relations
• Stress and Burnout
• Stress and Burnout: Emotional Labor
• Stress and Burnout: Home–Work Conflict
• Three Community and Five Cities Projects
• S. Centers for Disease Control and Prevention
• Working Well
• World Health Organization

Provider–Patient Interaction

• Adherence to Medical Regimens
• Anger Appeals
• Clinical Trial Participation
• Coding Health Interaction
• Collaborative Decision Making
• Contested Illnesses
• Conversation Analysis
• Decision Making Between Support Providers and Persons with Disabilities
• Dependent Variables Derived from Critical Health Outcomes
• Difficult Patients
• Discourse and Health
• Doctor–Patient Communication
• Emergency Rooms
• Emotions and the Medical Care Process
• Face and Politeness
• Health Care Environment
• HIV Test Counseling
• Identification
• Interactional Context and Intervention
• Interpersonal Communication Skills
• Interpreters and Language
• Interviewing in the Health Care Context
• Language and Negation Bias in Doctor–Patient Interaction
• Language Brokering
• Listening in Health Care Interactions
• Malpractice Litigation
• Medical Outcomes
• Nonverbal Communication in Health Care Settings
• Open Dialogue Approach
• Overtreatment and Overreliance on Diagnostic Testing
• Pathways to Health Outcomes
• Patient Activation
• Patient Education and Hospital Discharge and Readmission
• Patient Empowerment
• Patient Navigators and Family Advisors
• Patient Safety
• Patients and Communication Skills Training:
• Prescribing Medications
• Providers and Communication Skills Training and Assessment
• Quality of Life as a Health Outcome
• Satisfaction
• Shared Mind in Collaborative Decision Making:
• Supportive Listening
• Uncertainty in Collaborative Decision Making
• Public Health Communication
• Biopreparedness and Biosecurity
• Climate Change
• Communication of Scientific Complexity
• Developmental Health
• Disaster Relief
• Emergency Preparedness and Response
• Environmental Health
• Evolution of Public Health Communication
• Flu Vaccine Rhetoric
• HIV/AIDS Prevention
• Immunizations
• Memorable Messages
• Mother-to-Child HIV/AIDS Transmission
• Newborn Care
• Online Health Information Credibility
• Priming in Health Campaign Messages
• Public Engagement and Science Policy
• Public Health and Academic Partnerships
• Public Understanding of Research
• Public Understanding of Science
• Research in Environmental Health
• School Health
• Science Literacy
• Sexual Health
• Warning Labels
• Warning Labels on Alcohol
• Warning Labels on Cigarettes
• Warning Labels on Prescription Drugs
• Women’s Health
• Work Site Safety

Specific Health Issues/Providers

• Child and Spousal Abuse
• Acupuncture
• Age-Related Hearing Loss
• Alternative and Complementary Medicine
• Alzheimer’s Disease
• Ayurveda, Yoga, and Meditation
• Bioterrorism
• Birth Control and Contraception
• Breast Cancer
• Breastfeeding
• Bullying and Cyberbullying
• Cancer Risk Communication
• Cancer Survivorship
• Chronic Diseases
• Communication Interventions
• Contraception
• Dialectical Behavioral Therapy
• Distance Caregiving
• Drug and Alcohol Abuse Minimization
• Eating Disorders
• Emergency Health Communication
• Enhancement
• Gambling Addiction
• Heart Health
• HIV/AIDS and Disclosure Dilemmas
• HIV/AIDS Treatment
• HIV/AIDS, Condom Use, and Meanings
• Holistic Medicine
• Human Papillomavirus
• Influenza A Virus Subtype H1N1
• Integrative Medicine
• Internet Addiction
• Language, Metaphors, and Social Construction of HIV/AIDS
• Malaria and Mosquito Nets
• Male Circumcision
• Mammography
• Meanings of HIV/AIDS Test
• Mental Health
• Military Health
• Military Sexual Assault
• Multilevel Interventions
• Neurorhetoric
• Nutrition and Diet
• Oral Health and Dentistry
• Organ Donation
• Pharmacists
• Physical Activity and Weight
• Post-Traumatic Stress Disorder
• Prenatal Health Promotion
• Prostate Cancer
• Responses to Slow-Motion Technological Disaster
• Severe Acute Respiratory Syndrome
• Sex Education
• Sexual Assault
• Sexually Transmitted Disease Prevention
• Skin Cancer and Sun Safety
• Skin Cancer and Tanning
• Social Determinants of Disparities in HIV/AIDS
• Transitions, Health Effects, and Support
• Traumatic Brain Injury
• Tuberculosis
• Vaccinations

Technology and Health Communication

• Biomedical and Health Informatics
• Bundled Interventions
• Communication Technology Theoretical Frameworks
• Computer-Tailored Interventions
• Customization as Tailoring 2.0
• Digital Personal Health Records
• Electronic Medical Records
• Free-Standing Computer Kiosks
• Geographic Information Systems Technology
• Internet and Information Acquisition
• Medical Body Implants
• Mobile Health
• New Reproductive Technologies
• Online Focus Groups
• Online Health Information Exchange and Privacy
• Online Support Groups
• Online Support Groups Advantages and Disadvantages
• Persuasive Technologies for Health
• Secondary Data Analysis
• Social Media
• Technology and Health Outcomes
• Technology Impact on Physician–Patient Dialogue
• Telemedicine
• Virtual Reality Environments
• Weak Tie/Strong Tie Network Support
• Web-Based Delivery

Health Communication Theories, Ethics, and Philosophy

• Acculturation
• Action Tendency Emotions
• Acute Versus Preventive Care
• Affection Exchange Theory
• Agenda Setting
• Amputee Wannabes
• Attribution Theory and Attribution Error
• Biological Citizenship
• Biopower and Biopolitics
• Care Model and Productive Interaction
• Change Approaches
• Communication Accommodation Theory
• Communication Privacy Management Theory
• Communication Theory of Identity
• Community Resilience
• Control Theory
• Critical Approaches
• Cultivation Theory
• Cultural Variance Model
• Culture-Centered Approaches
• Cyberchondria
• Diffusion of Innovations Model
• Double ABC-X Model of Family Stress and Coping
• Dual-Processing Models
• Ecological Perspectives
• Encoded Exposure and Aided Versus Unaided Awareness
• Ethic of Care
• Ethics and Health Campaigns
• Ethics and Health Communication Strategies
• Ethics and New Technologies
• Ethics of Provider–Patient Interaction
• Ethnography
• Ethnomethodology
• Fear Appeals and the Extended Parallel Process Model
• Generative Tensions in Health Communication Theory
• Globalization Theory
• Grounded Theory
• Harm Reduction Theory
• Health Belief Model
• Health Communication Ethics
• Health Locus of Control
• Hofstede’s Dimensions of Culture
• Inconsistent Nurturing as Control Theory
• Inoculation Effects
• Instructional Principles of Risk Communication
• Invisible Disabilities
• Loose Versus Tight Coupling
• Measurement of Social Networks
• Media Complementarity Theory
• Medicalization
• Message Sensation Value
• Meta-Analysis
• Motivational Interviewing
• Multilevel Modeling
• Narrative Engagement Theory
• Narrative Medicine
• Narratives and Barrier Reduction
• Narratives and Health Campaigns
• Narratives and Social Marketing
• Negotiated Morality Theory
• Olson’s Circumplex Model of Marital and Family Systems
• Organization–Public Relations Theory
• O-S-O-R Model
• Perceived Effectiveness
• Phenomenology
• Placebo Effects
• Problematic Integration Theory
• Problem-Based Learning
• Psychological Reactance
• Psychometric Theory and Reliability/Validity of Measures
• Reconceptualized Health Belief Model
• Relational Dialectics Theory
• Relational Health Communication Competence Model
• Rhetoric, Health, and Medicine
• Risk Information Seeking and Processing Model
• Risk Perception Attitude Framework
• Self-Determination Theory
• Self-Efficacy
• Situational Theory and Communication Behaviors
• Social Cognitive Theory
• Social Comparison Theory
• Social Construction of Reality
• Social Construction Perspective on Risk Communication
• Social Judgment Theory
• Social Networks
• Social Networks and Message Delivery
• Societal Risk Reduction Motivation Model
• Sociometric Social Networks
• Structural Violence and Health
• Systems Theory
• Theory of Motivated Information Management
• Theory of Normative Social Behavior
• Theory of Planned Behavior
• Theory of Reasoned Action
• Traditions of Health Communication Theory
• Trait Approaches
• Uncertainty Management Theory
• Uses and Gratifications Theory
• Weick’s Model of Organizing

Organization of the Field

There is no simple or complete way to organize the field of health communication, though several sub-fields have existed depending on one’s research interests, as well as adventitious and historical circumstances. At the individual level, the focus is twofold: (1) how health cognitions affect, and behaviors influence and are influenced by, health communications; and (2) how interpersonal interactions between patients, family members, and providers, and with members of their social network, influence health outcomes. At the organizational level, some have studied the role of communication within health-care systems and how organization of the media and the practices of media professionals may influence population and individual health.

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Finally, at the societal level, the focus is on large-scale social changes and the role of communication with such changes. For example, one might examine how strategic communications as well as natural diffusion of information impact individual and population health; or how communication mediates and is influenced by social determinants such as social class, neighborhood, social cohesion and conflict, social and economic policies, and how that impacts individual and population health.

Even as these levels provide a useful organizing framework, two caveats are warranted. First, policymaking and research related to health may affect more than one level. Second, interest in a level of analysis and pursuit of work at one level is not inconsequential. Locating a problem at one level, and studying it at that level, have implications for the kind of policy or practice that is likely to emerge from that research.

Interpersonal Communication

Extensive attention has been given to understanding the consequences of communication between physicians and patients on patient satisfaction, adherence, and quality of life. One theme is who controls the interaction between providers and patients, known as ‘relational control.’ A second theme focuses on the outcomes of patient– provider interactions. Extensive research has documented that patient–provider communication influences patient satisfaction which, in turn, is related to patient adherence and compliance to treatment regimens, ease of distress, physiological response, length of stay in the hospital, quality of life, and health status, among others. Third, researchers have documented stark differences in patient preparation and access, and in care received and health outcomes, between social classes as well as racial and ethnic groups.

The implications of interpersonal interaction in the context of families, friends, co-workers, and voluntary associations on health outcomes have become one of the most dynamic areas of research in health communication. This topic has been pursued from diverse theoretical viewpoints by researchers focusing on social networks, social support, family communications, and social capital based on the researcher’s disciplinary origins and research interests. In addition to social support, social networks can accelerate or decelerate diffusion of new information, and also influence how it is interpreted (Himelboim & Han 2014). Members within networks can serve as role models for lifestyle behaviors such as smoking and obesity. The emergence and spread of the Internet have broadened the scope of interpersonal interaction and its influence in health communication by moderating the limits of geography.

Mass Media and Health

The incidental and routine use of media for news and entertainment serves four functions in health. (1) The informational function is served when casual use of media for news or other purposes may expose the audience to developments on new treatments or new drugs, alert them to risk factors, or warn them of impending threats such as avian flu; (2) media serve an instrumental function by providing information that facilitates action; e.g., in times of natural disasters the audience may learn about places where they should take shelter, and information of this kind allows for practical action; (3) media defines what is acceptable and legitimate, performing a social control function; (4) the communal function is served when media provide social support, generate social capital, and connect people to social institutions and groups.

Information seeking, as a construct, has gained greater currency in recent times as more information on health has become routinely available because of greater coverage of health in the media, the spread of health-related content on the world wide web, or the consumerist movement in health that promotes informed or shared decision-making. It is widely assumed that under certain conditions some people actively look for health information to seek a second opinion, make a more informed choice on treatments, and learn in greater depth about a health problem that afflicts them or their friends or family members.

The most visible and popular means of strategic communications is through health campaigns which have become a critical arsenal in health promotion. A typical health campaign attempts to promote change by increasing the amount of information on the health topic, and by defining the issue of interest in such a way as to promote health or prevent disease. Recent reviews of the vast literature on health campaigns have identified conditions under which health campaigns can be successful (e.g. Noar 2006; Randolph & Viswanath 2004).

Emerging Challenges/Dimensions

First, the combined impact of computers and telecommunications on society has been transformative, impinging on almost every facet of human life including art, culture, science, and education. Consumer informatics integrates consumer information needs and preferences with clinical systems to empower patients to take charge of their healthcare, bring down costs, and improve quality of care. For example, the integration of electronic medical records with communications should facilitate communications between patients and providers, send automatic reminders to patients to stay on schedule, and help patients navigate the health-care system. Second, technological developments are coinciding with the consumerist movement in health-care. The paternalistic model that characterized the physician–patient relationship is slowly being complemented by alternative models such as shared/informed decisionmaking models (SDM/IDM) or patient-centered communication (PCC). Third, the significant investments in biomedical research enterprise in the developing world, and movement toward more evidence- based medicine, have led to calls for translation of the knowledge from the laboratory to the clinic and the community. Lastly, an urgent and a moral imperative in health is addressing the profound inequities in access to health-care and the disproportionate burden of disease faced by certain groups.

References:

• Epstein, R. M. & Street, R. L., Jr. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. NIH Publication no. 07–6225. Bethesda, MD: National Cancer Institute.
• Glanz, K., Rimer, B., & Viswanath, K. (eds.) (2008). Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass.
• Himelboim, I. & Han, J. Y. (2014). Cancer talk on twitter: Community structure and information sources in breast and prostate cancer social networks. Journal of Health Communication: International Perspectives, 19(2), 210–225.
• Hornik, R. (ed.) (2002). Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum.
• McCauley, M., Blake, K., Meissner, H., & Viswanath, K. (2013). The social group influences of U.S. health journalists and their impact on the newsmaking process. Health Education Research, 28(20), 339–51.
• Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11, 21–42.
• Obregon, R. & Waisbord, S. (eds.) (2012). The handbook of global health communication. Oxford: Wiley Blackwell.
• Parker, J. C. & Thorson, E. (2008). Health communication in the new media landscape. New York: Springer.
• Randolph, W. & Viswanath, K. (2004). Lessons learned from public health mass media campaigns: Marketing health in a crowded media world. Annual Review of Public Health, 25, 419–37.
• Snyder, L. B. & Hamilton, M. A. (2002). A meta-analysis of U.S. health campaign effects on behavior: Emphasize enforcement, exposure, and new information, and beware of secular trend. In R. Hornik (ed.), Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum, pp. 357–383.
• Viswanath, K. (2005). The communications revolution and cancer control. Nature Reviews Cancer, 5(10), 828–835.

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Shifting to Serious Illness Communication

• 1 Harvard Medical School, Boston, Massachusetts
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Although the research evidence for advance care planning has been debated, 1 the underlying need remains. Every day, patients and families engaged in medical decisions toward the end of life experience distress that could have been lessened or even prevented through communication.

Advance care planning originally focused on the completion of advance directives and tries to address this need by preparing patients for decision-making. Advance care planning is now considered to be a “process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.” 2 There is significant face validity to this person-centered approach: the only way for clinicians to know and honor patients’ values and goals is to ask about them. Yet research questions remain about which patients, which clinicians, when to start, and the key elements that lead to benefit.

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Jacobsen J , Bernacki R , Paladino J. Shifting to Serious Illness Communication. JAMA. 2022;327(4):321–322. doi:10.1001/jama.2021.23695

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• Published: 09 May 2024

Skin-interfacing wearable biosensors for smart health monitoring of infants and neonates

• Lauren Zhou   ORCID: orcid.org/0009-0008-0199-5296 1 , 2 ,
• Matthew Guess   ORCID: orcid.org/0000-0002-7113-743X 1 , 2 ,
• Ka Ram Kim   ORCID: orcid.org/0000-0001-9495-2392 1 , 2 &
• Woon-Hong Yeo   ORCID: orcid.org/0000-0002-5526-3882 1 , 2 , 3 , 4  

Communications Materials volume  5 , Article number:  72 ( 2024 ) Cite this article

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Health monitoring of infant patients in intensive care can be especially strenuous for both the patient and their caregiver, as testing setups involve a tangle of electrodes, probes, and catheters that keep the patient bedridden. This has typically involved expensive and imposing machines, to track physiological metrics such as heart rate, respiration rate, temperature, blood oxygen saturation, blood pressure, and ion concentrations. However, in the past couple of decades, research advancements have propelled a world of soft, wearable, and non-invasive systems to supersede current practices. This paper summarizes the latest advancements in neonatal wearable systems and the different approaches to each branch of physiological monitoring, with an emphasis on smart skin-interfaced wearables. Weaknesses and shortfalls are also addressed, with some guidelines provided to help drive the further research needed.

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An epidermal patch for the simultaneous monitoring of haemodynamic and metabolic biomarkers

Introduction.

The advancements in the miniaturization of electronics have allowed impressive achievements toward improving healthcare. Wearable sensing technology enables comfortable, continuous, and convenient alternatives to standard care while maintaining quality and accuracy. These systems are especially valuable for neonatal applications, where small footprints, gentle handling, and ease of use are essential. Traditional intensive care within the Neonatal Intensive Care Unit (NICU) involves a complicated mess of electrodes, tubing, and tape that is visually disturbing and makes it extremely difficult for kangaroo care, which is skin-to-skin swaddling reported to have numerous physiological, behavioral, and therapeutic benefits 1 . In addition, neonatal skin is thin and fragile, making it especially susceptible to irritation, stripping, and sores, which may result in permanent scarring and damage 2 . With improvements in miniaturization, material choices, fabrication methods, signal analysis techniques, and wireless communication, new wearable sensors and systems that alleviate many of the inconveniences of conventional care have been developed (Fig.  1 ). In this review, we will detail the material basis for wearable devices. Then, we will share the underlying principles and technological progress of essential branches of physiological monitoring, including biopotential, optical, temperature, electrochemical, and multi-signal sensing. Finally, we will identify deficiencies that should be addressed for future work to improve the equity and accessibility of quality healthcare.

Methods include electronic miniaturization, soft and flexible materials, gentler adhesion mechanisms, designing all-in-one devices, prioritizing non-invasive monitoring and increased accessibility, wireless communication via Bluetooth, NFC, or radio, and cloud-based data processing. Stock image of infant outline adapted with permission from purchase by Getty Images iStock with color modifications and device adaptations added by the authors.

Material developments

Design considerations for neonates.

There are several nuances when designing for infant patient groups. First, infants are undeniably smaller than adults, with most high-risk patients suffering from prematurity (gestational age <37 weeks) and low birth weight (typically <2.5 kg) 3 . These patients undergo several monitoring options, including cardiac, respiratory, neurological, and general physiological monitoring 4 . Blood draws for diagnostic tests are also standard, subjecting neonates to an average of ~7.5–17.3 painful procedures per day 5 . These monitoring practices require expensive specialty equipment, with electrodes and tubing needing to be secured with adhesive tapes that are applied and removed multiple times daily. This can be especially damaging and dangerous to infant groups, as the stratum corneum and epidermis layers are 30% and 20% thinner than adult skin 6 , and the cohesion between the dermis and epidermis is much weaker 2 , 6 . This reduced skin function results in a high risk of epidermal stripping, contact dermatitis, pressure wounds, tension blisters, and burns (Fig.  2a, b ) 2 , 7 , and leads to a greater risk of infections due to percutaneous invasion of pathogens 8 . Thus, when it comes to modernizing this technology and making it wearable, the critical design considerations include small and conformal form factors, gentle and biocompatible adhesion to the skin, and making the design appear benign to caregivers, all while maintaining excellent signal quality and effective operation.

a Contact dermatitis from repeated adhesive wet electrode placement. Reproduced with permission 2 . Copyright 2014, Elsevier Inc. b Second-degree burn from pulse oximeter clip. Reproduced with permission 94 . Copyright 2012, Elsevier Inc. c Robust and conformal adhesion of EES via liquid bandage. Adapted with permission 11 . Copyright 2013, WILEY‐VCH Verlag GmbH. d High EES conformality to skin texture. Reproduced with permission 11 . Copyright 2013, WILEY‐VCH Verlag GmbH. e Geometric serpentine lines allowing linearly elastic response up to 100% strain. Reproduced with permission 13 . Copyright 2014, Springer Nature Limited. f Ionic liquid-filled decoupling layer within EES device. Reproduced under the terms of the Creative Commons CC BY license from ref. 12 . g Comparison of peel force between conventional NICU adhesive and elastomeric EES adhesive. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 33 . h Peel force comparison between Ecoflex and common NICU tapes Tegaderm and Kind Removal tape. Reproduced with permission 32 . Copyright 2020, IEEE. i Image demonstrating thicker elastomeric layers prevent irreparable EES deformation. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 12 . j Diagram illustrating glucose trigger-activated hydrogel adhesive that loses adhesion after wetting. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 18 .

Epidermal electronic systems

One of the primary technological techniques to combat these issues is called “epidermal electronic systems” (EES), where the material properties of the system match that of the epidermis 9 . The skin surface topology is imperfect, with creases, pores, and general surface texture forming gaps between the electrode-skin interface, resulting in increased impedance, motion artifacts, and worsened signal acquisition. EES systems are soft and flexible electronics that are fabricated using microelectromechanical systems (MEMS) fabrication techniques; however, while typical MEMS methods with silicon wafers produce delicate and brittle devices 10 , EES approaches allow robust flexibility. Employing thin film materials like polyimide (PI) (<100 μm thick) as a structural substrate and dielectric material and thin depositions of metals like Cr/Al/Cu/Au (<500 nm thick) to serve as the conductive layers 9 , 11 , 12 one can achieve ultrathin and flexible devices with sub-nanometer bending stiffnesses and effective moduli ~140 kPa 9 , preventing delamination from the skin. They can be easily attached to the skin with a thin adhesive transfer film like that of a temporary tattoo 9 or via liquid bandage (Fig.  2c ) 11 with very intimate contact with the skin’s surface (Fig.  2d ) 11 . Integrating modified geometric designs using curvilinear serpentine interconnects enables greater strain tolerance and stretchability as they act as pre-buckled lines. High amplitude serpentines are capable of 100% strain with minimal stress and maintain elastic responses (Fig.  2e ) 13 , surpassing the elastic behavior of skin where it is only linearly elastic up to tensile strains of 15% 14 . The high conformality allows the system to move dynamically with the skin, assures prominent signal quality, eliminates motion artifacts, and maintains continuous contact with the skin. The thin-film properties of these electronics allow comfortable and gentle physiological monitoring that protects the integrity of fragile infant skin while ensuring high-quality data recordings.

Thin film systems can have broader applications when interfaced with elastomers. More affordable than silicon wafer technology, they can have varying Young’s modulus depending on the amount of crosslinking allowed, and they are unique in that they can form tight seals with itself, silicon, and glass. Tight seals make the devices water resistant, which is necessary in high humidity NICU incubators, and they can be injected with ionic liquid to serve as a decoupling layer to reduce mechanical stresses within the device (Fig.  2f ) 12 . This quality also makes elastomers excellent for micro and nanofluidic applications for biofluid sensing which will be discussed later in this review. For applications with EES, elastomers are an excellent substrate to embed soft electronics within because they are biocompatible and naturally adhesive due to Van der Waals forces. Typical adhesive tapes used in the NICU to secure tubing and wires are pressure-based and have tackifiers derived from acrylate, resin, or petroleum. After applying pressure to the tape onto the skin, the adhesive flows into the creases and folds of the skin via wetting and form a bond, building strength over time 15 , 16 . Because the adhesive forms a strong bond with the skin, there is a very high likelihood that it is stronger than the bond between the skin cells, causing the epidermal layers to be stripped away with removal. This makes the elastomeric Van der Waals adhesion especially attractive because it can bond strongly to the skin (even wet) while allowing extremely gentle removal (Fig.  2g ). Compared to other standard adhesives used in the NICU designed to be delicate on the skin, Ecoflex has a peel force 15 and 10 times smaller than Tegaderm and Kind Removal tape, respectively (Fig.  2h ) 17 . In a clinical test on 50 neonates observing changes in skin condition (erythema, dryness, or breakdown) after 15 minutes of EES application, the average change was negligible to slightly improved 17 . Thicker layers of elastomer prevent EES disturbance (Fig.  2i ) and depending on the elastomer type, can be reusable, improving device longevity. Alternative adhesives that emphasize and improve on gentle removal processes are also being explored, like trigger-detachable hydrogels that swell and lose their adhesive energy once treated with glucose 18 (Fig.  2j ), water 19 , or shear force 20 , or thermally switchable copolymer tapes 21 and silicone-based adhesive with meltable oil crystallites 22 . These alternative and gentler removal processes may be better suited for infants with especially fragile skin, like premature infants.

All-in-one systems

Depending on the criticality of a patient, they may be connected to several monitors simultaneously, each with its own apparatus. These complicated setups form a perceived barrier of untouchability, curtailing skin-to-skin contact and exacerbating visual disturbance and stress. Elastomeric encapsulation is excellent for hybrid electronics, allowing the mix of flexible EES sensors, rigid passive and active electronics, wireless communication, and data processing to form all-in-one devices with real-time wireless monitoring. These self-sufficient devices are the basis for several systems described in this review.

Textile sensors

Textiles are a popular mechanism by which to integrate sensors for biosignal sensing. From a review of the literature for noninvasive infant monitoring, textile sensors were historically the preferred mechanism due to its perceived familiarity and simplicity. Integration methods of conductive materials include direct weaving of electrically conductive fibers 23 , 24 , sewing on pieces of Ag- or Au-coated nylon 25 or polyurethane 26 , or printing electric inks on the fibers directly 27 . These components can then be easily attached to items of clothing like onesies 24 , straps/bands 28 , jackets 29 , and more. Textile electrodes embedded within clothes eliminates the need for tapes and conductive gels, but at the cost of signal quality. Physiological metrics like respiration rate and motion can be measured by the resistive and capacitive strain response of conductive fibers 24 , 28 . Most of these works transfer data with wired connectors or bulky wireless transmitters; however, antennas can be knitted within clothing coupled with radio frequency identification (RFID) tags for battery-free wireless data transfer 30 . We found that as EES systems and flexible electronics were developed and advanced for adult monitoring, they had become the state of the art for infant monitoring as well; thus, it will be the main point of focus for this review.

Physiological monitoring

The measurement of physiological metrics can be performed over various modalities, including biopotential, optical, temperature, electrochemical, and multi-signal sensing. Here, we report gold standard of testing and non-invasive skin-interfaced alternatives applicable to neonatal patient groups, summarized in Table  1 .

Biopotential sensing

The human body functions via chemical reactions that generate action potentials to power and control the physiological processes within the body. Several of these biopotentials are measurable through the skin with electrodes that transduce the ionic current into assessable electric signals. Several biopotential signals that are significant for health monitoring including electrocardiograms (ECG) for heart activity, electromyograms for muscle activation, electroencephalograms (EEG) for brain activity, and electrooculograms for eye movement tracking, with ECG and EEG being most relevant for neonatal applications. Traditional wet Ag/AgCl electrodes use conductive gels (sometimes abrasive) to reduce the impedance made by the nonconformal gaps between the electrode and skin surface and improve electrical conductivity. However, these gels dry out over time degrading signal quality, irritating the skin, and still requiring the use of a strong adhesive to affix the electrode. Furthermore, conventional electrodes are wired to stationary monitors that restrict movement. Therefore, recent works to improve biopotential sensing have focused on using EES as dry electrodes that do not require the use of conductive gels, which mitigate and improve on these weaknesses.

Electrocardiography

Electrocardiography (ECG), which measures the electrical activity of the heart muscles, is a key signal used to monitor heart function by being able to derive heart rate (HR), heart rate variability (HRV), heart rhythms, and respiration rate (RR). To determine if the signal recorded is high quality, ECG fiducials and timings including the P, QRS, and T waves should be distinct and consistent without distortion. To minimize device footprints, lead placement is modified to place the electrodes closer to one another. With the adapted lead placement, it is important to ensure maintained accuracy. To extract real-time heart rate from the ECG signal, the Pan-Tompkins algorithm is a widely used method to identify the QRS complex which is then used by an automated algorithm to quantify HR, HRV, heart rhythm, and RR (Fig.  3a ) 31 , 32 . By recursively checking if the heart and respiratory rates are within normal range, emergency alarms can sound to alert the provider of abnormal behavior, thus meeting the standards of NICU monitoring. Chung et al. 33 were the first to apply an all-in-one EES system to mimic vital signs monitoring in the NICU (Fig.  3b ). Semiconductor fabrication steps form the circuital base of the device, including the electrodes, near field communication (NFC) coil, and sensor interconnects. Off-the-shelf active and passive components for biopotential amplification and filtering and an NFC System-on-a-Chip (SoC) allow wireless inductive power transfer and data sharing to a host reader platform that lays beneath the patient’s mattress. An ionic fluid injected into a microfluidic space beneath the circuitry maintains the resonant frequency and quality factor for the NFC antenna coil. In addition, the battery-free, open mesh design allows device usage during medical imaging (MRI and X-ray). Although only two electrodes are used, they had strong agreement in their HR and RR determination to the gold standard; however, they still required the use of a conductive gel. Weaknesses of this system is that it is mechanically fragile, collapsing on itself after extreme deformation during the removal process 9 , 17 . Due to it complicated fabrication steps requiring specialized facilities, these expensive systems are not suitable for popular and disposable use. In addition, the NFC communication protocol only has modest operating distances up to 25 cm, keeping the infant bedridden for continuous monitoring. Kim et al. 12 optimized the construction strategy for EES to preserve high conformality while improving the system hardiness, finding that a mixed elastomer with a 2:1 ratio of EcoFlex Gel to EcoFlex 0030 had the greatest adhesion force and conformability with robust manipulability. They applied this discovery to their own neonatal ECG monitoring device (Fig.  3c ) 32 , which had a removable lithium-ion polymer (LiPo) battery allowing hours of continuous monitoring and a Bluetooth low energy (BLE) SoC allowing long-range telemetry up to 15 meters. Using a modified Lead V2 configuration, they were able to easily distinguish the ECG fiducial PQRST waves and had an SNR over 40 dB without the use of conductive gels. This work also used semiconductor fabrication steps including spin coating, sputter deposition, chemical vapor deposition, wet/dry etching, and photolithography to form the device. Textile electrodes are also popular for ECG recording (Fig.  3d ) without conductive gels and have relatively good performance with low drift and distinguishable QRS complexes 29 . However, constant pressure needs to be applied, either by having the infant laying on the electrodes or with a tight-fitting jacket. With wireless communication and smart computation with machine learning, these device systems can perform real-time HR, RR, HRV, and heart rhythm determination. However, the real-time study of heart rhythms from wirelessly recorded systems should be taken fastidiously, as issues with inconsistent data transfer like data drop out and lagging can give artificial results.

a Process diagram for heart rate and respiration rate determination from ECG waveform following Pan-Tompkins algorithm. The calculated values can be studied recursively for alert systems. Reproduced with permission 32 . Copyright 2020, IEEE. b First neonatal all-in-one EES system (left) for neonatal cardiovascular monitoring (right). Reproduced under the terms of the Creative Commons CC BY 4.0 license from 33 . c Thicker, more robust EES cardiovascular monitoring with V2 lead setup. Reproduced with permission 32 . Copyright 2020, IEEE. d Textile-based electrodes. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 29 .

Electroencephalography

Electroencephalography (EEG) measures the electrical activity of the brain with electrodes placed on the scalp, typically used for seizure detection. Common modes are single-channel amplitude integrated EEG (aEEG) and multichannel continuous EEG (cEEG), where cEEG is considered the diagnostic gold standard. aEEG can easily be performed on premature infants to observe abnormalities associated with brain injury 34 while cEEG, requiring ~10-20 electrodes, is more comprehensive and used for seizure detection and cortical function assessment 35 . Due to incubator limitation, head size constraints, and hair, placement and maintenance of the electrodes is difficult. In addition, EEG waveforms are very small in amplitude and susceptible to artifacts. A wireless communication device helps allow space-saving communication between the 23-lead system and a bedside laptop 36 , however limited research has been performed to materially redesign an EEG electrode system. Most developments involve designing textile caps or bands that improve the ease of electrode placement but still use traditional wet electrodes 37 , 38 , 39 . Although not designed for neonatal applications, Mullen et al. 40 designed a rigid cEEG headset using novel hybrid electrodes that have an ionic hydrogel sandwiched between a semi-permeable membrane and Ag/AgCl plates to transduce the electrical signal. This hybrid electrode design combines the improved conductivity and signal quality of wet electrodes with the skin biocompatibility of dry electrodes. Bristle electrodes, shaped like the bristles of a brush with a conductive tip, may also be a suitable dry electrode replacement, as they can part the hair for gentle conformal contact with the skin and record with high signal quality 41 . This design, however, has been reported as irritating after long term use as a constant pressure is required for low skin-electrode impedance.

Optical sensing

Optical sensing for medical use uses the principles of spectrophotometry to noninvasively observe physiological phenomena transcutaneously. Using pairs of light emitting diodes (LEDs) with corresponding photodetectors, the LED shines a wavelength with a known intensity into the tissue that then gets received by the photodetector. Based on how much light gets absorbed, one can form a representative relationship for key tissue metrics like blood oxygenation, hydration, and chemical composition 42 . There are two modes that exist: transmissive (LED and photodetector on opposite sides of the observed tissue) and reflective (LED and photodetector are side-by-side).

Photoplethysmography

Photoplethysmography (PPG) is an optical sensing technique used to estimate blood oxygen saturation (SpO2), also called pulse oximetry (POX). The gold standard of POX is with an invasive arterial line to find arterial oxygen saturation (SaO2), but optically derived values from POX are acceptable as well. POX is a dominant metric used for clinical decision making, including the decision to supply additional oxygen, the detection of early sepsis and cardiopulmonary complications, and is the sole screening metric for congenital heart defects (CHDs) 43 . POX can track respiration rate and indicate apnea events in premature infants, as cessations of breathing are accompanied by either bradycardia or oxygen desaturation (SpO2 < 80%) 44 . Using two sets of LED/photodetector pairs, one LED operates at a 640–660 nm wavelength (red) while the other at 880–940 nm (infrared) 45 to measure the differential light absorption through the observed skin tissue. This ratio is calibrated against SaO2 measurements to establish a measurement of SpO2. Typical POX probes for adults are designed for the finger and utilize the transmissive mode, often in a clip-style packaging. However, the strong forces of the clip can be especially damaging on fragile infant anatomy (Fig.  2b ). Thus, neonatal pulse oximeters operate with the reflective mode on the hand or foot and are often packaged within an adhesive wrap. POX is highly susceptible to motion artifacts, and because infants frequently swing around their limbs, packaging for these sensors are designed to induce a constant force and must be checked regularly to avoid pressure wounds and burns. In addition, due to their small anatomy and low body fat, neonates often have low blood perfusion in their limbs, which is necessary for accurate measurement. In these cases, clinicians will monitor from more proximal locations like the earlobe and forehead 46 . Grubb et al. 47 proposed forehead reflectance PPG for neonates in the NICU. Henry et al. 48 presented a wireless, cap-mounted device for measuring heart rate via PPG. The device was optimized for preterm infants by miniaturizing and ruggedizing the sensor, which consisted of four 525 nm LEDs arranged in pairs on either side of a photodetector. The sensor was encapsulated in silicone and wired to a computer for data recording. The sensor was held to the forehead using a specialized T-shaped cap (Fig.  4a ). They demonstrated the clinical capabilities of the device by comparing the heart rate from ECG. Chung et al. 33 developed a flexible PPG sensor for the foot that utilized ultra-thin electronics to allow a small bending radius of 5 mm to allow for conformality with the foot (Fig.  4b ). The thinness and design of the perforations of the device allowed for adhesion via only van der Waals forces. The PPG device offered on-board AC/DC calculation before transmitting data, reducing the bandwidth needed. The group built on this work in 2020 by introducing a system that improved on the limitations of the previous system (Fig.  4c ) 17 . This system improved the wireless data communication operating distance, the fragile nature of the designs, and specialized fabrication. The PPG unit was made with a flexible printed circuit board encapsulated with silicone, providing more stability. Due to the embedded battery, the full PPG waveform could be transmitted over the device with 95% limits of agreement (LOA) in HR of less than 4 BPM with standard clinical measurement. There exist global weaknesses with POX for infants that need to be addressed. First, skin color is a big factor, as individuals with darker skin absorb more light than lighter skin 49 . In an assessment among adult patients of different races and ethnicities, Black, Hispanic, and Asian patients experienced erroneous over-estimations by POX compared to SaO2 levels 50 . This is likely due to the historical limited inclusion of people of color in these formative studies, where calibration algorithms are derived from data sets primarily from individuals with lighter skin tones 51 . Additional research should also be conducted for modifying the calibration algorithms for infant patients, as a study found that conventional NICU pulse oximeters lose accuracy for hypoxic patients with blood saturations lower than 85%, often overestimating by more than 5% compared to arterial values 52 . Diseased neonatal patients that suffer from CHDs often have blood oxygen levels in the 75–85% region, therefore these overestimations are unacceptable for regular clinical care. Given POX’s clinical influence, these issues must be addressed with future research developments.

a Illustration of a cap-mounted device for measuring PPG at the forehead. The sensor sits above the eyebrow. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 48 . b Wireless PPG device bending around a glass cylinder. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 33 . c Schematic and photographs of a wireless limb unit for measuring PPG. Reproduced with permission 17 . Copyright 2020, Springer Nature.

Near-infrared spectroscopy

Complementary to POX is near-infrared spectroscopy (NIRS). NIRS is based on the near-infrared spectrum of wavelengths (700–1000 nm) and the absorption of chromophores such as myoglobin, hemoglobin, and cytochrome aa3 53 . Although similar in principle to POX, NIRS differs in that it represents the balance of local tissue oxygen supply and demand. Regional tissue oxygen saturation (rSO2) monitors discriminate light paths from different tissue depths, ergo measuring veinous as well as arterial hemoglobin oxygenation 54 . Therefore, NIRS can be more useful in measuring cerebral hemodynamics, which is helpful for seizure detection 55 , intraventricular hemorrhage 56 , and white matter injury 57 . Rwei et al. developed a soft, flexible, wireless system for monitoring infant cerebral hemodynamics 58 . The pair of LEDs emit at 740 nm and 850 nm wavelengths with four photodiodes at source-detector distances of 5, 10, 15, and 20 mm, allowing recording at different tissue depths for detection of both peripheral and cerebral hemodynamics, and was validated by Monte Carlo optical simulations and magnetic resonance imaging (MRI). Other wavelengths offer opportunities to measure different chromophores. If blue and green wavelengths of LEDs are used, the light absorption ratio of bilirubin can be monitored, and this principle was used by Inamori et al. 59 who reported a wearable device for jaundice detection. Calibrated by a commercial bilirubinometer, their device could successfully measure bilirubin concentration using the ratio of the reflected green and blue lights. Measuring NIRS offers challenges not found in photoplethysmography. The validation of NIRS is difficult because there is not a gold standard for tissue oxyhemoglobin content. Light absorption and scattering occurs from compounds other than hemoglobin, thus more wavelengths and source-detector distances are necessary for improved accuracy 60 .

Temperature sensing

Infants, due to their prematurity and lack of body fat, struggle to maintain a stable and normal body temperature between 36.5 and 37.5 °C 61 , thus are at extremely high risk of hypothermia. Premature infants are at even greater risks, which result in incubators stays tuned to the ideal temperature and levels of oxygen, humidity, and light. Skin and core temperatures are the two metrics studied. For skin temperature, single-measurement readings can be determined from a thermometer or human touch. For continuous readings, small flexible adhesive probes attached to the abdomen, chest, or back are used. Most wearable systems that have been developed for infants record skin temperature with off-the-shelf temperature gauges 17 , 19 , 62 . However, skin temperature is not very informative as a health metric because it cannot be used as a proxy for core temperature 63 , 64 . For core body temperature (CBT), common methods include measuring invasively from the pulmonary artery or semi-invasively with probes inserted into the esophagus, nasopharynx, tympanic membrane, or rectum 65 . However, these measurements still vary amongst each other depending on anatomical location because some organs produce heat (brain, liver) while others dissipate (lungs, skin) 66 . Nonetheless, except for the invasive line, the esophagus is considered the gold standard. Clinicians can also estimate temperature from the environment, where infants housed within an incubator have sensors that measure the ambient temperature. Little research has been conducted to develop a method to non-invasively and accurately measure neonatal core body temperature, but Atallah et al. 66 have succeeded with an unobtrusive method of continuous neonatal brain temperature (a proxy for CBT) monitoring with a zero-heat-flux (ZHF) sensor matrix placed beneath the head 67 . ZHF methodology assumes that if the heat loss from a surface is reduced to zero, the gradient between core and surface temperature will also reduce to zero. By placing thermistors on either side of a thermal resistance material, a control loop can control a heating pad beneath the matrix to heat one thermistor until it matches the skin-interfacing one, thus providing the cerebral temperature 68 , 69 . Clinically validated in comparison to esophageal measurements, they found moderately high correlations ( r  > 0.5, p  < 0.001) for most infants, with lower correlations likely due to poor head placement over the sensors. Alternatively, a miniaturized, skin-interfaced temperature sensing system usable by infants using two negative temperature coefficient (NTC) thermistors, one that is insulated within the foam and interfaces with the skin and the other that faces the ambient air 70 . Using single heat flux principles, they were able to estimate core body temperature with a mean difference of −0.05 °C with a 95% LOA of 0.24 °C in comparison to an ingestible temperature sensor. However, their estimation simply adds 1.2 °C to the measured skin temperature and was only tested on three adult subjects, thus further work is needed to observe if this system is usable for infants.

Electrochemical sensing

Detection of chemical or protein biomarkers from fluidic specimens by patients can provide progressive details for health pre-diagnosis, diagnosis, and prognosis. Typically, neonates admitted to the NICU are subjected to 7.5-17.3 painful procedures a day for laboratory tests 71 , with higher risk patients subjected to more frequent blood draws. Neonatal non-invasive thin film biomarker-sensing restricted to sweat, saliva, and urine can replace conventional invasive blood draws with the same sensitivity towards biomarker detection (e.g., electrolytes, metabolites, cell-secreted proteins). The electrochemical sensing principle relies on measuring the charge transfer of captured analyte reactions on a sensing electrode. These charges allow recordable changes in current (voltammetry/amperometry), conductivity (conductometry), and voltage/potential (potentiometry) for use with wearables. For saliva analysis, pacifiers can be an excellent platform for safe saliva sample-collecting (Fig.  5a ). Smart pacifiers can be used for detecting glucose 72 , sodium, and potassium 73 with amperometric and voltametric enzyme sensing. Glucose tracking is extremely important for neonatal monitoring, with admitted patients typically subjected to hourly glucose tests and contribute to more than 40% of all laboratory studies performed 71 . Garcia-Carmona, et al. 72 developed a pacifier with a rectifier system to enable forward saliva flow towards an electrochemical cell located in the back without backflow. Their system had excellent linearity ( R 2  = 0.994), sensitivity (0.69 ± 0.04 nA/mM), limits of detection (0.721 mg/dL), and limits of quantification (1.802 mg/dL) which are far below average glucose levels for neonates (70–150 mg/dL). The current prototype is limited by the biofouling characteristics of saliva affecting the long-term stability of the sensing electrode, but if addressed appropriately, can be effective for continuous glucose monitoring. Parilla et al. 74 designed a saliva-based wearable that aids in the monitoring of phenylalanine, the biomarker for phenylketonuria, a rare inheritable disorder that can be toxic to the nervous system and is tested for at birth. Their sensor has an affordable and user-friendly sampling strategy where saliva is absorbed by a filter paper pre-impregnated with a hydrogen carbonate buffer. The sample then gets placed onto a screen-printed electrode that is linked to a smart wristband that reports the phenylalanine levels after 15–240 s. This sensor has a dynamic range from 0.0004–18 mg/dL which spans below the normal levels (<2 mg/dL) to beyond the unhealthy limits (4 mg/mL) for neonates and can be a favorable alternative to conventional blood draws. For sweat analysis, patch-type sensors can be used to detect and analyze glucose. Open circuit potentiometry can identify the target ion concentration, and the monitoring of sodium and chloride contents trends can support the early detection of cystic fibrosis (Fig.  5b ) 75 . Although not a direct indicator of serum glucose levels, sweat glucose can track the tendency patterns, which could be beneficial for neonatal diabetes, where Lee et al. 76 developed a stretchable, ultra-thin, patch to facilitate drug delivery decisions. These devices utilize an enzymatic biosensing method within a chronoamperometric setup. From urine analysis, diapers are a simple wearable platform. Ning et al. 77 created a urea-based bilirubin detector for neonatal jaundice with hydrovoltaic-biosensing on a ZnO nanoarray (Fig.  5d ). It outputs a greater voltage the stronger the bilirubin concentration and proportionally powers a series of LEDs for visualization. The diaper has repeatable performance with multiple exposures spread over several hours and is expected to be discarded with the diaper. We expect much growth in wearable analyte-detection devices for neonatal applications, as there is an abundance of work being done with adult applications. However, there is a lack of defined relationships between these biofluids and serum ion concentrations, thus non-invasive diagnostic powers are limited.

a Electrochemical sensing pacifier that tracks electrolyte (sodium and potassium) levels from saliva. Reproduced with permission 73 . Copyright 2022, Elsevier B.V. All rights reserved. b Patch-style sweat sensor for sodium and chloride monitoring for cystic fibrosis monitoring. Reproduced with permission 95 . Copyright 2016, Springer Nature Limited. c Diaper-integrated urea sensing for jaundice monitoring using a ZnO nanoarray. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 77 .

Multi-signal systems

The synchronous recording of a multi-signal system being uploaded to a single data sink allows comparative relationships to form between the signals, driving new physiological metrics to be computed (Fig.  6a ). For example, the aforementioned work by Chung et al. 33 had a binodal ECG and PPG measuring system. Because both signals were recorded and saved concurrently, they were able to identify the time elapsed between the ECG R peak to the PPG valley fiducial to derive the pulse arrival time (PAT) (Fig.  6b ). They used the Moens-Korteweg equation to demonstrate a linear relationship between 1/PAT and systolic blood pressure (BP); however, their testing was conducted on one adult and with limited statistical validation compared to a cuff monitor. Improving upon their previous design, a year later, Chung et al. 17 developed a thicker, yet still conformal, binodal system with an added high-sensitivity tri-axial accelerometer for posture recognition and cry analysis (Fig.  6c ). From the accelerometer, they were also able to measure seismocardiograms (SCG), which is the recording of the physical vibrations of the heartbeat through the chest wall. SCG provides a new perspective to cardiovascular monitoring because it can distinguish key cardiological events including valve openings, closings, fillings, and ejections. The time delay between the tallest SCG peak representing aortic opening with the PPG valley provides the pulse transit time (PTT). Combined with a known distance between both sensors and vascular assumptions about arterial wall thickness, modulus, and blood density, a surrogate of systolic and diastolic blood pressure (BP) can be derived. Comparing their system to values from invasive arterial lines of two patients, they were able to generate their own calibration curves for BP with respect to pulse arrival/transit time. Testing with additional subjects showed their system performed within the ANSI/AAMI Sp10 requirements for blood pressure cuffs, which requires a mean difference <5 mmHg and standard deviation <8 mmHg. While the ability to determine BP noninvasively and continuously is incredibly beneficial, it is an extremely volatile metric depending on emotional and active states, body position, temperature, stress, and genetic history, thus requiring frequent calibration with a gold standard (invasive arterial line or oscillometric cuff) to maintain accuracy. Additionally, it is important to be cautious relying on metrics derived from timing differences between signals because data time synchronization can be unreliable. Lagging and imprecise time stamps can lead to poor relational data, which for BP estimation from PTT, even an erroneous hundredth of a second can be detrimental as the average PTT times of a 3-month-old is 140 ± 11 ms 78 (assumed even shorter for preterm neonates). Chung, et al. 17 navigated this issue by having their chest unit transmit its 16 MHz local clock information to the limb unit, eliminating drift to enable time syncing of less than 1 ms. The combination of ECG and SCG can also be used to estimate stroke volume of patients with congenital heart defects 79 . Yoo et al. 80 created a multi-signal system that combines an inertial measurement unit (IMU) with two microphones to acousto-mechanically monitor cardiorespiratory and gastrointestinal events. Combining the data recorded from each sensor allows spaciotemporal mapping of the lungs and bowels. The two microphones face opposite directions, one towards the body and other towards the environment, which allow sound separation and audio reconstruction of physiological sounds in noisy environments (Fig.  6d ). Simultaneous tracking from multiple of the same sensors can be advantageous as well. A four-IMU system applied to the wrists and ankles combined with machine learning has found high correspondence to cramped-synchronized general movements as compared to visually validated videos for cerebral palsy detection 81 . Additional IMUs can be used to reconstruct and track 3D body motions 82 (Fig . 6e ).

a Schematic diagram showing how concurrent and time-synced data uploading and processing allows new physiological phenomena to be monitored. b Systolic and diastolic blood pressure derivation from timing differences between fiducials from ECG, SCG, and PPG waveforms. Reproduced under the terms of the Creative Commons CC BY 4.0 license from ref. 96 . c Binodal multi-signal system that tracks ECG, PPG, SCG, and temperature. Reproduced with permission 17 . Copyright 2020, Springer Nature. d Dual-mic setup with one towards the body and another towards the environment allows real-time noise canceling and audio reconstruction (right) even in noisy environment (left). Reproduced with permission 80 . Copyright 2020, Springer Nature. e) Multi-device IMU system (left) that allows body position reconstruction (right). Reproduced with permission 82 . Copyright 2020, Springer Nature.

Future work

Most of the technology discussed in this review has been developed to simplify and improve treatment options within the NICU. Table  1 shows the comparative wearable methods to conventional physiological monitoring. Notably, there are many adult systems that we refrained from discussing because they had yet to be applied to neonatal and pediatric applications. However, we will share several developments that we find worthwhile but will need to be adapted to accommodate pediatric physiological differences. Wearable stethoscope technology 80 , 83 could be used to aid in asthma monitoring and continuous studying of cardiopulmonary sounds. Wearable dry cEEG, like the cap device by Mullen et al. 40 , could greatly improve ease of seizure monitoring for preterm infants. Wearable piezoelectric ultrasound patches could assist with complex and expensive internal imaging 84 . Use of continuous electrochemical sensing that are currently developed but not in a wearable form factor would be beneficial to help detect and monitor ailments like lactic acidosis 85 , neonatal sepsis 86 , and jaundice recovery 87 . The application of soft, flexible, and inexpensive passive sensors could help to monitor physiological metrics and movement 88 , 89 . It is also important to solve known deficiencies, like developing a more accurate pulse oximetry algorithm for hypoxic neonates and infants of various skin tone, as current commercial devices are often inaccurate for patients with blood saturation below 85% or dark skin.

Although the work on pediatric wearables is relatively new, with advanced multimodal systems being developed only within the past five years, it would be extremely valuable to integrate them into real hospital settings for monitoring. Though there is may exist a lack of trust in the efficacy in these devices, hesitating to implement them as tools for influential medical decision making, neonatal and infant patient groups are the most to benefit from this technology. With their fragile skin and risk for severe injury even from acrylic adhesive tapes with weak adhesion forces like paper tape and Tegaderm, the gentle adhesion from elastomers with Van der Waals forces ensure protected skin integrity. Wireless devices reduce the overwhelming visual stress of NICU monitoring systems making parents feel more comfortable to approach and hold their sick child. They also make it easier to transport patients between wards, hospitals, or even from the bed to their parent’s arms for kangaroo care 90 . Kangaroo care is critically important for newborn development, parent-baby bonding, and improving patient outcomes, especially for high-risk preterm neonates, with benefits for the infant including more stable physiological metrics, less pain, better sleep, improved weight gain, and earlier discharge 90 , 91 , 92 . Recent wearable technology has also been designed to account for sanitization in the hospital environment, either prepared for autoclave sterilization 17 or to be low cost for economic single-use 93 . The use of machine learning algorithms may aid in the detection of unusual behavior, with highly accurate systems being especially beneficial in remote or lower-resource areas with less-experienced physicians, increasing accessibility to quality healthcare. Combined with cloud-based processing and data storage, long-term patient-specific trend analysis could be manipulated to help clinicians recognize patient recovery/decline, discern abnormal deviations, and reduce misdiagnoses. Concerns for high-fidelity data transfer without dropouts or loss of connection are problems that should be addressed to improve trust in wireless systems, as they are highly likely in hospital environments with lots of devices communicating in the same frequency spectrum as BLE. However, operating with different communication protocols like ultra-wideband transmission may reduce signal interference from other devices while still operating at low power.

The wearable devices developed would provide even greater benefit to outpatient care and use in lower-resource communities. While still mostly in their exploratory and validations phases, the market lacks adequate and trustworthy home infant health monitoring systems. A drive for commercialization allowing normal use will be especially beneficial for recovery monitoring of post-surgical high-risk patients like interstage single-ventricle patients. At the same time, it is important to design user-friendly devices to be able to entrust nonmedically trained individuals to record high-quality data. Battery-free systems with passive sensors often use induction-based data transfer to receiver units. If embedded within clothes, it could standardize and improve ease of use by non-physician caretakers. With the rise of telehealth, low-cost reusable and disposable devices could improve healthcare accessibility, allowing remote or rural patients to conduct a pre-screening at home before deciding to travel long distances to hospitals with specialized care options. It could also reduce strain on hospital resources, allowing low-risk patients to be monitored remotely in the comfort of their own homes. These automated monitoring systems would be especially beneficial for diseased school-age children to improve independence, allowing them to be more self-sufficient and in tune with their medical needs during the long periods of the day they spend with reduced adult supervision. It is important to ensure proper and limited usage of these devices, as they can provide a false sense of safety and increase parental anxiety.

The development of flexible electronics and wearable health monitoring systems has been a growing field that greatly benefits a vulnerable and understudied population. They can assist in the measurement of key physiological metrics, including cardiovascular operation and rhythm, cerebral hemodynamics, blood oxygen saturation, temperature, and ion concentrations, replacing invasive procedures and improving patient outcomes. Other advanced signal processing allows further medical derivations including blood pressure, core body temperature, and reconstructive imaging of body movements. The information combined from these metrics can help with diagnostic practices and recovery monitoring; however, the work discussed has only brushed the surface of possible biomedical applications for neonatal populations. With further research and development tuned specifically for infants, this demographic may be the largest beneficiaries from what wearable biosensors and smart health monitoring systems have to offer.

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Acknowledgements

The authors acknowledge the support of the National Institutes of Health (Grant No. R21EB034893). This work was also supported by the Imlay Foundation – Innovation Fund.

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Zhou, L., Guess, M., Kim, K.R. et al. Skin-interfacing wearable biosensors for smart health monitoring of infants and neonates. Commun Mater 5 , 72 (2024). https://doi.org/10.1038/s43246-024-00511-6

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The public health comms gap: We have the behavioral data, now we have to use it

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For The Drum’s health & pharma focus , Jack Ryan’s Ryan Dunlop looks at the gap between theory and practice in public health comms.

Public health messaging needs an overhaul - first, we have to understand how it got here, says Ryan Dunlop / Myriam Zilles via Unsplash

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