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Su JJ, Chan MHS, Ghisi GLDM, Kwan RYC, Wong AKC, Lin R, Yeung JWF, He Q, Pepera G, Batalik L. Real-World Mobile Health Implementation and Patient Safety: Multicenter Qualitative Study. J Med Internet Res 2025; 27:e71086. [PMID: 40299494 PMCID: PMC12076031 DOI: 10.2196/71086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 03/12/2025] [Accepted: 03/31/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Mobile health (mHealth) is increasingly being used in contemporary health care provision owing to its portability, accessibility, ability to facilitate communication, improved interprofessional collaboration, and benefits for health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, especially as care settings extend beyond traditional center-based technology usage to home-based care. OBJECTIVE This study aimed to explore health care professionals' perspectives on the safety aspects of mHealth integration in real-world service provision, focusing on Hong Kong Special Administrative Region (SAR) and Wuhan city in mainland China. In Hong Kong SAR, real-world mHealth care provision is largely managed by the Hospital Authority, which has released various mobile apps for home-based care, such as Stoma Care, Hip Fracture, and HA Go. In contrast, mHealth care provision in Wuhan is institutionally directed, with individual hospitals or departments using consultation apps, WeChat mini-programs, and the WeChat Official Accounts Platform (a subapp within the WeChat ecosystem). METHODS A multicenter qualitative study design was used. A total of 27 participants, including 22 nurses and 5 physicians, from 2 different health care systems were interviewed individually. Thematic analysis was used to analyze the data. RESULTS The mean age of the participants was 32.19 (SD 3.74) years, and the mean working experience was 8.04 (SD 4.05) years. Most participants were female (20/27, 74%). Nearly half of the participants had a bachelor's degree (13/27, 48%), some had a master's degree (9/27, 33%), and few had a diploma degree (3/27, 11%) or a doctoral degree (2/27, 7%). Four themes emerged from the data analysis. Considering the current uncertainties surrounding mHealth implementation, participants emphasized "liability" concerns when discussing patient safety. They emphasized the need for "change management," which includes appropriate referral processes, adequate resources and funding, informed mHealth usage, and efficient working processes. They cautioned about the risks in providing mHealth information without ensuring understanding, appreciated the current regulations available, and identified additional regulations that should be considered to ensure information security. CONCLUSIONS As health care systems increasingly adopt mHealth solutions globally to enhance both patient care and operational efficiency, it becomes crucial to understand the implications for patient safety in these new care models. Health care professionals recognized the importance of patient safety in making mHealth usage reliable and sustainable. The promotion of mHealth should be accompanied by the standardization of mHealth services with institutional, health care system, and policy-level support. This includes fostering mHealth acceptance among health care professionals to encourage appropriate referrals, accommodate changes, ensure patient comprehension, and proactively identify and address threats to information security.
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Affiliation(s)
- Jing Jing Su
- School of Nursing, Tung Wah College, Hong Kong, China (Hong Kong)
- Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong, China (Hong Kong)
| | | | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rick Yiu Cho Kwan
- School of Nursing, Tung Wah College, Hong Kong, China (Hong Kong)
- Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong, China (Hong Kong)
| | | | - Rose Lin
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, NY, United States
| | - Jerry Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Qijun He
- School of Journalism and Communication, Shanghai University, Shanghai, China
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Rehabilitation Clinic, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Thomas JL, Yarrington JS, Chen T, Benedicto R, Sumner JA, Keenan-Miller D. Acceptance and Commitment Therapy for Posttraumatic Psychopathology: A Group-Based Telehealth Intervention. Am J Psychother 2025:appipsychotherapy20240030. [PMID: 40200795 DOI: 10.1176/appi.psychotherapy.20240030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
OBJECTIVE Transdiagnostic treatments are needed to address the diverse manifestations and effects of trauma-related psychopathology. Acceptance and commitment therapy (ACT) is a promising intervention, although little is known about its application among trauma-exposed civilians. A single-arm pilot study evaluated outcomes of a virtual, group-based ACT intervention for trauma delivered through a training clinic. METHODS Five female clients (mean age=42.6 years) with a history of criterion A trauma completed an 11-week skills group and repeated measures assessing posttraumatic and related psychopathology symptoms (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), emotion regulation, quality of life, posttraumatic growth, and experiential avoidance. Paired-samples t tests were used to assess pre- to postintervention effects. RESULTS All clients completed the intervention, suggesting high acceptability. Analyses of pre- to postintervention effects demonstrated significant reductions in depression (d=1.16, p=0.03) and anxiety (d=0.95, p=0.05) symptoms but not in PTSD symptoms; effect sizes for significant changes were large. Significant and large increases in effective use of emotion regulation strategies (d=1.02, p=0.04) and posttraumatic growth (d=1.18, p=0.03) were also observed. Experiential avoidance, a hypothesized treatment mechanism in ACT, decreased from pre- to postintervention (d=1.22, p=0.03). CONCLUSIONS Findings provide initial evidence for acceptability and beneficial clinical outcomes of a virtual, group-based ACT intervention to address the transdiagnostic consequences of traumatic stress.
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Affiliation(s)
- Jordan L Thomas
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Julia S Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Tiffany Chen
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Rosalita Benedicto
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Danielle Keenan-Miller
- Department of Psychology, University of California, Los Angeles, Los Angeles (Thomas, Yarrington, Chen, Sumner, Keenan-Miller); Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles (Benedicto). Dr. Thomas is now with the Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, and National Center for PTSD at the VA Boston Healthcare System, Boston, and Dr. Yarrington is now with the Department of Psychology, University of Arizona, Tucson, and the Department of Psychology, University of California, Los Angeles, Los Angeles
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Ma Y, Wan L, Hu R, Yin Y, Huang H, Li X. Status and analysis of Free Hospital-Based Internet + Nursing Health Consultation Services: a retrospective study. BMC Nurs 2025; 24:369. [PMID: 40181369 PMCID: PMC11969795 DOI: 10.1186/s12912-025-02973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/13/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND With the increasing demand for healthcare services, Free Hospital-Based Internet + Nursing Health Consultation Services have emerged as an innovative model to provide patients with timely and convenient nursing guidance. OBJECTIVE To comprehensively evaluate the implementation and effectiveness of Free Hospital-Based Internet + Nursing Health Consultation Services, identify existing challenges, and propose evidence-based optimization strategies to enhance the precision and efficiency of future services. METHODS A retrospective analysis was conducted based on the hospital information system, retrieving orders for Free Hospital-Based Internet + Nursing Health Consultation Services from Mianyang Central Hospital between 2021 and 2023. This analysis included the staffing structure on the nurse's side and details of patient orders. Statistical analyses were performed using SPSS 25.0 software. RESULTS Our hospital's talent pool for Free Hospital-Based Internet + Nursing Health Consultation Services comprises 128 nurses, with dynamic adjustments to the nurses and departments based on health consultation orders. From 2021 to 2023, the total number of consultations was 2,328, with a consultation time of 3,001,409 min. Among them, 2,203 consultations were accepted, 25 were declined, and 100 exceeded the time limit. The top three departments in terms of consultation volume were Obstetrics and Gynecology (25.78%), Pediatrics (23.92%), and Dermatology (20.96%). With the annual growth in the service, the total number of consultations, accepted consultations, declined consultations, and overdue orders increased each year, although the differences were not statistically significant (P > 0.05). The consultation waiting time showed a decreasing trend, recorded at 665, 356, and 404 min, respectively. The average consultation time remained stable at 1,414, 1,373, and 1,346 min. CONCLUSION Nurse-led Free Hospital-Based Internet + Nursing Health Consultation Services provide patients with convenient and efficient health consultation channels, helping to meet the growing health demands of patients. As the service has expanded over the years, the overall consultation volume has shown an upward trend while maintaining stable service quality and gradually reducing waiting times, offering more timely nursing health consultation services. Future recommendations include multicenter studies to explore the effectiveness and safety of Free Hospital-Based Internet + Nursing Health Consultation Services.
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Affiliation(s)
- Yanfei Ma
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China
| | - Li Wan
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China
| | - Rong Hu
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China
| | - Yang Yin
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China
| | - Huaping Huang
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China.
| | - Xixi Li
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, PR China.
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Wakeman M, Buckman DW, El-Toukhy S. Disparities in Digital Health Care Use in 2022. JAMA Netw Open 2025; 8:e255359. [PMID: 40244585 DOI: 10.1001/jamanetworkopen.2025.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2025] Open
Abstract
Importance Digital health care services expanded with the COVID-19 pandemic. Disparities in telehealth, telemedicine, and telemonitoring use remain understudied. Objective To examine associations between individual-level characteristics and digital health care use and if these associations differ by county-level social vulnerability. Design, Setting, and Participants This cross-sectional study was an online survey that included a nonprobability sample of US adults aged 18 years or older who resided in 871 counties in the least or most vulnerable quartiles of the Minority Health Social Vulnerability Index (MHSVI), an indicator of county-level social vulnerability. The study was conducted between February and August 2022, and data were analyzed from August 2023 to August 2024. Exposures Participant characteristics and MHSVI county-level social vulnerability. Main Outcomes and Measures Self-reported use of telehealth, telemedicine, and telemonitoring. Multivariable logistic regression models were fit to examine associations between sociodemographic, health, and technology factors and each service use, overall and stratified by MHSVI. Results Of the 5444 participants who were included in this study, 2927 were female (53.77%), 798 were non-Hispanic Black or African American (14.66%), 838 were Hispanic or Latino (15.39%), 3542 were non-Hispanic White (65.06%); the mean (SE) age was 45.4 (0.2) years. Overall, 2754 participants used telehealth (50.59%), 1609 used telemedicine (29.56%), and 854 used telemonitoring (15.69%). Being English nonproficient (adjusted odds ratio [aOR], 1.54; 95% CI, 1.23-1.92) and having had in-person health care visits (aOR, 4.71; 95% CI, 3.93-5.63) were associated with higher odds of using telehealth, whereas not having a primary care clinician was associated with lower odds (aOR, 0.68; 95% CI, 0.59-0.78). Similar findings were documented for telemedicine and telemonitoring use. Education was associated with higher odds of digital health care use in MHSVI most vulnerable counties (telehealth: aOR, 1.18; 95% CI, 1.06-1.32; telemedicine: aOR, 1.18; 95% CI, 1.05-1.33), whereas individuals who did not self-identify as heterosexual (telehealth: aOR, 1.47; 95% CI, 1.10-1.97; telemedicine: aOR, 1.57; 95% CI, 1.16-2.11; telemonitoring: aOR, 1.54; 95% CI, 1.02-2.31) and those who self-reported fair or poor mental health (telehealth: aOR, 1.29; 95% CI, 1.03-1.61) had higher odds of digital service use in the least vulnerable counties. Self-identifying as Black or African American or Hispanic was associated with high odds of telehealth (Black or African American: aOR, 1.41; 95% CI, 1.17-1.70; Hispanic or Latino: aOR, 1.41; 95% CI, 1.17-1.70), telemedicine (Black or African American: aOR, 1.44; 95% CI, 1.18-1.76; Hispanic or Latino: aOR, 1.27; 95% CI, 1.04-1.54), and telemonitoring (Black or African American: aOR, 1.40; 95% CI, 1.11-1.78; Hispanic or Latino: aOR, 1.46; 95%CI, 1.16-1.84) use overall, but these associations varied across MHSVI strata. Conclusions and Relevance In this cross-sectional study of US adults from MHSVI most and least vulnerable counties, digital health care use varied by participant characteristics. Some traditionally underserved groups self-reported higher use of digital health care. Differing associations between individual-level characteristics and digital health care use by county-level social vulnerability reflect the importance of place-based disadvantage indicators. Eliminating digital health care use disparities is important as it represents a complementary avenue to access health care for underserved populations.
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Affiliation(s)
- Michael Wakeman
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland
| | | | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland
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Duffy CMC, Benotsch EG. Nonverbal behavior in telehealth visits: A narrative review. PATIENT EDUCATION AND COUNSELING 2025; 132:108600. [PMID: 39662111 DOI: 10.1016/j.pec.2024.108600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 08/06/2024] [Accepted: 11/30/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVES To synthesize findings from research examining nonverbal behavior (NVB) in telehealth. Use of telehealth has increased substantially in recent years-thus, it is critical to identify nonverbal strategies that facilitate positive patient-provider communication in this context. METHODS Four peer-reviewed databases were searched: PubMed, PsycINFO, CINAHL, and EMBASE. Following a review of abstracts and full texts by the first author, 50 studies met inclusion criteria. RESULTS The role of six NVBs- gaze, facial expression, gesture, head movement, proxemics, and posture- has been examined in the context of telehealth. Most included studies assessed patients' and providers' perspectives of NVB in telehealth. There was a lack of research examining nonverbal behaviors, and their associations with patient-centered outcomes, in naturalistic clinical settings. CONCLUSIONS While this review identified some promising nonverbal strategies to facilitate patient-provider rapport in telehealth, there is a need for future research that objectively measures NVBs and examines relationships between these behaviors and patient-centered outcomes. PRACTICE IMPLICATIONS Potential strategies for providers to enhance quality of communication in telehealth include gazing at the camera (vs. the screen), mirroring patients' facial expressions and head movements, leaning forward, and exaggerating gestures and facial expressions.
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Affiliation(s)
- Conor M C Duffy
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Toenne R, Neuhaus U, Höcker M, Koch A, Menzel A, Scharfe D, Geffron J, Reschke F. Exploring the viability of telehealth integration into specialised paediatric palliative care. Int J Palliat Nurs 2025; 31:58-67. [PMID: 39969901 DOI: 10.12968/ijpn.2025.31.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
BACKGROUND Specialised outpatient paediatric palliative care (SOPPC) is vital for young people with life-limiting conditions and telehealth integration might improve this care. AIM Evaluate the acceptance and challenges of implementing teleconsultations among SOPPC healthcare professionals. METHODS A questionnaire, tailored to various professions in SOPPC, was developed. After pilot testing, it was distributed to all healthcare professionals in SOPPC in the county of Lower Saxony, Northern Germany. Statistical analyses, using descriptive methods, ensured the reliability of the findings. FINDINGS The survey involved 96 participants from SOPPC teams. Teleconsultations were perceived as time-saving (physicians (80%), nursing (68%), psychosocial varied), facilitating patient-centred discussions (physicians (87%), nursing staff (72%), psychosocial had varied responses) and maintaining intensive contact during restrictions (85% agreement). Improved team communication (91%) and patient-family communication (physicians (80%), nursing (68%), psychosocial (62%) were perceived benefits. Concerns included language barriers (84%) and technical readiness (80%). While physicians and nursing professionals saw telehealth enhancing patient safety (64-95%), psychosocial professionals were more skeptical (38-62%). CONCLUSION This study highlights telehealth's potential in SOPPC, stressing the need for tailored strategies. While nursing staff and physicians generally accept telehealth, psychosocial professionals express reservations. Overcoming barriers like language and technical readiness is crucial for maximising telehealth benefits.
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Affiliation(s)
- Rebecca Toenne
- Nursing managing director, Graduate student, Paediatric Haematology and Oncology, Medical Centre, University of Essen, Essen, Germany; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Ursula Neuhaus
- Betreuungsnetz Project Management, Westphalian Wilhelms University to Münster, Westphalia; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Maike Höcker
- Psychologist paediatric palliative care; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Annika Koch
- Coordinator paediatric palliative care; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Anke Menzel
- Coordinator paediatric palliative care; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Dirk Scharfe
- Coordinator paediatric palliative care; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Julia Geffron
- Betreuungsnetz project management; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
| | - Felix Reschke
- Senior consultant, Specialised Outpatient Palliative Care for Children and Adolescents; Consultant and medical director paediatric palliative care, Department of Paediatric Palliative Care, Auf Der Bult Hospital, Hannover, Germany; Betreuungsnetz, Section of Specialised Outpatient Palliative Care for Children and Adolescents; Network for the Care of Seriously Ill Children, Adolescents and Young Adults, Hannover, Germany
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Susmarini D, Shin H, Choi S. Telehealth implementation for children with attention deficit hyperactivity disorder: a scoping review. CHILD HEALTH NURSING RESEARCH 2024; 30:227-244. [PMID: 39477230 PMCID: PMC11532349 DOI: 10.4094/chnr.2024.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/14/2024] [Accepted: 09/05/2024] [Indexed: 11/06/2024] Open
Abstract
The objective of this research was to examine current telehealth practices in managing children with attention deficit hyperactivity disorder (ADHD) and to map existing implementations using the American Medical Association's Virtual Care Value Framework. A scoping review was conducted following the Arksey and O'Malley framework. The databases, CINAHL, PsycINFO, and PubMed, were searched with specific keywords related to telehealth and ADHD. The screening process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In-clusion criteria were restricted to articles published in English between January 2000 and July 2024, focusing on children with ADHD, their parents, caregivers, family members, teachers, healthcare professionals, and articles implementing telehealth interventions. As a result, out of 389 initially identified articles, 22 met the inclusion criteria. The studies were predominantly conducted in the United States. The most common telehealth meth-ods included videoconferencing and telephone-based communications. Key areas of fo-cus in these studies included clinical outcomes, access to care, patient and family experi-ence, caregiver experience, clinician experience, and financial and operational impact. However, none of the studies addressed health equity. In conclusion, telehealth has shown effectiveness in improving ADHD assessment, treatment adherence, and parental education, leading to positive patient outcomes and experiences. However, the financial impact of telehealth remains uncertain. Further research is needed, particularly outside the United States, to explore emerging telehealth technologies and areas overlooked by the Virtual Care Value Framework, such as health equity.
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Affiliation(s)
- Dian Susmarini
- Graduate student, College of Nursing, Ewha Womans University, Seoul, Korea
| | - Hyewon Shin
- Associate Professor, College of Nursing, Ewha Womans University, Seoul, Korea
| | - Sunyeob Choi
- Assistant Professor, Dongguk University WISE, Gyeongju, Korea
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Werkmeister B, Haase AM, Fleming T, Officer TN. Environmental Factors for Sustained Telehealth Use in Mental Health Services: A Mixed Methods Analysis. Int J Telemed Appl 2024; 2024:8835933. [PMID: 39314675 PMCID: PMC11419844 DOI: 10.1155/2024/8835933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 09/25/2024] Open
Abstract
Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID-19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID-19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system-level factors influencing telehealth use and thus informs policy and practice in postpandemic environments. Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population-level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use. Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software. Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID-19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input.
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Affiliation(s)
- Benjamin Werkmeister
- School of HealthTe Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
- Department of Psychological MedicineTe Whatu Ora-Health New Zealand, Wellington, New Zealand
- Department of Psychological MedicineUniversity of Otago-Wellington, Wellington, New Zealand
| | - Anne M. Haase
- School of HealthTe Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Theresa Fleming
- School of HealthTe Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Tara N. Officer
- School of NursingMidwiferyand Health PracticeTe Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
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Vakulenko DV, Palagin OV, Sergienko IV, Stetsyuk PI. Algorithmization and Optimization Models of Patient-Centric Rehabilitation Programs*. CYBERNETICS AND SYSTEMS ANALYSIS 2024; 60:736-752. [DOI: 10.1007/s10559-024-00711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Indexed: 01/04/2025]
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10
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Moretti V, Pronzato R. The emotional ambiguities of healthcare professionals' platform experiences. Soc Sci Med 2024; 357:117185. [PMID: 39142145 DOI: 10.1016/j.socscimed.2024.117185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/16/2024]
Abstract
This paper investigates how healthcare professionals experience digital platforms in their work practices and how these relationships enable forms of emotional labour and contribute to shaping their emotional health. Methodologically, the contribution draws on audio-diaries kept by 15 healthcare professionals and a final semi-structured interview conducted with the same informants. The research material was analysed using open and axial coding techniques, in a grounded theory fashion. Findings provides meaningful insights to the literature on the emotional labour of healthcare professionals, as well as to studies on digital health and labour. Specifically, we show that participants associate different and even contrasting reflections and emotional states with their relationships with digital platforms. Thus, there is not exclusively one trajectory that can explain the implications of media uses, as different and potentially conflicting emotions coexist within the same experience. Given this scenario, we argue that it can be fruitful to use the lens of 'ambiguity' to scrutinise the ambivalences and tensions characterising platform experiences, and how emotional labour in healthcare intertwines with technological developments. Moreover, we advocate for the development of critical digital literacy skills among healthcare professionals.
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Affiliation(s)
- Veronica Moretti
- University of Bologna, Department of Sociology and Business Law, Strada Maggiore 45, Bologna, Italy.
| | - Riccardo Pronzato
- University of Bologna, Department of Sociology and Business Law, Strada Maggiore 45, Bologna, Italy.
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Barry R, Green E, Robson K, Nott M. Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study. BMC Health Serv Res 2024; 24:908. [PMID: 39113042 PMCID: PMC11308699 DOI: 10.1186/s12913-024-11233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations. METHODS This research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach. RESULTS Sixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments. CONCLUSIONS This research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.
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Affiliation(s)
- Rebecca Barry
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia.
| | - Elyce Green
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
| | - Kristy Robson
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
| | - Melissa Nott
- Three Rivers Department of Rural Health, Charles Sturt University, Locked Bag 588, Tooma Way, Wagga Wagga, NSW, 2678, Australia
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Dhunnoo P, Kemp B, McGuigan K, Meskó B, O'Rourke V, McCann M. Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review. J Med Internet Res 2024; 26:e53266. [PMID: 38980704 PMCID: PMC11267102 DOI: 10.2196/53266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. OBJECTIVE With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. METHODS PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. RESULTS Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. CONCLUSIONS For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.
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Affiliation(s)
- Pranavsingh Dhunnoo
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
- The Medical Futurist Institute, Budapest, Hungary
| | - Bridie Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Karen McGuigan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | | | - Vicky O'Rourke
- Faculty of Business, Atlantic Technological University, Letterkenny, Ireland
| | - Michael McCann
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
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Mattisson M, Börjeson S, Årestedt K, Lindberg M. Interaction between telenurses and callers - A deductive analysis of content and timing in telephone nursing calls. PATIENT EDUCATION AND COUNSELING 2024; 123:108178. [PMID: 38387390 DOI: 10.1016/j.pec.2024.108178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To explore the content and timing of verbal interaction between telephone nurses and callers, and to suggest areas for improvement. METHODS Transcribed telephone conversations (n = 30) to a national nurse-led advisory service were analyzed using deductive content analysis. Categorization of data was based on components of interaction in the Interaction Model of Client Heath Behavior (IMCHB): health information, affective support, decisional control, and professional-technical competencies. The content was described both quantitatively, based on word count, and qualitatively, using descriptions and exemplars. Transcripts were also coded according to five phases in the conversation process: opening, listening, analyzing, motivating, and ending. The distribution of interaction components among phases was explored. RESULTS Interaction primarily focused on health information, particularly during the listening and analyzing phases. Telenurses based their advice on medical facts and guided callers through the conversation process. Callers' emotions and reflections on advice were rarely discussed. CONCLUSIONS Health information dominate conversations. Interaction can be further developed, particularly with respect to acknowledging callers' emotional responses, their reactions to advice, and ensuring clarity in exchange of health information. PRACTICE IMPLICATIONS Findings offer valuable guidance for future development of interaction in telenursing.
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Affiliation(s)
- Marie Mattisson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.
| | - Sussanne Börjeson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Department of Research, Region Kalmar County, Kalmar, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden, Region Kalmar County, Kalmar, Sweden
| | - Malou Lindberg
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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Batalik L, Chamradova K, Winnige P, Dosbaba F, Batalikova K, Vlazna D, Janikova A, Pepera G, Abu-Odah H, Su JJ. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer 2024; 24:600. [PMID: 38760805 PMCID: PMC11100177 DOI: 10.1186/s12885-024-12348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic.
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Katerina Chamradova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Batalikova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Daniela Vlazna
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- School of Nursing, Tung Wah College, Hong Kong, China.
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Teerawongpairoj C, Tantipoj C, Sipiyaruk K. The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study. Sci Rep 2024; 14:9216. [PMID: 38649451 PMCID: PMC11035619 DOI: 10.1038/s41598-024-58425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.
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Affiliation(s)
- Chayanid Teerawongpairoj
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chanita Tantipoj
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kawin Sipiyaruk
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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Zettergren L, Larsson EC, Hellsten L, Kosidou K, Nielsen AM. Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden. BMC Health Serv Res 2024; 24:411. [PMID: 38566080 PMCID: PMC10988956 DOI: 10.1186/s12913-024-10932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. METHODS We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. CONCLUSION Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health.
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Affiliation(s)
- Linn Zettergren
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Department of Womens and Childrens Health, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Lovisa Hellsten
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Anna Maria Nielsen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden.
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden.
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Golden BN, Elrefaay S, McLemore MR, Alspaugh A, Baltzell K, Franck LS. Midwives' experience of telehealth and remote care: a systematic mixed methods review. BMJ Open 2024; 14:e082060. [PMID: 38553065 PMCID: PMC10982796 DOI: 10.1136/bmjopen-2023-082060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. METHODS Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. RESULTS After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. CONCLUSIONS Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.
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Affiliation(s)
- Bethany N Golden
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Shaimaa Elrefaay
- Department of Community Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Monica R McLemore
- Child, Family, and Population Health Nursing Department, University of Washington, Seattle, Washington, USA
| | - Amy Alspaugh
- The University of Tennessee Knoxville College of Nursing, Knoxville, Tennessee, USA
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Al Baalharith IM, Aboshaiqah AE. A Delphi Study on Identifying Competencies in Virtual Healthcare for Healthcare Professionals. Healthcare (Basel) 2024; 12:739. [PMID: 38610161 PMCID: PMC11011667 DOI: 10.3390/healthcare12070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery. OBJECTIVE This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method. METHODS A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In Round 1, an open-ended questionnaire elicited competencies needed for virtual care. The competencies were distilled and rated for importance in Rounds 2 and 3 until consensus was achieved. RESULTS Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5), and clinical expertise (11).
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Affiliation(s)
- Ibrahim Mubarak Al Baalharith
- College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia;
- Governance and Excellence, SEHA Virtual Hospital, Riyadh 11421, Saudi Arabia
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Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med 2023; 6:161. [PMID: 37723240 PMCID: PMC10507089 DOI: 10.1038/s41746-023-00899-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/01/2023] [Indexed: 09/20/2023] Open
Abstract
Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3522, USA
| | - Hebatullah Abdulazeem
- Department of Sport and Health Science, Techanische Universität München, Munich, 80333, Germany
| | - Lenny Thinagaran Vasanthan
- Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Edson Zangiacomi Martinez
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University Library of Southern Denmark, Odense, 5230, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark.
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English W, Robinson J, Gott M. Health professionals' experiences of rapport during telehealth encounters in community palliative care: An interpretive description study. Palliat Med 2023:2692163231172243. [PMID: 37129344 DOI: 10.1177/02692163231172243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Despite the reported importance of rapport, there are knowledge gaps in the ways rapport is developed and experienced by health professionals during telehealth calls in palliative care. AIM To gain an understanding about developing rapport during telehealth calls by exploring the experiences of health professionals in community palliative care. DESIGN A qualitative Interpretive Description study was conducted with semi-structured interviews and focus groups between November 2020 and May 2021. Data was audio recorded, transcribed, and analysed using Reflexive thematic analysis. A COREQ checklist was completed. SETTING/PARTICIPANTS Thirty-one palliative care professionals who had participated in telehealth calls were recruited from four hospice locations in Aotearoa, New Zealand. RESULTS There were two themes identified: (1) 'Getting on together', which included how rapport shows up in telehealth, with examples of calls with rapport and without rapport, and (2) 'Rapport is a soft skill', which identified health professionals using body language and listening in specific ways in telehealth, while being aware of the privacy of calls, and lack of training concerns. CONCLUSION Based on health professionals experiences of rapport it was determined that rapport is vitally important in telehealth calls, as it is in-person interactions. Rapport is a soft skill that can potentially be learned, practiced and mastery developed, although rapport in each interaction is not guaranteed. Patient and family experiences of rapport in the palliative telehealth area warrants further research and there is some urgency for health professional training in telehealth interpersonal skills.
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Affiliation(s)
- Wendy English
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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