Lessons for guidelines from the diffusion of innovations

Nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare: A qualitative feasibility study

OBJECTIVES

The objectives of the present study were to qualitatively investigate nursing home caregivers' acceptance of, and experiences with, a new digital intervention for oral healthcare after a period of real-life testing in three nursing homes located in Rogaland county, Norway.

BACKGROUND

Nursing home caregivers report numerous barriers when it comes to provision of adequate oral care for care-dependent older adults. Among the reported barriers are lack of knowledge and skills, care-resistant behaviours, lack of adequate routines and documentation systems for oral health, a high workload, and unclear responsibilities. To overcome these barriers, a digital tool named SmartJournal was developed to assist caregivers in preserving nursing home residents' oral health.

MATERIALS AND METHODS

Semistructured interviews were performed with selected caregivers (n = 12) taking part in SmartJournal testing. A theory-driven thematic analysis based on technology acceptance model was conducted.

RESULTS

SmartJournal was generally described as a userfriendly and useful tool. The initial reaction of the participants was mixed; some were positive, some had concerns, but many seemed to have a neutral stance to the intervention. Both barriers and facilitating factors for SmartJournal usage were revealed. Interestingly, the usage gradually changed from norm-based to routine-based behaviour during the test period. Although the tool was well-accepted, as demonstrated with study participants' willingness to use it in the future, they had several suggestions for improvements to further adapt it to a nursing home setting.

CONCLUSION

Results from the present study provide valuable information on questions about SmartJournal acceptance and intervention delivery, thereby preparing the ground for a larger scale evaluation study assessing measurable effects of SmartJournal usage in nursing homes.

Network Analysis of Medical Claims Data Suggests Network-Based, Regional Targeting and Intervention Delivery Strategies to Increase Access to Office Based Opioid Treatment (OBOT) for Opioid Use Disorder (OUD)

Opioid overdose and Opioid Use Disorder (OUD) statistics underscore an urgent need to significantly expand access to evidence-based OUD treatment. Office Based Opioid Treatment (OBOT) has proven effective for treating OUD. However, limited access to these treatments persists. Recognizing the need for significant investment in clinical, behavioral, and translational research, the Indiana State Department of Health and Indiana University embarked on a research initiative supported by the "Responding to the Addictions Crisis" Grand Challenge Program. This brief presents recommendations based on existing research and our own analyses of medical claims data in Indiana, where opioid misuse is high and treatment access is limited. The recommendations cover target providers, intervention focus, priority regions, and delivery methods.

Technology adoption review for ageing well: analysis of technical solutions

While several technological solutions are available for older adults to improve their wellbeing and quality of life, little is known about the gaps between the needs, provided solutions, and their adoption from a more pragmatic perspective. This paper reports on reviewing existing technological solutions for older adults, which span the work life, life in the community, and wellbeing at home. We analyzed 50 different solutions to uncover both negative and positive features of these solutions from the perspective of the impact of technology adoption on the quality of life of older adults. Our approach harnesses holistic reasoning to determine the most suitable technologies available today and provides suggestions for improvement toward designing and implementing better solutions.

Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework

Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."

"I'm a security professional, a counselor, a leader, and sometimes a father figure": Transformative social emotional learning through the eyes of school security professionals

Schools are increasingly hiring full-time, unarmed school security professionals (SSPs), who are different from School Resource Officers (SROs), to help facilitate safe and supportive school climates. However, there is a paucity of literature about how they describe and engage with social emotional learning (SEL), particularly equity-focused or transformative SEL. The current study is a secondary data analysis using qualitative responses to content embedded in two online professional development (PD) modules created for school security: SEL and cultural competence (CC). Forty-eight SSPs completed the SEL module and 18 of these SSPs also completed the CC module. Informed by the Collaborative for Academic, Social, and Emotional Learning's transformative SEL literature, researchers sought to understand how SSPs describe SEL and how they apply transformative SEL in their work. A qualitative transcript analysis was performed, and transformative SEL's five subthemes were identified through this iterative process: working collaboratively, equity and inclusion, cultural humility, ties to identity, and advocacy. Findings demonstrated that SSPs who completed the modules apply transformative SEL principles in various, overlapping ways, illustrating their capacity to support student SEL. However, some SSPs struggled to make ties to their own identity, highlighting the need for widespread training and additional emphasis on self-awareness in transformative SEL PD.

Investigating the intention of purchasing private pension scheme based on an integrated FBM-UTAUT model: The case of China

The newly established private pension scheme in China has received great attention as it would be an important supplement to China’s social safety net and corporate annuity amid an aging population. It provides a way of helping to address the challenge of ensuring adequate retirement income, and the scheme is expected to grow significantly in the coming years. This study investigates factors affecting the intention of purchasing the private pension scheme using a conceptual model based on the integration of Fogg Behavioral Model (FBM) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. The questionnaire-based data from a sample of 462 respondents had been analyzed. Both exploratory factor analysis and confirmatory factor analysis were used to assess validity. The hypothesized relationships in the integrated FBM-UTAUT model were tested using structural equation modeling. The research findings indicate that anticipation, social influence, effort expectancy, performance expectancy, side benefits and facilitating conditions have significant positive impacts on intention to purchase. According to the exploratory factor analysis, the integrated FBM-UTAUT model can explain more than 70% of the total variance. Meanwhile, effort expectancy can be affected by time effort, thought effort and physical effort collectively, while performance expectancy can be affected by risk and trust. It is revealed that the integrated FBM-UTAUT model can be effective in explaining purchase intentions in a private pension scheme context, and this study is expected to offer helpful advice on the design of pension products and the reform of pension policies.

Exploring innovation adoption behavior for sustainable development of Mediterranean tree crops

Introduction

The combination of knowledge, personal skills and company resources influences, all things being equal, such as the availability of new technologies, market conditions and other factors external to the company, farmers in their innovation choices. This study is an attempt to understand which psychological constructs influence the decision-making process of farmers specialized in typical Mediterranean crops with regard to innovation. Previous studies on the adoption of agricultural innovations have often considered socio economic characteristics and ignored the underlying motivational factors that influence the behavioral intention of farmers.

Methods

This study adopted three socio-psychological constructs, Attitude (ATT), Subjective Norm (SN), and Perceived Behavioral Control (PBC), derived from the Theory of Planned Behavior (TPB), and proposed three new constructs, Perceived Innovations Characteristics (PIC), Benefits (B), and Transferability (T), thus using an Extended Model of the Theory of Planned Behavior.

Results

The outcome of the multiple regression revealed that farmers' intention (I) to adopt sustainable irrigation innovations is positively influenced by attitude (ATT), subjective norm (SN), and perceived innovation characteristics (PIC). This last construct had mediating effects on the indirect relationships between PBC, benefits (B), transferability (T), and intention (I).

Discussion

The results provide numerous insights, useful both for outlining the demand for innovation and for calibrating future policies aimed at the primary sector, especially on the sustainable management of irrigation resources. In particular, the analyses carried out highlight the importance of factors external to the company as key levers in shaping the demand for innovations.

Pilot Evaluation of the Elementary Social-Emotional Learning Program Sources of Strength

Schools and students have faced a variety of challenges during the 2020-2021 academic year as the COVID-19 pandemic continues. These issues have drawn attention to the increased need for robust social-emotional learning skills at the elementary level to address the deficits exacerbated by the pandemic. Sources of Strength is an evidence-based suicide prevention program for middle and high school students. In 2020, Sources of Strength launched an elementary school curriculum focused on promoting protective factors and resilience. Data were collected across 11 elementary schools (N = 1022; 3-5th graders) in the Great Plains region of the USA at two time points during the COVID-19 pandemic (T1: Fall of 2020, T2: Spring of 2021). We examine the effectiveness of the program using a pre- and post-test design measuring various student social-emotional outcomes including positive classroom climate, emotional problems, school belonging, help-seeking attitudes, bullying perpetration, peer victimization, student and teacher intervention, student well-being, and student resilience. The program was evaluated using multilevel regression models to examine the associations between self-reported student program exposure and student outcomes. Although comparisons between T1 and T2 indicated a worsening of several student outcomes, positive associations were found when accounting for the degree of student exposure to the program. Greater student exposure was associated with improved positive classroom climate, school belonging, help-seeking attitudes, student well-being, resiliency, and lower reports of emotional problems. Implications for research and practice are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-023-09567-0.

The effect of trust, IT knowledge, and entrepreneur's innovativeness to embrace or shun the internet of things

This study examines critical factors influencing Omani entrepreneurs' adoption of the internet of things (IoT) by expanding the constructs at the unified theory of acceptance and use of technology (UTAUT2) with entrepreneurs' innovativeness, IT knowledge (ITK), and trust. A cross-sectional survey questionnaire was used to collect data from 158 entrepreneurs in Oman. Data were analyzed through the structural equation modeling technique using SmartPLS. The results indicated that performance expectancy, habit, social influence, trust (TR), ITK, and entrepreneurs' innovativeness (PI) significantly affect Omani entrepreneurs' intention to adopt IoT. Nonetheless, the results show that there is no significant relationship between hedonic motivation, effort expectancy, price value, and facilitating conditions to adopt IoT. This study contributes to previous literature by incorporating entrepreneurs' innovativeness, ITK, and trust into UTAUT2. Furthermore, this study was conducted in a Middle Eastern country with solid support from the government for entrepreneurs; also, there is a gap in such studies in this area. This study helps practitioners in the field better understand how to influence entrepreneurs, push them toward using IoT applications further, and encourage non-users to start using them.

Analysis of the Conditions Influencing the Assimilation of the Robotic Process Automation by Enterprises

More and more companies are implementing the RPA (Robotic Process Automation) tools that belong to the newly emerging category of IT solutions used to automate business processes and enable the development of the so-called software robots. The term robot has a metaphorical meaning here – it is a special kind of software, not a device. Due to the fact that this is a new product category and many companies do not have extensive experience in this area yet, the use of the RPA tools is associated with many risks. At the same time, due to the increasingly competitive environment, it seems that there is no turning back from the implementation thereof. For this reason, two goals have been set in the article. The first is to build and verify a research model based on the TOE model (Technology-Organization-Environment), allowing for the identification of the determinants (drivers) influencing the assimilation of the robotic process automation by enterprises. The second goal is to develop recommendations for the managers responsible for implementing the RPA tools that will allow for increasing the assimilation of the robotic process automation. The following methods were used to accomplish these goals: literature research, a survey (conducted on 267 Polish enterprises) and statistical analysis (with the use of the structural equation models).

Innovation diffusion effects on student housing investment in Ghana

Purpose

The diffusion of innovations in student housing, a commercial real estate subsector, is a critical concern to developers. Aside from how innovations contribute to investor' returns, there is a question of interest in real estate investment policies and contemporary real estate research. The study aims to assess the extent of innovation diffusion in student housing and its effects on investment returns in Ghana.

Design/methodology/approach

The study used a mixed methods approach foregrounded on the innovation diffusion theory. With the mix of surveys and interviews of 828 student housing managers/investors and 25 key student housing association leaders across selected off-campus student housing among six universities in Ghana, the study used both primary and secondary sources. Selection criteria were based on at least one of these criteria: Have operated in the student housing market over the past ten years, have adopted the use of technology in student housing management, have introduced new student housing marketing strategies and have made improvements (added value) to student housing services. Multiple regression and narratives were the main analytical tools employed in this study.

Findings

The study demonstrates that over the past ten years, student housing investors in Ghana have invested hugely in product, marketing, process and organisation innovations. Among these innovations, innovations by: marketing through souvenirs and annual-get-togethers product through Internet services processes through Information Management Systems (IMS), and organisation through student leadership were most utilised to descending extent. Furthermore, the study identified marketing and organisation innovation to have the highest effects on investment returns. However, process and product innovation showed a weak and moderate effect on investment returns because management hastily implemented these services without understanding the consequences it has on investment returns in the long run.

Practical implications

The moderate effect of product and process innovation on student housing investment can be a predictor for future student housing investment innovation strategies for new entrants as they do not provide an immediate positive investment return. Key takeaways require management to incrementally implement these innovations and adopt space management practices that create opportunities for future product and process innovations in Ghana. Investors should capitalise on marketing and organisational innovations as the best innovation strategies that yield the highest returns in Ghana.

Social implications

Student housing investors should focus on emerging student preferences such as entertainment, improved building services and Information Communication to stimulate student housing selection intentions.

Originality/value

Innovation diffusion in student housing is understudied. The closest connection of innovation diffusion theory to product enhancement, marketing and managerial improvement is a strategic tool that facilitates efficiency and productivity in student housing investment.

Research knowledge transfer to improve the care and support of adolescents with sickle cell disease in Ghana

INTRODUCTION

Effective transfer of research findings to key knowledge users, particularly in low- and middle-income countries, is not always achieved, despite being a shared priority among researchers, funders, healthcare and community stakeholders and decision-makers. A constructivist grounded theory study conducted in 2015-2019 in Ghana that explored sickle cell-related fatigue in adolescence resulted in numerous implications for practice and policy. Peer-reviewed funding was obtained to support disseminating these findings to relevant stakeholders.

METHODS

Key steps in implementing this study dissemination project included: (1) identifying and attracting target stakeholders from healthcare and community organizations; (2) tailoring tools for communication of research findings for the stakeholder groups and (3) designing interactive workshops to facilitate knowledge sharing and uptake.

FINDING

Despite the COVID-19 pandemic, 50 healthcare and community stakeholders participated in the dissemination workshops. The dissemination activities contributed new layers of understanding to the original research findings through discussions. Through the workshops, participants identified culturally valuable and actionable recommendations that they could take forward to improve care and support for young people with sickle cell disease in Ghana. A follow-up 6 months post the workshops indicated some positive knowledge usage and benefits.

CONCLUSION

This dissemination project provided a unique opportunity for researchers and stakeholders to share in the interpretation of research findings and to strategically plan recommendations to improve SCD-focused care and support for young people in Ghana. Further research dissemination should continue to be grounded in locally generated knowledge, include systematic, long-term evaluation of dissemination outcomes and be adequately financed.

PATIENT AND PUBLIC CONTRIBUTION

Public involvement in this study was critical to the research dissemination project. The Sickle Cell Association of Ghana (Kumasi chapter) actively supported the project's development, organization and facilitation. Parent members of the Association, the Association's executive members and volunteers, and the health professionals involved in sickle cell care at the Komfo Anokye Teaching Hospital participated in the project workshops. They contributed to the knowledge transfer and uptake.

An application of data mining algorithms for predicting factors affecting Big Data Analysis adoption readiness in SMEs

The adoption of Big Data Analysis (BDA) has become popular among firms since it creates evidence for decision-making by managers. However, the adoption of BDA continues to be poor among small and medium enterprises (SMEs). Therefore, this study adopted the Technology-Organization-Environment (TOE) framework to identify the drivers of readiness to adopt BDA among SMEs. Chi-square automatic interaction detection (CHAID), Bayesian network, neural network, and C5.0 algorithms of data mining were utilized to analyze data collected from 240 Vietnamese managers of SMEs. The evaluation model identified the C5.0 algorithm as the best model, with accurate results for the prediction of factors influencing the readiness to adopt BDA among SMEs. The findings revealed management support, data quality, firm size, data security and cost to be the fundamental factors influencing BDA adoption readiness. Moreover, the results identified the service sector as having a higher level of readiness toward the adoption of BDA compared to the manufacturing sector. The findings are imperative for the enhancement of the decision-making process and advancement of comprehension of the determinants of BDA adoption among SMEs by researchers, managers, providers and policymakers.

Adoption of Sustainable Agriculture Intensification in Maize-Based Farming Systems of Katete District in Zambia

Sustainable agricultural intensification (SAI) has been hailed as the solution to increasing crop productivity among farmers. Despite the significant promotion, there still remains a dearth of information on the adoption and intensity of SAI in Zambia. This study sought to identify factors that influence farmers’ adoption of SAI practices and intensity of use. A cross-sectional survey was conducted among 300 smallholder farmers of Katete district in Zambia. The Cragg’s double hurdle model was used to assess the key decision factors for SAI adoption and intensity of use. Empirical estimates revealed that limited years of farming and smaller total cropped field size were statistically significant decision factors that led to a reduced likelihood of SAI adoption. The results of the truncated model showed that smaller farm sizes and limited access to farmer extension services reduced the adoption intensity of SAI practices, whereas farmer affiliation with farmer associations and farmer training in crop production increased SAI adoption intensity. We recommend an increase in farmer training on and sensitization to the benefits of SAI practices aligned to their respective landholdings.

Profiling knowledge brokers in the rehabilitation sector across Canada: A descriptive study

RATIONALE

Knowledge brokers (KBs) can help promote the uptake of the latest research evidence into clinical practice. Little is known about who they are, the types of roles they perform, and the training they receive. Establishing a portrait of Canadian KBs working in the rehabilitation sector may inform health care organizations and knowledge translation specialists on how best to advance KBs practices. The overall goal was to describe the profile of KBs working to promote the uptake of evidence within rehabilitation settings in Canada. Specifically, this study aimed to describe the sociodemographic and professional characteristics, work activities, and training of KBs.

METHODS

A cross-sectional online survey was administered to KBs working in rehabilitation settings across Canada. The survey included 20 questions covering sociodemographic and professional characteristics, work activities, and training opportunities. Response frequency and percentage were calculated for all categorical variables, and the weighted average (WA) for each role was calculated across participants. Descriptive analysis was conducted for all open-ended questions.

RESULTS

Of 475 participants accessing the website, 198 completed the survey questionnaire, including 99 clinicians, 35 researchers, and 26 managers. While over two-thirds of respondents had completed a graduate degree, only 38% reported receiving KBs-related training. The respondents' primary roles corresponded to a linking agent (WA = 1.84), followed by capacity builder (WA = 1.76), information manager (WA = 1.71), facilitator (WA = 1.41), and evaluator (WA = 1.32).

CONCLUSIONS

KBs are mostly expert clinicians who tend to perform brokering activities part-time targeting their peers. Participants mostly perform the linking agent, capacity builder, and information roles. Moreover, only a few participants received formal training to perform brokering activities.

How Does Corporate Social Responsibility Affect Sustainability of Social Enterprises in Korea?

Social enterprises (SEs) are a new concept, integrating corporate profitability and social purposes. SEs seek to realize sustainable social values, rather than short-term profits. It is therefore important to study the factors that affect the sustainable management of SEs. Corporate social responsibility (CSR) is known to improve corporate image and performance; it can also promote the sustainable development of companies. Innovation has been described as the driving force behind corporate growth and ultimate performance. This study aims to investigate whether CSR can affect sustainability through the economic and social performance of SEs. In addition, it attempts to verify the moderating role of innovativeness in the relationship between CSR and social enterprise (SE) performance. Using survey data from 226 employees of 204 SEs in Korea, we have empirically tested this conceptual framework. The results suggest that, while CSR can improve sustainability through economic and social performance, innovativeness has no moderating effect on the relationship between CSR and SE performance. This study enriches our understanding of the important role played by CSR in driving SE sustainability. It provides new insights into the mechanisms through which SEs can achieve sustainable development. It also contributes to the literature by emphasizing the need for innovation through technical support for SEs.

Factors Influencing Teachers’ Use of ICT in Class: Evidence from a Multilevel Logistic Model

Information and Communication Technologies (ICTs) have become a key factor in the educational context, especially in the aftermath of the COVID-19 pandemic, and, correctly implemented, can help to improve academic performance. The aim of this research was to analyse the factors that influence teachers’ decisions to use ICT more- or less frequently to carry out tasks and exercises in their classes. To this end, we estimated a multilevel logistic model with census data from the individualized evaluation of students of the Community of Madrid (Spain) carried out at the end of the 2018–2019 academic year in primary and secondary education. Additionally, we applied multiple imputation techniques to deal with missing values. Based on our results, we found that motivated teachers who have received ICT training, teach calm and respectful classes, and work at schools where students have access to digital devices and frequently use ICT at home, have a high predisposition to use ICT in their classes. Considering our results, our recommendations are aimed at improving teacher training in ICT, encouraging a frequent but responsible use of ICT at home, and increasing the provision of technological resources in schools.

An Effective Communication Strategy Based on Trust: the Key Element to Adopting a Covid-19 Contact Tracking Application

To cope with the COVID-19 pandemic, contact tracing applications have been proposed to limit positive cases and reinforce other measures, especially before the appearance of vaccines. A high rate of adoption by citizens is required. This study investigates the impact of trust on the adoption of tracking applications. A survey was administered in Morocco, where the authorities proposed the «Wiqaytna» application. Structural Equation Modeling was used to test the hypotheses of the proposed model. The model explains 53% of the variance of the “intention to use” and 40.8% of the “actual use” of the application. The model was based on the UTAUT technology acceptance model and the GAM model of e-gov service acceptance. Our main objective was to study the impact of trust in the decision of Moroccans to use this type of application. Technology trust, government trust and social influence were important determinants of intention to use. The proposed model also shows that perceived awareness is an important antecedent of trust constructs. The impact of «perceived awareness» on the trust constructs (technology and government) is stronger than the social influence on the latter. Moreover, our model shows that «Perceived Awareness» has a more significant impact on «technology trust» than on «government trust». Due to their lack of interest (in seeking information) and attention (communications on the application), citizens lack information about the application's usefulness and the security of users' data. Even those who have had contact with the information they are looking for cannot often verify its credibility (e.g. the source code of the «Wiqaytna» application was available on Github). Therefore, cognitive and individual factors give way to social influence, and the intention to use becomes dependent on the norms and suggestions of influential people in the individual's environment. The latter construct is complex and has multiple determinants. Several factors act on the construction of trust in the authorities' quality of public services. Finally, the strongest relationship in the model is the effect of intention to use on using the Wiqaytna application. Based on these findings, suggestions are made for policymakers. First, a significant effort must be made to improve citizens' awareness of the importance of such an application for the control of the pandemic, even after the launch of the vaccination campaign and the application of social distancing measures. Indeed, a few posters here and there and a few commercials are not enough. An effective communication strategy must be built to explain to citizens the critical role these applications can play and reduce fears about citizens' privacy to increase the adoption rate of these applications. Secondly, the role of social influence is critical in adopting applications. This must be considered in communication campaigns and the involvement of opinion leaders and influencers to be more effective and increase the intention to use them.

A Model for Decision-Makers’ Adoption of Big Data in the Education Sector

Big Data Adoption (BDA) has already gained tremendous attention from executives in various fields. However, it is still not well explored in the education sector, where a large amount of academic data is being produced. Therefore, integrating Technology Organization Environment (TOE) and Diffusion of Innovation (DOI), this study aims to develop a theoretical model to identify the factors that influence BDA in the higher education sector. To do so, significant technology-, organization-, and environment-related factors have been extracted from previous BDA studies. Meanwhile, the moderating effects of the university size and the university age are added into the developed model. A sample of 195 data was collected from the managerial side of virtual university (VU) campuses in Pakistan using an online survey questionnaire. Structural equation modeling (SEM) was used to test the research model and developed hypotheses. The results showed that relative advantage, complexity, compatibility, top management support, financial resources, human expertise and skills, competitive pressure, security and privacy, and government policies are significant determinants of BDA. However, the results did not support the influence of IT infrastructure on BDA. Based on the findings, this study provides guidelines for the successful adoption of big data in higher education sector. This study can serve as a piece of help to the ministry of education, administrators, and big data service providers for the smooth adoption of big data.

Communicating climate change adaptation strategies: climate-smart agriculture information dissemination pathways among smallholder potato farmers in Gilgil Sub-County, Kenya

Proven and sustainable practices like climate-smart agricultural practices (CSAPs) need to be prioritized and promoted for uptake especially by the farmers to achieve sustainable development. These are capable of contributing to the realization of sustainable development goals through averting food and nutritional insecurity, increasing and sustaining yields that translate into increased incomes and later reduced poverty. This is because CSAPs enable farmers to adapt and mitigate climate change effects. However, due to inappropriate communication of CSAPs to the farmers, to date, some farmers still see no escape route from the frightening effects of climate change and they are currently adopting a rather fatalistic attitude. This study investigated the information dissemination pathways used by different categories of smallholder potato farmers for and practice of CSAPs. It found a difference between information sources and practice of CSAPs at a 5% level of significance (χ2 = 100.12139, df = 2, p < 0.05, Cramer's V = 1.0), and a difference in the use of the three information dissemination pathways between men and women at a 5% level of significance (χ2 = 6.05949, df = 2, p < 0.05, Cramer's V = 0.17406). The three information dissemination pathways included media, neighbors and friends, and extension officers. Generally, farmers were aware and practiced the CSAPs investigated in this study except for irrigation with high awareness yet with low uptake percentage and potato seedlings and minitubers both with low awareness and practice respectively. This study recommended mainstreaming of CSAPs information.

Acceptability and Feasibility of Perioperative Music Listening: A Rapid Qualitative Inquiry Approach

Perioperative music decreases pain, anxiety, and analgesia requirements while increasing patient satisfaction. We investigated the acceptability of perioperative music at a women's and children's hospital in Singapore, seeking to uncover barriers and facilitators to implementation in routine practice over a 12-week period. We used an undergraduate-led Rapid Qualitative Inquiry approach that includes data collection from multiple sources, iterative analysis, and additional data collection when necessary. Participants consisted of anesthesiologists and nurses working in the preoperative area, operating room, and postoperative recovery areas. In Stage 1, nurses and anesthesiologists answered a survey assessing attitudes and knowledge about perioperative music and attended a presentation introducing the intervention. In Stage 2, the results of the Stage 1 survey were disclosed, and nurses and anesthesiologists completed a second survey (Stage 1 survey questions with an additional query about implementation). Twenty-nine nurses were interviewed with semi-structured questions on barriers and facilitators to implementation. In Stage 3, nurses retook the Stage 2 survey after one month of implementation. The implementation of perioperative music was both acceptable and feasible in Singapore. The nurses' and anesthesiologists' acceptability increased over time with mostly positive qualitative feedback. Implementation barriers, including patient interest, timing of patient turnover, and added staff workload, appeared minor and could potentially be overcome by utilizing the intervention in the preoperative instead of postoperative area, deploying music in operating rooms with slower turnover, and evenly distributing staff workload. Local implementation stakeholders may make additional recommendations for scaling-up perioperative music interventions to fit other workflows while improving the patient experience.

The determinant factors for the adoption of CRM in the Palestinian SMEs: The moderating effect of firm size

CRM adoption can provide innumerable benefits to the SMEs performance, including solving customer problems in a timely manner, enhancing customer satisfaction by appointing an expert to solve issues and queries, and the like. This study aims to examine the moderating effects of the firm size in the adoption of CRM in the Palestinian SMEs. A quantitative approach was used to investigate the relationships between the variables, which are compatibility, IT infrastructure, complexity, relative advantage, security, top management support, customer pressure, and competitive pressure. A questionnaire was designed to collect data from 420 SMEs in Palestine. A total of 331 respondents completed and returned the survey. The Partial Least Square-Structural Equation Model (PLS-SEM) approach was used to assess both the measurement and structural models. The Diffusion of Innovation Theory (DOI) and Technology, Organization, and Environment Framework (TOE) framework were employed to identify the determinant factors from the technological, organizational, and environmental perspectives. The findings and conclusions of this study provide show that the moderating effect of firm size has significant effect compatibility, top management support, customer pressure, and IT infrastructure factors.

Determinants of intention to play Pokémon Go

This paper examines the influence of personal and game factors on gamers' perceived values, drawing from the Theory of Consumption Value (TCV), explores the impacts of values on the Pokémon Go (PG) adoption, and identifies differences between two consumer groups. A sample of 474 (215 PG non-players and 259 PG players) was collected and analysed. Game aesthetics increase all perceived values of both groups. Game aesthetics and innovativeness have no direct impact on gamers' intention to play. Emotional value and functional value are crucial for their behavioural intention. Social value is important for non-players, while conditional value influences players' intentions. This study contributes to the expansion of the TCV in mobile location-based AR game adoption and reveals the insights of players' and non-players’ value perceptions. It is one of the first studies investigating the TCV factors, antecedents, and consequence in the mobile AR game literature.

Barriers to Financial Innovation—Corporate Finance Perspective

This paper addresses the application of financial innovations from the corporate finance perspective. The objective is to identify and prioritize the main types of barriers to the implementation of financial innovations by nonfinancial firms. The motivation behind the study lies in the importance of financial innovations for the firms’ ability to create value. As proven by the extensive literature review, comprehensive studies on financial innovation applications by nonfinancial firms are relatively rare. To cover this cognitive gap, the theoretical argumentation followed by the discussion of results of the empirical research are presented in this paper. The paper provides the results of two-stage survey research, aiming to find opinions of financial managers (end-users) and experts (creators of innovation) on the main barriers to financial innovations in Poland. According to managers, the most important are exogenous barriers, including: (1) Unclear tax and accounting regulations, (2) complex construction of financial innovations, and (3) transaction costs related to their application. On the other side, the experts from financial institutions recognized the greater importance of endogenous factors such as: (1) Lack of sufficient knowledge about financial innovations and (2) the reluctance to change observable in many firms. This study contributes to the ongoing debate on financial innovations by adding the perspective of corporate financial strategy. It also offers insights into the potential actions (at the institutional and individual level) aiming to reduce the barriers and support the implementation of financial innovations by nonfinancial firms.

Are serious games too serious? Diffusion of wearable technologies and the creation of a diffusion of serious games model

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Developers and manufacturers of wearables should make their devices more relevant, more reliable and easier to use.

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129 interviews to find requirements and validate first prototype of the game.

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Results are positive from a formal technology acceptance point of view showing relevance and usefulness.

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Game can in fact be an obstruction. Moreover, the artefact should not be patronizing and age differences can also pose problems, hence the title not to make the serious game too serious.

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Habit should be studied as a potential dependent variable for intention to use.

Today globally, more people die from chronic diseases than from war and terrorism. This is not due to aging alone but also because we lead unhealthy lifestyles with little or no exercise and typically consume food with poor nutritional content. This paper proffers the design science research method to create an artefact that can help people study the diffusion of serious games. The ultimate goal of the study is to create a serious game that can help people to improve their balance in physical exercise, nutrition and well-being. To do this, first we conducted 97 interviews to study if wearables can be used for gathering health data. Analysis indicates that designers, manufacturers, and developers of wearables and associated software and apps should make their devices reliable, relevant, and user friendly. To increase the diffusion, adoption, and habitual usage of wearables key issues such as privacy and security need to be addressed as well. Then, we created a paper prototype and conducted a further 32 interviews to validate the first prototype of the game, especially with respect to the diffusion possibilities of the game. Results are positive from a formal technology acceptance point of view showing relevance and usefulness. But informally in the open questions some limitations also became visible. In particular, ease of use is extremely important for acceptance and calling it a game can in fact be an obstruction. Moreover, the artefact should not be patronizing and age differences can also pose problems, hence the title not to make the serious game too serious. Future research plans to address these problems in the next iteration while the future implementation plan seeks for big platforms or companies to diffuse the serious game. A key theoretical contribution of this research is the identification of habit as a potential dependent variable for the intention to use wearables and the development of a diffusion model for serious games. The hedonic perspective is added to the model as well as trust and perceived risks. This model ends the cycle of critical design with an improvement of theory as result contributing to the societal goal of decreasing Obesities and Diabetes.

Experiences of digital communication with automated patient interviews and asynchronous chat in Swedish primary care: a qualitative study

OBJECTIVES

To explore staff experiences of working with a digital communication platform implemented throughout several primary healthcare centres in Sweden.

DESIGN

A descriptive qualitative approach using focus group interviews. Qualitative content analysis was used to code, categorise and thematise data.

SETTING

Primary healthcare centres across Sweden, in both rural and urban settings.

PARTICIPANTS

A total of three mixed focus groups, comprising 19 general practitioners and nurses with experience using a specific digital communication platform.

RESULTS

Five categories emerged: 'Fears and Benefits of Digital Communication', 'Altered Practice Workflow', 'Accepting the Digital Society', 'Safe and Secure for Patients' and 'Doesn't Suit Everyone and Everything'. These were abstracted into two comprehensive themes: 'Adjusting to a novel medium of communication' and 'Digitally filtered primary care', describing how staff experienced integrating the software as a useful tool for certain clinical contexts while managing the communication challenges associated with written communication.

CONCLUSIONS

Family medicine staff were ambivalent concerning the use of digital communication but, after a period of adjustment, it was seen as a useful communication tool especially when combined with continuity of care. Staff acknowledged limitations regarding use by inappropriate patient populations, information overload and misinterpretation of text by both staff and patients.

Insights for Sustainability of Smartphone Business: Understanding Customer Switching Behavior in Smartphone Services

Competition in smartphone market has been fierce, and customers’ switching has become a primary concern for the success of smartphone businesses. Nonetheless, research on customer switching behavior regarding smartphones is still under investigation. The purpose of this study is to examine how social factors affect users’ smartphone switching intention and how customer rational and emotional factors moderate the customers’ switching behavioral intention. In an attempt to understand the switching behavior of smartphone users, this study develops and tests a model drawn from social factors (e.g., media and peer influence), customer rational factors (e.g., switching experience and confidence in decision making), and customer emotional factors (e.g., anticipated regret and alternative attractiveness). The model is tested with data collected from 302 smartphone users. The results of structural equation modeling analysis demonstrate that, when customers make switching decision, both media influence and peer influence affect behavioral switching intention. Further, this study also revealed that customer rational and emotional factors moderate the effects of media influence and peer influence toward customers’ switching intention. Overall, this study enhances the omnidirectional understanding of the switching behavior of smartphone users and can help smartphone companies in fierce competition to lead to sustainable growth.

Promoting the creation of R&D intentions in primary healthcare measured by a validated instrument

BACKGROUND

Primary healthcare has a long and successful patient care history in Sweden. Nevertheless, a research-oriented attitude has been more or less absent in this context. In society today, access to information has significantly influenced the nature of patients' demand for up-to-date healthcare. A prerequisite for this new demand is health professionals who are interested in novel ways of thinking and view a change of work practices as necessary. One way to achieve this goal is by means of strategic communication, which is a relatively new interdisciplinary field. The aim of this study was to analyse the role of strategic communication in the creation of intentions in Research and Development (R&D) among primary healthcare staff as measured by a validated instrument.

METHODS

An intervention study on staff was performed. A 15-item questionnaire was validated and implemented. All primary healthcare staff from the southwestern Swedish province of Halland were included. In total, 846 employees (70%) agreed to participate in the measurements. After 12 years, 352 individuals who had participated in the intervention and remained in the organisation were identified and followed up. The intervention comprised established communication channels. The measurements were performed after 7 and 12 years. A questionnaire was designed for this purpose. The questions were validated by a factor analysis, and the degree of reliability was measured with Cronbach's alpha coefficient. χ² and Fisher's exact tests were used as statistical tests in comparisons.

RESULTS

Factor analysis identified five pure factors (most Cronbach's alpha > 0.70). Strategic communication contributed to a significant improvement in the staff members' interest in R&D and willingness to change in both the short (P < 0.05) and long (P < 0.05) term. The positive attitude was stable over time.

CONCLUSIONS

Strategic communication seems to be a significant tool for creating a stable positive attitude towards R&D in the primary healthcare context. The creation of a positive attitude towards a scientific approach is a relevant finding that deserves special attention in a context as complex as healthcare. Using a validated instrument seems to contribute to pure results in this case.

Dissemination and stakeholder engagement practices among dissemination & implementation scientists: Results from an online survey

INTRODUCTION

There has been an increasing focus on disseminating research findings, but less about practices specific to disseminating and engaging non-researchers. The present project sought to describe dissemination practices and engagement of stakeholders among dissemination & implementation (D&I) scientists.

METHODS

Methods to disseminate to and engage non-research stakeholders were assessed using an online survey sent to a broad, diverse sample of D&I scientists.

RESULTS

Surveys were received from 210 participants. The majority of respondents were from university or research settings in the United States. (69%) or Canada (13%), representing a mix of clinical (28%) and community settings (34%). 26% had received formal training in D&I. Respondents indicated routinely engaging in a variety of dissemination-related activities, with academic journal publications (88%), conference presentations (86%), and reports to funders (74%) being the most frequent. Journal publication was identified as the most impactful on respondents' careers (94%), but face-to-face meetings with stakeholders were rated as most impactful on practice or policy (40%). Stakeholder involvement in research was common, with clinical and community-based researchers engaging stakeholder groups in broadly similar ways, but with critical differences noted between researchers with greater seniority, those with more D&I training, those based in the United States vs. Canada, and those in community vs. clinical research settings.

CONCLUSIONS

There have been increases in stakeholder engagement, but few other practices since the 2012 survey, and some differences across subgroups. Methods to engage different stakeholders deserve more in-depth investigation. D&I researchers report substantial misalignment of incentives and behaviors related to dissemination to non-research audiences.

Can user innovation grow a firm? The case of the Korean smart media industry

With the rapid development of information and communications technology (ICT), smart society has arrived. The emergence of smart media has changed the user’s role. Broader communication coverage, faster Internet speeds, and an expanding application market promote user participation. Therefore, the role of users in innovation has become more important than ever. In this rapidly changing environment, it has become important for firms to consider the role of users when developing innovation strategies. It is hard for a firm to maintain all abilities and resources amid this sudden change; therefore, firms have to develop their strategy considering the user’s role. For that reason, firms need to network with universities, researchers, firms, and users from the open innovation perspective. This study divides firm strategy into exploitation and exploration strategies in the value chain and identifies the effects of utilization strategy, exploration strategy, and the role of users in the smart media industry on firm performance.

Primary care provider perceptions and experiences of implementing hepatitis C virus birth cohort testing: a qualitative formative evaluation

Background

In 2014, the Department of Veterans Affairs (VA) adopted a screening test policy for hepatitis C virus (HCV) in all “Baby Boomers” - those born between 1945 and 1965. About 1 in 12 Veterans were estimated to be infected with HCV yet approximately 34% of the birth cohort remained untested. Early HCV diagnosis and successful antiviral treatment decrease the risk of onward transmission, cirrhosis, hepatocellular carcinoma, liver transplant, and death. Implementing evidence-based HCV screening in primary care has great potential to reduce morbidity and mortality. To inform design and implementation of a quality improvement intervention, we studied primary care provider (PCP) perceptions of and experiences with HCV birth cohort testing.

Methods

We conducted a formative evaluation using qualitative semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Twenty-two PCPs in six states across a large integrated US healthcare system were interviewed. Content analysis with a priori and emergent codes was performed on verbatim interview transcripts.

Results

We identified three themes related to primary care provider HCV testing and linkage practices, as mapped to i-PARIHS constructs: 1) evaluating cues to HCV testing (innovation/evidence), 2) framing HCV testing decisions (recipients), and 3) HCV testing and linkage to care in the new treatment era (context). The most frequently reported HCV testing cue was an electronic clinical reminder alert, followed by clinical markers and the presence of behavioral risk factors. Most PCPs saw testing as routine, but less urgent, leading to some reluctance. Providers largely saw themselves as performing guideline-concordant testing, yet no performance data were available to assess performance. Given the recent availability of new HCV medications, many PCPs were highly motivated to test and link patients to specialty care for treatment.

Conclusions

Our results suggest a multi-component intervention around awareness and education, feedback of performance data, clinical reminder updates, and leadership support, would address both a significant need, and be deemed acceptable and feasible to primary care providers.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4043-z) contains supplementary material, which is available to authorized users.

Nurses Leading Safe Infant Sleep Initiatives in the Hospital Setting

Every day, 10 otherwise healthy infants die from sleep-related deaths in the United States. These deaths, termed sudden unexpected infant death, remain the leading cause of post-neonatal death in the United States despite known modifiable risk factors and prevention recommendations. In birthing hospitals, many parents report being given incorrect and sometimes no information about infant sleep safety, which creates immediate and long-term safety concerns. In this article, we provide an overview of sudden unexpected infant death, including sudden unexpected postnatal collapse, and the latest safe sleep recommendations from the American Academy of Pediatrics. We also offer practical guidelines for nurses-those working at the bedside and those in leadership positions-who may be seeking to improve the quality of infant sleep practices in their organizations.

Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study

OBJECTIVE

To compare and contrast illustrative examples of the adoption of high value practices and the de-adoption of low value practices.

DESIGN

(1) Retrospective, population-based audit of low molecular weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis (high value practice) and albumin for fluid resuscitation (low value practice) and (2) cross-sectional survey of healthcare providers.

SETTING

Data were collected from nine adult medical-surgical intensive care units (ICUs) in two large Canadian cities. Patients are managed in these ICUs by a group of multiprofessional and multidisciplinary healthcare providers.

PARTICIPANTS

Participants included 6946 ICU admissions and 309 healthcare providers from the same ICUs.

MAIN OUTCOME MEASURES

(1) The use of LMWH for VTE prophylaxis (per cent ICU days) and albumin for fluid resuscitation (per cent of patients); and (2) provider knowledge of evidence underpinning these practices, and barriers and facilitators to adopt and de-adopt these practices.

RESULTS

LMWH was administered on 38.7% of ICU days, and 20.0% of patients received albumin.Most participants had knowledge of evidence underpinning VTE prophylaxis and fluid resuscitation (59.1% and 84.2%, respectively). Providers perceived these practices to be followed. The most commonly reported barrier to adoption was insufficient knowledge/understanding (32.8%), and to de-adoption was clinical leader preferences (33.2%). On-site education was the most commonly identified facilitator for adoption and de-adoption (67.8% and 68.6%, respectively).

CONCLUSIONS

Despite knowledge of and self-reported adherence to best practices, the audit demonstrated opportunity to improve. Provider-reported barriers and facilitators to adoption and de-adoption are broadly similar.

'Having to learn this so late in our lives…' Swedish elderly patients' beliefs, experiences, attitudes and expectations of e-health in primary health care

OBJECTIVE

The elderly are an increasing group and large consumers of care in Sweden. Development of mobile information technology shows promising results of interventions for prevention and treatment of chronic diseases. Exploring the elderly patients' beliefs, attitudes, experiences and expectations of e-health services helps us understand the factors that influence adherence to such tools in primary care.

MATERIAL AND METHODS

We conducted focus group interviews with 15 patients from three primary health care centers (PHCCs) in Southern Sweden. Data were analysed with thematic content analysis with codes and categories emerged from data during analysis.

RESULTS

We found one comprehensive theme: 'The elderly's ambivalence towards e-health:  reluctant curiosity, a wish to join and need for information and learning support'. Eight categories emerged from the text during analysis: 'E-health - a solution for a non-existing problem?', 'The elderly's experiences of e-health', 'Lack of will, skills, self-trust or mistrust in the new technology', 'Organizational barriers', 'Wanting and needing to move forward', 'Concerns to be addressed for making e-health a good solution', 'Potential advantages with e-health versus ordinary health care' and 'Need for speed, access and correct comprehensive information'.

CONCLUSIONS

Elderly patients in Sweden described feelings of ambivalence towards e-health, raising concerns as accessibility to health care, mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly. Key points Exploring the elderly patients' beliefs, experiences, attitudes and expectations of the fast developing e-health services helps us understand the factors that influence adherence to such tools in primary care. Elderly patients in Sweden reported ambivalence and different experiences and attitudes towards e-health, raising concerns as accessibility to health care, costs and mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly.

Audio-/Videorecording Clinic Visits for Patient's Personal Use in the United States: Cross-Sectional Survey

Background

Few clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States.

Objective

Our objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States.

Methods

We administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording.

Results

In total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised.

Conclusions

Policy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.

Quality Improvement in Athletic Health Care

CONTEXT

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.

OBJECTIVES

  To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.

DESCRIPTION

  As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

Survey of Anxiety in Ordinary Workers and Doctors Regarding Sedative Use during Endoscopic Examination in the Seoul Metropolitan Area

BACKGROUND/AIMS

Sedative use is common in endoscopic examinations. The anxiety regarding sedative use may be different between doctors and nonmedical individuals.

METHODS

A questionnaire survey was conducted by a research company (DOOIT Survey), and responses were collected from 649 doctors and 1,738 individuals who perform typical jobs in nonmedical fields. In this study, these ordinary workers are considered to represent nonmedical individuals. Anxiety was measured using a 5-point Likert scale.

RESULTS

The nonmedical individuals exhibited more anxiety regarding the sedative use than the doctors. Age <40 years (odds ratio [OR], 2.27; p<0.001), female sex (OR, 1.62; p=0.002), experience of an adverse event (OR, 1.79; p=0.049), and insufficient explanation (OR, 2.05; p<0.001) were the significant factors that increased the anxiety of the nonmedical individuals. The doctors who experienced a sedative-related adverse event reported increased anxiety compared with the doctors who did not report this experience (OR, 1.73; p=0.031).

CONCLUSIONS

Anxiety regarding sedative use during an endoscopic examination was significantly different between doctors and non-medical individuals. A younger age, female sex, an adverse event, and insufficient explanation affect the anxiety of nonmedical individuals. An adverse event also affects the anxiety of doctors.

The Exnovation of Chronic Care Management Processes by Physician Organizations

Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations.

CONTEXT

Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time.

METHODS

Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians.

FINDINGS

Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse care management and registries were largely retained. Greater proportions of baseline Medicaid practice revenue (incidence rate ratio [IRR] = 1.44, p < 0.001) and increasing proportions of revenue from Medicaid (IRR = 1.02, p < 0.05) were associated with greater CMP exnovation by physician organizations on net. Practices with greater expansion of HIT functionality exnovated fewer CMPs (IRR = 0.91, p < 0.001) compared to practices with less expansion of HIT functionality.

CONCLUSIONS

Exnovation of CMPs is an important reason why the population-level adoption of CMPs by physician organizations has remained low. Expanded HIT functions and changes to Medicaid reimbursement and incentives may aid the retention of CMPs by physician organizations.

Early Adoption of a Multitarget Stool DNA Test for Colorectal Cancer Screening

OBJECTIVES

To characterize early adoption of a novel multitarget stool DNA (MT-sDNA) screening test for colorectal cancer (CRC) screening and to test the hypothesis that adoption differs by demographic characteristics and prior CRC screening behavior and proceeds predictably over time.

PATIENTS AND METHODS

We used the Rochester Epidemiology Project research infrastructure to assess the use of the MT-sDNA screening test in adults aged 50 to 75 years living in Olmsted County, Minnesota, in 2014 and identified 27,147 individuals eligible or due for screening colonoscopy from November 1, 2014, through November 30, 2015. We used electronic Current Procedure Terminology and Health Care Common Procedure codes to evaluate early adoption of the MT-sDNA screening test in this population and to test whether early adoption varies by age, sex, race, and prior CRC screening behavior.

RESULTS

Overall, 2193 (8.1%) and 974 (3.6%) individuals were screened by colonoscopy and MT-sDNA, respectively. Age, sex, race, and prior CRC screening behavior were significantly and independently associated with MT-sDNA screening use compared with colonoscopy use after adjustment for all other variables (P<.05 for all). The rates of adoption of MT-sDNA screening increased over time and were highest in those aged 50 to 54 years, women, whites, and those who had a history of screening. The use of the MT-sDNA screening test varied predictably by insurance coverage. The rates of colonoscopy decreased over time, whereas overall CRC screening rates remained steady.

CONCLUSION

The results of the present study are generally consistent with predictions derived from prior research and the diffusion of innovation framework, pointing to increasing use of the new screening test over time and early adoption by younger patients, women, whites, and those with prior CRC screening.

Working up rectal bleeding in adult primary care practices

RATIONALE, AIMS AND OBJECTIVES

Variation in the workup of rectal bleeding may result in guideline-discordant care and delayed diagnosis of colorectal cancer. Accordingly, we undertook this study to characterize primary care clinicians' initial rectal bleeding evaluation.

METHODS

We studied 438 patients at 10 adult primary care practices affiliated with three Boston, Massachusetts, academic medical centres and a multispecialty group practice, performing medical record reviews of subjects with visit codes for rectal bleeding, haemorrhoids or bloody stool. Nurse reviewers abstracted patients' sociodemographic characteristics, rectal bleeding-related symptoms and components of the rectal bleeding workup. Bivariate and multivariable logistic regression models examined factors associated with guideline-discordant workups.

RESULTS

Clinicians documented a family history of colorectal cancer or polyps at the index visit in 27% of cases and failed to document an abdominal or rectal examination in 21% and 29%. Failure to order imaging or a diagnostic procedure occurred in 32% of cases and was the only component of the workup associated with guideline-discordant care, which occurred in 27% of cases. Compared with patients at hospital-based teaching sites, patients at urban clinics or community health centres had 2.9 (95% confidence interval 1.3-6.3) times the odds of having had an incomplete workup. Network affiliation was also associated with guideline concordance.

CONCLUSION

Workup of rectal bleeding was inconsistent, incomplete and discordant with guidelines in one-quarter of cases. Research and improvements strategies are needed to understand and manage practice and provider variation.

Facilitators and barriers to the adoption of ergonomic solutions in construction

BACKGROUND

Rates of musculoskeletal disorders in construction remain high. Few studies have described barriers and facilitators to the use of available ergonomic solutions. This paper describes these barriers and facilitators and their relationship to the level of adoption.

METHODS

Three analysts rated 16 proposed ergonomic solutions from a participatory ergonomics study and assessed the level of adoption, six adoption characteristics, and identified the category of adoption from a theoretical model.

RESULTS

Twelve solutions were always or intermittently used and were rated positively for characteristics of relative advantage, compatibility with existing work processes and trialability. Locus of control (worker vs. contractor) was not related to adoption. Simple solutions faced fewer barriers to adoption than those rated as complex.

CONCLUSIONS

Specific adoption characteristics can help predict the use of new ergonomic solutions in construction. Adoption of complex solutions must involve multiple stakeholders, more time, and shifts in culture or work systems. Am. J. Ind. Med. 60:295-305, 2017. © 2017 Wiley Periodicals, Inc.

Key Recommendations from the MedtecHTA Project

There are particular characteristics of Medical Devices, such as the device-user interaction, the incremental nature of innovation and the broader organizational impact that lead to additional challenges for health technology assessment (HTA). The project explored key aspects of the conduct and methods of HTA for MDs. Systematic reviews and original research studies were conducted to determine improvements in processes and methods that could enhance the potential for HTA and optimize the diffusion of MDs. Regulatory processes for MDs should be more closely aligned, the HTA evaluative framework should be harmonized and processes for conditional coverage and evidence development should be used. The methods for HTA should consider MDs as complex interventions, require the establishment of high quality registries, consider an iterative approach to the evaluation over time, recognize and allow for the particular characteristics of devices and use appropriate approaches for confounder adjustment in comparative effectiveness studies. To optimize the diffusion, a common classification should be developed across countries in order to facilitate international comparisons, factors driving diffusion should be explored in HTA reports and physicians' personal goals and motivation should be better understood. The key recommendations of the MedtecHTA project should improve the conduct and use of HTA for MDs. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.