Determinants of the intention to use e-Health by community dwelling older people

Study on the "digital divide" in the continuous utilization of Internet medical services for older adults: Combination with PLS-SEM and fsQCA analysis approach

BACKGROUND

With the rapid digitalization of healthcare and an aging population, understanding the factors influencing older adults' sustained adoption of Internet medical services is critical. However, existing research often oversimplifies these factors by relying on linear models. This study integrates Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to explore the complex pathways driving continued use.

METHODS

A survey of 1,920 older adults (60-75 years) in China assessed satisfaction, e-health literacy, self-efficacy, social support, social influence, social participation, and willingness to use Internet medical services. PLS-SEM examined the relationships between variables, while fsQCA identified multiple configurations leading to sustained use.

RESULTS

PLS-SEM identified satisfaction as the strongest predictor of sustained use (β = 0.281, p < 0.001), acting as both a direct determinant and a mediator for e-health literacy and social participation. Social influence (β = 0.189, p < 0.001) and social support (β = 0.172, p < 0.001) also contributed significantly. FsQCA revealed six distinct configurations, with satisfaction and e-health literacy as core conditions across most pathways.

CONCLUSIONS

By integrating linear and configurational approaches, this study provides a nuanced understanding of older adults' digital healthcare behaviors. Enhancing satisfaction, digital literacy, and social engagement is key to fostering sustained adoption. Tailored interventions based on distinct configurations can maximize the effectiveness of digital health programs.

IMPLICATIONS

This research bridges gaps in understanding complex behaviors and provides actionable insights for policymakers and healthcare providers, highlighting the critical role of digital literacy and social support.

D, Pino M, Wieching R, Maranesi E, Rigaud AS, Watanabe S, Wulf V, Taki Y. The Impact of Depression and Leisure Activities on E-Health Literacy Among Older Adults: A Cross-Cultural Study in the EU and Japan

Health services through digital technologies (e-health) offer a promising solution, but some older adults may encounter difficulties in utilizing these resources due to varying levels of e-health literacy. This study investigated the relationship between depression, leisure activities, and e-health literacy among older adults in the EU and Japan using cross-sectional data from the e-ViTA baseline survey. Findings revealed that depression was negatively associated with e-health literacy in both regions (EU: β = -0.54, 95% confidence interval (CI): -0.79, -0.28; Japan: β= -0.24, 95%CI: -0.46, -0.02). Leisure activities were positively associated with e-health literacy only in the EU (β = 0.55, 95%CI: 0.23, 0.87). Moreover, leisure activities appeared to partially mediate the relationship between depression and e-health literacy in the EU group. These results highlight the need to address mental health issues and promote leisure activities to improve e-health literacy among older adults, emphasizing tailored interventions for different cultural contexts.

Intention to use mobile phone-based TB screening among HIV patients in Debre Tabor Town public health facilities, Northwest Ethiopia: a cross-sectional study

BACKGROUND

To ensure fair access to TB screening, early diagnosis of TB infections, and timely starting of appropriate treatment, mobile technology tools provide convenience and feasibility for communities with limited infrastructure. This study aimed to assess the intention to use mobile-based TB screening among HIV patients in Debre Tabor Town Public health facilities, in Ethiopia.

METHOD

A facility-based cross-sectional study was conducted among 423 HIV patients. Data was collected from May 23 to July 11, 2022, through the use of an interviewer-administered questionnaire. Epi-data 4.6 was utilized for data entry, and analysis was performed using Stata 14. Binary logistic regression analysis was employed to assess factors associated with the outcome variable. A P-value of less than 0.05 was considered statistically significant.

RESULT

Around 70.7% of HIV patients indicated their intention to use mobile phone-based TB screening services. being employed, (AOR = 2.93; 95% CI: 1.35-6.34), experience reading received text messages (AOR = 2.81; 95% CI: 1.05-7.49), perceived usefulness (AOR = 7.29; 95% CI: 4.00 -13.31), perceived ease of use (AOR = 2.15; 95% CI: 1.17-3.95) clients having clinical follow-ups at the hospital (AOR = 3.03; 95% CI: 1.63-5.62) are significantly associated with intention to use mobile phone-based TB screening.

CONCLUSION

In conclusion, approximately 70.7% of HIV clients intend to use mobile phone-based TB screening services, which is higher compared to previous studies. Factors such as employment status, experience reading received text messages, perceived usefulness, perceived ease of use, and having clinical follow-ups at a hospital were found to be significantly associated with the intention to use mobile phone-based TB screening. Healthcare providers, mobile health developers, and policymakers should take into account these factors when developing and deploying mobile phone-based TB screening initiatives.

Efficacy and Acceptability of a Mobile App for Monitoring the Clinical Status of Patients With Chronic Obstructive Pulmonary Disease Receiving Home Oxygen Therapy: Randomized Controlled Trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) primarily originates from exposure to tobacco smoke, although factors, such as air pollution and exposure to chemicals, also play a role. One of the primary treatments for COPD is oxygen therapy, which helps manage dyspnea and improve survival rates. Mobile health (mHealth) technologies have demonstrated significant potential in monitoring patients with chronic diseases, offering new avenues for enhancing patient care and disease management.

OBJECTIVE

The purpose of this study was to evaluate the efficacy and acceptability of a mobile app designed for the clinical monitoring of patients with COPD and home oxygen (HO) therapy, compared with conventional monitoring in real-world community settings.

METHODS

A parallel-group, nonblinded, multicenter randomized controlled trial was conducted with 45 participants; the intervention group (IG), which used the mobile app in addition to conventional monitoring (n=23) and the control group, which received only conventional monitoring (n=22), administered by therapists over a duration of 3 months. The primary outcomes included the chronic obstructive pulmonary disease assessment test (CAT) score, the level of dyspnea measured by the Borg scale, and oxygen saturation percentage, assessed at both the beginning and end of the trial. Secondary outcomes included the frequency of app use, the number of hospitalizations, and survival rates. In addition, a satisfaction survey and an interview were conducted with the IG.

RESULTS

The median use of the mobile app was 21 (IQR 16-28) days. At the end of the follow-up, the Borg dyspnea scale was significantly lower in patients who used the mobile app for HO therapy monitoring (mean 0.6, SD 0.8 vs mean 4.1, SD 1.4; P=.001). Regarding the impact of COPD on quality of life, as measured by the CAT, no differences were found in the scores between baseline and end-of-follow-up within the control group. However, a significant decrease was observed in the IG (baseline median CAT 27, IQR 23-31 vs final median CAT 22, IQR 14-28; P<.001). In addition, the CAT score was significantly higher in patients receiving conventional monitoring compared with those monitored with the mobile app (median 30, IQR 23-32 vs median 22, IQR 14-28; P=.02).

CONCLUSIONS

The use of the mobile app, AppO2 (SINCO), designed for the clinical monitoring of patients with COPD and HO therapy, is associated with improved quality of life. In addition, the app is highly accepted by users, promotes self-care, and fosters patient confidence in managing their own condition.

TRIAL REGISTRATION

ClinicalTrials NCT04820790; https://clinicaltrials.gov/study/NCT04820790.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi.org/10.1186/s12875-021-01450-8.

Diabetes apps cannot "stand alone": A qualitative study of facilitators and barriers to the continued use of diabetes apps among type 2 diabetes

Background: Diabetes apps have the potential to improve self-management among people with type 2 diabetes mellitus (T2DM) and thereby prevent complications. However, premature disengagement of diabetes apps hinders this potential. Objective: This study aimed to identify facilitators of and barriers to the continued use of apps among T2DM patients and to formulate recommendations to enhance patients' adherence to diabetes apps. Design: Qualitative study that followed the Consolidated Criteria for Reporting. Qualitative Research (COREQ) guidelines. Methods: Semi-structured interviews were conducted among 15 T2DM patients who continued real-world use of a diabetes app over 1 month. Data were analyzed using conventional content analysis. Results: The results showed that patients were triggered to continue app use by internally directed facilitators (health concerns, need for knowledge, self-conscious emotions) and externally directed facilitators (change in medication, reminders from health professionals). However, app use declined among all participants due to user-specific barriers (increased knowledge and experience, therapeutic inertia, diabetes stigma) and app-specific barriers. Notably, different app-specific barriers were identified in different self-managers: for novice self-managers, the app provided inconsistent information; for competent self-managers, the app provided invalid information and service; and for expert self-managers, the app was no longer being intelligent and new. Conclusions: The success of diabetes app continuance cannot be achieved by diabetes apps alone; rather, diabetes patients, health professionals, medical organizations, regulators, and integration technologies need to be gathered. Consistent, relevant, and current information, timely and continual service, psychological support should be guaranteed.

Intention to use mobile text message reminders for medication adherence among hypertensive patients in North West Ethiopia: a cross-sectional study

BACKGROUND

Reminders via digital technology offer a novel and efficient means to address medication forgetfulness, as they are easily accessible and user-friendly for patients. In particular mobile text message reminders are more suitable for chronic patients, as they require few technical skills, can operate without internet connectivity, and are less expensive than other technologies. This study aimed to assess the intention to use mobile text message reminders for medication adherence among hypertensive patients at the Gondar City health facilities.

METHODS

A facility-based cross-sectional study was conducted. A simple random sampling method was used to select 423 hypertensive patients. Data was collected from April 1 to May 15, 2023. Data was collected using Kobo Toolbox, and the collected data was exported to MS Excel. Subsequently, the data was imported and analyzed using the SPSS version 20. Binary and multivariable logistic regression analysis was employed to assess factors associated with the outcome variable.

RESULT

The finding indicates that 64.5% of the patients have an Intention to use mobile text message reminders for medication adherence. Perceived usefulness (AOR = 2.53: 95%CI: 1.41, 4.52), perceived ease of use (AOR = 3.28: 95% CI: 1.81, 5.95), forgetting to take medication (AOR = 2.20: 95%CI: 1.38, 3.50) and patient holds their mobile phone always (AOR = 1.96: 95%CI: 1.04, 3.68) were associated factors with outcome variable.

CONCLUSION

Forget taking medication, the patient holds their mobile phone always, Perceived ease of use and Perceived usefulness were significantly associated with the outcome variable. We recommend designing and implementing user-friendly text message reminder systems and educating hypertensive patients about the system's benefits.

Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.

Determinants of the intention to use mHealth in the future: Evidence from an intervention study of patients with chronic diseases in Slovenia

BACKGROUND

Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users' intentions to use it in the future. User-centred intervention studies based on users' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use.

METHODS

An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses.

RESULTS

The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use.

CONCLUSION

Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases.

Determining the acceptance of e-mental health interventions in elite athletes using the unified theory of acceptance and use of technology

Background

Elite athletes are exposed to many different sport-specific stressors that may put them at particular risk for mental health symptoms and disorders. E-mental health interventions could be a feasible option to support elite athletes in need. The aim of the present study was to assess the acceptance of e-mental health interventions among elite athletes and explore its underlying drivers and barriers.

Materials and methods

A cross-sectional study was conducted with N = 382 elite athletes. Of these, N = 275 (71.99%, 167 females) were included in the statistical analyses. The impact of various sociodemographic, sport-related and medical characteristics on acceptance was assessed. EHealth-related data and acceptance of e-mental health interventions were examined using a modified assessment based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

Results

Overall, the acceptance of e-mental health interventions in elite athletes can be classified as high (M = 3.69 SD = 0.97). In the UTAUT regression model sex, financial situation, depression symptoms, digital confidence, digital overload as well as the UTAUT predictors performance expectancy, effort expectancy, and social influence predicted acceptance significantly.

Conclusions

The UTAUT model has proven to be a valuable instrument in predicting of acceptance of e-mental health interventions in elite athletes. Given the strong association between acceptance and future use, new interventions should focus on the explored factors to establish effective e-mental health interventions for elite athletes.

Assessing Patient Use of and Attitudes toward eHealth Services for Communication with Primary Care Centers in Saudi Arabia and Factors Affecting Usage

BACKGROUND

This study investigates patients' use of eHealth services, their awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence the use of these services.

METHODS

A cross-sectional design using questionnaires was conducted. Based on the unified theory of acceptance and use of technology (UTAUT), the participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. A simple linear regression was conducted to identify factors influencing the participants' intention to use eHealth services.

RESULTS

In total, 1203 participants with an average age of 43.7 years were surveyed. The participants' usage rates varied, with the lowest at 2.4%, for measuring vital signs, and the highest at 47.4%, for booking appointments. The intentions to use the services ranged from 22.5%, for video consultations, to 46.6%, for prescription refill requests. Approximately 20% of the respondents were unaware of each service's availability. Positive associations were found between all the constructs and the intention to use online services, with a younger age being the most significant factor.

CONCLUSIONS

The use of and intention to use eHealth services varied greatly. The participants were often unaware of the availability of these services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.

Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study

BACKGROUND

During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care.

OBJECTIVE

Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ≥65 years during the COVID-19 pandemic.

METHODS

A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks.

RESULTS

Of the 21,830 participants aged ≥65 years, the proportion who indicated adopting telehealth ranged from 50.77% (11,082/21,830) at survey 1 in 2020 to 39.4% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001).

CONCLUSIONS

This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services.

Understanding the Role of Technology Anxiety in the Adoption of Digital Health Technologies (DHTs) by Older Adults with Chronic Diseases in Shanghai: An Extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model

The unprecedented rapid growth of digital health has brought new opportunities to the health field. However, elderly patients with chronic diseases, as an important potential beneficiary group, are affected by the digital divide, leading to unsatisfactory usage of digital health technologies (DHTs). Our study focused on the factors influencing the adoption of DHTs among this vulnerable group. To extend the UTAUT theory, technology anxiety and several demographic predictors were included to address the age characteristics of the respondents. An on-site survey was conducted in general, district, and community hospitals in Shanghai (n = 309). Facilitating conditions negatively influenced technology anxiety. Technology anxiety hindered behavioural intention. Social influence had a significant but negative impact on behavioural intention. Education, whether older adults have had experience with DHTs and previous smartphone usage experiences were significantly associated with technology anxiety. The findings provide valuable information for multiple stakeholders, including family members of elderly users, product designers, and policymakers. Ameliorating facilitating conditions, improving devices' usage experience, encouraging attempts and focusing on groups with lower educational levels can help to reduce technology anxiety and promote DHT acceptance and use in older age groups.

Understanding Factors Influencing Diabetic Patients' Intention to Use Digital Health Services in Saudi Arabia Using the Technology Acceptance Model

This study employs the Technology Acceptance Model to investigate the factors influencing Saudi Arabian diabetic patients' intention to use digital health services. There is an urgent need to investigate the possibilities of digital health services in managing diabetes given the startlingly rapidly increasing prevalence rate of diabetes in KSA. The study examines the variables affecting patients' acceptance and desire to use digital health tools to manage their diabetes. The study employs the Technology Acceptance Model to ascertain the crucial factors that impact patients' opinions regarding the usefulness and ease of use of digital healthcare technologies. The proposed model extends the traditional Technology Acceptance Model by adding two new constructs, perceived privacy and trust. These constructs were examined by analyzing the intentions of 600 respondents through online surveys. The study's conclusions showed that attitudes toward using digital health services for KSA diabetic patients are greatly influenced by every component of the extended Technology Acceptance Model. The study's conclusions add to the body of knowledge already in existence and offer insightful information to decision-makers hoping to improve digital health services.

Healthcare providers' perception of caring for older patients with depression and physical multimorbidity: insights from a focus group study

BACKGROUND

The caretaking process for older adults with depression and physical multimorbidity is complex. Older patients with both psychiatric and physical illnesses require an integrated and comprehensive approach to effectively manage their care. This approach should address common risk factors, acknowledge the bidirectional relationship between somatic and mental health conditions, and integrate treatment strategies for both aspects. Furthermore, active engagement of healthcare providers in shaping new care processes is imperative for achieving sustainable change.

OBJECTIVE

To explore and understand the needs and expectations of healthcare providers (HCPs) concerning the care for older patients with depression and physical multimorbidity.

METHODS

Seventeen HCPs who work with the target group in primary and residential care participated in three focus group interviews. A constructivist Grounded Theory approach was applied. The results were analyzed using the QUAGOL guide.

RESULTS

Participants highlighted the importance of patient-centeredness, interprofessional collaboration, and shared decision-making in current healthcare practices. There is also a need to further emphasize the advantages and risks of technology in delivering care. Additionally, HCPs working with this target population should possess expertise in both psychiatric and somatic care to provide comprehensive care. Care should be organized proactively, anticipating needs rather than reacting to them. Healthcare providers, including a dedicated care manager, might consider collaborating, integrating their expertise instead of operating in isolation. Lastly, effective communication among HCPs, patients, and their families is crucial to ensure high-quality care delivery.

CONCLUSION

The findings stress the importance of a comprehensive approach to caring for older adults dealing with depression and physical comorbidity. These insights will fuel the development of an integrated care model that caters to the needs of this population.

How Social Influence Promotes the Adoption of Mobile Health among Young Adults in China: A Systematic Analysis of Trust, Health Consciousness, and User Experience

As mobile health (mHealth) offers several advantages in healthcare, researchers are exploring the motivational factors for its adoption. However, few studies have elucidated the complex relationship between social influence and behavioral intentions to adopt mHealth among young adults in China. This study explored the impact of social influence on young adults' behavioral intentions to adopt mHealth, the mediating roles of trust and health consciousness, and the moderating effect of mHealth user experience on the relationship between the predictors. In total, 300 valid responses were collected from a university in China, and a research model was developed. The partial least squares structural equation modeling method was used to verify the relationship between the main research variables. mHealth adoption behavioral intentions among young adults were significantly positively impacted by social influence; it indirectly increased mHealth adoption behavioral intentions by positively affecting trust and health consciousness. mHealth use weakened the positive impact of social influence on trust and health consciousness, while user experience positively moderated the relationship between health consciousness and behavioral intentions. Trust and health consciousness play important roles in the complex multivariate relationships between social influence and behavioral intentions to adopt mHealth. Future research should consider the moderating role of the mHealth user experience. These findings enrich the mHealth technology acceptance theory framework and provide specific guidance strategies for marketing mHealth applications.

Analysis of demand and influencing factors for smart senior care among older adults in underdeveloped regions of western China: a case study of Lanzhou

Introduction

With the rapid development of artificial intelligence and Internet-of-Things technology, internal support systems among families are gradually weakening, which can no longer satisfy the current demands of older adults. In this context, smart senior care has become a new development direction. However, existing studies on the demand for smart senior care are primarily concentrated in economically developed provinces and mega-cities in eastern China; their research results or conclusions may not apply to underdeveloped areas in the Western region. Therefore, our study selects Lanzhou as a representative city in an underdeveloped western region to investigate the demand of older adults for smart senior care and analyze the influencing factors.

Methods

This cross-sectional study included 4,815 older adults from Lanzhou, China. A structured questionnaire was designed to investigate the demands of the older adults for smart senior care and analyze thie influencing factors. The Chi-square test was used for single factor analysis of each variable. The logistic regression model included the statistically significant variables to analyze factors influencing older adults' demand for smart senior care. A significance level of p < 0.05 was considered statistically significant.

Results

Among the surveyed older adults, 1,625 (33.75%) expressed a demand for smart senior care. The finding indicated that participants' age, level of education, marital status, monthly income, number of children, type of endowment insurance, and knowledge of smart senior care were significantly associated with their demands for smart senior care (p < 0.05). Notably, medical care emerged as the smart senior care service with the highest demand rate (79.45%).

Conclusion

In Lanzhou, older adults show a low level of knowledge but a high demand for smart senior care. Their demand is influenced by personal, family, health conditions, senior care security, and other factors. To advance smart senior care, government departments should accelerate the improvement of the laws and regulations on smart senior care while vigorously enhancing the service's publicity to raise knowledge about it. Additionally, the service contents for smart senior care should be expanded to meet the diversified demands of older adults.

Social influence, performance expectancy, and price value as determinants of telemedicine services acceptance in Chile

Medicine is a discipline based on and nurtured by scientific research and technological development. The use of health services supported by information technology is increasing worldwide, and Latin America is no exception. Factors such as needing more specialists in peripheral cities, large geographic areas, and socio-cultural aspects limit the possibility of receiving timely and quality medical care services. Information Technology (IT) for health purposes, such as e-health, is a cost-effective solution for equitable access to quality healthcare services and optimization of the rising associated costs. As an e-health service, telemedicine facilitates and mediates distance communication between the patient and medical staff. Even though Latin America is at the beginning of the development of telemedicine, it would have a relevant impact, given the geographic and socioeconomic conditions of the population in this part of the world. Drawing on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) theory, we developed a theoretical model to identify the latent factors influencing the public acceptance of telemedicine and examined their interrelationships. A survey questionnaire was designed and administered to 391 residents in Antofagasta, a mine region of Chile. After that, structural equation modeling was employed to analyze the survey data. The results reveal that the UTAUT2 factors' performance expectancy, social influence, and price value significantly impact the intention to use (R 2 = 0.693). Additionally, the model presented a good fit. This study enriches the existing theoretical research on the acceptance of telemedicine services and offers insights into understanding and managing technology in the Chilean health sector.

Navigating the Adoption Maze: Evolutionary Dynamics of Stakeholder Behavior in AI-Driven Elderly Care Solutions

In the face of a rapidly aging population and the increasing demand for elderly care, the adoption of artificial intelligence (AI) in healthcare products has emerged as a promising solution to enhance service delivery. This paper investigates the behavioral evolution of multiple stakeholders-namely, government entities, AI healthcare enterprises, and medical professionals-in the adoption process of AI-enabled elderly care products. By employing an evolutionary game theory model, we analyze the stability strategies of these stakeholders under varying initial conditions. Our findings reveal that government subsidies and regulatory measures play a crucial role in promoting the adoption of these technologies, while the attitudes of enterprises and medical professionals are significantly influenced by perceived costs and benefits. Simulation analyses were conducted using MATLAB 2019a to validate the model, providing insights into optimizing stakeholder engagement and enhancing the adoption of AI in elderly care. We propose actionable recommendations for policymakers and industry leaders to foster the integration of AI into elderly care services, addressing critical challenges and leveraging opportunities in this evolving landscape.

Empirical Evidence of Internal and External Factors Influencing Users' Motivation Toward Teleconsultation Use

Introduction: The use of teleconsultation systems has increased in recent years, which has improved patients' access to health care providers and enabled seamless interaction between them. The literature points out several factors that either facilitate or impede the use of teleconsultation. However, there is a lack of studies that provide empirical evidence of factors that influence consumers' motivation toward the use of teleconsultation systems. Aim and Objective: This study aimed to provide empirical evidence of the internal and external factors that influence consumers' motivation toward the use of teleconsultation systems. Methods: A cross-sectional survey was used to collect data from consumers who used a real-time teleconsultation system called the Sehha application in Saudi Arabia between March 13 and June 14, 2021. SPSS 27.0.1 was used for descriptive analysis. Results: Four hundred eighty-five participants completed the survey, 471 of whom were included in the analysis. The findings confirmed that internal and external factors exert an influence on consumers' motivation toward the use of teleconsultation systems. The findings indicated that the presence of factors such as saving time, saving cost, accessibility to health care, ease-of-use, reliable internet access, availability of devices, and appropriate places during the online connection would increase consumers' motivation toward teleconsultation systems use. Also, the findings indicated that users' familiarity with systems similar to teleconsultation systems, users' perception of teleconsultation convenience, the influence of others on users' decision to use teleconsultation, and user's skills and confidence in using teleconsultation easily, and their trust in the teleconsultation system would also increase their motivation to use it. Furthermore, the findings showed that demographic factors, including age, gender, level of education, and employment status, did not influence users' motivation toward the use of teleconsultation Conclusions: This study provided empirical evidence of a variety of internal and external factors that exert an influence on consumers' motivation toward the use of teleconsultation systems.

Role of mobile health applications in prevention and detection of pandemic disease: A population perspective

Background

The Saudi government and the MOH launched six mobile application help in tracking positive cases, get medical consultation from home, and vaccination for coronavirus disease 2019 (COVID-19). Our study was conducted to evaluate the role of mobile health applications in the prevention and detection of pandemic disease from population perspectives.

Methods

A cross-sectional descriptive exploratory research design was utilized in this study. Based on the sample size calculation (described below), we recruited a convenience sample of 462 participants from the Northern Border Region according to the set of inclusion and exclusion criteria: Anyone over 12 years of age, including both genders and both Saudi citizens and non-Saudi citizens, were eligible to participate during the period from March 2022 to the end of July.

Results

In total 462 were participated, and 79.2% of them were females. There was a statistically significant difference between educational level and the overall score of public satisfaction with the ease of use of mobile health applications as well as overall satisfaction with the services provided by mobile health apps during the COVID-19 pandemic. Additionally, there was a statistically significant difference between gender and the role of mobile applications in the prevention of COVID-19 (p = 0.028).

Conclusion

The study found that most participants agree that the mobile health applications launched by the Saudi government and Ministry of Health have been successful in aiding the anticipation and early detection of COVID-19 cases, as well as facilitating access to healthcare services. Over half of the participants strongly agree that these mobile applications have been very effective and beneficial for their health and have helped save time.

Exploring observed and instructed mHealth use in the middle-aged and elderly people (MAEP): A social learning perspective

Objective

Based on social learning theory, this study aimed to explore the intention of middle-aged and elderly people (MAEP) to engage with mobile health (mHealth) and the underlying effects of usability and utility. The goal was to garner insights that could enhance the advancement of mHealth and improve the scope of benefits of mHealth use among MAEP in the future.

Methods

We employed a survey-based approach to delve into the mHealth use intentions among MAEP individuals aged 45 and above. A total of 371 valid survey responses were collected and analyzed using SmartPLS 3.0 for statistical examination and model verification.

Results

Our hypotheses tests revealed that vicarious utility fully mediated the relationship between observed use and direct use intention and both indirect use intentions. Instructed usability and instructed utility were found to fully and partially mediate the relationship between instructed use and indirect use intention, respectively.

Conclusions

This study demonstrates that the observed and instructed use behaviors of MAEP can promote their eventual intention to adopt mHealth through processes of observational and reinforcement learning. These findings underscore the importance of understanding the underlying effects of MAEP's intention to use mHealth is critical to increasing their adoption of mHealth, and thereby potentially improving their health outcomes.

Factors Influencing the Behavioral Intentions and Use Behaviors of Telemedicine in Patients With Diabetes: Web-Based Survey Study

BACKGROUND

Telemedicine has great potential for diabetes management. The COVID-19 pandemic has boosted the development of telemedicine. However, the factors influencing the behavioral intentions to use and use behaviors of telemedicine in patients with diabetes in China are not clear.

OBJECTIVE

We aimed to understand the determinants of behavioral intention to use telemedicine based on an extended Unified Theory of Acceptance and Use of Technology model and to identify demographic factors associated with telemedicine use in patients with diabetes in China.

METHODS

Patients with diabetes who are aged ≥18 years were surveyed from February 1 to February 7, 2023. We distributed the survey link in 3 WeChat groups including a total of 988 patients with diabetes from the outpatient department or patients discharged from Changsha Central Hospital. Structural equation modeling was used to understand the determinants of behavioral intention. A multivariate logistic regression analysis was used to identify the demographic factors associated with telemedicine use.

RESULTS

In total, 514 questionnaires were collected. Of the respondents, 186 (36.2%) were diagnosed with COVID-19. The measurement model showed acceptable reliability, convergent validity, discriminant validity, and data fit indices. The model explained 63.8% of the variance in behavioral intention. Social influence, performance expectancy, and facilitating conditions positively influenced behavioral intention (β=.463, P<.001; β=.153, P=.02; and β=.257, P=.004, respectively). Perceived susceptibility, perceived severity, and effort expectancy had no significant impact on behavioral intention (all P>.05). The overall use of telemedicine was 20.6% (104/514). After adjusting for the behavioral intention score, the multivariate regression analysis showed that age, education, and family income were associated with telemedicine use. Telemedicine use was higher in the 40 to 59 years and 18 to 39 years age groups than in the ≥60 years age group (odds ratio [OR] 4.35, 95% CI 1.84-10.29, P=.001; OR 9.20, 95% CI 3.40-24.88, P<.001, respectively). Telemedicine use was higher in the senior high school and the university and more groups than in junior high school education and less group (OR 2.45, 95% CI 1.05-5.73, P=.04; OR 2.63, 95% CI 1.11-6.23, P=.03, respectively). Patients with a higher family income used telemedicine more often than the patients who had an annual family income ≤¥10,000 (CNY ¥1=US $0.1398; ¥10,000-¥50,000 group: OR 3.90, 95% CI 1.21-12.51, P=.02; ¥50,000-¥100,000 group: OR 3.91, 95% CI 1.19-12.79, P=.02; >¥100,000 group: OR 4.63, 95% CI 1.41-15.27, P=.01).

CONCLUSIONS

Social influence, performance expectancy, and facilitating conditions positively affected the behavioral intention of patients with diabetes to use telemedicine. Young patients, highly educated patients, and patients with high family income use telemedicine more often. Promoting behavioral intention and paying special attention to the needs of older adult patients, patients with low income, and patients with low levels of education are needed to encourage telemedicine use.

Use of information communication technologies by older people and telemedicine adoption during COVID-19: a longitudinal study

OBJECTIVES

To investigate how information communication technology (ICT) factors relate to the use of telemedicine by older people in Ireland during the pandemic in 2020. Furthermore, the paper tested whether the supply of primary care, measured by General Practitioner's (GP) accessibility, influenced people's telemedicine options.

METHOD

Based on 2 waves from The Irish Longitudinal Study on Ageing, a nationally representative sample, multivariate logistic models were applied to examine the association between pre-pandemic use of ICTs and telemedicine usage (GP, pharmacist, hospital doctor), controlling for a series of demographic, health, and socioeconomic characteristics.

RESULTS

Previously reported having Internet access was a statistically positive predictor for telemedicine usage. The availability of high-speed broadband Internet did not exhibit a statistical association. The association was more prominent among those under 70 years old and non-Dublin urban areas. People with more chronic conditions, poorer mental health, and private health insurance had higher odds of using telemedicine during the period of study. No clear pattern between telemedicine use and differential geographic access to GP was found.

DISCUSSION

The important role of ICT access and frequent engagement with the Internet in encouraging telemedicine usage among older adults was evidenced.

CONCLUSION

Internet access was a strong predictor for telemedicine usage. We found no evidence of a substitution or complementary relationship between telemedicine and in-person primary care access.

Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study

BACKGROUND

Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption.

OBJECTIVE

We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF.

METHODS

We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use.

RESULTS

Less than half (31/84, 37%) of all included hospitals had claims for telemonitoring, and 20% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring.

CONCLUSIONS

The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups.

Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study

BACKGROUND

The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD.

OBJECTIVE

In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use.

METHODS

Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults' use of airway mHealth.

RESULTS

Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults' use of asthma and COPD mHealth tools.

CONCLUSIONS

Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts.

Exploring factors that influence the behavioural intention of medical students to use 3D gastroscopic model to learn how to operate gastroscope using UTAUT Model

BACKGROUND

The application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration.

METHODS

All methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM).

RESULTS

The results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified.

CONCLUSIONS

This study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.

Modeling the predictors of mobile health adoption by Rohingya Refugees in Bangladesh: An extension of UTAUT2 using combined SEM-Neural network approach

While the healthcare facilities for the people is questionable in Bangladesh, Rohingya refugees is a burning issue for both Bangladesh and global community. Integrating Rohingya refugees into the framework of mHealth could be beneficial for both Bangladesh and Rohingya refugees in general, and in specific situation like COVID-19 outbreak. However, no research has been found on what motivates Rohingya refugees to accept mHealth in Bangladesh. Drawing on the UTAUT2 model, this study investigates the predictors of acceptance of mHealth services technologies among Rohingya refugees. The study also seeks to clarify the roles of mHealth developers, the Bangladesh government, and non-governmental organizations working with the 1.1 million Rohingya refugees in Bangladesh. Quantitative data were collected from refugee camps with the permission of the Refugee Relief and Repatriation Commissioner (RRRC). The data were analyzed in two stages using a mixed approach that combines PLS-SEM and Artificial Neural Network (ANN). This study revealed that Effort expectancy (EE, with t = 5.629, β = 0.313) and facilitating conditions (FC with t = 4.442, β = 0.269) in PLS-SEM, and FC (with 100 percent importance) and Health consciousness (HC, with 94.88 percent importance) in ANN analysis were found to be the most substantial predictors of mHealth adoption. The study also revealed that EE and FC are more important for low education group, while PE and Situational Constraint (SC) are more important for the high education group of refugees. In addition to providing insights for mHealth developers, this study particularly focuses on the role of government institutions and non-governmental social workers in working with the subjects to increase FC and HC among Rohingya refugees and bring them under mHealth services.

Determinants of health-conscious consumers’ intention to adopt fitness apps

This study aims to investigate the factors influencing consumers’ intention to adopt health fitness apps. The target population for this study were current users of health fitness apps. The data collection process was completed using a Google e-mail form with a cover letter for the convenience of customers, wherein 308 respondents were the final sample size. Data were collected from current members of health clubs and fitness centers in Dhaka, Bangladesh. Most of the respondents were males (56%, n = 308), whereas females were 44%, n = 134. Five-point Likert scale was used, where ‘1’ means ‘Strongly Disagree’ and ‘5’ ‘Strongly Agree’, to clarify the item-wise questionnaire. SPSS data analysis software for research purposes was used to evaluate the hypotheses. Cronbach Alpha (α) value was used to justify the reliability of the variables. Four items measure price value; perceived performance, health consciousness, facilitating condition, hedonic motivation are measured by two items; self-efficacy – by three. The results show that the selected six determinants positively and significantly affect consumers’ intention to use health fitness apps. Overall, these variables can explain 55.50% of the variance in predicting behavioral intentions to adopt health fitness apps. Furthermore, this results could provide significant clues to health fitness app developers that can severely influence users to adopt health fitness apps for their wellbeing.

Patients' Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study

BACKGROUND

Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability.

OBJECTIVE

This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care.

METHODS

A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach.

RESULTS

Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs.

CONCLUSIONS

Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the "voice of the stroke patients" regarding both functionality and the characteristics of the interface.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12877-022-03333-8.

Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study

BACKGROUND

Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments.

OBJECTIVE

This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies.

METHODS

A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis.

RESULTS

The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar.

CONCLUSIONS

This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them.

Usability of an animated diabetes information tool for patients with different health literacy levels: a qualitative study

OBJECTIVES

Most currently available medication self-management support tools do not meet the needs of patients with limited health literacy. Recently, tools that are better tailored to the needs of patients with limited health literacy have been developed. This study aimed to assess the usability of an animated diabetes information tool by patients with diabetes with limited and adequate health literacy levels.

METHODS

Participants with limited and adequate health literacy levels were selected based on three health literacy questions in a screening interview, and asked to use the tool three times a week, after which individual semistructured interviews were conducted. The interview topics were based on the technology acceptance model (i.e. perceived ease of use, perceived usefulness, and intention to use). Twenty-five patients with diabetes were included in the study.

KEY FINDINGS

All participants perceived the tool as easy to use due to a clear overview of topics and only personalized information being provided. Those with limited health literacy indicated that they had learned from the tool and had the intention to continue using it in the future. These participants also expressed the need for the tool to be more actively offered by healthcare professionals, while participants with adequate health literacy expressed the need for more in-depth information.

CONCLUSION

The tailored self-management support tool was perceived as usable by all participants. To better serve them, the tool could be further improved by addressing the additional needs of people with limited as well as adequate health literacy.

Feasibility and Acceptance of Augmented and Virtual Reality Exergames to Train Motor and Cognitive Skills of Elderly

The GAME2AWE platform aims to provide a versatile tool for elderly fall prevention through exergames that integrate exercises, and simulate real-world environments and situations to train balance and reaction time using augmented and virtual reality technologies. In order to lay out the research area of interest, a review of the literature on systems that provide exergames for the elderly utilizing such technologies was conducted. The proposed use of augmented reality exergames on mobile devices as a complement to the traditional Kinect-based approach is a method that has been examined in the past with younger individuals in the context of physical activity interventions, but has not been studied adequately as an exergame tool for the elderly. An evaluation study was conducted with seniors, using multiple measuring scales to assess aspects such as usability, tolerability, applicability, and technology acceptance. In particular, the Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to assess acceptance and identify factors that influence the seniors’ intentions to use the game platform in the long term, while the correlation between UTAUT factors was also investigated. The results indicate a positive assessment of the above user experience aspects leveraging on both qualitative and quantitative collected data.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model

Background

The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers.

Methods

A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model.

Results

In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation.

Conclusions

In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.

Social Media Use Among Members of the Assessment of Spondyloarthritis International Society: Results of a Web-Based Survey

BACKGROUND

The use of social media in health care may serve as a beneficial tool for education, information dissemination, telemedicine, research, networking, and communications. To better leverage the benefits of social media, it is imperative to understand the patterns of its use and potential barriers to its implementation in health care. A previous study in 2016 that investigated social media use among young clinical rheumatologists (≤45 years) and basic scientists showed that there was substantial social media use among them for social and professional reasons. However, there is a limited inquiry into social media use in different areas of rheumatology, such as spondyloarthritis.

OBJECTIVE

We aimed to explore the motivations, barriers, and patterns of social media use among an international group of experts in spondyloarthritis.

METHODS

We distributed a web-based survey via email from March 2021 to June 2021 to 198 members of the Assessment of Spondyloarthritis International Society. It contained 24 questions about demographic characteristics, patterns of current social media use, and perceptions of utility. Univariable and multivariable logistic regression analyses were performed to identify the characteristics associated with use trends.

RESULTS

The response rate was 78.8% (156/198). Of these, 93.6% (146/156) of participants used at least one social media platform. Apart from internet-based shopping and entertainment, the use of social media for clinical updates (odds ratio [OR] 6.25, 95% CI 2.43-16.03) and research updates (OR 3.45, 95% CI 1.35-8.78) were associated with higher social media consumption. Among the respondents, 66% (103/156) used social media in a work-related manner. The use of social media for new web-based resources (OR 6.55, 95% CI 2.01-21.37), interaction with international colleagues (OR 4.66, 95% CI 1.21-17.90), and establishing a web-based presence (OR 4.05, 95% CI 1.25-13.13) were associated with higher levels of consumption for work-related purposes. Time investment, confidentiality concerns, and security concerns were the top 3 challenges to a wider adoption of social media.

CONCLUSIONS

Most respondents (103/156, 66%) use social media in a work-related manner. Professional development, establishing a web-based presence, and international collaboration were associated with higher use. Challenges to social media adoption should be addressed to maximize its benefits.

Needs assessment in community-dwelling older adults toward digital interventions to promote physical activity: Cross-sectional survey study

Background

Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults.

Objective

The aim was to investigate community-dwelling older adults' needs, requirements, and preferences toward DIs to promote PA.

Methods

The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions.

Results

Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60-98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%).

Conclusion

Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network

Objective

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites.

Methods

Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis.

Results

The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces.

Conclusions

Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Factors Associated With Intention and Use of e-Mental Health by Mental Health Counselors in General Practices: Web-Based Survey

BACKGROUND

Mental health care counselors have a high intention to use e-mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH.

OBJECTIVE

The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model.

METHODS

To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient.

RESULTS

The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38% (mean 0.38, SD 0.22), and it was 49% (mean 0.49, SD 0.25) during the pandemic. In total, 57% of the patient population was considered eligible for EMH. Usefulness and benefits (β=.440; P<.001), Task perception (β=.306; P=.001), and Accessibility (β=.140; P=.02) explained the intention to use EMH (F_3,131=54.151; P<.001; R²=0.559). In turn, intention explained patient eligibility (F_1,130=34.716; P<.001; R²=0.211), whereas intention and patient eligibility explained EMH use (F_2,129=41.047; P<.001; R²=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c'=0.116; P<.001) than indirect effect (c=0.065, 95% CI 0.035-0.099; P<.001). Mental health counselors assessed patients' eligibility for EMH mainly through the availability of computers and the internet and patient motivation.

CONCLUSIONS

To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients' motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use.

Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature

BACKGROUND

Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions in the form of smartphone apps and wearable activity trackers can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence on the acceptability and effectiveness of these interventions among midlife women is unclear.

OBJECTIVE

This systematic review evaluated the effectiveness, acceptability, and active behavior change techniques (BCTs) of mobile PA technologies among midlife menopausal women.

METHODS

A mixed methods systematic review of qualitative and quantitative studies was conducted. MEDLINE (Ovid), Embase, Scopus, CINAHL, Web of Science, SPORTDiscus, CENTRAL, PsycINFO, and the ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened according to predetermined eligibility criteria. In total, 2 reviewers independently assessed the risk of bias using the Mixed Methods Appraisal Tool and completed BCT mapping of the included interventions using the BCT Taxonomy v1.

RESULTS

A total of 12 studies were included in this review. Overall risk of bias was "Moderate to high" in 58% (7/12) of the included studies and "low" in 42% (5/12) of the studies. Of the 12 studies, 7 (58%) assessed changes in PA levels. The pooled effect size of 2 randomized controlled trials resulted in a small to moderate increase in moderate to vigorous PA of approximately 61.36 weekly minutes among midlife women, at least in the short term (95% CI 17.70-105.01; P=.006). Although a meta-analysis was not feasible because of heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality, and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCT Taxonomy v1. "Self-monitoring of behaviour," "Biofeedback," and "Goal setting (behaviour)" were the most frequently described BCTs across the included interventions.

CONCLUSIONS

This review demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective for small to moderate increases in moderate to vigorous PA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half the population worldwide, there is a substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes, which needs further investigation.

TRIAL REGISTRATION

PROSPERO CRD42021273062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062.

Digital Engagement of Older Adults: Scoping Review

BACKGROUND

Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time.

OBJECTIVE

Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement.

METHODS

We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability).

CONCLUSIONS

The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25616.

A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries

Background

The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content.

Objective

This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study.

Methods

The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).

Results

The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023.

Conclusions

The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons.

Trial Registration

Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346

International Registered Report Identifier (IRRID)

PRR1-10.2196/37827

What Determines the Acceptance and Use of eHealth by Older Adults in Poland?

An aging population is considered a major challenge for governments and healthcare planners. eHealth is perceived as a tool with the potential to ensure efficient healthcare. Moreover, eHealth services may help older adults to maintain longer life in good health. However, there are still several challenges to the large-scale implementation of these solutions among older adults. Therefore, the aim of this study was to explore determinants of the acceptance and use of eHealth by older adults in Poland. Data was collected by the questionnaire, and the UTAUT model was employed. This research covered older adults aged 60 to 69. The analysis of the results using nested regression analysis showed that performance expectancy has a strong significance on the older adults' acceptance and use of eHealth, followed by effort expectancy and social influence. In contrast, facilitating conditions do not have a significant influence on the acceptance and use of eHealth. These findings may also be beneficial for the government to provide relative policies to support the development and usage of eHealth services as well as for the healthcare devices industry to design more older adult-oriented products.

Digitally enabled cardiac rehabilitation following coronary revascularization: results from a single centre feasibility study

Wearable activity monitors, together with smartphone-based health and fitness applications (apps), are becoming more accessible and their widespread use provides an additional opportunity for the recording of cardiovascular metrics in patients with cardiovascular disease. The use of selected metrics by cardiac rehabilitation (CR) programmes allows the facilitation of individualized and tailored positive lifestyle changes to patients and places the patient at the centre of their recovery programme. To investigate the role of such devices on outcomes with patients on a CR programme, a cohort/case–control study was conducted. Patients post-myocardial infarction who were treated with either percutaneous coronary intervention or surgical coronary revascularisation at a single centre were invited to use a physical activity monitor linked to a customized app at their initial assessment for the rehabilitation programme. Those who accepted were allocated to the treatment group. The control group was selected from a larger pool of 400 historical and concurrent patients. Propensity matching was used to associate each case with their closest control. The changes in self-reported physical activity were similar for both groups at the end of the CR programme (EOP). The digitally monitored group tended to achieve greater METS (metabolic equivalent of task - a measure of exercise intensity) at 12 weeks (P &lt; 0.059); however, no difference was observed in the overall change in METS at EOP (P &lt; 0.333). Although no difference was noted in diastolic blood pressure, a statistically significant drop in the systolic blood pressure in the digitally monitored group (P &lt; 0.004) was detected. In this study, the innovative combination of technology and face-to-face CR showed promising results and assisted the individualization of delivered content. This intervention could easily be replicated and expanded. Challenges are the recruitment of the elderly population, those who may be less engaged with or have less access to technology, and the underrepresentation of women in the study sample.

Perspectives of Kidney Transplant Recipients on eHealth: Semistructured Interviews

The acceptability and impact of eHealth on patient outcomes may be limited if their concerns and priorities are not addressed. This study aimed to describe the perspectives and experiences of eHealth among kidney transplant recipients.

METHODS

Face-to-face semistructured interviews were conducted with 30 adult kidney transplant recipients from New South Wales, Australia (urban and regional), in ambulatory clinics. We used purposive sampling to obtain a wide range of demographic and clinical characteristics. Transcripts were analyzed thematically. Ethics was approved by the Western Sydney Local Health District (6054-2019/ETH08718).

FINDINGS

Six themes were identified: seeking access to quality care (prioritizing and trusting clinician advice, better safety and timeliness, enabled by user-friendly content); supporting self-management (responsive to individualized informational need, empowerment through practical knowledge, encouraging connectedness); assessing reliability and trustworthiness (discerning information integrity, applying to own context, apprehensive about privacy and confidentiality); enhancing health system capabilities (synergy with routine consultations, essential to coordination, achieving goals by real-time monitoring); technology burden and limitation (uncertainty with navigation and comprehension, challenged by technical difficulties, requiring additional preparation, confrontation and distress); and lacking applicable value (diminished assurance of medical services, existing practice and procedures, hampered by low expectations and disinterest).

CONCLUSION

Recipients felt eHealth could support healthcare delivery and self-management activities. However, they encountered challenges in navigating technology and were concerned about privacy, confidentiality, and misinformation. eHealth that is accessible, individualized, and secure may improve patient satisfaction and outcomes.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic

BACKGROUND

Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms.

METHOD

The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic.

RESULTS

More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship.

CONCLUSION

Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Older people's intention to use medical apps during the COVID-19 pandemic in China: an application of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and the Technology of Acceptance Model (TAM)

Previous studies on older adults' intention to adopt medical apps during irregular circumstances like the COVID-19 outbreak are still in its infancy. In order to fill this knowledge gap, we developed a theoretical framework based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model and the Technology of Acceptance Model (TAM) to explain Chinese older people's willingness to use medical apps during the COVID-19 pandemic. We collected 1,318 online questionnaires during the first wave of the pandemic in China in early 2020. We employed structural equation modelling to analyse the data, and the results show that (a) attitudes towards using apps influence older people's intention to use apps significantly; (b) only two factors, perceived usefulness and facilitating conditions, which were proposed in the UTAUT model, significantly predicted the older adults' intention to use apps, but not others; and (c) perceived usefulness, perceived ease of use, subjective norm and facilitating conditions all significantly impact attitudes towards using apps. Further mediation analysis found that attitudes towards using apps significantly mediated the paths suggested in the original UTAUT model. Due to the online survey method we used, older people who do not use the internet were excluded from our sampling process. However, our timely research contributes to the existing literature by showcasing older people's usage of eHealth technology in public health emergencies. It also builds on the broader discussions on technology use by combining the TAM and the UTAUT model, highlighting the vital role of people's attitude towards using technology in shaping their intention to use it.

The behavioral intention to adopt mobile health services: The moderating impact of mobile self-efficacy

This study explored the moderating impact of mobile self-efficacy on the adoption of mobile health services. The UTAUT was used as the theoretical foundation for this study. The results have indicated that mobile self-efficacy was significant in moderating the impact of both performance expectancy (β = -0.005, p < 0.05) and effort expectancy (β = -010, p < 0.05) on the adoption of mobile health services. In addition, it was revealed to our surprise that both performance (β = 0.521, t = 9.311, p > 0.05) and effort expectancy (β = 0.406, t = 7.577, p > 0.05) do not determine the behavioral intention to use mobile health services. Effort expectancy and behavioral intention to use were also, respectively, not significant in influencing performance expectancy (β = 0.702, t = 12.601, p > 0.05) and intention to recommend the adoption of mobile health services (β = 0.866, t = 13.814, p > 0.05). Mobile self-efficacy, however, was found to significantly predict the citizen's intention to recommend the adoption of mobile health services (β = 0.139, t = 2.548, p < 0.05). The implications of these findings on mobile health are discussed.

Advances in Psychotherapy for Older Adults Using Video-to-Home Treatment

Providing telemental health services to older adults has become especially important during the COVID-19 pandemic. Video-to-home (VTH) treatment is an effective treatment modality; research shows that older adults are open to using VTH. However, there are unique barriers to using VTH with older adults. Barriers include access to technology, acceptance of technology, and physical and cognitive limitations. Additional concerns include establishing rapport with older patients and the policy and ethical concerns surrounding the use of VTH. Methods of addressing these barriers have been developed, and more research is needed to develop evidence-based VTH practice.