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Gavin JP, Clarkson P, Muckelt PE, Eckford R, Sadler E, McDonough S, Barker M. Healthcare professional and commissioners' perspectives on the factors facilitating and hindering the implementation of digital tools for self-management of long-term conditions within UK healthcare pathways. PLoS One 2024; 19:e0307493. [PMID: 39178238 PMCID: PMC11343405 DOI: 10.1371/journal.pone.0307493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 07/05/2024] [Indexed: 08/25/2024] Open
Abstract
Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)'s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or 'making sense'). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action-needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action-promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation.
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Affiliation(s)
- James P. Gavin
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Paul Clarkson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, Hampshire, United Kingdom
| | - Paul E. Muckelt
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Rachael Eckford
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Euan Sadler
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Suzanne McDonough
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary Barker
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, United Kingdom
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Oudbier SJ, Souget-Ruff SP, Chen BSJ, Ziesemer KA, Meij HJ, Smets EMA. Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews. BMJ Open 2024; 14:e075833. [PMID: 38858155 PMCID: PMC11168143 DOI: 10.1136/bmjopen-2023-075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. DESIGN Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. ELIGIBILITY CRITERIA Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. DATA EXTRACTION AND SYNTHESIS Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. RESULTS Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33). CONCLUSIONS The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
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Affiliation(s)
- Susan J Oudbier
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Digital Health, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Sylvie P Souget-Ruff
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Britney S J Chen
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Kirsten A Ziesemer
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hans J Meij
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Personalized Medicine, Amsterdam, The Netherlands
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Hellstrand Tang U, Smith F, Karilampi UL, Gremyr A. Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool. JMIR Hum Factors 2024; 11:e50889. [PMID: 38669076 PMCID: PMC11087855 DOI: 10.2196/50889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Frida Smith
- Regional Cancer Centre West, Gothenburg, Sweden
- Department of Technology Management and Economics, Collaborative Plattform for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Ulla Leyla Karilampi
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Parés-Salomón I, Señé-Mir AM, Martín-Bozas F, Loef B, Coffey A, Dowd KP, Jabardo-Camprubí G, Proper KI, Puig-Ribera A, Bort-Roig J. Effectiveness of workplace interventions with digital elements to reduce sedentary behaviours in office employees: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2024; 21:41. [PMID: 38641816 PMCID: PMC11031993 DOI: 10.1186/s12966-024-01595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/14/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Digital interventions are potential tools for reducing and limiting occupational sedentary behaviour (SB) in sedentary desk-based jobs. Given the harmful effects of sitting too much and sitting for too long while working, the aim of this systematic review and meta-analysis was to examine the effectiveness of workplace interventions, that incorporated digital elements, to reduce the time spent in SB in office workers. METHODS Randomised control trials that evaluated the implementation of workplace interventions that incorporated digital elements for breaking and limiting SB among desk-based jobs were identified by literature searches in six electronic databases (PubMed, Web of Science, Scopus, CINAHL, PsycINFO and PEDro) published up to 2023. Studies were included if total and/or occupational SB were assessed. Only studies that reported pre- and postintervention mean differences and standard deviations or standard errors for both intervention arms were used for the meta-analysis. The meta-analysis was conducted using Review Manager 5 (RevMan 5; Cochrane Collaboration, Oxford, UK). Risk of bias was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. RESULTS Nineteen studies were included in the systematic review. The most employed digital elements were information delivery and mediated organisational support and social influences. Multicomponent, information, and counselling interventions measuring total and/or occupational/nonoccupational SB time by self-report or via device-based measures were reported. Multicomponent interventions were the most represented. Eleven studies were included in the meta-analysis, which presented a reduction of 29.9 (95% CI: -45.2, -14.5) min/8 h workday in SB (overall effect: Z = 3.81). CONCLUSIONS Multicomponent interventions, using a wide range of digital features, have demonstrated effectiveness in reducing time spent in SB at the workplace among desk-based employees. However, due to hybrid work (i.e., work in the office and home) being a customary mode of work for many employees, it is important for future studies to assess the feasibility and effectiveness of these interventions in the evolving work landscape. TRIAL REGISTRATION The review protocol was registered in the Prospero database (CRD42022377366).
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Affiliation(s)
- Iris Parés-Salomón
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC) and University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Anna M Señé-Mir
- Sports and Physical Activity Research Group, Sport and Physical Activity Studies Centre, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain.
| | | | - Bette Loef
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Alan Coffey
- SHE Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland
| | - Kieran P Dowd
- SHE Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland
| | - Guillem Jabardo-Camprubí
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC) and Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Manresa, Spain
| | - Karin I Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anna Puig-Ribera
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC) and University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Judit Bort-Roig
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC) and University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Wang Y, Lu J. The Management of Diabetes with Hyperuricemia: Can We Hit Two Birds with One Stone? J Inflamm Res 2023; 16:6431-6441. [PMID: 38161355 PMCID: PMC10757772 DOI: 10.2147/jir.s433438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Serum urate (SU) is an independent predictor for the incidence of diabetes. In current diabetes treatment regimens, there is insufficient appreciation of the importance of hyperuricemia (HU) in disease control and prevention. To summarize the updated knowledge on the effects of SU on β-cell function, insulin resistance and chronic diabetic complications, as well as to evaluate the management of patients with both HU and diabetes, we searched the MEDLINE PubMed database, and included 285 journal articles. An inverted U-shaped relationship between fasting plasma glucose and SU levels was established in this review. Elevated SU levels may enhance the development of chronic diabetic complications, including macrovascular and microvascular dysfunction. Diet and exercise are essential parts of the lifestyle changes necessary for HU and diabetes management. Glucose- and urate-lowering drug selection and combination should be made with the principle of ameliorating, and at least not deteriorating, diabetes and HU. Medical artificial intelligence technology and monitoring systems can help to improve the effectiveness of long-term management of HU and diabetes through digital healthcare. This study comprehensively reviews and provides a scientific and reliable basis for and viewpoints on the clinical management of diabetes and HU.
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Affiliation(s)
- Yunyang Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Jie Lu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
- Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
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Thompson CA, Daffu-O'Reilly A, Willis T, Gordon A, Noakes C, Khaliq K, Farrin A, Kemp A, Hall T, Bojke C, Spilsbury K. 'Smart' BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic-a process evaluation of the CONTACT feasibility study. Implement Sci Commun 2023; 4:155. [PMID: 38049924 PMCID: PMC10694939 DOI: 10.1186/s43058-023-00533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Rapid and mass transmission of the SARS-CoV-2 virus amongst vulnerable people led to devastating effects from COVID-19 in care homes. The CONTACT intervention introduced Bluetooth Low Energy 'smart' wearable devices (BLE wearables) as a basis for automated contact tracing in, and feedback on infection risks and patterns to, care homes to try and improve infection prevention and control (IPC). We planned a cluster randomised controlled trial (RCT) of CONTACT. To be feasible, homes had to adopt CONTACT's technology and new ways of working. This paper reports on the process evaluation conducted alongside CONTACT's feasibility study and explains why it lacked the feasibility and acceptability for a definitive RCT. METHODS This mixed method process evaluation used Normalisation Process Theory (NPT) qualitative (interviews, field notes, study case report forms and documents, and observation) and quantitative (survey instruments, counts of activity) data to plan, implement, and analyse the mechanisms, effects, and contextual factors that shaped the feasibility and acceptability of the CONTACT intervention. RESULTS Thirteen themes within four core NPT constructs explained CONTACT's lack of feasibility. Coherence: the home's varied in the scale and extent of commitment and understanding of the technology and study procedures. Leadership credibility was important but compromised by competing priorities. Management and direct care staff saw CONTACT differently. Work to promote (cognitive participation) and enact (collective action) CONTACT was burdensome and failed to be prioritised over competing COVID-19-related demands on time and scarce human and cognitive resources. Ultimately, staff appraisal of the value of CONTACT-generated information and study procedures (reflexivity) was that any utility for IPC was insufficient to outweigh the perceived burden and complexity involved. CONCLUSIONS Despite implementation failure, dismissing BLE wearables' potential for contact tracing is premature. In non-pandemic conditions, with more time, better co-design and integration of theory-driven implementation strategies tailored to care homes' unique contexts, researchers could enhance normalisation in readiness for future pandemic challenges. TRIAL REGISTRATION ISRCTN registration: 11,204,126 registered 17/02/2021.
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Affiliation(s)
- Carl A Thompson
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK.
| | | | - Thomas Willis
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Adam Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Kishwer Khaliq
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew Kemp
- School of Electronics and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Tom Hall
- South Tyneside Council, South Shields, NE33 2RL, UK
| | - Chris Bojke
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
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Kajander-Unkuri S, Vaismoradi M, Katajisto J, Kangasniemi M, Turjamaa R. Effect of robot for medication management on home care professionals' use of working time in older people's home care: a non-randomized controlled clinical trial. BMC Health Serv Res 2023; 23:1344. [PMID: 38042773 PMCID: PMC10693699 DOI: 10.1186/s12913-023-10367-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time. METHODS A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate. RESULTS With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group. CONCLUSION Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).
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Affiliation(s)
- Satu Kajander-Unkuri
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Diaconia University of Applied Sciences, Helsinki, Finland
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia.
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Satasairaala, Pori, Finland
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8
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Laugaland K, Aase I, Ravik M, Gonzalez MT, Akerjordet K. Exploring stakeholders' experiences in co-creation initiatives for clinical nursing education: a qualitative study. BMC Nurs 2023; 22:416. [PMID: 37932764 PMCID: PMC10626696 DOI: 10.1186/s12912-023-01582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Co-creation is an emerging approach in nursing education, wherein academics engage in multi-stakeholder collaborations to generate knowledge, ideate solutions, promote sustainability, and enhance educational quality. However, knowledge on stakeholders' experiences in participation in co-creation initiatives for nursing education is scarce. This study aimed to explore the experiences of student nurses, nurse educators, and e-learning designers in co-creation initiatives to design and develop a digital educational resource for clinical nursing education. METHODS The study adopted an exploratory qualitative design. Data were collected via three separate semi-structured focus group interviews with student nurses (n = 7), nurse educators (n = 8), and e-learning designers (n = 3) who participated in co-creation workshops. Collected data were then thematically analyzed. RESULTS Three themes related to the participants' experiences emerged: (1) The co-creation workshops were enjoyable, useful, and instructive; (2) power imbalances influenced the students' engagement; and (3) contextual factors influenced the participants' overall engagement. CONCLUSIONS This study shows that co-creation through workshops is a novel, enjoyable, and instructive approach that facilitates knowledge exchange. It also highlights the needs and experiences of stakeholders, especially student nurses. However, the use of co-creation in nursing education presents some challenges. Recognizing and managing power differentials are essential for successful co-creation in clinical nursing education, alongside a mindset of collaboration and mutuality. Future research is required to systematize knowledge about the benefits and impacts of the processes and outcomes of co-creation initiatives, including stakeholders' motivation, barriers, and facilitators to participation in co-creation, to improve the quality of clinical nursing education.
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Affiliation(s)
- Kristin Laugaland
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms Gate, Stavanger, 4036, Norway.
| | - Ingunn Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms Gate, Stavanger, 4036, Norway
| | - Monika Ravik
- Faculty of Health and Social Sciences, University of South-Eastern Norway-Campus Porsgrunn, Porsgrunn, Norway
| | - Marianne Thorsen Gonzalez
- Faculty of Health and Social Sciences, University of South-Eastern Norway-Campus Porsgrunn, Porsgrunn, Norway
| | - Kristin Akerjordet
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms Gate, Stavanger, 4036, Norway
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9
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Rigby K, Redley B, Hutchinson AM. Change agent's role in facilitating use of technology in residential aged care: A systematic review. Int J Med Inform 2023; 179:105216. [PMID: 37734272 DOI: 10.1016/j.ijmedinf.2023.105216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To synthesise the evidence on the roles and outcomes of change agents in facilitating the use of powered technology systems and devices for staff end-users in residential aged care workplaces. DESIGN Systematic review and narrative synthesis. DATA SOURCES CINAHL, MEDLINE and EMBASE databases were searched for articles published in English between January 2010 and July 2022. REVIEW METHODS Two of three reviewers independently screened each title and abstract, and subsequently the full texts of selected records. The Mixed Method Appraisal Tool was used to assess the quality of the included articles. RESULTS Of 3,680 records identified, ten articles reporting nine studies were included. In all the studies, the change agent role was a minor component embedded within implementation processes. Three key change agent roles were identified: 1) providing guidance, expertise, and support with implementing a new technology; 2) delivering training to others, and 3) troubleshooting and responding to issues. The key outcome of change agent roles related to achieving project implementation milestones and higher levels of implementation of technology. Change agent processes, however, were compromised when the designated change agent role was included late in the implementation process, or was not supported, recognised, embraced, or when roles or responsibilities were unclear. The direct contribution of change agents was difficult to elucidate because the roles and outcomes of change agents were embedded in multi-faceted implementation strategies. CONCLUSIONS The change agent can play an important role in facilitating technology implementation by providing support, training, and troubleshooting. Challenges with the change agent role included unclear role expectations and appointment late in the implementation process. Overall, there was limited evidence specific to the role and outcome of the change agent role to inform ideal approaches for their role in technology facilitation for end-users in residential aged care workplaces.
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Affiliation(s)
- Kerry Rigby
- School of Nursing and Midwifery; Centre for Quality and Patient Safety Research; Institute for Health Transformation, Deakin University, Australia; Australian Research Council (ARC) Industrial Transformation Research Hub for Digital Enhanced Living, Deakin University, Australia.
| | - Bernice Redley
- School of Nursing and Midwifery; Centre for Quality and Patient Safety Research; Institute for Health Transformation, Deakin University, Australia.
| | - Alison M Hutchinson
- School of Nursing and Midwifery; Centre for Quality and Patient Safety Research; Institute for Health Transformation, Deakin University, Australia; Barwon Health, Geelong, Australia.
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Latuapon E, Hochstenbach L, Mahr D, Scheenstra B, Kietselaer B, Spreeuwenberg M. Cocreation to Facilitate Communication and Collaboration Between Multidisciplinary Stakeholders in eHealth Research and Development: Case Study of the CARRIER (Coronary Artery Disease: Risk Estimations and Interventions for Prevention and Early Detection) Consortium. JMIR Hum Factors 2023; 10:e45006. [PMID: 37874629 PMCID: PMC10630860 DOI: 10.2196/45006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not "speak the same language" and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. OBJECTIVE This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. METHODS The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. RESULTS First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. CONCLUSIONS This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration.
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Affiliation(s)
- Elizabeth Latuapon
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Laura Hochstenbach
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dominik Mahr
- Department of Marketing & Supply Chain Management, School of Business and Economics, Maastricht University, Maastricht, Netherlands
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bas Kietselaer
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Marieke Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Kaihlanen AM, Laukka E, Nadav J, Närvänen J, Saukkonen P, Koivisto J, Heponiemi T. The effects of digitalisation on health and social care work: a qualitative descriptive study of the perceptions of professionals and managers. BMC Health Serv Res 2023; 23:714. [PMID: 37386423 DOI: 10.1186/s12913-023-09730-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work. Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals. METHODS We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach. RESULTS Digitalisation was perceived to have changed professionals' 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems. CONCLUSIONS The findings suggest that some of the effects of digitalisation on professionals' work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals' well-being and adaptation to changes, as well as the provision of quality health and social services.
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Affiliation(s)
- Anu-Marja Kaihlanen
- Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland.
| | - Elina Laukka
- Research Unit of Nursing Science and Health Management, University of Oulu, 90230, Oulu, Finland
| | - Janna Nadav
- Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Johanna Närvänen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Petra Saukkonen
- Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Juha Koivisto
- Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Tarja Heponiemi
- Finnish Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
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13
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Attitudes towards using artificial intelligence to determine real-time hand hygiene compliance in the food sector. Food Control 2023. [DOI: 10.1016/j.foodcont.2022.109439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nelson PA, Bradley F, Ullah A, Whittaker W, Brunton L, Calovski V, Money A, Dowding D, Cullum N, Wilson P. Implementation, uptake and use of a digital COVID-19 symptom tracker in English care homes in the coronavirus pandemic: a mixed-methods, multi-locality case study. Implement Sci Commun 2023; 4:7. [PMID: 36650559 PMCID: PMC9843982 DOI: 10.1186/s43058-022-00387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND COVID-19 spread rapidly in UK care homes for older people in the early pandemic. National infection control recommendations included remote resident assessment. A region in North-West England introduced a digital COVID-19 symptom tracker for homes to identify early signs of resident deterioration to facilitate care responses. We examined the implementation, uptake and use of the tracker in care homes across four geographical case study localities in the first year of the pandemic. METHODS This was a rapid, mixed-methods, multi-locality case study. Tracker uptake was calculated using the number of care homes taking up the tracker as a proportion of the total number of care homes in a locality. Mean tracker use was summarised at locality level and compared. Semi-structured interviews were conducted with professionals involved in tracker implementation and used to explore implementation factors across localities. Template Analysis with the Consolidated Framework for Implementation Research (CFIR) guided the interpretation of qualitative data. RESULTS Uptake varied across the four case study localities ranging between 13.8 and 77.8%. Tracker use decreased in all localities over time at different rates, with average use ranging between 18 and 58%. The implementation context differed between localities and the process of implementation deviated over time from the initially planned strategy, for stakeholder engagement and care homes' training. Four interpretative themes reflected the most influential factors appearing to affect tracker uptake and use: (1) the process of implementation, (2) implementation readiness, (3) clarity of purpose/perceived value and (4) relative priority in the context of wider system pressures. CONCLUSIONS Our study findings resonate with the digital solutions evidence base prior to the COVID-19 pandemic, suggesting three key factors that can inform future development and implementation of rapid digital responses in care home settings even in times of crisis: an incremental approach to implementation with testing of organisational readiness and attention to implementation climate, particularly the innovation's fit with local contexts (i.e. systems, infrastructure, work processes and practices); involvement of end-users in innovation design and development; and enabling users' easy access to sustained, high-quality, appropriate training and support to enable staff to adapt to digital solutions.
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Affiliation(s)
- Pauline A Nelson
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Fay Bradley
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Akbar Ullah
- Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Will Whittaker
- Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lisa Brunton
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Vid Calovski
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Annemarie Money
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Paul Wilson
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
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Boyle LD, Husebo BS, Vislapuu M. Promotors and barriers to the implementation and adoption of assistive technology and telecare for people with dementia and their caregivers: a systematic review of the literature. BMC Health Serv Res 2022; 22:1573. [PMID: 36550456 PMCID: PMC9780101 DOI: 10.1186/s12913-022-08968-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND One of the most pressing issues in our society is the provision of proper care and treatment for the growing global health challenge of ageing. Assistive Technology and Telecare (ATT) is a key component in facilitation of safer, longer, and independent living for people with dementia (PwD) and has the potential to extend valuable care and support for caregivers globally. The objective of this study was to identify promotors and barriers to implementation and adoption of ATT for PwD and their informal (family and friends) and formal (healthcare professionals) caregivers. METHODS Five databases Medline (Ovid), CINAHL, Web of Science, APA PsycINFO and EMBASE were searched. PRISMA guidelines have been used to guide all processes and results. Retrieved studies were qualitative, mixed-method and quantitative, screened using Rayyan and overall quality assessed using Critical Appraisal Skills Programme (CASP) and Mixed Methods Assessment Tool (MMAT). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and assigned within categories of high, moderate, or low. NVivo was used for synthesis and analysis of article content. A narrative synthesis combines the study findings. RESULTS Thirty studies (7 quantitative, 19 qualitative and 4 mixed methods) met the inclusion criteria. Identified primary promotors for the implementation and adoption of ATT were: personalized training and co-designed solutions, safety for the PwD, involvement of all relevant stakeholders, ease of use and support, and cultural relevance. Main barriers for the implementation and adoption of ATT included: unintended adverse consequences, timing and disease progress, technology anxiety, system failures, digital divide, and lack of access to or knowledge of available ATT. CONCLUSION The most crucial elements for the adoption of ATT in the future will be a focus on co-design, improved involvement of relevant stakeholders, and the adaptability (tailoring related to context) of ATT solutions over time (disease process).
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Affiliation(s)
- Lydia D. Boyle
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
| | - Bettina S. Husebo
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
| | - Maarja Vislapuu
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Årstadveien 17, 5009 Bergen, Norway ,grid.7914.b0000 0004 1936 7443Neuro-SysMed Center, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norge
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Hallam-Bowles FV, Logan PA, Timmons S, Robinson KR. Approaches to co-production of research in care homes: a scoping review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:74. [PMID: 36550509 PMCID: PMC9780102 DOI: 10.1186/s40900-022-00408-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies. METHODS A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives. RESULTS 19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators. CONCLUSION The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.
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Affiliation(s)
- F V Hallam-Bowles
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Centre for Rehabilitation and Ageing Research, Injury, Inflammation and Recovery Sciences, Medical School, University of Nottingham, Nottingham, UK.
| | - P A Logan
- Centre for Rehabilitation and Ageing Research, Injury, Inflammation and Recovery Sciences, Medical School, University of Nottingham, Nottingham, UK
- Nottingham CityCare Partnership, Nottingham, UK
| | - S Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - K R Robinson
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Rehabilitation and Ageing Research, Injury, Inflammation and Recovery Sciences, Medical School, University of Nottingham, Nottingham, UK
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Eide T, Gullslett MK, Eide H, Dugstad JH, McCormack B, Nilsen ER. Trust-based service innovation of municipal home care: a longitudinal mixed methods study. BMC Health Serv Res 2022; 22:1250. [PMID: 36243699 PMCID: PMC9569082 DOI: 10.1186/s12913-022-08651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in healthcare. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. METHODS The TM elements were developed through a comprehensive participatory process, resulting in the decision to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients' expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. RESULTS The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients' values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. CONCLUSIONS Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare.
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Affiliation(s)
- Tom Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Monika K Gullslett
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Janne H Dugstad
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Brendan McCormack
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Etty R Nilsen
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case. Int J Integr Care 2022; 22:1. [PMID: 36304784 PMCID: PMC9541166 DOI: 10.5334/ijic.6503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016–2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability. Methods: An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators. Discussion: Personalization and modularity of the intervention according to patients’ surgical risk were identified as core traits to enhance patients’ adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients’ and professionals’ decision support. The business model envisages operational costs financed by savings generated by the service. Conclusions: Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.
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Kruzan KP, Fitzsimmons-Craft EE, Dobias M, Schleider JL, Pratap A. Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking. PROCEDIA COMPUTER SCIENCE 2022; 206:6-22. [PMID: 37063642 PMCID: PMC10104522 DOI: 10.1016/j.procs.2022.09.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.
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Affiliation(s)
- Kaylee P. Kruzan
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mallory Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Abhishek Pratap
- Center for Addiction and Mental Health, Toronto, ON, M5T 1R8 Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, M5T 1R8, Canada
- Kings College London, London, WC2R 2LS, UK
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Duffy A, Christie GJ, Moreno S. The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review. JMIR Hum Factors 2022; 9:e35693. [PMID: 36083628 PMCID: PMC9508664 DOI: 10.2196/35693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. OBJECTIVE In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. METHODS A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as "digital health design," "mHealth design," "e-Health design," "agile health," and "agile healthcare." The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. RESULTS A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.
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Affiliation(s)
- Anthony Duffy
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
| | | | - Sylvain Moreno
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
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21
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Using health information technology in residential aged care homes: An integrative review to identify service and quality outcomes. Int J Med Inform 2022; 165:104824. [DOI: 10.1016/j.ijmedinf.2022.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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22
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New assistive technologies in dementia and mild cognitive impairment care: A PubMed review. Asian J Psychiatr 2022; 73:103135. [PMID: 35569363 DOI: 10.1016/j.ajp.2022.103135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Dementia is characterized by global cognitive dysfunction, which can cause difficulties in performing Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), leaving people with dementia (PwD) who do not have the proper support extremely vulnerable. Dementia management should involve preventative methods, including during the stage of mild cognitive impairment (MCI). Lay-caregivers are found to have poorer health in all three domains of the biopsychosocial model, as a result of the burden of care. New assistive technologies (ATs) have been designed to help care for PwD. ATs aim to be more affordable and widely available than human workers, achieving greater health equity and quality of life for all. METHODS To identify relevant articles, a literature search using PubMed was undertaken by one independent reviewer: S.L.C. The keywords of "dementia", "technology", and "management" were used, with no date of publication limitations, which revealed 571 results. RESULTS 44 articles were included in this review. Articles regarding new technologies to diagnose dementia or MCI were not included. ATs aim to help facilitate aging-in-place, reduce medical costs, and rates of caregiver burnout, by helping maintain patient functioning. DISCUSSION Legal issues in the form of workplace safety laws, data privacy laws and regulations, and health care ethics are major barriers to implementation that need to be resolved. The hope is that artificial intelligence (AI) systems may be able to advance what they are able to perceive and help uncover new knowledge and management options for dementia and MCI.
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23
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Grøndahl VA, Helgesen AK, Holm E, Magnussen J, Leonardsen AC. Remote monitoring of cancer patients during the Covid-19 pandemic - an interview study of nurses' and physicians' experiences. BMC Nurs 2022; 21:169. [PMID: 35765023 PMCID: PMC9238262 DOI: 10.1186/s12912-022-00953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Due to the Covid-19 pandemic, remote monitoring of patients outside hospitals rapidly increased. Previous studies show that healthcare professionals’ competence in digitalization needs to be improved. Little is known about how Covid-19 has affected the use of remote monitoring of cancer patients. The purpose of the study was therefore to explore healthcare personnels’ experiences with remote monitoring of cancer patients during the Covid-19 pandemic. Methods The study had an explorative and descriptive design using semi-structured individual interviews for data collection. Data was analyzed by content analysis. Results A total of ten healthcare personnel working in the cancer department and out-patient cancer clinic in the hospital participated; four physicians and six registered nurses. Two categories and four subcategories were identified: 1) «Maintaining personalized healthcare services» comprising the subcategories a) «Adjusting services to patients’ health condition» and b) «Ensuring continuity»; and 2) «A supplement, but not a replacement» comprising the subcategories a) «Impact on interpersonal relations» and b) «The importance of clinical assessment». Conclusions This study indicates that remote monitoring through telephone was preferred by both healthcare personnel and patients. The nurses and physicians experienced a more frequent contact with their patients, but emphasized the importance of physical meetings for building relationship, and for thorough clinical examination. Our findings indicate a need to facilitate a work environment where healthcare personnel can be fast learners in using digital tools to provide best possible healthcare quality. Moreover, it is imperative to develop a workplace suitable for the use of digital technology for remote monitoring, and to provide digital tools that is easy to use for both healthcare personnel and patients.
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Affiliation(s)
- Vigdis Abrahamsen Grøndahl
- Faculty of Health, Welfare and Organisation, Østfold University College, PB 700, NO-1757, Halden, Norway.
| | - Ann Karin Helgesen
- Faculty of Health, Welfare and Organisation, Østfold University College, PB 700, NO-1757, Halden, Norway
| | - Elisabet Holm
- Østfold Hospital Trust, Postboks 300, NO-1714, Grålum, Norway
| | | | - Ann-Chatrin Leonardsen
- Faculty of Health, Welfare and Organisation, Østfold University College, PB 700, NO-1757, Halden, Norway.,Østfold Hospital Trust, Postboks 300, NO-1714, Grålum, Norway
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24
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Enam A, Dreyer HC, De Boer L. Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation. BMC Health Serv Res 2022; 22:802. [PMID: 35729627 PMCID: PMC9209829 DOI: 10.1186/s12913-022-08164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management. Method In this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data. Result This study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective. Conclusion The main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08164-2.
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Affiliation(s)
- Amia Enam
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, 1365, Gløshaugen, Alfred Getz' vei 3, Trondheim, Norway.
| | - Heidi Carin Dreyer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
| | - Luitzen De Boer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
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25
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Londral A, Azevedo S, Dias P, Ramos C, Santos J, Martins F, Silva R, Semedo H, Vital C, Gualdino A, Falcão J, Lapão LV, Coelho P, Fragata JG. Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery. BMC Health Serv Res 2022; 22:680. [PMID: 35597936 PMCID: PMC9123610 DOI: 10.1186/s12913-022-08073-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients’ follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. Methods The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. Results Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service’s evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. Conclusions We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.
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Affiliation(s)
- A Londral
- Value for Health CoLAB, Lisbon, Portugal. .,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.
| | - S Azevedo
- Value for Health CoLAB, Lisbon, Portugal.,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.,CEG-IST, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - P Dias
- Value for Health CoLAB, Lisbon, Portugal.,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - C Ramos
- Value for Health CoLAB, Lisbon, Portugal.,Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - J Santos
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - F Martins
- Value for Health CoLAB, Lisbon, Portugal.,NOVA-LINCS, NOVA School of Science and Technology, Nova University of Lisbon, Lisbon, Portugal
| | - R Silva
- Value for Health CoLAB, Lisbon, Portugal.,NOVA CLUNL - Center of Linguistics, Nova University of Lisbon, Lisbon, Portugal
| | - H Semedo
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - C Vital
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - A Gualdino
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - J Falcão
- Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - L V Lapão
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.,UNIDEMI, NOVA School of Science and Technology, Nova University of Lisboa, Lisbon, Portugal
| | - P Coelho
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - J G Fragata
- Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal.,Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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26
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Tiittanen U, Turjamaa R. Social Inclusion and Communality of Volunteering: A Focus Group Study of Older People’s Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095141. [PMID: 35564534 PMCID: PMC9103720 DOI: 10.3390/ijerph19095141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023]
Abstract
The aim of this qualitative study was to describe the factors that motivate older people to volunteer and how volunteering influences their social inclusion and communality. Data were collected using focus group interviews in 2020–2021 from older people aged 65–81 years (n = 38) who had experience of volunteering in the community. The data were analyzed using inductive content analysis. Based on the results, the experiences described by older people who participate in volunteering consisted of factors encouraging older people to volunteer and depended on the activation, support, and motivation of volunteer operators. The support provided by the health care services and volunteer action organization for volunteers was a key factor in encouraging older people to participate in volunteering. Moreover, volunteering impacted the communality of volunteers in several ways, influencing social capital. The sense of communality was enhanced by the way in which volunteering was carried out, including collaboration with health care services and associations. In order to strengthen the importance of volunteering in society, there is a need for close collaboration between voluntary organizations and health care service providers to develop volunteering because health care organizations cannot respond to all of the challenges faced by the ageing population.
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Affiliation(s)
| | - Riitta Turjamaa
- Unit of Continuous Learning, Savonia University of Applied Sciences, 70210 Kuopio, Finland
- Department of Nursing Science, University of Eastern Finland, 70210 Kuopio, Finland
- Correspondence:
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27
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Rubeis G. Adiaphorisation and the digital nursing gaze: Liquid surveillance in long-term care. Nurs Philos 2022; 24:e12388. [PMID: 35355391 PMCID: PMC10078243 DOI: 10.1111/nup.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 12/01/2022]
Abstract
The nursing gaze, that is the specific ways of observing the patient in nursing practice, has been the object of ethical debates for decades. It has been argued that the specific feature of observing patients in nursing is the stereoscopic vision that allows nurses to see the patient at the same time as a subject and a body. However, with the increased use of technology in nursing and the focus on quantifiable biomedical data, some commentators see a shift from the view of the patient as subject to the patient as body, which results in a de-humanisation and objectification of patients. The new digital technologies in patient monitoring and surveillance add a further dimension to this topic. It is yet unclear how digital technologies affect the nursing gaze, and with it, nursing practice. Furthermore, the ethical implications of the digitally enhanced nursing gaze have yet to be analysed. It is the purpose of this study to make a first step in this direction. By focusing on digitally enhanced monitoring technologies in long-term care, these technologies are interpreted as liquid surveillance, an approach introduced by Zygmunt Bauman. The Baumanian concept of adiaphorisation, that is the detachment of social action from moral evaluation, is used as normative framework of the analysis. The analysis shows that the tendency to remove surveillance practices from moral evaluation by framing them as enablers of an active, healthy life and as tools for caring for the vulnerable, the stereoscopic vision of the nursing gaze is undermined.
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Affiliation(s)
- Giovanni Rubeis
- Department of Biomedical and Public Health Ethics, Karl Landsteiner University of Health Sciences, Krems, Austria
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28
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Fleury AL, Goldchmit SM, Gonzales MA, de Farias RR, Fernandes TL. Innovation in Orthopedics: Part 1-Design Thinking. Curr Rev Musculoskelet Med 2022; 15:143-149. [PMID: 35286559 PMCID: PMC8918897 DOI: 10.1007/s12178-022-09748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
Purpose of Review This narrative will focus on the adoption of design thinking to improve patient-centered care innovation in Orthopedics. Recent Findings The literature reveals a complete set of applications of the design thinking approach in the different stages of the patient experience throughout the health context; however, the papers identified focus on specific parts of the process, and there is no systemic analysis about the different aspects involved in each stage of the complete experience. This review presents a holistic analysis concerning the application of design thinking to the distinct phases of innovation development in orthopedics, from the identification of the specific initial challenges up to the introduction of technology-based artifacts, such as innovations in the musculoskeletal health market. Summary Systematic description of design thinking application to orthopedics, including concepts, methods, tools, and implementation examples in the most relevant phases of the patient experience—clinical treatment, perioperative care, and rehabilitation.
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Affiliation(s)
- Andre Leme Fleury
- Production Engineering Department, School of Engineering, Universidade de Sao Paulo, Av. Prof. Luciano Gualberto, 1380, Butanta, Sao Paulo, SP, 05508-010, Brazil.
| | - Sara Miriam Goldchmit
- Design Department, School of Architecture and Urbanism, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Alice Gonzales
- Design Department, School of Architecture and Urbanism, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rafaella Rogatto de Farias
- Sports Medicine Division, Institute of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tiago Lazzaretti Fernandes
- Sports Medicine Division, Institute of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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29
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Thijssen SV, Jacobs MJ, Swart RR, Heising L, Ou CX, Roumen C. The barriers and facilitators of radical innovation implementation in secondary healthcare: a systematic review. J Health Organ Manag 2021; ahead-of-print:289-312. [PMID: 34910413 PMCID: PMC10430798 DOI: 10.1108/jhom-12-2020-0493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to identify the barriers and facilitators related to the implementation of radical innovations in secondary healthcare. DESIGN/METHODOLOGY/APPROACH A systematic review was conducted and presented in accordance with a PRISMA flowchart. The databases PubMed and Web of Science were searched for original publications in English between the 1st of January 2010 and 6th of November 2020. The level of radicalness was determined based on five characteristics of radical innovations. The level of evidence was classified according to the level of evidence scale of the University of Oxford. The Consolidated Framework for Implementation Research was used as a framework to classify the barriers and facilitators. FINDINGS Based on the inclusion and exclusion criteria, nine publications were included, concerning six technological, two organizational and one treatment innovation. The main barriers for radical innovation implementation in secondary healthcare were lack of human, material and financial resources, and lack of integration and organizational readiness. The main facilitators included a supportive culture, sufficient training, education and knowledge, and recognition of the expected added value. ORIGINALITY/VALUE To our knowledge, this is the first systematic review examining the barriers and facilitators of radical innovation implementation in secondary healthcare. To ease radical innovation implementation, alternative performance systems may be helpful, including the following prerequisites: (1) Money, (2) Added value, (3) Timely knowledge and integration, (4) Culture, and (5) Human resources (MATCH). This study highlights the need for more high-level evidence studies in this area.
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Affiliation(s)
- Salina V. Thijssen
- Department of Radiation Oncology (Maastro), GROW School for Oncology,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Maria J.G. Jacobs
- Tilburg School of Economics and Management
,
Tilburg University
, Tilburg,
Netherlands
| | - Rachelle R. Swart
- Department of Radiation Oncology (Maastro), GROW School for Oncology,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
| | - Luca Heising
- Tilburg School of Economics and Management
,
Tilburg University
, Tilburg,
Netherlands
| | - Carol X.J. Ou
- Tilburg School of Economics and Management
,
Tilburg University
, Tilburg,
Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (Maastro), GROW School for Oncology,
Maastricht University Medical Centre+
, Maastricht,
The Netherlands
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30
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Laukka E, Kujala S, Gluschkoff K, Kanste O, Hörhammer I, Heponiemi T. Leaders' support for using online symptom checkers in Finnish primary care: Survey study. Health Informatics J 2021; 27:14604582211052259. [PMID: 34821152 DOI: 10.1177/14604582211052259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders' support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders' support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders' support for the service (β ranging from 0.41 to 0.44, p < 0.001). Leaders' support for the service was also associated with how well the leaders provided information about the service to their subordinates (β =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals' work. The developers of SCs should focus more on features that decrease health professionals' workload as well as how the solution can benefit patients.
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Affiliation(s)
- Elina Laukka
- Research Unit of Nursing Science and Health Management, 60653University of Oulu, Oulu, Finland; Health and Social Service System Research Team, 3837Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Kujala
- Department of Computer Science, 174277Aalto University, Espoo, Finland
| | - Kia Gluschkoff
- Health and Social Service System Research Team, 3837Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, 60653University of Oulu, Oulu, Finland; Medical Research Center, 60653Oulu University Hospital, Oulu, Finland
| | - Iiris Hörhammer
- Department of Industrial Engineering and Management, 174277Aalto University, Espoo, Finland
| | - Tarja Heponiemi
- Health and Social Service System Research Team, Finnish Institute for Health and Welfare, Helsinki, Finland
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A Scoping Review of Empirical Evidence on (Digital) Public Services Co-Creation. ADMINISTRATIVE SCIENCES 2021. [DOI: 10.3390/admsci11040130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The public sector is facing significant challenges regarding public services provision, including declination of users’ trust and limited resources. An alternative approach to traditional public service provision with the potential to address these challenges is the co-creation of public services. Co-creation promises to foster innovative solutions to provide high-quality services that respond to users’ needs. Considering this background, we aim at critically exploring public service co-creation via a scoping review, employing the PRISMA-ScR method. Our review focuses on 25 empirical studies out of 75 analyzed articles that examine the implementation of co-creation of (digital) public services and investigates how the empirical literature portrays the concept of public service co-creation. Our findings primarily suggest that co-creation can be implemented in a wide range of sectors and settings, to improve public services and to foster innovation, throughout the whole public service cycle, using a variety of digital, analog and hybrid co-creation tools and strategies. Yet, our review has also shown that there is still an implementation gap that needs to be bridged between knowing and doing in the context of public services co-creation in a digital setting.
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Nakanishi M, Yamasaki S, Endo K, Niimura J, Ziylan C, Bakker TJEM, Granvik E, Nägga K, Nishida A. e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study. JMIR MEDICAL EDUCATION 2021; 7:e30652. [PMID: 34543224 PMCID: PMC8513743 DOI: 10.2196/30652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 09/19/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. OBJECTIVE The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. METHODS A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. RESULTS A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=-0.61, P=.69). CONCLUSIONS The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Kaori Endo
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Junko Niimura
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Canan Ziylan
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Ton J E M Bakker
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Stichting Wetenschap Balans, Rotterdam, Netherlands
| | - Eva Granvik
- Center for Excellence in Dementia, University Hospital, Malmö, Malmö, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
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Ochieng L, Amaugo L, Ochieng BMN. Developing healthy weight maintenance through co-creation: a partnership with Black African migrant community in East Midlands. Eur J Public Health 2021; 31:487-493. [PMID: 33532825 DOI: 10.1093/eurpub/ckaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity prevalence in the UK varies according to ethnicity, with children from minority ethnic groups experiencing higher levels, and yet, there is a scarcity of projects that involve minority ethnic groups in the design of interventions to promote healthy weight maintenance. This article presents an account of the involvement of the participants in a co-creation activity to design public health resources for the maintenance of healthy weight. METHODS The material is drawn from a study that involved Black African parents (n = 30) and Health Visitors (n = 32), residing and working in the East Midlands, UK, respectively. The participants were purposely selected according to an inclusion/exclusion criterion and invited to participate in seven focus groups (FG) conducted for parents (FG-4) and health visitors (FG-3) at a time and place convenient to the participants. Following the focus groups, the Black African parents participated in three co-creation workshops. RESULTS The co-creation activities involved the participants, the researcher and a nutritionist. The outcome was an African heritage eatwell guide and a framework to promote healthy weight, which was well-received when presented to members of the community and local health and social care practitioners. CONCLUSION The co-creation process went beyond giving the participant a voice in shaping the promotion of healthy weight within their community, as they also became active participants in the design and creation of the specific public health service. The approach offered the potential for improved levels of community satisfaction for a public health intervention.
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Affiliation(s)
- Lorraine Ochieng
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Lucky Amaugo
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Bertha M N Ochieng
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
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Gullslett MK, Kristiansen E, Nilsen ER. Therapists' Experience of Video Consultation in Specialized Mental Health Services During the COVID-19 Pandemic: Qualitative Interview Study. JMIR Hum Factors 2021; 8:e23150. [PMID: 34096505 PMCID: PMC8284340 DOI: 10.2196/23150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 06/06/2021] [Indexed: 01/20/2023] Open
Abstract
Background As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available.
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Affiliation(s)
- Monika K Gullslett
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Eli Kristiansen
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Etty R Nilsen
- School of Business and Economics, University of Tromsø (UiT), Alta, Norway
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Mc Carthy V, Goodwin J, Saab MM, Kilty C, Meehan E, Connaire S, Buckley C, Walsh A, O'Mahony J, O'Donovan A. Nurses and midwives' experiences with peer-group clinical supervision intervention: A pilot study. J Nurs Manag 2021; 29:2523-2533. [PMID: 34213054 DOI: 10.1111/jonm.13404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to evaluate differences in supervisees' understanding of clinical supervision and their perceptions of organisational functioning before and after engaging in peer-group clinical supervision. BACKGROUND Protected reflective time allows discussion of complex issues affecting health care. Peer-group clinical supervision is one model of clinical supervision that could facilitate this, but it is poorly understood. METHODS A pre-post intervention pilot study was performed. The intervention was delivered over a 12-month period. Data were collected using surveys on demographic and work-related factors and experience of clinical supervision pre- and post intervention. RESULTS Adaptability increased significantly between the pre- and post surveys. The post survey data showed finding time for clinical supervision scoring lowest with open-ended comments reinforcing this. The supervisees found the sessions to offer a safe place despite initial concerns. CONCLUSION The peer-group model of clinical supervision allowed supervisees to build a rapport and trust with their colleagues and share experiences. IMPLICATIONS FOR NURSING MANAGEMENT The benefits to participating in peer-group clinical supervision traversed the individual and organisation. These data support the implementation of such sessions while addressing workload and time pressures to aid participation.
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Affiliation(s)
- Vera Mc Carthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sinead Connaire
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Carmel Buckley
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Anne Walsh
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - James O'Mahony
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Müller K, Peters M. [Tracking systems in people with dementia in long-term care - Update of an integrative review]. Pflege 2021; 34:181-190. [PMID: 34105985 DOI: 10.1024/1012-5302/a000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tracking systems in people with dementia in long-term care - Update of an integrative review Abstract. Background: This article is an update of the article by Hülsken-Giesler et al. (2019) and describes the latest findings on tracking systems in inpatient long-term care. RESEARCH QUESTION The research question also follows on from the underlying article and again deals with the application of tracking systems and their consequences for residents and nursing staff. METHODS A systematic literature search in the databases MEDLINE via PubMed and CINAHL as well as a hand search for the period starting in August 2017 was performed. The included literature was evaluated by two independent persons regarding content and methodology. RESULTS In addition to deductive categories from the underlying work, further inductive categories could be formed and thus ethical and implementation aspects could be included. CONCLUSION Since the first analysis, the focus in nursing science studies on the use of tracking systems in inpatient long-term care has shifted to ethical aspects. Also, the successful and long-term integration into care practice is now relevant.
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Halvorsrud L, Holthe T, Karterud D, Thorstensen E, Lund A. Perspectives on assistive technology among older Norwegian adults receiving community health services. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33861681 DOI: 10.1080/17483107.2021.1906962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The western world is seeking increased implementation of assistive technology (AT) to meet the challenges of an ageing population. The objective of this study is to explore perspectives on AT use among home-dwelling older adults with or without cognitive impairment. METHODS This study combines findings from a cross-sectional study with a questionnaire package (n = 83) and from qualitative individual interviews (n = 7) and is part of a larger study, the Assisted Living Project. Combining methods promotes complementary inquiries into a phenomenon. RESULTS The participants already use ATs: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers. They were both optimistic and skeptical of AT, and expressed different perspectives and expressed different perspectives on ATs in relation to usability, privacy and fear of losing personal face-to-face care. CONCLUSIONS This study reveals that older adults' perspectives on AT are multifaceted and complex, and can partly be explained by the interacting factors in the HAAT model: person, technology, environment, and context. Further exploration in relation to older adults with health challenges, as well as ethical perspectives on AT implementation, is required for this group. TRIAL REGISTRATION NUMBER The Norwegian Research Council, Number 47996, funds the Assisted Living Project (ALP).IMPLICATIONS FOR REHABILITATIONThe study was useful in order to inform the health care services about older adults "perspectives on assistive technology".This study reveals the complexity of understanding perspectives towards and the use of assistive technology among older adults with or without cognitive impairment.This study contributes to the understanding of the interactions between the four components: humans, activities, technology and the context.
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Affiliation(s)
- Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Torhild Holthe
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Norwegian Advisory Unity for Ageing and Health, Vestfold Hospital Trust, Tönsberg, Norway
| | - Dag Karterud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Erik Thorstensen
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Anne Lund
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Vansimaeys C, Benamar L, Balagué C. Digital health and management of chronic disease: A multimodal technologies typology. Int J Health Plann Manage 2021; 36:1107-1125. [PMID: 33786849 DOI: 10.1002/hpm.3161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/19/2021] [Accepted: 03/13/2021] [Indexed: 11/08/2022] Open
Abstract
This cross-sectional descriptive study aims to (1) describe the current digital technology (DT) use of people with chronic diseases (CD) by identifying different user profiles and (2) determine whether those profiles have specific characteristics regarding health-related variables and patient-doctor relationship quality (RQ). An online questionnaire assessing the uses of multiple types of DT (the Internet, mobile applications and connected devices) and several dimensions related to health and patient-doctor RQ was completed by 954 individuals living with CD. DT user groups were obtained by k-means cluster analysis and then compared using Mann-Whitney tests. The results show three profiles of DT users: (1) hyperconnected (8.9%, regular users of all DTs), (2) biconnected (19.1%, regular users of the Internet and mobile apps) and (3) hypoconnected (72%, casual users of the Internet only). The hyperconnected and biconnected groups are more empowered, more knowledgeable about their treatment and more committed to their doctors than the hypoconnected group. Nonadherence to treatment, health motivations, self-efficacy for health management and the trust dimension of the patient-doctor RQ did not differ between groups. We conclude by discussing the low use of the most recent technologies in the CD population, although these technologies seem to provide access to health information that empowers patients and leads to a better relationship with their doctors.
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Affiliation(s)
- Camille Vansimaeys
- LITEM, Univ Evry, IMT-BS, Université Paris-Saclay, Evry, France.,Université de Paris, LPPS, Boulogne Billancourt, France
| | - Lamya Benamar
- LITEM, Univ Evry, IMT-BS, Université Paris-Saclay, Evry, France
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. 'They just came with the medication dispenser'- a qualitative study of elderly service users' involvement and welfare technology in public home care services. BMC Health Serv Res 2021; 21:245. [PMID: 33740974 PMCID: PMC7977566 DOI: 10.1186/s12913-021-06243-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people's involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users' experience of user involvement in the implementation and everyday use of welfare technology in public home care services. METHOD This qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. RESULTS Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible. CONCLUSION The results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Postboks 509, N-4898, Grimstad, Norway
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
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Leonardsen ACL, Hardeland C, Helgesen AK, Grøndahl VA. Patient experiences with technology enabled care across healthcare settings- a systematic review. BMC Health Serv Res 2020; 20:779. [PMID: 32838784 PMCID: PMC7446109 DOI: 10.1186/s12913-020-05633-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Healthcare services are facing extensive challenges due to the increased proportion of elderly persons and persons with chronic disease. Technology enabled care (TEC) is a collective term for telecare, telehealth, telemedicine, mobile (m)-, digital- and electronic (e) health services. TEC is increasingly seen as a solution to many of the challenges facing the health sector. Patient perspectives may provide a useful evaluation tool for new healthcare technologies that have limited clinical data to support their effectiveness. More studies need to be done to better understand the acceptance of technology in healthcare. This review aim to summarize empirical studies exploring patient experiences with TEC. Findings in this study can be used to better understand what is needed to develop, implement and improve such services. METHODS Systematic searches were conducted in the Pubmed, Psycinfo, Cinahl, Embase, Cochrane systematic reviews and Cochrane clinical trials databases. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, subjected to quality appraisals using the Critical Appraisal Skills Program (CASP), and synthesized via integrative analysis. RESULTS After removal of duplicates, languages other than English, and non-scientific records, 4087 titles and abstracts were screened. After assessment against inclusion and exclusion criteria, 69 records were screened in full-text, and underwent quality appraisal. 21 records were included in the integrative analysis. Patients' experiences with TEC related to 1) technological features, namely functionality and appearance, and 2) evolving independence, namely empowerment, autonomy and security. Technological challenges lead to frustrations and negative experiences, while a stigmatizing appearance lead to patients not using the solution. Through the use of TECs, patients felt more empowered, learning about their condition, increasing awareness to their symptoms and treatment, and feeling more safe and self-efficient. Patient participation was seen as a central aspect of the development of the TECT, as well as when using it. CONCLUSION This review deepens the understanding of patients' experiences with technology enabled care solutions. Patients' experiences not only relate to the practical/technical element of the device or solution, but to how this impact on their everyday life. Patient participation in development and planned use of such solutions should be considered an integral part in healthcare quality initiatives.
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Affiliation(s)
| | - Camilla Hardeland
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Ann Karin Helgesen
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Vigdis A. Grøndahl
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. User involvement in the implementation of welfare technology in home care services: The experience of health professionals-A qualitative study. J Clin Nurs 2020; 29:4007-4019. [PMID: 33463827 DOI: 10.1111/jocn.15424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study is to learn more about factors that promote or inhibit user involvement among health professionals when implementing welfare technology in home care services. BACKGROUND It is a health policy goal to increase the use of welfare technology in order to address some of the challenges that healthcare services are facing. Health professionals' involvement is important for the successful implementation of welfare technology in home care services. DESIGN The study has an explorative and descriptive longitudinal design based on a qualitative approach. Five focus group interviews were conducted with 16 nurses and assistant nurses from three different municipalities over a period of 2 years. The data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes: competence a critical component, information and information lines, new ways of working, choice of welfare technology and change in patient services. From health professionals' perspective, there appeared to be a lack of preparedness for the change in the implementation of welfare technology entailed for home care services. The respondents experienced limited facilitation and opportunities for user involvement. CONCLUSION Health professionals want to be more involved but emphasised that competence, information and collaborative arenas are necessary factors if involvement in the process is to be increased. Competence affected some of the respondents' attitudes and willingness to use the technology. The respondents also experienced that the managements' focus on facilitation and interest in user involvement in addition to infrastructures that functioned in various ways had an impact on user involvement. RELEVANCE TO CLINICAL PRACTICE The knowledge gained from this study about factors that promote or inhibit user involvement among health professionals could contribute to better preparedness for further implementation of welfare technology in the field of home care.
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Affiliation(s)
- Heidi Snoen Glomsås
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
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Li K, Peng MYP, Du Z, Li J, Yen KT, Yu T. Do Specific Pedagogies and Problem-Based Teaching Improve Student Employability? A Cross-Sectional Survey of College Students. Front Psychol 2020; 11:1099. [PMID: 32714225 PMCID: PMC7344217 DOI: 10.3389/fpsyg.2020.01099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Higher education policy and manpower training have failed to meet the requirement of rapidly changing society and employers' expectation in Taiwan, resulting in a significant gap between university education and employment. Student employability should also be a focus of all higher education institutions, although whether a high degree of student learning outcomes can represent a high degree of student employability is still unclear. This study explores the relationships among pedagogy for employability, the problem-based teaching mode, absorptive capacity, and student employability in higher education institutions (HEIs). Based on analysis of a total sample of 553 undergraduates from 16 Taiwanese HEIs using structural equation modeling, the results show that the influences of pedagogy for employability and the problem-based teaching mode on absorptive capacity and student employability are positively statistically significant. Based on the findings, specific suggestions and managerial implications for HEIs, curriculum and instruction planning, and future research are provided.
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Affiliation(s)
- Kerang Li
- School of History and Culture, Hebei Normal University, Shijiazhuang, China
| | - Michael Yao-Ping Peng
- School of Economics and Managemant, Foshan University, Foshan, China
- School of Digital Economics, Guilin University of Electronic Technology, Guilin, China
| | - Zongmin Du
- Business School, University of National and World Economy, Sofia, Bulgaria
| | - Jing Li
- Dong Fureng Economic and Social Development School, Wuhan University, Wuhan, China
| | - Ke-Tien Yen
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan
| | - Tsao Yu
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan
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Deng X, Wang Y, Sun X. How Turbulence Brings Benefit: The Influence of Dynamic Team Environment on Entrepreneurial Team Innovation. Front Psychol 2020; 11:759. [PMID: 32528337 PMCID: PMC7265091 DOI: 10.3389/fpsyg.2020.00759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022] Open
Abstract
From the perspective of entrepreneurial team processes, this study examines the effect of a dynamic team environment on entrepreneurial team innovation. Through applying uncertainty reduction theory, it proposes the influence mechanism and boundary condition of the relationship between dynamic team environment and entrepreneurial team innovation. By analyzing a sample of 270 entrepreneurial teams in China, it is found that a dynamic team environment can evoke entrepreneurial team innovation via triggering team members' agreement-seeking behavior and then promoting team knowledge integration. In addition, team centralization of decision making can weaken the relationship between agreement-seeking behavior and team knowledge integration. Our findings contribute to a better understanding of entrepreneurial teams' reactions to dynamic environments and the multistep mechanism that transfers the impact of a dynamic team environment to entrepreneurial team innovation through team members' reactions and team interactions.
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Affiliation(s)
- Xiao Deng
- Business School, China University of Political Science and Law, Beijing, China
| | - Ying Wang
- Guanghua School of Management, Peking University, Beijing, China
| | - Xiuli Sun
- Guanghua School of Management, Peking University, Beijing, China
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Holthe T, Halvorsrud L, Thorstensen E, Karterud D, Laliberte Rudman D, Lund A. Community Health Care Workers' Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia. J Multidiscip Healthc 2020; 13:447-458. [PMID: 32547050 PMCID: PMC7245453 DOI: 10.2147/jmdh.s246180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D. Participants and Methods Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke. Results Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities. Conclusion This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D. Trial registration NSD project number 47996.
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Affiliation(s)
- Torhild Holthe
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Norway
| | - Liv Halvorsrud
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Erik Thorstensen
- Oslo Metropolitan University, Work Research Institute, Centre for Welfare and Labour Research, Oslo, Norway
| | - Dag Karterud
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Debbie Laliberte Rudman
- University of Western Ontario, School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, London, Canada
| | - Anne Lund
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Norway
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Nilsen ER, Stendal K, Gullslett MK. Implementation of eHealth Technology in Community Health Care: the complexity of stakeholder involvement. BMC Health Serv Res 2020; 20:395. [PMID: 32393265 PMCID: PMC7212667 DOI: 10.1186/s12913-020-05287-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development. Methods In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services. Results We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external–internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders). Conclusions Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context.
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Affiliation(s)
- Etty R Nilsen
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway.
| | - Karen Stendal
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway
| | - Monika K Gullslett
- University of South-Eastern Norway (USN), Post Office Box 235, 3603, Kongsberg, Norway
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Laukka E, Huhtakangas M, Heponiemi T, Kanste O. Identifying the Roles of Healthcare Leaders in HIT Implementation: A Scoping Review of the Quantitative and Qualitative Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2865. [PMID: 32326300 PMCID: PMC7215383 DOI: 10.3390/ijerph17082865] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022]
Abstract
Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders' roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O'Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders' roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation.
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Affiliation(s)
- Elina Laukka
- Social and Health Systems Research Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Moona Huhtakangas
- Research Unit of Nursing Science and Health Management, University of Oulu, 90230 Oulu, Finland; (M.H.); (O.K.)
| | - Tarja Heponiemi
- Social and Health Systems Research Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland;
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, 90230 Oulu, Finland; (M.H.); (O.K.)
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Dugstad J, Sundling V, Nilsen ER, Eide H. Nursing staff's evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study. BMC Health Serv Res 2020; 20:163. [PMID: 32131815 PMCID: PMC7057572 DOI: 10.1186/s12913-020-4998-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 02/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities. Methods The study had a cross-sectional descriptive design. We collected data from care providers (n = 98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores. MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation. Results More facilitators (n = 22) than barriers (n = 6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety, and the normative belief of unit managers. During the implementation process, 87% became familiar with the systems, and 86 and 90%, respectively regarded themselves and their colleagues as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge and that they found the WNCS difficult to learn. No features of the technology were identified as barriers. Conclusions Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services.
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Affiliation(s)
- Janne Dugstad
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Vibeke Sundling
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Etty R Nilsen
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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