Healthcare and the information revolution: re-configuring the healthcare service encounter

ICT penetration and life expectancy in emerging market economies: panel evidence from asymmetric causality analysis

BACKGROUND

Life expectancy is a significant result indicator of public health and sustainable development. Therefore, one of the final objectives of all economic and social policies is to increase the life expectancy. In this context, a limited number of researchers have investigated the relationship between ICT penetration and life expectancy. However, multiple interaction channels exist between ICT penetration and life expectancy. Furthermore, the studies have usually focused on the effect of ICT penetration on life expectancy through regression and ignored the effect of life expectancy on ICT penetration to a large extent. Therefore, this study aims to contribute to the empirical literature by investigating the causal relationship between ICT indicators and life expectancy.

METHODS

This study uses symmetric and asymmetric causality approaches to investigate the two-way interaction between ICT indicators and life expectancy in emerging market economies over the 1997-2020 period. Employment of the asymmetric causality test enables us to analyze the hidden relationships between ICT indicators and life expectancy, unlike the traditional causality test.

RESULTS

The results of the symmetric causality test uncover a bidirectional causal interaction between mobile subscriptions and life expectancy but a one-way causal relationship from life expectancy to internet usage. However, the asymmetric causality test results uncover a unidirectional causal relationship between mobile subscriptions and life expectancy in China, Colombia, Czechia, Egypt, Greece, India, Kuwait and Turkiye due to positive shocks from mobile subscriptions. On the other hand, a bidirectional causal interaction exists between internet usage and life expectancy in all countries due to negative shocks from internet usage and life expectancy. Last, a unidirectional causal relationship exists between internet usage and life expectancy in all countries due to positive shocks from internet usage.

CONCLUSION

ICT indicators significantly influence life expectancy health in a sample of emerging market economies. Therefore, internet usage and mobile devices are significant tools to improve life expectancy.

Online Health Searches and Their Perceived Effects on Patients and Patient-Clinician Relationships: ASystematic Review

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from January 1, 1990 to January 29, 2016 for studies in which patients searched online for any aspect of health care and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, although the nature of the effect could depend on the clinician's response to patient queries about the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship and commonly raised concerns about the accuracy of online content. Significant methodologic heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking.

Clients' initiatives and caregivers' responses in the organizational dynamics of care delivery

Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.

Exploring the Social Dynamics of Implementing Self-Managed Web-Based Wellness Tools

According to proponents of consumer-driven healthcare, the Web continues to offer huge opportunities to empower consumers to take individual ownership over their healthcare. Consequently many healthcare insurance service providers are integrating elements of Wellness into their product and service design and are making these available through Web-based portals. Based on a longitudinal case study of an e-Wellness implementation at a multinational consumer-driven healthcare insurance firm, key concepts from structuration theory are used to explore and analyse the social dynamics involved in the implementation of these contemporary forms of healthcare service encounters. This case study reports that in this particular context, face-to-face consultations continue to prevail over the use of virtual diagnosis and treatment by a computer-meditated virtual stress therapist and dietician practitioner. The author proposes the use of social frameworks to analyse and better understand the intricacies involved in implementing Wellness innovations.

Physicians' communicative strategies in interacting with Internet-informed patients: results from a qualitative study

This article describes the strategies used by physicians to interact with Internet-informed patients, alongside illustrating the motives underlying such strategies. Semistructured interviews were conducted with a sample of 17 physicians from primary care and medical specialist practices in the Italian part of Switzerland. The sample was diversified in terms of specialty, age, and gender. Data collection and analysis were driven by grounded theory and supported by a computer-assisted qualitative analysis program. A typology of four communicative strategies has been outlined. The adoption of these strategies is shaped by physicians' general attitude toward Internet-informed patients, based on their conception of medical information for lay people through the Internet. However, this general attitude is mediated by doctors' interpretation of the specific communicative context, that is, their appraisal of three aspects: the patient's health literacy, the relevance of the online information to be discussed, and their own communicative efficacy. At the end, the process of interpretation underlying the strategies is discussed to expand on it and to identify implications for practice and research.

Internet guidance in oncology practice: determinants of health professionals' Internet referral behavior

BACKGROUND

Many cancer patients turn to the Internet to obtain information on their disease. This digital quest is often motivated by a perceived discrepancy between the information received from health professionals and patients' actual informational needs. This discrepancy may be reduced by supplementing standard patient education with reliable online information sources. This study investigates health professionals' opinions, cognitions, and behavior regarding referring cancer patients to Internet-based information.

METHODS

Online and written questionnaires were distributed among Dutch oncology nurses and medical specialists, measuring perception of patients' informational needs, prompted and unprompted Internet referral, and socio-cognitive factors regarding referral behavior.

RESULTS

Health professionals (N = 130) positively appraised Internet use among cancer patients. Despite recognizing patients' needs for additional information (84%) and need for referral to reliable websites (67%), only 20% frequently referred patients to Internet-based information. Prompted Internet referral was higher (64%). Motives for nonreferral included unfamiliarity with websites and uncertainty about information quality. Intentions towards future referral were moderate to high. To translate intentions into referral, health professionals need reminder tools and information on reliability and content of websites. Cognitive determinants of referral behavior included professionals' attitude, self-efficacy, and intentions regarding referral.

CONCLUSIONS

Recognition of patients' information needs does not culminate in Internet referral among health professionals in cancer care. High intentions to change, however, indicate good prospects for future referral. This study yields valuable insights into behavioral determinants of health professionals' Internet referral behavior. Targeting determinants and barriers in future interventions will provide opportunities for optimization of educational practices.

Untangling the Web--the impact of Internet use on health care and the physician-patient relationship

OBJECTIVE

The use of Web (i.e. Internet)-derived health information within the health care encounter is rapidly increasing. In this article, an extensive review of the complex effects and sometimes contradictory roles of the Web in regard to health care delivery and the physician-patient relationship is presented.

METHODS

A review of relevant literature was conducted, with key points integrated into a physician guide for effective interaction with Web-activated patients.

RESULTS

An emerging consumerist model with "triangulation" of patient-Web-physician can be expected to significantly impact dynamics of the physician-patient relationship. Potential advantages of Web-acquired information include helping patients make informed health care choices (with potential to decrease health care disparities), shared decision-making with a collaborative, teamwork approach, more efficient use of clinical time, augmenting of physician-provided information, online support groups, and/or access to patients' own health information. Alternatively, factors such as misinformation due to highly variable quality of Web information, possible exacerbation of socioeconomic health disparities, and shifting of conventional notions of the physician-patient relationship ("traditional" medical authority) present their own set of challenges for the health care provider.

CONCLUSION

A tangible guide to the integration of patients' use of the Web within a medical practice is thus offered with recommended communication skills.

PRACTICE IMPLICATIONS

The "net-friendly" clinician can be effective by engendering a genuine partnership with patients, thus contributing to quality health care.

Internet marketing of bariatric surgery: contemporary trends in the medicalization of obesity

In the context of political, economic, and scientific anxiety around the 'epidemic' rise in obesity in the US, the social and historical forces engendering the medicalization of obesity have been widely discussed. However, the recent growth of bariatric-weight loss-surgery and the expanding presence of advertising for bariatric surgery on the Internet suggest the possible emergence of new loci and languages of medicalization. We sought to identify the nature and extent to which web advertising of bariatric surgery contributes to the medicalization of obesity by examining the design and textual content of 100 bariatric surgery center websites. We found that websites, through strategic use of text and images, consistently describe obesity as a serious disease that requires professional ascertainment and supervision, entails substantial individual suffering, and is remedied through the transformative yet low risk effects of bariatric surgery. In the process, social normalcy and risk reduction come to replace physical criteria as the basis for determining health. Further, websites draw upon contradictory discourses of medicalization; that is, they insist upon 'external' (e.g. genetics, environment) causes of obesity to legitimize surgical intervention while implicating individual behaviors in surgical failure. From this, we suggest that the economic and professional motivations underlying website advertisements for bariatric surgery may result in confusing messages being sent to prospective patients as well as the perpetuation of gendered notions of obesity and the entrenchment of health disparities.