1
|
Veerman LK, Fjermestad KW, Vatne TM, Sterkenburg PS, Derks SD, Brouwer-van Dijken AA, Willemen AM. Cultural applicability and desirability of 'Broodles': The first serious game intervention for siblings of children with disabilities. PEC INNOVATION 2024; 4:100277. [PMID: 38590338 PMCID: PMC11000116 DOI: 10.1016/j.pecinn.2024.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
Objective Serious games can serve as easily accessible interventions to support siblings of children with disabilities, who are at risk of developing mental health problems. The Dutch serious game 'Broodles' was developed for siblings aged 6-9 years. The current study aims to assess the cultural applicability, desirability, feasibility, and acceptability of 'Broodles' in Norway. Methods Norwegian siblings (N = 16) aged 6-13 years and parents (N = 12) of children with intellectual disabilities assessed the game. Their feedback data from interviews and questionnaires were sorted using a model of engagement factors in serious games. Results At pre-use, participants showed interest in the game, and after initial use the participants were overall positive about the format, content and objectives, including validation of emotions and recognition. The participants had suggestions for improved engagement and feasibility. Conclusion The game was found to be culturally applicable, desirable and acceptable, although Norwegian translation is necessary for further evaluation. Recommendations to enhance engagement were provided, including suggestions to play the game with parents or in a group. Innovation This initial assessment of the serious game Broodles in a non-Dutch setting shows promise for an innovative way of supporting siblings of children with disabilities.
Collapse
Affiliation(s)
- Linda K.M. Veerman
- Vrije Universiteit Amsterdam, Amsterdam Public Health, LEARN!, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
| | - Krister W. Fjermestad
- University of Oslo, Boks 1072 Blindern, 0316, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Sandbakkveien 18, 1404, Siggerud, Norway
| | - Torun M. Vatne
- University of Oslo, Boks 1072 Blindern, 0316, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Sandbakkveien 18, 1404, Siggerud, Norway
| | - Paula S. Sterkenburg
- Vrije Universiteit Amsterdam, Amsterdam Public Health, LEARN!, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
- Bartiméus, Oude Arnhemse Bovenweg 3, 3941 XM, Doorn, the Netherlands
| | - Suzanne D.M. Derks
- Vrije Universiteit Amsterdam, Amsterdam Public Health, LEARN!, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
| | | | - Agnes M. Willemen
- Vrije Universiteit Amsterdam, Amsterdam Public Health, LEARN!, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Duevel JA, Baumgartner A, Grosser J, Kreimeier S, Elkenkamp S, Greiner W. A Case Management Approach in Stroke Care: A Mixed-Methods Acceptance Analysis From the Perspective of the Medical Profession. Prof Case Manag 2024; 29:158-170. [PMID: 38015804 DOI: 10.1097/ncm.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF STUDY In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality. The concept of case management has the potential to improve cooperation between sectors and health care providers. Hence, a case management intervention for patients with stroke was evaluated with an acceptance analysis on the physicians' willingness to cooperate with stroke managers and their assessment of the potential of case management for the health care of patients with stroke. PRIMARY PRACTICE SETTINGS Primary practice settings included physicians working in the hospital, rehabilitation, and outpatient sectors who had actual or potential contact with a stroke case manager within the project region of East Westphalia-Lippe. METHODOLOGY AND SAMPLE The analysis was conducted using a mixed-methods approach. Expert interviews were conducted in 2020. Afterward a questionnaire was developed, which was then distributed to physicians in 2021. Both the interviews and the questionnaire included questions on conceptual knowledge and concrete expectations prior of the project, on experiences during the project and on recommendations and physicians' assessment of future organization in health care to classify and describe the acceptance. RESULTS Nine interviews were conducted and 23 questionnaires were completed. Only slightly more than 50% of the physicians had prior knowledge of the case management approach. Overall, ambiguous results concerning the acceptance of case managers were revealed. Additional personal assistance for patients with stroke was seen as beneficial at the same time critical perspectives regarding further fragmentation of health care and overlapping of competences with existing professional groups or forms of health care were collected. General practitioners in particular were critical of the case management approach. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE From the physicians' point of view, at least two changes are necessary for the project approach to be integrated into standard care. First, the target group should be adapted according to the case management approach. Second, the delegation of tasks and responsibilities to case managers should be revised. The sectoral difference in the acceptance of case managers by physicians indicates that active cooperation and communication in everyday work has direct impact on the acceptance of a new occupational profession. Physician acceptance has a significant impact on the implementation of new treatment modalities and thus influences the overall quality of health care.
Collapse
Affiliation(s)
- Juliane Andrea Duevel
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Alina Baumgartner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - John Grosser
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Simone Kreimeier
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Svenja Elkenkamp
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| | - Wolfgang Greiner
- Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences
- Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen
- John Grosser, MSc, has a master's degree in mathematics (Technical University, Dortmund), and another master's degree in Bioethics and Medical Humanities (Case Western Reserve University in Cleveland, Ohio). He is research associate with Prof. Greiner since October 2020
- Simone Kreimeier, DrPH, has been a research associate in Prof. Greiner's working group at the Bielefeld University since October 2010 and has been a senior research scientist since 2020 (doctoral degree in Public Health)
- Svenja Elkenkamp, MSc, MEd, has a master's degree in mathematics and biology and another master's degree in statistical science (Bielefeld University). She is research associate with Prof. Greiner since March 2018
- Wolfgang Greiner, has been Chair of "Health Economics and Health Care Management" at Bielefeld University since April 2005. He also holds the position of dean of the Faculty of Public Health since 2022
| |
Collapse
|
3
|
Nabelsi V, Lévesque-Chouinard A. Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study. JMIR Form Res 2024; 8:e52921. [PMID: 38814689 DOI: 10.2196/52921] [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: 09/19/2023] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide. OBJECTIVE This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. METHODS A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. RESULTS Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. CONCLUSIONS This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.
Collapse
Affiliation(s)
- Véronique Nabelsi
- Department of Administrative Sciences, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- GMF-U de la Haute-Ville du Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Sainte-Foy, QC, Canada
| |
Collapse
|
4
|
Amiot O, Sauvaget A, Alamome I, Bulteau S, Charpeaud T, Clair AH, Courtet P, Drapier D, Haffen E, Fakra E, Gaudeau-Bosma C, Gaillard A, Mouchabac S, Pineau F, Narboni V, Duburcq A, Lecardeur L. Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study. JMIR Form Res 2024; 8:e53204. [PMID: 38568139 DOI: 10.2196/53204] [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: 09/29/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. OBJECTIVE This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. METHODS Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. RESULTS A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. CONCLUSIONS DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression.
Collapse
Affiliation(s)
- Odile Amiot
- Groupe Hospitalier Paul Guiraud, Boulogne Billancourt, France
| | - Anne Sauvaget
- Movement - Interactions - Performance, Centre Hospitalier Universitaire Nantes, Nantes Université, Nantes, France
| | | | - Samuel Bulteau
- Institut national de la santé et de la recherche médicale 1246, MethodS in Patient-Centered Outcomes and HEalth ResEarch, Centre Hospitalier Universitaire de Nantes, Department of Addictology, Psychiatry and Old Age Psychiatry, University of Nantes, Nantes, France
- Department of Addictology, Psychiatry and Old Age Psychiatry, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | | | - Philippe Courtet
- Neuropsychiatrie: Recherche Epidemiologique et Clinique, Institut national de la sante et de la recherche medicale, Centre Hospitalier Universitaire de Montpellier, University of Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Dominique Drapier
- Centre Hospitalier Guillaume Régnier, Pôle hospitalo universitaire de psychiatrie adulte, Rennes, France
- Centre d'Investigation Clinique Institut national de la sante et de la recherche medicale 1414 équipe neuropsychiatrie du développement et du comportement, Université de Rennes, Rennes, France
| | - Emmanuel Haffen
- Service de Psychiatrie de l'Adulte, Centre d'Investigation Clinique 1431-Institut national de la sante et de la recherche medicale, Centre Hospitalier Universitaire de Besançon, Université de Franche-Comté, Besançon, France
| | - Eric Fakra
- Pôle Universitaire de Psychiatrie, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean Monnet, Equipe Troubles psychiatriques, Recherche en Neurosciences et Recherche Clinique- InInstitut national de la sante et de la recherche medicaleserm, Centre National de la Recherche Scientifique 5292, Université Lyon 1, Université Jean Monnet, Saint-Etienne, France
| | - Christian Gaudeau-Bosma
- Espace Territoriale d'Accompagnement Psychosociale, Groupe Hospitaliser Territorial Val de Marne-Est, Saint-Maurice, France
| | | | - Stéphane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Fanny Pineau
- Cabinet de psychologie, Bureaux du Polygone, Montpellier, France
| | | | - Anne Duburcq
- CEMKA - 43, boulevard du Maréchal Joffre, Bourg-La-Reine, France
| | | |
Collapse
|
5
|
Groom LL, Schoenthaler AM, Mann DM, Brody AA. Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research. PLOS DIGITAL HEALTH 2024; 3:e0000509. [PMID: 38776354 PMCID: PMC11111026 DOI: 10.1371/journal.pdig.0000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024]
Abstract
Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.
Collapse
Affiliation(s)
- Lisa L. Groom
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
| | - Antoinette M. Schoenthaler
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Devin M. Mann
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, New York, United States of America
| |
Collapse
|
6
|
Abouzeid N, Lal S. The role of sociodemographic factors on the acceptability of digital mental health care: A scoping review protocol. PLoS One 2024; 19:e0301886. [PMID: 38669278 PMCID: PMC11051634 DOI: 10.1371/journal.pone.0301886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Many individuals experiencing mental health complications face barriers when attempting to access services. To bridge this care gap, digital mental health innovations (DMHI) have proven to be valuable additions to in-person care by enhancing access to care. An important aspect to consider when evaluating the utility of DMHI is perceived acceptability. However, it is unclear whether diverse sociodemographic groups differ in their degree of perceived acceptability of DMHI. OBJECTIVE This scoping review aims to synthesize evidence on the role of sociodemographic factors (e.g., age, gender) in the perceived acceptability of DMHI among individuals seeking mental health care. METHODS Guided by the JBI Manual of Evidence Synthesis, chapter on Scoping Review, a search strategy developed according to the PCC framework will be implemented in MEDLINE and then adapted to four electronic databases (i.e., CINAHL, MEDLINE, PsycINFO, and EMBASE). The study selection strategy will be piloted by two reviewers on subsets of 30 articles until agreement among reviewers reaches 90%, after which one reviewer will complete the remaining screening of titles and abstracts. The full-text screening, data extraction strategy, and charting tool will be completed by one reviewer and then validated by a second member of the team. Main findings will be presented using tables and figures. EXPECTED CONTRIBUTIONS This scoping review will examine the extent to which sociodemographic factors have been considered in the digital mental health literature. Also, the proposed review may help determine whether certain populations have been associated with a lower level of acceptability within the context of digital mental health care. This investigation aims to favor equitable access to DMHI among diverse populations.
Collapse
Affiliation(s)
- Nagi Abouzeid
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, Québec, Canada
| | - Shalini Lal
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, Québec, Canada
- Douglas Research Centre, Montréal, Québec, Canada
| |
Collapse
|
7
|
Nasrun MWS, Kusumaningrum P, Malik K, Kusumaningsih W, Harimurti K, Prawiroharjo P, Mardhiyah FS, Matanta RH, Lalenoh LAP, Kiasati SK. Technological acceptance and features needed in mobile health apps development for people living with dementia and their caregivers in Indonesia. Inform Health Soc Care 2024:1-17. [PMID: 38578948 DOI: 10.1080/17538157.2024.2328029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
In Indonesia, the number of People Living with Dementia (PLWD) is predicted to be rising continuously. PLWD need help operating cell phones for their daily needs. Numerous mobile health applications have been innovated to deliver better dementia care. The objective of this study is to identify the technological acceptance and features needed by PLWD and caregivers in Indonesia. This study started with questionnaire development through focused-group discussion with experts, caregivers and PLWD. It was followed by item development involving experts in geriatrics (psychiatry, internal medicine, medical rehabilitation and neurology) to prepare an online questionnaire. We considered using jargon and words that are familiar to users. The data collected was analyzed for the technological acceptance model (TAM) using Structural Equation Model (SEM). This study showed that perceived usefulness and ease of use of the technology have positively correlated to the actual use. This study reflects the need for social connectedness and information for PLWD. For caregivers, the main feature needed is information related to dementia symptoms and treatment. The understanding gained from this study can be used to improve strategies related to developing mobile health technology for PLWD and caregivers.
Collapse
Affiliation(s)
- Martina Wiwie Setiawan Nasrun
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
| | - Profitasari Kusumaningrum
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
| | - Widjajalaksmi Kusumaningsih
- Neuroscience and Brain Development Research Cluster IMERI FKUI, Jakarta, Indonesia
- Department of Medical Rehabilitation, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pukovisa Prawiroharjo
- Department of Neurology, Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | | | - Saarah Khansa Kiasati
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
8
|
Alsulami S, Konstantinidis ST, Wharrad H. Use of wearables among Multiple Sclerosis patients and healthcare Professionals: A scoping review. Int J Med Inform 2024; 184:105376. [PMID: 38359683 DOI: 10.1016/j.ijmedinf.2024.105376] [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: 08/01/2023] [Revised: 01/28/2024] [Accepted: 02/10/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an increasingly prevalent chronic, autoimmune, and inflammatory central nervous system illness, whose common symptoms undermine the quality of life of patients and their families. Recent technical breakthroughs potentially offer continuous, reliable, sensitive, and objective remote monitoring solutions for healthcare. Wearables can be useful for evaluating falls, fatigue, sedentary behavior, exercise, and sleep quality in people with MS (PwMS). OBJECTIVE This scoping review of relevant literature explores studies investigating the perceptions of patients and healthcare professionals (HCPs) about the use of wearable technologies in the management of MS. METHODS The Joanna Briggs Institute methodology for scoping reviews was used. The search strategy was applied to the databases, MEDLINE via Ovid, Embase, APA PsycInfo, and CINAHL. Further searches were performed in IEEE, Scopus, and Web of Science. The review considered studies reporting quantitative or qualitative data on perceptions and experiences of PwMS and HCPs concerning wearables' usability, satisfaction, barriers, and facilitators. RESULTS 10 studies were included in this review. Wearables' usefulness and accessibility, ease of use, awareness, and motivational tool potential were patient-perceived facilitators of use. Barriers related to anxiety and frustration, complexity, and the design of wearables. Perceived usefulness and system requirements are identified as facilitators of using wearables by HCPs, while data security concerns and fears of increased workload and limited effectiveness in the care plan are identified as barriers to use wearables. CONCLUSIONS This review contributes to our understanding of the benefits of wearable technologies in MS by exploring perceptions of both PwMS and HCPs. The scoping review provided a broad overview of facilitators and barriers to wearable use in MS. There is a need for further studies underlined with sound theoretical frameworks to provide a robust evidence-base for the optimal use of wearables to empower healthcare users and providers.
Collapse
Affiliation(s)
- Shemah Alsulami
- Faculty of Medicine & Health Sciences, University of Nottingham, School of Health Sciences, Queen's Medical Centre, B floor, Nottingham, NG7 2UH, UK; College of Business Administration, King Saud University, Department of Health Administration, Building 3, Riyadh, 12371, KSA, Saudi Arabia.
| | - Stathis Th Konstantinidis
- Faculty of Medicine & Health Sciences, University of Nottingham, School of Health Sciences, Queen's Medical Centre, B floor, Nottingham, NG7 2UH, UK.
| | - Heather Wharrad
- Faculty of Medicine & Health Sciences, University of Nottingham, School of Health Sciences, Queen's Medical Centre, B floor, Nottingham, NG7 2UH, UK.
| |
Collapse
|
9
|
Karnatz N, Schwerter M, Liu S, Parviz A, Wilkat M, Rana M. Mixed Reality as a Digital Visualisation Solution for the Head and Neck Tumour Board: Application Creation and Implementation Study. Cancers (Basel) 2024; 16:1392. [PMID: 38611070 PMCID: PMC11011089 DOI: 10.3390/cancers16071392] [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: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
The preparation and implementation of interdisciplinary oncological case reviews are time-consuming and complex. The variety of clinical and radiological information must be presented in a clear and comprehensible manner. Only if all relevant patient-specific information is demonstrated in a short time frame can well-founded treatment decisions be made on this basis. Mixed reality (MR) technology as a multimodal interactive user interface could enhance understanding in multidisciplinary collaboration by visualising radiological or clinical data. The aim of the work was to develop an MR-based software prototype for a head and neck tumour board (HNTB) to support clinical decision-making. The article describes the development phases and workflows in the planning and creation of a MR-based software prototype that were required to meet the multidisciplinary characteristics of a HNTB.
Collapse
Affiliation(s)
- Nadia Karnatz
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | | | - Shufang Liu
- Brainlab AG, Olof-Palme-Str. 9, 81829 München, Germany
| | - Aida Parviz
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | - Max Wilkat
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| | - Majeed Rana
- Department of Oral and Plastic Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (M.R.)
| |
Collapse
|
10
|
An J, Fan W, Mittal A, Zhang Y, Chen AT. Mobile App Use among Persons with Fibromyalgia: A Cross-sectional Survey. THE JOURNAL OF PAIN 2024:104515. [PMID: 38522593 DOI: 10.1016/j.jpain.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Persons with fibromyalgia experience a diverse set of symptoms. Recommendations for management generally focus on multidisciplinary approaches involving multiple modalities. Mobile apps can be an essential component for self-management, yet little is known about how persons with fibromyalgia use mobile apps for health-related purposes. A cross-sectional survey (N = 663) was conducted to understand the real-world use of apps among persons with fibromyalgia. The survey included 2 main foci: 1) eHealth literacy and use of information sources, and 2) mobile app use patterns and preferences for health-related purposes, including the types of apps used and usage characteristics of apps currently in use, as well as those that had been discontinued. Respondents' average eHealth literacy as measured by eHealth Literacy Scale (eHEALS) was 31.4 (SD = 7.1), and they utilized diverse information sources. Approximately two-thirds of the sample used mobile apps; the remaining one-third did not. Diverse health management needs were represented in the apps reported, including scheduling/time management, notetaking, fitness, and wellness. Compared to apps that had been discontinued, participants rated apps that they still used higher in terms of ease of use and used them more frequently. Reasons for discontinuing app use included issues with privacy, the effort required, lack of interest, and lack of perceived quality. Other reasons for app nonuse were lack of awareness and how-to knowledge, indicating that disseminating information about apps and addressing other barriers, such as providing user support, are critical to increasing uptake. These study findings can inform both app design and dissemination. PERSPECTIVE: This article presents how persons with fibromyalgia use mobile apps to manage their health. The findings could inform the development of digital interventions or programs for this population.
Collapse
Affiliation(s)
- Jiaxin An
- School of Information, University of Texas at Austin, Austin, Texas
| | - Wei Fan
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Anant Mittal
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington
| | - Yan Zhang
- School of Information, University of Texas at Austin, Austin, Texas
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| |
Collapse
|
11
|
Triana AM, Saramäki J, Glerean E, Hayward NMEA. Neuroscience meets behavior: A systematic literature review on magnetic resonance imaging of the brain combined with real-world digital phenotyping. Hum Brain Mapp 2024; 45:e26620. [PMID: 38436603 PMCID: PMC10911114 DOI: 10.1002/hbm.26620] [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: 05/17/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
A primary goal of neuroscience is to understand the relationship between the brain and behavior. While magnetic resonance imaging (MRI) examines brain structure and function under controlled conditions, digital phenotyping via portable automatic devices (PAD) quantifies behavior in real-world settings. Combining these two technologies may bridge the gap between brain imaging, physiology, and real-time behavior, enhancing the generalizability of laboratory and clinical findings. However, the use of MRI and data from PADs outside the MRI scanner remains underexplored. Herein, we present a Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic literature review that identifies and analyzes the current state of research on the integration of brain MRI and PADs. PubMed and Scopus were automatically searched using keywords covering various MRI techniques and PADs. Abstracts were screened to only include articles that collected MRI brain data and PAD data outside the laboratory environment. Full-text screening was then conducted to ensure included articles combined quantitative data from MRI with data from PADs, yielding 94 selected papers for a total of N = 14,778 subjects. Results were reported as cross-frequency tables between brain imaging and behavior sampling methods and patterns were identified through network analysis. Furthermore, brain maps reported in the studies were synthesized according to the measurement modalities that were used. Results demonstrate the feasibility of integrating MRI and PADs across various study designs, patient and control populations, and age groups. The majority of published literature combines functional, T1-weighted, and diffusion weighted MRI with physical activity sensors, ecological momentary assessment via PADs, and sleep. The literature further highlights specific brain regions frequently correlated with distinct MRI-PAD combinations. These combinations enable in-depth studies on how physiology, brain function and behavior influence each other. Our review highlights the potential for constructing brain-behavior models that extend beyond the scanner and into real-world contexts.
Collapse
Affiliation(s)
- Ana María Triana
- Department of Computer Science, School of ScienceAalto UniversityEspooFinland
| | - Jari Saramäki
- Department of Computer Science, School of ScienceAalto UniversityEspooFinland
| | - Enrico Glerean
- Department of Neuroscience and Biomedical Engineering, School of ScienceAalto UniversityEspooFinland
| | | |
Collapse
|
12
|
Tadesse AW, Mganga A, Dube TN, Alacapa J, van Kalmthout K, Letta T, Mleoh L, Garfin AMC, Maraba N, Charalambous S, Foster N, Jerene D, Fielding KL. Feasibility and acceptability of the smart pillbox and medication label with differentiated care to support person-centered tuberculosis care among ASCENT trial participants - A multicountry study. Front Public Health 2024; 12:1327971. [PMID: 38444445 PMCID: PMC10913790 DOI: 10.3389/fpubh.2024.1327971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Digital adherence technologies (DATs) can offer alternative approaches to support tuberculosis treatment medication adherence. Evidence on their feasibility and acceptability in high TB burden settings is limited. We conducted a cross-sectional survey among adults with drug-sensitive tuberculosis (DS-TB), participating in pragmatic cluster-randomized trials for the Adherence Support Coalition to End TB project in Ethiopia (PACTR202008776694999), the Philippines, South Africa and Tanzania (ISRCTN 17706019). Methods From each country we selected 10 health facilities implementing the DAT intervention (smart pillbox or medication labels, with differentiated care support), ensuring inclusion of urban/rural and public/private facilities. Adults on DS-TB regimen using a DAT were randomly selected from each facility. Feasibility of the DATs was assessed using a standardized tool. Acceptability was measured using a 5-point Likert-scale, using the Capability, Opportunity, Motivation, Behavior (COM-B) model. Mean scores of Likert-scale responses within each COM-B category were estimated, adjusted for facility-level clustering. Data were summarized by country and DAT type. Results Participants using either the pillbox (n = 210) or labels (n = 169) were surveyed. Among pillbox users, phone ownership (79%), use of pillbox reminders (87%) and taking treatment without the pillbox (22%) varied by country. Among label users, phone ownership (81%), paying extra to use the labels (8%) and taking treatment without using labels (41%) varied by country. Poor network, problems with phone charging and access, not having the pillbox and forgetting to send text were reasons for not using DATs. Overall, people with TB had a favorable impression of both DATs, with mean composite scores between 4·21 to 4·42 across COM-B categories. Some disclosure concerns were reported. Conclusion From client-perspective, pillboxes and medication labels with differentiated care support were feasible to implement and acceptable in variety of settings. However, implementation challenges related to network, phone access, stigma, additional costs to people with TB to use DATs need to be addressed.
Collapse
Affiliation(s)
- Amare W. Tadesse
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Tanyaradzwa N. Dube
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | | | | | - Taye Letta
- National Tuberculosis Control Program, Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Liberate Mleoh
- National Tuberculosis Control Program, Ministry of Health, Dodoma, Tanzania
| | - Anna M. C. Garfin
- National Tuberculosis Control Program, Department of Health, Manila, Philippines
| | - Noriah Maraba
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nicola Foster
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Degu Jerene
- Evidence and Impact, KNCV Tuberculosis Plus, The Hague, Netherlands
| | - Katherine L. Fielding
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
Chang J, Mai Y, Zhang D, Yang X, Li A, Yan W, Wu Y, Chen J. Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study. J Med Internet Res 2024; 26:e50012. [PMID: 38373031 PMCID: PMC10912999 DOI: 10.2196/50012] [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: 06/18/2023] [Revised: 08/29/2023] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices. OBJECTIVE This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide. METHODS The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices. RESULTS A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels. CONCLUSIONS The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices.
Collapse
Affiliation(s)
- Jinghui Chang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Yanshan Mai
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Dayi Zhang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Xixi Yang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Anqi Li
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Wende Yan
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
| |
Collapse
|
14
|
Posselt J, Baumann E, Dierks ML. A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription. Front Digit Health 2024; 6:1275569. [PMID: 38375490 PMCID: PMC10875127 DOI: 10.3389/fdgth.2024.1275569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Background Depressive disorders are an emerging public health topic. Due to their increasing prevalence, patients with depressive disorders suffer from the lack of therapeutic treatment. Digital health interventions may offer an opportunity to bridge waiting times, supplement, or even substitute in-person treatment. Among others, the Unified Theory of Acceptance and Use of Technology (UTAUT) explains that actual technology use is affected by users' behavioural intention. However, patients' perspectives on digital interventions are rarely discussed within the specific context of primary care provided by general practitioners (GP) and need further exploration. Method A qualitative study design with semi-structured interviews was used to explore DTx-acceptance of patients with mild or moderate depression (n = 17). The audio-recorded interviews were transcribed verbatim, coded, and thematically analysed by qualitative content analysis. Results Patients' performance expectancies reveal that DTx are not perceived as a substitute for face-to-face treatment. Effort expectancies include potential advantages and efforts concerning technical, motivational, and skill-based aspects. Moreover, we identified health status and experience with depressive disorders as other determinants and potential barriers to patients' DTx acceptance: Difficult stages of depression or long-time experience are perceived hurdles for DTx use. GPs' recommendations were just partly relevant for patients and varied according to patients' consultancy preferences. But still, GPs have a crucial role for access due to prescription. GPs' influence on patients' DTx acceptance varies between three situations: (1) pre-use for consultation, (2) pre-use for access and (3) during DTx-use. Further, GPs' guidance could be especially relevant for patients during DTx-use in routine care. Discussion The UTAUT-based exploration suggests that acceptance determinants should be considered independently and embedded in personal and situational aspects. DTx require a healthcare professional to prescribe or diagnose the disease, unlike other digital offerings. We identified prescription- and depression-related determinants, exceeding existing theoretical constructs. GPs' guidance can compensate for some barriers to DTx use e.g., by increasing commitment and motivational support to strengthen patients' acceptance. Conclusion We argue for a multidimensional integration of acceptance determinants for further development of health technology acceptance research. Future research should specify how DTx can be integrated into routine care to strengthen user acceptance.
Collapse
Affiliation(s)
- Jacqueline Posselt
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hannover, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| |
Collapse
|
15
|
Luo C, Yuan R, Mao B, Liu Q, Wang W, He Y. Technology Acceptance of Socially Assistive Robots Among Older Adults and the Factors Influencing It: A Meta-Analysis. J Appl Gerontol 2024; 43:115-128. [PMID: 37750859 DOI: 10.1177/07334648231202669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
The purpose of this study was to deeply understand older adults' acceptance of socially assistive robots and their influencing factors and to compare the strength of the correlation between each influencing factor variable and the acceptance. The literature search was performed in five databases from their inception to January 17, 2023. The meta-analysis was performed using Review Manager 5.4 and Stata 16.0 software. Thirteen papers were included in this study. The mean value of acceptability after using the inverse variance method was 3.68. Education level is strongly related to technology acceptance; perceived ease of use, perceived usefulness, technology experience, technology attitude, perceived hedonism, and convenience are moderately related; anxiety is only weakly related.
Collapse
Affiliation(s)
- Chuhong Luo
- School of Medicine, Hunan Normal University, Changsha, China
| | - Rong Yuan
- School of Medicine, Hunan Normal University, Changsha, China
| | - Bin Mao
- School of Medicine, Hunan Normal University, Changsha, China
| | - Qian Liu
- School of Medicine, Hunan Normal University, Changsha, China
| | - Weihong Wang
- School of Medicine, Hunan Normal University, Changsha, China
| | - Ying He
- School of Medicine, Hunan Normal University, Changsha, China
| |
Collapse
|
16
|
Jiang Z, Huang X, Wang Z, Liu Y, Huang L, Luo X. Embodied Conversational Agents for Chronic Diseases: Scoping Review. J Med Internet Res 2024; 26:e47134. [PMID: 38194260 PMCID: PMC10806449 DOI: 10.2196/47134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/19/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) are computer-generated animated humanlike characters that interact with users through verbal and nonverbal behavioral cues. They are increasingly used in a range of fields, including health care. OBJECTIVE This scoping review aims to identify the current practice in the development and evaluation of ECAs for chronic diseases. METHODS We applied a methodological framework in this review. A total of 6 databases (ie, PubMed, Embase, CINAHL, ACM Digital Library, IEEE Xplore Digital Library, and Web of Science) were searched using a combination of terms related to ECAs and health in October 2023. Two independent reviewers selected the studies and extracted the data. This review followed the PRISMA-ScR (Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement. RESULTS The literature search found 6332 papers, of which 36 (0.57%) met the inclusion criteria. Among the 36 studies, 27 (75%) originated from the United States, and 28 (78%) were published from 2020 onward. The reported ECAs covered a wide range of chronic diseases, with a focus on cancers, atrial fibrillation, and type 2 diabetes, primarily to promote screening and self-management. Most ECAs were depicted as middle-aged women based on screenshots and communicated with users through voice and nonverbal behavior. The most frequently reported evaluation outcomes were acceptability and effectiveness. CONCLUSIONS This scoping review provides valuable insights for technology developers and health care professionals regarding the development and implementation of ECAs. It emphasizes the importance of technological advances in the embodiment, personalized strategy, and communication modality and requires in-depth knowledge of user preferences regarding appearance, animation, and intervention content. Future studies should incorporate measures of cost, efficiency, and productivity to provide a comprehensive evaluation of the benefits of using ECAs in health care.
Collapse
Affiliation(s)
- Zhili Jiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiting Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqian Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Liu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolin Luo
- Department of Quality Evaluation, Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, China
| |
Collapse
|
17
|
Raquel Costa-Brito A, Bovolini A, Rúa-Alonso M, Vaz C, Francisco Ortega-Morán J, Blas Pagador J, Vila-Chã C. Home-based exercise interventions delivered by technology in older adults: A scoping review of technological tools usage. Int J Med Inform 2024; 181:105287. [PMID: 37972483 DOI: 10.1016/j.ijmedinf.2023.105287] [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: 07/01/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite technology-based systems being considered promising tools to stimulate and increase physical function at home, most older adults are unfamiliar with technology, which may pose some difficulties. Technology-related parameters, such as adherence, acceptance, and acceptability, are crucial to achieving higher efficacy levels of home-based exercise interventions delivered by technology. In this scoping review, we aimed to revise the use of home-based technological tools to improve physical function in the older population, focusing on the user's experience and perspective. Methods This scoping review was conducted following PRISMA guidelines. The search was conducted in April 2022 and updated in April 2023. A total of 45 studies were included in the review. Results Most studies (95.5%) met the technology usage levels defined by the research team or reported satisfactory technology usage levels. Positive health-related outcomes were reported in 80% of studies. Although the existence of guidelines to correctly define and use measures associated with technology use, including adherence, acceptance and acceptability, some terms are still being used interchangeably. Some concerns related to the lack of an international consensus regarding technology usage measures and the exclusion of older adults who did not own or have previous experience with technology in a large percentage of the included studies may have limited the results obtained. Conclusions Altogether, home-based exercise interventions delivered through technology were associated with positive health-related outcomes in older adults, and technology usage levels are considered satisfactory. Older adults are willing and able to use technology autonomously if adequate support is provided.
Collapse
Affiliation(s)
| | - Antonio Bovolini
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal
| | - María Rúa-Alonso
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal; Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | | | | | - J Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Carolina Vila-Chã
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal.
| |
Collapse
|
18
|
Békés V, Ménard CG, Schmitz N, Aafjes-van Doorn K. Therapist-Reported Differences between Teletherapy via Phone and via Videoconferencing. Brain Sci 2023; 13:1714. [PMID: 38137162 PMCID: PMC10742214 DOI: 10.3390/brainsci13121714] [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: 10/31/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
When therapists provide teletherapy they can choose between teletherapy via phone and teletherapy via videoconferencing, however, little is known about differences between using these two teletherapy formats. We aimed to compare therapists' attitudes, level of professional self-doubt, and experience of the therapeutic relationship in sessions conducted via phone versus via videoconferencing. We administered an online survey to 117 therapists who had experience with sessions both via phone and videoconferencing. The results suggested that therapists' attitudes and perceptions of the therapeutic relationship were similar. However, therapists' level of professional self-doubt was higher in sessions conducted via videoconferencing. Therapists with previous experience of conducting teletherapy via phone perceived phone sessions more positively. Thus, familiarity with videoconferencing technology might be more important in shaping therapists' attitudes and confidence than the type of technology per se. This highlights the importance of practicing with new technologies.
Collapse
Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA; (V.B.); (N.S.)
| | | | - Natale Schmitz
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA; (V.B.); (N.S.)
| | - Katie Aafjes-van Doorn
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA; (V.B.); (N.S.)
| |
Collapse
|
19
|
Putra RH, Astuti ER, Nurrachman AS, Putri DK, Ghazali AB, Pradini TA, Prabaningtyas DT. Convolutional neural networks for automated tooth numbering on panoramic radiographs: A scoping review. Imaging Sci Dent 2023; 53:271-281. [PMID: 38174035 PMCID: PMC10761295 DOI: 10.5624/isd.20230058] [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: 03/08/2023] [Revised: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose The objective of this scoping review was to investigate the applicability and performance of various convolutional neural network (CNN) models in tooth numbering on panoramic radiographs, achieved through classification, detection, and segmentation tasks. Material and Methods An online search was performed of the PubMed, Science Direct, and Scopus databases. Based on the selection process, 12 studies were included in this review. Results Eleven studies utilized a CNN model for detection tasks, 5 for classification tasks, and 3 for segmentation tasks in the context of tooth numbering on panoramic radiographs. Most of these studies revealed high performance of various CNN models in automating tooth numbering. However, several studies also highlighted limitations of CNNs, such as the presence of false positives and false negatives in identifying decayed teeth, teeth with crown prosthetics, teeth adjacent to edentulous areas, dental implants, root remnants, wisdom teeth, and root canal-treated teeth. These limitations can be overcome by ensuring both the quality and quantity of datasets, as well as optimizing the CNN architecture. Conclusion CNNs have demonstrated high performance in automated tooth numbering on panoramic radiographs. Future development of CNN-based models for this purpose should also consider different stages of dentition, such as the primary and mixed dentition stages, as well as the presence of various tooth conditions. Ultimately, an optimized CNN architecture can serve as the foundation for an automated tooth numbering system and for further artificial intelligence research on panoramic radiographs for a variety of purposes.
Collapse
Affiliation(s)
- Ramadhan Hardani Putra
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Eha Renwi Astuti
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Aga Satria Nurrachman
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dina Karimah Putri
- Department of Dentomaxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Ahmad Badruddin Ghazali
- Oral Radiology Unit, Department of Oral Maxillofacial Surgery and Oral Diagnosis, Kulliyyah of Dentistry, International Islamic University Malaysia, Malaysia
| | - Tjio Andrinanti Pradini
- Undergraduate Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | |
Collapse
|
20
|
Reinders P, Augustin M, Kirsten N, Fleyder A, Otten M. Digital health interventions in dermatology-Mapping technology and study parameters of systematically identified publications. J Eur Acad Dermatol Venereol 2023; 37:2440-2449. [PMID: 37528462 DOI: 10.1111/jdv.19392] [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: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
Digital health interventions (DHI) potentially improve the efficiency and effectiveness of dermatological care. Currently, an overview clustering and characterizing the evidence on DHIs is missing. This systematic mapping of the literature aims to analyse published research on DHIs in dermatology to identify trends and gaps in research. For this purpose, a systematic search of the MEDLINE database was conducted in August 2022 to identify original publications on DHIs in dermatology. Data on country, targeted audience, DHI category, indication, outcome parameter and study design were extracted. Out of 12,009 records identified in MEDLINE, 403 studies were included in the final analysis. Studies on DHIs mainly performed in western countries, headed by the United States (n = 133), Germany (n = 32) and Spain (n = 23). Of all identified DHIs, 261 targeted healthcare providers (HCP), 66 clients (e.g. patients, caregivers, healthy individuals) and 67 both clients and HCPs. A majority of DHIs focussed on establishing a diagnosis (n = 254). Every other study analysed store-and-forward teledermatology (n = 187), followed by artificial intelligence applications for image analysis (n = 65). The most often analysed DHI category for clients was a support of health behaviour change (n = 31). Monitoring of clients was targeted by 77 studies. Skin cancer (n = 148), wounds (n = 29) and psoriasis (n = 29) were the most targeted indications by DHIs. Most studies analysed diagnostic performance (n = 166), fewer studies analysed acceptance (n = 92) and effectiveness (n = 98). Usability (n = 32) and efficiency (n = 36) were investigated only to a small extent. Studies on DHIs in dermatology have focused on teledermatology and AI applications, with an emphasis on skin cancer diagnosis. Apart from that, a range of DHIs for different user groups, purposes and indications were identified, demonstrating the broad potential for DHIs in dermatology. Further research with a wider set of outcome parameters is needed to fully understand the potential of DHIs and ensure their sustainable implementation into dermatological care.
Collapse
Affiliation(s)
- Patrick Reinders
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anastasia Fleyder
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
21
|
Nahas C, Gandit M, Quillion-Dupré L, Monfort E. How to engage patients in computerized cognitive training: a cognitive rehabilitation expert's perspective. Disabil Rehabil Assist Technol 2023:1-13. [PMID: 37994038 DOI: 10.1080/17483107.2023.2284879] [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: 05/31/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE The relationship between a patient and their therapist plays a crucial role in patient engagement. While Computerized Cognitive Training (CCT) may assist in preserving cognitive skills in cases of aging, dementia or acquired brain injuries, its effectiveness has not been definitively proven. Improving user engagement, acceptance, and software usability could aid in addressing this issue. The present study aims to identify potential obstacles and facilitators by examining the perspectives of rehabilitation professionals on the current usage of CCT software. METHODS Semi-structured interviews were conducted with 16 rehabilitation professionals, familiar with a CCT software. The data were transcribed and followed by an independent iterative thematic analysis. RESULTS Two major themes were identified: (1) facilitating factors and (2) difficulties related to use. The main obstacles were difficulties related to the computerized nature of the exercises, technology use, understanding the software and general learning difficulties. The main facilitators were the ecological and novel nature of the exercises, and the adaptability of the difficulty levels. CONCLUSION The complexity of the CCT presents challenges for its usage by rehabilitation professionals, which in turn can impede patient utilization as well. To address this issue and promote sustainable use of the software, providing instruction delivery to facilitate learning and understanding of the CCT is essential. Additionally, creating a standardized foundation that therapists can refer to for guidance may also aid in optimizing the software's usage. It is recommended to utilize a model for CCT acceptability and acceptance in developing these solutions to enhance patient engagement.
Collapse
Affiliation(s)
- Christelle Nahas
- TIMC Laboratory, Universite Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, Grenoble, France
- LIP/PC2S, EA 4145, Universite Grenoble Alpes, Grenoble, France
- COVIRTUA Healthcare, Colomiers, France
| | - Marc Gandit
- LIP/PC2S, EA 4145, Universite Grenoble Alpes, Grenoble, France
| | | | - Emmanuel Monfort
- TIMC Laboratory, Universite Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, Grenoble, France
| |
Collapse
|
22
|
Firima E, Gonzalez L, Ursprung F, Robinson E, Huber J, Belus JM, Raeber F, Gupta R, Deen GF, Amstutz A, Leigh B, Weisser M, Labhardt ND. Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: A scoping review. PLoS One 2023; 18:e0278353. [PMID: 37967126 PMCID: PMC10651052 DOI: 10.1371/journal.pone.0278353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/25/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients' homes. AIM We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available. METHODS We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was done, and comparisons made between community-based and facility-based models, where within-study comparison was reported. RESULTS We retrieved 5,335 unique studies, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were only add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias. CONCLUSION Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.
Collapse
Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fabiola Ursprung
- Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Elena Robinson
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jacqueline Huber
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jennifer M. Belus
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Fabian Raeber
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ravi Gupta
- SolidarMed, Swiss Organisation for Health in Africa, Maseru, Lesotho
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Internal Medicine, Connaught Hospital, Freetown, Sierra Leone
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Chronic Diseases Clinic, Ifakara Health Institute, Ifakara, Tanzania
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
23
|
Deegan O, Fullen BM, Hearty C, Doody CM. Acceptability of the combined online interactive mindfulness and exercise programme (MOVE-Online) for adults with chronic pain - A qualitative study. Disabil Rehabil 2023:1-13. [PMID: 37886895 DOI: 10.1080/09638288.2023.2274875] [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: 12/23/2022] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE The aim of this qualitative study was to utilise the recent Theoretical Framework of Acceptability (TFA) to explore participants' acceptability of the mindfulness and exercise interventions in the MOVE-Online pain management programme (PMP) and the programmes' online delivery method. METHODS Online focus groups were carried out following the completion of the PMP. The data were analysed using template analysis in terms of the seven TFA constructs of acceptability [(i) Perceived Effectiveness, (ii) Affective Attitude, (iii) Self-Efficacy, (iv) Ethicality, (v) Burden, (vi) Opportunity Costs and (vii) Intervention Coherence]. RESULTS Twenty-one participants took part in the focus groups. Five of the seven TFA constructs of acceptability were identified in the analysis. The participants perceived the intervention to have been effective at achieving the goals of the PMP (TFA construct: (i) Perceived Effectiveness), to have supported their emotional management ((ii) Affective Attitude), promoted long term self-directed engagement ((iii) Self-Efficacy), fostered a valued group environment ((iv) Ethicality) and the online delivery of the programme reduced the physical burden associated with participation at an in-person PMP ((v) Burden). CONCLUSION The results of the study supports the utility of the TFA as a tool to explore the multi-dimensional construct of acceptability for the participants in the MOVE-Online programme.
Collapse
Affiliation(s)
- Orla Deegan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Zhang M, Zhang H, Zhu R, Yang H, Chen M, Wang X, Li Z, Xiong Z. Factors affecting the willingness of patients with type 2 diabetes to use digital disease management applications: a cross-sectional study. Front Public Health 2023; 11:1259158. [PMID: 37937072 PMCID: PMC10626484 DOI: 10.3389/fpubh.2023.1259158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
Background The global burden of type 2 diabetes has significantly increased, leading to a considerable impact on healthcare systems worldwide. While the advent of mobile healthcare has provided some relief by addressing the shortage of certain medical resources, its adoption among the Chinese population remains relatively low. To extend the benefits of mHealth to a greater number of Chinese diabetic patients, it is essential to investigate the factors that influence their willingness to utilize it and implement targeted interventions based on these influencing factors. The Technology Acceptance Model (TAM) is widely employed to examine users' ultimate usage behaviors, and previous studies have indicated the potential relevance of the Perceived Risk (PR) theory and the eHealth Literacy Theory to users' usage behaviors. Objective Our objective was to investigate the determinants that affect the willingness of Chinese patients diagnosed with type 2 diabetes patients to utilize digital disease management applications (DDMAs). Methods We conducted a cross-sectional study of patients with type 2 diabetes in three tertiary general hospitals in Chengdu using questionnaires designed by the investigators. Participants were sampled using a convenience sampling method. The questionnaire comprised three sections: socio-demographic profile and medical history; current awareness and willingness to use digital disease management applications; and the current level of e-health literacy. Structural equation modeling was employed to assess the impact of patient awareness of DDMAs and e-health literacy on the willingness to use such DDMAs. Results (1) Patients' attitudes toward using DDMAs were significantly influenced by perceived ease of use (β = 0.380, P < 0.001) and perceived usefulness (β = 0.546, P < 0.001); (2) Electronic health literacy exerted a significant impact on patients' perceived usefulness (β = 0.115, P = 0.018) and perceived ease of use (β = 0.659, P < 0.001); (3) Patients' willingness to use was significantly influenced by perceived usefulness (β = 0.137, P < 0.001) and use attitude (β = 0.825, P < 0.001). Conclusions The present research findings hold both theoretical and practical significance, and can serve as a guide for healthcare practitioners and researchers to gain a deeper comprehension of the acceptance of digital disease management applications (DDMAs) among type 2 diabetes patients.
Collapse
Affiliation(s)
- Mingjiao Zhang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zhang
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Zhu
- The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Huiqi Yang
- Nanbu Country People's Hospital, Nanchong, Sichuan, China
| | - Mengjie Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiaoxia Wang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| |
Collapse
|
25
|
Sidek NN, Tengku Ismail TA, Kamalakannan S, Chen XW, Romli MH, Mat Said MZ, Papachristou Nadal I, Ibrahim KA, Musa KI. A mixed-methods study on the implementation of a mobile health application (mHealth app) for stroke caregivers in Malaysia: healthcare providers' perspective. Front Neurol 2023; 14:1222260. [PMID: 37905189 PMCID: PMC10613485 DOI: 10.3389/fneur.2023.1222260] [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: 05/14/2023] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Recognizing the burden experienced by caregivers of stroke survivors, an intervention using mobile health applications (mHealth apps) has been proposed to support and empower stroke caregivers. This study aimed to assess the acceptability and expectations of healthcare providers, who play a vital role as gatekeepers in the healthcare system, to ensure the effectiveness and sustainability of the intervention. Methods This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool. Results In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients. Conclusion Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.
Collapse
Affiliation(s)
- Norsima Nazifah Sidek
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Sureshkumar Kamalakannan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Social Work, Education, and Community Well-being, Northumbria University, Coach Lane Campus, Newcastle upon Tyne, United Kingdom
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, UPM Teaching Hospital, Faculty of Medicine and Health Sciences, Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | | | - Khairul Azmi Ibrahim
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
- Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| |
Collapse
|
26
|
Andrews NE, Ireland D, Vijayakumar P, Burvill L, Hay E, Westerman D, Rose T, Schlumpf M, Strong J, Claus A. Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing. JMIR Form Res 2023; 7:e47267. [PMID: 37801342 PMCID: PMC10589833 DOI: 10.2196/47267] [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: 03/14/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.
Collapse
Affiliation(s)
- Nicole Emma Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia
| | - David Ireland
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Pranavie Vijayakumar
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Lyza Burvill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Elizabeth Hay
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Daria Westerman
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mikaela Schlumpf
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Jenny Strong
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| |
Collapse
|
27
|
Conway A, Ryan A, Harkin D, Mc Cauley C. "It's Another Feather in My Hat"-Exploring Factors Influencing the Adoption of Apps With People Living With Dementia. DEMENTIA 2023; 22:1487-1513. [PMID: 37365816 PMCID: PMC10521156 DOI: 10.1177/14713012231185283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
INTRODUCTION With the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing adoption of mobile applications for people living with dementia. METHODS The recruitment of participants was facilitated through a dementia advocacy group of people living with dementia. A focus group design was applied to elicit discussion and to explore divergent views on the topic. The data was analysed using thematic analysis. FINDINGS The 15 individuals who participated in this study comprised of seven women and eight men within the age range of 60-90 years. This study reports key findings pertaining to the views and experiences of using mobile apps. Data analysis revealed the following four distinct themes; (Theme 1: Living with dementia)-"That's the difficulty there even with apps or anything else." (Theme 2: Motivation)- "It makes me feel good. I feel a little with it [laughs], that its not all gone in there" (Theme 3: Fears and Concerns)- "Can somebody else get into your personal memories?" (Theme 4- Support)- "So it's important that we have that support". Together these themes encapsulate the most influential aspects, as highlighted by the participants influencing the acceptance and adoption of apps. CONCLUSION This paper explores the barriers and facilitators to app acceptance and adoption. This includes the importance of "feel good moments" and positive experiences, challenges associated with living with dementia, the importance of ongoing support, and security of the user's information. This study adds to what is already known by capturing the views and experiences of people living with dementia in relation to the factors influencing the adoption of apps.
Collapse
Affiliation(s)
- Aoife Conway
- School of Nursing and Paramedic Science, Ulster University, Co Londonderry, NI, UK
| | - Assumpta Ryan
- School of Nursing and Paramedic Science, Ulster University, Co Londonderry, NI, UK
| | - Deirdre Harkin
- School of Nursing and Paramedic Science, Ulster University, Co Londonderry, NI, UK
| | - Claire Mc Cauley
- School of Nursing and Paramedic Science, Ulster University, Co Londonderry, NI, UK
| |
Collapse
|
28
|
Malik I, Perez A, Toombs E, Schmidt F, Olthuis JV, Charlton J, Grassia E, Squier C, Stasiuk K, Bobinski T, Mushquash AR. Female youth and mental health service providers' perspectives on the JoyPop™ app: a qualitative study. Front Digit Health 2023; 5:1197362. [PMID: 37829596 PMCID: PMC10566298 DOI: 10.3389/fdgth.2023.1197362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Mobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers. Method A qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach. Results All youth (n = 6 females; Mage = 14.60, range 12-17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers (n = 7 females; Mage = 43.75, range 32-60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app. Discussion Results support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.
Collapse
Affiliation(s)
- Ishaq Malik
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Arnaldo Perez
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Fred Schmidt
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Children’s Centre Thunder Bay, Thunder Bay, ON, Canada
| | | | - Jaidyn Charlton
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Elizabeth Grassia
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Crystal Squier
- Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | - Kristine Stasiuk
- Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | | |
Collapse
|
29
|
Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [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: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
Collapse
Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
| |
Collapse
|
30
|
Van Goethem V, Dierickx S, Matthys O, Northouse L, Lund L, Jordan C, Turola E, van der Wel M, Scott D, Harding R, Deliens L, Lapeire L, Hudson P, De Vleminck A, Cohen J. A self-management psychoeducational eHealth program to support and empower people with advanced cancer and their family caregivers: Development using the scrum methodology. Internet Interv 2023; 33:100659. [PMID: 37593143 PMCID: PMC10428037 DOI: 10.1016/j.invent.2023.100659] [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] [Received: 02/17/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
Background eHealth programs could be a flexible and scalable resource to support and empower people with advanced cancer and their family caregivers. A face-to-face intervention that has demonstrated effectiveness is the "FOCUS" program, developed and tested in the USA. Recently the FOCUS program was translated and adapted to the European context as part of an international study in six European countries, resulting in the "FOCUS+" program. FOCUS+ served as the basis for development of the web-based iFOCUS program. Objective We aim to (1) describe the development process of the iFOCUS program, (2) outline the challenges we encountered and how they were overcome, and (3) present findings regarding the acceptability and usability of iFOCUS. Methods We used the four phased agile Scrum methodology to develop iFOCUS and applied set timeframes of rapid program development and evaluation (sprints). Five teams were involved in the development i.e. a core development group, a web development team, an international consortium, audio-visual experts, and potential end-users. Results Development followed seven steps, integrated across the four phases of Scrum: (1) concept design, (2) development of mock-ups, (3) Feedback from the international consortium, (4) technical development of iFOCUS, (5) creating versions for the six participating countries, (6) preliminary testing of iFOCUS and (7) implementing the final version in a randomized controlled trial. User testing included 42 participants (twenty patient-family caregiver dyads and two bereaved family caregivers) who reviewed the iFOCUS program. Users found the iFOCUS program to be acceptable and usable. Feedback mainly focused on text size and fonts. Minor changes to the content, tailoring, and program flow were required. During development we encountered program specific and general challenges. Using the Scrum methodology facilitated iterative development to address these issues. For some challenges, such as tailoring, we had to make pragmatic choices due to time and resource limitations. Conclusions/discussion The development of a tailored, self-managed psychoeducational eHealth program for people with advanced cancer and their family caregivers is an intense process and requires pragmatic choices. By keeping the emphasis on the target population during development, no specific remarks pertaining to advanced cancer were identified. Some challenges we encountered are common to eHealth development, others were related to program specific requirements. Using the Scrum methodology allows teams to efficiently collaborate during program development and increases the flexibility of the development process. Interpersonal contact between research staff and potential end-users is recommended during and after the development of eHealth programs.
Collapse
Affiliation(s)
- Vincent Van Goethem
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Sigrid Dierickx
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Orphé Matthys
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | | | - Line Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Catherine Jordan
- University College Dublin, National University of Ireland, Dublin, Ireland
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - David Scott
- The School of Nursing and Midwifery, Queen's University of Belfast, Belfast, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University, Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lore Lapeire
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Ghent University Hospital, Department of Medical Oncology, C. Heymanslaan 10, 9000 Ghent, Belgium
| | | | - Peter Hudson
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- St Vincent's Hospital and the Univeristy of Melbourne, Centre of Palliative Care, Melbourne, Australia
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Joachim Cohen
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Laarbeeklaan 103, 1090 Brussels, Belgium
| |
Collapse
|
31
|
Achury Saldaña DM, Rodríguez Parrado IY, González RA. Cardio SEM: A Novel Approach for a Traffic Light System for Heart Failure Warning Signs. Comput Inform Nurs 2023; 41:673-678. [PMID: 37165833 DOI: 10.1097/cin.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Existing literature on the follow-up of heart failure patients with warning signs shows that it is necessary to increase patients' knowledge and of seeking help in a timely manner. This suggests an opportunity to implement strategies that integrate technology to visualize the risk of decompensation. This article studies the acceptance of Cardio Sem, a traffic light system mobile application for patients with heart failure. A descriptive, observational pilot study was performed with 23 outpatients belonging to a heart failure program. For 4 weeks, patients used Cardio Sem, which allows visualizing the risk of decompensation through a series of questions that patients must answer daily and provides guidance for managing signs and symptoms of decompensation. A technology acceptance questionnaire was applied to all patients, resulting in acceptance of the application, especially in the dimensions that emphasized perceived usefulness (100%), social influence (100%), and behavioral intent (99.8%). Cardio Sem is useful for early detection of symptoms that allow for early response to complications. Acceptance of the application by patients and its ease of use present the possibility to implement it as a complementary tool to promote self-care and effective management of symptoms.
Collapse
Affiliation(s)
- Diana Marcela Achury Saldaña
- Author Affiliations : School of Nursing, Pontificia Universidad Javeriana (Ms Achury Saldaña); Clínica Palermo (Ms Parrado); and Engineering Faculty, Pontificia Universidad Javeriana (Dr González), Bogotá, Colombia
| | | | | |
Collapse
|
32
|
Louart S, Hedible GB, Ridde V. Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis. BMC Health Serv Res 2023; 23:930. [PMID: 37649024 PMCID: PMC10469465 DOI: 10.1186/s12913-023-09897-4] [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: 04/11/2022] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
Acceptability is a key concept used to analyze the introduction of a health innovation in a specific setting. However, there seems to be a lack of clarity in this notion, both conceptually and practically. In low and middle-income countries, programs to support the diffusion of new technological tools are multiplying. They face challenges and difficulties that need to be understood with an in-depth analysis of the acceptability of these innovations. We performed a scoping review to explore the theories, methods and conceptual frameworks that have been used to measure and understand the acceptability of technological health innovations in sub-Saharan Africa. The review confirmed the lack of common definitions, conceptualizations and practical tools addressing the acceptability of health innovations. To synthesize and combine evidence, both theoretically and empirically, we then used the "best fit framework synthesis" method. Based on five conceptual and theoretical frameworks from scientific literature and evidence from 33 empirical studies, we built a conceptual framework in order to understand the acceptability of technological health innovations. This framework comprises 6 determinants (compatibility, social influence, personal emotions, perceived disadvantages, perceived advantages and perceived complexity) and two moderating factors (intervention and context). This knowledge synthesis work has also enabled us to propose a chronology of the different stages of acceptability.
Collapse
Affiliation(s)
- Sarah Louart
- Univ. Lille, CNRS, UMR 8019 - CLERSE - Centre Lillois d'Etudes Et de Recherches Sociologiques Et Economiques, 59000, Lille, France.
- ALIMA, the Alliance for International Medical Action, Dakar, Senegal.
| | | | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, 75006, Paris, France
- Institut de Santé Et Développement, Université Cheikh Anta Diop, Dakar, Sénégal
| |
Collapse
|
33
|
Martinez Agulleiro L, Patil B, Firth J, Sawyer C, Amann BL, Fonseca F, Torrens M, Perez V, Castellanos FX, Kane JM, Guinart D. A systematic review of digital interventions for smoking cessation in patients with serious mental illness. Psychol Med 2023; 53:4856-4868. [PMID: 37161690 PMCID: PMC10476065 DOI: 10.1017/s003329172300123x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
Collapse
Affiliation(s)
- Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Bhagyashree Patil
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Benedikt L. Amann
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francina Fonseca
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Universitat de Vic i Central de Catalunya, Vic, Spain
| | - Victor Perez
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Guinart
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| |
Collapse
|
34
|
Huwa J, Tweya H, Mureithi M, Kiruthu-Kamamia C, Oni F, Chintedza J, Chiwaya G, Waweru E, Kudzala A, Wasunna B, Ndhlovu D, Bisani P, Feldacker C. "It reminds me and motivates me": Human-centered design and implementation of an interactive, SMS-based digital intervention to improve early retention on antiretroviral therapy: Usability and acceptability among new initiates in a high-volume, public clinic in Malawi. PLoS One 2023; 18:e0278806. [PMID: 37471383 PMCID: PMC10358959 DOI: 10.1371/journal.pone.0278806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Early retention of people living with HIV (PLHIV) in antiretroviral therapy (ART) programs is critical to improve individual clinical outcomes and viral load suppression. Although many mobile health (mHealth) interventions aim to improve retention in care, there is still lack of evidence on mHealth success or failure, including from patient's perspectives. We describe the human-centered design (HCD) process and assess patient usability and acceptability of a two-way texting (2wT) intervention to improve early retention among new ART initiates at Lighthouse Trust clinic in Lilongwe, Malawi. METHODS An iterative HCD approach focused on patient and provider users' needs, incorporating feedback from multidisciplinary teams to adapt 2wT for the local, public clinic context. We present mixed-methods usability and acceptability results from 100 participants, 50 at 3-months and 50 at 6-months, post 2wT enrollment, and observations of these same patients completing core tasks of the 2wT system. RESULTS Among the 100 usability respondents, 95% were satisfied with visit reminders, and 88% would recommend reminders and motivational messages to friends; however, 17% were worried about confidentiality. In observation of participant task completion, 94% were able to successfully confirm visit attendance and 73% could request appointment date change. More participants in 4-6 months group completed tasks correctly compared to 1-3 months group, although not significantly different (78% vs. 66%, p = 0.181). Qualitative results were overwhelmingly positive, but patients did note confusion with transfer reporting and concern that 2wT would not reach patients without mobile phones or with lower literacy. CONCLUSION The 2wT app for early ART retention appears highly usable and acceptable, hopefully creating a solid foundation for lifelong engagement in care. The HCD approach put the local team central in this process, ensuring that both patients' and Lighthouse's priorities, policies, and practices were forefront in 2wT optimization, raising the likelihood of 2wT success in other routine program contexts.
Collapse
Affiliation(s)
| | - Hannock Tweya
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
| | | | | | | | | | | | | | | | | | | | | | - Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America
| |
Collapse
|
35
|
Dostie R, Gaboury I, Trottier N, Hurtubise K, Camden C. Acceptability of a Multimodal Telerehabilitation Intervention for Children Ages 3-8 Years with Motor Difficulties: Results of a Qualitative Study. Dev Neurorehabil 2023; 26:287-301. [PMID: 37403439 DOI: 10.1080/17518423.2023.2233020] [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: 09/14/2022] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE The purpose of this study is to explore the acceptability of a telerehabilitation intervention provided to parents of children with motor difficulties. MATERIAL AND METHODS Sixteen parents of children were purposefully recruited to participate in semi-structured interviews aimed at assessing the acceptability of the telerehabilitation intervention. Interviews were analyzed thematically. RESULTS All participants described evolving acceptability associated with their interactions with the web platform. The opportunities generated, suitability in relation to families' values and perceived effects positively impacted acceptability. The understanding and consistency of intervention delivery, the child's level of involvement, the associated parental burden of the intervention and the therapeutic alliances created also affected acceptability. CONCLUSION Our study findings support the acceptability of a telerehabilitation intervention for families of children with motor difficulties. Telerehabilitation seems to be more acceptable to families with children without suspected or confirmed diagnoses.
Collapse
|
36
|
Deng J, Pan Y. Evaluating Influencing Factors of Audiences' Attitudes toward Virtual Concerts: Evidence from China. Behav Sci (Basel) 2023; 13:478. [PMID: 37366730 DOI: 10.3390/bs13060478] [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: 05/15/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
The purpose of this study is to investigate and validate the influencing factors of audiences' attitudes toward virtual concerts. In order to address this issue, the current study proposes a conceptual model integrating player experience factors (autonomy, relatedness, and engagement) and the technology acceptance model (perceived usefulness, perceived ease of use, and perceived enjoyment). An online questionnaire on virtual concert experiences was conducted among Chinese audiences who had attended virtual concerts previously. Structural equation modeling was then used to establish the relationships between variables. The results suggested that autonomy, relatedness, and engagement positively impacted perceived usefulness, perceived ease of use, and perceived enjoyment. Furthermore, the perceived usefulness, perceived ease of use, and perceived enjoyment were significant predictors of audiences' attitudes. The findings of this study could provide a reference for relevant virtual entertainment providers and could also serve as a point of development and exploration for the technology acceptance model and player experience in the field of virtual concerts.
Collapse
Affiliation(s)
- Jing Deng
- Department of Smart Experience Design, Graduate School of Techno Design, Kookmin University, Seoul 02707, Republic of Korea
| | - Younghwan Pan
- Department of Smart Experience Design, Graduate School of Techno Design, Kookmin University, Seoul 02707, Republic of Korea
| |
Collapse
|
37
|
Carey N, Abathun E, Maguire R, Wodaje Y, Royce C, Ayers N. Co-design and prototype development of the 'Ayzot App': A mobile phone based remote monitoring system for palliative care. Palliat Med 2023; 37:771-781. [PMID: 37002562 DOI: 10.1177/02692163231162408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. AIM To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia. DESIGN Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019-2020. Phase-1 interviews (n = 40), Phase-2 focus groups (n = 3) and interviews (n = 10). SETTING/PARTICIPANTS Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. RESULTS Co-design activities lead to development of the prototype 'Ayzot' application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. CONCLUSION This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation.
Collapse
Affiliation(s)
- Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, UK
| | | | - Roma Maguire
- Digital Health and Care and Research, University of Strathclyde, UK
| | | | | | - Nicola Ayers
- Palliative Care Advisor, Ministry of Health, Ethiopia
- School of Nursing, BPP University, Waterloo, London, UK
| |
Collapse
|
38
|
Bardram JE, Cramer-Petersen C, Maxhuni A, Christensen MVS, Bækgaard P, Persson DR, Lind N, Christensen MB, Nørgaard K, Khakurel J, Skinner TC, Kownatka D, Jones A. DiaFocus: A Personal Health Technology for Adaptive Assessment in Long-Term Management of Type 2 Diabetes. ACM TRANSACTIONS ON COMPUTING FOR HEALTHCARE 2023; 4:1-43. [DOI: 10.1145/3586579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/08/2023] [Indexed: 07/25/2023]
Abstract
Type 2 diabetes (T2D) is a large disease burden worldwide and represents an increasing and complex challenge for all societies. For the individual, T2D is a complex, multi-dimensional, and long-term challenge to manage, and it is challenging to establish and maintain good communication between the patient and healthcare professionals. This article presents DiaFocus, which is a mobile health sensing application for long-term ambulatory management of T2D. DiaFocus supports an
adaptive
collection of physiological, behavioral, and contextual data in combination with ecological assessments of psycho-social factors. This data is used for improving patient-clinician communication during consultations. DiaFocus is built using a generic data collection framework for mobile and wearable sensing and is highly extensible and customizable. We deployed DiaFocus in a 6-week feasibility study involving 12 patients with T2D. The patients found the DiaFocus approach and system useful and usable for diabetes management. Most patients would use such a system, if available as part of their treatment. Analysis of the collected data shows that mobile sensing is feasible for longitudinal ambulatory assessment of T2D, and helped identify the most appropriate target users being early diagnosed and technically literate T2D patients.
Collapse
Affiliation(s)
| | | | - Alban Maxhuni
- Technical University of Denmark, Kgs. Lyngby, DK, Denmark
| | | | - Per Bækgaard
- Technical University of Denmark, Kgs. Lyngby, DK, Denmark
| | - Dan R. Persson
- Technical University of Denmark, Kgs. Lyngby, DK, Denmark
| | - Nanna Lind
- Steno Diabetes Center Copenhagen, Herlev, DK, Denmark
| | | | | | | | | | | | - Allan Jones
- Roche Diabetes Care GmbH, Mannheim, DE, Germany
| |
Collapse
|
39
|
Byrd TF, Speigel PS, Cameron KA, O'Leary KJ. Barriers to Adoption of a Secure Text Messaging System: a Qualitative Study of Practicing Clinicians. J Gen Intern Med 2023; 38:1224-1231. [PMID: 36376637 PMCID: PMC10110803 DOI: 10.1007/s11606-022-07912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secure text messaging systems (STMS) offer HIPAA-compliant text messaging and mobile phone call functionalities that are more efficient than traditional paging. Although some studies associate improved provider satisfaction and healthcare delivery with STMS use, healthcare organizations continue to struggle with achieving widespread and sustained STMS adoption. OBJECTIVE To understand the barriers to adoption of an STMS among physicians and advanced practice providers (APPs). DESIGN We qualitatively analyzed free-text comments that clinicians (physicians and APPs) across a large healthcare organization offered on a survey about STMS perceptions. PARTICIPANTS A total of 1110 clinicians who provided a free-text comment in response to one of four open-ended survey questions. APPROACH Data were analyzed using a grounded theory approach and constant comparative method to characterize responses and identify themes. KEY RESULTS The overall survey response rate was 20.5% (n = 1254). Clinicians familiar with the STMS frequently believed the STMS was unnecessary (existing tools worked well enough) and would overburden them with more communications. They were frustrated that the STMS app had to be downloaded onto their personal mobile device and that it drained their battery. Ambiguity regarding who was reachable in the app led to missed messages and drove distrust of the STMS. Clinicians saw the exclusion of other care team members (e.g., nurses) from the STMS as problematic; however, some clinicians at hospitals with expanded STMS access complained of excessive messages. Secondhand reports of several of these barriers prevented new users from downloading the app and contributed to ongoing low use. CONCLUSIONS Clinicians are reluctant to adopt an STMS that does not offer a clear and trustworthy communication benefit to offset its potential burden and intrusiveness. Our findings can be incorporated into STMS implementation strategies that maximize active users by targeting and mitigating barriers to adoption.
Collapse
Affiliation(s)
- Thomas F Byrd
- Division of Hospital Medicine, University of Minnesota, MMC 741, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
| | - Philip S Speigel
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
40
|
Wang X, Markert C, Sasangohar F. Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic. HUMAN FACTORS 2023; 65:50-61. [PMID: 33682467 DOI: 10.1177/0018720821998110] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This article analyzes the changes in downloads and activity of users of select popular mental health mobile applications (mHealth apps) during coronavirus disease 2019 (COVID-19). BACKGROUND The outbreak of the COVID-19 crisis has shown a negative impact on public mental health. Mobile health has the potential to help address the psychological needs of existing and new patients during the pandemic and beyond. METHOD Downloads data of 16 widely used apps were analyzed. The quality of apps was reviewed using the Mobile Application Rating Scale (MARS) framework. Correlation analysis was conducted to investigate the relationship between app quality and app popularity. RESULTS Among the 16 apps, 10 were meditational in nature, 13 showed increased downloads, with 11 apps showing above 10% increase in the downloads after the pandemic started. The popular apps were satisfactory in terms of functionality and esthetics but lacked clinical grounding and evidence base. There exists a gap between app quality and app popularity. CONCLUSION This study provided evidence for increased downloads of mental mHealth apps (primarily meditation apps) during the COVID-19 pandemic but revealed several gaps and opportunities to address deficiencies in evidence-based design, usability and effective assessment, and integration into current workflows. APPLICATION The COVID-19 pandemic is a potential turning point for mHealth applications for mental health care. Whereas the evidence suggests a need for alternative delivery of care, human factors and ergonomics methods should be utilized to ensure these tools are user-centered, easy to use, evidence-based, well-integrated with professional care, and used sustainably.
Collapse
Affiliation(s)
| | | | - Farzan Sasangohar
- 2655 Texas A&M University, College Station, USA
- Houston Methodist Hospital, Texas, USA
| |
Collapse
|
41
|
Szeto SG, Wan H, Alavinia M, Dukelow S, MacNeill H. Effect of mobile application types on stroke rehabilitation: a systematic review. J Neuroeng Rehabil 2023; 20:12. [PMID: 36694257 PMCID: PMC9872745 DOI: 10.1186/s12984-023-01124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Stroke is a significant contributor of worldwide disability and morbidity with substantial economic consequences. Rehabilitation is a vital component of stroke recovery, but inpatient stroke rehabilitation programs can struggle to meet the recommended hours of therapy per day outlined by the Canadian Stroke Best Practices and American Heart Association. Mobile applications (apps) are an emerging technology which may help bridge this deficit, however this area is understudied. The purpose of this study is to review the effect of mobile apps for stroke rehabilitation on stroke impairments and functional outcomes. Specifically, this paper will delve into the impact of varying mobile app types on stroke rehabilitation. METHODS This systematic review included 29 studies: 11 randomized control trials and 18 quasi-experimental studies. Data extrapolation mapped 5 mobile app types (therapy apps, education apps, rehab videos, reminders, and a combination of rehab videos with reminders) to stroke deficits (motor paresis, aphasia, neglect), adherence to exercise, activities of daily living (ADLs), quality of life, secondary stroke prevention, and depression and anxiety. RESULTS There were multiple studies supporting the use of therapy apps for motor paresis or aphasia, rehab videos for exercise adherence, and reminders for exercise adherence. For permutations involving other app types with stroke deficits or functional outcomes (adherence to exercise, ADLs, quality of life, secondary stroke prevention, depression and anxiety), the results were either non-significant or limited by a paucity of studies. CONCLUSION Mobile apps demonstrate potential to assist with stroke recovery and augment face to face rehabilitation, however, development of a mobile app should be carefully planned when targeting specific stroke deficits or functional outcomes. This study found that mobile app types which mimicked principles of effective face-to-face therapy (massed practice, task-specific practice, goal-oriented practice, multisensory stimulation, rhythmic cueing, feedback, social interaction, and constraint-induced therapy) and education (interactivity, feedback, repetition, practice exercises, social learning) had the greatest benefits. Protocol registration PROPSERO (ID CRD42021186534). Registered 21 February 2021.
Collapse
Affiliation(s)
- Stephen G. Szeto
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428UHN Toronto Rehab Institute, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Hoyee Wan
- grid.17063.330000 0001 2157 2938Division of Plastic, Reconstructive, and Aesthetic Surgery, University of Toronto, Toronto, Canada
| | - Mohammad Alavinia
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sean Dukelow
- grid.22072.350000 0004 1936 7697Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather MacNeill
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.492573.e0000 0004 6477 6457Physical Medicine & Rehabilitation, Hennick Bridgepoint Hospital, Sinai Health System, Toronto, Canada
| |
Collapse
|
42
|
Mizokami-Stout K, van Leersum CM, Olthuis TJJ, Bekhuis REM, den Ouden MEM. Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users' Acceptability and Acceptance. JMIR Diabetes 2023; 8:e41076. [PMID: 36692927 PMCID: PMC9947812 DOI: 10.2196/41076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) improve their health status and thereby achieve diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. OBJECTIVE This study provides an in-depth understanding of the perceptions of patients with T2DM before use (acceptability) and after use (acceptance) regarding 4 different mobile health apps for diabetes control and self-management. METHODS A descriptive qualitative research design was used in this study. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (ie, Clear.bio in combination with FreeStyle Libre, mySugr, MiGuide, and Selfcare). The selection was based on a systematic analysis of the criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy, and security. To explore acceptability, 25 semistructured in-depth interviews were conducted with patients with T2DM before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, that is, patients with T2DM collaborated with researchers as coresearchers. All coresearchers actively participated in the preparation of the study, data collection, and data analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9. RESULTS In total, 25 coresearchers with T2DM participated in this study. Of them, 12 coresearchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All coresearchers participated in semistructured interviews, and 18 of them attended focus groups. Personal health was the main driver of app use. Most coresearchers were convinced that a healthy lifestyle would improve blood glucose levels. Although most coresearchers did not expect that they need to put much effort into using the apps, the additional effort to familiarize themselves with the app use was experienced as quite high. None of the coresearchers had a health care professional who provided suggestions on using the apps. Reimbursement from insurance companies and the acceptance of apps for diabetes control and self-management by the health care system were mentioned as important facilitating conditions. CONCLUSIONS The research showed that mobile health apps provide support for diabetes control and self-management in patients with T2DM. Integrating app use in care as usual and guidelines for health care professionals are recommended. Future research is needed on how to increase the implementation of mobile health apps in current care pathways. In addition, health care professionals need to improve their digital skills, and lifelong learning is recommended.
Collapse
Affiliation(s)
| | - Catharina Margaretha van Leersum
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | | | | | - Marjolein Elisabeth Maria den Ouden
- Technology, Health & Care Research Group, Saxion University of Applied Sciences, Enschede, Netherlands.,Care & Technology Research Group, Regional Community College of Twente, Hengelo, Netherlands
| |
Collapse
|
43
|
Hansen MA, Chen R, Hirth J, Langabeer J, Zoorob R. Impact of COVID-19 lockdown on patient-provider electronic communications. J Telemed Telecare 2023:1357633X221146810. [PMID: 36659875 PMCID: PMC9892807 DOI: 10.1177/1357633x221146810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. METHODS All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. RESULTS Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. CONCLUSION Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.
Collapse
Affiliation(s)
- Michael A. Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Rebecca Chen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James Langabeer
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
44
|
Student peer mentoring: Feasibility and acceptability of mHealth-based tool for alcohol and substance abuse prevention by peer mentors at a university in Kenya. PLOS DIGITAL HEALTH 2023; 2:e0000177. [PMID: 36812633 PMCID: PMC9931292 DOI: 10.1371/journal.pdig.0000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/06/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The use of mobile health (mHealth)-based interventions for the prevention of alcohol and other psychoactive substances use is an emerging practice for which new evidence is required. This study evaluated the feasibility and acceptability of a mHealth-based peer mentoring tool for early screening, brief intervention, and referral of students who abuse alcohol and other psychoactive substances. It compared the implementation of a mHealth-delivered intervention to the paper-based practice that is the standard at the University of Nairobi. METHODS A quasi-experimental study using purposive sampling was used to select a cohort of n = 100 (51 experimental, 49 control) first-year student peer mentors on two campuses of the University of Nairobi in Kenya. Data were collected on the mentors' sociodemographic characteristics as well as the feasibility and acceptability of the interventions by way of, the magnitude of reach, feedback to investigators, referral of cases, and perceived ease of use. RESULTS The mHealth-based peer mentoring tool scored high with 100% of users rating it as feasible and acceptable. Among the two study cohorts, there were no differences in the acceptability of the peer mentoring intervention. When comparing the feasibility of the peer mentoring practice, actual use of the interventions, and intervention reach, the mHealth-based cohort mentored four mentees for every one mentored by the standard practice cohort. CONCLUSION The mHealth-based peer mentoring tool had high feasibility and acceptability among student peer mentors. The intervention provided evidence for the need to expand the availability of screening services for alcohol and other psychoactive substances use among students in the university and promote the appropriate management practices within and outside the university.
Collapse
|
45
|
Vietzke J, Schenk L, Baer NR. Middle-aged and older adults' acceptance of mobile nutrition and fitness tools: A qualitative typology. Digit Health 2023; 9:20552076231163788. [PMID: 36937695 PMCID: PMC10017948 DOI: 10.1177/20552076231163788] [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: 07/13/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Background The utilization of mobile health (mHealth) devices such as nutrition and fitness tools seems to be promising in facilitating healthy lifestyle behaviors in middle-aged and older adults. As user acceptance plays a decisive role in the successful implementation of mHealth tools, it is vital to examine the target groups' acceptance, particularly their usage behavior and attitudes toward these tools. This qualitative study aimed to explore how far middle-aged as well as older adults accept mobile nutrition and fitness tools and to identify facilitators and barriers shaping their acceptance. Methods Twenty-one qualitative semi-structured interviews were conducted with German adults aged 50 years and older. Data material was analyzed using Qualitative Content Analysis (Kuckartz). Results A comprehensive acceptance typology with three acceptance types could be reconstructed: The Rejection Type, The Selective Acceptance Type, and The Comprehensive Acceptance Type. The target group's acceptance of mobile nutrition and fitness tools appeared to differ considerably across the three acceptance types and between the two different types of mHealth tools - with mobile nutrition tools having been less accepted. Among others, high levels of usability were identified as a key facilitator, while a desire for autonomy and privacy concerns showed to be prominent barriers. Conclusion The resulting typology indicates a pronounced heterogeneity among middle-aged and older adults regarding their acceptance of mobile nutrition and fitness tools. The findings highlight a need for more individualized mHealth tools along with respective promotion strategies that are specifically tailored to the needs and expectations of middle-aged and older adults.
Collapse
Affiliation(s)
- Julia Vietzke
- Julia Vietzke, Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | | | | |
Collapse
|
46
|
Conway A, Ryan A, Harkin D, Mc Cauley C, Goode D. A review of the factors influencing adoption of digital health applications for people living with dementia. Digit Health 2023; 9:20552076231162985. [PMID: 36937696 PMCID: PMC10017937 DOI: 10.1177/20552076231162985] [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: 11/16/2023] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Researchers have used various theories and models to understand technology adoption, however, with the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing the adoption of digital health applications for people living with dementia and add to the current literature on this topic. Methods Searches were conducted in CINHAL, Web of Science, Psych Info, ProQuest Health and Medical, IEEE Xplore and Scopus. Citation searching and handsearching were used in the identification of other studies. Results Following an assessment of relevancy, nine studies remained and are included within this review. Methodological quality was assessed using The Mixed Methods Appraisal Tool (MMAT). A thematic analysis was used for the data synthesis of included studies. Each study reported on different types of apps. Conclusion From the synthesis of included studies, four analytic themes were identified; Theme 1: Personal and contextual factors; Theme 2: Perceived value and benefit; Theme 3: Design and content of app; and Theme 4: Digital Literacy and Confidence. People are diverse and so are their reasons for the adoption of apps. These findings provide an insight into the range of factors that impact the adoption of apps for people living with dementia. Understanding the factors that impact the adoption of mobile applications is critical to their success. These findings can be beneficial for app developers and for people living with dementia and their carers.
Collapse
Affiliation(s)
- Aoife Conway
- School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Ulster University, Co. Derry, Northern Ireland
- Aoife Conway, School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Magee Campus, Ulster University, Co. Derry, Northern Ireland.
| | - Assumpta Ryan
- School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Ulster University, Co. Derry, Northern Ireland
| | - Deirdre Harkin
- School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Ulster University, Co. Derry, Northern Ireland
| | - Claire Mc Cauley
- School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Ulster University, Co. Derry, Northern Ireland
| | - Deborah Goode
- School of Nursing and Paramedic Science, Faculty of Life & Health Sciences, Ulster University, Co. Derry, Northern Ireland
| |
Collapse
|
47
|
Tuominen M, Koski P, Axelin A, Stenholm S, Leskinen T. Acceptable, useful, and ineffective? Recent retirees’ experiences of a 12-month activity tracker-based physical activity intervention. Digit Health 2023. [DOI: 10.1177/20552076221147419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective Activity trackers appear cost-effective and acceptable intervention tools for promoting physical activity among older adults, particularly in the short-term. However, long-term studies focused on participants’ experiences continue to be scarce. This study evaluated participants’ experiences of a 12-month activity tracker-driven physical activity intervention. Methods Participants’ experiences were assessed qualitatively using open-ended questionnaire items ( n = 113) and semi-structured interviews conducted after the 12-month intervention ( n = 27). Quantitative items assessed the perceived ease-of-use and usefulness of the activity tracker during the intervention. Qualitative data was analyzed using thematic analysis and Wilcoxon signed-rank tests were used to examine changes in the perceived ease-of-use and usefulness over time. Results The 113 participants completing the 12-month intervention were on average 65.2 ( SD 1.0) years old and 81.4% women with 92.3% providing activity tracker data on at least 2 weeks per each intervention month. In the qualitative analysis, four main themes with 20 subthemes were identified: (a) burdens of participation, (b) affective attitudes of using the activity tracker, (c) perceived effects of using the activity tracker, and (d) no perceived behavioral effects. At 12 months, the participants found activity trackers mainly easy to use (mean 4.6, SD 0.6), reliable (mean 3.6, SD 1.2), motivating (mean 3.9, SD 1.0), and helpful in reducing sitting (mean 3.7, SD 1.0) with no changes observed during the intervention. Conclusions The participants’ experiences were highly varied suggesting that tailored intervention designs are likely to be required for effectively using activity trackers to promote long-term changes in daily activity among older adults.
Collapse
Affiliation(s)
- Miika Tuominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Pasi Koski
- Department of Teacher Education, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Tuija Leskinen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
48
|
Baer NR, Vietzke J, Schenk L. Middle-aged and older adults' acceptance of mobile nutrition and fitness apps: A systematic mixed studies review. PLoS One 2022; 17:e0278879. [PMID: 36520839 PMCID: PMC9754197 DOI: 10.1371/journal.pone.0278879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To promote healthy aging, the support of digital mobile health tools such as mobile applications (apps) addressing a healthy diet or physical activity appears promising, particularly when initiated before entering old age. For such tools to be effective, middle-aged and older adults' acceptance need to be studied in depth. OBJECTIVE The aim of this systematic review was to provide an integrative synthesis of the current state of research regarding the question in how far middle-aged and older adults (people aged 50 years and above) accept mobile nutrition and fitness apps to gain a deeper understanding of the influencing factors shaping this target group's usage behaviour and needs. METHODS The review process followed the PRISMA guidelines. The databases Medline, Embase, Web of Science as well as reference lists were systematically searched. Study quality was assessed using the MMAT and AXIS appraisal tools. Data of the included studies were extracted and thereupon narratively synthesized, involving thematic analysis. RESULTS Of N = 8823 articles screened, n = 7 studies could be identified-five quantitative, cross-sectional ones and two qualitative studies. Overall, the synthesized findings showed a lower acceptance among middle-aged and older adults compared to younger populations, which was particularly reflected in lower usage rates and more negative attitudes towards such apps (e.g., Perceived usefulness, Ease of use). The target group's acceptance of fitness apps was greater compared to nutrition apps. Findings on contextual factors and social determinants were inconsistent (e.g., regarding gender differences). CONCLUSION While cross-study comparability was limited, the synthesized evidence underscores the importance to target mobile nutrition and fitness apps to the distinctive and heterogeneous needs of middle-aged and, particularly, of older adults. The scarcity of the existing body of knowledge highlights the need of further (longitudinal) research. PROSPERO PROTOCOL REGISTER NUMBER CRD42020159409.
Collapse
Affiliation(s)
- Nadja-Raphaela Baer
- Institute of Medical Sociology and Rehabilitation Science, Charité – University Medicine Berlin, Berlin, Germany
- * E-mail:
| | - Julia Vietzke
- Institute of Medical Sociology and Rehabilitation Science, Charité – University Medicine Berlin, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité – University Medicine Berlin, Berlin, Germany
| |
Collapse
|
49
|
Deng J, Huang S, Wang L, Deng W, Yang T. Conceptual Framework for Smart Health: A Multi-Dimensional Model Using IPO Logic to Link Drivers and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16742. [PMID: 36554622 PMCID: PMC9779490 DOI: 10.3390/ijerph192416742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Smart health is considered to be a new phase in the application of information and communication technologies (ICT) in healthcare that can improve its efficiency and sustainability. However, based on our literature review on the concept of smart health, there is a lack of a comprehensive perspective on the concept of smart health and a framework for how to link the drivers and outcomes of smart health. This paper aims to interweave the drivers and outcomes in a multi-dimensional framework under the input-process-output (IPO) logic of the "system view" so as to promote a deeper understanding of the model of smart health. In addition to the collection of studies, we used the modified Delphi method (MDM) to invite 10 experts from different fields, and the views of the panelists were analyzed and integrated through a three-round iterative process to reach a consensus on the elements included in the conceptual framework. The study revealed that smart health contains five drivers (community, technology, policy, service, and management) and eight outcomes (efficient, smart, sustainable, planned, trustworthy, safe, equitable, health-beneficial, and economic). They all represent a unique aspect of smart health. This paper expands the research horizon of smart health, shifting from a single technology to multiple perspectives, such as community and management, to guide the development of policies and plans in order to promote smart health.
Collapse
Affiliation(s)
- Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Sibo Huang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Liuan Wang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
| | - Wenhao Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| | - Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing 100081, China
| |
Collapse
|
50
|
Eysenbach G, Leung T, Holst H, Galvin K. Digital Engagement of Older Adults: Scoping Review. J Med Internet Res 2022; 24:e40192. [PMID: 36477006 PMCID: PMC9773036 DOI: 10.2196/40192] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/21/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time. OBJECTIVE Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. METHODS We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability). CONCLUSIONS The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25616.
Collapse
Affiliation(s)
| | | | - Hanna Holst
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Kathleen Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
| |
Collapse
|