Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study

Pathophysiology, Clinical Heterogeneity, and Therapeutic Advances in Amyotrophic Lateral Sclerosis: A Comprehensive Review of Molecular Mechanisms, Diagnostic Challenges, and Multidisciplinary Management Strategies

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the progressive degeneration of upper and lower motor neurons, leading to muscle atrophy, paralysis, and respiratory failure. This comprehensive review synthesizes the current knowledge on ALS pathophysiology, clinical heterogeneity, diagnostic frameworks, and evolving therapeutic strategies. Mechanistically, ALS arises from complex interactions between genetic mutations (e.g., in C9orf72, SOD1, TARDBP (TDP-43), and FUS) and dysregulated cellular pathways, including impaired RNA metabolism, protein misfolding, nucleocytoplasmic transport defects, and prion-like propagation of toxic aggregates. Phenotypic heterogeneity, manifesting as bulbar-, spinal-, or respiratory-onset variants, complicates its early diagnosis, which thus necessitates the rigorous application of the revised El Escorial criteria and emerging biomarkers such as neurofilament light chain. Clinically, ALS intersects with frontotemporal dementia (FTD) in up to 50% of the cases, driven by shared TDP-43 pathology and C9orf72 hexanucleotide expansions. Epidemiological studies have revealed a lifetime risk of 1:350, with male predominance (1.5:1) and peak onset between 50 and 70 years. Disease progression varies widely, with a median survival of 2-4 years post-diagnosis, underscoring the urgency for early intervention. Approved therapies, including riluzole (glutamate modulation), edaravone (antioxidant), and tofersen (antisense oligonucleotide), offer modest survival benefits, while dextromethorphan/quinidine alleviates the pseudobulbar affect. Non-pharmacological treatment advances, such as non-invasive ventilation (NIV), prolong survival by 13 months and improve quality of life, particularly in bulb-involved patients. Multidisciplinary care-integrating physical therapy, respiratory support, nutritional management, and cognitive assessments-is critical to addressing motor and non-motor symptoms (e.g., dysphagia, spasticity, sleep disturbances). Emerging therapies show promise in preclinical models. However, challenges persist in translating genetic insights into universally effective treatments. Ethical considerations, including euthanasia and end-of-life decision-making, further highlight the need for patient-centered communication and palliative strategies.

Acceptance of Virtual Reality Training for Chemotherapy Administration Among Nursing Students

Virtual reality technology offers an extended and repeatable environment for delivering digital learning and training. This study investigated the acceptance of a smartphone virtual reality training program among nursing students for chemotherapy administration using a modified Technology Acceptance Model. The teaching materials for the chemotherapy administration process were designed using smartphone virtual reality to provide prelicensure students with an opportunity to learn procedural steps in a controlled, risk-free environment. A total of 56 nursing students, both undergraduate and postbaccalaureate, participated in the virtual reality training and completed questionnaires assessing their perceptions of usefulness, ease of use, and intention to use the technology. Three factors of the modified Technology Acceptance Model had positive correlations with the overall complexity of chemotherapy (skill complexity): perceived usefulness (r = 0.27, P = .04), perceived ease of use (r = 0.27, P = .04), and intention to use (r = 0.38, P = .004). No significant correlation was observed between attitude toward use and skill complexity. In subsequent path analysis, the model explained 63.4% of the variance in the intention to use virtual reality. Positive correlations were found for five hypotheses: perceived usefulness (γ = 0.586) and age (γ = 0.244) with attitude toward use, perceived ease of use with perceived usefulness (γ = 0.749), and perceived usefulness (γ = 0.595) and skill complexity (γ = 0.176) with intention to use. Nursing students showed a high willingness to learn and practice through virtual reality, particularly when techniques and skills were inherently difficult or dangerous. This suggests that virtual reality can be an effective teaching medium for complex and high-risk procedures in nursing education.

The mediating effects of perceived usefulness and perceived ease of use on nurses' intentions to adopt advanced technology

This study explored the role of technology systems in influencing nurses' intentions to adopt medical applications that enhance their performance and how technology contributes to improvements in hospital systems. The study examines the intention to use technology through the mediating effects of perceived usefulness and perceived ease of use, with technology sophistication. A random sampling method was employed to gather 687 responses from nurses. The statistical analysis was conducted using AMOS version 25.0 and SPSS. The findings indicate a significant association between technology sophistication (TS), perceived usefulness (PU), perceived ease of use (PEU), and intention to use (IU). Additionally, PU and PEU positively mediate the relationship between TS and IU. This research will benefit policymakers aiming to enhance nurses' performance by adopting modern technology. Authorities should consider introducing advanced technology systems to meet the goals of hospital administration and support nurses effectively.

Perceptions of Telehealth Services Among Rural Lung Cancer Patients in China: A Qualitative Study Using the Technology Acceptance Model

OBJECTIVES

To describe the perceptions of telehealth services among lung cancer patients in rural areas of China, as well as to explore the potential of telemedicine to improve long-term health recovery at home for rural lung cancer patients.

METHODS

A qualitative descriptive study design was used in this study and we conducted semi-structured interviews with 14 rural Chinese lung cancer patients between December 2022 and March 2023. Interview content was analyzed using Nvivo software and a framework analysis was performed using the Technology Acceptance Model to identify meaningful themes.

RESULTS

Participants identified perceptual and technical factors related to perceived ease of use, benefits and drawbacks related to perceived usefulness, and facilitators and barriers related to intention to use. However, regional and disease features including literacy barriers, medical insurance condition, symptom burden, and rural cultural health seeking behavior conduct must be taken into account.

CONCLUSIONS

Lung cancer patients in rural China believe that telehealth services could be an alternative solution for addressing health and care needs, but various aspects, such as user interface design, cost-effectiveness, and technological anxiety, need to be optimized.

IMPLICATIONS FOR NURSING PRACTICE

More highly specialized nursing team, friendly telecare lung function modules, and media technology training courses should be developed for rural lung cancer patients to enhance the quality of their home care, meet their information needs and better control their disease progression.

Telerobotic Intergroup Contact: Acceptance and Preferences in Israel and Palestine

We explore telerobotics as a novel form of intergroup communication. In this form, remotely operated robots facilitate embodied and situated intergroup contact between groups in conflict over long distances, potentially reducing prejudice and promoting positive social change. Based on previous conceptual frameworks and design hypotheses, we conducted a survey on the acceptance and preferences of the telerobotic medium in Israel and Palestine. We analyzed the responses using a mixed-method approach. The results shed light on differences in attitudes between the groups and design considerations for telerobots when used for intergroup contact. This study serves as a foundation for the implementation of a novel method of technology-enhanced conflict resolution in the field.

Applying the Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey

BACKGROUND

Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients' intentions to use teledelivered SCC is unknown.

OBJECTIVE

The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level.

METHODS

A sample of 209 (209/287, 72.8% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants' intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures.

RESULTS

Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: β=0.16, P=.03 to β=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care (β=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (β=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level.

CONCLUSIONS

The findings of this study implied that enhancing BCS' skills at using telehealth, BCS' and their important others' perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS' intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level.

Factors influencing telehealth awareness, utilization, and satisfaction in KSA: A national population-based study

Background

Telehealth involves delivering healthcare remotely through digital platforms such as telephone and video calls. Use of telehealth surged during the COVID-19 pandemic because of the need for contactless healthcare. The Saudi Ministry of Health established the "937 telephone medical consultation call center" almost 10 years ago.

Objectives

The aim of this study was to examine public awareness of, utilization of, and satisfaction with the 937 call center service, and to assess associated factors.

Materials and methods

This national community-based, cross-sectional study was conducted through multistage sampling with proportional allocation from 20 health directorates. Participants were selected from the general population in public places and were interviewed with a validated questionnaire.

Results

Of 7951 approached individuals, 7692 agreed to participate (response rate 96.7%). Seventy-eight percent of participants were aware of the 937 service, and 56.4% had previously used the service. Most (86%) users were satisfied with the service. Long waiting times were the most frequent reason (46.6%) for dissatisfaction. In multivariable analysis, service awareness and utilization were both significantly associated with having higher education (aOR 4.03, 95%CI: 3.17-5.12 and aOR 3.42, 95%CI: 2.64-4.42, respectively). Positive impressions of telephone medical consultation services, Saudi nationality, having children, having medical insurance, and having a history of chronic disease were significantly associated with awareness of, utilization of, and satisfaction with the service.

Conclusion

The study revealed high awareness of, utilization of, and satisfaction with the 937 telephone medical consultation call center, thus suggesting increased public acceptance of the service. Moreover, the study identified socio-demographic factors influencing public awareness of, utilization of, and satisfaction with telehealth. Further studies are required to increase understanding of the facilitators of, and barriers to, the use of service among various population groups.

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

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.

Long-Term Impact of COVID-19 Related Disruption of National Health Service Elective Services on Emergency Major Lower Limb Amputations

BACKGROUND

The COVID-19 pandemic has affected the healthcare systems worldwide since the dawn of 2020. In March 2020, the United Kingdom government announced the first national lockdown which severely disturbed all National Health Service (NHS) healthcare elective services. Our aim is to assess the long-term impact of COVID-19 related disruption of NHS elective services on emergency major lower limb amputations (MLLAs).

METHODS

Patients' data for emergency MLLA for critical limb-threatening ischemia and diabetic foot infections performed at Aberdeen Royal Infirmary was collected through Trakcare and divided into the control prepandemic group (April 2018-March 2020) and the pandemic group (April 2020-March 2022). The statistical analysis was conducted using the IBM SPSS software (v28.0.1.1 [14]).

RESULTS

A total of 358 patients underwent MLLA and 206 (57.5%) of these had diabetes mellitus. There was a 17% increase in the number of urgent referrals and every 1 in 5 of these finally underwent an amputation. There was an increase in the absolute number of Above- and Below-Knee amputations. There was a statistically significant increase by 33% in emergency MLLAs during the pandemic period (P < 0.05). A total of 165 postoperative deaths up to December 2022 were recorded with 30-day mortality rate of 7.26% (n = 26).

CONCLUSIONS

NHS vascular management groups should update themselves with evolving technologies to optimize the care provided during future unprecedented times. Furthermore, more effective measures should also be implemented to avoid delayed presentations, which can potentially lead to higher rates of major limb amputations.

Investigating perceptions and attitude toward telenursing among undergraduate nursing students for the future of nursing education: a cross-sectional study

BACKGROUND

Telenursing is poised to emerge as a novel healthcare delivery system in the digital age. Hence, understanding nursing students' perspectives and readiness is pivotal for its effective implementation. This study investigated nursing students' perceptions regarding, and attitudes toward, telenursing and the factors that influenced their attitudes based on the technology acceptance model.

METHODS

This study used a cross-sectional descriptive approach. The participants consisted of 188 nursing students (first to fourth year) enrolled in the College of Nursing in Korea. Differences in attitudes toward telenursing were analyzed using independent t-test and one-way analysis of variance. Pearson's correlation coefficient was used to examine the correlations between the main variables. Factors that influenced attitudes toward telenursing were analyzed using multiple regression.

RESULTS

Of the participants, 65.4% lacked substantial awareness of telenursing and 19.1% had prior telenursing experience. Although prospects on telenursing indicated that 90.4% had an optimistic view, face-to-face nursing was heavily preferred for both satisfactory and favored healthcare delivery. Many cited the Internet as their source of knowledge, and only 18.6% had received telenursing education. Attitude toward telenursing was significantly more positive among those with experience of telenursing, telenursing observation in clinical practice, and telenursing education exposure. The regression model was statistically significant (F = 67.445, p < .000). Factors, such as perceived usefulness, social influence, innovativeness, and self-efficacy, influenced attitudes toward telenursing.

CONCLUSIONS

Nursing students exhibited a lack of substantial awareness of telenursing; however, they simultaneously displayed a positive outlook. This lack of comprehensive understanding could stem from the absence of formal education in telenursing. Understanding and utilizing the potential of telenursing could be significantly aided by nursing students' education and knowledge. Thus, it is necessary to include telenursing education in the nursing curriculum. The skills and knowledge required for telenursing clinical practice can be developed through telenursing education. Such preparedness will affect nurses' attitudes and intentions and the quality of telenursing offered to patients in the future.

Technology acceptance model perspective on the intention to participate in medical talents training in China

Objectives

This study seeks to investigate the willingness of medical professionals to embrace training in sports medicine integrated talents, as well as the factors that influence their decision-making process. By utilizing technology acceptance models, the objective is to gain a comprehensive understanding of this phenomenon and provide valuable recommendations to facilitate the development of proficient integration of sports and medicine (ISM) talents.

Methods

The questionnaire was developed through a comprehensive review of relevant literature and consultation with experts in the field. A cluster sampling method was employed to select medical professionals from various medical institutions in Guangxi Zhuang Autonomous Region (Guangxi) who had participated in ISM talent training. The collected data were analyzed using the AMOS structural equation model, ensuring a rigorous and systematic approach to data analysis.

Results

A total of 403 questionnaires were collected in this survey, and 8 out of the 9 research hypotheses formulated for the model variables were found to be supported. Perceived usefulness, perceived ease of use, subjective norm and training satisfaction were identified as significant factors influencing the behavioral intention of medical professionals to engage in ISM talent training (P < 0.05). The path coefficients for these factors were 0.17, 0.16, 0.31 and 0.24, respectively.

Conclusion

In order to enhance the effectiveness of training for ISM talents, it is imperative for relevant departments to collaborate and focus on improving the perceived usefulness, perceived ease of use, and training satisfaction. By doing so, we can effectively harness the subjective initiative of medical professionals, thereby increasing their willingness to participate in training programs. This, in turn, will contribute to the cultivation of "high-quality, high-level" ISM talents that are essential for the betterment of society.

Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review

BACKGROUND

During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented.

OBJECTIVE

The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic.

METHODS

A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

RESULTS

The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines.

CONCLUSIONS

This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic.

TRIAL REGISTRATION

PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu.

Eye Segmentation Method for Telehealth: Application to the Myasthenia Gravis Physical Examination

Due to the precautions put in place during the COVID-19 pandemic, utilization of telemedicine has increased quickly for patient care and clinical trials. Unfortunately, teleconsultation is closer to a video conference than a medical consultation, with the current solutions setting the patient and doctor into an evaluation that relies entirely on a two-dimensional view of each other. We are developing a patented telehealth platform that assists with diagnostic testing of ocular manifestations of myasthenia gravis. We present a hybrid algorithm combining deep learning with computer vision to give quantitative metrics of ptosis and ocular muscle fatigue leading to eyelid droop and diplopia. The method works both on a fixed image and frame by frame of the video in real-time, allowing capture of dynamic muscular weakness during the examination. We then use signal processing and filtering to derive robust metrics of ptosis and l ocular misalignment. In our construction, we have prioritized the robustness of the method versus accuracy obtained in controlled conditions in order to provide a method that can operate in standard telehealth conditions. The approach is general and can be applied to many disorders of ocular motility and ptosis.

Telehealth during COVID-19: Perspectives on Usability by US Physicians

Objective

To understand the usability of telehealth among physicians caring for older adults during the COVID-19 pandemic.

Methods

We interviewed US-based physicians specializing in emergency medicine, geriatrics, and primary care who provided care during the COVID-19 pandemic. The interview guide was grounded in the unified theory of acceptance and use of technology (UTAUT). After conducting interviews probing their experiences delivering care using telehealth, we performed framework analysis to reveal major themes in telehealth usability.

Results

Forty-eight physicians (15 emergency physicians, 18 geriatricians, 15 primary care physicians) participated in interviews from September 2, 2020 to November 20, 2020. Lack of prior use of telehealth, quick adoption of telehealth, technical deficiencies in platforms, and frequent visits with older adults made using telehealth more difficult. Physicians shared low self-efficacy when using telehealth for diagnosis in certain patient populations, like older patients, new patients, and patients with atypical presentations or non-specific symptoms. By contrast, they had high self-efficacy if they received training, had existing technical proficiency, or were meeting established patients. Key facilitating conditions include easy-to-use telehealth platforms, the inclusion of third parties-like patients' children or nurses-in virtual visits, and at-home medical devices like blood pressure cuffs or pulse oximeters.

Conclusions

While physicians largely found that telehealth platforms were usable to deliver care to patients remotely, there were several technical and training-related barriers that impeded telehealth's usability at the onset of the pandemic. Simpler telehealth platforms with easy-to-use features, involvement of caregivers, telehealth training, and remote diagnostic devices increased the usability of telehealth.

Refining 2SVCA Method for Measuring Telehealth Accessibility of Primary Care Physicians in Baton Rouge, Louisiana

Equity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed "2-Step Virtual Catchment Area (2SVCA) method" to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana. The result is compared to that of spatial accessibility via physical visits to care providers based on the popular 2-Step Floating Catchment Area (2SFCA) method. The study shows that both spatial and telehealth accessibilities decline from urban to low-density and then rural areas. Moreover, disproportionally higher percentages of African Americans are in areas with higher spatial accessibility scores; but such an advantage is not realized in telehealth accessibility. In the study area, absence of broadband availability is mainly a rural problem and leads to a lower average telehealth accessibility than physical accessibility in rural areas. On the other side, lack of broadband affordability is a challenge across the rural-urban continuum and is disproportionally associated with high concentrations of disadvantaged population groups such as households under the poverty level and Blacks.

A Study on Technology Acceptance of Digital Healthcare among Older Korean Adults Using Extended Tam (Extended Technology Acceptance Model)

The use of digital health and wrist-worn wearable technologies have been increasingly utilized, especially during COVID-19 surge, to help monitor patients and vulnerable groups such as elderly people. As one of the countries with highest aging population, South Korean older adults are expected to be familiarized with these healthcare technologies. However, there have been a few studies on the investigation of Korean older adults’ attitude towards the acceptance of wearable technologies, such as a smart health watch after the COVID-19 curve flattened in South Korea. Thus, the purpose of this study is to investigate the acceptability of digital health wearable technology in healthcare by the Korean older adults and their attitude towards the use of smart health watches by using an extended Technology Acceptance Model while considering the context of the COVID-19 pandemic. We performed a cross-sectional survey of Korean adults aged 56 years and older who are living in Busan, and a total of 170 respondents were received. Results reveal that perceived usefulness, perceived ease of use, and facilitating conditions have a significant impact on older Korean’s attitudes towards the use of a smart health watch, while the relationship between social influence and attitude towards its use was found to not be statistically significant. The attitude towards the use of smart health watches had an effect on their intention to use the smartwatch. By using the findings from the study, the digital wearables providers, manufacturers, and promotors can enhance their strategy to elevate the use of digital healthcare wearables among Korean elderly people while ensuring these products are of good quality and affordable, as well as ensuring necessary assistance is provided to the elderly people when utilizing and adopting these wearables in their everyday lives. Moreover, the results of this study can be utilized to accommodate the needs of Korean elderly people regarding their use of smart health watches and help promote the benefits of healthcare wearable technologies after the pandemic subsides.

Adoption of video consultations during the COVID-19 pandemic

BACKGROUND

Video consultations have the potential to play a significant role for the future of healthcare by solving some of the imminently arising healthcare challenges, as pointed by the European Commission in Europe and the National Academy of Medicine in the United States of America. This technology can improve quality, efficiency, and enhance access to healthcare.

OBJECTIVE

The aim of this study is to explore and understand individual video consultations acceptance drivers.

METHODS

An extended technology acceptance model was created based on the diffusion of innovation theory (DOI), unified theory of acceptance and use of technology (UTAUT), health belief model (HBM), and concerns for information privacy framework (CFIP). 346 valid responses were collected through an online questionnaire, and the partial least squares (PLS) modeling approach was used to test the model.

RESULTS

The model explained 77.6 % (R2) of the variance on intention to use, and 71.4 % (R2) of the variance in attitude. The predictors of intention to use are attitude (beta = 0.504, p-value<0.001), performance expectancy (beta = 0.196, p-value = 0.002), and COVID-19 (beta = 0.151, p-value<0.001). The predictors of attitude are performance expectancy (beta = 0.643, p-value>0.001), effort expectancy (beta = 0.138, p-value = 0.001), and COVID-19 (beta = 0.170, p-value<0.001).

CONCLUSIONS

This research model highlights the importance of creating extended acceptance models to capture the specificities of each technology in healthcare. The model created helps to understand the most important drivers of video consultation acceptance, highlighting the importance of the COVID-19 pandemic and perceived health risks.

An Innovative Nurse Practitioner Curricular Design Using an Adaptive Learning Platform, Adaptive Case Studies, and Telehealth Simulations: A Feasibility Study

Introduction

This project explored the feasibility of implementing an innovative cross-curricular framework using an adaptive learning (AL) platform and telehealth simulations.

Objective

To determine the feasibility of implementing an innovative cross-curricular framework using an AL platform and telehealth simulations.

Methods

A mixed-method pilot study was conducted using novel AL modules, adaptive case studies, and telehealth simulation.

Results

Quantitative data analysis demonstrated significant correlations within and across demographics using the Technology Acceptance Model (TAM) and Simulation Effectiveness Tool-Modified (SET-M). Specifically, significant correlations are evident between TAM ease of use items 1-6, 8, and 10 and TAM usefulness 1, 3, and 9, with SET-M items 3 and 5-15. Thematic analysis revealed that participants felt that the overall project was worthwhile and increased confidence in telehealth.

Conclusion

Participants found the technology used in this study was easy and useful, and they indicated a positive experience with telehealth simulation. Overall, this study demonstrated that implementation of AL using our paradigm is feasible and supports further investigation into implementing a cross-curricular framework using an AL platform and telehealth simulations.

Experiences and Perceptions of Telephone-delivery of the Common Elements Treatment Approach for Mental Health Needs Among Young People in Zambia During the COVID-19 Pandemic

Background

Mental and behavioral health needs are immense in low-to-middle income countries (LMIC), particularly for adolescents and young adults (AYA). However, access to mental health services is limited in LMIC due to barriers such as distance to a health care site, low number of providers, and other structural and logistical challenges. During the COVID-19 pandemic, these barriers were significantly exacerbated and, thus, mental health services were severely disrupted. A potential solution to some of these barriers is remote delivery of such services via technology. Exploration of AYA experiences is needed to understand the benefits and challenges when shifting to remotely delivered services.

Methods

Participants included 16 AYA (15-29 years) residing in Lusaka, Zambia who met criteria for a mental or behavioral health concern and received telehealth delivery of the Common Elements Treatment Approach (CETA). AYA participated in semi-structured qualitative interviews to explore feasibility, acceptability, and barriers to telephone-delivered treatment in this context. Thematic coding analysis was conducted to identify key themes.

Findings

Three major response themes emerged: 1) Advantages of telehealth delivery of CETA, Disadvantages or barriers to telehealth delivery of CETA, 3) AYA recommendations for optimizing telehealth (ways to improve telehealth delivery in Zambia. Results indicate that logistical and sociocultural barriers i.e., providing AYA with phones to use for sessions, facilitating one face-to-face meeting with providers) need to be addressed for success of remotely delivered services.

Conclusion

AYA in this sample reported telehealth delivery reduces some access barriers to engaging in mental health care provision in Zambia. Addressing logistical and sociocultural challenges identified in this study will optimize feasibility of telehealth delivery and will support the integration of virtual mental health services in the Zambian health system.

Stimuli Influencing Engagement, Satisfaction, and Intention to Use Telemedicine Services: An Integrative Model

Telemedicine ensures quality, cost-effective, and equally accessible healthcare services for everyone. Nonetheless, a poor usage rate could curb its progression in developing cultures like Bangladesh. Therefore, this research examines how external stimuli promote the continuous usage intentions of synchronous telemedicine services through engagement and satisfaction by deploying the stimulus-organism-response framework. A final sample of 312 telemedicine users was analyzed using the structural equation modeling in AMOS. The average age of the participants was 26.28 (std. deviation 5.53), and their average use of telemedicine was 2.39 times (std. deviation 1.31) over the last six months. This study empirically endorsed that the stimuli, including performance expectancy, information quality, and contamination avoidance, as well as organismic factors such as engagement and satisfaction, directly impacted the continuance desires for telemedicine use. In addition, the analyses validated the mediation roles of engagement and satisfaction. Furthermore, performance and effort expectancies influenced engagement, which affected satisfaction along with performance expectancy, functionality, and information quality. Accordingly, telemedicine facilitators should integrate these critical attributes into the system to sustain engagement, satisfaction, and usage intentions. This study has pioneered the effects of performance and effort expectancies on continuous usage intentions facilitated by engagement and satisfaction in the telemedicine landscape.

Virtual Care Prior to and During COVID-19: A Cross-Sectional Survey of Rural and Urban Adults

BACKGROUND

To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between healthcare providers and patients, rural-urban differences in virtual are relatively unexplored.

OBJECTIVE

The two-fold purpose of the present study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs.

METHODS

A cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis.

RESULTS

Overall, 501 (373, 74.4% female; Age 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over half reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic compared to prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all Ps<.05) and eHealth literacy (all Ps<.001) were positively associated with participants' perceptions of virtual care usefulness, ease of use, and satisfaction with no rural/urban differences. Rural participants were less likely to have used video in communicating with doctors/healthcare providers, compared to urban participants (P<.001). When describing unmet needs, participants described: 1) lack of access to care; 2) limited health promotion and prevention options; and 3) lack of mental health service options.

CONCLUSIONS

The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider post-pandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

CLINICALTRIAL

Use of telelactation interventions to improve breastfeeding outcomes among mothers: A mixed-studies systematic review

BACKGROUND

Breastfeeding has multiple positive impacts on infants, mothers, and the economy.

PROBLEM

However, the global breastfeeding rates fall short of the World Health Organization's recommendations. Telelactation interventions have been shown to improve breastfeeding outcomes, yet this field has not been systematically reviewed.

AIM

This mixed-studies systematic review aims to consolidate and synthesize findings on the available evidence of telelactation interventions on breastfeeding outcomes, uptake of these interventions, and provide recommendations for future lactation interventions.

METHODS

A literature search was conducted in six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and Scopus) and one gray literature (Mednar) from their inception date to October 2021. Thirteen articles met the selection criteria, and thematic synthesis was conducted to consolidate and synthesize findings from the included studies.

FINDINGS

Three themes and nine subthemes were identified: (1) Attributes and receptivity of telelactation interventions, (2) Benefits associated with telelactation interventions, and (3) Recommendations and improvement opportunities.

DISCUSSION

Telelactation interventions were well-received by stakeholders (mothers, fathers, and healthcare providers), and receptivity was found to be influenced by primiparity and the perceived usefulness of telelactation consultations (extrinsic motivation). These interventions showed promising improvement in the provider-user relationship and breastfeeding outcomes. Future studies should make telelactation user-friendly, secure their telelactation platforms, increase communication options and built-in functions, and improve care continuity.

CONCLUSION

This review highlighted the advantages, recommendations, and future considerations for telelactation interventions. More research is needed to pilot telelactation interventions in various regions and obtain longitudinal data with different time points.

Understanding the Drivers of Ghanaian Citizens' Adoption Intentions of Mobile Health Services

Mobile health (m-health) application development and diffusion in developing countries have always been a challenge; therefore, research that seeks to provide an elucidation of the drivers of m-Health adoption is vital. Mobile health information systems and applications can contribute to the delivery of a good healthcare system. This study examined the factors influencing citizens' adoption of mobile health services. The Technology Acceptance Model (TAM) was used as the research underpinning for this study, while the data gathered were analyzed with SmartPLS through the use of the structural equation modeling technique. The results showed that perceived usefulness and ease of use were both significant predictors of the behavioral intention to use and recommend the adoption of mobile health services. Also, perceived risk was negative but significant in predicting the intention to use and recommend adoption. Mobile self-efficacy was found to significantly determine the behavioral intention to use, intention to recommend, perceived usefulness, and perceived ease of use of mobile health services. Besides, word-of-mouth showed a positive impact on both the intention to use and recommend. Contrary to expectations, the intention to use had no significant impact on the recommendation intention. The theoretical and practical implications of these findings are thoroughly examined.

Role of Agile in Digital Public Health Transformation

The digitalisation of healthcare, fueled by advances in technology and the COVID-19 pandemic can not only empower equitable access to global expert-level healthcare but also make healthcare more patient-centric. Every digital health solution has one common fundamental component: they all run on computing platforms and are powered by complex software. Traditional software development life cycles have often failed in designing complex software; consequently, the agile approach was introduced. To assess the role of agile in digital public health transformation, we used the synthetic knowledge synthesis, a triangulation of bibliometric mapping, and thematic analysis to analyse the available literature harvested from PubMed. The analysis showed that the use of the agile approach is underutilised in developing digital health software. Moreover, the study revealed that health organisations did not yet embrace the agile culture and should adapt using innovative agile solutions to deliver clinical value to patients and public health systems. Following the software industry, where agile software development is becoming the mainstream approach also for sensitive and regulated software, it is becoming even more essential that the digital health software development process should be modernised. Furthermore, a shift to agile collaboration, agile decision-making, trial tolerance, active engagement, purposeful technology adoption, knowledge sharing, and an open agile innovation ecosystem must be achieved.

Experience With and Awareness of Telemedicine Among Korean Outpatients During the COVID-19 Pandemic

Introduction: Owing to the coronavirus disease 19 pandemic, the demand for telemedicine has increased. However, the awareness of and experience with telemedicine among the Korean population have not been investigated. Therefore, we examined Korean outpatients' experience with and awareness of telemedicine. Methods: From December 2020 to March 2021, we conducted a survey exploring the awareness of and experience with telemedicine of outpatients who were consecutively enrolled by family physicians from four hospitals. The participants completed questionnaires on sociodemographic characteristics and knowledge, experience, satisfaction, preference, and future considerations concerning telemedicine. We evaluated factors associated with satisfaction with telemedicine experiences using multivariate logistic regression analysis. Results: Among the 563 study participants, 364 participants had experience with telemedicine. More than 95% of the telemedicine visits were performed by telephone consultation, and the most common disease type for telemedicine visits was chronic diseases (67.5%). Overall, 82.4% of the participants were satisfied with telemedicine. More than 90% of the participants were satisfied with telemedicine in terms of saving time and money relative to hospital visits, no risk of infection, and convenience. According to the multivariate logistic regression analysis, adults aged ≥65 years (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.44-8.68), residents of a metropolitan city (OR 6.8, 95% CI 1.41-32.55), and those with knowledge of telemedicine (OR 2.96, 95% CI 1.21-7.26) were more likely to be satisfied with their telemedicine experience, compared with their counterparts. For chronic diseases, participants with telemedicine experience were significantly more likely to prefer telemedicine for revisits, compared with those with no telemedicine experience. Nonetheless, most respondents recognized that telemedicine requires improvement. Conclusions: Most Korean outpatients showed high satisfaction with telemedicine. Telemedicine may be considered in various medical situations in the future. Therefore, building a practical system for telemedicine and changes in the medical environment are required.

Determinants of Satisfaction With Hospital Online Appointment Service Among Older Adults During the COVID-19 Pandemic: A Cross-Sectional Study

Background

How did older adults who had to use online medical service during the COVID-19 pandemic bridge the “digital divide”? Taking Internet-based appointment service (IBAS) as an example, this study aimed to investigate the subjective feelings of older adults and evaluate their user-satisfaction.

Methods

This study was based on data from a questionnaire survey involving 325 outpatients 60 years old in shanghai during the COVID-19 pandemic. The satisfaction of IBAS was evaluated and compared from six domains including convenience, visiting time, correct identification of specialists, on-site assist service, COVID-19 prevention, and privacy protection. Logistic regression analysis was used to investigate the correlation between satisfaction and social factors.

Results

No significant difference between older adults with or without previous experience using IBAS in terms of overall satisfaction. In the domain of operation difficulty (81.9 vs. 97.5%) and precise medicine (88.1 vs. 96.9%), such as correctly identifying the specialist, the satisfaction of previous user group was significantly higher than that of first-time user group. However, there was no significant difference in the remaining four domains between the two groups. Among the first time IBAS users, the satisfaction was higher than the walk-in registration they used before. Logistic regression revealed that some “intention to use IBAS”-associated social factors such as distance from the hospital, living status, and frequency of hospital visit, were related to the satisfaction of older adults.

Conclusions

Driven by the external pandemic and internal intention, older adults would choose and manage network medical resources with their high satisfaction, which essentially demonstrates not only behavioral adjustment but also inner acceptance in older adults. Our findings support the need for promoting the driving force of older adults in using Internet-based medical service as well as transforming the design factors and behavior patterns.

European Respiratory Society Statement on Long COVID-19 Follow-Up

Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force convened and prioritised eight clinical questions. A targeted search of the literature defined the timeline of “long COVID” as 1–6 months post-infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period, and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QoL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID is limited.

Follow-up care of patients infected with SARS-CoV-2 is crucial and may improve their quality of life. More evidence and research is emerging to understand the causes, mechanisms and risks of long COVID consequences.https://bit.ly/3J1WMWy

What Drives Construction Practitioners’ Acceptance of Intelligent Surveillance Systems? An Extended Technology Acceptance Model

With the advent of intelligent construction, the intelligent surveillance system using computer vision technology has emerged as a prominent tool to identify unsafe behaviors on construction sites. At the same time, it is still viewed with suspicion by the construction industry, and its penetration rate remains low. To promote the successful implementation of the intelligent surveillance system, this study applied the technology acceptance model approach and developed an intelligent surveillance system acceptance model (ISSTAM) containing 12 variables from individual, organizational, environmental, and technical perspectives. Questionnaires were distributed to construction industry practitioners, 220 of whom provided valid data. Moreover, a structural equation model (SEM) was established for hypothesis testing. The research results suggest that job relevance, government action, training, and technical support positively and indirectly influence the use intention. Meanwhile, perceived usefulness, perceived ease of use, and cost savings directly and positively affect use intention, while privacy risk is verified to have a negative impact upon use intention. This study can help the government, organizations, and technology developers better apply the intelligent surveillance system to improve safety management levels.

Identifying the Factors Influencing Patients' Telehealth Visit Satisfaction: Survey Validation Through a Structural Equation Modeling Approach

Introduction: The COVID-19 pandemic accelerated the adoption of telehealth as an alternative to in-person hospital visits. To understand the factors impacting the quality of telehealth services, there is a need for validated survey instruments and conceptual frameworks. The objective of this study is to validate a telehealth patient satisfaction survey by structural equation modeling (SEM) and determine the relationship between the factors in the proposed telehealth patient satisfaction model (TPSM). Methods: We conducted a cross-sectional survey of pediatric patients and families receiving care from a comprehensive pediatric hospital in the Midwest between September 2020 and January 2021. In total, 2,039 usable responses were collected. We used an SEM approach by performing confirmatory factor analysis with Diagonally Weighted Least Squares modeling and Partial Least Squares-Path Modeling to establish the structural validity and examined the relationships among the constructs of "Admission Process" (AP), "Perceived Quality of Service" (PQS), and "Telehealth Satisfaction" (TS). Results: Participants were predominantly White (75%) and English-speaking (95%) parents (85%) of patients (mean age of patients was 10.2 years old). The survey responses were collected from patients visiting 43 department specialties, whereas 50% were behavioral and occupational therapy patients. The structural model showed that the admission process (AP) had a strong positive impact on perceived quality of service (PQS) (p = 0.67, t = 36.1, p < 0.001). The PQS had a strong positive impact on telehealth satisfaction (TS) (p = 0.66, t = 31.8, p < 0.001). The AP had a low positive direct impact on TS (p = 0.16, t = 7.46, p < 0.05). Overall, AP and PQS explained 61% variances (R²) of TS. Conclusions: We validated a newly proposed TS assessment model by using SEM. The TPSM will inform researchers to better understand the influencing factors in TS and help health care systems to improve telehealth patient satisfaction through a validated model.

The impact of the SARS-CoV-2 pandemic on the management of chronic limb-threatening ischemia and wound care

In the wake of the coronavirus pandemic, the critical limb ischemia (CLI) Global Society aims to develop improved clinical guidance that will inform better care standards to reduce tissue loss and amputations during and following the new SARS‐CoV‐2 era. This will include developing standards of practice, improve gaps in care, and design improved research protocols to study new chronic limb‐threatening ischemia treatment and diagnostic options. Following a round table discussion that identified hypotheses and suppositions the wound care community had during the SARS‐CoV‐2 pandemic, the CLI Global Society undertook a critical review of literature using PubMed to confirm or rebut these hypotheses, identify knowledge gaps, and analyse the findings in terms of what in wound care has changed due to the pandemic and what wound care providers need to do differently as a result of these changes. Evidence was graded using the Oxford Centre for Evidence‐Based Medicine scheme. The majority of hypotheses and related suppositions were confirmed, but there is noticeable heterogeneity, so the experiences reported herein are not universal for wound care providers and centres. Moreover, the effects of the dynamic pandemic vary over time in geographic areas. Wound care will unlikely return to prepandemic practices. Importantly, Levels 2–5 evidence reveals a paradigm shift in wound care towards a hybrid telemedicine and home healthcare model to keep patients at home to minimize the number of in‐person visits at clinics and hospitalizations, with the exception of severe cases such as chronic limb‐threatening ischemia. The use of telemedicine and home care will likely continue and improve in the postpandemic era.