Testing the technology acceptance model for evaluating healthcare professionals' intention to use an adverse event reporting system

Health professionals' technology readiness on the acceptance of teleradiology in the Amhara regional state public hospitals, northwest Ethiopia: Using technology readiness acceptance model (TRAM)

BACKGROUND

Considering individual differences caused by personality differences is crucial for end users' technology acceptance. However, previous studies overlooked the influence of users' technology readiness on technology acceptance. This study, therefore, aimed to evaluate the influence of technology readiness on teleradiology acceptance in the Amhara Regional State Public Hospitals using a technology readiness acceptance model.

METHODS

An institutional-based cross-sectional mixed study design was conducted in September 2021 among 547 health professionals working at sixteen public hospitals in the Amhara region of northwest Ethiopia. Eight key informants were interviewed to explore organizational-related factors. Face-to-face and Google Meet approaches were used to collect the data. We applied structural equation modeling to investigate the influence of technology readiness on health professionals' teleradiology acceptance using Analysis of Moment Structures Version 23 software.

RESULTS

Of the total participants, 70.2% and 85.7% were ready and intended to use teleradiology, respectively. According to technology readiness measuring constructs, optimism and innovativeness positively influenced health professionals' technology acceptance. Perceived ease of use and perceived usefulness showed a statistically positive significant effect on health professionals' intention to use teleradiology. In addition, a statistically significant mediation effect was observed between technology readiness measuring constructs and behavioral intention to use. Furthermore, a shortage of budget, inadequate infrastructure, and users' lack of adequate skills were reported as critical organizational challenges.

CONCLUSIONS

We found a higher proportion of readiness and intention to use teleradiology among health professionals. Personality difference measuring constructs and organizational factors played considerable influence on teleradiology acceptance. Therefore, before the actual implementation of teleradiology, ensuring the system's user-friendliness, improving infrastructure, allocating an adequate budget, and availing of capacity-building opportunities are recommended.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Evaluation of the intention to use the electronic medical record (EMR) by health professionals in healthcare facilities of Libreville and Owendo in Gabon

Introduction

Health systems in several countries have integrated information and communication technologies into their operations. Electronic medical records (EMRs) are at the core of patient care. The working of these EMRs requires their acceptance and use by medical and paramedical personnel. The objective of this study was to empirically evaluate the intention of health professionals to use these EMRs.

Materials and Methods

A questionnaire on the intention of health professionals to use the EMR was developed following a Likert scale. The survey was done via in-person interviews of health professionals in major health facilities in the cities of Libreville and Owendo in Gabon. The technology acceptance model (TAM) was tested using a step-down logistic regression analysis to identify the main factors explaining the intention of health professionals to use the EMR.

Results

A total of 218 health professionals responded to the questionnaire. Thirty-eight percent (38%) of respondents were male. The average age was 41.33 years (±8.98 years) and the average length of service at work in the system was 12.02 years (±8.47 years). The integrated model showed that the intention to use the EMR was significantly associated with the perceived usefulness, the subjective standard, and experience. No socio-demographic variables explained the intention to use the EMR.

Conclusion

The perceived ease, familiarity with the computer, and motivation are not associated with the intention to use the EMR. Actions should be taken to raise awareness and train health professionals to motivate them to accept and use EMRs in their medical practices.

Use of Telemedicine Technology among General Practitioners during COVID-19: A Modified Technology Acceptance Model Study in Poland

During the COVID-19 pandemic, telehealth became a popular solution for the remote provision of primary care by General Practitioners (GPs) in Poland. This study aimed to assess the GPs' acceptance of telehealth during the COVID-19 pandemic in Poland and to explain the factors that drive GPs' need to implement a telehealth system in primary care using the modified Technology Acceptance Model (TAM). In Poland, 361 GPs from a representative sample of 361 clinics drawn from 21,500 outpatient institutions in Poland participated in the empirical study. Structural equation modelling (SEM) was used to evaluate the causal relationships that were formulated in the proposed model. Research has shown that Polish GPs reported a positive perception and high acceptance of the telehealth system during the COVID-19 pandemic. Overall, the results show that the social factors (image, decision autonomy, perception of patient interaction) significantly positively influence the technological factors (perceived ease of use and perceived usefulness) that influence the need to implement a telehealth system. The proposed socio-technological model can serve as a theoretical basis for future research and offer empirical predictions for practitioners and researchers in health departments, governments, and primary care settings.

Analyzing the determinants to accept a virtual assistant and use cases among cancer patients: a mixed methods study

Background

Technological progress in artificial intelligence has led to the increasing popularity of virtual assistants, i.e., embodied or disembodied conversational agents that allow chatting with a technical system in a natural language. However, only little comprehensive research is conducted about patients' perceptions and possible applications of virtual assistant in healthcare with cancer patients. This research aims to investigate the key acceptance factors and value-adding use cases of a virtual assistant for patients diagnosed with cancer.

Methods

Qualitative interviews with eight former patients and four doctors of a Dutch radiotherapy institute were conducted to determine what acceptance factors they find most important for a virtual assistant and gain insights into value-adding applications. The unified theory of acceptance and use of technology (UTAUT) was used to structure perceptions and was inductively modified as a result of the interviews. The subsequent research model was triangulated via an online survey with 127 respondents diagnosed with cancer. A structural equation model was used to determine the relevance of acceptance factors. Through a multigroup analysis, differences between sample subgroups were compared.

Results

The interviews found support for all factors of the UTAUT: performance expectancy, effort expectancy, social influence and facilitating conditions. Additionally, self-efficacy, trust, and resistance to change, were added as an extension of the UTAUT. Former patients found a virtual assistant helpful in receiving information about logistic questions, treatment procedures, side effects, or scheduling appointments. The quantitative study found that the constructs performance expectancy (ß = 0.399), effort expectancy (ß = 0.258), social influence (ß = 0.114), and trust (ß = 0.210) significantly influenced behavioral intention to use a virtual assistant, explaining 80% of its variance. Self-efficacy (ß = 0.792) acts as antecedent of effort expectancy. Facilitating conditions and resistance to change were not found to have a significant relationship with user intention.

Conclusions

Performance and effort expectancy are the leading determinants of virtual assistant acceptance. The latter is dependent on a patient’s self-efficacy. Therefore, including patients during the development and introduction of a VA in cancer treatment is important. The high relevance of trust indicates the need for a reliable, secure service that should be promoted as such. Social influence suggests using doctors in endorsing the VA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08189-7.

Toward an Ecologically Valid Conceptual Framework for the Use of Artificial Intelligence in Clinical Settings: Need for Systems Thinking, Accountability, Decision-making, Trust, and Patient Safety Considerations in Safeguarding the Technology and Clinicians

The health care management and the medical practitioner literature lack a descriptive conceptual framework for understanding the dynamic and complex interactions between clinicians and artificial intelligence (AI) systems. As most of the existing literature has been investigating AI's performance and effectiveness from a statistical (analytical) standpoint, there is a lack of studies ensuring AI's ecological validity. In this study, we derived a framework that focuses explicitly on the interaction between AI and clinicians. The proposed framework builds upon well-established human factors models such as the technology acceptance model and expectancy theory. The framework can be used to perform quantitative and qualitative analyses (mixed methods) to capture how clinician-AI interactions may vary based on human factors such as expectancy, workload, trust, cognitive variables related to absorptive capacity and bounded rationality, and concerns for patient safety. If leveraged, the proposed framework can help to identify factors influencing clinicians' intention to use AI and, consequently, improve AI acceptance and address the lack of AI accountability while safeguarding the patients, clinicians, and AI technology. Overall, this paper discusses the concepts, propositions, and assumptions of the multidisciplinary decision-making literature, constituting a sociocognitive approach that extends the theories of distributed cognition and, thus, will account for the ecological validity of AI.

Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: an underestimated need for patient safety

Objective

We aimed to investigate the perception of the implementation success of reporting and learning systems in German hospitals, the perceived relevance of the implementation outcomes and whether and how these implementation outcomes are monitored. An reporting and learning system is a tool used worldwide for patient safety that identifies and analyses critical events, errors, risks and near misses in healthcare.

Methods

A pretested exploratory cross-sectional online survey was conducted with reporting and learning system experts from 51 acute care hospitals. For communicative validation, the results were discussed in person in an expert panel discussion (N=23).

Results

Fifty-three per cent (n=27) of the participants (N=51) of the online survey perceived that their reporting and learning system was being comprehensively and successfully implemented. However, no service or patient outcomes were reported to ultimately capture the concept of implementation success. Most of the participants reported a (high) relevance of the implementation outcomes’ acceptability and sustainability. In total, 44 measures were provided to monitor implementation outcomes. However, most of the quantitative measures were based on the (relative) number of entered reports. Qualitative measures were reported in relation to the ‘quality of the report’. In general, the measures were poorly specified.

Conclusion

There is an underestimated need to develop validated ‘implementation patient safety indicator(s) (sets)’ to monitor implementation outcomes of reporting and learning systems. We also identified a potential need to facilitate awareness of the concept of implementation success and its relevance for patient safety. Drafts of indicators that could be used as a starting point for the further development of ‘implementation patient safety indicators’ were provided.

Determinant factors in adopting mobile health application in healthcare by nurses

Background

Mobile applications are among effective learning tools and have a significant role in transferring information and knowledge to nurses. The current study was carried to identify the factors affecting nurses’ use of practical health related mobile applications in education and patient interaction based on the combined Technology Acceptance Model (TAM) and Diffusion of Innovation (DOI).

Method

The study is a descriptive-analytical study with a cross-sectional method. The research population includes nurses working at Tabriz University of Medical Sciences hospitals, 150 of which were selected as the research sample using simple and available sampling. The data collection instrument was a questionnaire, the validity and reliability of which were confirmed (α = 0.9). Data analysis was carried out using a correlation test and regression analysis by applying SPSS _v16 software.

Results

The findings show that perceived usefulness and perceived ease of use have a direct and significant effect on the rate of using mobile applications by nurses (P value ≤ 0.01), [(β = 0.52), (β = 0.40)]. Other findings indicate that relative advantage, compatibility, trialability and observability, have a direct and significant effect on nurses’ use of mobile applications, while complicatedness does not have a significant effect.

Conclusion

The current study identifies the effective factors in nurses’ use of health-related mobile applications based on an integrated model of TAM and DOI. Designers of mobile applications should consider these factors in designing and developing programs so that mobile applications can successfully fulfill their purpose in healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01784-y.

Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study

Background

The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind.

Objective

We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed.

Methods

We conducted a qualitative case study of cloud computing in health care settings, interviewing a range of individuals with perspectives on supply, implementation, adoption, and integration of cloud technology. Data were collected through a series of in-depth semistructured interviews exploring current applications, implementation approaches, challenges encountered, and visions for the future. The interviews were transcribed and thematically analyzed using NVivo 12 (QSR International). We coded the data based on a sociotechnical coding framework developed in related work.

Results

We interviewed 23 individuals between September 2020 and November 2020, including professionals working across major cloud providers, health care provider organizations, innovators, small and medium-sized software vendors, and academic institutions. The participants were united by a common vision of a cloud-enabled ecosystem of applications and by drivers surrounding data-driven innovation. The identified barriers to progress included the cost of data migration and skill gaps to implement cloud technologies within provider organizations, the cultural shift required to move to externally hosted services, a lack of user pull as many benefits were not visible to those providing frontline care, and a lack of interoperability standards and central regulations.

Conclusions

Implementations need to be viewed as a digitally enabled transformation of services, driven by skill development, organizational change management, and user engagement, to facilitate the implementation and exploitation of cloud-based infrastructures and to maximize returns on investment.

Factors Affecting User's Behavioral Intention and Use of a Mobile-Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Small-Scale UTAUT Analysis

A mobile app could be a powerful medium for providing individual support for cognitive behavioral therapy (CBT), as well as facilitating therapy adherence. Little is known about factors that may explain the acceptance and uptake of such applications. This study, therefore, examines factors from an extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT2) model to explain variation between people's behavioral intention to use a CBT for insomnia (CBT-I) app and their use-behavior. The model includes eight aspects of behavioral intention: performance expectancy, effort expectancy, social influence, self-efficacy, trust, hedonic motivation, anxiety, and facilitating conditions, and investigates further the influence of the behavioral intention and facilitating conditions on app-usage behavior. Data were gathered from a field trial involving people (n = 89) with relatively mild insomnia using a CBT-I app. The analysis applied the Partial Least Squares-Structural Equation Modeling method. The results found that performance expectancy, effort expectancy, social influence, self-efficacy, trust, and facilitating conditions all explained part of the variation in behavioral intention, but not beyond the explanation provided by hedonic motivation, which accounted for R² = 0.61. Both behavioral intention and facilitating conditions could explain the use-behavior (R² = 0.32). We anticipate that the findings will help researchers and developers to focus on: (1) users' positive feelings about the app as this was an indicator of their acceptance of the mobile app and usage; and (2) the availability of resources and support as this also correlated with the technology use.

Novel Telephone-Based Interactive Voice Response System for Incident Reporting

BACKGROUND

The voluntary reporting of medical errors and near misses is a well-established patient safety reporting mechanism. However, studies suggest that these incident reporting systems (IRSs) detect less than 10% of all adverse events. Improving the process of reporting can facilitate more informative and timely data capture while providing more opportunities to improve health care quality and safety. The purpose of this study was to understand the barriers to incident reporting via the existing Web-based IRS and develop solutions to increase the ease and efficiency of reporting.

METHODS

A survey of staff in a diagnostic imaging department in St. Catharines, Ontario was performed to identify barriers to incident reporting. Based on the barriers identified, two methods of incident reporting were tested in successive phases: (1) a phone-based voice message mailbox, in the computed tomography suite; and (2) a phone-based structured interactive voice response system (IVRS), across the entire department. We measured the rate of incident reports/day and time required to complete reports.

OUTCOMES

The three most common barriers to reporting identified were lack of time, complexity of reporting system, and lack of feedback. There was a significant difference in reports per day for the IVRS (mean [M] = 3.43, standard deviation [SD] = 2.71) compared to the IRS (M = 0.99, SD = 0.55); t(31) = 4.58, p ≤ 0.00001. There was also a significant difference in the average time to make a report for the IVRS (M = 97 seconds [s], SD = 30 s) compared to the IRS (M = 644 s, SD = 90 s); t(4) =13.55, p = 0.00025.

CONCLUSION

IVRS is an innovative approach to incident reporting that may prove to be more efficient than Web-based approaches and encourage higher reporting rates.

Research on the use intention of potential designers of unmanned cars based on technology acceptance model

The success of unmanned car, an emerging tool of transportation with so many advantages, depends to a large extent on its user acceptability. Potential designers are both the decision makers of driverless car design and the users of driverless cars. This study aims to explore the influencing factors of the potential designers’ intention to use unmanned cars. Based on the theory of Technology Acceptance Model (TAM), this study further expanded the TAM by incorporating perceived trust, perceived enjoyment and self-efficacy, so as to explain and predict potential designers’ intention to use unmanned cars. The questionnaire is determined through theoretical literature, pre-tests, etc., and the Structural Equation Model is used to analyze the data of 202 valid survey samples to investigate the influencing factors of the willingness to use unmanned vehicles. The results show that potential designers’ intention to use unmanned cars is positively affected by perceived trust, perceived enjoyment, perceived usefulness and perceived ease of use, and perceived trust has a positive effect on perceived ease of use, self-efficacy and perceived ease of use also have a positive effect on perceived usefulness. The findings of this study can provide designers and developers of unmanned cars, policy makers and implementers with guidance in the follow-up design, policy formulation and advertising of unmanned cars.

Fear of Hospital-Acquired Infections: The Combined Impact of Patient's Hygiene Sensitivity and Perceived Staff Preventive Behavior

Over the years, the public has paid growing attention to hospital-acquired infections (HAIs). Currently, infection prevention and control are considered a number one national priority in leading developed countries. However, while some hospital visitors are knowledgeable of the topic, others may be ignorant or careless as regards sterility and hygiene-related matters. This study, conducted in Israel, compared people cognizant of hygiene-related issues to those who are less so, in an attempt to account for differences in terms of attitudes and perceptions regarding the hospital environment. Based on Endsley's (in: Proceedings of the IEEE 1988 national aerospace and electronics conference, IEEE, 1988, 1995) situation awareness concept, we hypothesized that people attending the hospital with different hygiene schema would react differently when faced with HAI-related triggers. Based on a survey of 208 respondents, the results support the hypotheses, and showed a significant moderating effect of hygiene-sensitivity on the relationship between the staffs' hospital acquired infection-related proactive behavior and avoidance tendencies among hospital visitors. Theoretical as well as practical recommendations are discussed.

Willingness to Report Medical Incidents in Healthcare: a Psychological Model Based on Organizational Trust and Benefit/Risk Perceptions

Many healthcare organizations have incident reporting systems to reduce and prevent medical errors. However, many systems have failed or not been implemented due to medical professionals' reluctance to report errors made by themselves or others. This study investigated the factors influencing their willingness to report incidents voluntarily. A psychological model based on the trust heuristic was proposed, hypothesizing that organizational trust could affect willingness to report based on the perceived benefits and risks of incident reporting or directly influence willingness to report. Three hundred twenty participants were recruited from 19 provinces in China to participate in an online survey conducted between June and July 2018. Participants included doctors, nurses, medical technicians, medical service staff, and administrative staff from different hospitals. All had access to incident reporting systems. Partial least squares structural equation modeling (PLS-SEM) was applied to examine the proposed psychological model. Participants had a modest willingness of reporting. Organizational trust was found to, directly and indirectly, affect participants' willingness to report their own incidents. Compared with perceived risk, perceived benefit was a more important predictor for willingness of reporting and a more important mediator in the effect of organizational trust on willingness of reporting. Our results highlight the importance of increasing the perceived benefit from incident reporting and building a "trust culture" for improving incident reporting.

The Relationship between Nurses' Training and Perceptions of Electronic Documentation Systems

Electronic documentation systems have been widely implemented in the healthcare field. These systems have become a critical part of the nursing profession. This research examines how nurses' general computer skills, training, and self-efficacy affect their perceptions of using these systems. A sample of 248 nurses was surveyed to examine their general computer skills, self-efficacy, and training in electronic documentation systems in nursing programs. We propose a model to investigate the extent to which nurses' computer skills, self-efficacy, and training in electronic documentation influence perceptions of using electronic documentation systems in hospitals. The data supports a mediated model in which general computer skills, self-efficacy, and training influence perceived usefulness through perceived ease of use. The significance of these findings was confirmed through structural equation modeling. As the electronic documentation systems are customized for every organization, our findings suggest value in nurses receiving training to learn these specific systems in the workplace or during their internships. Doing so may improve patient outcomes by ensuring that nurses use the systems consistently and effectively.

Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND

Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings.

METHOD

The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument.

RESULTS

Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability.

CONCLUSION

Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017065348.

Factors influencing acceptance of robotics in hospital pharmacy: a longitudinal study using the Extended Technology Acceptance Model

OBJECTIVES

To explore factors influencing hospital pharmacy staff acceptance of a pharmacy robotic dispensing system during implementation and over time.

METHODS

A single centred, prospective, longitudinal cohort quantitative study was conducted in an Australian tertiary public hospital using the Extended Technology Acceptance Model (ETAM). Staff were surveyed during the implementation of a pharmacy dispensing robot (May 2016) and again after working with the system for fifteen months (August 2017). Fishers exact test and correlation analysis of paired responses were used to identify significant factors influencing use of the system between the two time points.

KEY FINDINGS

Sixty four respondents completed surveys during implementation (n=64) and 34-paired surveys were collected fifteen months later. Respondents were predominantly young, female with a tertiary qualification. Initial perceptions did not change over time, with the exception of reliability. Departmental leaders had greatest influence on technology acceptance during implementation and over time. Other key factors correlating with acceptance included: how useful the robot was perceived to be; ease of use and how relevant the robot was for an individual role. Higher levels of education had a negative association with usage during implementation and age was not a factor.

CONCLUSION

This study identified critical insights influencing staff acceptance of pharmacy robots that will help inform future implementation. The influence of pharmacy leaders emerged as key influence on technology acceptance. Leveraging on this influence a communication strategy prior to implementation should include information on useful functions and known benefits of the system customised for individual roles.

Determining Factors Affecting Nurses' Acceptance of a Care Plan System Using a Modified Technology Acceptance Model 3: Structural Equation Model With Cross-Sectional Data

Background

Health information technology is used in nursing practice worldwide, and holistic patient care planning can serve as a guide for nursing practice to ensure quality in patient-centered care. However, few studies have thoroughly analyzed users’ acceptance of care plan systems to establish individual plans.

Objective

Based on the technology acceptance model 3 (TAM3), a user technology acceptance model was established to explore what determines the acceptance of care plan systems by users in clinical settings.

Methods

Cross-sectional quantitative data were obtained from 222 nurses at eight hospitals affiliated with public organizations in Taiwan. Using the modified TAM3, the collected data were employed to analyze the determinants of user acceptance of a care plan system through structural equation modeling (SEM). We also employed moderated multiple regression analysis and partial least squares–SEM to test the moderating effects.

Results

We verified all significant effects from the use of a care plan system among bivariate patterns in the modified TAM3, except for moderating effects. Our results revealed that the determinants of perceived usefulness and perceived ease of use significantly influenced perceived usefulness and perceived ease of use, respectively. The results also indicated that nurses’ perceptions of subjective norm (path coefficient=.25, P<.001), perceived ease of use (path coefficient=.32, P<.001), and perceived usefulness (path coefficient=.31, P<.001) had significantly positive effects on their behavioral intention to use the care plan system, accounting for 69% of the total explained variance.

Conclusions

By exploring nurses’ acceptance of a care plan system, this study revealed relationships among the variables in TAM3. Our results confirm that the modified TAM3 is an innovative assessment instrument that can help managers understand nurses’ acceptance of health information technology in nursing practice to enhance the adoption of health information technology.

Iranian Health Information Technology Acceptance Model (IHITAM) from Users' Views

Introduction

Information technology (IT) is an important component of medical informatics. Information needs to be accepted by users to function effectively. At different ages and from different views, several models have been proposed and used to show factors affecting users' IT acceptance. However, such models are in need of frequent revision and development due to variable conditions.

Aim

The present research aims to design a new health IT acceptance model from Iranian users' views. The research aims both to design a model for status quo by reviewing previous models and consider features of Iranian users.

Methods

This is a correlative, cross-sectional study. Firstly, the primary model was presented by studying important IT acceptance models. Then, a structured questionnaire was designed and, after confirmation of validity and reliability of the questionnaire, it was given to users of information and health IT systems in different wards of hospitals in Iran. Data were analyzed by SPSS and Lisrel and the final model was designed by structural equations.

Results

The model showed that there are six key factors which are effective on attitude and use intention including performance expectancy, observability, effort expectancy, facilitating conditions, empowerment and subjective norms via three interface factors of perceived usefulness, perceived ease of use, self-efficacy. The size of technology use is an important factor in technology acceptance and application as well.

Conclusion

The present model has more details compared to the other models and can show a new image of important factors in technology acceptance and their relationships.

Factors Influencing the Adoption of Online Health Consultation Services: The Role of Subjective Norm, Trust, Perceived Benefit, and Offline Habit

The cyberspace plays an important role in improving the quality, equity, and efficiency of health services. Studying people's adoption of online health services, such as online health consultation services (OHCS) can benefit both industry and policy in the health service sector. This paper investigates influencing factors and paths of people's intention of adopting OHCS by employing the extended valence framework, with our new contribution of integrating subjective norm and offline habit into the model. Five hundred forty-three university students participated in the survey. Structural equation models and Sobel-Goodman tests were applied to test the models. The results show that subjective norm (β = 0.077, p = 0.041), trust in providers (β = 0.194, p = 0.002) and perceived benefit (β = 0.463, p < 0.001) positively affect the intention to adopt OHCS, while offline habit (β = -0.111, p = 0.026) has a negative effect. However, the association of perceived risk (β = -0.062, p = 0.315) and adoption is not supported. Moreover, trust in providers plays a mediating role between subjective norm and the intention of adopting, while perceived benefit mediates the relationship between trust in providers and the intention of adopting. This study highlights the importance of trust, subjective norm, perceived benefit, and persisting habits in promoting the adoption of OHCS.

End-user experiences with two incident and injury reporting systems designed for led outdoor activities - challenges for implementation of future data systems

Background

Injury and incident (near miss) prevention is heavily dependent upon robust and high-quality data systems. Evaluations of surveillance systems designed to report factors associated with incidents and injuries are essential to understand their value, as well as to improve their performance and efficiency. Despite, this there have been few such evaluations published in the peer-review literature.

Methods

The attitudes and experiences of industry representatives who used one of two variants of an incident and injury surveillance system to collect injury and incident data for the led outdoor activity setting were obtained through an online self-report survey following a 12-month trial. Survey respondents were 18 representatives of 33 organisations who were users of a comprehensive incident reporting and surveillance system – the Understanding and Preventing Led Outdoor Accidents Data System Software Tool (UPLOADS-ST) - and six out of 11 users of a modified system (UPLOADS-Lite). The survey collected information on user experiences in relation to system training, accessibility, ease of use, security, feedback and perceived value to the sector of collating and reporting data across organisations.

Findings

Only four UPLOADS-ST responding users found the system easy to use and just three considered entering incident reports to be easy. However, many considered the training on reporting incidents to be sufficient and that the incident reports contained relevant details. Fewer than half of respondents (seven for UPLOADS-ST, three for UPLOADS-Lite) believed entering data was a good use of staff time and resources. Nonetheless, a majority of respondents (seven for UPLOADS-ST, five for UPLOADS-Lite) found the reporting format easy to read and felt the information provided was useful for their organisation.

Conclusions

Usability barriers to incident reporting were identified, particularly for UPLOADS-ST, including time constraints and user friendliness. The majority of users believed aggregating and reporting incident and injury data across organisations would be of value in making the led outdoor activity sector safer. Improving the utility of the surveillance systems will assist in ensuring their sustainability in the led outdoor activity sector.

Theoretical integration of user satisfaction and technology acceptance of the nursing process information system

Background

The nursing process system (NPS) is used to establish the nursing process involving assessment, diagnosis, planning, intervention, and evaluation in solving the health problems of patients.

Objectives

The factors influencing the use of the NPS by nurses were analyzed based on user satisfaction and technology acceptance within the 3Q (service quality, information quality, and system quality) model.

Methods

In this cross-sectional quantitative study, the valid responses of 222 nurses to a questionnaire were obtained; these nurses worked at eight hospitals affiliated with public organizations in Taiwan. Structural equation modeling was used to analyze information quality, system quality, service quality, user satisfaction, perceived usefulness, perceived ease of use, perceived enjoyment, behavioral attitude, and intention after the nurses had used the NPS system for more than 1 month.

Results

Information quality, service quality, and system quality influenced user satisfaction. User satisfaction affected perceived usefulness, perceived ease of use, and perceived enjoyment and had the highest explanatory power (R² = 0.75). Furthermore, perceived usefulness, perceived ease of use, and perceived enjoyment influenced behavioral attitude and intention to use the system. The proposed model explained 53% of the variance in the intention to use the NPS.

Conclusions

The relationships between the variables of the 3Q model were successfully used to examine the intention of nurses toward using the NPS. Using the findings of this study, designers and programmers can comprehensively understand the perceptions of nurses and further improve the performance of the NPS.

Adoption of Hospital Information System Among Nurses: a Technology Acceptance Model Approach

Introduction:

The successful implementation of Hospital Information Systems (HIS) depends on user acceptance. Nurses are the largest group of HIS users in hospitals. This study aims to evaluate some factors may affect the utilization of the Hospital Information System.

Aim:

To explore factors that contribute to using of Hospital Information System.

Methods:

In this cross-sectional study, 325 nurses from training Hospitals affiliated with Lorestan University of Medical Sciences (LUMS) were chosen. A valid and reliable structured questionnaire based on Technology Acceptance Model 1&2 and Unified Theory of Acceptance and Use of Technology was used as the data collection tool. Descriptive statistics, Correlations analysis, multiple regression analysis, path analysis technique, Structure Equation Model using AMOS software was used to examine factors that influenced the Adoption of Hospital Information System.

Results:

The findings indicate a significant direct relationship between Management Support and Perceived Usefulness of HIS. Perceived Usefulness has a significant effect on attitudes. While there was no significant effect of perceived ease of use on attitude. Attitude has a significant effect on behavioral intention.

Conclusion:

This research provides a tool to realize what factors undertake the behavioral intention of healthcare professionals to use hospital information system and how this may affect future use.

Patient safety culture among nurses at a tertiary government hospital in the Philippines

AIM

To assess the patient safety culture (PSC) among nurses at a government hospital BACKGROUND: Culture of patient safety is acknowledged as a critical component to the quality of health care. Despite the increasing curiosity on PSC, little studies are available in the Philippine context.

METHODS

A descriptive, cross-sectional, single-center study using total population sampling technique was conducted. PSC was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC) among Registered Nurses. Descriptive statistics were employed to express demographic data and composites of safety culture.

RESULTS

292 nurses completed the survey, yielding a response rate of 86.65%. Of the 12 composites evaluated, Teamwork within Units (91.50%) was the highest positively-rated followed by Organizational Learning - Continuous Improvement (86.89%) while Nonpunitive Response to Error (17.65%) was the least positively-rated. Most (71.48%) of the respondents had not reported any event within the past 12 months. Majority (45%) reported that the overall patient safety grade of the hospital was very good and no one thought that it was failing.

CONCLUSIONS

This study showed that nurses value Teamwork within Units and Organizational Learning-Continuous Improvement as important aspects of PSC. Nonpunitive Response to Error was the area that requires improvement. Determining PSC level should be a continuous process. The first step should be obtaining the support of the administration and assuming a non-punitive approach to those who make and report medical errors. If the problem of personnel not reporting events is to be resolved, any barriers to reporting should be identified and addressed.

A Systematic Review of the Technology Acceptance Model in Health Informatics

BACKGROUND

One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM).

OBJECTIVE

This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction.

METHOD

An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM.

RESULTS

The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered.

CONCLUSION

Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Factors Affecting Acceptance of Hospital Information Systems Based on Extended Technology Acceptance Model: A Case Study in Three Paraclinical Departments

OBJECTIVE

Regardless of the acceptance of users, information and communication systems can be considered as a health intervention designed to improve the care delivered to patients. This study aimed to determine the adoption and use of the extended Technology Acceptance Model (TAM2) by the users of hospital information system (HIS) in paraclinical departments including laboratory, radiology, and nutrition and to investigate the key factors of adoption and use of these systems.

MATERIALS AND METHODS

A standard questionnaire was used to collect the data from nearly 253 users of these systems in paraclinical departments of eight university hospitals in two different cities of Iran. A total of 202 questionnaires including valid responses were used in this study (105 in Urmia and 97 in Khorramabad). The data were processed using LISREL and SPSS software and statistical analysis technique was based on the structural equation modeling (SEM).

RESULTS

It was found that the original TAM constructs had a significant impact on the staffs' behavioral intention to adopt HIS in paraclinical departments. The results of this study indicated that cognitive instrumental processes (job relevance, output quality, result demonstrability, and perceived ease of use), except for result demonstrability, were significant predictors of intention to use, whereas the result revealed no significant relationship between social influence processes (subjective norm, voluntariness, and image) and the users' behavioral intention to use the system.

CONCLUSION

The results confirmed that several factors in the TAM2 that were important in previous studies were not significant in paraclinical departments and in government-owned hospitals. The users' behavior factors are essential for successful usage of the system and should be considered. It provides valuable information for hospital system providers and policy makers in understanding the adoption challenges as well as practical guidance for the successful implementation of information systems in paraclinical departments.

How does leadership influence incident reporting intention in healthcare? A dual process model of leader–member exchange

Building on social exchange and social identity theory, we examined how leader–member exchange (LMX) influences intention to report incidents in healthcare organizations through two different mechanisms. Using survey data of 15 hospitals in Germany ( N = 480) and multilevel structural equation modelling, we found as expected that LMX positively related to reporting-specific trust and organizational identification of employees. However, only reporting-specific trust but not organizational identification was directly related to incident reporting intention. Furthermore, top management support for patient safety moderated the link between LMX and reporting-specific trust, indicating a compensatory mechanism of top management support for followers with a low-quality leadership relationship. In addition, codification of patient safety regulations moderated the link between organizational identification and incident reporting intention. As expected, the institutionalization of patient safety norms through a strong follow-through of the organization is related to increased reporting only for employees with high organizational identification. Results are discussed in terms of how safety leadership can be enacted at both the supervisory and top management level in order to promote safety behaviour in healthcare organizations.

Acceptability of picture archiving and communication system (PACS) among hospital healthcare personnel based on a unified theory of acceptance and use of technology

Background and aim

The picture archiving and communication system (PACS) is a healthcare system technology which manages medical images and integrates equipment through a network. There are some theories about the use and acceptance of technology by people to describe the behavior and attitudes of end users towards information technologies. We investigated the influential factors on users’ acceptance of PACS in the military hospitals of Tehran.

Methods

In this applied analytical and cross-sectional study, 151 healthcare employees of military hospitals who had experience in using the PACS system were investigated. Participants were selected by census. The following variables were considered: performance expectancy, efforts expectancy, social influence, facilitating conditions and behavioral intention. Data were gathered using a questionnaire. Its validity and reliability were approved by a panel of experts and was piloted with 30 hospital healthcare staff (Cronbach’s alpha =0.91). Spearman correlation coefficient and multiple linear regression analysis were used in analyzing the data.

Results

Expected performance, efforts expectancy, social impact and facilitating conditions had a significant relationship with behavioral intention. The multiple regression analysis indicated that only performance expectancy can predict the user’s behavioral intentions to use PACS technology.

Conclusion

Performance and effort expectancies are quite influential in accepting the use of PACS in hospitals. All healthcare personnel should become aware that using such technology is necessary in a hospital. Knowing the influencing factors that affect the acceptance of using new technology can help in improving its use, especially in a healthcare system. This can improve the offered healthcare services’ quality.

The Feasibility and Acceptability of a Web-Based Alcohol Management Intervention in Community Sports Clubs: A Cross-Sectional Study

Background

The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol-related harm at sporting venues. Supporting sports venues to implement alcohol management strategies via the Web may represent an effective and efficient means of reducing harm caused by alcohol in this setting. However, the feasibility and acceptability of such an approach is unknown.

Objective

This study aimed to identify (1) the current access to and use of the Web and electronic devices by sports clubs; (2) the perceived usefulness, ease of use, and intention to use a Web-based program to support implementation of alcohol management policies in sports clubs; (3) the factors associated with intention to use such a Web-based support program; and (4) the specific features of such a program that sports clubs would find useful.

Methods

A cross-sectional survey was conducted with club administrators of community football clubs in the state of New South Wales, Australia. Perceived usefulness, ease of use and intention to use a hypothetical Web-based alcohol management support program was assessed using the validated Technology Acceptance Model (TAM) instrument. Associations between intention to use a Web-based program and club characteristics as well as perceived ease of use and usefulness was tested using Fisher’s exact test and represented using relative risk (RR) for high intention to use the program.

Results

Of the 73 football clubs that were approached to participate in the study, 63 consented to participate and 46 were eligible and completed the survey. All participants reported having access to the Web and 98% reported current use of electronic devices (eg, computers, iPads/tablets, smartphones, laptops, televisions, and smartboards). Mean scores (out of a possible 7) for the TAM constructs were high for intention to use (mean 6.25, SD 0.87), perceived ease of use (mean 6.00, SD 0.99), and perceived usefulness (mean 6.17, SD 0.85). Intention to use the Web-based alcohol management program was significantly associated with perceived ease of use (P=.02, RR 1.4, CI 1.0-2.9), perceived usefulness (P=.03, RR 1.5, CI 1.0-6.8) and club size (P=.02, RR 0.8, CI 0.5-0.9). The most useful features of such a program included the perceived ability to complete program requirements within users’ own time, complete program accreditation assessment and monitoring online, develop tailored action plans, and receive email reminders and prompts to complete action.

Conclusions

A Web-based alcohol management approach to support sports clubs in the implementation of recommended alcohol management policies appears both feasible and acceptable. Future research should aim to determine if such intended use leads to actual use and club implementation of alcohol management policies.

Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service

BACKGROUND

For many eServices, end-user trust is a crucial prerequisite for use. For the telemedicine context however, knowledge about the coming about and measurement of end-user trust is scarce.

OBJECTIVE

To develop and validate the PAtient Trust Assessment Tool (PATAT): a survey instrument to quantitatively assess patient trust in a telemedicine service.

METHODS

Informed by focus groups, we developed a survey that includes measurement scales for the following factors: trust in the care organization, care professional, treatment, and technology, as well as a scale that assesses a holistic view on trust in the telemedicine service. The survey was completed by 795 patients that use a telemedicine application to manage their anticoagulation treatment. Data were analyzed by means of Partial Least Squares Structural Equation Modeling (PLS-SEM).

RESULTS

The measurement model yielded good to excellent quality measures, after the removal of one item. The causal model resulted in high explained variance (R²=0.68). Trust in healthcare professionals and the treatment had a small effect on overall trust, while trust in the technology displayed a large effect. Trust in the care organization did not result in a significant effect on overall trust.

CONCLUSION

The PATAT is a valid means to assess patient trust in a telemedicine service and can be used to benchmark such a service or to elicit redesign input.

Acceptance of the German e-mental health portal www.psychenet.de: an online survey

Background. Taking into account the high prevalence of mental disorders and the multiple barriers to the use of mental health services, new forms of fostering patient information, involvement, and self-management are needed to complement existing mental health services. The study aimed at investigating acceptance regarding design and content of the e-mental health portal www.psychenet.de.

Methods. An online cross-sectional survey was conducted between May 2013 and May 2015 using a self-administered questionnaire including items on perceived ease of use, perceived usefulness, attitude towards using, and perceived trust. Effects of different participants’ characteristics on the portals’ acceptance were analyzed.

Results. The majority of the N = 252 respondents suffered from mental disorders (n = 139) or were relatives from persons with mental disorders (n = 65). The portal was assessed as “good” or “very good” by 71% of the respondents. High levels of agreement (89–96%) were shown for statements on the perceived ease of use, the behavioral intention to use the portal, and the trustworthiness of the portal. Lower levels of agreement were shown for some statements on the perceived usefulness of the portals’ content. There were no effects of different participants’ characteristics on the perceived ease of use, the perceived usefulness, the attitude towards using the website and the perceived trust.

Discussion. This survey provides preliminary evidence that the e-mental health portal www.psychenet.de appears to be a usable, useful and trustworthy information resource for a broad target group. The behavioral usefulness of the portals’ content might be improved by integrating more activating patient decision aids.

Learning from defects using a comprehensive management system for incident reports in critical care

Incident reporting systems are often used without a structured review process, limiting their utility to learn from defects and compromising their impact on improving the healthcare system. The objective of this study is to describe the experience of implementing a Comprehensive Management System (CMS) for incident reports in the ICU. A physician-led multidisciplinary Incident Report Committee was created to review, analyse and manage the department incident reports. New protocols, policies and procedures, and other patient safety interventions were developed as a result. Information was disseminated to staff through multiple avenues. We compared the pre- and post-intervention periods for the impact on the number of incident reports, level of harm, time needed to close reports and reporting individuals. A total of 1719 incidents were studied. ICU-related incident reports increased from 20 to 36 incidents per 1000 patient days (P=0.01). After implementing the CMS, there was an increase in reporting 'no harm' from 14.2 to 28.1 incidents per 1000 patient days (P<0.001). There was a significant decrease in the time needed to close incident report after implementing the CMS (median of 70 days [Q1-Q3: 26-212] versus 13 days [Q1-Q3: 6-25, P<0.001]). A physician-led multidisciplinary CMS resulted in significant improvement in the output of the incident reporting system. This may be important to enhance the effectiveness of incident reporting systems in highlighting system defects, increasing learning opportunities and improving patient safety.

Applying Electronic Medical Records in Health Care: Physicians' Perspective

BACKGROUND

In order to fulfill comprehensive interoperability and recognize the electronic medical records (EMRs') benefits, physicians' attitudes toward using and applying EMR must be recognized.

OBJECTIVES

The purpose of this study was to present an integrated model of applying EMRs by physicians.

METHODS

This was a cross sectional study in which a sample of 330 physicians working in hospitals affiliated to the Tehran University of medical sciences (TUMS) was selected. Physicians' attitudes toward using and accepting EMR in health care have been analyzed by an integrated model of two classical theories i.e. technology acceptance model (TAM) and diffusion of innovation (DOI). The model was tested using an empirical survey. The final model was tested by structural equation modeling (SEM) and represented by Analysis of Moment Structures (AMOS).

RESULTS

The results suggest that the hybrid model explains about 43 percent of the variance of using and accepting of EMRs (R2=0.43). The findings also evidenced that Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Relative Advantage, Compatibility, Complicatedness and Trainability have direct and significant effect on physicians' attitudes toward using and accepting EMRs. But concerning observeability, significant path coefficient was not reported.

CONCLUSIONS

The integrated model supplies purposeful intuition for elucidates and anticipates of physicians' behaviors in EMRs adoption. The study identified six relevant factors that affect using and applying EMRs that should be subsequently the major concern of health organizations and health policy makers.

International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process

BACKGROUND

Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care.

OBJECTIVE

To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role.

METHODS

After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised.

RESULTS

Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally.

CONCLUSIONS

We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally.

Investigating factors influencing the adoption of e-Health in developing countries: A patient's perspective

PURPOSE

The aim of the study was to investigate factors that influence the adoption and use of e-Health applications in Bangladesh from citizens' (patients') perspectives by extending the technology acceptance model (TAM) to include privacy and trust.

METHODS

A structured questionnaire survey was used to collect data from more than 350 participants in various private and public hospitals in Dhaka, the capital city of Bangladesh. The data were analyzed using the partial least-squares (PLS) method, a statistical analysis technique based on structural equation modeling (SEM).

RESULTS

The study determined that perceived ease of use and perceived usefulness and trust (p < 0.05) were significant factors influencing the intention to adopt e-Health. Privacy (p > 0.05) was identified as a less significant factor in the context of e-Health in Bangladesh. The findings also revealed that gender was strongly associated with the adoption and use of e-Health services.

CONCLUSIONS

The findings of the present study contribute to the development of strategies and policies to enhance e-Health services in Bangladesh. Furthermore, as a result of the generic approach used in this study, the acceptance model developed can be easily modified to investigate the adoption of e-Health in other developing countries.

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals

BACKGROUND

For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional.

METHODS

We held two focus groups with patients (total n = 15) and two with healthcare professionals (total n = 13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment.

RESULTS

Trust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes).

CONCLUSIONS

The set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.

What influences patients' acceptance of a blood pressure telemonitoring service in primary care? A qualitative study

BACKGROUND

Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients' acceptance of such service in routine clinical care.

OBJECTIVE

This study aimed to explore patients' acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM).

METHODS

A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis.

RESULTS

Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and suggested improvement to the BP telemonitoring functionalities to improve interactions. Patients cited being involved in research as the main reason for their intention to use the service. They felt that patients with limited experience with the internet and information technology, who worked out of town, or who had an outdoor hobby would not be able to benefit from such a service.

CONCLUSION

Patients found BP telemonitoring service in primary care easy to use but needed help to interpret the meanings of monitored BP readings. Implementations of BP telemonitoring service must tackle these issues to maximize the patients' acceptance of a BP telemonitoring service.

Cultural Influence on Adoption and Use of e-Health: Evidence in Bangladesh

BACKGROUND

E-health is an important initiative among the public and private hospitals in Bangladesh in the last few years. The factors influencing e-health adoption have been a well-investigated research area in both developed and developing countries. However, there have been only a few studies exploring the role of cultural factors in the adoption and use of e-health, particularly in developing countries. In this study, we investigated the influence of culture on the adoption of e-health in Bangladesh.

MATERIALS AND METHODS

This study developed a more adequate research framework by integrating Hofstede's cultural dimension model and the Technology Acceptance Model (TAM). A structured questionnaire was used to collect data from respondents in different private and public hospitals in Bangladesh. The partial least squares method, a statistical analysis technique based on the Structural Equation Model, was used to analyze the collected data.

RESULTS

The study found that cultural dimensions such as Power Distance, Masculinity, and Restraint had significant impacts on Intention to Use e-Health, whereas Uncertainty Avoidance, Collectivism, and Pragmatism had no significant impact on Intention to Use e-Health in Bangladesh. The results also revealed that Perceived Usefulness was a significant indicator of e-health adoption decisions, whereas Perceived Ease of Use was an insignificant predictor of e-health adoption.

CONCLUSIONS

The findings of this study may assist governments, organizations, and policy makers to understand the key factors affecting e-health adoption and to develop strategies and policies to enhance e-health services in Bangladesh.

Determinants of Physicians' Intention to Collect Data Exhaustively in Registries: an Exploratory Study in Bamako's Community Health Centres

BACKGROUND

The incomplete collection of health data is a prevalent problem in healthcare systems around the world, especially in developing countries. Missing data hinders progress in population health and perpetuates inefficiencies in healthcare systems.

OBJECTIVE

This study aims to identify the factors that predict the intention of physicians practicing in community health centres of Bamako, Mali, to collect data exhaustively in medical registries.

DESIGN

A cross sectional study.

METHOD

In January and February 2011, we conducted a study with a random sample of thirty two physicians practicing in community health centres of Bamako, using a questionnaire. Data was analyzed by using descriptive statistics, correlations and linear regression.

MAIN OUTCOMES MEASURES

Trained investigators administered a questionnaire measuring physicians' sociodemographic and professional characteristics as well as constructs from the Theory of Planned Behaviour.

RESULTS

Our results showed that physicians' intention to collect data exhaustively is influenced by subjective norms and by the physician's number of years in practice.

CONCLUSIONS

the results of this study could be used as a guide for health workers and decision makers to improve the quality of health information collected in community health centers.