Article

A Holistic Framework to Improve the Uptake and Impact of eHealthTechnologies

Journal of Medical Internet Research (Impact Factor: 4.67). 01/2011;
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Available from: Julia E W C van Gemert-Pijnen, Aug 14, 2015
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    • "The CeHRes Roadmap [18] is a framework that can be used to evaluate and improve existing eHealth technologies. The roadmap states that eHealth development is a participatory process and that development is intertwined with implementation into daily health care processes. "
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    ABSTRACT: A Personal Health Record (PHR) is a promising technology for improving the quality of chronic disease management. Despite the efforts that have been made in a research project to develop a PHR for patients with type 2 diabetes mellitus in primary care (e-Vita), differences have been reported between the number of registered users in the participating primary practices. To gain insight into the factors that influence the implementation of the PHR into daily health care processes and into the possibilities to improve the content, interviews have been conducted with participating primary practice nurses and other stakeholders in the research project. A first impression of the interviews indicated that in many cases, the low impact of the PHR is due to a lack of information about the purpose, content and use of the system.
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    ABSTRACT: Increasing lifestyle-related ill health, escalating health care costs, expanding health inequalities within and between nations, and an aging population are challenges facing governments globally. Governments, especially in industrialized countries like Sweden are investing in health promotion and health communication, especially in ICT-supported health communication as a way to increase health literacy and empowerment at individual and population levels. Studies show that many eHealth communication efforts are narrow in scope, medical oriented and therefore not enough to address the complexity of lifestyle-related ill health and equity issues. This thesis proposes integrating health promotion values and principles in the design process of eHealth systems for health promotion in order to develop usable, sustainable, engaging, eHealth resources that are adaptable to their context of use and user’s skills. The overall aim of this thesis was study the participatory development process of an interactive ICT-supported health communication channel for health promotion and enhancing health literacy in PHC context. Participatory Action Research (PAR) with a multi-phase and multi-method approach was used in this thesis. A model entitled Spiral Technology Action Research (STAR) was used to guide the development of the health channel. This design process was framed in three developmental and evaluation phases corresponding to formative, process and outcome evaluation. A total of 146 participants consisting of professionals from primary health care services, information technology and academia, and local citizens participated in the project’s different phases. A triangulation of methods was used to collect the data; survey, document analysis, participatory observations with field notes, individual interviews, focus groups, think aloud protocols and log statistics. Qualitative and quantitative content analyses were used to analyse data. The results revealed that integrating health promotion values and principles in the design process proved to be valuable not only to the content of the channel, but also in PHC practice. The different design phases yielded valuable results that built into each other and contributed to an eHealth channel that was perceived as relevant to the local people’s need for health communication; accessible and user friendly. The results also indicated that an Internet based interactive health channel, could be a valuable resource for enhancing health literacy if users are involved in the design.
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    ABSTRACT: Despite the huge potential of telemedicine services (increasing accessibility of care, increasing quality of care and lowering of healthcare costs), its implementation in daily clinical practice is very limited and most services fade away after a project or pilot phase. The aim of this thesis has been to contribute to knowledge concerning the added value of telemedicine services for physical rehabilitation. For this, two state of the art evaluation studies of telemedicine services for physical rehabilitation (chapter 2 and 3) have been performed and in addition, the actual use of these telemedicine services and its association between actual use and clinical benefit have been addressed (chapter 5 and 6). Results of this thesis show that telemedicine services have potential to comply with the increased demand of care in the field of rehabilitation and other fields. To provide concrete guidelines to other researchers active in the field of evaluation of telemedicine services the “DeChant” framework [4] is refined into a new stage approach framework focusing on four different aspects 1] evaluation objective, 2] evaluation context, 3] evaluation design and 4] evaluation endpoints. Actual use is an aspect that is hugely underexposed given that it is significantly related to clinical outcome and the measure that reflects real adoption of telemedicine by its end users. In addition, based on the knowledge that actual use of telemedicine decreases over time, it is important that new tools and techniques will be developed that improve actual use. It is hypothesized that this can be realized on one hand by enhancing technologies, such as using ambulant technology that allows objective monitoring and feedback and gaming technology but also by addressing implementation strategies such as implementation intentions.
    Universiteit Twente, 12/2014, Degree: PhD