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Professional values, technology and future health care: The view of health care professionals in The Netherlands
... In a health care context, there is evidence of a positive and significant relationship between both variables: the perceived ease of use of a new technology explains, together with the perceived usefulness, up to 40% of the variance of the intention to use the new technologies that are being implemented in recent years in the industry [44]. It is also confirmed that, in a telehealth context, effort expectancies are among the most prominent predictors of usage intention [45]. ...
... Virtual doctor appointments and telemedicine are innovative forms of health care that come in handier for communicating with medical staff and stand for saving time spent travelling and waiting, among other factors. Performance expectancy is an important predictor in a telehealth context [45] and a significant influence on the intention to use a telemedicine service for diabetes management [47]. Therefore, and in line with the aforementioned, the second hypothesis states as follows: ...
... Academic evidence of the impact of social influences in the telemedicine context is scarce and not conclusive [42], as the impact of this construct is significant in certain studies [45,50] but sometimes merely marginal or not significant at all [51]. These controversial results may obey, in part, to the characteristics of the study context itself, since health is a highly personal manner and where social pressure exerts a different influence from that played in other contexts of purchase and consumption. ...
UNSTRUCTURED
The aim of this paper is to offer a holistic and integrative approach to telemedicine adoption in an international context. A modified version of UTAUT2, specifically tailored to the telemedicine field, analyzes the factors that influence the usage intention of virtual doctor appointments from a patient's point of view. The research model furthermore integrates one of the core constructs of the Diffusion of Innovations Theory [1], namely relative advantage, and empirically projects the theoretical framework onto three countries that encounter themselves in different stages of the telemedicine adoption curve: Germany, Spain, and the United States of America. A mixed-methods approach was used, and the hypothesis were tested applying structural equation modelling (AMOS 24). It was found that performance expectancy, hedonic motivation, habit, relative advantage and perceived security positively impact the usage intention of virtual doctor appointments, Additionally, it has been shown that age moderates the relationships between effort expectancy and hedonic motivation and usage intention, and gender moderates performance expectancy, hedonic motivation and habit. In the last part of the study, the managerial implications are discussed alongside the limitations and future research lines.
... Many healthcare professionals working in healthcare practice nowadays, do not consider technology routinely as an important solution for health problems [17]. Several factors can explain this often problematic adoption of technology [18]. ...
... Apart from considering factors such as usefulness and ease of use, and changes in professional roles and care processes, we also explicitly wanted to include the patient-healthcare professional relationship and also refer to important others who are close to patients. It is important to acknowledge that technology can change relationships between healthcare professionals and care recipients and their loved ones [17,27]. These changes can create opportunities for new and meaningful connections between them, but they also pose moral questions that may interfere with successful implementation of technology in practice. ...
... However it also showed several dilemmas arising from conflicting interests. As has been reported in earlier studies [17], these conflicting interests act as a barrier to use technology in practice. After all, according to the Normalization Process Theory (NPT), coherence in values is one of the conditional factors for actual use. ...
... To date, however, there have been few successful implementations of eHealth services [14,15]. The slow adoption of services by users [16], the lack of collaboration between healthcare organisations and their systems [17], a shortage of funding [13], and the lack of care models to guide implementation are factors that obstruct the development and implementation of sustainable eHealth services [18]. This research therefore focuses on the design of a care model for eHealth services. ...
... Measuring blood pressure at home enables patients to be in control of their own healthcare (16). Moreover, it gives a better overview and therefore more accurate measurements (9). ...
... Almost all the participants mentioned that patients gain greater control over their health by measuring their blood pressure at home (16). They can decide when to measure and analyse their measurements. ...
BACKGROUND
eHealth services could provide a solution for monitoring the blood pressure of at-risk patients while also decreasing expensive doctor visits. However, a major barrier that posed their implementation is the lack of integration into organisations.
OBJECTIVE
To design a Care Pathway for monitoring blood pressure of at-risk patients, in order to increase the implementation of eHealth in secondary preventive care.
METHODS
A qualitative design study was performed for this research. Data was collected by conducting visual mapping sessions including semi-structured interviews with hypertension patients and doctors. The data was transcribed and coded and thereafter mapped into a Care Pathway.
RESULTS
Common agreement on four themes: (1) the current approach to blood pressure measuring has disadvantages; (2) risk and lifestyle factors of blood pressure measuring need to be considered; (3) there are certain influences of the at-home context on measuring blood pressure; and (4) new touchpoints between actors need to be designed. These the in-depth insights combined with the visualisation of the current blood pressure process resulted in the Care Pathway design for monitoring the blood pressure of at-risk patients as secondary preventive care.
CONCLUSIONS
The Care Pathway guides the implementation of the SBPM eHealth devices. It showcases the pathway of at-risk patients and increases their involvement in managing their blood pressure. It serves as a basis for a new service using eHealth.
... Technology use is influenced by the following factors: the technology itself, the potential user, the organizational setting, and the wider socio-political context (Fleuren et al. 2004;Van der Zande et al. 2013;Lau et al. 2016). With respect to potential users, the extent to which technologies align with their professional values is crucial for a technology to be used (Nieboer et al. 2014;Van der Zande et al. 2013;Greenhalgh et al. 2004). As described by Nieboer et al (Nieboer et al. 2014), opinions on technology use are influenced by such values. ...
... With respect to potential users, the extent to which technologies align with their professional values is crucial for a technology to be used (Nieboer et al. 2014;Van der Zande et al. 2013;Greenhalgh et al. 2004). As described by Nieboer et al (Nieboer et al. 2014), opinions on technology use are influenced by such values. Professional values, though used in many studies, are often not further explained, and are operationalized in different ways. ...
... Scores on craftsmanship and immediate results were higher among higher technology users, indicating that these aspects were more motivating for those with higher technology use. This is in line with the findings of other studies (Nieboer et al. 2014;Lau et al. 2016). However, being more motivated in general is also related to use of a technological application (Mertz et al. 2015). ...
The use of digital dental technologies influences oral health care, and the way in which oral health care is practiced influences the use of digital dental technologies. Dental practices, dentists, and experiences of patients with oral care influence whether and how digital technologies are used. In this thesis, technology use in dental practices is studied. It looks at technology use from a social perspective rather than a technical one. Technology use, then, is inseparable from political, economic, social, and cultural realms. This thesis looks at how technologies, users, and the context in which they are situated mutually shape each other and become mixed. The studies presented herein aim to investigate the impact of digital innovations on the practice of dentistry. They focus on three key research questions: (1) Which promoting and constraining characteristics can be identified in dentists’ adoption and rejection of digital developments? (2) Which changes impacting on the dental workforce can be expected to develop alongside the increasing role of digital techniques in the field of dentistry? and (3) How do dentists and dental practices adapt to these changes, and what are the consequences of these adjustments?
Semi-structured interviews with experts in dentistry, dental technology and dental education in the Netherlands showed that the main barriers and incentives to digital technology use were perceived advantages over analogue methods, perceived influence on treatment quality, dentists’ personal and professional orientation, and social influence from peers and external groups. Characteristics of dentists and dental practices were also important in explaining use and non-use of digital dental technologies.
Using this interview study, a questionnaire was developed which asked dentists about (1) their use of administrative and clinical digital technologies and (2) characteristics of themselves, and of the dental practice they worked in. In general, dentists used administrative technologies more than clinical technologies. Dentists had adopted an average number of 6.3±2.3 technologies. With few exceptions, dentists use some or a substantial number of digital technologies. On the basis of the number of digital technologies that dentists used, three groups of technology users were distinguished: low technology users (who used 0 to 4 technologies), intermediate technology users (who used 5 to 7 technologies) and high technology users (who used 8 to12 technologies). High technology users more frequently had a specialization, were younger on average, and worked more hours per week than low technology users. They also invested more hours per year in professional activities than intermediate technology users did. High technology use was also more common for dentists who worked in larger practices: those which were visited by more patients per year on average, and where more dentists and more staff were working.
How dentists scored on opinions about digital technologies and on motivating work aspects, varied with their level of technology use (low, intermediate or high). A multiple linear regression analysis was then done to assess the association of dentists’ scores on opinions about technology use with the number of technologies dentists used. In this analysis, motivating work aspects, as well as the characteristics of the dentist and dental practice were included in the model first, and then opinion scales were added. In this model, in addition to the factors just mentioned, being more focused on technologies and perceiving a higher added value from using technologies were associated with using more digital dental technologies.
In a survey study conducted in New Zealand, dentists' use of newer, clinical technologies. Of the 17 technologies investigated, digital intra-oral radiography, digital apex locators and rotary endodontic units were the most commonly used. Least commonly-used were digital impression units, digital colour determination and ozone units. Dentists in this study ranked improving quality of care and increasing efficiency as the two most important factors when deciding about using a newer technology. Dentists used an average of 4.9 ± 2.5 technologies. In this study there were no significant differences apart from a significantly greater average number of technologies used by men compared to women.
Finally, a constructivist grounded theory study was conducted using in-depth semi-structured interviews with 24 dental practitioners in the Netherlands. This study posits that when using digital technologies, dentists go through several phases. These phases are ‘starting points’, ‘evaluating influences and making decisions’, ‘acting on disruptions and continuities’ and ‘seeing results and consequences’. The analysis showed that dentists’ use of technologies is future-oriented: expectations about their profession and about technologies formed the base for how technology use is experienced, and which actions dentists take. Fitting technologies into dental practice often involved a large amount of work. This work takes place in aligning skills, the team working in a practice, and material and social contexts. Technology use was to some extent incorporated into dental professionalization, this study found. This incorporation of technology use in professionalization showed differences between older digital technologies, which were defined as a part of professional practice, and newer digital technologies, which were questioned and often kept at a distance. Core ideas about the dental profession were very important in how dentists adapted to technologies and to consequences of technology use. At the same time, using technologies rearranged parts of these core ideas of professionalism.
This thesis suggests that digital technology use is extensively present in dental practice. Technologies’ attributes, dentists’ characteristics, dental practices’ characteristics, opinions and attitudes of dentists, and socio-political context all influence the extent and character of digital technology use by dentists. Furthermore, this thesis has shown that technology use has a substantial impact on developments in dental practicing. This impact needs to be understood and addressed when implementing technologies and when using digital technologies in dental practice.
... Several factors hinder the implementation of the aforementioned technologies, including low adoption levels among potential users [11,46,65,67], difficulties in building sustainable business cases [68,69], a lack of interoperability between systems of different vendors [66,68,70], and scarcity of robust scientific evidence on cost and outcomes [71][72][73]. All the aforementioned factors are complicated by the fact that multiple stakeholders are involved [68,74]. ...
... However, it is important to note that only a small number of technologies were mentioned by all stakeholder groups. Furthermore, care professionals mentioned considerably fewer different types of technology than other stakeholder groups, which is in line with previous research [67]. Additionally, studies have shown that older adults may not be aware of technologies that could be of benefit to them [84,85]. ...
... Collectively, stakeholders feel they need to take the leap (i.e., change attitude(s), change policies, collaborate with other organizations), bridge the gap (i.e., match technology with individuals, stimulate interdisciplinary education), facilitate technology for the masses (i.e., work on products and research that supports large scale rollouts, train target groups on how to use technology), and take time to reflect (i.e., evaluate use and outcomes). Some of the aforementioned steps or recommended actions have also been reported by similar stakeholder groups in other studies, e.g., the need to focus on changing the attitudes of care receivers and care givers [94,95], the need to match technology with individual clients [84,94,96], and the need for training stakeholder groups [67,96,97]. Additionally, studies have pointed to recommended actions that were not mentioned by participants in the current study. ...
... 17,18,21 With respect to potential users, the extent to which technologies align with their professional values is crucial for a technology to be used. 15,18,22 As described by Nieboer et al, 22 opinions on technology use are influenced by such values. Professional values, though used in many studies, are often not further explained and are operationalized in different ways. ...
... 17,18,21 With respect to potential users, the extent to which technologies align with their professional values is crucial for a technology to be used. 15,18,22 As described by Nieboer et al, 22 opinions on technology use are influenced by such values. Professional values, though used in many studies, are often not further explained and are operationalized in different ways. ...
... This is in line with the findings of other studies. 21,22 However, being more motivated in general is also related to use of a technological application. 44 The relatively lower scores on motivating factors among low technology users could be related to lower job satisfaction in general, which might result in lower motivation to invest in improving workplace conditions, including the use of digital technologies. ...
Objectives:
To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account.
Methods:
A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice.
Results:
The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses.
Conclusion:
Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.
... However, research shows that new technology is not always positively perceived by health professionals. 3,4 For example, the occurrence of problems with power supply and lack of knowledge can make health professionals sceptical about the use of new technology. 4,5 Furthermore, research indicates that in order for a technological application to be adequately implemented, health care professionals should feel competent to use the technology. ...
... 4,5 Furthermore, research indicates that in order for a technological application to be adequately implemented, health care professionals should feel competent to use the technology. 3 The speed at which technological developments are introduced is increasing; especially people working in technology-driven professions are constantly confronted with technological innovations. It is therefore of utmost importance to collect the views and experiences of health professionals regarding technology. ...
... An interview guide was developed based on the available literature. 3,5,9 The interview guide ensured that the same set of topics (and questions) was covered in all the interviews, namely (1) the role of technology in daily practice, (2) assistance regarding the use of technology and (3) the role of technology in their professional future. Participation was voluntary. ...
Introduction
New technology is continuously introduced in health care. The aim of this study was (1) to collect the opinions and experiences of radiographers, nuclear medicine technologists and radiation therapists regarding the technology they use in their profession and (2) to acquire their views regarding the role of technology in their future practice.
Methods
Participants were recruited from five departments in five hospitals in The Netherlands. All radiographers, nuclear medicine therapists and radiation therapists who were working in these departments were invited to participate (n = 252). The following topics were discussed: technology in daily work, training in using technology and the role of technology in future practice. The recorded interviews were transcribed verbatim and analysed using open and axial coding.
Results
A total of 52 participants (57.7% radiographer) were included, 19 men and 33 women (age range: 20–63). Four major themes emerged: (1) technology as an indispensable factor, (2) engagement, support and training in using technology, (3) transitions in work and (4) the radiographer of the future. All participants not only value technological developments to perform their occupations, but also aspects such as documentation and physical support. When asked about the future of their profession, contradictory answers were provided; while some expect less autonomy, others belief they will get more autonomy in their work.
Conclusion
Technology plays a major role in all three occupations. All participants believe that technology should be in the best interests of patients. Being involved in the implementation of new technology is of utmost importance; courses and training, facilitated by the managers of the departments, should play a major role. Only when a constant dialogue exists between health care professionals and their managers, in which they discuss their experiences, needs and expectations, technology can be implemented in a safe and effective manner. This, in turn, might positively influence quality of care.
... Of these four, interactional workability relates to how the technological innovation interferes with interactions between persons, especially between health care professionals and patients or residents, which is considered one of the most important values for professionals working in chronic health care (Murray et al. 2011;Nieboer et al. 2014). One good example (Nieboer et al. 2014) was that of a nurse who perceived the hoist not only to be useful in order to avoid her developing back problems. ...
... Of these four, interactional workability relates to how the technological innovation interferes with interactions between persons, especially between health care professionals and patients or residents, which is considered one of the most important values for professionals working in chronic health care (Murray et al. 2011;Nieboer et al. 2014). One good example (Nieboer et al. 2014) was that of a nurse who perceived the hoist not only to be useful in order to avoid her developing back problems. She experienced that it was also contributing the improvement of her relationship with residents: bed ridden persons who never had been at height level with herself, came at level when sitting in the hoist. ...
... Relational integration refers to the impact that the new technology has on responsibilities between groups of professionals, feelings of trust and confidence, and how these might change as a result of the technology. If, for instance, there is no technical back up whenever technology fails, or if responsibilities in follow up of sensor alarms are not clear, this disrupts relational integration and causes a lot of stress and, consequently, non-adoption of the technology (Nieboer et al. 2014;Niemeijer et al. 2013). Similarly, in a comparative study by Murray et al. (2011), PACS (Picture Archiving and Communication System) was reported as promoting communication and trust between different professional groups because it enabled multiple users to view the same image from different locations. ...
In order to accept and implement technology in a successful manner, not only determinants (acceptance barriers or facilitators) related to individual persons, for instance, health care providers as well as health care recipients, are important. Also interpersonal relationships on the work floor as well as the readiness and support of the organization itself are involved in the process of uptake of innovations. The Normalization Process Theory explains how this can be understood. The Technology Adoption Readiness Scale (TARS), developed based on this theory, offers a tool to diagnose the opportunities and challenges in health care organizations with respect to the implementation of certain technology- or eHealth applications. In order to guide the process of large scale implementation of technological innovations, also a pre implementation diagnosis is useful. This diagnosis, when provided by a “neutral party” has proved to be helpful for monitoring, guiding and thus supporting the implementation process of technological innovations in health care settings.
... Additionally, the majority of studies regarding the adoption of HIS are carried out in western countries compared to the number of studies conducted within a Medial East environment (Gagnon et al., 2012;Holden & Karsh, 2010;Hu, Al-Gahtani, & Hu, 2010). Also, a limited number of empirical studies have addressed the issue of HIS adoption by applying qualitative methods (Nieboer, van Hoof, van Hout, Aarts, & Wouters, 2014;Paré & Trudel, 2007;Zakaria, Yusof, & Zakaria, 2009) compared to a much larger size of research that followed a quantitative approach (Aldosari, 2012;AL-Hadban, Hashim, & Yusof, 2016;Holden & Karsh, 2010;Hung, Tsai, & Chuang, 2014;McGinn et al., 2011;Venkatesh, Sykes, & Zhang, 2011); therefore, this adds another motivation to carry out this qualitative study to fill the gap in the literature within the study's new context. What have been presented above emphasizes the scope and encourages the aim of this study which is exploring the opinions of healthcare staff regarding the barriers and facilitators to the usage and adoption of HIS in the Iraqi public hospitals. ...
... The technological factors that were identified by the current study (i.e. lack of integration, system quality, lack of standardization, compatibility, security issues) represented the technical barriers as perceived by the healthcare staff within the Iraqi healthcare context; however, such technological factors were also mentioned and studied within the literature of technology adoption (Boonstra & Broekhuis, 2010;Holden & Karsh, 2010;McGinn et al., 2011;Nieboer et al., 2014). ...
... The healthcare staff expressed several organizational factors (i.e. low training, management support, shortage of skillful maintenance staff, management innovativeness, motivational system, long administrative routine) that could influence their behavior regarding the usage of new technologies in their daily work; other researchers have also examined such organizational factors and their effect within different settings (Hage et al., 2013;Lambrou, Kontodimopoulos, & Niakas, 2010;Lluch, 2011;Nieboer et al., 2014;Thakur et al., 2012). ...
The use of new technologies and information systems within healthcare practice provides several advantages and functionalities for healthcare institutions. However, the use of these advanced technologies is not an easy task and the literature has documented several cases of resistance to adopting such technologies by the healthcare staff. Furthermore, governmental reports stated that Iraq healthcare sector is enduring challenges in this regard. For this reason, the current study explored the opinions of healthcare professionals using semi-structured interviews to highlight the important factors and issues that influence the use and adoption of new technologies within Iraq public healthcare sector. To our best knowledge, this empirical study is the first to employ a qualitative approach to address the issue of healthcare information system adoption in Iraq healthcare domain. Twenty six themes have emerged in the findings of this qualitative study which can be helpful for healthcare seniors in order to overcome the present challenges related to the adoption of healthcare information systems and to improve the healthcare practice in general.
... Several factors hinder the implementation of the aforementioned technologies, including low adoption levels among potential users [3,4,7,8], difficulties in building sustainable business cases [9,10], a lack of interoperability between systems of different vendors [6,9,11], and scarcity of robust scientific evidence on cost and outcomes [12][13][14]. All the aforementioned factors are complicated by the fact that multiple stakeholders are involved [9,15]. ...
... However, it is important to note that only a small number of technologies were mentioned by all stakeholder groups. Furthermore, care professionals mentioned considerably fewer different types of technology than other stakeholder groups, which is in line with previous research [8]. Additionally, studies have shown that older adults may not be aware of technologies that could be of benefit to them [28,29]. ...
... Collectively, stakeholders felt they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations), bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education), facilitate technology for the masses (ie, work on products and research that supports large-scale rollouts and train target groups on how to use technology), and take time to reflect (ie, evaluate use and outcomes). Some of the aforementioned steps or recommended actions have also been reported by similar stakeholder groups in other studies; for example, the need to focus on changing the attitudes of care receivers and care givers [40,41], the need to match technology with individual clients [28,40,42], and the need for training stakeholder groups [8,42,43]. Additionally, studies have pointed to recommended actions that were not mentioned by participants in this study. These include the need to consider how the introduction of technology affects the existing workflow in home care organizations [40][41][42] and the fact that care professionals require support while using technology [8,44,45]. ...
Background: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce.
Objective: To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations?
Methods: Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis.
Results: Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults’ needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard to who should pay for the technology. Additionally, each stakeholder group mentioned specific steps that need to be taken to achieve successful implementation. Collectively, stakeholders felt that they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations); bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education); facilitate technology for the masses (ie, work on products and research that support large-scale rollouts and train target groups on how to use technology); and take time to reflect (ie, evaluate use and outcomes).
Conclusions: Stakeholders largely agree on the direction in which they should be heading; however, they have different perspectives with regard to the technologies that can be employed and the work that is needed to implement them. Central to these issues seems to be the tailoring of technology or technologies to the specific needs of each community-dwelling older adult and the work that is needed by stakeholders to support this type of service delivery on a large scale.
... 34,35 However, TAMs suit poorly in organizational contexts 36 where the use of technology is involuntary 37 and the users' work environment, cultural background and individual characteristics have not been thoroughly considered. 34,[36][37][38][39][40] In this study, we assume that the use of videoconferencing tools is required by the organization, and we examine how care worker-related factorsnamely age, education, perceived ICT support, interest in technology and ICT skills and possible previous experience of using videoconferencing toolsare related to the perceived benefits of videoconferencing in care for older people. The research questions defined for the study are: RQ1: Which personal characteristics of a care worker are related to the use of videoconferencing? ...
... 16 Based on our results, the tasks which videoconferencing tools are used for are highly related to their perceived benefits. Thus, our study demonstrates that it is not enough to include only technology user, cultural context and a certain technology in the theoretical model, as also noted in previous studies, 36,37,39,40 but also how and for what purpose technology is used in organizations should be considered. ...
Objective
The purpose of this study is to examine how care workers’ characteristics are related to the perceived benefits and drawbacks of using videoconferencing in the care of older people. The factors chosen for this study are: age, education, perceived information and communication technology (ICT) support, interest in technology, ICT skills and possible prior experience of using videoconferencing tools.
Methods
Our data source was the second wave (2021) of the University of Jyväskylä survey on elder care work (N = 3607), collected from four large trade unions in Finland. We used a multinomial logistic regression to group respondents according to their experiences of technology use and a path analysis to estimate the effects of care workers’ characteristics and prior experiences on the perceived benefits of videoconferencing tools in eldercare work.
Results
We found that the personal characteristics of a care worker are associated with both the use of videoconferencing and its perceived benefits and drawbacks. In addition, we discovered that prior use of videoconferencing tools, especially in direct care work, affects the perceived benefits of them. Those who have used videoconferencing in direct care work perceive them as more beneficial for both their own work and for clients.
Conclusions
Based on these results, we suggest that healthcare and social welfare organizations pay attention to the characteristics of care workers, especially when estimating the necessary amount of ICT support. More ICT support should be targeted to those with a lower level of education and higher age.
... Interactive technology will become the public feature of a community and commercial life in Australia. This paper would benefit schools, TAFE and university students who want to become IT practitioners and professionals (Nieboer, Van Hoof, Van Hout, Aarts & Wouters, 2014). It will also be noteworthy for the public and private hospitals to take part and play a leading role in ICT and health sector in Australia. ...
... ❖ The Australian Government should use faster processes to set up a national cybercrime unit to capture more cybercriminals (Cyber Crime, 2015). ❖ Determine a transition plan, so professionals from a range of Health disciplines can be upskilled and cross skilled into cybersecurity professionals (Nieboer et al., 2014). ❖ Interactive mobile technology services must always be trustworthy. ...
The research questions, ‘As an Australian, can we expect fully mobile technology integrated health care services in Australia? Is it possible everywhere in Australia’? A healthcare system whether private or public should provide comprehensive health care services all over in Australia, including countryside and CBD. The term ‘Mobile Technology integrated health care’ refers to a healthcare system designed for electronic and smart devices which can be used anytime and anywhere in the world. This research paper examines ‘how patients can access GPs, specialists, private and public hospitals in Australia’, which provide interactive mobile technology-based health services. The research has mainly used secondary research data analysis and methods to provide a broad investigation of the issues relevant to interactive mobile technology and health care system in Australia, the problems, problem factors, benefits and opportunities in the health care industry. Finally, the mobile technology integrated health care system will ensure that the framework is user and environmentally friendly. Keywords: Interactive mobile technology, quality, health care, services, hospitals, Australia.
... Interactive Technology will become the public feature of a community and commercial life in Australia. This paper would benefit schools, TAFE and university students who want to become IT practitioners and professionals [31]. It will also be noteworthy for the public and private hospitals to take part and play a leading role in ICT and health sector in Australia. ...
... • The Australian Government should use faster processes to set up a national cybercrime unit to capture more cyber criminals [26]. • Determine a transition plan so professionals from a range of Health disciplines can be upskilled and cross skilled into cyber security professionals [31]. • Interactive Mobile Technology Services must always be trustworthy. ...
p>The research questions, "As an Australian, can we expect fully Mobile Technology integrated health care services in Australia? Is it possible everywhere in Australia?" A healthcare system whether private or public should provide comprehensive health care services all over in Australia including countryside and CBD. In addition, the term ‘Mobile Technology integrated health care’ refers to a healthcare system designed for electronic and smart devices which can be used anytime and anywhere in the world. This research paper examines ‘how patients can access GPs, specialists, private and public hospitals in Australia’, which provide interactive Mobile Technology based health services. The research has mainly used secondary research data analysis and methods to provide a broad investigation of the issues relevant to interactive Mobile Technology and health care system in Australia, the problems, problem factors, benefits and opportunities in the health care industry. The research is subject to academic journal articles, conference proceedings, academic text books, project reports, online media articles, corporation-based documents and other appropriate information, including a technology adoption or acceptance research model for Mobile Technology integrated health care system. The preliminary stage of the research findings show that the proposed integrated Mobile Technology model can be applied to the current health care system in Australia, particularly improving patients’ smooth access to GPs, specialists, public and private hospitals. Finally, the Mobile Technology integrated health care system will ensure that the framework is user and environmentally friendly including positive and active interactions with all system functions.</p
... This requires a well-structured division of time, without having time lost on trivial tasks such as retrieving items, which, in turn, may lead to a higher level of perceived stress. Technological solutions play an important role in improving the efficiency of care processes [4][5][6]. The SCHAT project (Smart Care Homes and Assistive Technologies) concerns the investigation of how location technologies can be utilized in the nursing home environment in order to address the problems of finding lost and misplaced items and monitoring the use of assistive devices. ...
... Staff do not wish to carry around more portable devices or learn to master new technologies that come on top of the existing set of assistive technologies, computer stations and DECT devices. In addition, technology needs to match with the needs and professional values of care professionals, which are mainly focussed on the quality of the provision of care and spending time with residents [5]. ...
INTRODUCTION
Modern healthcare, including nursing home care, goes together with the use of technologies to support treatment, the provision of care and daily activities. The challenges concerning the implementation of such technologies are numerous. One of these emerging technologies are location technologies (RTLS or Real-Time Location Systems). that can be utilized in the nursing home for monitoring the use and location of assets.
METHODOLOGY
This paper describes a participatory design study of RTLS based on context mapping, conducted in two nursing home organizations. Rather than investigating the technological possibilities, this study investigates the needs and wishes from the perspective of the care professional.
RESULTS
The study identified semantic themes that relate to the practicalities of lost and misplaced items in the nursing home, as well as latent themes that cover the wishes regarding technology in the nursing homes. The organizational culture and building typology may play a role in losing items.
CONCLUSION
The participants in this study indicated that RTLS can provide a solution to some of the challenges that they encounter in the workplace. However, the implementation of new technologies should be done with care and should be integrated into existing ICT systems in order to minimize additional training and posing a burden on the workload.
... A satisfied patient is considered to be a very important value. Also in other studies on job satisfaction and health care, it was confirmed that satisfaction of care professionals increases when individual care recipients' needs were met in a favorable manner (Brownie and Nancarrow 2013;Nieboer et al. 2014), and one of the determinants most strongly related to professional values and job satisfaction is their patient orientation (Harris et al. 2007). Related to this is the result of another study that found that if a holistic patient-centered approach is applied, caregivers tend to be more satisfied with their job (Nolan et al. 1998). ...
... A supportive and cohesive team is associated with higher job satisfaction, less stress, and enhanced perceived autonomy (Larrabee et al. 2003;Nolan et al. 1998;Rafferty et al. 2001), and leaving the job in stable teams is far less common. Also in a more recent study, the importance of a good, stable, and supportive team, together with a good team manager, was confirmed (Nieboer et al. 2014). ...
For care professionals, the main drive and, related to that, their job satisfaction, is based on being able to satisfy the needs of those who receive their care. Furthermore, most professionals working in contexts in which chronic care is provided, value inter-collegial respect and appreciation of supervisors. Therefore, success and failure factors of implementation of technology in health-care situations are associated with the disruption or support of these values. Mostly, health-care professionals do not themselves think about technological solutions for clinical problems, and therefore, they need support in relating technological solutions to care recipients’ needs. In this chapter, a short overview of professional values is given. Next, we outline how technology can be seen as disrupting professional values but also how it can be supportive of professional values, sometimes unexpected, as practice examples show. The chapter is concluded by consequences for daily practice and education in health-care professions.
... It is crucial to understand the perception of healthcare professionals to implement new technology into practice successfully [9]. The research has shown that insights into the perception of AI will allow for informed decisions on education, adoption strategies, and clinical applications [14]. Thus, research should expand on the existing knowledge and prioritize understanding how radiation therapists perceive AI [10,[15][16][17]. ...
... Naujos SPT ne visada laukiamos ir priimamos, neretai susiduriama su kritiniu jų vertinimu. Pagrindinės diegimo kliūtys -medikų (paslaugų teikėjų) ir pacientų (paslaugų gavėjų) elgsena SPT atžvilgiu, sąlygota įvairių priežasčių -konkurencijos, baimės netekti darbo vietos, sudėtingo naujų SPT naudojimo, naudos nesupratimo, naudojimo privalomumo (pasirinkimo nebuvimo), religinių ir moralinių nuostatų [16][17]. ...
Straipsnyje apžvelgiama pastarojo dešimtmečio mokslinė literatūra, nagrinėjanti išmaniųjų sveikatos priežiūros technologijų (SPT) vystymąsi. Apžvelgiama kompiuterizacija ir procesų skaitmenizavimas, išmanieji įrenginiai, neribotų duomenų bazės (NDB) bei debesų technologijos, dirbtinis intelektas (DI), procesų robotizacija, blokų grandinės, nanotechnologijos, žmogaus genomo tyrimai ir jų taikymas sveikatos priežiūrai. Analizuota išmaniųjų technologijų pritaikymo sveikatos priežiūrai nauda bei iššūkiai. Pateiktos sveikatos priežiūros paradigmos pokyčių gairės.
... 15,22 Guidance is important and employing a participatory approach can prove key to understanding the needs and expectations of users and can lead to various outputs including a podcast or a guidance booklet (ATAT Project). 15 Although many scholars have studied the level of digital skills and literacy gaps in citizens including healthcare professionals (such as Wouters et al. 25 and Nieboer et al. 26 ), their findings have sadly not yet found a wide-spread application which helps overcome problems in practice. For successful delivery of care in the form of digital transformation and eHealth, there are multiple factors that have to be considered: ...
... Interestingly, no consensus was reached for technological sources (e.g., apps, Internet, and video calls). Presently, many healthcare professionals do not consider technology routinely as an important solution for health problems [36], despite the rapid development of digital tools. One main factor is the fear that technology interferes with the relationship with the patient [37]. ...
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
... If they cannot master the effective job information or well prepare themselves for employment, then they would face a muddy choice when determining their career direction in the future [1][2][3][4][5][6][7][8][9][10][11][12]. At this time, the occupational values are playing a significant role in instructing the career decisions of college students who do not have a clear career goal, especially in aspects of career expectation, career selection, job search, job training, and job satisfaction [13][14][15][16][17][18][19]. The numerous recruitment information and the information asymmetry between college majors and work posts make it difficult for college students to seize the job opportunities that conform to their occupational values, and the employment success rate is always at a low level, so it's a meaningful work find an objective, effective, and personalized career recommendation method for college students based on their own occupational values. ...
The numerous recruitment information and the information asymmetry between college majors and work posts make it difficult for college students to seize the job opportunities that conform to their occupational values, and the employment success rate is always at a low level. The effect of current college student career recommendation systems is usually unsatisfactory, and the existing systems haven’t fully considered the role of college students’ occupational values in instructing their employment. To fill in this research blank, this paper studied a career recommendation method for college students based on occupational values. At first, the paper proposed a collaborative filtering algorithm based on the features of collect students’ occupational values, introduced a few features that can affect their occupational values, assigned weight values to these features, and gave the method for determining the weight. Then, based on the principle of the Kruskal’s algorithm (the minimum spanning forest), this paper modified the K-Means algorithm and clustered the features of occupational values. At last, the paper elaborated in detail the principle of generating career recommendation results for college students based on occupational values, and used experimental results to verify the correctness of the proposed career recommendation algorithm.
... In the digitisation era, technology has become an essential tool for human beings. The huge networks can be used to provide healthcare facilities to human beings [231]. The mHealth application can act as a preliminary disease prevention medium, which can help the government to save a huge amount of money on public health. ...
Providing health care services has become a challenge for the government, especially for emerging economies, which face huge resource problems. mHealth (mobile health) has the potential to reduce health-related problems significantly in the long run. It can be used as a preventive healthcare tool also. Despite the potential, minimal studies exist on the technology adoption of mHealth. There have been inadequate studies in the context of India. To find out the domains where studies can be conducted and after a thorough literature review, the study employed the Technology Acceptance Model (TAM) for the smooth running of mobile health services.
As a theoretical contribution, this research is an extended version of the TAM, suggested by Davis, through considering six additional variables such as social influence, technology anxiety, trust, perceived risk, perceived physical condition, Resistance to change. To validate the linkages, a close-ended questionnaire was developed after a thorough literature survey. The current study collected 289 valid responses from different mHealth services users. The constructs of the model have been tested in Indian settings by conducting exploratory and confirmatory factor analysis. Further, Structural equation modelling is ably employed to validate the model to suit the Indian requirements. The adoption of mHealth was found to have had an enormous impact on social influence, behavioural intention and trust. The empirical examination showed high predictive power for adoption intention of mHealth services and the influential role of these important constructs. The implications for academics and policymakers have been discussed in this study. Finally, the future scope and limitations of the study have been discussed.
... De meerwaarde van technologische innovaties zoals beeldschermzorg is voor veel zorgverleners niet vanzelfsprekend of beeldschermzorg wordt zelfs beschouwd als een 'verschraling' van de zorg (4,17). De spanning tussen technologiegebruik en het in praktijk brengen van professionele waarden kan als een van de belangrijkste belemmerende factoren worden beschouwd voor het implementatieproces van nieuwe technologie zoals beeldschermzorg (18). Zorgprofessional, zorgvrager en diens relevante naaste(n) fungeren immers als sleutelfiguren om technologie, in een zorg-relatie, (duurzaam) te gaan gebruiken (12,13,19). ...
... The following nine papers dealt with technological solutions and ageing built on the foundations laid out by Marston and van Hoof [19], who laid down the importance of technology and digitalisation as a third pillar for age-friendly cities and communities. Aspects of use-friendly and sustainable design, technology acceptance, and aspects of implementation and needs of carers were all acknowledged in the following contributions [8,9,[70][71][72][73][74][75][76][77]. ...
The number of older adults is increasing rapidly, and this demographic shift places an increased level of strain and tension on the various international healthcare and welfare systems [...]
... Extant qualitative research surrounding technological familiarity spanned a broad range of technological areas, varying from travel based smartphone usage (Wang, Xiang, & Fesenmaier, 2014b) to the healthcare technology implementation (Nieboer, van Hoof, van Hout, Aarts, & Wouters, 2014) to the educators influence during knowledge sharing platform implementation (Harris, 2012). Nevertheless, I am interested in case studies that consider technology acceptance, particularly studies employing UTAUT conceptual frame. ...
... In their busy work environment, it is hard to keep their knowledge about technological advancement up to date. This knowledge gap generates technology anxiety and resistance when healthcare professionals have to use a new technology [4][5][6]. ...
... Furthermore, participants of the current study mentioned various facilitating and impeding factors for the use of eHealth in support for daily functioning: a lack of equipment, a lack proper IT support, and a lack of time to delve into a specific eHealth application were considered to be impeding factors for the use of eHealth in support for daily functioning. Similar to Palmer, Wehmeyer, Davies, and Stock (2012), Clifford Simplican et al. (2018) and Nieboer, van Hoof, van Hout, Aarts, and Wouters (2014), the participants of the current study suggested that accessibility of all stakeholders to the used eHealth applications, appropriate training into how to use these applications, and the availability of a help desk would be essential. Regarding the facilitating factors, participants mentioned adequate informing and involving of all stakeholders, centrally positioning the individual needs and possibilities of each service user, and accepting that not everyone wants to, or is able to, work with eHealth because of a lack of interest or age as important aspects. ...
Background: The use of eHealth in support for daily functioning of service users with intellectual disability (ID) is a rather unexplored domain. Therefore, the current study identified the a) level of familiarity, b) advantages/disadvantages, and c) facilitating/impeding factors for the use of eHealth in support for daily functioning of people with ID according to service users, relatives, and professionals.
Method: Four focus groups and one semi-structured qualitative interview were conducted.
Results: Participants were familiar with numerous eHealth applications. Benefits were related to service users (e.g., increased independency) and relatives/professionals (e.g., providing more efficient support). Adequate informing and involving all stakeholders and centrally positioning the needs and possibilities of service users were reported as important facilitators. Contrary, impeding factors were malfunctioning Internet, expenses of eHealth, and lack of proper IT-support.
Conclusions: The results provide imperative information for future eHealth implementations and to direct its use more specifically to people with ID.
... Participants in the present study, primarily expressed their need for training on the use of the IHIS. This is reinforced by several studies that show that knowledge on the IHIS (29) and training of healthcare professionals can result in more successful use of technology and improved user satisfaction (2,(37)(38)(39). Training of the users seem to be an important way of covering the daily needs of healthcare professionals, and would most specifically impact on the satisfaction of doctors and nurses. ...
Introduction:
The Ministry of Health of the Republic of Cyprus has implemented an Integrated Health Information System (IHIS) in two hospitals. However, no evaluation of IHIS has been conducted to assess its safety, efficiency and effectiveness. The proper utilization of IHIS is essential for the provision of quality healthcare services.
Aim:
The purpose of this study was to evaluate the current IHIS in public hospitals in Cyprus utilizing the DIPSA evaluation framework.
Methods:
A total of 309 subjects, including doctors, nurses and other healthcare professionals, participated in the study. The DIPSA evaluation framework assessed the users' perception in five categories namely, satisfaction, collaboration, system quality, safety and procedures, using Likert scale and 3 open questions. Correlation between the categories was assessed using the Pearson correlation coefficient, and multiple regression analysis was used to examine the relationship between the demographic characteristics and categories. Data analysis was done using SPSS v24.
Results:
All five categories were rated moderately, between 2.5 and 3, by the participants. All categories were correlated (P < 0.01). Multiple regression analysis indicated the need for improvement between the professionals (mainly doctors and nurses) and the categories. The open questions pointed out the need for improvement in all 3 factors examined (Technology, Human Factor, Organization).
Discussion:
The moderately rated categories, in the Cyprus IHIS, suggest that there is a lot of room for improvement. Some interventions are suggested that could positively and simultaneously affect one or more categories.
... Ideally, the perspectives of all stakeholders should be covered. Individuals differ in their values and motives with regard to health, care, their desired living environment, and technologies [33][34][35][36][37][38][39][40][41][42][43][44]. Therefore, the need for new ways of designing technology and the environment are needed, for instance, through the co-design and participatory approaches in research, while also considering and including the least-voiced in our societies, such as persons living with dementia or a physical limitation [37,[45][46][47][48][49][50]. ...
Quality of life is an umbrella term for the quality of the various domains in life [...].
... The integration and use of technology within the age-friendly city domain and frameworks needs to be discussed. It should be noted since the turn of the new millennium, we have seen a phenomenal growth and interest across society, research and development by people who are focusing their attentions on the use and implementation of technology to assist citizens with their daily activities as well as care support [14,15]. ...
The World Health Organization (WHO) strives to assist and inspire cities to become more “age-friendly”, and the fundamentals are included in the Global Age-Friendly Cities Guide. An age-friendly city enables residents to grow older actively within their families, neighbourhoods and civil society, and offers extensive opportunities for the participation of older people in the community. Over the decades, technology has become essential for contemporary and future societies, and even more imperative as the decades move on, given we are nearly in our third decade of the twenty-first century. Yet, technology is not explicitly considered in the 8-domain model by the WHO, which describes an age-friendly city. This paper discusses the gaps in the WHO’s age-friendly cities model in the field of technology and provides insights and recommendations for expansion of the model for application in the context of countries with a high human development index that wish to be fully age-friendly. This work is distinctive because of the proposed new age-friendly framework, and the work presented in this paper contributes to the fields of gerontology, geography urban and development, computer science, and gerontechnology.
... The concept of AAL itself is not understood by end users as it is generally defined, being documented that users' concept of technology is less exclusive by including devices that are not ICT-based (e.g. home adaptations; Peek et al., 2016). Therefore, the literature is prolific in calls for delivering awareness and training to all stakeholders about the opportunities and challenges in the AAL field (Agbakoba et al., 2015;Nieboer et al., 2014;Olphert et al., 2009). Older adults, as well as their relatives, have a preference to receive advice f2f , as this allows personalisation, which constitutes a major benefit since it gives response to the users' needs. ...
... The UTAUT has been applied in different qualitative studies that have used semi-structured interviews in the field of health information system (Cranen et al. 2012;Nieboer et al. 2014). Conducting this method to collect the data via the semi-structured interview will contribute significantly to discover and identify more factors that affect the acceptance of CDSS. ...
Existing Clinical Decision Support Systems (CDSS) research have been focused on technological aspects. The adoption of CDSS remains poorly understood, due to the dependence of diverse CDSS technologies and their uses on decision-maker oriented factors. Understanding these user factors is of paramount interests for developing country contexts, such as Saudi Arabia, where cultural attitudes and norms can impact technology adoption. The study explores on perceptions of CDSS adoption in the healthcare sectors of Saudi Arabia. We conducted a qualitative study to reveal perceptions on CDSS use and adoption using semi-structured interview techniques to collect data from nine medical practitioners who are currently working in the Saudi healthcare sector. The findings are informed through the unified theory of adoption and use of technology (UTAUT) framework for their better meanings and representations. The findings suggested five determinants that affect the intention to use and actual use of CDSS: (1) performance expectancy; (2) effort expectancy; (3) facilitating conditions; (4) diagnostic accuracy; and (5) patient confidence. Patient confidence and diagnostic accuracy were two new determinants of CDSS acceptability not represented in previous models. These findings contribute to understanding CDSS adoption in the Saudi Arabian context.
... De meerwaarde van technologische innovaties zoals beeldschermzorg is voor veel zorgverleners niet vanzelfsprekend of beeldschermzorg wordt zelfs beschouwd als een 'verschraling' van de zorg (4,17). De spanning tussen technologiegebruik en het in praktijk brengen van professionele waarden kan als een van de belangrijkste belemmerende factoren worden beschouwd voor het implementatieproces van nieuwe technologie zoals beeldschermzorg (18). Zorgprofessional, zorgvrager en diens relevante naaste(n) fungeren immers als sleutelfiguren om technologie, in een zorg-relatie, (duurzaam) te gaan gebruiken (12,13,19). ...
Samenvatting
DOEL: Het in kaart brengen van opvattingen en ervaringen van zorgverleners en zorgvragers met betrekking tot de invloed van beeldschermzorg op de zorgrelatie en eigen regie in de thuiszorg.
METHODE: Kennissynthese op basis van vijf kleinschalige kwalitatieve studies naar opvattingen en ervaringen ten aanzien van beeldschermzorg. Dit is gebaseerd op interviews met respectievelijk 31 zorgvragers, 36 zorgverleners en negen managers.
RESULTATEN: Uit de resultaten bleek dat beeldschermzorg invloed heeft op zowel de mate van nabijheid in de relatie (tussen zorgverleners en zorgvragers) als op de verdeling van regie in de relatie. Ook gaven de resultaten inzicht in opvattingen over de wijze waarop dit gefaciliteerd moet worden.
DISCUSSIE: Opvallend was dat beeldschermzorg vooral door mensen die er ervaring mee hebben wordt geassocieerd met nabijheid in de relatie. Ook werden aan het gebruik van beeldschermzorg waarden toegeschreven (zoals controle door zorgverleners en autonomie van zorgvrager) die met elkaar op gespannen voet staan. Ten slotte bleken zorgverleners en zorgvragers verschillende opvattingen te hebben over het faciliteren van beeldschermzorg.
CONCLUSIE: Bij toepassing van beeldschermzorg dient de verdeling van rollen, taken en verantwoordelijkheden tussen zorgverleners en zorgvragers te worden geëxpliciteerd en afgestemd. Daarbij is het raadzaam om regelmatig te (blijven) evalueren hoe de zorgrelatie verandert als beeldschermzorg wordt geïntroduceerd.
Trefwoorden
Beeldschermzorg, eigen regie, autonomie, nabijheid, afstand
... In addition, the open questions pointed out the 5 most common problems that healthcare professionals encounter in their jobs. Participants in the study primarily expressed their need for training on IHIS, several studies showed that training of healthcare professionals can result in more successful use of technology (4,(32)(33)(34). Ahmadian et al. (5) suggests that training should be done in the work environment in order to promote the use of the systems. ...
BACKGROUND
Ministry of Health of Cyprus has implemented Integrated Health Information Systems (IHIS) in two hospitals in Cyprus. Effective use of IHIS could increase the effectiveness and quality of healthcare services. The absence of any evaluation of the existing IHIS prevents a detailed assessment of its safety, efficiency and effectiveness.
OBJECTIVE
The purpose of this study was to implement DIPSA evaluation framework which assessed the safety, quality of the system, collaborative interprofessional work, user satisfaction and the processes and procedures in place of the current IHIS in public hospitals in Cyprus.
METHODS
This project was conducted in 2017 in Cyprus. Doctors, nurses and other healthcare professionals, in total 309 subjects participated in the study. For the selection of the sample, a stratified random sampling was used based on the profession and the hospital of each participant. DIPSA evaluation framework was implemented and inferential statistics were used. Correlations were performed between the categories in the framework with the Pearson correlation method. Comparison of means (with independent samples T-test and One-way Anova) were also done between demographic characteristics and categories, the tests that were found with P -value ≤ 2 were then used in multiple regression analysis. Data analysis was done using SPSS v24.
RESULTS
Categories Satisfaction, Collaboration, System quality, Safety, Procedures were all rated moderately between 2.5 and 2.9. Every correlation between the categories was statistically significant with P < 0.01, but the highest Pearson correlation = 0.692 was found to be between System Quality and Satisfaction. Comparison of means between demographic characteristics and categories were performed and used in multiple regression analysis, which indicated where exactly the IHIS lacks. In addition, the open questions pointed out the 5 most common problems/needs that healthcare professionals encounter in their jobs (training, system upgrade, keep a log of data/procedures, collaboration and access).
CONCLUSIONS
DIPSA evaluation framework was implemented, which showed that some interventions could positively affect simultaneously one or more categories. For example, the most important need of intervention was the training of healthcare professionals, that was found that it could be affecting positively multiple categories (Satisfaction, Collaboration, Safety and Procedures). Other interventions that could affect IHIS in a positive way could be, that technical support that should be provided at all times, to upgrade the hardware where needed. To schedule daily collaboration of healthcare professionals with programmers, in order to cover their needs, by upgrading the software. To install “smart devices” within the different departments of the hospitals in order to support each other. There are also many other suggestions can help improve the healthcare services provided.
... To date, however, there have been few successful implementations of eHealth services [14,15]. The slow adoption of services by users [16], the lack of collaboration between health care organizations and their systems [17], a shortage of funding [13], and the lack of care models to guide implementation are factors that obstruct the development and implementation of sustainable eHealth services [18]. This research therefore focuses on the design of a care model for eHealth services. ...
Background: Electronic health (eHealth) services could provide a solution for monitoring the blood pressure of at-risk patients while also decreasing expensive doctor visits. However, a major barrier to their implementation is the lack of integration into organizations.
Objective: Our aim was to design a Care Pathway for monitoring the blood pressure of at-risk patients, in order to increase eHealth implementation in secondary preventive care.
Methods: A qualitative design study was used in this research. Data were collected by conducting visual mapping sessions including semistructured interviews with hypertension patients and doctors. The data were transcribed and coded and thereafter mapped into a Care Pathway.
Results: Four themes emerged from the results: (1) the current approach to blood pressure measuring has disadvantages, (2) risk and lifestyle factors of blood pressure measuring need to be considered, (3) there are certain influences of the at-home context on measuring blood pressure, and (4) new touchpoints between patients and health professionals need to be designed. These in-depth insights combined with the visualization of the current blood pressure process resulted in our Care Pathway design for monitoring the blood pressure of at-risk patients as secondary preventive care.
Conclusions: The Care Pathway guides the implementation of eHealth devices for blood pressure self-measurement. It showcases the pathway of at-risk patients and increases their involvement in managing their blood pressure. It serves as a basis for a new service using eHealth.
... Too often, however, end-users of technological solutions are not included, or only consulted in a tokenistic way in the design processes and implementation of technology solutions in practice. On the other hand, studies show that the inclusion of end-users in these processes is paramount to the success of engineers and designers in their efforts to improve aged-care (Nieboer et al., 2014;Peek et al., 2016). ...
... Magnetic Resonance Imaging (MRI) is a complex modality based on specific scientific principles and requires a high level of knowledge and expertise for optimal scanning of both routine and complex examinations [1,2]. Nieboer et al. (2014) stated that healthcare professionals should feel competent to use medical imaging technology in order to provide adequate health care [3]. Literature has endorsed the need for further training and education for radiographers in the area of diagnostic image quality optimisation [4][5][6]. ...
Aim:
The aim was to design an app-based eLearning tool to provide radiographers with information about the physical basis of MR artefacts and practical elimination or/and minimisation strategies to optimise image quality, and to evaluate the impact of a smartphone app on radiographers' knowledge.
Methods:
The study used the comparison-experimental approach (pre- and post-test). Thirty-five MR radiographers independently reviewed a prepared series of MR images (n = 25). The participants were requested to identify image quality related errors, to specify error-correction strategies and to score how confident they were in their responses. Participants were then divided into experimental (n = 19) and control cohorts (n = 16). The app was provided to the experimental cohort for 3 months; after this period both cohorts re-reviewed the MR image datasets and repeated their identification of image quality errors.
Results:
The results showed a statistically significant difference between control and experimental cohorts relative to participants' pre- to post-test knowledge level. For the experimental cohort, years of experience, qualification and type of hospital were not associated with radiographer knowledge level and confidence in recognising the presence of an image quality error, naming the error and specifying appropriate correction strategies (p > 0.05).
Conclusion:
The study identified the potential of the smartphone app as an effective educational tool to support MR radiographers' knowledge in recognising and characterising MR image quality errors.
Key points:
• A high level of knowledge to optimise MR image quality is crucial. • Ongoing education in image quality optimisation is required. • The potential role of app as an effective educational tool is identified.
... In their busy work environment, it is hard to keep their knowledge about technological advancement up to date. This knowledge gap generates technology anxiety and resistance when healthcare professionals have to use a new technology [4][5][6]. ...
It is believed that IT applications can improve quality, reliability, efficiency, sustainability, effectiveness and research environment in healthcare industry.
This study addresses the effects of technology anxiety and resistance to change on acceptance of newly introduced breast tumor registry system (BTRS) in Turkey. It is an electronic health recording (EHR) especially design for breast tumor. As the deployment of this system is not a legal obligation, its spread and utilization depend on its acceptance. A modified Technology Acceptance Model (TAM) is introduced with the aim of explaining effects of aforementioned factors role in acceptance of this technology. PLS-SEM is used in model testing. Resistance to change appeared as insignificant whereas technology anxiety is a significant role player in adoption.
... 10 Another study conducted with Korean nurses relieved self-concept of the profession on top of the list 11 while Dutch nurses mentioned that their main value was being able to contribute to the well-being of their care recipients. 12 Taiwanese nurses identified six important values: humanistic caring, professionally competent holistic care, fostering growth, experiencing the give and take in caring, fair compensation, and health promotion. 13 However, studies from Turkey consistently revealed that human dignity was the most important professional value for nurses, indicating that Turkish nurses respected human and individuality the most in their clinical practice. ...
One of the most important criteria for professionalism is accumulation of knowledge that is usable in professional practice. Nursing models and theories are important elements of accumulating nursing knowledge and have a chance to guarantee the ethical professional practice. In recent years, there has been an increase in the use of models in nursing research and newly created terminology has started to be used in nursing. In this study, a new model, termed as the Professional Values Model, developed by the authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase not only the patients’ satisfaction with nursing care, but also the nurses’ job satisfaction and quality of nursing care. Contemporary literature has been reviewed and synthesized to develop this theoretical paper on the Professional Values Model in nursing. Having high values in nursing increases job satisfaction, which results in the improvement of patient care and satisfaction. Also, individual characteristics are effective in the determination of individual needs, priorities, and values. This relation, proved through research about the Professional Values Model, has been explained. With development of these concepts, individuals’ satisfaction with care and nurses’ job satisfaction will be enhanced, which will increase the quality of nursing care. Most importantly, nurses can take proper decisions about ethical dilemmas and take ethical action when they take these values into consideration when giving care. The Professional Values Model seems suitable for nurse managers and it is expected that testing will improve it. Implementation of the Professional Values Model by nurse managers may increase motivation of nurses they work with. It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.
Objective
To develop a framework that models the impact of electronic health record (EHR) systems on healthcare professionals’ well-being and their relationships with patients, using interdisciplinary insights to guide machine learning in identifying value patterns important to healthcare professionals in EHR systems.
Materials and Methods
A theoretical framework of EHR systems’ implementation was developed using interdisciplinary literature from healthcare, information systems, and management science focusing on the systems approach, clinical decision-making, and interface terminologies.
Observations
Healthcare professionals balance personal norms of narrative and data-driven communication in knowledge creation for EHRs by integrating detailed patient stories with structured data. This integration forms 2 learning loops that create tension in the healthcare professional–patient relationship, shaping how healthcare professionals apply their values in care delivery. The manifestation of this value tension in EHRs directly affects the well-being of healthcare professionals.
Discussion
Understanding the value tension learning loop between structured data and narrative forms lays the groundwork for future studies of how healthcare professionals use EHRs to deliver care, emphasizing their well-being and patient relationships through a sociotechnical lens.
Conclusion
EHR systems can improve the healthcare professional–patient relationship and healthcare professional well-being by integrating norms and values into pattern recognition of narrative and data communication forms.
Introduction: The aim of this study is to determine the usage intention levels by health professionals of telemedicine applications whose legal infrastructure is recently completed by the Ministry of Health in Turkey and whose use is desired to be expanded. Methods: In addition to the questions posed to determine the demographic characteristics of the health professional, their relationship with technology, and their level of knowledge about the word telemedicine; survey data, which included statements to determine factors such as telemedicine use intentions, perceived usefulness, perceived ease, and attitude, were analyzed. Results: Survey questions were answered by 337 health professionals. It has been determined that 83.4% of health professionals have a medium and high level of relationship with technology, 26.4% have never heard of telemedicine, and the rest have various interactions with medicine. According to the results of the research, it is clearly stated that the intention of health professionals to use telemedicine applications is shaped by factors such as perceived usefulness, perceived ease, and attitude. Conclusion: It has been clearly determined that the intention of health professionals to use telemedicine applications is shaped by factors such as perceived usefulness, perceived ease, and attitude. In parallel with this information, it is seen that the possibility of affecting the intentions of using telemedicine by managing the perceptions of health professionals is possible within the obtained results.
Implementation of health information technology does not occur in a vacuum or devoid of people. Implementation is substantially affected by the user and organizational culture. This chapter focuses on creating a comprehensive and effective strategy for implementation that promotes the adoption and effective use of a clinical information system. Specifically addressed are organizational culture and behavior assessments based on social-psychology theories that affect the entire implementation process and adoption. Key success factors in implementation include communication, champions’ role, understanding user requirements/needs and workflow, and incorporating user feedback.KeywordsImplementationOrganizational cultureChange managementPeople-process side of changeAdoptionWorkflowCommunication
To explore relatives’, community nurses’ and general practitioners’ perspectives and experiences in promoting Personal Safety Alerting Device (PSAD) use among community-dwelling older adults, we applied a qualitative study design. Altogether 15 focus groups and 11 semi-structured interviews were conducted. Data-analysis followed the Qualitative Analysis Guide of Leuven. PSAD use was considered to be complex. Relatives and health care professionals are involved in a negotiation process comprising three phases: A) waiting for a critical event in the older adult's everyday life; B) introducing the idea of a PSAD; C) deciding on and supporting PSAD use. In conclusion, the actors involved in PSAD use should be aware of the negotiation process, which is complex, dynamic, iterative and needs time. While nurses play a crucial role, they lack sufficient knowledge for comprehensive PSAD counselling. The negotiation process could serve as an example for other technologies in the context of aging in place.
Use of technology has been making the lives of people easier for a very long time now, and technology has provided so many solutions and has satisfied so many needs in the past that it has become almost indispensable in most activities. Implementing of technology, on the other hand, may be challenging, especially when it requires a certain level of change that impacts activities, processes, regulations, users and resources. The business environment might be the one environment in which the challenges and difficulties implied by technology implementing and use are actually weighted in the effect that technology use has on results. Companies in healthcare have been developing and expanding mostly through the use of technology and that is why the aim of this study is to investigate the extent to which technology is used in private healthcare companies in order to survive in competitive environments and identify the factors that can favor or limit their development. Using the feedback provided by workers in healthcare through qualitative research has made possible for this study to emphasize, from a management and marketing point of view, the need for technology in improving quality of service, patient satisfaction, processes and employee performance, and how, in the developing of a company, achieving qualitative growth (quality of service, time and process management) is as important as quantitative growth (usually measured in number of patients, revenues and other financial indicators).
Aim: Technology is suggested to support ageing-in-place. For care- and technology professionals working with older persons it is important to know how to facilitate the use of technology by older persons. This paper presents the translation of the results of a field study into multilevel and multidisciplinary educational material. Method: During home visits, community-dwelling seniors were interviewed regarding reasons for their level of technology use. All types of technology that could support activities of daily living, were included. Resulting themes formed the basis of the development of personas and scripts for education. Next, lecturers from vocational and higher technical and care education developed an evidence-based educational module from the perspective of professional service provision. Results: 53 older adults were interviewed. The level of technology use is influenced by six themes: challenges in the domain of independent living; behavioural options; personal thoughts on technology use; influence of the social network; influence of organisations; and the role of the physical environment. Four personas were developed, one of which was featured into a film, with twelve separate scenes. For each scene, lessons were developed that consisted of specific questions (first level), in-depth questions (second level) and suggestions for classes (for lecturers). Three personas were translated into case histories. Conclusion: Older adults’ perceptions and use of technology are embedded in their personal, social, and physical context. To improve successful technology use to support ageing-in-place, professionals from the domain of care and technology can be trained to be aware of these factors.
For care professionals, the main drive and, related to that, their job satisfaction, is based on being able to satisfy the needs of those who receive their care. Furthermore, most professionals working in contexts in which chronic care is provided, value inter-collegial respect and appreciation of supervisors. Therefore, success and failure factors of implementation of technology in health-care situations are associated with the disruption or support of these values. Mostly, health-care professionals do not themselves think about technological solutions for clinical problems, and therefore, they need support in relating technological solutions to care recipients’ needs. In this chapter, a short overview of professional values is given. Next, we outline how technology can be seen as disrupting professional values but also how it can be supportive of professional values, sometimes unexpected, as practice examples show. The chapter is concluded by consequences for daily practice and education in health-care professions.
Dynamic lighting systems (DLS) are an innovative way to improve the behavioural symptoms of older people with dementia residing in nursing homes. The use of such systems by care professionals and underlying beliefs of these professionals are essential in the successful implementation of DLS. Therefore, this study investigated the beliefs of staff of nursing homes in relation to the use of DLS. Through focus group sessions and interviews, a number of beliefs emerged which influence the use of DLS in practice. The intention to use is influenced by the control options of the system, and the way DLS is embedded in care routines. The most important factor impacting the use of DLS is the creation of homelike living conditions. The identified factors can help in the implementation and design of DLS in psychogeriatric nursing home wards.
Implementation of health information technology does not occur in a vacuum, and is substantially affected by user and organizational culture. The chapter on Change Management discusses change theory as well as strategies for promoting the adoption and effective use of clinical information systems. Specifically addressed are assessment of organizational culture and behavior, social-psychology theories affecting change management and adoption, identification of non-technical factors that influence the adoption of clinical information systems, and the role of diffusion in an organization for adoption of a new system. Key success factors in an implementation including communication, the role of champions, understanding of user requirements/needs and workflow, and incorporating user feedback are discussed.
Politici promoten telezorg als de meest efficiënte oplossing van het probleem van de vergrijzing en ontgroening. Met behulp van telezorg, zo beweren ze, gaan chronisch zieke ouderen ‘zichzelf managen’ en zullen er minder professionals nodig zijn. Aan de andere kant stellen technologie-pessimisten dat er een verschraling en verkilling in de zorg zal optreden als professionals telezorg grootschalig gaan invoeren. Zieke ouderen zullen hun laatste adem uitblazen onder toezicht van camera’s en sensoren, ver van menselijk contact.Grootse beloften noch inktzwarte nachtmerries hebben veel te maken met de praktijk waarin professionals en patiënten daadwerkelijk met telezorg werken. Dat blijkt uit dit boek, waarin de auteur gedetailleerd en uiterst leesbaar verslag doet van de wederwaardigheden van patiënten en verpleegkundigen in een aantal pioniersprojecten van telezorg. De combinatie van etnografisch onderzoek en theoretische inzichten uit onder andere wetenschaps- en techniekstudies en ethiek levert verrassende inzichten op. Zo blijkt telezorg de zorg intensiever te maken omdat het contact tussen patiënten en professionals vaak spectaculair toeneemt. De ouderen zijn hier doorgaans erg tevreden over, niet omdat ze zichzelf nu eindelijk kunnen managen, maar juist omdat ze zich veilig en gekoesterd voelen door al die extra zorg die via apparatuur mogelijk wordt gemaakt. Het boek stelt een aantal prikkelende vragen over de toekomst van telezorg en de manier waarop we innovaties in de zorg zouden kunnen baseren op feiten in plaats van dromen, hypes of nachtmerries.
Background:
In primary care settings, users often rely on vendors to provide support for health information technology (HIT). Yet, little is known about the vendors' perspectives on the support they provide, how support personnel perceive their roles, the challenges they face and the ways they deal with them.
Objective:
To provide in-depth insight into an electronic medical record (EMR) vendor's perspective on end-user support.
Methods:
As part of a larger case study research, we conducted nine semi-structured interviews with help desk staff, trainers and service managers of an EMR vendor, and observed two training sessions of a new client.
Results:
With a growing client base, the vendor faced challenges of support staff shortage and high variance in users' technical knowledge. Additionally, users sometimes needed assistance with infrastructure, and not just software problems. These challenges sometimes hindered the provision of timely support and required supporters to possess good interpersonal skills and adapt to diverse client population.
Conclusion:
This study highlights the complexity of providing end-user support for HIT. With increased adoption, other vendors are likely to face similar challenges. To deal with these issues, supporters need not only strong technical knowledge of the systems, but also good interpersonal communication skills. Some responsibilities may be delegated to super-users. Users may find it useful to hire local IT staff, at least on an on-call basis, to provide assistance with infrastructure problems, which are not supported by the software vendor. Vendors may consider expanding their service packages to cover these elements.
Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.
We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.
The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias.
Typically, person-centered interventions are multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care. The complexity of the interventions and range of outcomes examined makes it difficult to form accurate conclusions about the impact of person-centered care interventions adopted and implemented in aged-care facilities. The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider "hierarchy of needs" structure, where safety and physiological need are met before moving onto higher level needs. Further research is necessary to establish the effectiveness of these elements of person-centered care, either singly or in combination.
Background:
Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.
Methods:
Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.
Results:
Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents' views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.
Conclusions:
These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.
The response of health professionals to the use of health information technology (HIT) is an important research topic that can partly explain the success or failure of any HIT application. The present study applied a modified version of the revised technology acceptance model (TAM) to assess the relevant beliefs and acceptance of HIT systems in a sample of health professionals (n = 133). Structured anonymous questionnaires were used and a cross-sectional design was employed. The main outcome measure was the intention to use HIT systems. ANOVA was employed to examine differences in TAM-related variables between nurses and medical doctors, and no significant differences were found. Multiple linear regression analysis was used to assess the predictors of HIT usage intentions. The findings showed that perceived ease of use, but not usefulness, relevance and subjective norms directly predicted HIT usage intentions. The present findings suggest that a modification of the original TAM approach is needed to better understand health professionals' support and endorsement of HIT. Perceived ease of use, relevance of HIT to the medical and nursing professions, as well as social influences, should be tapped by information campaigns aiming to enhance support for HIT in healthcare settings.
Information technology (IT) acceptance research has yielded many competing models, each with different sets of acceptance determinants. In this paper, we (1) review user acceptance literature and discuss eight prominent models, (2) empiri- cally compare the eight models and their exten- sions, (3) formulate a unified model that integrates elements across the eight models, and (4) empiri- cally validate the unified model. The eight models reviewed are the theory of reasoned action, the technology acceptance model, the motivational model, the theory of planned behavior, a model combining the technology acceptance model and the theory of planned behavior, the model of PC utilization, the innovation diffusion theory, and the social cognitive theory. Using data from four organizations over a six-month period with three points of measurement, the eight models ex- plained between 17 percent and 53 percent of the variance in user intentions to use information technology. Next, a unified model, called the Unified Theory of Acceptance and Use of Tech- nology (UTAUT), was formulated, with four core determinants of intention and usage, and up to four moderators of key relationships. UTAUT was then tested using the original data and found to outperform the eight individual models (adjusted
Valid measurement scales for predicting user acceptance of computers are in short supply. Most subjective measures used in practice are unvalidated, and their relationship to system usage is unknown. The present research develops and validates new scales for two specific variables, perceived usefulness and perceived ease of use, which are hypothesized to be fundamental determinants of user acceptance. Definitions for these two variables were used to develop scale items that were pretested for content validity and then tested for reliability and construct validity in two studies involving a total of 152 users and four application programs. The measures were refined and streamlined, resulting in two six-item scales with reliabilities of .98 for usefulness and .94 for ease of use. The scales exhibited high convergent, discriminant, and factorial validity. Perceived usefulness was significantly correlated with both self-reported current usage (r=.63, Study 1) and self-predicted future usage (r =.85, Study 2). Perceived ease of use was also significantly correlated with current usage (r=.45, Study 1) and future usage (r=.59, Study 2). In both studies, usefulness had a significantly greater correlation with usage behavior than did ease of use. Regression analyses suggest that perceived ease of use may actually be a causal antecedent to perceived usefulness, as opposed to a parallel, direct determinant of system usage. Implications are drawn for future research on user acceptance.
To examine the factors that could influence the decision of healthcare professionals to use a telemonitoring system.
A questionnaire, based on the Technology Acceptance Model (TAM), was developed. A panel of experts in technology assessment evaluated the face and content validity of the instrument. Two hundred and thirty-four questionnaires were distributed among nurses and doctors of the cardiology, pulmonology, and internal medicine departments of a tertiary hospital. Cronbach alpha was calculated to measure the internal consistency of the questionnaire items. Construct validity was evaluated using interitem correlation analysis. Logistic regression analysis was performed to test the theoretical model. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were computed.
A response rate of 39.7% was achieved. With the exception of one theoretical construct (Habit) that corresponds to behaviors that become automatized, Cronbach alpha values were acceptably high for the remaining constructs. Theoretical variables were well correlated with each other and with the dependent variable. The original TAM was good at predicting telemonitoring usage intention, Perceived Usefulness being the only significant predictor (OR: 5.28, 95% CI: 2.12-13.11). The model was still significant and more powerful when the other theoretical variables were added. However, the only significant predictor in the modified model was Facilitators (OR: 4.96, 95% CI: 1.59-15.55).
The TAM is a good predictive model of healthcare professionals' intention to use telemonitoring. However, the perception of facilitators is the most important variable to consider for increasing doctors' and nurses' intention to use the new technology.
The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.
We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).
Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.
Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.
Investment in information and communication technology (ICT) in the health sector can bring important benefits. To date, the focus has been on automating clinical work practices such as ordering tests and prescriptions, which significantly improves efficiency and safety. Uptake of ICT has been slow and the results less favourable than anticipated for various reasons, including poor integration of systems into complex clinical work processes, limited training, and the intermittent nature of ICT funding. As a result, many health care organisations have been operating hybrid paper and computer systems that introduce new patient risks, staff frustration, and outcomes below expectation. The focus must shift from automation of clinical work to innovation; from evolutionary application of ICT to revolutionary uses. Health professionals must embrace ICT as a "disruptive technology" that will produce significant changes in their roles and responsibilities and lead to real health reform with new, innovative models of health care delivery. As other industries have shown, substitution and role changes are areas in which ICT can lead to the greatest gains.
Politicians across the political spectrum support greater investment in health care information and communications technology (ICT) and expect it to significantly decrease costs and improve health outcomes. We address three policy questions about adoption of ICT in health care: First, why is there so little adoption? Second, what policies will facilitate and accelerate adoption? Third, what is the best pace for adoption? We first describe the unusual economics of ICT, particularly network externalities, and then determine how those economics interact with and are exacerbated by the unusual economics of health care. High replacement costs and the need for technical compatibility are general barriers to ICT adoption and often result in lock-in to adopted technologies. These effects are compounded in health care because the markets for health care services, health insurance, and labor are interlinked. In addition, the government interacts with all markets in its role as an insurer. Patient heterogeneity further exacerbates these effects. Finally, ICT markets are often characterized by natural monopolies, resulting in little product diversity, an effect ill-suited to patient heterogeneity. The ongoing process for setting technical standards for health care ICT is critical but needs to include all relevant stakeholders, including patient groups. The process must be careful (i.e., slow), flexible, and allow for as much diversity as possible. We find that waiting to adopt ICT is a surprisingly wise policy.
Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks--medical management, role management, and emotional management--and six self-management skills--problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap.
We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages.
Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity.
Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.
This paper outlines the background and significance of philosophy of technology as a focus of inquiry emerging within nursing scholarship and research. The thesis of the paper is that philosophy of technology and nursing is fundamental to discipline development and our role in enhancing health care. It is argued that we must further our responsibility and interest in critiquing current and future health care systems through philosophical inquiry into the experience, meaning and implications of technology. This paper locates nurses as important contributors to the use and integration of health care technology and identifies nursing as a discipline that can provide specific insights into the health experience(s) of individuals, cultures and societies. Nurses are encouraged to undertake further examination of epistemological, ontological and ethical challenges to arise from technology as a focus of philosophical inquiry. The advancement of philosophy of technology and nursing will make a profound contribution to inquiry into the experience of technology, the needs of humanity and the development of appropriate health care.
‘Warm care’ is often contrasted with ‘cold technology’. But is this a meaningful opposition? Much research into healthcare technology frames the relation between humans and their technologies as purely rational and instrumental, where technologies are functional means to a human end. Other studies, however, foreground how technologies and users (re)configure each other in particular use practices. In this paper, we build on the latter work by studying relations with healthcare technologies as not only functional but also social and affective. We analyse a documentary about robot pets next to ethnographic material about a particular care technology. We analyse the relations between these technologies and their users, the values that are brought into play and the identities generated in the interaction. Then we analyse the structuredness of the interaction, and trace the social relations that are brought into being. Our main argument is that the opposition between cold technology and warm care does not hold, but that there are different relations between people and technologies within different use practices, allowing different affective and social relations, and that this blurs taken-for-granted categories such as medical versus social problems, warm versus cold care, play and seriousness, and affective versus rational technologies.
An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers.
This literature review identifies and categorises, from an organisational management perspective, barriers to the use of HIT or ICT for health. Based on the review, it offers policy interventions.
This systematic literature review was carried out during December 2009 and January 2010. Additional on-going reviews of updates through automated system alerts took place up until this paper was submitted. A total of thirty-one sources were searched including nine software platforms/databases, fifteen specialised websites/targeted databases, Google Scholar, ISI Science Citation Index and five journals hand-searched.
The study covers seventy-nine articles on organisational barriers to ICT adoption by healthcare professionals. These are categorised under five main headings - (I) Structure of healthcare organisations; (II) Tasks; (III) People policies; (IV) Incentives; and (V) Information and decision processes. A total of ten subcategories are also identified. By adopting an organisational management approach, some recommendations to remove organisational management barriers are made.
Despite their apparent promise, health information technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers associated to organisational management and their interrelations. Several important future directions in the field are also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the development of optimal HIT applications; (2) more information is needed regarding organisational change, incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in realising the benefits from HIT. Future policy interventions should consider the five dimensions identified when addressing the impact of HIT in healthcare organisational systems, and how the impact of an intervention aimed at a particular dimension would interrelate with others.
Written for anyone beginning a research project, this introductory book takes you through the process of analysing your data from start to finish. It presents an easy-to-use model for coding data in order to break it down into parts, and then to reassemble it to create a meaningful picture of the phenomenon under study. Full of useful advice, the book guides the researcher through the last difficult integrating phase of qualitative analysis.
Increasing interest in end users' reactions to health information technology (IT) has elevated the importance of theories that predict and explain health IT acceptance and use. This paper reviews the application of one such theory, the Technology Acceptance Model (TAM), to health care. We reviewed 16 data sets analyzed in over 20 studies of clinicians using health IT for patient care. Studies differed greatly in samples and settings, health ITs studied, research models, relationships tested, and construct operationalization. Certain TAM relationships were consistently found to be significant, whereas others were inconsistent. Several key relationships were infrequently assessed. Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications. Aside from improved study quality, standardization, and theoretically motivated additions to the model, an important future direction for TAM is to adapt the model specifically to the health care context, using beliefs elicitation methods.
It is well-known that the United States faces a serious nursing shortage. A number of factors have contributed to the problem including an aging nursing workforce, fewer nursing job candidates, the aging of the baby boom population, and increased nurse dissatisfaction. The current work addresses one issue that is central to the problem: nursing satisfaction/dissatisfaction. Drawing from previous research in the services marketing literature, the work introduces the "patient orientation" construct and suggests that it is a critical motivational factor that is related to nursing satisfaction. Results from an empirical study reveal that the construct is positively related to overall nursing satisfaction while controlling for external factors including pay, benefits, supervisor, and reward satisfaction. Implications for healthcare managers and suggestions for future research are discussed.
The millennium has become the metaphor for the extraordinary challenges and opportunities available to the nursing profession and to those academic institutions responsible for preparing the next generation of nurses. Signal change is all around us, defining not only what we teach, but also how we teach our students. Transformations taking place in nursing and nursing education have been driven by major socioeconomic factors, as well as by developments in health care delivery and professional issues unique to nursing. Here are 10 trends to watch, described in terms of their impact on nursing education.
New developments in assistive technology are likely to make an important contribution to the care of elderly people in institutions and at home. Video-monitoring, remote health monitoring, electronic sensors and equipment such as fall detectors, door monitors, bed alerts, pressure mats and smoke and heat alarms can improve older people's safety, security and ability to cope at home. Care at home is often preferable to patients and is usually less expensive for care providers than institutional alternatives.
The purpose of this paper is to give an overview about the state of the art in research on home telehealth in an international perspective.
The study is based on a review of the scientific literature published between 1990 and 2003 and retrieved via Medline in January/February 2004. All together, the abstracts of 578 publications have been analyzed.
The majority of publications (44%) comes from the United States, followed by UK and Japan. Most publications deal with vital sign parameter (VSP) measurement and audio/video consultations ("virtual visits"). Publications about IT tools for improved information access and communication as well as decision support for staff, patients and relatives are relatively sparse. Clinical application domains are mainly chronic diseases, the elderly population and paediatrics.
Internationally, we observe a trend towards tools and services not only for professionals but also for patients and citizens. However, their impact on the patient-provider relationship and their design for special user groups, such as elderly and/or disabled needs to be further explored. In general, evaluation studies are rare and further research is critical to determine the impacts and benefits, and limitations, of potential solutions and to overcome a number of hinders and restrictions, such as - the lack of standards to combine incompatible information systems; - the lack of an evaluation framework considering legal, ethical, organisational, clinical, usability and technical aspects; - the lack of proper guidelines for practical implementation of home telehealth solutions.
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Proposed pathway for technology adoption in health care facilities
Fig. 1. Proposed pathway for technology adoption in health care facilities.
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