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Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States
Abstract
Purpose:
The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency.
Methods:
Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics.
Findings:
In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77).
Conclusions:
The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.
... Despite the overwhelming evidence of potential benefits, the number of studies investigating the adoption of portals by specific patient groups is limited. Although patient portal use has increased over time, only a fraction of the overall patient population uses patient portals [12,13,15,16,[20][21][22][23][24]. Most studies, including systematic reviews conducted between 2015 and 2021, indicate that sociodemographic factors may explain why some patients do not use patient portals [13,15,16,[21][22][23][24][25]. ...
... Although patient portal use has increased over time, only a fraction of the overall patient population uses patient portals [12,13,15,16,[20][21][22][23][24]. Most studies, including systematic reviews conducted between 2015 and 2021, indicate that sociodemographic factors may explain why some patients do not use patient portals [13,15,16,[21][22][23][24][25]. These studies suggest that patient characteristics such as age, sex, race, ethnicity, marital status, income, and insurance status constitute barriers to portal use. ...
... These findings align with those of the previous studies examining sociodemographic differences in patient portal use. Similar results highlight disparities among patient portal users, with rural, male, older, single, uninsured, publicly insured, and racial minority patients being disadvantaged [12,13,15,16,[20][21][22][23][24]56,57]. Some studies, however, showed mixed results regarding sex and age differences in patient portal use [11,58,59]. ...
Background
Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited.
Objective
This study aimed to explore the factors associated with portal messaging use by rural patients.
Methods
We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient’s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient’s home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density.
Results
A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.
Conclusions
Patients’ use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.
... Digital health technology refers to the use of digital tools and platforms to improve healthcare outcomes [5][6][7][8][9][10][11]. It encompasses a wide range of technologies, including telehealth, mobile apps, and wearables [1][2][3][5][6][7][8][9][10][11]. ...
... Digital health technology refers to the use of digital tools and platforms to improve healthcare outcomes [5][6][7][8][9][10][11]. It encompasses a wide range of technologies, including telehealth, mobile apps, and wearables [1][2][3][5][6][7][8][9][10][11]. Digital health technology has the potential to improve the accuracy of diagnosis and treatment, enhance the delivery of healthcare, and increase access to care, especially in underserved rural areas [6][7][8]. ...
... Digital health technology has the potential to improve the accuracy of diagnosis and treatment, enhance the delivery of healthcare, and increase access to care, especially in underserved rural areas [6][7][8]. By using telehealth, patients in rural areas can receive medical consultations and diagnoses from specialists located in urban areas, improving access to care and reducing travel costs [5][6][7][8][9][10][11]. Digital health technology can also help reduce healthcare disparities by improving the efficiency and accuracy of healthcare delivery [5]. ...
Background:
Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care.
Objective:
To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey.
Methods:
Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors.
Results:
The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers.
Conclusion:
We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.
... They suggest that patient socioeconomic and demographic factors explain why patients may be slow to using the patient portal. [35][36][37][38] Given these studies, it can be inferred that the individual characteristics of patient play an important role in determining their willingness to use innovations like the patient portals. It would however be helpful to know other unique characteristics of patients who are resistant to using patient portals. ...
... Socioeconomic and demographic factors highlighted in prior studies were collected and included in the analyses as control variables. [35][36][37][38] The covariates included are age, gender, race, academic attainment, health insurance type, household income, geographic location, employment, and marital status. ...
... Previous studies have examined the role of individual demographic and socioeconomic status in determining their use of patient portals. [35][36][37][38] However, to the best of our knowledge, none have examined the extent to which individual level of IT sophistication will predict individual use of the technology. This study suggests that when controlling for the demographic and socioeconomic factors, individual IT sophistication is important in predicting patient portal use. ...
Even with the extolled benefits of patient portals, there has been some challenges to ensuring patient portal use. This study examines if a patient’s level of information technology (IT) sophistication, defined as the degree of use of diverse information technologies by an individual, is associated with their use of a patient portal. Patients previous experience and exposure to other similar technologies like desktop computer, laptop, internet, smart phone, or social media explains their willingness to use information technology for their health. Data on a cross-sectional survey of 565 individuals in Eastern NC was available for analysis. Multinomial regression analyses revealed that IT sophistication is important in determining whether patients will use a patient portal. It specifies that patients with low IT sophistication compared to those with high IT sophistication were more likely to have never activated their patient portals (RRR = 2.2155, p < 0.009), or to have activated but never used a patient portal (RRR = 3.5869, p < 0.010). The findings of this study should aid healthcare leaders as they strive to improve patient engagement. They should continue to promote the benefits of the patient portal and consider offering personalized support programs for patients with low IT sophistication.
... However, an accumulating body of evidence indicates that equitable access to digital health technology is not assured, with significant spatial disparities evident, particularly between urban and rural areas. Residents in remote rural areas encounter substantial barriers to the use of digital health technology [91] and exhibit less positive engagement in digital health behaviors [22,29]. A survey conducted by Hong et al. [33] found that urban residents in China were approximately twice as likely to engage in digital health behaviors compared to their rural counterparts. ...
... In the rapidly transforming digital society, users' participation in digital health behavior transcends the passive receipt of health information [45]. Instead, users grapple with diverse and intricate digital health scenarios, encompassing activities such as searching for health information, managing health digitally, seeking online health consultations, and making online drug purchases [29]. These scenarios demand not only a foundational level of digital literacy for basic information interaction but also a sophisticated level of digital literacy for diagnostic or treatment-related activities through online platforms [86]. ...
Objective
Within the digital society, the limited proficiency in digital health behaviors among rural residents has emerged as a significant factor intensifying health disparities between urban and rural areas. Addressing this issue, enhancing the digital literacy and health literacy of rural residents stands out as a crucial strategy. This study aims to investigate the relationship between digital literacy, health literacy, and the digital health behaviors of rural residents.
Methods
Initially, we developed measurement instruments aimed at assessing the levels of digital literacy and health literacy among rural residents. Subsequently, leveraging micro survey data, we conducted assessments on the digital literacy and health literacy of 968 residents in five administrative villages in Zhejiang Province, China. Building upon this foundation, we employed Probit and Poisson models to empirically scrutinize the influence of digital literacy, health literacy, and their interaction on the manifestation of digital health behaviors within the rural population. This analysis was conducted from a dual perspective, evaluating the participation of digital health behaviors among rural residents and the diversity to which they participate in such behaviors.
Results
Digital literacy exhibited a notably positive influence on both the participation and diversity of digital health behaviors among rural residents. While health literacy did not emerge as a predictor for the occurrence of digital health behavior, it exerted a substantial positive impact on the diversity of digital health behaviors in the rural population. There were significant interaction effects between digital literacy and health literacy concerning the participation and diversity of digital health behaviors among rural residents. These findings remained robust even after implementing the instrumental variable method to address endogeneity issues. Furthermore, the outcomes of robust analysis and heterogeneity analysis further fortify the steadfastness of the aforementioned conclusions.
Conclusion
The findings suggest that policymakers should implement targeted measures aimed at enhancing digital literacy and health literacy among rural residents. This approach is crucial for improving rural residents' access to digital health services, thereby mitigating urban–rural health inequality.
... Studies have shown that patients in rural areas of the United States may face additional difficulties in recovery due to fewer opportunities for in-person physical activity programs as a consequence of limited access to indoor facilities, limited transportation, and a lower overall health status when compared to urban patients [24,32]. Additionally, rural residents are less likely to report having home broadband than those living in urban or suburban areas [70], which seriously impacts their access to digital health care tools and electronic communication with health providers [71]. ...
... In this study, engagement was similar between both rural and urban areas (eg, the number of sessions and interactions with a PT), and completion rates were higher in the rural cohort. The reasons behind these observations may be multifactorial, but one can speculate that the lack of access to alternative health care resources, as well as the provision of a Wi-Fi hotspot to those without internet, might have prompted patients from rural areas to not only engage with the exercise sessions but also to achieve higher completion rates [70,71]. Also, despite lower educational levels, patients from rural areas engaged more with curated health educational articles advocating for telerehabilitation programs as enablers of health literacy. ...
Background
Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied.
Objective
The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain.
Methods
This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain.
ResultsPatients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P
... During this period, there has been a large shift to virtual care. Although this change has the possibility to close the gap in health care delivery in the United States, studies have shown that there are disparities in health technology use and the use of technology in general [5][6][7][8][9][10][11]. These studies have shown that low health literacy, lower educational attainment, residence in a rural area, being of minority race/ethnicity, and older age are associated with lower rates of health app and general technology use (ie, computer and cellphone ownership) [5][6][7][8][9][10][11]. ...
... Although this change has the possibility to close the gap in health care delivery in the United States, studies have shown that there are disparities in health technology use and the use of technology in general [5][6][7][8][9][10][11]. These studies have shown that low health literacy, lower educational attainment, residence in a rural area, being of minority race/ethnicity, and older age are associated with lower rates of health app and general technology use (ie, computer and cellphone ownership) [5][6][7][8][9][10][11]. ...
Background
During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs.
Objective
Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center.
Methods
In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic’s patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated.
ResultsWe identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P
... The rapid expansion of digital health provided people with ongoing access to vital health services while minimizing their potential exposure to infection. However, despite the potential for digital health in rural and regional areas, emerging research indicates lower uptake among these populations compared to their metropolitan counterparts [6,9,10]. A 2023 study investigating consumer preferences for telehealth reported that consumers living in rural and regional Australia preferred travelling to see their doctor and were less likely to engage with any telehealth modalities [11]. ...
Background
Access to healthcare significantly influences health outcomes, and rural, regional and remote populations face greater challenges in accessing healthcare than urban populations. Digital health tools, such as remote patient monitoring (RPM), have significant potential to address these healthcare challenges, yet there is little research on the facilitators and barriers of RPM in these regions.
Aim
This study aims to identify and understand the facilitators and barriers healthcare staff face implementing RPM in rural and regional Australia, with focus on challenges that arose after the onset of the COVID-19 pandemic.
Methods
Semi-structured focus groups were conducted with healthcare professionals from publicly funded health services in western rural and regional Victoria, Australia. An open-ended interview guide based on the Consolidated Framework for Implementation Research (CFIR) was used to identify key themes and strategies for effective RPM implementation. The analysis considered barriers and facilitators at micro, meso, and macro levels.
Results
Several barriers to RPM implementation were identified across different levels: (1) Micro-Level Factors, such as perceived low digital literacy and language barriers among individuals; (2) Meso-Level Factors, including disparities in IT infrastructure and device availability, limited training opportunities, and the need for enhanced governance within healthcare settings; and (3) Macro-Level Factors, encompassing evolving funding models and the reliability of service providers. Despite these challenges, participants acknowledged potential benefits such as improved technological interoperability, enhanced community engagement, and a data-driven approach to quality improvement. Importantly, a flexible, tailored RPM approach to accommodate specific rural and regional needs was deemed valuable.
Conclusion
Effective RPM deployment in rural and regional areas is viewed by health professionals as crucial for bridging healthcare divides. However, if strategies developed for urban settings are not recalibrated to address rural challenges, the risk of RPM failure may escalate. Future initiatives must prioritize region-specific strategies and policy reforms aimed at ensuring equitable digital infrastructure and financial resource allocation to enhance healthcare access in rural and regional settings. This approach may ensure that RPM solutions are both adaptable and effective, tailored to the unique needs of each community.
... The greater organizational complexity of urban settlements and their higher availability of resources, healthcare facilities, and social services positively impact public health overall (4). Cities also serve as information hubs, promoting better adherence to medical guidelines compared with rural settlements, where knowledge is typically shared within household networks and traditional practices may prevail (101,102). This pattern extends to infant feeding practices. ...
Our study explores the potential relationship between infant feeding practices and settlement complexity in the Roman Empire through high-resolution Bayesian-modeled stable isotope measurements from incremental dentine. We compiled isotopic data from permanent first molars of individuals from various Roman sites: five from Bainesse (UK), 30 from Thessaloniki (Greece), along with new carbon and nitrogen isotope analyses from four individuals from Pompeii and six from Ostia Via del Mare (AVM). Our results reveal significant inter-site variability in breastfeeding durations, ranging from 1.5 years to approximately 5 years. Notably, individuals from the highly complex urban centers of Pompeii and Thessaloniki ceased breastfeeding around or below the 2-year weaning threshold recommended by Roman physicians. In contrast, individuals from the rural site of Ostia AVM and the site of Bainesse, near the northern frontier of the Roman Empire, generally ceased breastfeeding after 2 years of age. The link between settlement complexity and duration of breastfeeding observed in our study may have resulted from adherence to medical guidelines, support infrastructures, and/or strategies to mitigate financial constraints within households.
... These findings align with the results of a study by Greenberg et al., which revealed that, despite similar rates of smartphone ownership and health app installations, rural residents were less likely to engage with digital health tools for communicating with healthcare providers or managing personal health information online. This suggests that rural residents, while having access to technology, may face barriers in effectively utilizing digital health tools for healthcare purposes [44]. Research indicates that there are substantial disparities between rural and urban regions concerning socio-economic conditions, access to healthcare, and lifestyle variations. ...
Introduction
Communication disorders are one of the most common disorders that, if not treated in childhood, can cause many social, educational, and psychological problems in adulthood. One of the technologies that can be helpful in these disorders is mobile health (m-Health) technology. This study aims to examine the attitude and willingness to use this technology and compare the advantages and challenges of this technology and face-to-face treatment from the perspective of patients.
Methods
This descriptive study was conducted with a researcher-made questionnaire and investigated the willingness and attitude of patients with communication disorders to use mobile health technology. The face and content validity of the questionnaire were examined with the help of experts in speech therapy, health information management, and medical informatics. Chi-square, Fisher's exact test, and the Kruskal–Wallis test were used to analyze the relationship between variables. Also, the challenges and advantages of mobile health technology and face-to-face treatment were extracted from the patient's answers and presented in the form of main themes and sub-themes.
Results
One hundred seventy patients participated in this study. The results of this study showed that 57 (33.5%) participants preferred face-to-face visits, 11 (6.5%) preferred m-Health, and 102 (60.0%) preferred the combination of mobile applications and the face-to-face visits method. The results showed a statistically significant relationship between "Residence (rural or urban)", "Having trouble traveling to speech therapy centers", and "Delaying treatment due to lack of access to speech therapists" with treatment methods (face-to-face, mobile health, face to face and mobile health). Accessibility and convenience, treatment efficacy and variety, patient empowerment and confidence, family involvement and support, cost and time efficiency, treatment adherence and completion, and comfort and lifestyle compatibility were six categories related to the advantages of mobile health technology from the point of view of patients with communication disorders. Also, technological challenges, effectiveness and quality concerns, patient experience and engagement, and trust and confidence issues were mobile health challenges from the patients' point of view.
Conclusion
The results of this study showed that patients tend to use both face-to-face interactions and mobile health. Integrating both m-Health and traditional methods can optimize speech therapy outcomes. Addressing challenges such as inadequate technological infrastructure and data security is crucial for successful implementation.
... While patients with cancer benefited from the ESMSs, some still encountered barriers to their use. Like other studies regarding technology use in medical settings, patients who were older [59,64], less educated [65,66], and lived in rural areas [67] faced greater challenges with using ESMSs. Older adults tend to have high levels of technology anxiety and even resistance to using technology [68], possibly resulting in a digital divide that hinders their use of ESMSs [69]. ...
Background
There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients’ adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients’ experiences with ESMSs.
Objective
The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs.
Methods
A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings.
Results
A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved.
Conclusions
This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer.
Trial Registration
PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421730
... 49 While age is generally a strong indicator of differences in digital service use, older adults are a highly divergent group with respect to technology access and digital health literacy, which affects their use of eHealth services. 25 Some studies have identified factors that might hinder PAEHR use, including sociodemographic background, 50 health literacy, 51,52 and technology skills. 53 Blease et al. 6 hypothesised that some patient populations may experience more pitfalls in communication during face-to-face visits rendering them more likely to suffer health disparities. ...
Objective
The current understanding of the breadth of individual differences in how eHealth technologies are perceived as useful for different purposes is incomprehensive. The aim/purpose of the study is to improve the understanding of diverse perceptions of the usefulness of technologies by exploring older adults’ use of their patient-accessible electronic health records (PAEHRs).
Methods
The study applies and extends Affordance Theory based on an empirical analysis of data from the NORDeHEALTH 2022 Patient Survey on attitudes toward PAEHR in Norway, Sweden, Finland, and Estonia. Responses from 3964 participants in Sweden, aged 65 + years were analysed. Data included demographics and agreement ratings to reasons for using PAEHR. To analyse variation in the reasons for using PAEHR, group comparisons were conducted based on gender (male/female), age group (65–74, 75–84 and 85+) and earlier encouragement to use PAEHR.
Results
Overall, the findings suggest that PAEHRs have multiple parallel affordance trajectories and affordance potencies that actualise differently depending on needs. The top reasons, pointing to both orientational and goal-oriented affordances for using PAEHR, were improving understanding of health issues, getting an overview of medical history/treatment and ensuring understanding of what the doctor said. Men reported more often sharing information with relatives or friends as a reason to access PAEHR. Women were more inclined, albeit similarly to men less frequently, to read their PAEHR for detecting errors. Age had little influence on reasons for using PAEHR.
Conclusions
The study applies and extends Affordance Theory in the context of older adults’ PAEHR use based on findings from the largest national investigation of reasons for older users to access PAEHR in Sweden demonstrating the applicability of the theory in improving the understanding of the diversity of individual perceptions on eHealth technologies.
... Lower socioeconomic status, older age, rural residence, male gender, and public or no insurance are consistently linked to the lower adoption of patient portals. [26][27][28] There are also numerous barriers identified by studies, including low digital literacy, a lack of internet access, privacy concerns, and the existence of multiple provider-specific portals. [29][30][31][32] The studies performed by UTAUT2 show that performance expectancy, effort expectancy, facilitating condition, social influence, price value, habit, hedonic motivation, and selfperception are indicated as factors for low patients' behavioral intention to use the patient. ...
Background
Patient portal technology is increasingly utilized in the health care system for diabetes management as a means of communication and information-sharing tools, and it has the potential to improve access, quality, and outcomes for patients with diabetes. However, its adaptation is very low, and patients’ intention toward the patient portal is unknown. This study aims to fill this gap by determining the intention to use the patient portal and its predictors among patients with diabetes in Ethiopia.
Method
An institution-based cross-sectional study was conducted on patients with diabetes from April 3 to May 8 in eight referral hospitals in the Amhara region, Ethiopia 2023. Samples were proportionally allocated for each hospital, and participants were selected by using a systematic random sampling method. The data were collected by using an interviewer-administered questionnaire using the Kobo collection mobile app. Descriptive statistics were performed using SPSS version 26. The degree of association between exogenous and endogenous variables was assessed and validated using structural equation modeling using AMOS version 21.
Result
A total of 1037 (96.2% response rate) patients with diabetes participated in the study. Of them, 407 (39.25%), 95% CI: [36.4–42.2] were found to have an intention to use the patient portal. Digital literacy (β = 0.312, 95% CI: [0.154–0.465], p < .01), performance expectancy (β = 0.303, 95% CI: [0.185–0.420], p < .01), effort expectancy (β = 0.25, 95% CI: [0.131–0.392], p < 0.01) facilitating condition (β = 0.22, 95% CI: [0.081–0.36], p < .01) and habit (β = 0.111, 95% CI: [−0.009 to 0.227], p < .05) were significantly associated with the intention to use patient portals. Effort expectancy and facilitating conditions were positively moderated by gender.
Conclusion
This study found that patient with diabetes’ intention to use patient portals was low. To increase patients with diabetes’ intention to use the patient portal, interventions in digital literacy, performance expectations, effort expectations, facilitating conditions, and habits are required.
... Moreover, changes in patient behavior may also be linked to the allocation of health resources. Districts with more abundant health resources have demonstrated effective mHealth implementation [25]. In the Nanshan district, abundant resources (including substantial government funding and strong talent development measures) supported frequent quality control measures based on the data from the mHealth app, facilitating timely interventions. ...
Background
Postpartum depression (PPD) has received widespread attention. Shenzhen has been running a large-scale program for PPD since 2013. The program requires mothers to self-assess when applying information technology to PPD screening beginning in 2021. The purpose of this study was to conduct a longitudinal analysis of the impact of mHealth apps on the health-seeking behaviors of PPD patients.
Methods
Longitudinal data from districts in the Shenzhen Maternal and Child Health Management Information System (MCHMIS) for ten years was used in this study. Referral success rate (RSR, successful referrals to designated hospitals as a percentage of needed referrals) was used to assess health-seeking behavior. Trend χ2 tests were used to assess the overall trend of change after the implementation of mHealth in ten districts in Shenzhen. Interrupted Time Series Analysis (ITSA) was employed to assess the role of the mHealth app in changing patient health-seeking behaviors.
Results
For the results of the trend χ2 tests, the ten districts of Shenzhen showed an upward trend. For the ITSA results, different results were shown between districts. Nanshan district, Longhua district, and Longgang district all demonstrated an upward trend in the first-year application of the mHealth app. Nanshan district and Longgang district both exhibited an upward trend in terms of sustained effects.
Conclusions
There is a difference in the performance of the mHealth app across the ten districts. The results show that the three districts with better health resource allocation, Nanshan, Longgang, and Longhua districts, demonstrated more significant mHealth app improvements. The mHealth app’s functions, management systems, and health resource allocation may be potential factors in the results. This suggests that when leveraging mHealth applications, the first step is to focus on macro-level area resource allocation measures. Secondly, there should be effective process design and strict regulatory measures. Finally, there should also be appropriate means of publicity.
... Existing research has also pointed to technological challenges, regulatory issues, rural-urban disparities and privacy concerns in OMC treatment. 6,9 The benefits and challenges of OMC during COVID-19 have led researchers to call for sustainable strategies for OMC beyond the pandemic. 10,11 Obesity is a primary candidate for OMC. ...
Objective
With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences.
Method
We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants’ WTP for one-click services (OCS) and used DCE to estimate obesity participants’ preferences and WTP for OMC with different attributes.
Results
Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors’ hospital level, doctors’ level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found.
Conclusion
To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential ‘unfair’ pricing.
... In contrast, rural residents face challenges accessing these services due to limited infrastructure and medical resources. 16,21 Thus, the Chinese Social Survey (CSS) 2021 survey specifically targeted urban residents for internet healthcare utilization, so this study aims to identify the factors contributing to the formation of the health digital divide among urban residents, providing a scientific rationale for promoting digital health equity and social justice. ...
Background
The deep integration of digital technology and healthcare services has propelled the healthcare system into the era of digital health. However, vulnerable populations in the field of information technology, they face challenges in benefiting from the digital dividends brought by digital health, leading to the emerging phenomenon of the “health digital divide.”
Methods
This study utilized the sample of 3547 urban from the 2021 Chinese Social Survey data for analysis. Models were constructed with digital access divide, digital usage divide, and digital outcome divide for urban residents, and structural equation modeling was implemented for analysis.
Results
The impact β coefficients (95% CI) of urban residents’ digital access on the frequency of digital use, internet healthcare utilization, and patient experience were (β = 0.737, P < 0.001), (β = 0.047, P < 0.05), and (β = 0.079, P < 0.001), respectively. Urban elderly groups were at a disadvantage in digital access and usage (β = −0.007, β = −0.024, and β = −0.004), as well as those with lower educational levels (β = 0.109, β = 0.162, and β = 0.045). However, these two factors did not have a significant direct impact on the patient experience in urban areas.
Conclusions
The health digital divide of urban residents exhibits a cascading effect, primarily manifested in the digital access and usage divide. To bridge health digital divide among urban residents, efforts must be made to improve digital access and usage among the elderly and those with lower educational levels.
... Empowering all healthcare ecosystem participants with digital skills is the key to unlocking the full potential of digitalization for patient benefit [2,3]. Future physicians must not only know how to use digital tools [4] but they are also required to bring this knowledge into the healthcare ecosystem [5][6][7]. ...
Purpose
The public medical universities in Austria (educating 11,000 students) developed a joint public distance learning series in which clinicians discussed current digital lighthouse projects in their specialty. This study aims to examine the changes in attitude and knowledge of the participants before and after the lecture series to gain insights for future curriculum developments.
Method
The lecture series was announced via various channels at the universities, in health newsletters and in social media. Attitudes toward digitalization in medicine were surveyed before and after the lecture series, together with demographic data. The data were analyzed statistically and descriptively for four groups of interest: female medical students, male medical students, faculty members and members from industry and public agencies.
Results
Out of 351 subjects who attended at least 1 lecture, 117 took part in the survey before and 47 after the lectures. Most participants had a positive attitude towards digitalization (85.3%). They improved their self-assessment of their knowledge from 34.4% to 64.7% ( p < 0.05). After the lecture series 55.8% of participants considered digital medical applications to be important or very important today and 68.6% in the future.
Conclusion
The study shows that the presentation and discussion of lighthouse projects improves understanding of digitalization in medicine but does not trigger a strong desire for additional further training.
... Health information technologies, like PHRs, are seen as an important component for addressing these health disparities [8]. However, despite the benefits for improved health and access, rural residents appear less likely to electronically communicate with doctors and manage personal health information online compared to urban residents [9]. Cited reasons include lack of broadband access in rural areas and lower income and education among rural residents compared to their urban counterparts [10]. ...
Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers’ perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients’ activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation.
... Rural areas in the United States often lack access to the internet, which can result in mortality rate disparities [37,38] and limit economic opportunity [39]. However, rural areas also provide essential ecosystem services such as food production [40][41][42], biodiversity protection [43,44], and carbon sequestration [45], outdoor recreation [46], and relief from the COVID-19 pandemic [47]. ...
Industrial agriculture, climate change, biodiversity loss, global conflict, and increasing inequality undermine the life-supporting services provided by our planet. Recently, the global community has started developing frameworks aimed at averting a climate catastrophe. Global agreements are undoubtedly instrumental in providing humanity with a roadmap for sustainable transformation, but policies to affect national and regional change are needed. Here, we argue that regional sustainable transformation is an actionable way to work toward global sustainability. We used the Doughnut Model (DM) and compiled a database of 8 ecological ceiling metrics and 12 social foundation metrics to assess regional sustainability across 32 metro areas and 180 counties in the United States representing roughly 35% of the US population. Using targeted keywords, we reviewed county-level websites to assess to what extent urban and rural counties collaborate on regional sustainable transformation. Finally, we provide two case studies of regional sustainable transformation across urban and rural regions. We found that generally urban areas had lower social foundation deficits (6 of 12 metrics) and higher ecological ceiling overshoot (3 of 8 metrics) compared to rural areas. We also found low levels (16 out of 180 counties) of cross county collaboration between urban and rural counties for sustainability transformation. Disparities across and between urban and rural areas highlight the potential for cross county collaborative programming to increase regional sustainability. We end with a call for increased private and public funding to develop and maintain programs focused on sustainable transformation and increased cross-county collaboration between urban and rural areas.
... 29 Second, compared with rural areas, aging in urban areas is assumed to involve better access to the Internet and digital devices and more active use of technology. 31 However, digital literacy among urban older adults is assumed to be heterogeneous, 29 and the impact of inadequate digital literacy may be more profound in urban older adults because of the rapid digitalization of various service industries essential to managing health and daily life. 30 To our knowledge, few qualitative studies to date have exclusively evaluated daily experience of digital literacy in older adults, especially community-dwelling older adults in urban South Korea, using a well-established conceptual model. ...
This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels.
... In some cases, even access to better public transportation does not effectively improve healthcare access due to other co-occurring barriers, such as general socioeconomic disadvantage [68]. Also, it is important to consider that the availability of resources such as helipads also does not guarantee access, as many rural residents do not have health insurance or adequate access to information about such available services [37]. Future studies are needed to examine access to transportation and its effectiveness during a pediatric medical emergency. ...
Vehicle access, travel time, and distance to hospitals and emergency rooms with sufficient patient beds are critical healthcare accessibility measures, especially for children who require specific pediatric services. In a large state like Texas with vast rural areas and limited public transit infrastructure, 75% of the children live over an hour from the closest facility that provides pediatric emergency services or specialty care. In view of this challenge, this study first sought to map the prevailing geographical accessibility to children’s hospitals and, second, to model the hospital beds per capita for each hospital’s service area within the state of Texas. The results showed disparities in accessing emergency pediatric care, especially in rural areas. However, despite major metro areas recording better geographical accessibility to pediatric healthcare, residents in these areas may experience limited hospital bed availability. The findings indicate an urgent need for more pediatric healthcare services in rural Texas. Given the increasing population growth in metro areas and their surroundings, there is also a need for the expansion of healthcare infrastructure in these areas.
... Telehealth delivery of nonpharmacologic care could lessen disparities [28], but application has been limited [29,30]. Experiences during COVID support telehealth's potential to increase access [31], but issues specific to implementation in underserved communities must be considered [32]. ...
Background
Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study.
Methods
During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes.
Results
CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies.
Conclusions
Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings.
Trial registration
ClinicalTrials.gov Identifier: NCT04923334. Registered June 11, 2021.
... Our study also found that adolescents living in major cities used more online services than those who were living in regional/remote areas. This could primarily be because adolescents living in major cities had more access to modern hi-tech devices such as smartphones, iPad/tabs, and laptops with very good internet connections for their personal use than adolescents living in regional/remote areas [44][45][46][47]. ...
Aim:
In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample.
Subject and methods:
The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services.
Results:
Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality.
Conclusion:
Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.
... 2,18 Such like media serves as a bridge between rural population and health educators during critical health information dissemination. 19,20 There are different types of mass medias that can be used to reach out rural communities, particularly mobile, radio and television, play a pivotal role for persuading target audiences to adopt new habits, bring a health behavior, and to remind individuals about important health topics. 21,22 Moreover, they can not only notify the public about new health ailments and where to receive health care but also, these medias are helpful to keep the public up to date about health issues, especially during pandemic and other health and health-related disasters. ...
Background
The demand for health-related information has increased dramatically in recent years. Media is crucial in reaching health messages to audiences, especially those who are distant and rural. Therefore, the study aimed to assess demands, access, and factors associated with access to health messages through mass media in the rural community of Kersa District of East Hararghe, Eastern Ethiopia.
Methods
A mixed-methods study was conducted from October 15 to November 20, 2020. A quantitative cross-sectional and a qualitative phenomenological study design were applied. A total of 578 participants were included by using a systematic sampling technique. Collected data were entered into Epidata version 3.1 and analyzed using SPSS version 22.0. A multivariate logistic regression analysis model was used and reported using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was set at p <0.05. For qualitative, six-focused group discussions (FGDs) were used and then analyzed thematically.
Results
Overall, the demand of and access to health messages through mass media was 32.5% (95% CI=28.5–34.2%) and 26.6% (95% CI=24.6–28.7%), respectively. Factors such as having electric services (AOR=2.36, 95% CI=2.13–5.41), having a mobile phone (AOR=4.56, 95% CI=4.32–8.73), exposure to TV (AOR=4.73, 95% CI=1.03–11.62), and exposure to social media and printed media (AOR=5.24, 95% CI=1.07–15.63), a preference for programs such as news, current affairs, entertainment, health and educational were 2.37, 9.47, 4.75 and 7.55 times more likely to access health messages (AOR=2.37, 95% CI=1.00–5.61; AOR=9.47, 95% CI=3.54–25.34; AOR=4.75, 95% CI=1.23–18.38; and AOR=7.55, 95% CI=3.12–8.66, respectively). Qualitative findings, participants demand for health messages from health workers, radio, and the main source for accessing the message was the radio.
Conclusion
Approximately one in every three and one in every four rural communities in the study area had demand, and access to health messages through mass media, respectively. As a result, all stakeholders should emphasize and strengthen expanding methods of reaching health messages using mass media.
... 27 Telehealth delivery of nonpharmacologic care could lessen disparities, 28 but application has been limited. 29,30 Experiences during COVID support telehealth's potential to increase access, 31 but issues speci c to implementation in underserved communities must be considered. 32 Implementation mapping (IM) is a systematic approach to iteratively develop scalable and sustainable EBI implementation strategies. ...
Background
Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study.
Methods
During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes.
Results
CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies.
Conclusions
Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings.
Trial Registration
Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334
... In rural areas, health awareness is of particular importance since people have less health information available through primary care providers, specialist doctors, blogs, magazines and internet search engines. On the other hand, rural dwellers have greater difficulty accessing mass media and scientific literature, and this has a negative impact on health literacy as well as the attitude of the population toward their health [20][21][22]. ...
Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.
... In the past, it was believed that rural communities were isolated, with poor access to web-based information and being excluded from social media. This is partially true [1]. However, in recent times, in both high-income and transitional countries, a remarkable number of individuals from rural areas are using social media to communicate to receive up-to-date information and access quality health support and services [2]. ...
Background
Individuals from rural areas are increasingly using social media as a means of communication, receiving information, or actively complaining of inequalities and injustices.
Objective
The aim of our study is to analyze conversations about rural health taking place on Twitter during a particular phase of the COVID-19 pandemic.
Methods
This study captured 57 days’ worth of Twitter data related to rural health from June to August 2021, using English-language keywords. The study used social network analysis and natural language processing to analyze the data.
Results
It was found that Twitter served as a fruitful platform to raise awareness of problems faced by users living in rural areas. Overall, Twitter was used in rural areas to express complaints, debate, and share information.
Conclusions
Twitter could be leveraged as a powerful social listening tool for individuals and organizations that want to gain insight into popular narratives around rural health.
... A lack of widespread availability of broadband internet access has contributed to a digital divide, defined as the difference in the prevalence of broadband internet access between urban and rural communities. This digital divide causes a lack of access to technologies such as digital healthcare and the ability to work remotely for many members of rural communities (Greenberg et al., 2017). ...
Unlabelled:
To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting.
Supplementary information:
The online version contains supplementary material available at 10.1007/s40653-022-00507-9.
... Second, our study revealed potential limitations of using urban/rural classification to understand patient portal use by device type across geographic locations. In agreement with previous studies [21,25,26], we found patients located in rural areas were less likely to be active patient portal users, as compared to patients in urban areas. Moreover, among active users, we did not observe a difference in device type used to access the portal, or in the number of mobile logins, between urban and rural locations. ...
Disparities in patient portal use are impacted by individuals’ access to technology and the internet as well as their skills and health behaviors. An individual’s geographic location may impact these factors as well as contribute to their decision to use a portal, their choice of device to access the portal, and their use of portal functions. This study evaluated patient portal use by geographic location according to three comparators: proximity to the medical center offering the portal, urban/rural classification, and degree of digital distress. Patients residing farther from the medical center, in rural areas, or in areas of higher digital distress were less likely to be active portal users. Patients in areas of higher digital distress were more likely to use the mobile portal application instead of the desktop portal website alone. Users of the mobile portal application used portal functions more frequently, and being a mobile user had a greater impact on the use of some portal functions by patients residing in areas of higher digital distress. Mobile patient portal applications have the potential to increase portal use, but work is needed to ensure equitable internet access, to promote mobile patient portal applications, and to cultivate individuals’ skills to use portals.
... With COVID-19, telehealth suddenly shifted to the home. Previous research has indicated that rural dwellers have less access to the internet and are less likely to use health information technologies such as patient portals and mHealth applications (Bhuyan et al., 2016;Greenberg et al., 2018). While lack of broadband access and digital literacy have emerged as possible answers to this puzzle, researchers have suggested that there are underlying factors beyond internet access that must be considered (Jaffe et al., 2020;Jewett et al., 2022). ...
The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile’s influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile’s influence on a person’s decision to use telehealth in order to provide optimal care.
... Internet resources also did not improve COVID-19 preventive behaviors of rural public. There is a digital divide between urban and rural areas (30). Compared to the urban public, the rural public is less likely to access information through internet. ...
Introduction
It has been approved that information sources would affect public behaviors. However, due to the outbreak of COVID-19, this influence was enhanced and showed a distinctive pattern among different populations, which has been less noticed before. We aimed to investigate the potential roles of different information sources in COVID-19 preventive behaviors of different publics.
Methods
A cross-sectional online survey with 11,190 participants from 33 province-level regions in China was conducted during the COVID-19 pandemic. Sociodemographic characteristics, COVID-19 preventive behaviors, and information sources for COVID-19-related information were assessed. A mixed linear model was used to analyze risk factors of COVID-19 preventive behaviors. The effects of different information sources on COVID-19 prevention behaviors of different publics were analyzed.
Results
Generally, the Chinese public had good COVID-19 preventive behaviors, and the top three COVID-19 preventive behaviors with the higher action rate were avoiding eat bushmeat (76.1%), a healthy diet (74.8%), and avoiding contact with people with symptoms of respiratory diseases (73.0%). About information sources, 12320 telephone (National Public Health Hotline) (−0.62, 95% CI: −0.94 to −0.31) and acquaintances consulting (−1.00, 95% CI: −1.31 to −0.69) were negatively associated with COVID-19 preventive behaviors, while internet resources, family doctors, hospitals, and community health centers were positively associated with COVID-19 preventive behaviors (1.00 vs. 0.47 vs. 0.46 vs. 0.33, P < 0.05). For older adults, accessing to COVID-19-related information through family doctors and community health centers were positively associated with COVID-19 preventive behaviors. For the non-educated, family doctors and community health centers had positive effects on their COVID-19 preventive behaviors. Family doctors and internet resources were positively associated with COVID-19 preventive behaviors among those earning 5,000 yuans and above. The effects of family doctors, hospitals, and internet resources were higher for COVID-19 preventive behaviors of urban publics than for rural publics. Finally, the effect of internet resources on COVID-19 preventive behaviors of females was lower than males.
Conclusions
Obtaining COVID-19-related information through internet resources had the most significant effect on COVID-19 preventive behaviors, but was not significant among publics with old age, low education, low income, and living in rural area.
... An alternative hypothesis is that the lack of a relationship is driven by the fact that rural residents are less likely to manage their personal health information online. 51 Additional research should explore why increased EHR functionality is associated with reduced outpatient costs in urban, but not rural, facilities. ...
Objectives The aim of the study is to examine the relationship between electronic health record (EHR) use/functionality and hospital operating costs (divided into five subcategories), and to compare the results across rural and urban facilities.
Methods We match hospital-level data on EHR use/functionality with operating costs and facility characteristics to perform linear regressions with hospital- and time-fixed effects on a panel of 1,596 U.S. hospitals observed annually from 2016 to 2019. Our dependent variables are the logs of the various hospital operating cost categories, and alternative metrics for EHR use/functionality serve as the primary independent variables of interest. Data on EHR use/functionality are retrieved from the American Hospital Association's (AHA) Annual Survey of Hospitals Information Technology (IT) Supplement, and hospital operating cost and characteristic data are retrieved from the American Hospital Directory. We include only hospitals classified as “general medical and surgical,” removing specialty hospitals.
Results Our results suggest, first, that increasing levels of EHR functionality are associated with hospital operating cost reductions. Second, that these significant cost reductions are exclusively seen in urban hospitals, with the associated coefficient suggesting cost savings of 0.14% for each additional EHR function. Third, that urban EHR-related cost reductions are driven by general/ancillary and outpatient costs. Finally, that a wide variety of EHR functions are associated with cost reductions for urban facilities, while no EHR function is associated with significant cost reductions in rural locations.
Conclusion Increasing EHR functionality is associated with significant hospital operating cost reductions in urban locations. These results do not hold across geographies, and policies to promote greater EHR functionality in rural hospitals will likely not lead to short-term cost reductions.
... However, the digital divide between periphery and urban residents also extends to health technologies [6]. On the one hand, according to the Spanish National Institute of Statistics [7], the evolution of user internet access among people aged 16-74 years has increased from 78.7% in 2015 to 93.2% in 2020 with no gender differences (95.7% men and 96% women). ...
Increasing technological advances have generated a digital dependency in the population, resulting in a group of digitally excluded vulnerable people that lack basic digital skills. The aim of this study was to assess the digital divide in patients in relation to the healthcare environment. We explored the extent and effects of the digital health divide by undertaking a systematic review of the academic literature and comparing our findings with the results of a cross-sectional in-person survey answered by 881 people at four community pharmacies. In terms of the sociodemographic profile of the patients, we collected data regarding their gender, age, education level, and location (periphery or urban). The parameters evaluated were use of the internet to search for health information, use of telemedicine, use of different medical/healthcare applications, understanding explanations given by physicians regarding health, and asking pharmacists for help about newly prescribed treatments. Moreover, 168 pharmacists answered an online survey about how often they helped patients to make health center appointments or to download their COVID-19 vaccination certificate. Gender did not influence these results, but age, education level, and population location did. Those with the lowest levels of education required more help to request a health center appointment. People with high education levels and those living in an urban environment more often searched the internet for information about treatments that were new to them. Finally, people living in periphery areas received more help from their pharmacists, 60% of which said they had helped patients to download their COVID-19 vaccination certificate, with 24% of them saying they helped patients with this on a daily basis.
... 37 A previous study has found that rural residents had lower access to online health information like social media compared to urban residents. 38 Trusted media information sources could influence the public on COVID-19 vaccination acceptance. 25 This study suggested that television was the alternative information source after social media as the biggest one. ...
Purpose
The Coronavirus disease (COVID-19) vaccination program has been rolled out to address the pandemic. However, the COVID-19 vaccination coverage rate in Indonesia, especially in Central Java, is low. The study aimed to identify COVID-19 vaccine acceptance and to determine the factors associated with COVID-19 vaccine hesitancy.
Participants and Methods
A cross-sectional study was conducted from September to October 2021. A self-reported questionnaire was distributed to participants aged ≥ 18 years and living permanently in the area of study by the multistage sampling technique. Bivariate and multivariate analyses were performed to determine the association. All statistical tests were significantly considered if the p-value <0.05 at 95% confidence interval (CI).
Results
A total of 500 participants were eligible, with the age ranging from 18 to 76 years old. COVID-19 vaccine acceptance rate was 93.6%. In the multivariate logistic regression analysis, we found that the elderly (aOR=5.231; 95% CI=1.891–14.468), having comorbidity (aOR=4.808; 95% CI=1.975–11.706), not being exposed to information (aOR=7.039; 95% CI=2.072–23.908), not believing in the vaccine halalness (OR=3.802; 95% CI=1.272–11.364), not believing that vaccines could prevent the COVID-19 infection (OR=4.964; 95% CI=1.970–12.507), and having vaccination-related mild-moderate anxiety (OR=14.169; 95% CI=2.405–83.474) were more likely to have vaccine hesitancy (p<0.05). Place of residence, education level, belief that the vaccine could prevent the severe symptoms of COVID-19, and knowledge were significantly related to the vaccine acceptance in the bivariate analysis (p<0.05), but they were no longer significant in the multivariate (p>0.05).
Conclusion
A high acceptance rate of the COVID-19 vaccine was found in this study. However, vaccine hesitancy is a major public health concern for attaining herd immunity and reducing the risk of case mortality. These findings could be the strategic focus for the government to improve COVID-19 vaccination coverage.
This study assessed urban–rural differences in patient engagement through access and use of digital health tools. Government policies have sought to encourage patient engagement by enabling access and use of digital health tools in the US. This is because patients with access to their health information tend to be better informed and more engaged in the management of their health and health care. Patient engagement has the potential improve quality of care and patient health outcomes as well as reduce costs. To what extent have current government policies improved digital patient engagement?
Data from the 2020 and 2022 iteration of the nationally representative annual Health Information National Trends Survey (HINTS) was used for this study. Bivariate analyses were used to examine urban–rural differences across study variables. Multiple logistic regressions were performed, controlling for demographic variables, access and use of digital health technology.
While the rates of access and use of patient portals have increased overtime, statistically significant urban–rural differences were observed. Rural residents viewed their test results, downloaded their medical records, contacted their health providers and made appointments online at comparably lower rates than urban residents.
Urban–rural disparities in the digital patient engagement persists, highlighting the need for more equitable access.
Background
Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population.
Objective
This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth.
Methods
A cross-sectional analysis of the National Cancer Institute’s Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use.
Results
Overall, 17% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9%), digital device ownership (n=676, 94.9%), and social media use (n=448, 66.6%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95% CI 0.32-0.97; P =.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95% CI 1.13-6.19; P =.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year.
Conclusions
Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors.
Digitization in healthcare has been an ongoing trend for several decades, strengthened by the acute needs presented by current health areas such as the COVID-19 pandemic, non-communicable diseases, and the mental health crisis. While in many cases technological development has been a conduit for reducing healthcare inequalities, in others it has had the opposite effect. One of the reasons for the suboptimal impact of technology has been the digital divide, in other words the lack of technological availability and development. This chapter is a scoping review that identifies the key factors in recent scientific literature that relate to the root causes of the digital divide. Key aspects such as connectivity, digital literacy and accessibility have been firmly mentioned through most of the identified publications. Also, through the scoping review recommendations were identified. This chapter has highlighted the diverse factors affecting the digitization of healthcare in relation to the digital divide, as well as the potential actions that can mitigate this divide based on digital technology availability and development.
Public participation serves as a critical component of rural health interventions and epitomizes the full realization of people’s democracy. Consequently, it is essential to tailor rural health construction based on public feedback. This study introduces an opinion mining model based on Long Short-Term Memory (LSTM) networks, designed to extract public opinions from intelligent media platforms. The methodology includes data preprocessing through text filtering, word segmentation, and lexical tagging to prepare the data for analysis. To enhance the model’s performance and avoid overfitting, dropout techniques were employed during training. Opinion classification was subsequently performed using a softmax function. Initial findings from the opinion mining process indicated that 38.29% of the analyzed comments expressed a negative view of rural health conditions. Following targeted interventions to address areas receiving low sentiment scores, a notable improvement in perceptions was observed. Specifically, the sentiment score concerning the attitudes of healthcare workers in the village increased by 14.75%. Additionally, enhancements in waste management practices led to a 19.34% increase in the related sentiment score, contributing to an overall rise of 19.85% in positive public sentiment. These results underscore the efficacy of employing this LSTM-based opinion-mining approach in fostering improvements in rural health environments through informed public participation.
Industrial agriculture, climate change, biodiversity loss, global conflict, and increasing inequality undermine the life-supporting services provided by our planet. Recently, the global community has started developing frameworks aimed at averting a climate catastrophe. Global agreements are undoubtedly instrumental in providing humanity with a roadmap for sustainable transformation, but policies to affect national and regional change are needed. Here, we argue that regional sustainable transformation is an actionable way to work toward global sustainability. We used the Doughnut Model (DM) and compiled a database of 8 ecological ceiling metrics and 12 social foundation metrics to assess regional sustainability across 32 metro areas and 180 counties in the United States representing roughly 35% of the US population. Using targeted keywords, we reviewed county-level websites to assess to what extent urban and rural counties collaborate on regional sustainable transformation. Finally, we provide two case studies of regional sustainable transformation across urban and rural regions. We found that generally urban areas had lower social foundation deficits (6 of 12 metrics) and higher ecological ceiling overshoot (3 of 8 metrics) compared to rural areas. We also found low levels (16 out of 180 counties) of cross county collaboration between urban and rural counties for sustainability transformation. Disparities across and between urban and rural areas highlight the potential for cross county collaborative programming to increase regional sustainability. We end with a call for increased collaboration between private and public sectors focused on sustainable transformation and increased cross-county collaboration between urban and rural areas.
Digital health technologies are ubiquitous in the healthcare landscape. Older adults represent an important user group who may benefit from improved monitoring of physical and cognitive health and in-home access to care, but there remain many barriers to widespread use of digital health technologies in gerontology and geriatric medicine. The National Institute on Aging Research Centers Collaborative Network convened a workshop wherein geriatricians and gerontological researchers with expertise related to mHealth and digital health applications shared opportunities and challenges in the application of digital health technologies in aging. Discussion broadly centered on 2 themes: promises and challenges in (i) the use of ecological momentary assessment methodologies in gerontology and geriatric medicine, and (ii) the development of health promotion programs delivered via digital health technologies. Herein, we summarize this discussion and outline several promising areas for future research.
Background
Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.
Objective
We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.
Methods
We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).
Results
Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients’ expectations and the reality of limitations regarding both physicians’ availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.
Conclusions
This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients’ expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.
The chapter explores the critical role of health information communication in rural settings during pandemics. It looks into rural populations' unique challenges in accessing health information, information dissemination, and improving health outcomes. The chapter discusses the current health information communication in rural settings, the need for tailoring health information, the barriers, and the potential of technology and innovations in improving access to rural information. It also highlights the importance of cultural sensitivity and policy considerations in effectively addressing health information disparities in rural areas.
Background
Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses.
Objective
The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions.
Methods
Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled.
Results
A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support.
Conclusions
The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change.
Trial Registration
PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168
Background
Patient portal technology is increasingly utilized in the health care system for diabetes management, as means of communication and information-sharing tools and it has the potential to improve access, quality, and outcomes for diabetic patients. However, its adaption is relatively low and patients’ intention towards patient portal is unknown. This study aims to fill this gap by determining the intention to use the patient portal and its predictors among diabetic patients in Ethiopia.
Method
An institution-based cross-sectional study was conducted on 1078 diabetes patients from April 3 to May 8 in eight referral hospitals Amhara region, Ethiopia 2023. Sample was proportionally allocated for each hospital and participants were selected by using a systematic random sampling method. The data were collected in the same period in all hospitals by using interviewer-administered questioner; by kobo collect mobile app. Descriptive statistics were done using SPSS version 26. The degree of association between exogenous and endogenous variables was assessed and validated using structural equation modeling by AMOS version 21.
Result
A total of 1037 (96.2% response rate) diabetic patients participated in the study. Of them 407(39.25%), 95% CI: [36.4–42.2] were found to have an intention to use patient portal. Digital literacy (β = 0.312, 95% CI: [0.154–0.465], p < 0.01) performance expectancy (β = 0.303, 95% CI: [0.185–0.420], p < 0.01) effort expectancy (β = 0.25 95% CI: [0.131–0.392], p < 0.01) facilitating condition (β = 0.22 95% CI: [0.081–0.36], p < 0.01) and habit (β = 0.111 95% CI: [-0.009-0.227], p < 0.05) were significantly associated with intention to use patient portal. Effort expectancy and facilitating condition were positively moderated by gender.
Conclusion
This study found that diabetes patient’s intention to use patient portal was low. Intervention in digital literacy, performance expectancy, effort expectancy, facilitating conditions and habit are needed to improve diabetic patient’s intention to use the patient portal.
Background: Patient portal technology is increasingly utilized in the health care system for diabetes management, as means of communication and information-sharing tools and it has the potential to improve access, quality, and outcomes for diabetic patients. However, its adaption is relatively low and patients’ intention towards patient portal is unknown. This study aims to fill this gap by determining the intention to use the patient portal and its predictors among diabetic patients in Ethiopia.
Method: An institution-based cross-sectional study was conducted on 1078 diabetes patients from April 3 to May 8 in eight referral hospitals Amhara region, Ethiopia 2023. Sample was proportionally allocated for each hospital and participants were selected by using a systematic random sampling method. The data were collected in the same period in all hospitals by using interviewer-administered questioner; by kobo collect mobile app. Descriptive statistics were done using SPSS version 26. The degree of association between exogenous and endogenous variables was assessed and validated using structural equation modeling by AMOS version 21.
Result: A total of 1037 (96.2% response rate) diabetic patients participated in the study. Of them 407(39.25%), 95% CI: [36.4–42.2] were found to have an intention to use patient portal. Digital literacy (β =0.312, 95% CI: [0.154-0.465], p < 0.01) performance expectancy (β =0.303, 95% CI: [0.185-0.420], p < 0.01) effort expectancy (β = 0.25 95% CI: [0.131-0.392], p < 0.01) facilitating condition (β = 0.22 95% CI: [0.081-0.36], p < 0.01) and habit (β = 0.111 95% CI: [-0.009-0.227], p < 0.05) were significantly associated with intention to use patient portal. Effort expectancy and facilitating condition were positively moderated by gender.
Conclusion: This study found that diabetes patient’s intention to use patient portal was low. Intervention in digital literacy, performance expectancy, effort expectancy, facilitating conditions and habit are needed to improve diabetic patient’s intention to use the patient portal.
Objective
Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals.
Materials and Methods
This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA’s My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions.
Results
In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01).
Conclusion
Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
The digital divide first emerged as an important social and human rights issue in the 1990s. With the rapid development of wireless network technology (e.g., Wi-Fi and cellular networks) and mobile terminal devices (e.g., mobile phones, laptops, and tablets), this issue has shifted to concern mobile Internet access. The three main Chinese telecom operators (China Mobile Communications Corporation, China Unicom Communications Corporation, and China Telecom Communications Corporation) have recently promoted unlimited data plans (UDPs) to reduce information usage costs and increase mobile data use. However, assessments of the impact of these policy changes on the mobile digital divide are limited. This study therefore offers insights into how a reduction in information costs can eliminate this divide. Using a difference-in-differences (DID) approach based on a monthly panel of system-generated mobile app data for subscribers, we find that the UDPs have various effects on promoting the use of mobile Internet and on the digital divide, depending on whether subscribers are of high or low socioeconomic status (i.e., urban versus rural and rich versus poor). We show that the relative differences are alleviated, but the absolute difference further increases after the implementation of a UDP subscription. In addition, a UDP subscription has heterogeneous effects on lifestyles. For the poor or those in rural areas, only promoting UDP does not effectively narrow the mobile digital divide because of insufficient cognition about and persistent weaknesses in the use of information technology.
Personal Health Records (PHR) offer the opportunity for improved care for patients. Older adults, who often face a larger number of chronic diseases, could particularly benefit from the use of PHR. However, confident and self-determined use requires a high degree of digital and content-related competence. The object of this paper is to assess the attitudes and experiences of older adults in connection to the PHR and their requirements towards an eLearning system for appropriate PHR use. To answer the research questions, semi-structured interviews with older adults (aged ≥ 65 years) were conducted. A focus group was also set up, consisting of older adults. Sociodemographic data, previous knowledge about the PHR and willingness to use technology were additionally collected using validated and self-developed questionnaires. While previous knowledge about the PHR was relatively low within the study population, general attitudes towards the PHR were mostly positive. The study participants mainly expressed hope for improved care and concerns about possible incomprehensibility of the content. In terms of learning content, information about access rights and data security were the aspects most frequently mentioned. A high demand for a learning platform enabling the target group to use the PHR successfully was evident. Such a platform could facilitate implementation of the PHR and help older adults to actively participate in their healthcare. At the same time, the specific requirements of older adults should be considered during development.KeywordsPersonal health recordeLearningOlder adults
The use of social media to promote prescription drugs is controlled by ethical and legal behavior and practice standards. Only two countries, the USA and New Zealand, have made it lawful to contact patients directly in order to sell medications. This reasonable approach is no longer applicable due to technological developments. The use of social media for health information, including drug marketing, is gaining popularity. This development has been lauded by a wide spectrum of organizations. This is owing to the fact that it provides a wide range of advantages. The advantages of this form of advertising are widely established. According to some studies, SMP is related to many factors such marginalized group can get lots of benefit using social media and patients’ party think that it is ethical and nothing wrong can happen while sharing personal information in social media. This study has significant implications for marketers, physicians, and policymakers who play critical roles in promoting the creation of safe systems to improve health systems. Future research should use an enhanced communication model tailored to the social media environment to ensure a thorough investigation.KeywordsSocial media promotionSocial media health informationMarginalized groupEthical aspect
This study explores the use of mobile health applications (mHealth apps) on smartphones or tablets for health-seeking behavior among US adults. Data was obtained from cycle 4 of the 4th edition of the Health Information National Trends Survey (HINTS 4). Weighted multivariate logistic regression models examined predictors of 1) having mHealth apps, 2) usefulness of mHealth apps in achieving health behavior goals, 3) helpfulness in medical care decision-making, and 4) asking a physician new questions or seeking a second opinion. Using the Andersen Model of health services utilization, independent variables of interest were grouped under predisposing factors (age, gender, race, ethnicity, and marital status), enabling factors (education, employment, income, regular provider, health insurance, and rural/urban location of residence), and need factors (general health, confidence in their ability to take care of health, Body Mass Index, smoking status, and number of comorbidities). In a national sample of adults who had smartphones or tablets, 36 % had mHealth apps on their devices. Among those with apps, 60 % reported the usefulness of mHealth apps in achieving health behavior goals, 35 % reported their helpfulness for medical care decision-making, and 38 % reported their usefulness in asking their physicians new questions or seeking a second opinion. The multivariate models revealed that respondents were more likely to have mHealth apps if they had more education, health insurance, were confident in their ability to take good care of themselves, or had comorbidities, and were less likely to have them if they were older, had higher income, or lived in rural areas. In terms of usefulness of mHealth apps, those who were older and had higher income were less likely to report their usefulness in achieving health behavior goals. Those who were older, African American, and had confidence in their ability to take care of their health were more likely to respond that the mHealth apps were helpful in making a medical care decision and asking their physicians new questions or for a second opinion. Potentially, mHealth apps may reduce the burden on primary care, reduce costs, and improve the quality of care. However, several personal-level factors were associated with having mHealth apps and their perceived helpfulness among their users, indicating a multidimensional digital divide in the population of US adults.
While rural hospitals and physicians have adopted health information technology at the same, or greater, rates as their urban counterparts, meaningful-use attestation varies dramatically among rural providers. Also, rural providers are more likely to skip a year of declaring that they have met meaningful-use requirements, putting them at a financial disadvantage compared to urban providers.
Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature) and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC). Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements.
Introduction:
Mobile phone technologies have been promoted to improve adherence to antiretroviral therapy (ART). We studied the receptiveness of patients in a rural Ugandan setting to the use of short messaging service (SMS) communication for such purposes.
Methods:
We performed a cross-sectional analysis measuring mobile phone ownership and literacy amongst patients of The AIDS Support Organisation (TASO) in Jinja, Uganda. We performed bivariate and multivariate logistic regression analyses to examine associations between explanatory variables and a composite outcome of being literate and having a mobile phone.
Results:
From June 2012 to August 2013, we enrolled 895 participants, of whom 684 (76%) were female. The median age was 44 years. A total of 576 (63%) were both literate and mobile phone users. Of these, 91% (527/ 576) responded favourably to the potential use of SMS for health communication, while only 38.9% (124/319) of others were favourable to the idea (p<0.001). A lower proportion of literate mobile phone users reported optimal adherence to ART (86.4% vs. 90.6%; p=0.007). Male participants (AOR=2.81; 95% CI 1.83-4.30), sub-optimal adherence (AOR=1.76; 95% CI 1.12-2.77), those with waged or salaried employment (AOR=2.35; 95% CI 1.23-4.49), crafts/trade work (AOR=2.38; 95% CI 1.11-5.12), or involved in petty trade (AOR=1.85; 95% CI 1.09-3.13) (in comparison to those with no income) were more likely to report mobile phone ownership and literacy.
Conclusions:
In a rural Ugandan setting, we found that over 60% of patients could potentially benefit from a mobile phone-based ART adherence support. However, support for such an intervention was lower for other patients.
Introduction:
Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province.
Materials and methods:
We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care.
Results:
There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south.
Conclusions:
Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.
The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children.We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care.Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence based guidelines. In many cases, telemedicine can significantly improve provider, patient and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care.Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.Pediatric Research (2015); doi:10.1038/pr.2015.192.
Introduction:
The Ontario Telemedicine Network (OTN) uses technology to help make medical services more accessible to people in medically underserved rural and remote parts of Ontario, Canada. We examined access to OTN-enabled health and medical services in Northern Ontario, which has 775,000 people in communities scattered across an area of 803,000 km(2).
Materials and methods:
We used ArcGIS Network Analyst (Esri, Redlands, CA) to conduct a service area analysis with travel time as a measure of potential access to care. We used road distance and speed limits to estimate travel time between Northern Ontario communities and the nearest OTN unit.
Results:
In 2014 there were 2,331 OTN units, of which 552 (24%) were located in Northern Ontario. All seven communities in Northern Ontario with a population of 10,000 or greater had OTN units. Almost 97% of the 59 communities with 1,000-10,000 people were within 30 min of an OTN unit. The percentage of communities within 30 min steadily decreased with decreasing population size, to 58% for communities with fewer than 50 people. In total, 86% (690/802) of Northern Ontario communities were within an hour's drive of an OTN unit.
Conclusions:
This study showed that most Northern Ontario communities were within an hour's drive of an OTN unit. The current distribution of OTN units has the potential to increase access to medical services and to reduce the need for medically related travel for residents of these communities.
Up to 50 % of HIV-infected persons in sub-Saharan Africa are lost from care between HIV diagnosis and antiretroviral therapy (ART) initiation. Structural barriers, including cost of transportation to clinic and poor communication systems, are major contributors.
We conducted a prospective, pragmatic, before-and-after clinical trial to evaluate a combination mobile health and transportation reimbursement intervention to improve care at a publicly operated HIV clinic in Uganda. Patients undergoing CD4 count testing were enrolled, and clinicians selected a result threshold that would prompt early return for ART initiation or further care. Participants enrolled in the pre-intervention period (January - August 2012) served as a control group. Participants in the intervention period (September 2012 - November 2013) were randomized to receive daily short message service (SMS) messages for up to seven days in one of three formats: 1) messages reporting an abnormal result directly, 2) personal identification number-protected messages reporting an abnormal result, or 3) messages reading "ABCDEFG" to confidentially convey an abnormal result. Participants returning within seven days of their first message received transportation reimbursements (about $6USD). Our primary outcomes of interest were time to return to clinic and time to ART initiation.
There were 45 participants in the pre-intervention period and 138 participants in the intervention period (46, 49, and 43 in the direct, PIN, and coded groups, respectively) with low CD4 count results. Median time to clinic return was 33 days (IQR 11-49) in the pre-intervention period and 6 days (IQR 3-16) in the intervention period (P < 0.001); and median time to ART initiation was 47 days (IQR 11-75) versus 12 days (IQR 5-19), (P < 0.001). In multivariable models, participants in the intervention period had earlier return to clinic (AHR 2.32, 95 %CI 1.53 to 3.51) and earlier time to ART initiation (AHR 2.27, 95 %CI 1.38 to 3.72). All three randomized message formats improved time to return to clinic and time to ART initiation (P < 0.01 for all comparisons versus the pre-intervention period).
A combination of an SMS laboratory result communication system and transportation reimbursements significantly decreased time to clinic return and time to ART initiation after abnormal CD4 test results.
Clinicaltrials.gov NCT01579214 , approved 13 April 2012.
The health of rural America is more important than ever to the health of the United States and the world. Rural Healthy People 2020's goal is to serve as a counterpart to Healthy People 2020, providing evidence of rural stakeholders' assessment of rural health priorities and allowing national and state rural stakeholders to reflect on and measure progress in meeting those goals. The specific aim of the Rural Healthy People 2020 national survey was to identify rural health priorities from among the Healthy People 2020's (HP2020) national priorities.
Rural health stakeholders (n = 1,214) responded to a nationally disseminated web survey soliciting identification of the top 10 rural health priorities from among the HP2020 priorities. Stakeholders were also asked to identify objectives within each national HP2020 priority and express concerns or additional responses.
Rural health priorities have changed little in the last decade. Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no. 1 rural health priority, followed by, no. 2 nutrition and weight status (n = 661), no. 3 diabetes (n = 660), no. 4 mental health and mental disorders (n = 651), no. 5 substance abuse (n = 551), no. 6 heart disease and stroke (n = 550), no. 7 physical activity and health (n = 542), no. 8 older adults (n = 482), no. 9 maternal infant and child health (n = 449), and no. 10 tobacco use (n = 429).
© 2015 The Authors The Journal of Rural Health published by Wiley Periodicals, Inc. on behalf of National Rural Health Association.
The Healthy People initiative outlines a comprehensive set of goals aimed at improving the nation's health and reducing health disparities. Health communication has been included as an explicit goal since the launch of Healthy People 2010. The Health Information National Trends Survey (HINTS) was established as a means of exploring how the changing information environment was affecting the public's health, and is therefore an ideal tool for monitoring key health communication objectives included in the Healthy People agenda. In this article, the authors apply an integrative data analysis strategy to more than 10 years of HINTS data to demonstrate how public health surveillance can be used to evaluate broad national health goals, like those set forth under the Healthy People initiative. The authors analyzed just one item from the HINTS survey regarding Internet access in order to illustrate what public health surveillance tools, like HINTS, can reveal about important indicators that are of interest to all those who work to improve the health of the public. Results show that reported Internet penetration has exceeded the Healthy People 2020 target of 75.4%. HINTS data also allowed modeling of the effects of various sociodemographic factors, which revealed persistent differences on the basis of age and education, with the oldest age groups and those with less than a college education falling short of the Healthy People 2020 target as of 2013. Furthermore, although differences by race/ethnicity were observed, the analyses suggest that race in itself accounts for very little of the variance in Internet access.
Background:
The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah.
Subjects and methods:
This was a nonrandomized prospective observational preintervention-postintervention study, using a convenience sample. Patients with uncontrolled diabetes and/or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program. The primary clinical outcome measures were changes in hemoglobin A1C (A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program.
Results:
Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the program (P<0.0001). Systolic blood pressure also declined significantly, from 130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7 mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly. Knowledge of diabetes and hypertension increased significantly (P<0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful.
Conclusions:
Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and/or hypertension.
Background:
Mobile health (m-health) utilizes widespread access to mobile phone technologies to expand health services. Community health workers (CHWs) provide first-level contact with health facilities; combining CHW efforts with m-health may be an avenue for improving primary care services. As part of a primary care improvement project, a pilot CHW program was developed using a mobile phone-based application for outreach, referral, and follow-up between the clinic and community in rural Zambia.
Materials and methods:
The program was implemented at six primary care sites. Computers were installed at clinics for data entry, and data were transmitted to central servers. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to clinic, and followed up clinic patients.
Results:
From January to April 2011, 24 CHWs surveyed 6,197 households with 33,304 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic.
Conclusions:
CHWs completed all planned aspects of surveillance and outreach, demonstrating feasibility. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications. Thus, m-health has the potential to improve service outreach, guide activities, and facilitate data collection in Zambia.
Health communication and health information technology influence the ways in which health care professionals and the public seek, use, and comprehend health information. The Health Information National Trends Survey (HINTS) program was developed to assess the effect of health communication and health information technology on health-related attitudes, knowledge, and behavior. HINTS has fielded 3 national data collections with the fourth (HINTS 4) currently underway. Throughout this time, the Journal of Health Communication has been a dedicated partner in disseminating research based on HINTS data. Thus, the authors thought it the perfect venue to provide an historical overview of the HINTS program and to introduce the most recent HINTS data collection effort. This commentary describes the rationale for and structure of HINTS 4, summarizes the methodological approach applied in Cycle 1 of HINTS 4, describes the timeline for the HINTS 4 data collection, and identifies priorities for research using HINTS 4 data.
Little is known about access, sources, and trust of cancer-related information, or factors that facilitate or hinder communication on a populationwide basis. Through a careful developmental process involving extensive input from many individuals and organizations, the National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to help fill this gap. This nationally representative telephone survey of 6,369 persons aged !18 years among the general population was first conducted in 2002–2003, and will be repeated biennially depending on avail-ability of funding. The purpose of creating a population survey to be repeated on a cyclical basis is to track trends in the public's rapidly changing use of new The authors gratefully acknowledge the contributions of, without whom launching a new survey program would not have been possible.
Recent government initiatives to deploy health information technology in the USA, coupled with a growing body of scholarly evidence linking online heath information and positive health-related behaviors, indicate a widespread belief that access to health information and health information technologies can help reduce healthcare inequalities. However, it is less clear whether the benefits of greater access to online health information and health information technologies is equitably distributed across population groups, particularly to those who are underserved. To examine this issue, this article employs the 2007 Health Information National Trends Survey (HINTS) to investigate relationships between a variety of socio-economic variables and the use of the web-based technologies for health information seeking, personal health information management and patient-provider communication within the context of the USA. This study reveals interesting patterns in technology adoption, some of which are in line with previous studies, while others are less clear. Whether these patterns indicate early evidence of a narrowing divide in eHealth technology use across population groups as a result of the narrowing divide in Internet access and computer ownership warrants further exploration. In particular, the findings emphasize the need to explore differences in the use of eHealth tools by medically underserved and disadvantaged groups. In so doing, it will be important to explore other psychosocial variables, such as health literacy, that may be better predictors of health consumers' eHealth technology adoption.
Access to health care is often contingent upon an individual's ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs.
The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions.
We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame.
Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of "other" race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant.
This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations.
Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery--synchronous or real time video communication--rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area.
A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded.
36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study.
Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.
The Internet is a valuable tool that continues to revolutionize many aspects of our lives; however, the ability to disseminate diverse data across populations and nations presents both opportunities and challenges. Online resources are increasingly used in health care, providing wider access to information for patients, researchers, and clinicians. At the turn of the millennium, the National Cancer Institute (NCI) predicted that Internet-based technologies would create a revolution in communication for oncology professionals and patients with cancer. Herein, findings from the NCI's Health Information National Trends Survey are reviewed to give insight into how Internet trends related to oncology patients are evolving. Future trends are discussed, including examples of 'connected health' in oncology; the spread of mobile and ubiquitous access points to Internet-hosted information; the diffusion of devices, sensors, and apps; the spread of personal data sharing; and an evolution in how networks can support person-centred and family-centred care.
Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations. In order to improve early diagnosis four things are paramount: increased patient participation in prevention methods, establishment of screening guidelines, increased diagnostic accuracy of malignant lesions, and easier access to dermatologists. Recent expansion in smartphone mobile application technology offers simple ways for rural practitioners to address these problems. More than 100,000 health related applications are currently available, with over 200 covering dermatology. This review will evaluate the newest and most useful of those applications offered to enhance the prevention and early diagnosis of skin cancer, particularly in the rural population.
A pilot program was initiated to improve self-management of type 2 diabetes by rural adults. Using an iOS-based, individually tailored pre-/postintervention to improve diabetes self-management, undergraduate students developed a native mobile application to help participants effectively manage their diabetes. Brief quizzes assessed diabetes knowledge. A diabetes dictionary and physical activity assessment provided additional support to users of the app. On completion of the pilot, data analysis indicated increased diabetes knowledge and self-efficacy, and ease of use of the technology. Native app technology permits ready access to important information for those living with type 2 diabetes.
This study describes the feasibility and usability of a mobile device and selected electronic evidence-based information programs used to support clinical decision making in a rural health clinic. The study focused on nurses' perceptions on when they needed more information, where they sought information, what made them feel comfortable about the information they found, and rules and guidelines they used to determine if the information should be used in patient care. ATLAS.ti, the qualitative analysis software, was used to assist with qualitative data analysis and management.
Copyright © 2015 Elsevier Inc. All rights reserved.
Objectives
To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA.
Study design
This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA.
Methods
Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) ‘Rural Health Services’ and ‘Rural Health.’ MeSH subtitle headings used were ‘USA,’ ‘utilization,’ ‘trends’ and ‘supply and distribution.’ Keywords added to the search parameters were ‘access,’ ‘rural’ and ‘health care.’ Searches in Google Scholar employed the phrases ‘health care disparities in the USA,’ inequalities in ‘health care in the USA,’ ‘health care in rural USA’ and ‘access to health care in rural USA.’ After eliminating non-relevant articles, 34 articles were included.
Results
Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts.
Conclusions
Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion.
With the recent governmental focus on increasing broadband capabilities throughout the nation, with rapid advances in technology, and with other regulatory and reimbursement barriers falling, a great number of sites across the United States are in the process of either initiating or expanding their Telehealth capabilities. The Nebraska Statewide Telehealth Network, one of the most comprehensive networks in the nation, is no exception. Built through a collaborative effort of hospitals, health departments, the Nebraska Hospital Association, and other organizations, the Network's members include nearly every hospital and health department in the State. The Nebraska Statewide Telehealth Network has been awarded more than $1.4 million in grant funding since 2008 and, last year, provided 3633 clinical consultations to rural residents across the State.Among its many benefits, Telehealth increases access to specialty care for patients in rural areas; decreases travel time and saves money for patients and caretakers alike; provides the potential for earlier disease intervention; enhances clinical support between specialists and primary care providers; and serves as a medium for easy access to professional education, training, and collaboration. And, now, this technology is becoming increasingly mobile, allowing practitioners the opportunity to connect anywhere. In a rural state dominated by Health Care Professional Shortage Areas and Medically Underserved Areas, Telehealth has the opportunity to help patients receive care at home.
Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services.
To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky.
Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals' health status and sociodemographic characteristics.
The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults.
In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.
To determine whether health literacy is lower in rural populations.
We analyzed health, prose, document, and quantitative literacy from the National Assessment of Adult Literacy study. Metropolitan Statistical Area designated participants as rural or urban.
Rural populations had lower literacy levels for all literacy types (P<0.001 for each). After adjusting for known confounders, there was no longer a difference in health or prose literacy (P>0.05). However, rural populations had higher document (P=0.04) and quantitative (P=0.01) literacy.
Health literacy is lower in the rural population although this difference is explained by known confounders.
Through an analysis of recent data on adults' and children's computer use and experiences, this DataWatch shows that use of computers and the Internet is widespread and that significant percentages of the public are already using the Internet to get health information. The surveys also show that the Internet is already a useful vehicle for reaching large numbers of lower-income, less-educated, and minority Americans. However, a substantial digital divide continues to characterize computer and Internet use, with lower-income blacks especially affected. Implications for the future of health communication on the Internet also are explored.
The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.
This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies.
The demographics of device ownership Technology Device Ownership: 2015; 2015 Available at: http://www.pewinternet.org
- M Anderson
Anderson M. The demographics of device ownership.
Technology Device Ownership: 2015; 2015. Available at:
http://www.pewinternet.org/2015/10/29/the-
demographics-of-device-ownership/. Accessed August 1,
2016.
Driving distance to telemedicine units in northern Ontario as a measure of potential access to healthcare
- O Gorman
- Ld Hogenbirk
O'Gorman LD, Hogenbirk JC. Driving distance to
telemedicine units in northern Ontario as a measure of
potential access to healthcare. Telemed J E Health.
2016;22(4):269-275.
The Affordable Care Act -What it means for rural America
- Services Usdohah
Services USDoHaH. The Affordable Care Act -What it means
for rural America. Washington, DC: US Department of
Health and Human Services; 2013.
7%) Hispanic 3,632 (15.1%) 273 (4.6%) NH black 3
- Race
Race/ethnicity
118.222
<.001
NH white
17,203 (61.6%)
4,639 (78.7%)
Hispanic
3,632 (15.1%)
273 (4.6%)
NH black
3,427 (11.1%)
441 (6.5%)
NH other
1,712 (7.0%)
250 (4.3%)
Missing
1,346 (5.2%)
311 (5.9%)
Education
80.33
<.001
Cycle 4 Methodology Report Available at: http://hints.cancer.gov/docs
- Westat
Westat. Health Information National Trends Survey 4
(HINTS 4): Cycle 4 Methodology Report; 2015. Available
at: http://hints.cancer.gov/docs/HINTS_4_Cycle_4_
Methodology_Report.pdf. Accessed August 25, 2015.
Clinical telemedicine utilization in Ontario over the Ontario Telemedicine Network
- O Gorman
- Ld Hogenbirk
- Jc Warry
O'Gorman LD, Hogenbirk JC, Warry W. Clinical
telemedicine utilization in Ontario over the Ontario
Telemedicine Network. Telemed J E Health.
2015;22(6):473-479.
Rural-Urban Continuum Codes Documentation
- Parkert
Parker T. Rural-Urban Continuum Codes Documentation;
2013. Available at: http://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes/
documentation.aspx. Accessed August 1, 2016.
The Affordable Care Act and Insurance Coverage in Rural Areas
- Ii
- Vrn
- A Damico
II VRN, Damico A. The Affordable Care Act and Insurance
Coverage in Rural Areas. Menlo Park, CA: Kaiser Family
Foundation; 2014.
Smartphones enable teledermatology in South Dakota: an overview and primer for primary care providers
- E E Gaster
- I Chabra
- G F Burrish
Gaster EE, Chabra I, Burrish GF. Smartphones enable
teledermatology in South Dakota: an overview and
primer for primary care providers. S D Med.
2015;68(10):449-453, 455.
Mobile health data collection at primary health care in Ethiopia: a feasible challenge
- A A Medhanjie
- A Moser
- M Spigt
Medhanjie AA, Moser A, Spigt M, et al. Mobile health
data collection at primary health care in Ethiopia: a
feasible challenge. J Clin Epidemiol. 2015;68(1):80-86.
15% of Americans don't use the internet
- M Anderson
- A Perrin
Anderson M, Perrin A. 15% of Americans don't use the
internet. Who are they? FactTank: News in the Numbers,
Vol 2016. Washington, DC: Pew Research Center; 2015.
Health IT Quick-State #5: Hospital Progress to Meaningful Use by Size, Type, and Urban/Rural Location Available at: dashboard. healthit.gov/quickstats/pages/FIG-Hospital-Progress-to- Meaningful-Use-by-size-practice-setting-area-type.php
- Technology Ootncfhi
Technology OotNCfHI. Health IT Quick-State #5: Hospital
Progress to Meaningful Use by Size, Type, and
Urban/Rural Location; 2016. Available at: dashboard.
healthit.gov/quickstats/pages/FIG-Hospital-Progress-to-
Meaningful-Use-by-size-practice-setting-area-type.php.
Accessed August 1,2016.
Cell Internet Use 2013: main findings; 2013 Available at: http://www.pewinternet.org
- M Duggan
- A Smith
Duggan M, Smith A. Cell Internet Use 2013: main
findings; 2013. Available at: http://www.pewinternet.org/
2013/09/16/main-findings-2/. Accessed August 5, 2016.
Available at: dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Progress-to-Meaningful-Use-by-size-practice-setting-area-type
- Technology Ootncfhi
Technology OotNCfHI. Health IT Quick-State #5: Hospital
Progress to Meaningful Use by Size, Type, and
Urban/Rural Location; 2016. Available at: dashboard.
healthit.gov/quickstats/pages/FIG-Hospital-Progress-to-Meaningful-Use-by-size-practice-setting-area-type.php.
Accessed August 1,2016.
The demographics of device ownership
- Anderson M
Anderson M. The demographics of device ownership.
Technology Device Ownership: 2015; 2015. Available at:
http://www.pewinternet.org/2015/10/29/thedemographics-of-device-ownership/. Accessed August 1,
2016.
Cell Internet Use 2013: main findings
- M Duggan
- A Smith
Duggan M, Smith A. Cell Internet Use 2013: main
findings; 2013. Available at: http://www.pewinternet.org/
2013/09/16/main-findings-2/. Accessed August 5, 2016.
Mobile health data collection at primary health care in Ethiopia: a feasible challenge
- Medhanjie
Smartphones enable teledermatology in South Dakota: an overview and primer for primary care providers
- Gaster EE
Cell Internet Use 2013: main findings
- Dugganm Smitha