Factors impacting the adoption of big data in healthcare: A systematic literature review

BACKGROUND

The term "big data" refers to the vast volume, variety, and velocity of data generated from various sources-e.g., sensors, social media, and online platforms. Big data adoption within healthcare poses an intriguing possibility for improving patients' health, increasing operational efficiency, and enabling data-driven decision-making. Despite considerable interest in the adoption of big data in healthcare, empirical research assessing the factors impacting the adoption process is lacking. Therefore, this review aimed to investigate the literature using a systematic approach to explore the factors that affect big data adoption in healthcare.

METHODS

A systematic literature review was conducted. The methodical and thorough process of discovering, assessing, and synthesizing relevant studies provided a full review of the available data. Several databases were used for the information search. Most of the articles retrieved from the search came from popular medical research databases, such as Scopus, Taylor & Francis, ScienceDirect, Emerald Insights, PubMed, Springer, IEEE, MDPI, Google Scholar, ProQuest Central, ProQuest Public Health Database, and MEDLINE.

RESULTS AND CONCLUSION

The results of the systematic literature review indicated that several theoretical frameworks (including the technology acceptance model; the technology, organization, and environment framework; the interactive communication technology adoption model; diffusion of innovation theory; dynamic capabilities theory; and the absorptive capability framework) can be used to analyze and understand technology acceptance in healthcare. It is vital to consider the safety of electronic health records during the use of big data. Furthermore, several elements were found to determine technological acceptance, including environmental, technological, organizational, political, and regulatory factors.

Nuclear medicine technologists practice impacted by AI denoising applications in PET/CT images

PURPOSE

Artificial intelligence (AI) in positron emission tomography/computed tomography (PET/CT) can be used to improve image quality when it is useful to reduce the injected activity or the acquisition time. Particular attention must be paid to ensure that users adopt this technological innovation when outcomes can be improved by its use. The aim of this study was to identify the aspects that need to be analysed and discussed to implement an AI denoising PET/CT algorithm in clinical practice, based on the representations of Nuclear Medicine Technologists (NMT) from Western-Switzerland, highlighting the barriers and facilitators associated.

METHODS

Two focus groups were organised in June and September 2023, involving ten voluntary participants recruited from all types of medical imaging departments, forming a diverse sample of NMT. The interview guide followed the first stage of the revised model of Ottawa of Research Use. A content analysis was performed following the three-stage approach described by Wanlin. Ethics cleared the study.

RESULTS

Clinical practice, workload, knowledge and resources were de 4 themes identified as necessary to be thought before implementing an AI denoising PET/CT algorithm by ten NMT participants (aged 31-60), not familiar with this AI tool. The main barriers to implement this algorithm included workflow challenges, resistance from professionals and lack of education; while the main facilitators were explanations and the availability of support to ask questions such as a "local champion".

CONCLUSION

To implement a denoising algorithm in PET/CT, several aspects of clinical practice need to be thought to reduce the barriers to its implementation such as the procedures, the workload and the available resources. Participants emphasised also the importance of clear explanations, education, and support for successful implementation.

IMPLICATIONS FOR PRACTICE

To facilitate the implementation of AI tools in clinical practice, it is important to identify the barriers and propose strategies that can mitigate it.

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

BACKGROUND

The escalating prevalence of diabetes, with its multifaceted complications, poses a pressing challenge for healthcare systems globally. In response, the advent of continuous glucose monitoring (CGM) systems, offering technological solutions for daily diabetes management, presents significant opportunities. However, the widespread adoption faces several barriers, linked both to the technological configuration of the devices and to the psychological dimension of patients. Therefore, this study aims to apply and test a theoretical model that investigates the antecedents of the intention to use Continuous Glucose Monitoring systems.

METHODS

The research model was built to unveil the impacts of psychological factors, functional components and rational constructs derived from the Technology Acceptance Model (TAM) on CGM systems sustained adoption. To ensure the comparability of results, we have collected data from people who had used Dexcom ONE Dexcom (San Diego, CA) for the first time for at least one month. Employing Structural Equation Modelling (SEM) techniques, the hypothesized relationships among constructs were assessed.

RESULTS

The analyses confirmed the positive correlation of rational factors to the Intention to Use. Subjective Norm, intended as the physicians' influence, is positively correlated with the Perceived Usefulness. Trend Arrows, albeit being negatively correlated with Perceived Usefulness, have a positive correlation on Perceived Ease Of Use, reinforcing its mediating effect towards Perceived Usefulness. Among psychological factors, Trust in the CGM technology positively correlates with Intention to Use. Health Literacy is negatively correlated to the Intention to Use.

CONCLUSIONS

These findings contribute to theoretical and managerial understanding, providing recommendations to enhance the adoption of CGM systems like Dexcom ONE.

Determinants of land management technology adoptions by rural households in the Goyrie watershed of southern Ethiopia: Multivariate probit modeling estimation

Land management technology (LMT) adoption is one of Ethiopia's crucial strategies to combat soil depletion and promote agricultural production. However, there is scant information concerning the intensity, interdependent nature, and households' decision to adopt multiple LMTs. Thus, the purpose of this study is to identify factors influencing households' decisions to adopt multiple LMTs and the intensity and interdependency of the technologies in the Goyrie watershed of southern Ethiopia. The data was collected from 291 randomly selected household heads, focus group discussion participants, and key informant interview respondents. The quantitative data was analyzed using descriptive statistics and econometric methods like multivariate probit and ordered probit modeling, while the qualitative data was presented through content analysis. The result indicated that more than half of respondents (67 %) applied one or two LMTs. The highest complementary effects were observed in mixed soil bunds with desho grasses and manure applications. However, soil bunds and fanya-juu, manure application and agroforestry showed interchangeability with one another. Sex, education, family size, landholding size, access to development agents and credit institutions, training, and village membership increased the probability of adopting multiple LMTs, whereas age, land rent, and crop sharing discouraged the likelihood of households' decisions to adopt LMT. The results of the ordered probit model revealed that village membership and contact with extension agents highly encouraged the intensity of LMT adoptions. Thus, policymakers and planners should consider social, institutional, human asset, and technological related factors to increase adoption rates and intensity of land management technologies.

Family planning preferences in transgender youth in an urban multi-disciplinary gender clinic

Background

Known barriers to family planning in the transgender population include low utilization of cryopreservation and decisional regret. There is growing data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options.

Objective

Assess preferences regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning.

Methods

Forty one adolescents aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed over a 6-month period from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. Participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment.

Results

Forty one participants completed the survey. Four (10 %) expressed interest in discussing family planning with their provider. Eighteen (45 %) were open to discussion in the future; 16 (39 %) were not interested at all. 12 (30 %) participants were planning for future parenthood, and 16 (40 %) participants were undecided. Of those interested in parenthood 7 (53.8 %) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. Twenty (50 %) participants recalled prior family planning discussion with their endocrinologist.

Conclusion

Family planning discussions may not be optimally impactful given that 50 % of participants did not recall the conversations. Family planning is a lower priority in this population as most desired to postpone discussion with their provider despite choosing treatment that could influence fertility. It is essential to identify methods to engage transgender youth in discussions related to family planning during GAHT.

Adoption of residential rooftop solar PV systems in South Africa: A scoping review of barriers

Global sustainability challenges such as climate change are linked to carbon emissions from fossil fuel powered energy needed for commercial and household consumption. South Africa is highly depended on coal for energy production hence the transition to renewable energy sources such as solar PV is seen as a pathway towards emissions reduction and a sustainable future. Yet, despite the huge potential for solar PV technologies adoption remains very low. This scoping review examines the barriers to household solar PV adoption in South Africa to advance our understanding beyond case study level studies. We analysed all published literature on household solar PV in South Africa as a basis for finding themes, gaps, and trends on solar PV research. Review results show that key barriers can be grouped into financial, personal, institutional, technical and societal barriers, however there were no studies on barriers across an income gradient, a glaring omission given debates on just transitions. Given the complexity of the barriers ranging from personal, societal, to technical barriers, it is not reasonable to expect the government to facilitate transition to solar PV alone. Rather, collective approaches are needed to create enabling conditions for solar PV adoption such as the financial means and information availability. The private sector has a key role to play either in supporting state-initiated programmes or creating the means for solar PV adoption such as power purchase agreements. That said, the state remains a central player in facilitating an enabling economic and political environment to leverage responsiveness from other actors. Without an integrated approach to addressing barriers to solar PV adoption, solar adoption will remain a source of energy for the economically privileged, and the imperative to just transition to renewable energy a pipe dream, in a country characterised by large inequalities among households.

HIV self-testing adoption and post-test linkage to care among men who have sex with men in China: a nationwide cross-sectional survey

BACKGROUND

HIV self-testing (HIVST) was recommended to improve HIV testing services. China initiated some of the first HIVST pilots in the world, providing a unique opportunity for implementation research. We aim to investigate HIVST adoption and its following linkage to care among Chinese men who have sex with men (MSM).

METHODS

Data were collected using an online questionnaire distributed on major social media platforms in 2018, one year after HIVST was officially endorsed and allowed for sale. MSM who were at least 16 years old, assigned as male at birth, and ever tested for HIV were eligible. Primary outcome, adoption was defined as ever use of HIVST. Bivariate and multivariable logistic regressions were performed to explore the association between HIVST adoption and sociodemographic and behavioral factors. Linkage to care was also described via the following sequential events as indicators: (1) receiving result after recent test (2), seeking care from healthcare facility if test result was positive or indeterminate, and (3) delayed time before seeking care.

RESULTS

A total of 540 participants were included with an average age of 27.4 ± 6.6. Most were never married (87.4%) and half completed college (52.2%). Overall, 75.2% had adopted HIVST. Self-test kits were commonly obtained from community-based organizations (54.4%) and from online (46.6%). HIVST adoption was positively associated with having college or higher education (OR = 1.66, 95%CI: 1.07-2.57), and negatively associated with age older than 30 (AOR = 0.52, 95%CI: 0.32-0.84). Adoption was not associated with other socio-demographic or behavioral factors. After receiving HIV-positive or indeterminate results, 25/25 of HIVST adopters sought care while 3 out of 7 (42.9%) non-adopters sought care (p < 0.001). Delays before seeking care were not significantly different between HIVST adopters compared to non-adopters (P = 0.366).

CONCLUSION

Many MSM adopted HIVST shortly after its launch. Our findings suggested that HIVST linkage to care is promising among MSM in China. Integration of HIVST with other essential sexual health services is needed.

Perception of middle-aged and older adults towards mHealth apps: A comparative factor analysis between Australia and Germany

OBJECTIVE

Although evidence of the global effectiveness and usability of mobile health (mHealth) apps as non-drug interventions is growing, older adults often demonstrate low adoption rates of these apps. This study aims to identify the perspectives of older adults on introducing and adopting mHealth apps in Australia and Germany.

MATERIALS AND METHODS

We conducted two online cross-sectional surveys to examine factors from contextual, technological and personal perspectives that influence older adults in mHealth app adoption. Using descriptive statistics, chi-square tests and exploratory factor analysis, we identified the differences and similarities between respondents' perspectives across two countries.

RESULTS

A total of 290 respondents (149, Australia; 141, Germany) completed the survey. Older adults' ability to use a mHealth app, the user-friendliness of the app, their positive self-efficacy regarding their health and resource availability for using mHealth apps were related to intended adoption. Differences between Germany and Australia were found in issues concerned with data sharing and empowerment by the doctor, while similarities were related to trust in the doctor and their treatment approaches.

DISCUSSION AND CONCLUSION

This study highlights participants' perspectives and attitudes towards mHealth app use, unmet needs and barriers, and the facilitating influences in the two countries. These insights can be used to inform the development and implementation of mHealth apps and to construct tailored strategies to increase the adoption rates of mHealth apps among older adults and to maximise their potential benefits.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

BACKGROUND

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents.

METHODS

The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes.

RESULTS

The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level.

CONCLUSIONS

The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Good agricultural practices (GAP) adoption intensity and production constraints in apple orchards of western Nepal

The declaration of 'Fruits Decade 2016/17-2026/27' and the enaction of the 'NepalGAP Scheme' by the Government of Nepal has redirected increased public investments to promote apple production and marketability in the western high hills of Nepal. This study explores major good agricultural practices (GAP) related to orchard management, factors influencing their adoption intensity, and key underlying constraints to production using cross-sectional survey data from apple growers in Dolpa district, Nepal. The results showed that farmers mostly adopted GAP such as frequent weeding, intercropping, and nutrient management in apple orchards. Based on the negative binomial regression estimates, household characteristics such as gender of the orchard owner, experience, and number of literate household members were found influential in determining the GAP adoption intensity. The analysis of the problem severity index implied that apple production is mostly constrained by limited access to production inputs and transportation. The findings provide useful insights to the farmers and policymakers regarding the current scenario of GAP adoption along with the diversity of barriers that severely limits the realization of apple production potential in western Nepal.

Adoption of ICT4D and its determinants: A systematic review and meta-analysis

Various Digital Agricultural Technologies (DAT) have been developed and implemented around the world. This study aims to estimate the overall adoption rate and identify the determinant factors for a better adoption perspective after decades of innovation and dissemination. A systematic review was conducted on published studies that reported adoption rates and determinant factors using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. We used meta-regression and the partial correlation coefficient to estimate the effect size and establish the correlation between socioeconomic characteristics and the adoption of various technologies reported. Fifty-two studies with 32400 participants met the selection criteria and were included in the study. The results revealed an overall pooled adoption rate of 39 %, with the highest adoption rates in developing countries in Africa and South America. Socioeconomic factors such as age, education, gender, and income were found to be the main determinants and should be considered when designing technology for sustainable adoption. The study also found that young farmers were more susceptible to adoption. Moreover, farmers with higher income levels and educational attainment are more likely to use technology linked to agricultural production, market access, and digital advising, implying that high-income farmers with more education are more tech-savvy. However, this does not exclude low-income and low-educated farmers from adopting the technologies, as many models and strategies with socioeconomic considerations were developed. It is one of the reasons behind the underlying enthusiasm for digital agricultural adoption in low and middle-income countries.

Farmer's climate smart livestock production adoption and determinant factors in Hidebu Abote District, Central Ethiopia

This study aimed to identify the status, determining factors, and challenges in adopting climate smart livestock production practices by farmers. Three-staged sampling techniques were used to select the research sites and 233 sample farmer household respondents. Data were collected mainly using a pre-tested structured questionnaire. Key informant interviews and focus group discussions were also conducted to complement the household survey data. Descriptive statistics and an ordered logistic regression model were applied to analyze the quantitative data. The result revealed that the most adopted practices were composting (85.41%) and manure management (70.39%) while the least adopted technologies were biogas generation (3.86%) and rotation grazing (22.32%). The adoption status of the sampled farmers was also categorized into low (19.74%), medium (67.81%), and high adopter (12.45%). The high cost of improved breed, use of manure for fuel, free grazing, lack of information and awareness were the major constraints to adopting the climate smart livestock production technologies. The result also revealed that education, grazing land, total livestock holding, and extension agent contact contributed significantly and positively to the adoption of smart livestock production technology, while the distance from the water source had an insignificant and negative effect on the adoption status of climate smart livestock production practices. The study suggests the relevance of the cooperation of stakeholders and strengthening extension services for the maximum benefits of climate smart livestock production.

English as a foreign language students' acceptance of Google Classroom in writing classes: A case study in Vietnam

Google Classroom is a virtual education platform created by Google that allows both instructors and learners to actively participate in educational environments inside and outside of the classroom in an innovative way. This research aims to determine how university students perceived the adoption of Google Classroom in writing classes. This research was a convergent parallel mix-methods approach in which data were gathered through a 5-point Likert scale questionnaire and semi-structured interviews. The participants of this study included 130 university students in Vietnam. The results revealed that students expressed their approval of using Google Classroom in writing classes and that they had a positive view since it benefited them greatly in their learning writing process. This study suggests practical implications for language educators to use Google Classroom in writing classes.

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey

BACKGROUND

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

OBJECTIVE

This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

METHODS

A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

RESULTS

Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

CONCLUSIONS

These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health.

TRIAL REGISTRATION

RR2-10.2196/41040.

Assessing soil erosion and farmers' decision of reducing erosion for sustainable soil and water conservation in Burji woreda, southern Ethiopia

Inadequate conservation practice affects the sustainable production of agricultural watersheds due to erosion and fertility decline. Understanding soil erosion and implementing site-specific conservation practice could enhance agriculture-based rural development. The study was aimed to document soil erosion problem and soil and water conservation effort. The specific objectives of this study were to assess soil erosion severity, practices to reduce erosion, and determinants of the decision to reduce erosion. Data were collected by interviewing 198 farm household heads, undertaking four focus group discussions, and assessing rill erosion in 10 farm fields in Morayo and Wacho sub-watersheds of southern Ethiopia. Descriptive statistics and binary logit model were applied to analyze the data. Results indicated that many of the farm households, 63% in Morayo and 83% in the Wacho sub-watershed, perceived moderate to severe soil erosion, which is characterized by big rills and small gullies on the farmlands. Rill densities of 231.4 m ha-1 and 84.1 m ha-1 in the Morayo and Wacho sub-watersheds were observed, respectively. The estimated annual soil loss due to rills was 61.2 and 23.4 Mg ha-1 in the Morayo and Wacho sub-watersheds, respectively. The soil erosion from rills alone exceeds the expected tolerable soil erosion (11 tons ha-1 year-1). Due to erosion, about 90% of farmers perceived farmland degradation as described by a progressive decline in crop yield. Farmers used to practice traditional techniques to reduce erosion and government introduced conservation measures such as soil and stone bunds. However, many farmers did not use well-promoted conservation measures such as bunds, which could have negative impact on long-term erosion control effort and sustainable implementation of the conservation options. Among the assessed explanatory variables, educational level, farm distance from home, slope of the cultivated land, and frequency of extension contact were significantly affected (p < 0.05) farmers' sustainable use of conservation measures. Development planners and policy makers are advised to consider site-specific and innovative approaches to implement conservation measures in sustainable approach in the smallholder crop-livestock mixed agriculture system.

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden

BACKGROUND

Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.

METHODS

We conducted a 4 year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau's Compatibility Gaps to understand assimilation.

RESULTS

The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.

CONCLUSIONS

In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.

The 'peptide for life' initiative in the emergency department study

AIMS

Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The 'Peptide for Life' (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED.

METHODS AND RESULTS

This registry examined NP adoption before and after implementing the P4L-ED study across 10 centres in five countries: Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia, and Serbia. A train-the-trainer programme was implemented to enhance awareness of NP testing in the ED, and centres without access received point-of-care instruments. Differences in NP testing between the pre-P4L-ED and post-P4L-ED phases were evaluated. A total of 2519 patients were enrolled in the study: 1224 (48.6%) in the pre-P4L-ED phase and 1295 (51.4%) in the post-P4L-ED phase. NP testing was performed in the ED on 684 patients (55.9%) during the pre-P4L-ED phase and on 1039 patients (80.3%) during the post-P4L-ED phase, indicating a significant absolute difference of 24.4% (95% CI: 20.8% to 27.9%, P < 0.001). The use of both NPs and echocardiography significantly increased from 37.7% in the pre-P4L-ED phase to 61.3% in the post-P4L-ED phase. There was an increased prescription of diuretics and SGLT2 inhibitors during the post-P4L-ED phase.

CONCLUSIONS

By increasing awareness and providing resources, the utilization of NPs increased in the ED, leading to improved diagnostic accuracy and enhanced patient care.

Demographics and tenure of the Chilean urban dog population. A mathematical model

BACKGROUND

Irresponsible dog ownership in urban areas is a public health concern with significant implications for human, animal, and environmental welfare. Factors such as abandonment, variations in adoption, insufficient supervision, emerging identification initiatives, and collective feeding impact the growth of stray dog populations and the transmission of diseases. Developing a modeling tool to understand the dynamics of canine population growth and the effect of human behavior on this phenomenon is essential.

METHODS

An ordinary differential equation model was developed to depict the growth dynamics and movements of urban dog populations, distinguishing between those with owners (restricted and semi-restricted) and those without (stray and community dogs). Two equilibrium states of the system were analyzed: with and without the presence of individually owned dogs. An increase rate for the population of individually owned dogs was calculated, and a local sensitivity analysis was conducted to assess the impact of parameters on the reduction of this population. Additionally, two global sensitivity analysis methods were used to evaluate the simultaneous influence of the parameters.

RESULTS

Findings indicate that system equilibrium depends on various dog categories. Although total eradication of stray and community dogs is unlikely, equilibrium levels are directly related to subpopulation growth rates, responsible ownership practices, and adoption and abandonment rates. The growth rates of the population of dogs without individual owners have a direct and proportional influence on their regulation, while adoption rates have an inverse and proportional effect. The study, through global sensitivity analysis, identifies key parameters for each dog subpopulation. For restricted dogs, environmental carrying capacity is the most variable factor; for semi-restricted dogs, awareness of responsible ownership is crucial. The abandonment of restricted dogs significantly impacts stray dog dynamics, while the transition from stray to community status is an important variable factor for community dogs.

CONCLUSION

Addressing the situation of unowned dogs requires a collective effort to reduce risks associated with the spread of zoonotic diseases, environmental pollution, and biodiversity loss, thus contributing to public health and environmental conservation.

A Mixed Methods Examination of Decision-Making During Program Exploration and Implementation in Schools

Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.

Determinants of mobile health (M-Health) application adoption, usage and discontinuity among corporate workers diagnosed with hypertension and diabetes

PURPOSE

This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana.

DESIGN/METHODOLOGY/APPROACH

The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data.

FINDINGS

The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana.

ORIGINALITY/VALUE

This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.

Enabling food system innovation: accelerators for change

It is widely accepted that current food systems are not on a trajectory for achieving the Sustainable Development Goals by the end of the decade. Technological innovation will have a considerable role to play in different parts of the food system; many promising options exist or are in the pipeline, some of which may be highly disruptive to existing value chains. Scaling up the innovations required, at the same time as protecting those who may lose out in the short term, will require a strong enabling environment. Here we apply an existing framework of eight change accelerators to six case studies of historical agricultural innovation. We estimated the degree to which each accelerator had been addressed at some stage in the innovation process, as a measure of the gap between what was needed and what was achieved. For the innovations that are being taken to scale and widely utilized, these accelerator gaps are small. Uptake of other innovations is stalled, and for these we found large gaps for one or more of the eight accelerators. Impactful innovation processes address all eight change accelerators at some point, with different phasing of the accelerators depending on the nature of the technology and on the impact pathway being pursued. This simple framework, when used in combination with narratives of uptake based on theories of change and impact pathways, may provide an effective means of screening future innovation processes to help prioritize and guide investment that can lead to more resilient, sustainable and equitable food systems.

Implementation Requires Evaluation of Adoption: Lessons From a Multimodal Pain Regimen Order Set

INTRODUCTION

Multimodal pain regimen (MMPR) protocols are the standard of care per the 2020 Trauma Quality Improvement Program guidelines. MMPR implementation methodology in trauma services has not been reported. The primary objective of this study was to evaluate the adoption of an MMPR order set at a level 1 trauma center and to describe its implementation. We hypothesized that order set utilization would be about 50%, and barriers to adoption would be related to personal biases.

METHODS

This was a mixed-methods study at a level 1 trauma center. We retrospectively evaluated MMPR utilization from July 1, 2021 to February 28, 2022. Agile implementation was the method used to implement a clinical decision support tool for the MMPR: a flow chart order set in the electronic medical record. This methodology utilizes short experiment sprints during which data are collected to guide the next iterations. During this process quantitative as well as qualitative data were collected. This included end user testing of the order set and a survey distributed to surgical residents about the order set. Manual thematic network analysis was employed to identify basic and organizing themes from the survey responses.

RESULTS

A total of 587 trauma patients were admitted during the study period and 95 patients (16.2%) had MMPR ordered through the order set. The survey response rate was 19% (13/68). We identified ease of use, desire for options, inadequate education, and assumption of personal expertise as the four basic themes from the survey. These basic themes were further analyzed to two organizing themes: heuristics and overconfidence bias.

CONCLUSIONS

The MMPR order set was easy to use but had low adoption at our center in the first 8 months of implementation. Agile implementation methodology provided an ideal framework to identify reasons for low adoption and guide the next sprint to address personal biases, improve heuristics, and provide effective education and dissemination. Evaluation of utilization and qualitative analysis are key components to ensuring clinical decision support tool adoption.

Adoption of additive manufacturing in oral and maxillofacial surgery among university and non-university hospitals in Sweden: findings from a nationwide survey

PURPOSE

Additive manufacturing (AM) is an innovative printing technology that can manufacture 3-dimensional solid objects by adding layers of material from model data. AM in oral and maxillofacial surgery (OMFS) provides several clinical applications such as surgical guides and implants. However, the adoption of AM in OMFS is not well covered. The purpose was to study the adoption of AM in OMFS in university and non-university hospitals in Sweden. Three research questions were addressed: What is the degree of using AM solutions in university and non-university hospitals?; What are AM solutions used?; How are the AM solutions accessed (production mode) in university hospitals and non-university hospitals?

METHODS

A survey was distributed to OMF surgeons in Sweden. The questionnaire consisted of 16 questions. Data were analyzed through descriptive and content analysis.

RESULTS

A total of 14 university and non-university hospitals were captured. All 14 hospitals have adopted AM technology and 11 of the hospitals adopted AM in OMFS. Orthognathic and trauma surgery are two major types of surgery that involve AM technology where material extrusion and vat polymerization are the two most used AM technologies in OMFS. The primary application of AM was in medical models and guides.

CONCLUSION

Majority of Swedish university hospitals and non-university hospitals have adopted AM in OMFS. The type of hospital (university or non-university hospital) has no impact on AM adoption. AM in OMFS in Sweden can be perceived to be a mature clinical application.

Determinants of adoption of urban agricultural practices in eastern Haraghe zone of Oromia region and Dire Dawa City administration, eastern Ethiopia

Although urban agriculture (UA) can aid economic development, food inflation, unemployment, and nutritional insecurity often necessitate urban households to engage in various agricultural practices. Hence, the study aimed to identify UA practices adopted and their determinants in the Eastern Haraghe zone of the Oromia region and Dire Dawa City Administration, Eastern Ethiopia. Data was collected from 385 randomly selected urban households using a semi-structured questionnaire. Descriptive statistics and a Multivariate Probit (MVP) model were used to analyze the data. The results of the MVP model reveal that sex, age, education level, land size, extension contact, credit access, community group participation, training, and household non-farm income significantly influenced vegetable farming adoption. On the other hand, livestock production adoption was also affected by factors such as sex, land size, perception, credit access, farming experience, community group participation, market distance, training, and non-farm income. Crop-fruit production adoption was also influenced by factors like age, perception, farming experience, market distance, training, and dependency ratio. Improving the ability to use the land for UA purposes, empowering female-headed households, improving livestock breeds, creating awareness through short-term training, and improving credit accessibility are important recommendations to enhance the adoption of UA practices in the study areas.

Uterus transplantation: what the world's religions have to say

Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine-in consultation with their spiritual advisors or religious authorities when needed-how these options align with religious beliefs or teachings.