Examining the Association Between Digital Stress Components and Psychological Wellbeing: A Meta-Analysis

Extant research suggests that digital stress (DS) and its various components (Hall et al. in Psychol Assess 33(3):230-242, 2021) may mediate the association between social media use and psychosocial distress among adolescents and young adults. Yet no systematic review and meta-analysis has been conducted to examine the direct associations among DS components (i.e., approval anxiety, availability stress, fear of missing out [FOMO], connection overload, and online vigilance) and psychological outcomes. Thus, we aimed to comprehensively synthesize and quantify the association between these five DS components and psychosocial distress, and to examine whether these associations were statistically different from one another. Our search of PubMed, PsycINFO, and Communication and Mass Media Complete yielded a wide range of article abstracts across the five DS components. After reviewing inclusion and exclusion criteria, 7, 73, 60, 19, and 16 studies were included for availability stress, approval anxiety, FOMO, connection overload, and online vigilance, respectively. The results suggested that all five digital stress components had significant medium association with psychosocial distress (r = .26 to .34; p < .001). Age and sex did not significantly moderate the association between most digital stress components and psychosocial distress. However, age moderated the association between connection overload and psychosocial distress. Our findings further suggested no statistical differences among the associations between the five digital stress components and psychosocial distress. Notwithstanding its limitations, our outcomes help integrate the disparate effect sizes in the literature, indicate the strength of associations, and suggest directions for clinical intervention and future research.

Childhood emotional dysregulation paths for suicide-related behaviour engagement in adolescence

This study aimed at identifying the heterogeneous trajectories of emotional dysregulation across childhood and to study the relationship between specific trajectories and adolescent suicide-related behaviour (SRB). Data from the Millennium Cohort Study (N = 13,853 children; 49.07% female, M = 3.13 years at baseline, SD = 0.2) were used to identify the emotional dysregulation trajectories from 3 to 8 years old, using growth mixture modelling. Moreover, 1992 participants (52.86% female) from the initial sample were used to study the relationship between childhood emotional dysregulation trajectory and engagement in both self-harm and suicide attempt at age 17, using logistic regression. Some other time-invariant and proximal (adolescent) risk factors were incorporated into this analysis. Six emotional dysregulation trajectories were identified. Self-harm at age 17 was significantly associated with the history of self-harm and other proximal factors, but not with emotional dysregulation trajectory membership. Childhood trajectories featured by earlier emotional dysregulation were associated with higher risk of lifetime suicide attempt, as well as other proximal factors (concurrent self-harm). This study found differential risk profiles involved in both SRB forms. A relationship between early emotional dysregulation and suicide attempt engagement in adolescence was identified. Early interventions should be developed to deal with SRB risk factors from childhood.

Gambling-like Features in fan Tokens

Fan tokens are a form of cryptocurrency that allow owners to participate in various fan-related experiences such as voting on the music to be played during half-time breaks in sporting events. Since 2020, many elite sport teams have issued fan tokens, allegedly as a way to engage with fans and hear their voice. However, fan tokens also raise some concerns. They are largely gamified digital items that intend to keep fans within the providers' app. Also, they can be traded in exchange platforms, which arguably transform them into collectibles, whose value can vary over time. Here, we explore fan tokens through a case study from a football (soccer) club (i.e., an F.C. Barcelona fan token). Drawing on literature from situational and structural characteristics of gambling, we analyse the gambling-like features that fan tokens include in their product design. Such features are discussed from a public health perspective, comparing what they mean in gambling contexts and how potentially harmful they could be for fan token holders.

A smartphone-based online platform for clinical skills training and assessment with standardized patients: platform development and pilot study outcomes

There are limitations and difficulties in the management of traditional in-person standardized patient (SP) practice. The latest developments in online communication tools and the COVID-19 pandemic have promoted the needs for online clinical skills training objectively. However, existing commercial online platforms may not meet the requests for SP-based medical simulation. This paper described the methodology applied to develop a smartphone-based online platform for the management of clinical skills training and assessment with remote SPs, and aimed to determine whether this new platform is acceptable or useful through a pilot run in September 2020. The post-run survey including questionnaire inspired by technological acceptance model and determinants of the perceived ease of use was used to assess the acceptability and usefulness of the platform. Twenty four-year students of clinical medicine participated in the pilot study with twenty SPs and ten faculties. Data from the post-run survey showed that there was a general recognition that the platform is easy to use among all the users. Two questions regarding the usefulness of the platform showed significant differences between the SPs/faculties and the students. More SPs found the platform useful as a training method than the students did. The faculties showed more attempts than the students to use this platform for clinical skills training in the future. This smartphone-based online platform was widely accepted among the tested students, SPs and faculties, which meets the requests and challenges of the new era. It provides an effective approach for clinical skills training and assessment with remote SPs.

Patients With Depression and/or Anxiety Having Arthroscopic Rotator Cuff Repair Show Decreased Number of Prescriptions and Number of Psychotherapy Sessions in the Year After Surgery

PURPOSE

To determine whether the utilization of psychological treatments changes after arthroscopic rotator cuff repair (RCR) for patients with preoperative depression and/or anxiety.

METHODS

The Truven Healthcare Marketscan database was used to identify patients who underwent arthroscopic RCR between January 2009 and December 2016. We included all patients with diagnosis codes associated with either depression or anxiety before RCR. Patients were excluded if they did not have complete insurance coverage for 1 year before or after surgery, or if they had arthroscopic RCR in the year before the index surgical procedure. We compared the proportion of patients with preoperative depression or anxiety who filled a prescription and had psychotherapy procedural codes in the year before and the year after arthroscopic RCR.

RESULTS

A total of 170,406 patients who underwent RCR were identified, of which depression and/or anxiety was found in 46,737 patients (43.7% male). Of the 46,737 patients, 19.6% filled a prescription for a depression/anxiety medication at least once in the year before surgery. Of this subset of patients, 41.5% did not fill a prescription for depression or anxiety medication after surgery, whereas 32.6% continued medication use but demonstrated a median 30-day reduction in the number of days' worth of medication. Similarly, 13.1% of patients were attending psychotherapy sessions preoperatively, but 76.6% of those patients either stopped or reduced the amount of psychotherapy sessions in the year following RCR.

CONCLUSIONS

The number of prescriptions and psychotherapy sessions decreased in the year after RCR for patients with preoperative diagnoses of depression and/or anxiety.

LEVEL OF EVIDENCE

Level IV, case series.

Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis

Objective

The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs.

Materials and Methods

A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases. Quantitative data were descriptively analyzed, and qualitative data were described and synthesized using inductive thematic analysis.

Results

Twenty-three studies were included in the analysis. The usability metrics most frequently evaluated were efficiency and usefulness, followed by user errors, satisfaction, learnability, effectiveness, and memorability. Methods used to assess usability included questionnaires in 20 (87%) studies, user trials in 17 (74%), interviews in 6 (26%), and heuristic evaluations in 3 (13%). Most CDSS inputs consisted of manual input (18, 78%) rather than automatic input (2, 9%). Most CDSS outputs comprised a recommendation (18, 78%), with a minority advising a specific treatment (6, 26%), or a score, risk level or likelihood of diagnosis (6, 26%). Interviews and heuristic evaluations identified more usability-related barriers and facilitators to adoption than did questionnaires and user testing studies.

Discussion

A wide range of metrics and methods are used to evaluate the usability of mobile CDSS in medical emergencies. Input of information into CDSS was predominantly manual, impeding usability. Studies employing both qualitative and quantitative methods to evaluate usability yielded more thorough results.

Conclusion

When planning CDSS projects, developers should consider multiple methods to comprehensively evaluate usability.

Privacy Concerns in Group Format Lifestyle Interventions for Obesity

BACKGROUND

Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake.

METHOD

In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences.

RESULTS

Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns.

CONCLUSION

Strategies to address privacy concerns in group-based interventions warrant further attention.

Monitoring Your Weight-Loss Process Online: The Impacts of Prior Experiences and Online Social Support on Subsequent Weight-Loss Outcome

Online weight-loss communities (OWCs) have become increasingly popular for weight management; they enable individuals to monitor (i.e. self-monitoring) and discuss (i.e. social interaction) their weight-loss experiences. This study investigates the relationship between prior weight-loss experiences (success and failure), online social support, and subsequent weight-loss outcome in the context of OWCs and based on self-determination theory. We collected the data of 1465 users from one popular OWC and deployed two logit regression models to estimate the effects of prior weight-loss experiences on subsequent weight-loss success as well as the moderating role of social support. The results revealed that prior successful weight-loss experiences were positively related to subsequent weight-loss outcome, while the relationship between prior failed weight-loss experiences and subsequent weight-loss outcome was negative. Meanwhile, online social support can not only be positively related to subsequent weight-loss outcome, but also buffer the negative role of prior failed weight-loss experiences. Nevertheless, social support had no significant moderating role in the relationship between prior successful weight-loss experiences and subsequent weight-loss outcome. This study contributes to the literature on prior experiences and online social support in the context of OWCs and provides valuable insights to improve participants' engagement and their weight-loss success.

Influence of Pokémon Go Playing Style on Physical Activity and Its Effect on Kinanthropometry Variables and Body Composition in Adolescents

BACKGROUND

Pokémon Go is a mobile app that offers both continuous and intermittent (gamified) gameplay, but no previous research in adolescents is known to have addressed changes in physical activity and body composition according to playing style. For this reason, the aims of the present investigation were (1) to establish the differences in the level of physical activity, and its influence on the kinanthropometric and body composition, of the adolescent population, considering their Pokémon Go playing style; and (2) to analyze whether the practice of previous physical activity has an influence on the effects of the use of Pokémon Go on the level of physical activity and changes in kinanthropometric and body composition variables.

METHODS

A total of 94 adolescents (50 males and 44 females; mean age: 13.66 [1.17] years-old; mean body mass index: 20.82 [4.03] kg/m2) whose physical activity level and body composition were measured, participated in the investigation. Two groups of adolescents completed a 10-week intervention using Pokémon Go continuously (n = 30) or intermittently (n = 31), while the control group (n = 33) did not use any after-school app. A one-way analysis of variance (ANOVA), a multivariate analysis of variance, and 2 repeated-measures ANOVA were performed to analyze the data.

RESULTS

Inactive adolescents in the continuous use group increased their physical activity between the pretest and posttest (P = .038), but this did not occur in the active group. Regarding body composition variables, the increase in body mass (P < .001) and body mass index (P = .006) in the control group was significantly higher than in the continuous use group of adolescents who were inactive, but not in the active group, while the decrease in fat mass (P < .001-.036) and sum of 3 skinfolds (P < .001-.003) was significantly higher in both Pokémon Go use groups as compared to the control group, regardless of the previous physical activity level.

CONCLUSIONS

The continuous style of play seems to be more effective in increasing physical activity in adolescents, but the changes in body composition and kinanthropometric variables occur similarly with continuous and intermittent gameplay. Therefore, the playful use of Pokémon Go can be used in educational and health fields to produce changes in body composition in this population.

Politics Over Public Health: Analysis of Twitter and Reddit Posts Concerning the Role of Politics in the Public Health Response to COVID-19

The purpose of this study is to foster an understanding of the safety, science, and political polarization issues public health officials (PHOs) must navigate in response to the COVID-19 pandemic. This study analyzed posts on two social media outlets, Twitter and Reddit, to understand how political polarization impacted sensemaking around COVID-19. Qualitative analysis revealed that sensemaking around COVID-19 encompasses the following narratives: (a) the concept of public health is ambiguous, (b) political polarization causes burnout amongst PHOs, and (c) political polarization influences sensemaking. The conceptualization of politics was explored and the following themes were found: (d) politics can override public health decisions, (e) politics equates to death and other negative outcomes, (f) politics directly relates to the spreading of misinformation and disinformation, and (g) politics is used as a catch-all for sensemaking about issues in the pandemic that were viewed negatively. We then discuss the theoretical and practical implications of our findings.

Understanding the Use of the Term "Weaponized Autism" in An Alt-Right Social Media Platform

BACKGROUND

The term "weaponized autism" is frequently used on extremist platforms. To better understand this, we conducted a discourse analysis of posts on Gab, an alt-right social media platform.

METHODS

We analyzed 711 posts spanning 2018-2019 and filtered for variations on the term "weaponized autism".

RESULTS

This term is used mainly by non-autistic Gab users. It refers to exploitation of perceived talents and vulnerabilities of "Weaponized autists", described as all-powerful masters-of-technology who are devoid of social skills.

CONCLUSIONS

The term "weaponized autism" is simultaneously glorified and derogatory. For some autistic people, the partial acceptance offered within this community may be preferable to lack of acceptance offered in society, which speaks to improving societal acceptance as a prevention effort.

Identifying the determinants of face mask disposal behavior and policy implications: An application of the extended theory of planned behavior

A study in Nigeria examined the psychological factors affecting face mask disposal behavior (DB) during the COVID-19 pandemic. The Theory of Planned Behavior (TPB) was used, with awareness of consequences and institutional barriers added. 1183 respondents completed an online survey, and structural equation modeling was used to analyze the data. The original TPB model revealed that attitudes, perceived behavioral control, and subjective norms explained 65% of the variance in respondents' behavior. Behavioral intention and perceived behavioral control accounted for 59.3% of the variance in DB. The extended TPB model, which included awareness of consequences and perceived institutional barriers, improved the model's explanatory power by 12.8%. Both TPB models adequately predicted face mask (FM) disposal behavior, with implications for policymakers and waste management authorities to design interventions to promote proper FM disposal behavior.

Use of Assistive Technologies and Alternative Means by Older People: The "Actional Model of Older People´s Coping with Health-Related Declines"

This paper presents the "Actional Model of Older people´s Coping with Health-Related Declines" to explain the use of a broad range of action alternatives of older persons for dealing with current or anticipated diseases, functional declines, activity limitations and participation restrictions. The general background is the action-theoretical model of intentional self-regulation of human development (e.g., Brandtstädter, 2006; Rothermund & Brandtstädter, 2019). Yet, our model provides an increased specification of major model components toward the situation of older people coping with current or anticipated health-related declines. The model development follows an adapted theory construction methodology (TCM) by Borsboom et al. (Perspectives on Psychological Science, 16(4), 756-766, 2021) and adapted principles for constructing practically useful theories by Berkman & Wilson (Perspectives on Psychological Science, 16(4), 864-874, 2021). Regarding content, we further draw on models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using ATs, and quantitative studies on health-related goals. The resulting model includes these components: (1) Discrepancies between perceived or anticipated and desired health-related development, (2) health-related discrepancy reduction and prevention goals, (3) action possibilities for reducing or preventing health-related discrepancies, (4) further motivating and demotivating goals, (5) beliefs about effective means for reaching the goals (2) and (4), (6) generation of the particular coping actions by goals (2) and (4) in combination with beliefs about effective means, (7) external context factors, and (8) modes of joint decision-making and decision-making on behalf of older people. The explanatory and practical value of the model are discussed as well as its implications for future research and geropsychology teaching.

Drivers of consumers' behavioral intention toward private umbilical cord blood banking: a review

Immunitary bioeconomy encompasses a significant share of the bioeconomy that is accompanied by a ‎high degree of complexity and various religious and ethical controversies for both customers and the ‎service providers. Compared to blood banking, these complexities are more substantial for the ‎new state-of-the-art technology of umbilical cord blood (UCB) banking, in which the viable ‎therapeutically active substance of cord blood (i.e., cord blood stem cells (CBSCs)) is banked for much ‎less likely future demand. It became even more complicated when we knew that the main three types ‎of cord blood banking industry (i.e., private, public, or hybrid models) are not the same regarding ‎economic, ‎ethical, and even social considerations. The present paper aims to review and discuss the ‎main drivers of behavioral intention among the customers of private UCB banking. We focused on ‎private UCB banking because, although there is a low likelihood of childs' future need for their siblings' ‎CBSCs, there is an unnecessary growing demand for using private UCB banking services. Based on the ‎previously published pieces of research, we discussed five main influential factors (i.e., awareness, ‎reference group, usability, disease history, and price) that can affect the customers' risk perception ‎‎(and further their behavioral intention) to preserve their child UCB for private applications. Finally, we ‎concluded that private UCB banking must not be considered a commercial activity, and ethically healthcare ‎managers must be more actively involved in ‎facilitating the proper flow of information among the ‎customers.

A privacy calculus model for contact tracing apps: Analyzing the use behavior of the German Corona-Warn-App with a longitudinal user study

The SARS-CoV-2 pandemic is a pressing societal issue today. The German government promotes a contract tracing app named Corona-Warn-App (CWA), aiming to change citizens' health behaviors during the pandemic by raising awareness about potential infections and enable infection chain tracking. Technical implementations, citizens' perceptions, and public debates around apps differ between countries, e. g., in Germany there has been a huge discussion on potential privacy issues of the app. Thus, we analyze effects of privacy concerns regarding the CWA, perceived CWA benefits, and trust in the German healthcare system to answer why citizens use the CWA. In our initial conference publication at ICT Systems Security and Privacy Protection - 37th IFIP TC 11 International Conference, SEC 2022, we used a sample with 1752 actual users and non-users of the CWA and and support for the privacy calculus theory, i. e., individuals weigh privacy concerns and benefits in their use decision. Thus, citizens privacy perceptions about health technologies (e. g., shaped by public debates) are crucial as they can hinder adoption and negatively affect future fights against pandemics. In this special issue, we adapt our previous work by conducting a second survey 10 months after our initial study with the same pool of participants (830 participants from the first study participated in the second survey). The goal of this longitudinal study is to assess changes in the perceptions of users and non-users over time and to evaluate the influence of the significantly lower hospitalization and death rates on the use behavior which we could observe during the second survey. Our results show that the privacy calculus is relatively stable over time. The only relationship which significantly changes over time is the effect of privacy concerns on the use behavior which significantly decreases over time, i. e., privacy concerns have a lower negative effect one the CWA use indicating that it did not play such an important role in the use decision at a later point in time in the pandemic. We contribute to the literature by introducing one of the rare longitudinal analyses in the literature focusing on the privacy calculus and changes over time in the relevant constructs as well as the relationships between the calculus constructs and target variables (in our case use behavior of a contact tracing app). We can see that the explanatory power of the privacy calculus model is relatively stable over time even if strong externalities might affect individual perceptions related to the model.

How changing needs change technological practices during a crisis: An explanation using practice theory

The COVID-19 pandemic as a global crisis has created an opportunity to examine the theoretical tenets of the technology as routine capability perspective, and its extensions. We argue that the pandemic acted as a crisis that shifted technology use patterns via changing daily routines, or patterns of what we practice, and how we communicate in the social context. Specifically, we focus on changes in human needs as the primary mechanism that mediate the impact of the pandemic crisis on changes in technology practices. We collected survey responses from 213 participants before COVID-19, and 447 after the rapid spread of COVID-19. Empirical results mostly confirmed our hypotheses, and revealed that the pandemic crisis created a significant shift in four practices: communication, browsing, information sourcing, and material sourcing. We also found that the human needs of autonomy and relatedness mediated this relationship between the pandemic crisis and technology practices. These findings provided support for our proposed mediating role of human needs in explaining how major shifts create technology change and extending the technology as routine capability perspective. We conclude with a discussion, implications, and directions for future researchers.

Assessing the impact of health information exchange on hospital data breach risk

OBJECTIVE

Widespread electronic health information exchange (HIE) across hospitals remains an important policy goal for reducing costs and improving the quality of care. Meanwhile, cybersecurity incidents are a growing threat to hospitals. The relationship between the electronic sharing of health information and cybersecurity incidents is not well understood. The objective of this study was to empirically examine the impact of hospitals' HIE engagement on their data breach risk.

MATERIALS AND METHODS

A balanced panel dataset included 4,936 US community hospitals spanning the period 2010-2017, which was assembled by linking the American Hospital Association annual survey database and the Information Technology (IT) supplement, and the Department of Health and Human Services reports of health data breaches. The relationship between HIE engagement and hospital data breaches was modeled using a difference-in-differences specification controlling for time-varying hospital characteristics.

RESULTS

The percentage of hospitals electronically exchanging information has more than tripled (from 18% to 68%) from 2010 to 2017. Hospital data breaches increased concurrently, largely due to the rise in hacking and unauthorized access. HIE engagement was associated with a 0.672 percentage point increase in the probability of an IT breach three years after the engagement. Hospitals actively engaging in a health information organization and exchanging data with outside providers were associated with a higher risk of IT related breaches in the long run; however, hospitals actively engaging in HIE and exchanging data with inside providers were not associated with any significant risk of IT related breaches.

DISCUSSION

Over time, the increasing amount and complexity of patient information being exchanged can create challenges for cybersecurity if data protection is not up to date. Additionally, data security depends on the weakest link of HIE, and providers with fewer resources for data governance and infrastructure are more vulnerable to data breaches.

CONCLUSION

Moving toward widespread health information exchange has important cybersecurity implications that can significantly impact both patients and healthcare organizations.

Patients' experiences with a welfare technology application for remote home care: A longitudinal study

AIMS AND OBJECTIVES

To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home.

BACKGROUND

Introducing welfare technology in home-based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home-based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found.

DESIGN

A qualitative study with a longitudinal, exploratory design.

METHODS

Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study.

RESULTS

Three themes were identified: (1) potential to facilitate self-governance of life-limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care.

CONCLUSION

The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness-management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow-up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase.

RELEVANCE TO CLINICAL PRACTICE

By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies.

PATIENT OR PUBLIC CONTRIBUTION

The remote home care was developed by interdisciplinary healthcare professionals.

Factors Influencing Instructors' Adoption and Continued Use of Computing Science Technologies: A Case Study in the Context of Cell Collective

Acquiring computational modeling and simulation skills has become ever more critical for students in life sciences courses at the secondary and tertiary levels. Many modeling and simulation tools have been created to help instructors nurture those skills in their classrooms. Understanding the factors that may motivate instructors to use such tools is crucial to improve students' learning, especially for having authentic modeling and simulation learning experiences. This study designed and tested a decomposed technology acceptance model in which the perceived usefulness and perceived ease of use constructs are split between the teaching and learning sides of the technology to examine their relative weight in a single model. Using data from instructors using the Cell Collective modeling and simulation software, this study found that the relationship between perceived usefulness-teaching and attitude toward behavior was insignificant. Similarly, all relationships between perceived ease of use-teaching and the other variables (i.e., perceived usefulness-teaching and attitude toward behavior) became insignificant. In contrast, we found the relationships between perceived ease of use-learning and the other variables (i.e., perceived usefulness-teaching, perceived usefulness-learning, and attitude toward behavior) significant. These results suggest that priority should be given to the development of features improving learning over features facilitating teaching.

Exploring the Impact of Education Strategies on Individuals' Attitude Towards Telemental Health Service: Findings from a Survey Experiment Study

While COVID-19 has caused significant mental health consequences, telemental health services have the potential to mitigate this problem. But due to the sensitive nature of mental health issues, such services are seriously underutilized. Based on an integrated variance-process theoretical framework, this study examines the impact of applying different education strategies on individuals' attitude toward telemental health and subsequently their intention to adopt telemental health. Two different education videos on telemental health (peer- or professional-narrated) were developed based on social identity theory. A survey experiment study was conducted at a major historically black university, with 282 student participants randomly assigned to the two education videos. Individual perceptions of the telemental health service (usefulness, ease of use, subjective norms, relative advantage, trust, and stigma) and their attitude and usage intention data were collected. The results show that ease of use, subjective norms, trust, relative advantage, and stigma significantly influence individuals' attitude toward telemental health in the peer-narrated video group. Only trust and relative advantage were found to be significant factors toward attitude in the professional-narrated video group. This study highlights the importance of designing education strategies and builds a theoretical foundation for understanding the nuanced differences in individuals' responsiveness to different educational materials.

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

BACKGROUND

Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected.

OBJECTIVE

We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines?

METHODS

We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE).

RESULTS

Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001).

CONCLUSIONS

Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.

Double burden: Exploring the digital divide in the Burmese educational system following the 2021 coup d' etat and the COVID-19 pandemic

The 2021 military coup d'état in Myanmar and the Coronavirus (COVID-19) pandemic commencing at the end of 2019 have had major impacts on the already existing digital divide in this Southeast Asian country. This paper aims to explore the effects of these two events on the digital divide and their consequences on the learning practices of students in Myanmar. Following a broad review of relevant literature, primary data were collected from students in Myanmar about their use of IT for online learning and the outcomes. The raw data resulting from this field research has been shared with stakeholders who analyzed, evaluated, and commented on it during expert interviews. The main findings are: IT usage for online education among students in Myanmar is a matter of major concern. A majority of students nationwide have no access to computers. The IT skill level in the country corresponds to this finding and is only on an average level. Smartphones are more accessible but are often old or of lower quality. Internet connections are available but are vulnerable to disruptions initiated by the military regime. Therefore, it can be concluded that students in Myanmar in many cases did not have the technical equipment or skills necessary to learn effectively through the usage of IT during the national crises. Nevertheless, it can be stated that IT helped and was also supportive in sustaining and improving the well-being of students in Myanmar.

Esophageal cancer patients' need for information and support in making a treatment decision between standard surgery and active surveillance

BACKGROUND

This study explores patients' need for information and support in deciding on esophageal cancer treatment, when experimental active surveillance and standard surgery are both feasible.

METHODS

This psychological companion study was conducted alongside the Dutch SANO-trial (Surgery As Needed for Oesophageal cancer). In-depth interviews and questionnaires were used to collect data from patients who declined participation in the trial because they had a strong preference for either active surveillance (n = 20) or standard surgery (n = 20). Data were analyzed using both qualitative and quantitative techniques.

RESULTS

Patients prefer to receive information directly from their doctors and predominantly rely on this information to make a treatment decision. Other information resources are largely used to confirm their treatment decision. Patients highly value support from their loved ones and appreciate emphatic doctors to actively involve them in the decision-making process. Overall, patients' needs for information and support during decision-making were met.

CONCLUSIONS

The importance of shared decision-making and the role doctors have in this process is underlined. The role of doctors is essential at the initial phase of decision-making: Once patients seem to have formed their treatment preference for either active surveillance or surgery, the influence of external resources (including doctors) may be limited.

Towards Precision Medicine in Spinal Surgery: Leveraging AI Technologies

This critique explores the implications of integrating artificial intelligence (AI) technology, specifically OpenAI's advanced language model GPT-4 and its interface, ChatGPT, into the field of spinal surgery. It examines the potential effects of algorithmic bias, unique challenges in surgical domains, access and equity issues, cost implications, global disparities in technology adoption, and the concept of technological determinism. It posits that biases present in AI training data may impact the quality and equity of healthcare outcomes. Challenges related to the unique nature of surgical procedures, including real-time decision-making, are also addressed. Concerns over access, equity, and cost implications underscore the potential for exacerbated healthcare disparities. Global disparities in technology adoption highlight the importance of global collaboration, technology transfer, and capacity building. Finally, the critique challenges the notion of technological determinism, emphasizing the continued importance of human judgement and patient-care provider relationship in healthcare. The critique calls for a comprehensive evaluation of AI technology integration in healthcare to ensure equitable and quality care.

Predicting the intention and adoption of wearable payment devices using hybrid SEM-neural network analysis

This study aims to examine the mediating effect of the intention to use wearable payment devices (WPD) between perceived ease of use (PE), perceived usefulness (PU), social influence (SI), perceived trust (TR), and lifestyle compatibility (CM) on the adoption of WPD. Examination was made on the moderating effect of age and gender to improve the understanding of the adoption of WPD as a new payment system. Empirical data was collected through an online survey from 1094 respondents in Malaysia. Furthermore, this study employed dual-stage data analysis through partial least squares structural equation modelling (PLS-SEM) to test the causal and moderating effects, including artificial neural network (ANN) to examine the predictive power of the selected model. As a result, it was found that PE, PU, TR, and CM had a significant positive influence on the intention to use WPD. Furthermore, facilitating conditions and the intention to use WPD exhibited strong positive impacts on the adoption of WPD among Malaysian youth. The intention to use WPD positively and significantly mediated all predictors of adoption of WPD. Following that, ANN analysis confirmed high prediction accuracy of the data fitness. Overall, the findings for ANN highlighted the importance of PE, CM, and TR on the intention to adopt WPD and the impact of facilitating conditions on the adoption of WPD among Malaysian youth. Theoretically, the study extended UTAUT with two additional determinants (e.g., perceived trust and lifestyle compatibility), which were found to have significant influences on the intention to use WPD. The study results would be able to help payment service providers and the smart wearable device industry offer an innovative spectrum of products and present effective marketing tactics to encourage the prospective consumers of Wearable Payment Devices in Malaysia.

What factors determine users' knowledge payment decisions? A mixed-method study

Methods for obtaining valuable knowledge from the vast amount of mixed-quality information have become a top priority for knowledge demanders. As an online knowledge-sharing channel, the socialized question and answer (Q&A) platform provides important support services for knowledge payment. Based on the personal psychological dimensions of users and social capital theory, this paper aims to study the behavior mechanisms of knowledge payment users and examine the significant factors affecting user payment. Our research was conducted in two steps: a qualitative study to find these factors and a research model based on a quantitative study for testing the hypothesis. The results show that the three dimensions of individual psychology are not all positively correlated with cognitive and structural capital. Our results fill a gap in the literature on the formation of social capital in the knowledge payment environment by showing how individual psychological dimensions affect cognitive and structural capital differently. Thus, this study offers effective countermeasures for knowledge producers on social Q&A platforms to better amass their social capital. This research also makes practical recommendations for social Q&A platforms to strengthen the knowledge payment model.

A Study of the Relationship Between Perceived Class Mobility, Philanthropic Sentiment and Consumer Online Giving Behavior Intention

Purpose

Although the motives of philanthropy vary from country to country around the world, it is still conducive to building a harmonious society to a certain extent.

Methods

It uses partial least squares (PLS) to verify the stability of the model and test the model's hypotheses to analyze the mechanism of action between perceived class mobility and behavioral intention to give online.

Results

It was found that perceived class mobility, philanthropic sentiment, and philanthropic cognition affected online giving intention; perceived class mobility had a significant effect on philanthropic cognition and philanthropic sentiment; philanthropic sentiment and philanthropic cognition mediated the relationship between perceived class mobility and giving behavior intention.

Conclusion

The study suggests that nonprofit organizations should stimulate behavioral intentions to give by creating an atmosphere of upward class mobility.