Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions

Perceptions of eHealth and digitalization among professional anaesthesia personnel: A Swedish national study

BACKGROUND

The objective of this study was to evaluate anaesthesia care professionals' perceptions and attitudes regarding the implementation and advancement of digital solutions in perioperative care.

METHODS

Anaesthesia personnel working in public Swedish institutions where anaesthesia is administered were invited to respond to an online survey regarding their attitudes towards digitalization in the workplace and their perceptions of information provision and future digitalization within anaesthesia and surgical healthcare. Data were analyzed using descriptive statistics, independent-samples Kruskal-Wallis tests, and post-hoc pairwise comparisons.

RESULTS

The survey response rate was 64.0% (n = 627). Most respondents agreed/strongly agreed that digital solutions facilitate their work, the preoperative preparation, patient participation, and being involved in the patients' journeys throughout the perioperative care process. The majority also agreed/strongly agreed that digital solutions could make more patients adequately prepared before anaesthesia/surgery, reduce the number of non-optimized patients, and adapt the perioperative process to the patients' individual needs, as well as lead to reduced costs for the healthcare provider and reduced cancelled anaesthesia/surgeries. However, there were statistically significant differences between responses in relation to age groups, where the largest differences were observed between respondents in the age groups 20-30 and 61-70 years and in relation to what part of Sweden respondents worked in, with the largest differences between respondents working in Southern Sweden and the middle part of Sweden.

CONCLUSION

Swedish anaesthesia personnel are confident that digital solutions may enhance the efficiency of care within the anaesthesia setting. However, varying perceptions on the benefits and necessity of digital solutions are indicated.

Exploring Haemodialysis Nurses' Perceptions on Kidney Replacement Therapy Modality Education: A Framework Analysis

BACKGROUND

Many people with kidney failure start and remain on in-centre haemodialysis treatment despite evidence of improved outcomes with home dialysis. To make an informed modality decision patients must receive frequent, high-quality modality education. This education is inconsistent in the in-centre haemodialysis setting, where patients spend the most time with nurses while receiving haemodialysis treatments.

OBJECTIVES

The aim of this study was to examine in-centre haemodialysis nurses' perceptions around modality education for patients receiving in-centre haemodialysis using the COM-B model of behaviour change.

DESIGN

We used framework analysis as a research method, applying the COM-B model as a theoretical framework to understand nurses' perceptions of modality education.

PARTICIPANTS

We interviewed 13 in-centre haemodialysis nurses in a single province in Canada.

APPROACH

We completed semi-structured interviews via Zoom, which ranged from 30 to 60 min.

FINDINGS

Participants reported knowledge deficits, lack of experience or exposure to other dialysis modalities, and lack of resources to support modality education practices. In-centre haemodialysis nurses reported some factors that enhanced modality education, including strong nurse-patient therapeutic relationships and previous experience in other dialysis modalities.

CONCLUSIONS

Nurses could have a role in modality education but had different views on what this role should be. Nurses faced barriers in modality education such as knowledge deficits, a lack of experience with home modalities, and limited patient teaching resources. Factors that favoured modality education were strong nurse-patient relationships and previous experience with other modalities.

Enhancing adapted physical activity training for community organizations: co-construction and evaluation of training modules

Community-based physical activity programmes benefit persons with disabilities. However, there is a lack of evidence-based tools to support kinesiologists' training in such programmes. This study aimed to co-create and evaluate physical activity training modules for community-based adapted physical activity (APA) programmes. In Phase 1, a working group (n = 8) consisting of staff, kinesiologists from two community-based APA programmes, and researchers met over four online meetings to discuss needs, co-create training modules, and assess usability. In Phase 2, a pre-post quasi-experimental design evaluated changes in capability, opportunity, and motivation of kinesiologists (n = 14) after completing the training modules, which included standardized mock client assessments and participant ratings of module feasibility. Means and standard deviations were computed for feasibility, followed by paired-samples t-tests, along with Hedge's correction effect size. Mock client sessions underwent coding and reliability assessment. The working group meetings generated two main themes: training in (i) motivational interviewing and behaviour change techniques and (ii) optimizing APA prescription. Nine online training modules were created. In Phase 2, medium to large effects of training modules were observed in capability (Hedge's g = 0.67-1.19) for 8/9 modules, opportunity (Hedge's g = 0.77-1.38) for 9/9 modules, and motivation (Hedge's g = 0.58-1.03) for 6/9 modules. In mock client assessments, over 78% of participants appropriately used five behaviour change techniques and, on average, participants demonstrated good use of motivational interviewing strategies. The findings indicate that training kinesiologists was feasible and has the potential to enhance community-based physical activity programmes for persons with disabilities.

Brief Review and Primer of Key Terminology for Artificial Intelligence and Machine Learning in Hypertension

Recent breakthroughs in artificial intelligence (AI) have caught the attention of many fields, including health care. The vision for AI is that a computer model can process information and provide output that is indistinguishable from that of a human and, in specific repetitive tasks, outperform a human's capability. The 2 critical underlying technologies in AI are used for supervised and unsupervised machine learning. Machine learning uses neural networks and deep learning modeled after the human brain from structured or unstructured data sets to learn, make decisions, and continuously improve the model. Natural language processing, used for supervised learning, is understanding, interpreting, and generating information using human language in chatbots and generative and conversational AI. These breakthroughs result from increased computing power and access to large data sets, setting the stage for releasing large language models, such as ChatGPT and others, and new imaging models using computer vision. Hypertension management involves using blood pressure and other biometric data from connected devices and generative AI to communicate with patients and health care professionals. AI can potentially improve hypertension diagnosis and treatment through remote patient monitoring and digital therapeutics.

Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting

Background

Patients with heart failure (HF) can experience a poor quality-of-life (QOL), recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) integrate patients' voices into clinical care, by assessing patient symptoms, function, and QOL. In 2022, PROMs were incorporated into the electronic health record system (Epic) at a large academic hospital in Toronto, Ontario, Canada. The purpose of this study was to use implementation-science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care.

Methods

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year, quality-improvement project. Data sources included the following: clinician use of PROMs; patient-level data on completed PROMs; and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF-symptom frequency, physical limitations, social limitations, and QOL (KCCQ-12 is used as an example case of PROMs in general). Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using behaviour-change frameworks and latent content analysis.

Results

Over the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 80% of patients had high scores on the questionnaire. Clinicians experience barriers-related to attention and decision processes, the environmental context, and their professional role-to integrating PROMs into practice. Suggested changes to improve PROM uptake include adding language licenses for PROM translations, reducing cognitive load for clinicians who are assigning and interpreting PROMs in the Epic system, and championing modelling of use of PROMs in practice.

Conclusions

This study demonstrates the benefit of using implementation science frameworks, to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.

Patterns and Perceptions of Standard Order Set Use Among Physicians Working Within a Multihospital System: Mixed Methods Study

BACKGROUND

Electronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they are used and what factors influence their adoption in practice.

OBJECTIVE

This study aims to (1) describe the patterns of use of standard order sets implemented in a widely used EMR (PowerPlans and Cerner Millennium) within a multihospital digital health care system; (2) explore the experiences and perceptions of implementers and users regarding the factors contributing to the use of these standard order sets; and (3) map these findings to the Capability, Opportunity, and Motivation Behavior (COM-B) model of behavior change to assist those planning to develop, improve, implement, and iterate the use of standard order sets in hospital settings.

METHODS

Quantitative data on standard order set usage were captured from 5 hospitals over 5-month intervals for 3 years (2019, 2020, and 2021). Qualitative data, comprising unstructured and semistructured interviews (n=15), were collected and analyzed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behavior change (COM-B) to identify determinants of standard order set usage in routine clinical practice. The COM-B model is an evidence-based, multicomponent framework that posits that human actions result from multiple contextual influences, which can be categorized across 3 dimensions: capability, opportunity, and motivation, all of which intersect.

RESULTS

The total count of standard order set usage across the health system during the 2019 observation period was 267,253, increasing to 293,950 in 2020 and 335,066 in 2021. There was a notable shift toward using specialty order sets that received upgrades during the study period. Four emergent themes related to order set use were derived from clinician interviews: (1) Knowledge and Skills; (2) Perceptions; (3) Technical Dependencies; and (4) Unintended Consequences, all of which were mapped to the COM-B model. Findings indicate a user preference for customized order sets that respond to local context and user experience.

CONCLUSIONS

The study findings suggest that ongoing investment in the development and functionality of specialty order sets has the potential to enhance usage as these sets continue to be customized in response to local context and user experience. Sustained and continuous uptake of appropriate Computerized Provider Order Entry use may require implementation strategies that address the capability, opportunity, and motivational influencers of behavior.

Evaluation of ImpENSA technology-enabled behaviour change module delivered to healthcare professionals in South Africa to improve micronutrient nutrition during the first 1000 days

Healthcare professionals (HCPs) have vital roles in providing evidence-based care to promote healthy micronutrient nutrition in early life. Providing such care requires scalable training to strengthen knowledge and confident application of effective behaviour change skills. Among 33 public and private HCPs (primarily dietitians) in South Africa, we evaluated the behaviour change aspects of a technology-enabled National Qualification Sub-Framework level 6 programme, Improving Early Nutrition and Health in South Africa ('ImpENSA'). This programme comprises two self-directed micronutrient and behaviour change knowledge-based eLearning and one facilitated online practical skills modules to improve maternal and infant micronutrient nutrition. Using assessments, questionnaires and interviews, we collected data at baseline, after module completion and at 3-month follow-up after programme completion. Questionnaire and interview data showed major improvements in understanding of and attitudes towards person-centred behaviour change support immediately following the eLearning module on behaviour change. The assessment pass rate increased from 38% at baseline to 88% postmodule, demonstrating significant knowledge gain in behaviour change support. Intention to change practice towards a person-centred approach was high and many had already started implementing changes. Three months postprogramme, support was centred around patients' needs. Open relationships with patients, improved patient outcomes and increased job satisfaction were among reported outcomes. Many reported becoming better change facilitators and reflective practitioners. Additional improvements in understanding and attitudes to behaviour change support were evident, reinforced by making changes and experiencing positive outcomes. The findings suggest that technology-enabled learning can equip HCPs with knowledge and skills to effectively support behaviour change for healthy micronutrient nutrition during pregnancy and infancy.

Registered Nurses' Digital Client Work and Associating Factors: A Cross-Sectional Study

AIMS

To describe the frequency of digital client work among Finnish registered nurses, including video consultations, secured messaging and digital promotion of care without direct contact with the client. In addition, the study examines the association between various factors related to nurses' characteristics and work environment with digital client work and its frequency.

DESIGN

A cross-sectional survey study.

METHODS

A total of 2970 nurses responded to a nationwide survey in spring 2023. Descriptive statistics were used to characterise the frequency of different types of digital client work. Binary logistic regression analyses were used to examine the associations.

RESULTS

One-third of the respondents reported digital client work during the last 6 months. The majority had worked digitally with their clients daily or weekly. Secured messaging was the most frequently used type of digital client work, whereas video consultations were less frequent. Nurses working in acute care, home-based care or other environments worked more frequently digitally with their clients than those working in inpatient care. Nurses with higher digital dedication and collegial support had greater odds of digital client work than those with lower dedication. Among those who reported frequent digital client work, lower skills in information security were observed.

CONCLUSIONS

Given the significant variation in the frequency of digital client work among nurses across different environments, assessing broader digitalisation adoption opportunities is essential. Organisations must ensure that nurses have sufficient skills for secure handling of client data, and efforts should be made in creating motivational and supportive work environments to facilitate digital client work.

IMPLICATIONS

By understanding the factors influencing nurses' digital client work, organisations can create stronger structures to support their work. Enhancing digital service availability across different healthcare settings would offer clients more care options, thereby potentially improving their access to healthcare.

IMPACT

This research addresses a knowledge gap regarding the current extent of nurses' digital client work in various healthcare environments and explores potential influencing factors. As governments aim to significantly expand the provision of digital healthcare services, understanding the variation in nurses' digital client work is crucial. This information can guide targeted interventions, such as continuous education, and organisational and collegial support, facilitating dedication to use digital technologies and ensuring secure and impactful advancements in digital healthcare. Our research will benefit healthcare organisations, decision-makers, nursing professionals and educational institutions.

REPORTING METHOD

Our study adheres to the relevant EQUATOR guidelines and follows the STROBE checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Educational interventions and their effects on healthcare professionals' digital competence development: A systematic review

INTRODUCTION

The digitalisation of healthcare requires that healthcare professionals are equipped with adequate digital competencies to be able to deliver high-quality healthcare. Continuing professional education is needed to ensure these competencies.

OBJECTIVE

This systematic review aimed to identify and describe the educational interventions that have been developed to improve various aspects of the digital competence of healthcare professionals and the effects of these interventions.

METHODS

A systematic literature review following the Joanna Briggs Institute's guidelines for Evidence Synthesis was conducted. Five electronic databases (CINAHL, PubMed, ProQuest, Scopus and Medic) up to November 2023 were searched for studies. Two researchers independently assessed the eligibility of the studies by title, abstract and full text and the methodological quality of the studies. Data tabulation and narrative synthesis analysis of study findings were performed. The PRISMA checklist guided the review process.

RESULTS

This review included 20 studies reporting heterogeneous educational interventions to develop the digital competence of healthcare professionals. The participants were mainly nurses and interventions were conducted in various healthcare settings. The length of the education varied from a 20-minute session to a six-month period. Education was offered through traditional contact teaching, using a blended-learning approach and through videoconference. Learning was enhanced through lectures, slide presentations, group work, case studies, discussions and practical exercises or simulations. Educational interventions achieved statistically significant results regarding participants' knowledge, skills, attitudes, perception of resources, self-efficacy or confidence and output quality.

CONCLUSIONS

The findings of this review suggest that digital competence education of nurses and allied health professionals would benefit from a multi-method approach. Training should provide knowledge as well as opportunities to interact with peers and instructors. Skills and confidence should be enhanced through practical training. Adequate organisational support, encouragement, and individual, needs-based guidance should be provided.

Measuring the Digital Competence of Health Professionals: Scoping Review

BACKGROUND

Digital competence is listed as one of the key competences for lifelong learning and is increasing in importance not only in private life but also in professional life. There is consensus within the health care sector that digital competence (or digital literacy) is needed in various professional fields. However, it is still unclear what exactly the digital competence of health professionals should include and how it can be measured.

OBJECTIVE

This scoping review aims to provide an overview of the common definitions of digital literacy in scientific literature in the field of health care and the existing measurement instruments.

METHODS

Peer-reviewed scientific papers from the last 10 years (2013-2023) in English or German that deal with the digital competence of health care workers in both outpatient and inpatient care were included. The databases ScienceDirect, Scopus, PubMed, EBSCOhost, MEDLINE, OpenAIRE, ERIC, OAIster, Cochrane Library, CAMbase, APA PsycNet, and Psyndex were searched for literature. The review follows the JBI methodology for scoping reviews, and the description of the results is based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

RESULTS

The initial search identified 1682 papers, of which 46 (2.73%) were included in the synthesis. The review results show that there is a strong focus on technical skills and knowledge with regard to both the definitions of digital competence and the measurement tools. A wide range of competences were identified within the analyzed works and integrated into a validated competence model in the areas of technical, methodological, social, and personal competences. The measurement instruments mainly used self-assessment of skills and knowledge as an indicator of competence and differed greatly in their statistical quality.

CONCLUSIONS

The identified multitude of subcompetences illustrates the complexity of digital competence in health care, and existing measuring instruments are not yet able to reflect this complexity.

The use of a digital life story to support person-centred care of older adults with dementia: A scoping review

Introduction

A life story (LS) is a tool healthcare professionals (HCPs) use to help older adults with dementia preserve their identities by sharing their stories. Applied health technology can be considered a niche within welfare technology. Combining technology and nursing, such as using life stories in digital form, may support person-centred care and allow HCPs to see the person behind the disease.

Objective

The study's objective was to summarise and describe the use of life stories in digital form in the daily care of older adults with dementia.

Methods

A scoping review was conducted in five stages. Database searches were conducted in Cinahl, PubMed, Scopus, Web of Science, and Google Scholar; 31 articles were included. A conventional qualitative content analysis of the collected data was conducted.

Results

The qualitative analysis resulted in three categories: (1) benefits for older adults, (2) influence on HCPs' work, and (3) obstacles to implementing a digital LS in daily care.

Conclusion

Older adults with dementia can receive person-centred care through a digital LS based on their wishes. A digital LS can enable symmetric communication and serve as an intergenerational communication tool. It can be used to handle behavioural symptoms. Using a digital LS in the later stages of dementia may differ from using it earlier in dementia. However, it may compensate for weakening abilities in older adults by enhancing social interaction.

Failures and fallacies of eHealth initiatives: Are we finally able to overcome the underlying theoretical and practical orthodoxies?

The growing and ubiquitous digitalization trends embodied in eHealth initiatives have led to the widespread adoption of digital solutions in the healthcare sector. These initiatives have been heralded as a potent transformative force aiming to improve healthcare delivery, enhance patient outcomes and increase the efficiency of healthcare systems. However, despite the significant potential and possibilities offered by eHealth initiatives, the article highlights the importance of critically examining their implications and cautions against the misconception that technology alone can solve complex public health concerns and healthcare challenges. It emphasizes the need to critically consider the sociocultural context, education and training, organizational and institutional aspects, regulatory frameworks, user involvement and other important factors when implementing eHealth initiatives. Disregarding these crucial elements can render eHealth initiatives inefficient or even counterproductive. In view of that, the article identifies failures and fallacies that can hinder the success of eHealth initiatives and highlights areas where they often fall short of meeting rising and unjustified expectations. To address these challenges, the article recommends a more realistic and evidence-based approach to planning and implementing eHealth initiatives. It calls for consistent research agendas, appropriate evaluation methodologies and strategic orientations within eHealth initiatives. By adopting this approach, eHealth initiatives can contribute to the achievement of societal goals and the realization of the key health priorities and development imperatives of healthcare systems on a global scale.

Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample

BACKGROUND

Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations.

METHODS

We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions.

RESULTS

Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure.

CONCLUSIONS

Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

Nurses' Informatics Competency Assessment of Health Information System Usage: A Cross-sectional Survey

Nurses' informatics competencies are nurses' professional requirements to guarantee the quality of patient care and affect nurses' use of health information systems. The purpose of this survey was to describe nurses' perceptions of their informatics competencies regarding health information system usage. A previously tested web-based questionnaire with multiple-choice questions was sent to nurses whose e-mail address was available through three Finnish Nursing Associations (N = 58 276). A total of 3610 nurses working in Finland responded. Both descriptive and explanatory statistics were used to analyze the data. The three dependent variables "nursing documentation," "digital environment," and "ethics and data protection" were formulated from the data. Nurses' overall informatics competency was good. The "ethics and data protection" competency score was higher than that of "nursing documentation" or "digital environment." Recently graduated nurses and nurses working in outpatient care, virtual hospital, examination, or operation had highest "digital environment" competency score. Health information system experience was associated with "nursing documentation." Nurses are highly qualified health information systems users. However, the competency requirements generated by rapidly expanding digitalization have challenged nurses. It is important to increase educational programs for nurses of how to use digital devices, and how to support patients to use digital services.

Nursing informatics competence profiles and perceptions of health information system usefulness among registered nurses: A latent profile analysis

AIMS

To identify different nursing informatics competence (NIC) profiles in nurses, examine the factors associated with profile memberships and examine the associations of the derived profiles with the nurses' perception of the usefulness of a health information system (HIS).

DESIGN

A cross-sectional study.

METHODS

A sample of 3610 registered nurses responded to a nationwide survey in March 2020. A latent profile analysis was performed to identify NIC profiles based on three competence areas: nursing documentation, working in digital environment, and ethics and data protection. A multinomial logistic regression was carried out to examine the associations of demographic and background variables with the profile membership. Linear regression analyses were carried out to examine the association between the profile membership and perceived HIS usefulness.

RESULTS

Three NIC profiles were identified and labelled as low, moderate and high competence groups. A younger age, recent graduation year, sufficient orientation and high-rated proficiency as an HIS user were associated with nurses belonging to a high or moderate competence group relative to a low competence group. Competence group membership was associated with perceived HIS usefulness. The high competence group consistently expressed the highest usefulness of the HIS and the low competence group the lowest.

CONCLUSION

Tailored training and support should be provided for nurses with different levels of informatics competence, thereby facilitating their ability to respond to increasingly digitalized work. This could contribute to higher usefulness of the HIS in terms of supporting the nurses' work tasks and promoting the quality of care.

IMPACT

This was the first study exploring latent profiles of informatics competence in nurses. Insights from this study are useful for nursing management to identify different competence profiles of their employees, provide support and training to meet their needs, and promote the successful use of an HIS.

Development and validation of the information security attitude questionnaire (ISA-Q) for nurses

AIM

The aim of the study was to understand nurses' information security attitudes towards patient information. This study developed the Information Security Attitude Questionnaire (ISA-Q) to measure the physical, technical and administrative aspects of information security for nurses and assessed its validity and reliability.

DESIGN

Cross-sectional study and scale development.

METHODS

Exploratory and confirmatory factor analyses and correlation analyses were performed to assess construct, discriminant and convergent validity; Cronbach's α and test-retest reliability were examined.

RESULTS

Exploratory and confirmatory factor analyses yielded a 6-factor, 30-item solution. Six factors accounted for 60.19% of the total variance. The confirmatory factor analysis was achieved through structural equation modelling. Discriminant and convergent validity were confirmed. The internal consistency of the ISA-Q was 0.94, and the test-retest reliability was 0.74. The ISA-Q is an appropriate questionnaire for identifying information security attitudes of nurses, making it useful for developing systematic performance methods to enhance nurses' information security levels.

Digital Maturity Consulting and Strategizing to Optimize Services: Overview

The National Health Service (NHS), the health care system of the United Kingdom, is one of the largest health care entities in the world and has been successfully serving the UK population for decades. The NHS is also the fourth-largest employer globally. True to its reputation, some of the most modern and technically advanced medical services are available in the United Kingdom. However, between the acute, primary, secondary, and tertiary care providers of the NHS, there needs to be seamless integration and interoperability to provide timely holistic care to patients at a national level. Various efforts have been taken and programs launched since 2002 to achieve digital transformation in the NHS but with partial success rates. As it is important to understand a problem before trying to solve it, in this paper, we focus on tools used to assess the digital maturity of NHS trusts and organizations. Additionally, we aim to present the impact of ongoing transformation attempts on secondary services, particularly mental health. This paper considered the literature on digital maturity and performed a rapid review of currently available tools to measure digital maturity. We have performed a multivocal literature review that included white papers and web-based documents in addition to peer-reviewed literature. Further, the paper also provides a perspective of the ground reality from a mental health service provider's point of view. Assessment tools adopted from the global market, later modified and tailor-made to suit local preferences, are currently being used. However, there is a need for a robust framework that assesses status, allows target setting, and tracks progress across diverse providers.

eHealth competence building for future doctors and nurses - Attitudes and capabilities

BACKGROUND

Digitalisation is rapidly changing health care processes and the health care sector, thus increasing the need to improve the digital competence of future health care professionals.

PURPOSE

The aim of this study was to describe the attitudes of medical and nursing students towards digital health based on self-evaluation as well as to compare the differences in perceptions between the two student groups.

METHODS

A cross-sectional study was conducted as an online survey using the Webropol in April 2021 at the University of Oulu and Oulu University of Applied Sciences in Finland. The survey questionnaire consisted of seven background questions and 16 statements on a five-point Likert scale (fully disagree to fully agree) to survey student attitudes towards eHealth, and their digital capabilities.

RESULTS

A total of 250 medical and nursing students were invited to participate in the study and 170 of them took the survey (response rate 68 %). Of those answered, 38 % (n = 64) were nursing and 32 % (n = 106) medical students. Students generally had a positive attitude towards eHealth and health care digitalisation. The differences in perceptions and preparedness between medical and nursing students were surprisingly small in the two student groups. There was a statistically significant difference between the two groups in three out of 16 statements: these were related to changes in the roles of health care professionals and patients as well as the students' knowledge of information contained in the national patient portal.

CONCLUSIONS

The results of this study provide a good starting point for further harmonisation of the curriculum for both health professional groups regarding the teaching of eHealth and telemedicine.

A bibliometric analysis on global eHealth

Background

The current coronavirus disease 2019 pandemic highlights the potential of eHealth. Drawing the knowledge map of eHealth research through data mining and visual analysis technology was helpful to systematically present the research status and future trends of global academic circles.

Methods

Based on the web of Science Core Collection (SCIE/SSCI) database, using bibliometric theory and visual analysis technology, this work analyzed the global eHealth research publications from 2000 to 2021, and introduced the interdisciplinary characteristics, hot topics and future trends in this field.

Results

A total of 10188 authors, 891 journals, 3586 institutions, 98 countries using 12 languages had conducted eHealth research in the world. The United States, the Netherlands, Australia and the United Kingdom were the main forces and international cooperation. However, the international co-operation between Eastern and Western countries was still relatively few. The frontier of global eHealth research mainly focused on #0eHealth innovation, #1physical activity, #2generalised anxiety disorder, #3lightweight authentication protocol, #4 eHealth information, #5technology readiness, #6 ehealth literacy scale, #7family carer, #8citance analysis, #9 guiding patient. Clusters #3 lightweight authentication protocol and #9 guiding patient were the latest clusters, indicating the research trend and direction of eHealth in the future.

Conclusions

Cooperation network framework at the regional, national and global levels and the cooperation of multidisciplinary teams with complementary backgrounds and expertise were needed to realize the in-depth popularization and application of eHealth knowledge. Interdisciplinary international cooperation should be the trend of eHealth research in the future.

Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study

Background

Lassitude and a rather high degree of mistrust toward the authorities can make regular or overly constraining COVID-19 infection prevention and control campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 infection prevention and control guidelines. Escape COVID-19 is a serious game for teaching COVID-19 infection prevention and control practices that has previously been validated in a population of nursing home personnel.

Objective

We aimed to identify factors learned from playing the serious game Escape COVID-19 that facilitate or impede intentions of changing infection prevention and control behavior in a large and heterogeneous Swiss population.

Methods

This fully automated, prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on the platform, participants were asked to complete a short demographic questionnaire before accessing the serious game. The only incentive given to the potential participants was a course completion certificate, which participants obtained after completing the postgame questionnaire. The primary outcome was the proportion of participants who reported that they were willing to change their infection prevention and control behavior. Secondary outcomes were the infection prevention and control areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with intention to change infection prevention and control behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness, and usefulness of the serious game; impression of engagement and boredom while playing the serious game; and willingness to recommend its use to friends or colleagues.

Results

From March 9 to June 9, 2021, a total of 3227 accounts were created on the platform, and 1104 participants (34.2%) completed the postgame questionnaire. Of the 1104 respondents, 509 respondents (46.1%) answered that they intended to change their infection prevention and control behavior after playing the game. Among the respondents who answered that they did not intend to change their behavior, 86.1% (512/595) answered that they already apply these guidelines. Participants who followed the German version were less likely to intend to change their infection prevention and control behavior (odds ratio [OR] 0.48, 95% CI 0.24-0.96; P=.04) and found the game less engaging (P<.001). Conversely, participants aged 53 years or older had stronger intentions of changing infection prevention and control behavior (OR 2.07, 95% CI 1.44-2.97; P<.001).

Conclusions

Escape COVID-19 is a useful tool to enhance correct infection prevention and control measures on a national scale, even after 2 COVID-19 pandemic waves; however, the serious game's impact was affected by language, age category, and previous educational training, and the game should be adapted to enhance its impact on specific populations.

Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study

BACKGROUND

Psychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals' mental and physical health.

OBJECTIVE

This study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals.

METHODS

Cross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence.

RESULTS

The sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress (β=-.20; P<.001). Among the individual characteristics, age (β=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms (β=10.32; P<.001), job satisfaction (β=-6.08; P<.001), intention to leave the profession (β=4.53; P=.002), organization (β=7.68; P<.001), general health status (β=-4.47; P<.001), quality of sleep (β=-5.87; P<.001), headaches (β=6.58; P<.001), and work ability (β=-1.40; P<.001).

CONCLUSIONS

Physicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes.