Understanding health information literacy of mHealth app users from digital wellbeing perspective: Evidence from regression analysis and fsQCA

Health Maintenance Organization-mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study

BACKGROUND

Health maintenance organization-mobile health (HMO-mHealth) services have a direct impact on patients' daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them.

OBJECTIVE

This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction.

METHODS

Israeli adults aged ≥18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model.

RESULTS

A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services.

CONCLUSIONS

HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups.

Exploring ways to improve China's ecological well-being amidst air pollution challenges using mixed methods

Ecological well-being performance (EWP), a novel concept in sustainable development research, diverges from traditional ecological efficiency in terms of perspectives, core content, and driving factors. However, research on EWP remains insufficiently comprehensive, particularly the corresponding theoretical and methodological investigations into driving pathways. To address this gap, this study develops an "economy-environment-health" framework, incorporating air pollution and associated health losses into the evaluation system, and employs a two-stage Super-NSBM and Window DEA model for reevaluating EWP. The study further investigates the primary pathways of EWP, focusing on environmental regulations, technological innovation, and structural adjustments through both quantitative and qualitative methods. Quantitative spatial econometric analysis reveals that factors such as market-driven environmental regulations, green invention patents, and industrial and energy consumption structures significantly enhance EWP. While examining the "net effects" contributions of individual variables using spatial econometric models, the fsQCA method is employed to identify four effective driving paths for EWP from a configurational perspective. These paths are 1) technological innovation and structural adjustment under environmental regulations with public participation; 2) a combination of environmental regulation, technological innovation, and structural adjustment; 3) structural adjustment with minimal influence from environmental regulations and technological innovation; and 4) structural adjustment directed by market-incentive environmental regulations.

Revisiting the ought implies can dictum in light of disruptive medical innovation

It is a dominant dictum in ethics that 'ought implies can' (OIC): if an agent morally ought to do an action, the agent must be capable of performing that action. Yet, with current technological developments, such as in direct-to-consumer genomics, big data analytics and wearable technologies, there may be reasons to reorient this ethical principle. It is our modest aim in this article to explore how the current wave of allegedly disruptive innovation calls for a renewed interest for this dictum. As an effect of prevention and prediction oriented technological innovation, an increased focus on assumedly controllable lifestyle risks may be anticipated. For lay people who might turn into patients, this may entail a reinforced behavior-based individual responsibilisation. Holding on to the OIC dictum, such responsibilisation seems to require that individuals can actually control what is framed as 'lifestyle risks' when there is not always a reliable consensus about what one should do. As such, reference to OIC may be mobilised in function of a political task of designing institutions so as to enable such choice and control.

A fuzzy-set qualitative comparative analysis exploration of multiple paths to users' continuous use behavior of diabetes self-management apps

BACKGROUND

Despite the obvious potential benefits of diabetes self-management apps, users' continuous use of diabetes self-management apps is still not widespread. Influential factors coexisted in information ecologies are likely to have a synthetic effect on users' continuous use behavior. However, it is less clear how factors in information ecologies combine to influence users' continuous use behavior.

OBJECTIVE

The objectives of this study are to explore combinations of factors (perceived severity, information quality, service quality, system quality, and social influence) in information ecologies that lead to users' continuous use behavior of diabetes self-management apps and which combination is the most important.

METHODS

Purpose sampling was used to recruit diabetes self-management app users from July 1, 2021 to January 31, 2022. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis.

RESULTS

In total 280 diabetes self-management app users participated. The necessity analysis indicated that no single factor was necessary to cause users' continuous use behavior, and the sufficiency analysis identified five different combinations of factors that lead to users' continuous use behavior. Of these five, the combination of high information quality, high service quality, and high social influence was found to be the most important path.

CONCLUSIONS

Users' continuous use behavior of diabetes self-management apps results from the synergistic effects of factors in information ecologies. The five paths that directly contribute to users' continuous use, as well as the four user types preliminarily identified in this study may provide a reference for healthcare providers and app developers.

How to enhance psychological security of enterprise employees during the COVID-19 pandemic: Based on MRA and fsQCA

The economic impact caused by the outbreak and dynamic evolution of COVID-19 has reduced employees' psychological security (PS), which not only threatens the physical and mental health of employees but also seriously affects the stable operation and sustainable development of enterprises. PS has been determined to be closely related to daily life experiences. Therefore, the purpose of this article is to examine the types and combinations of life events that improve employees' PS during the pandemic. Cross-sectional data came from 764 enterprise employees in 8 provinces and cities in China during the pandemic period. The participants completed the PS scale to evaluate their PS, and the PS events scale to evaluate the different types of daily life events they experienced. Multiple regression analysis (MRA) and fuzzy-set qualitative comparative analysis (fsQCA) methods were used to test the research hypothesis. The results of MRA suggest that rich leisure activities (RLA), harmonious family relationship (HFR), stable economic order (SEO) and recognition and support from others (RSO) are important life events that enhance employees' PS. The results of fsQCA suggest that the independent role of SEO, the combined role of sound social security system (SSSS), peace and health events (PHE) and HFR, the combined role of PHE, fulfilling work/life status (FWLS), SEO and RSO can substitute for each other to promote employees' high PS. This article reveals the contribution of daily life events to the PS of enterprise employees, and provides an empirical basis for formulating corresponding intervention measures to promote the physical and mental health of enterprise employees and effective enterprise management.

A mixed-method approach to assess users' intention to use mobile health (mHealth) using PLS-SEM and fsQCA

Purpose

Despite the enormous potential of mobile health (mHealth), identifying the asymmetric relationship among the predictors towards intention to use (ITU) of mHealth tends to remain unresolved. This study aims to investigate the predictors and their asymmetric effects on ITU of mHealth through patients and healthcare professionals.

Design/methodology/approach

An integrated information systems (IS) model with four additional constructs has been developed to analyze symmetric and asymmetric effects on ITU of mHealth. An exploratory survey on 452 mHealth users with prior experience was conducted to evaluate the model using a mixed-method approach including partial least squares-based structural equation modeling (PLS-SEM) and fuzzy-set qualitative comparative analysis (fsQCA) technique.

Findings

The findings show that facilitating conditions, personal awareness building, perceived enjoyment, effort expectancy and perceived usefulness have predictive power for ITU of mHealth. In contrast, fsQCA reveals four more alternative solutions, including the main drivers explored by PLS-SEM. The results indicate that various conditions that were not crucial in PLS-SEM analysis are shown to be sufficient conditions in fsQCA.

Research limitations/implications

This study contributes to theory by integrating self-actualization factors (i.e. personal awareness building, patients as decision support unit) into the IS model. And practically, this study makes an essential contribution to users' ITU of mHealth, enabling relevant stakeholders to build strategies to implement mHealth successfully.

Originality/value

While mHealth has revolutionized healthcare and the prior literature only showed linear relationships, this empirical study revealed asymmetrical relationships among the determinants of ITU of mHealth. Thus, this study extends to the growing body of literature on the use of mHealth technology in the least developing nation.