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Algera E, Leusink P, Gerrits T, Pols J, Ravesloot JH. mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice. Eur J Gen Pract 2024; 30:2302435. [PMID: 38264977 PMCID: PMC10810654 DOI: 10.1080/13814788.2024.2302435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. OBJECTIVES To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. METHODS We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. RESULTS In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. CONCLUSION To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.
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Affiliation(s)
- Ellen Algera
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
- Institute for Interdisciplinary Studies, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Trudie Gerrits
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
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van Lonkhuizen PJC, Heemskerk AW, Meijer E, van Duijn E, de Bot ST, Klempir J, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Chavannes NH, Vegt NJH. Development of the Huntington Support App (HD-eHelp study): a human-centered and co-design approach. Front Neurol 2024; 15:1399126. [PMID: 39011363 PMCID: PMC11246862 DOI: 10.3389/fneur.2024.1399126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction eHealth seems promising in addressing challenges in the provision of care for Huntington's disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients' home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. Methods This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people's experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. Results The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app's prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. Discussion By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app's prototype are provided.
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Affiliation(s)
- Pearl J C van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiri Klempir
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | | | - Alzbeta Mühlbäck
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- Isar-Amper-Klinikum, Huntington-Zentrum-Süd, Klinik Taufkirchen, Munich, Germany
| | - Jennifer Hoblyn
- St. John of God Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
- Centro Malattie Neurologiche Rare (CMNR), Italian League for Research on Huntington (LIRH) Foundation, Rome, Italy
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niko J H Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Parsaei Z, Jangi M, Tahmasebian S, Ehteshami A. Functional and Nonfunctional Requirements of Virtual Clinic Mobile Applications: A Systematic Review. Int J Telemed Appl 2024; 2024:7800321. [PMID: 38899062 PMCID: PMC11186682 DOI: 10.1155/2024/7800321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/24/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: The Virtual Clinic Mobile Application (VCMA) is a valuable tool for managing and remotely monitoring patients with various medical conditions. It can alleviate the strain on outpatient services and offer follow-up options for patients who do not require a physical examination. A thorough understanding of recent literature can assist in identifying suitable functionalities for new development and future improvement of current applications (apps). This review study is aimed at identifying functional and nonfunctional requirements for VCMA. Methods: This study conducted a systematic search using databases such as PubMed, Scopus, ISI Web of Science, Science Direct, ProQuest, and IEEE to gather requirements of VCMA articles published in English from the inception of the databases up to April 2022. Out of a total of 1223 articles, 76 met the inclusion criteria. These articles were then analyzed using conventional content analysis to extract and categorize their requirements. Results: Two main themes and 8 subthemes in terms of VCMA requirements were extracted as follows: (1) functional requirements with 3 subthemes (demographic data documentation, health record, general features of the user interface (UI)); (2) nonfunctional requirements with 5 subthemes (usability, accessibility, compatibility, efficiency, and security). Conclusion: The findings highlight the importance of mHealth solutions for virtual care and the need for the development of apps based on the extracted functional and nonfunctional requirements for VCMA; however, controlled trials are necessary. It is recommended that transparent reporting of mHealth interventions be prioritized to enable effective interpretation of the extracted data.
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Affiliation(s)
- Zahra Parsaei
- Health Information Technology Research CenterIsfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Jangi
- Health Information Technology Research CenterIsfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Tahmasebian
- Department of Medical BiotechnologySchool of Advanced TechnologiesShahrekord University of Medical Science, Shahrekord, Iran
| | - Asghar Ehteshami
- Health Information Technology Research CenterIsfahan University of Medical Sciences, Isfahan, Iran
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Willemsen RF, Chavannes NH, Aardoom JJ. Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study. JMIR Form Res 2024; 8:e51408. [PMID: 38809585 PMCID: PMC11170047 DOI: 10.2196/51408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform "FitKnip" was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. OBJECTIVE The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. METHODS This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire-8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one's perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). RESULTS A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. CONCLUSIONS A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users' needs and preferences. This can help to increase uptake, engagement, and ultimately the platform's adoption and effectiveness.
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Affiliation(s)
- Romy Fleur Willemsen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niels Henrik Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska Joëlle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
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van den Berg LN, Hallensleben C, Vlug LA, Chavannes NH, Versluis A. The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study. JMIR Hum Factors 2024; 11:e54386. [PMID: 38574348 PMCID: PMC11027062 DOI: 10.2196/54386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/26/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication-specifically, short-acting beta2-agonist (SABA) overuse-is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. OBJECTIVE This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. METHODS A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. RESULTS The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. CONCLUSIONS The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.
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Affiliation(s)
- Liselot N van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Ae Vlug
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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6
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Schnoor K, Versluis A, Chavannes NH, Talboom-Kamp EPWA. Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners' Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners. JMIR Hum Factors 2024; 11:e49221. [PMID: 38252474 PMCID: PMC10845018 DOI: 10.2196/49221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs' decision-making process. OBJECTIVE The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs' daily medical practice. The second objective was to learn which factors influence GPs' decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs' decision-making process. METHODS A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. RESULTS In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants' decision-making process were the patient's anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. CONCLUSIONS The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs' decision-making process was influenced by patients' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.
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Affiliation(s)
- Kyma Schnoor
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Esther P W A Talboom-Kamp
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Zuyderland, Sittard-Geleen, Netherlands
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Rakers M, van de Vijver S, Bossio P, Moens N, Rauws M, Orera M, Shen H, Hallensleben C, Brakema E, Guldemond N, Chavannes NH, Villalobos-Quesada M. SERIES: eHealth in primary care. Part 6: Global perspectives: Learning from eHealth for low-resource primary care settings and across high-, middle- and low-income countries. Eur J Gen Pract 2023; 29:2241987. [PMID: 37615720 PMCID: PMC10453992 DOI: 10.1080/13814788.2023.2241987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND eHealth offers opportunities to improve health and healthcare systems and overcome primary care challenges in low-resource settings (LRS). LRS has been typically associated with low- and middle-income countries (LMIC), but they can be found in high-income countries (HIC) when human, physical or financial resources are constrained. Adopting a concept of LRS that applies to LMIC and HIC can facilitate knowledge interchange between eHealth initiatives while improving healthcare provision for socioeconomically disadvantaged groups across the globe. OBJECTIVES To outline the contributions and challenges of eHealth in low-resource primary care settings. STRATEGY We adopt a socio-ecological understanding of LRS, making LRS relevant to LMIC and HIC. To assess the potential of eHealth in primary care settings, we discuss four case studies according to the WHO 'building blocks for strengthening healthcare systems'. RESULTS AND DISCUSSION The case studies illustrate eHealth's potential to improve the provision of healthcare by i) improving the delivery of healthcare (using AI-generated chats); ii) supporting the workforce (using telemedicine platforms); iii) strengthening the healthcare information system (through patient-centred healthcare information systems), and iv) improving system-related elements of healthcare (through a mobile health financing platform). Nevertheless, we found that development and implementation are hindered by user-related, technical, financial, regulatory and evaluation challenges. We formulated six recommendations to help anticipate or overcome these challenges: 1) evaluate eHealth's appropriateness, 2) know the end users, 3) establish evaluation methods, 4) prioritise the human component, 5) profit from collaborations, ensure sustainable financing and local ownership, 6) and contextualise and evaluate the implementation strategies.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Paz Bossio
- Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Nic Moens
- Africa eHealth Foundation, Veenendaal, the Netherlands
| | | | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- School of Nursing Guangzhou, Guangzhou Medical University, Guangdong, China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - María Villalobos-Quesada
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
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8
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Villalobos-Quesada M, Ho K, Chavannes NH, Talboom-Kamp EPWA. Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. Eur J Gen Pract 2023; 29:2273615. [PMID: 37947197 PMCID: PMC10653613 DOI: 10.1080/13814788.2023.2273615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Diagnostics are increasingly shifting to patients' home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients' and healthcare professionals' needs. However, it needs to be clarified how to determine the success of these interventions. OBJECTIVES We aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics. STRATEGY Here, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry. RESULTS Two use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective. CONCLUSIONS We conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based 'responsible digital diagnostics' (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.
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Affiliation(s)
- María Villalobos-Quesada
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kendall Ho
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Cloud Innovation Centre for Community Health and Wellbeing, University of British Columbia, Vancouver, Canada
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | - Esther PWA Talboom-Kamp
- Department of Public Health and Primary Care, National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
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Latuapon E, Hochstenbach L, Mahr D, Scheenstra B, Kietselaer B, Spreeuwenberg M. Cocreation to Facilitate Communication and Collaboration Between Multidisciplinary Stakeholders in eHealth Research and Development: Case Study of the CARRIER (Coronary Artery Disease: Risk Estimations and Interventions for Prevention and Early Detection) Consortium. JMIR Hum Factors 2023; 10:e45006. [PMID: 37874629 PMCID: PMC10630860 DOI: 10.2196/45006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not "speak the same language" and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. OBJECTIVE This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. METHODS The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. RESULTS First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. CONCLUSIONS This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration.
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Affiliation(s)
- Elizabeth Latuapon
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Laura Hochstenbach
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dominik Mahr
- Department of Marketing & Supply Chain Management, School of Business and Economics, Maastricht University, Maastricht, Netherlands
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bas Kietselaer
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Marieke Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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10
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Willemsen RF, Meijer E, van den Berg LN, van der Burg L, Chavannes NH, Aardoom JJ. A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders. JMIR Form Res 2023; 7:e49473. [PMID: 37773608 PMCID: PMC10576224 DOI: 10.2196/49473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. OBJECTIVE The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. METHODS This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. RESULTS A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. CONCLUSIONS This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health.
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Affiliation(s)
- Romy Fleur Willemsen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Liselot Nicoline van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Luuk van der Burg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niels Henrik Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska Joelle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
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11
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Aborode AT, Karra-Aly A, Ogunleye SC, Olorunshola MM, Folorunso TN, Aloba CO, Ogunware AE. Overcoming hurdles: Enhancing post-mortem capabilities for neurological investigations in Africa. AGING BRAIN 2023; 4:100099. [PMID: 37809277 PMCID: PMC10556755 DOI: 10.1016/j.nbas.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
| | - Ayah Karra-Aly
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Seto Charles Ogunleye
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 39760 MS, USA
| | | | | | | | - Adedayo Emmanuel Ogunware
- Department of Neuroscience, Development and Regenerative Biology, The University of Texas at San Antonio, TX, USA
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12
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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6854. [PMID: 37835125 PMCID: PMC10572344 DOI: 10.3390/ijerph20196854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem's readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions' impact.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD 4111, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
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13
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Karampatakis GD, Wood HE, Griffiths CJ, Lea NC, Ashcroft RE, Day B, Walker N, Coulson NS, De Simoni A. Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care. J Med Internet Res 2023; 25:e44886. [PMID: 37756051 PMCID: PMC10568391 DOI: 10.2196/44886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Abstract
Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.
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Affiliation(s)
- Georgios Dimitrios Karampatakis
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Helen E Wood
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Chris J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Nathan C Lea
- Department of Medical Informatics & Statistics, The European Institute for Innovation through Health Data, Ghent University Hospital, Ghent, Belgium
| | | | - Bill Day
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil S Coulson
- Medical School, Nottingham City Hospital, Nottingham, United Kingdom
| | - Anna De Simoni
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
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14
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Chang CH, Lien WC, Chiu TP, Yang TH, Wei CC, Kuo YL, Yeh CH, Liu B, Chen PJ, Lin YC. A novel smart somatosensory wearable assistive device for older adults' home rehabilitation during the COVID-19 pandemic. Front Public Health 2023; 11:1026662. [PMID: 37790724 PMCID: PMC10544986 DOI: 10.3389/fpubh.2023.1026662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Due to the Coronavirus disease 19 (COVID-19) related social distancing measures and health service suspension, physical activity has declined, leading to increased falling risk and disability, and consequently, compromising the older adult health. How to improve the quality of older adult life has become a crucial social issue. Objective In traditional rehabilitation, manual and repetitive muscle training cannot identify the patient's rehabilitation effect, and increasing the willingness to use it is not easy. Therefore, based on the usability perspective, this study aims to develop a novel smart somatosensory wearable assistive device (called SSWAD) combined with wireless surface electromyography (sEMG) and exergame software and hardware technology. The older adult can do knee extension, ankle dorsiflexion, and ankle plantar flexion rehabilitation exercises at home. Meanwhile, sEMG values can be digitally recorded to assist physicians (or professionals) in judgment, treatment, or diagnosis. Methods To explore whether the novel SSWAD could improve the older adult willingness to use and motivation for home rehabilitation, 25 frail older adult (12 males and 13 females with an average age of 69.3) perform the rehabilitation program with the SSWAD, followed by completing the system usability scale (SUS) questionnaire and the semi-structured interview for the quantitative and qualitative analyses. In addition, we further investigate whether the factor of gender or prior rehabilitation experience would affect the home rehabilitation willingness or not. Results According to the overall SUS score, the novel SSWAD has good overall usability performance (77.70), meaning that the SSWAD makes older adult feel interested and improves their willingness for continuous rehabilitation at home. In addition, the individual item scores of SUS are shown that female older adult with prior rehabilitation experience perform better in "Learnability" (t = 2.35, p = 0.03) and "Confidence" (t = -3.24, p = 0.01). On the contrary, male older adult without rehabilitation experience are more willing to adopt new technologies (t = -2.73, p = 0.02), and perform better in "Learnability" (t = 2.18, p = 0.04) and "Confidence" (t = -3.75, p < 0.001) with the SSWAD. In addition, the result of the semi-structured interview shows that the operation of the SSWAD is highly flexible, thus reducing older adult burden during the rehabilitation exercise and using them long-term. Conclusion This novel SSWAD receives consistently positive feedback regardless of the gender or prior rehabilitation experience of elders. The SSWAD could be used as a novel way of home rehabilitation for elders, especially during the COVID-19 pandemic. Older adult can do rehabilitation exercises at home, and physicians could make proper judgments or adjust suitable treatments online according to the sEMG data, which older adult can know their rehabilitation progress at the same time. Most importantly, older adult do not have to go to the hospital every time for rehabilitation, which significantly reduces time and the risk of infection.
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Affiliation(s)
- Chien-Hsiang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tseng-Ping Chiu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Hua Yang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Chun Wei
- Department of Digital Multimedia Design, National Taipei University of Business, Taipei, Taiwan
| | - Yu-Liang Kuo
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Hsing Yeh
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Bo Liu
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Jun Chen
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Yang-Cheng Lin
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
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15
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van Deursen L, Aardoom JJ, Alblas EE, Struijs JN, Chavannes NH, van der Vaart R. Exploring colorectal cancer survivors' perspectives on improving care delivery and the role of e-health technology: a qualitative study. Support Care Cancer 2023; 31:544. [PMID: 37650936 PMCID: PMC10471668 DOI: 10.1007/s00520-023-08007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The purpose of this study was to gather insights from colorectal cancer (CRC) survivors on how to improve care for CRC survivors and how e-health technology could be utilized to improve CRC care delivery. METHODS Three semi-structured focus groups were held with sixteen CRC survivors. To initiate the discussion, an online registration form and two vignettes were used. The data was analyzed using the framework method. RESULTS Based on survivors' experiences, five themes were identified as opportunities for improving CRC care delivery. These themes include better recognition of complaints and faster referrals, more information as part of the care delivery, more guidance and monitoring of health outcomes, more collaboration between practitioners, and more attention for partners and relatives. In addition, survivors expressed opportunities for using e-health to facilitate information provision, improve communication, and monitor survivors' health conditions. CONCLUSION Several suggestions for improvement of CRC care delivery were identified. These often translated into possibilities for e-health to support or improve CRC care delivery. The ideas of survivors align with the vast array of existing e-health resources that can be utilized to enhance CRC care delivery. Therefore, the next step involves addressing the implementation gap between the needs of stakeholders, such as CRC survivors and healthcare providers, and the e-health tools currently available in clinical practice.
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Affiliation(s)
- Liza van Deursen
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
- National eHealth Living Lab, Leiden, the Netherlands.
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
| | - Eva E Alblas
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
- Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
| | - Rosalie van der Vaart
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
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16
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Frennert S, Petersson L, Erlingsdottir G. "More" work for nurses: the ironies of eHealth. BMC Health Serv Res 2023; 23:411. [PMID: 37106404 PMCID: PMC10136406 DOI: 10.1186/s12913-023-09418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND eHealth applications are considered a technological fix that can potentially address some of the grand challenges in healthcare, including burnout among healthcare professionals, the growing burden of patients with chronic conditions, and retaining and recruiting healthcare professionals. However, as the deployment of eHealth applications in healthcare is relatively novel, there is a lack of research on how they affect the work environment of healthcare professionals. This study explores how work evolves-particularly for nurses-during the utilisation of three eHealth applications. METHODS The study is a qualitative case study with an interpretive approach. The utilisation of three different eHealth applications was studied. Seventy-five healthcare professionals were interviewed, most of whom were nurses (n = 47). Interviews were transcribed verbatim and qualitative content analysis was used to analyse the text. RESULTS Three main themes were identified: work that is ignored and overlooked; actions needed to complete visible work; and more sedentary work activities. The findings suggest that work surrounding the utilisation of eHealth applications in care practices is mostly performed by nurses. While the promise of more efficient workflows resulting from healthcare's digital transformation may be realised to different degrees, the utilisation of eHealth applications creates additional invisible labour for nurses. CONCLUSION We identified through our analysis that the extra work created by eHealth applications is invisible at the organisational level. Most of the invisible labour was performed by nurses, who were engaged in utilising the eHealth applications. This needs to be recognised when implementing eHealth applications in care practices.
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Affiliation(s)
| | - Lena Petersson
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
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17
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Deng W, M J J van der Kleij R, Shen H, Wei J, Brakema EA, Guldemond N, Song X, Li X, van Tol MJ, Aleman A, Chavannes NH. eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e39250. [PMID: 36917145 PMCID: PMC10131777 DOI: 10.2196/39250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. OBJECTIVE We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. METHODS We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health-related outcomes. RESULTS Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=-1.01, 95% CI -1.12 to -0.89; P<.001) and improved sleep quality (Hedges g=-0.58, 95% CI -0.75 to -0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI -0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. CONCLUSIONS eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy.
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Affiliation(s)
- Wenrui Deng
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Junjie Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Nick Guldemond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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18
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Frennert S, Erlingsdóttir G, Muhic M, Rydenfält C, Milos Nymberg V, Ekman B. 'It increases my ability to influence my ways of working': A qualitative study on digitally mediated patient management in primary healthcare. Scand J Caring Sci 2023; 37:88-105. [PMID: 35833314 DOI: 10.1111/scs.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/19/2022] [Accepted: 06/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Digitally mediated primary healthcare is increasingly influencing working conditions, raising questions about how digitally mediated patient management is experienced. AIM The aim of this study was to generate insights, through the lens of postphenomenology, into how digitally mediated primary healthcare affects the work and working environment, by gathering perspectives from primary healthcare professionals who regularly manage patient errands through a digital platform. METHODS Two rounds of interviews were conducted with a diversified sample of primary healthcare professionals at a primary healthcare centre. The first round of interviews was conducted during the initial phase of the deployment of a digital platform for patient management, with the second round conducted a year later (n = 24). The interview transcripts were analysed using reflexive thematic analysis. RESULTS Four themes relating to digitally mediated care work were identified: 'positive feelings towards digitally mediated primary healthcare', 'seeing a positive work atmosphere as a prerequisite for change', 'experiencing increased control over the pace of workflow' and 'reconfiguration of previous problems'. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Building on postphenomenology, our study adds to the understanding of how material and symbolic aspects mutually affect the mediating role of a digital platform for patient management. Thus, the results indicate that the experience of using digitally mediated care processes is conditioned by the discourse towards digitalisation at the workplace and the management's approach to and inclusion of employees in the digital transition of primary healthcare, as well as the usefulness and usability of the digital platform. The findings can inform both practice and policy.
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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20
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Eysenbach G, Pang WS, Wong YY, Mak FY, Chan FSW, Cheung CSK, Wong WN, Cheung NT, Wong MCS. Factors Associated With the Acceptance of an eHealth App for Electronic Health Record Sharing System: Population-Based Study. J Med Internet Res 2022; 24:e40370. [PMID: 36382349 PMCID: PMC9793296 DOI: 10.2196/40370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/05/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the second stage of the Electronic Health Record Sharing System (eHRSS) development, a mobile app (eHealth app) was launched to further enhance collaborative care among the public sector, the private sector, the community, and the caregivers. OBJECTIVE This study aims to investigate the factors associated with the downloading and utilization of the app, as well as the awareness, perception, and future improvement of the app. METHODS We collected 2110 surveys; respondents were stratified into 3 groups according to their status of enrollment in the eHRSS. The primary outcome measure was the downloading and acceptance of the eHealth app. We collected the data on social economics factors, variables of the Technology Acceptance Model and Theory of Planned Behavior. Any factors identified as significant in the univariate analysis (P<.20) will be included in a subsequent multivariable regression analysis model. All P values ≤.05 will be considered statistically significant in multiple logistic regression analysis. The structural equation modeling was performed to identify interactions among the variables. RESULTS The respondents had an overall high satisfaction rate and a positive attitude toward continuing to adopt and recommend the app. However, the satisfaction rate among respondents who have downloaded but not adopted the app was relatively lower, and few of them perceived that the downloading and acceptance processes are difficult. A high proportion of current users expressed a positive attitude about continuing to adopt and recommend the app to friends, colleagues, and family members. The behavioral intention strongly predicted the acceptance of the eHealth app (β=.89; P<.001). Attitude (β=.30; P<.001) and perceived norm; β=.37; P<.001) played important roles in determining behavioral intention, which could predict the downloading and acceptance of the eHealth app (β=.14; P<.001). CONCLUSIONS Despite the high satisfaction rate among the respondents, privacy concerns and perceived difficulties in adopting the app were the major challenges of promoting eHealth. Further promotion could be made through doctors and publicity. For future improvement, comprehensive health records and tailored health information should be included.
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Affiliation(s)
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Yuet Yan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Florence S W Chan
- Information Technology and Health Informatics Division, Hospital Authority, Kowloon, Hong Kong
| | - Clement S K Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Kowloon, Hong Kong
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Kowloon, Hong Kong
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Kowloon, Hong Kong
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong.,Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
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21
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Neves AL, Burgers J. Digital technologies in primary care: Implications for patient care and future research. Eur J Gen Pract 2022; 28:203-208. [PMID: 35815445 PMCID: PMC9278419 DOI: 10.1080/13814788.2022.2052041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Digital health is the convergence of digital technologies with health, healthcare, living, and society. Contrasting with the slow trend during the last decades, in the last few years, we have observed an expansion and widespread adoption and implementation. In this paper, we revisit the potential that digital health presents for the delivery of higher quality, safer and more equitable care. Focussing on three examples - patient access to health records, big data analytics, and virtual care - we discuss the emerging opportunities and challenges of digital health, and how they can change primary care. We also reflect on the implications for research to evaluate digital interventions: the need to evaluate clear outcomes in light of the six dimensions of quality of care (patient-centredness, efficiency, effectiveness, safety, timeliness, and equity); to define clear populations to understand what works and for which patients; and to involve different stakeholders in the formulation and evaluation of the research questions. Finally, we share five wishes for the future of digital care in General Practice: the involvement of primary healthcare professionals and patients in the design and maintenance of digital solutions; improving infrastructure, support, and training; development of clear regulations and best practice standards; ensuring patient safety and privacy; and working towards more equitable digital solutions, that leave no one behind.
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Affiliation(s)
- Ana Luísa Neves
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.,Centre for Health Technology and Services Research/Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jako Burgers
- Department Family Medicine, Care and Public Health Research Institute, Maastricht, The Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
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22
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research. Eur J Gen Pract 2022; 28:1-12. [PMID: 35037811 PMCID: PMC8765256 DOI: 10.1080/13814788.2021.2010700] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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23
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Banimfreg BH, Shamayleh A, Alshraideh H. Survey for Computer-Aided Tools and Databases in Metabolomics. Metabolites 2022; 12:metabo12101002. [PMID: 36295904 PMCID: PMC9610953 DOI: 10.3390/metabo12101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/14/2022] Open
Abstract
Metabolomics has advanced from innovation and functional genomics tools and is currently a basis in the big data-led precision medicine era. Metabolomics is promising in the pharmaceutical field and clinical research. However, due to the complexity and high throughput data generated from such experiments, data mining and analysis are significant challenges for researchers in the field. Therefore, several efforts were made to develop a complete workflow that helps researchers analyze data. This paper introduces a review of the state-of-the-art computer-aided tools and databases in metabolomics established in recent years. The paper provides computational tools and resources based on functionality and accessibility and provides hyperlinks to web pages to download or use. This review aims to present the latest computer-aided tools, databases, and resources to the metabolomics community in one place.
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24
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Wood GM, van Boom S, Recourt K, Houwink EJF. FHH Quick App Review: How Can a Quality Review Process Assist Primary Care Providers in Choosing a Family Health History App for Patient Care? Genes (Basel) 2022; 13:genes13081407. [PMID: 36011320 PMCID: PMC9407515 DOI: 10.3390/genes13081407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Family health history (FHH) is a data type serving risk assessment, diagnosis, research, and preventive health. Despite technological leaps in genomic variant detection, FHH remains the most accessible, least expensive, and most practical assessment tool for assessing risks attributable to genetic inheritance. The purpose of this manuscript is to outline a process to assist primary care professionals in choosing FHH digital tools for patient care based on the new ISO/TS 82304-2 Technical Specification (TS), which is a recently developed method to determine eHealth app quality. With a focus on eHealth in primary care, we applied the quality label concept to FHH, and how a primary care physician can quickly review the quality and reliability of an FHH app. Based on our review of the ISO TS’s 81 questions, we compiled a list of 25 questions that are recommended to be more succinct as an initial review. We call this process the FHH Quick App Review. Our ‘informative-only’ 25 questions do not produce a quality score, but a guide to complete an initial review of FHH apps. Most of the questions are straight from the ISO TS, some are modified or de novo. We believe the 25 questions are not only relevant to FHH app reviews but could also serve to aid app development and clinical implementation.
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Affiliation(s)
| | | | - Kasper Recourt
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- National eHealth Living Lab (NELL), 2333 ZD Leiden, The Netherlands
| | - Elisa J. F. Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- National eHealth Living Lab (NELL), 2333 ZD Leiden, The Netherlands
- Correspondence:
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25
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van den Berg LN, Hallensleben C, Chavannes NH, Versluis A. Developing a Smartphone Application That Promotes Responsible Short-Acting Beta2-Agonist Use in People with Asthma: A Participatory Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148496. [PMID: 35886348 PMCID: PMC9318130 DOI: 10.3390/ijerph19148496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 01/27/2023]
Abstract
Around 339 million people worldwide have asthma, and 50% have uncontrolled asthma. One trait of uncontrolled asthma, often seen in primary care, is short-acting β2-agonist (SABA) overuse, defined as using SABA more than twice a week. SABA overuse can cause adverse health effects. An application could help patients gain more insight into their SABA use. Engaging stakeholders during the development is important to maximize the usability of and adherence to an application. This study describes the development process of an application that promotes responsible SABA use in people with asthma, using a participatory design. Different stakeholder groups were involved in two iterative development cycles. In the first cycle, four end-users evaluated the app’s prototype. During the second cycle, five end-users were interviewed about the usability of the new version. Resulting in an app that allows patients to register SABA use, asthma symptoms, and symptom triggers. A graph shows how these factors are related, and end-users can show the graph to their physician to facilitate communication. Medication use is compared to the medical guidelines or, when applicable, to the advice given by the users’ healthcare professionals. End-users found the app helpful. Research into the usability and effectiveness of the app in a bigger sample will follow.
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Affiliation(s)
- Liselot N. van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-526-57-61
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
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Abstract
The European General Practice Research Network (EGPRN) has recently published an updated research strategy with the overall aim being to promote relevant research of the highest quality within general practice/family medicine (GP/FM). The Research Strategy indicates a global direction and serves as a basis for more detailed plans in individual countries that will take into account the characteristics of a country, its specific needs and the level of current research capacity. This paper aims to provide a summary of the EGPRN Research Strategy.The Research Strategy suggests that it is necessary to consider what the knowledge deficits are and to set research priorities. Research capacity building (RCB) is required at all levels. Research in GP/FM will also have to reflect the changes in the profession. An innovative and sustainable-oriented approach to conducting research is needed. Use of existing toolkits and engagement with patient platforms and representative groups are necessary to ensure meaningful user involvement. Knowledge transfer and exchange (KTE) is an important component to ensure a process of exchange between researchers and knowledge users.Working to improve leadership, to support the creation of a research culture in GP/FM and to increase national and international networking are considered as fundamental to ensuring a portfolio of high-quality research and for improving the impact of GP/FM research. The recommendations in the Research Strategy are based on a review of the literature on general practice research from 2010 to 2019 and are set in the context of a theoretical framework.
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Affiliation(s)
- Claire Collins
- Irish College of General Practitioners, Dublin, Ireland.,European General Practice Research Network, Maastricht, The Netherlands
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27
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Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research. Eur J Gen Pract 2022; 28:118-124. [PMID: 35593106 PMCID: PMC9132407 DOI: 10.1080/13814788.2022.2053106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article, the sixth in a series aiming to provide practical guidance for qualitative research in primary care, introduces two approaches for addressing longitudinal and complex health themes in primary care research. The first approach – longitudinal qualitative research – supports the study of change during the life course. The second approach – mixed-methods research – integrates quantitative and qualitative research to gain new insights to address the complex and multifaceted themes in primary care. We discuss the context, what, why, when and how of these approaches and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Irene Korstjens
- Faculty of Health Care, Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
| | - Albine Moser
- Faculty of Health Care, Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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28
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Utility, barriers and facilitators to the use of connected health to support families impacted by paediatric cancer: a qualitative analysis. Support Care Cancer 2022; 30:6755-6766. [PMID: 35524147 PMCID: PMC9075925 DOI: 10.1007/s00520-022-07077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/19/2022] [Indexed: 10/26/2022]
Abstract
AIM As healthcare systems are increasingly burdened, the efficiencies and cost savings offered by connected health (CH, i.e. two-way communicative healthcare technologies such as eHealth or mHealth) present an attractive solution for supporting families impacted by cancer. More research is required, however, to examine attitudes towards CH to better facilitate its use in practice. This study seeks to examine the utility, barriers and facilitators of CH use for families affected by paediatric cancer living in Ireland. METHODS Healthcare professionals (n = 5) and parents of children with cancer (n = 7) completed semi-structured interviews on their experiences of and attitudes to CH via Microsoft Teams. A reflexive thematic approach to analysis was employed. RESULTS CH was perceived to provide support for a number of current needs with themes of 'shifting responsibilities', 'individualisation of care' and 'knowledge as power'. Through facilitating communication, information sharing and monitoring of child health, CH was perceived to support decreased parental burden and increased parental control, with positive child outcomes thought likely. Perceived barriers and facilitators to the use of CH included the 'importance of trust', 'pace of change' and 'access'. CONCLUSION While results suggest an acceptance of CH across key stakeholders, barriers and facilitators should be considered to support effective implementation. While further analysis of the efficacy of CH to support families impacted by paediatric cancer is needed, these findings highlight key areas where CH may be effectively employed.
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29
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Tossaint-Schoenmakers R, Kasteleyn MJ, Rauwerdink A, Chavannes N, Willems S, Talboom-Kamp EPWA. Development of a quality management model and self-assessment questionnaire for hybrid health care: a concept mapping study (Preprint). JMIR Form Res 2022; 6:e38683. [PMID: 35797097 PMCID: PMC9305399 DOI: 10.2196/38683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Unilabs Netherlands, Utrecht, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Marise J Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Gastroenterology and Metabolism, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sofie Willems
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther P W A Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- Unilabs Group, Geneve, Switzerland
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30
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Feldthusen C, Bergenheim A, Barenfeld E, Gjertsson I, Larsson A, Mannerkorpi K. Experience of co-creation of a health plan and support for sustainable physical activity among people with chronic widespread pain: a qualitative interview study in Sweden. BMJ Open 2022; 12:e059432. [PMID: 35396312 PMCID: PMC8996005 DOI: 10.1136/bmjopen-2021-059432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The aim of this study was to gain deeper knowledge about how people with chronic widespread pain (CWP) experience the co-creation of a health plan for sustainable physical activity, working in partnership with a physiotherapist, supported by a digital platform. DESIGN Qualitative semistructured in-depth individual interviews were analysed with qualitative content analysis. SETTING Five primary healthcare centres in western Sweden. PARTICIPANTS The interviewees comprised 19 individuals with CWP who had previously participated in a person-centred intervention involving co-creation of a health plan and support via a digital platform. The interviews were carried out from late 2019 to spring 2020, 1-6 months after the respondents' final follow-up. RESULTS The analysis resulted in an overarching theme; hope for physical activity that actually works, illustrating the experience of taking part in co-creating a reasonable health plan, based on the respondents' own goals and interests with the potential to actually work. This theme was based on two categories: a plan tailored for me and a frame for participation and accessibility to help fulfil the plan. The digital platform provided a way to participate and an assurance that there was someone there for them if necessary. CONCLUSIONS The co-creation of a health plan nurtured hope of having developed a manageable plan for physical activity that could lead to improved future health and well-being. Digital support may serve as a valuable complement in order to sustain and adjust the planned physical activity. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03434899.
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Affiliation(s)
- Caroline Feldthusen
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg Institute of Neuroscience and Physiology, Goteborg, Sweden
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, Region Västra Götaland, Goteborg, Sweden
| | - Anna Bergenheim
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg Institute of Neuroscience and Physiology, Goteborg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Goteborg, Sweden
| | - Emmelie Barenfeld
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, Region Västra Götaland, Goteborg, Sweden
- University of Gothenburg Institute of Health and Care Sciences, Goteborg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation research, University of Gothenburg, Goteborg, Sweden
| | - Anette Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg Institute of Neuroscience and Physiology, Goteborg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Goteborg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg Institute of Neuroscience and Physiology, Goteborg, Sweden
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Göbl L, Weis A, Hoffmann M, Wiezorreck L, Wensing M, Szecsenyi J, Litke N. [An exploratory cross-sectional study on technical affinity and smartphone use among practice staff and patients: development of an app for multimorbid patients in general practice]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:39-47. [PMID: 35058166 DOI: 10.1016/j.zefq.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Due to individual care needs, the provision of care to patients with two or more chronic diseases (multimorbidity) is described as complex. In addition, the number of chronically ill people is increasing, due in part to demographic changes which pose a challenge, especially for outpatient primary care. In order to fulfil patients' needs and to promote self-management as a central care element of chronically ill patients, the use of eHealth applications increases. TelePraCMan will be developed as one of these applications and includes a symptom-based electronic diary, which will be implemented in the established German disease management programme 'PraCMan'. This study is conducted as a part of the TelePraCMan project and aims to detect the needs of potential end users (physicians, medical assistants, patients). METHODS In the TelePraCMan development phase, an explorative cross-sectional study was conducted with potential end users of the TelePraCMan app (patients, physicians and medical assistants). For this purpose, a written survey was conducted in Baden-Wurttemberg between April 2019 and March 2020. The survey covered smartphone usage behaviour, technology affinity using the standardised questionnaire TA-EG, support network for technical questions and sociodemographic data. RESULTS A total of n=202 patients (n=98), physicians (n=58) and medical assistants (n=43) participated in the survey. Concerning smartphone use, 78.2 % of the participants stated that the function used most frequently was writing short messages. Health apps were the least used function (9.6 %). Furthermore, patients (12.6 %) use health apps more often than medical assistants (10.3%) and doctors (4.4 %). Participants aged 50 and younger were found to have a higher affinity for technology (mean=3.20, SD=0.51) than participants over 50 years of age (mean=2.98, SD=0.67). Older, multimorbid respondents had a particularly low affinity for technology (mean=2.52, SD=0.69). 10.9 % of the over-fifties and 12.5 % of the multimorbid persons felt able to fix any technical problems on their own without help. Multimorbid participants over the age of 50 were observed to prefer personal support over internet-based support. DISCUSSION On average, multimorbid respondents in the age group over 50 have a lower affinity for technology than respondents aged under 50 without multimorbidity. The most frequent negative attitude towards electronic devices is also found among patients over 50 years of age, who are expected to be the main target group of the TelePraCMan app. These findings can be used to derive requirements for the design and development of functions of the app, as well as accompanying measures, such as intuitive and simple user interface, a telephone hotline to support users, close consultation with users on the planned functions, and more. CONCLUSION Based on this survey, we were able to determine the needs of the future target group of the TelePraCMan app. This is seen as a starting point for the development of an implementation strategy and the pilot testing of the app in primary care.
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Affiliation(s)
- Linda Göbl
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Aline Weis
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Mariell Hoffmann
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Lars Wiezorreck
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michel Wensing
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Joachim Szecsenyi
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Nicola Litke
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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Boudewijns E, Gidding-Slok A, Burgers J. Samen sterk door persoonsgerichte en digitale zorg. HUISARTS EN WETENSCHAP 2022; 65:14-18. [PMID: 35309971 PMCID: PMC8920056 DOI: 10.1007/s12445-022-1423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Digitale zorg voor chronische patiënten heeft zich in de huisartsenpraktijk de afgelopen jaren stormachtig ontwikkeld, mede door COVID-19. Past die ontwikkeling wel bij persoonsgerichte zorg? Het NHG-Standpunt E-health voor huisarts en patiënt uit 2015 is positief-kritisch en ook de auteurs van deze beschouwing denken dat het kan. Ze geven nieuwe voorbeelden uit de praktijk die dat bevestigen, maar stippen ook de randvoorwaarden aan: training, toegankelijkheid en verder onderzoek naar de effecten.
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Affiliation(s)
- Esther Boudewijns
- Promovendus huisartsgeneeskunde, Universiteit Maastricht, afdeling Huisartsgeneeskunde, Maastricht, Nederland
| | - Annerika Gidding-Slok
- Onderzoeker, Universiteit Maastricht, afdeling Huisartsgeneeskunde, Maastricht, Nederland
| | - Jako Burgers
- Huisarts, leerstoelhouder Nederlands Huisartsen Genootschap ‘Bevorderen van persoonsgerichte zorg in richtlijnen’., NHG, Utrecht, Nederland
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Versluis A, Schnoor K, Chavannes NH, Talboom-Kamp EP. Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics. J Med Internet Res 2022; 24:e29303. [PMID: 35019848 PMCID: PMC8792777 DOI: 10.2196/29303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/14/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The number of people with chronic diseases and the subsequent pressure on health care is increasing. eHealth technology for diagnostic testing can contribute to more efficient health care and lower workload. OBJECTIVE This systematic review examines the available methods for direct web-based access for patients to diagnostic testing and results in the absence of a health care professional in primary care. METHODS We searched the PubMed, Embase, Web of Sciences, Cochrane Library, Emcare, and Academic Search Premier databases in August 2019 and updated in July 2021. The included studies focused on direct patient access to web-based triage leading to diagnostic testing, self-sampling or testing, or web-based communication of test results. A total of 45 studies were included. The quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Most studies had a quantitative descriptive design and discussed a combination of services. Diagnostic test services mainly focused on sexually transmitted infections. Overall, the use was high for web-based triage (3046/5000, >50%, who used a triage booked a test), for self-sampling or self-testing kits (83%), and the result service (85%). The acceptability of the test services was high, with 81% preferring home-based testing over clinic-based testing. There was a high rate of follow-up testing or treatment after a positive test (93%). CONCLUSIONS The results show that direct access to testing and result services had high use rates, was positively evaluated, and led to high rates of follow-up treatment. More research on cost-effectiveness is needed to determine the potential for other diseases. Direct access to diagnostic testing can lower the threshold for testing in users, potentially increase efficiency, and lower the workload in primary care.
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Affiliation(s)
- Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Kyma Schnoor
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Saltro Diagnostic Center, Utrecht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Esther Pwa Talboom-Kamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Saltro Diagnostic Center, Utrecht, Netherlands
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Henni SH, Maurud S, Fuglerud KS, Moen A. The experiences, needs and barriers of people with impairments related to usability and accessibility of digital health solutions, levels of involvement in the design process and strategies for participatory and universal design: a scoping review. BMC Public Health 2022; 22:35. [PMID: 34991540 PMCID: PMC8734131 DOI: 10.1186/s12889-021-12393-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/02/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Globally, the number of digital health solutions is increasing, but they are not always designed with access and utilisation for people with impairments in mind. Development efforts have often not included the voice and requirements of people with impairments, who make up 15% of the world’s population, despite the fact that this can help ensure broad access and utilisation. Little attention to and limited inclusion of people with impairments in the development of digital health solutions results in continued and reinforced inequalities in health services provision for people with impairments. This review investigates the needs and barriers of people with impairments related to use of digital health solutions and strategies to foster user participation, access and utilisation of digital health solutions. Methods This scoping review, based on the Joanna Briggs Institute Manual, had five phases: 1) identification of aim and research questions, 2) literature search in five databases (April/May 2020), 3) literature screening based on predetermined inclusion and exclusion criteria, 4) data extraction, and (5) reporting results. Results The literature search resulted in 5968 sources, of which 25 met our inclusion criteria. People with impairments appreciate digital health solutions that are designed to meet their specific impairment-related challenges. The reported needs and barriers related to technological design varied depending on the individuals’ challenges. The literature reported different types of participatory co-design strategies to foster access and utilisation of digital health solutions. Conclusion This scoping review support needs for increased awareness among developers to design solutions that meet people’s needs, contexts and states of health. By applying universal design as a strategy and including people with different types of impairments, starting in the idea creation phase of digital health solutions and throughout the development, developers can design solutions with better accessibility. Digital health solutions that are accessible and usable have a tremendous opportunity to foster health equity and achieve health promotion, prevention and self-care. This in turn can contribute to closing the gap between different population groups, reduce disparities and get the most from available healthcare services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12393-1.
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Affiliation(s)
- Silje Havrevold Henni
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, NO-0318, Oslo, Norway.
| | - Sigurd Maurud
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, NO-0318, Oslo, Norway
| | | | - Anne Moen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, NO-0318, Oslo, Norway
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Jiang Y, Sun P, Chen Z, Guo J, Wang S, Liu F, Li J. Patients' and healthcare providers' perceptions and experiences of telehealth use and online health information use in chronic disease management for older patients with chronic obstructive pulmonary disease: a qualitative study. BMC Geriatr 2022; 22:9. [PMID: 34979967 PMCID: PMC8721473 DOI: 10.1186/s12877-021-02702-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telehealth and online health information provide patients with increased access to healthcare services and health information in chronic disease management of older patients with chronic diseases, addressing the challenge of inadequate health resources and promoting active and informed participation of older patients in chronic disease management. There are few qualitative studies on the application of telehealth and online health information to chronic disease management in older patients. Chronic obstructive pulmonary disease is one of the most common chronic diseases in older adults. Telehealth is widely used in the management of chronic obstructive pulmonary disease. The purpose of this study was to explore the perceptions and experiences of older patients and healthcare providers in the application of telehealth and online health information to chronic disease management of chronic obstructive pulmonary disease. METHODS A qualitative descriptive study with data generated from 52 individual semi-structured interviews with 29 patients [Law of the People's Republic of China on the protection of the rights and interests of older people (2018 Revised Version) = >60 years old] with chronic obstructive pulmonary disease and 23 healthcare providers. The inductive thematic analysis method was used for data analysis. RESULTS Four themes and 16 sub-themes were identified in this study. Four themes included: faced with a vast amount of online health information, essential competencies and personality traits ensuring older patients' participation and sustained use, user experience with the use of technology, being in a complex social context. CONCLUSION The ability of patients to understand health information should be fully considered while facilitating access to online health information for older patients. The role of health responsibility and user experience in older patients' participation and sustained use of telehealth and online health information needs to be emphasised. In addition, the complex social context is a determining factor to be considered, particularly the complex impact of a reliance on offspring and social prejudice on the behaviour of older adults using telehealth and online health information.
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Affiliation(s)
- Yuyu Jiang
- Research office of chronic disease management and rehabilitation, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, China.
| | - Pingping Sun
- Research office of chronic disease management and rehabilitation, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, China
| | - Zhongyi Chen
- Research office of chronic disease management and rehabilitation, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, China
| | - Jianlan Guo
- Research office of chronic disease management and rehabilitation, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Avenue, Wuxi, 214122, Jiangsu Province, China
| | - Shanshan Wang
- Department of Nursing, Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
| | - Fenglan Liu
- School of Medicine, Liaocheng University, Liaocheng, 252000, Shandong Province, China
| | - Jinping Li
- Department of Public Health, Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
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Frennert S, Petersson L, Muhic M, Rydenfält C, Nymberg VM, Ekman B, Erlingsdottir G. Materiality and the mediating roles of eHealth: A qualitative study and comparison of three cases. Digit Health 2022; 8:20552076221116782. [PMID: 35935713 PMCID: PMC9346257 DOI: 10.1177/20552076221116782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance.
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Affiliation(s)
| | - Lena Petersson
- Department of Health and Welfare, Halmstad University, Halmstad, Halland, Sweden
| | - Mirella Muhic
- Department of Informatics, Umeå University, Umea, Sweden
| | | | | | - Björn Ekman
- Department of Clinical Sciences, Malmö, Lund University, Lund
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Rombouts M, Raaijmakers LGM, Kuunders TJM, Van Steijn-Martens R, de Vuijst T, van Donkersgoed H, van de Goor LAM. The Acceptance and Use of the e-Health Instrument 'The Personal Health Check' in Four Dutch Municipalities: Lessons Learned. J Prim Prev 2021; 43:25-48. [PMID: 34714455 PMCID: PMC8887919 DOI: 10.1007/s10935-021-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
This pilot study assessed the acceptance and use of the e-Health instrument “the Personal Health Check” (PHC) among clients and professionals in primary care settings. By filling in the online PHC instrument, participants were provided insights into their health and lifestyle. When results revealed an increased health risk, participants were advised to undertake additional lab tests measuring blood pressure and haemaglobin levels. Based on the online questionnaire and optional lab tests, participants then received a report that included individually-tailored feedback from the e-Health application about personal health risks and suggestions for health interventions. The PHC was implemented in 2016 in four Dutch municipalities that determined which neighbourhood(s) the PHC targeted and how participants were invited. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework to address our research questions. Methods used to assess acceptance were: PHC instrument data, data from additional questionnaires completed by PHC participants, focus groups with PHC participants and professionals in primary care, and telephone interviews with non-responders to the invitation to participate in the online PHC. Of the 21,735 invited, 12% participated. Our results showed that participants and professionals in this pilot were predominantly positive about the PHC. Participants reported that they made an effort to apply the PHC lifestyle advice they received. Almost all had the knowledge and resources needed to use the PHC online instrument. Invitations from general practitioners almost doubled participation relative to invitations from the sponsoring municipalities. The overall low response rate, however, suggests that the PHC is unsuitable as a foundation on which to develop local public health policy.
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Affiliation(s)
- M Rombouts
- Municipal Health Service West-Brabant, Breda, The Netherlands
| | | | - T J M Kuunders
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - T de Vuijst
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands
| | - H van Donkersgoed
- Netherlands Institute for Prevention and E-Health Development (NIPED), Amsterdam, The Netherlands
| | - L A M van de Goor
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Taha-Mehlitz S, Hendie A, Taha A. The Development of Electronic Health and Artificial Intelligence in Surgery after the SARS-CoV-2 Pandemic-A Scoping Review. J Clin Med 2021; 10:jcm10204789. [PMID: 34682912 PMCID: PMC8537136 DOI: 10.3390/jcm10204789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND SARS-CoV-2 has significantly transformed the healthcare environment, and it has triggered the development of electronic health and artificial intelligence mechanisms, for instance. In this overview, we concentrated on enhancing the two concepts in surgery after the pandemic, and we examined the factors on a global scale. OBJECTIVE The primary goal of this scoping review is to elaborate on how surgeons have used eHealth and AI before; during; and after the current global pandemic. More specifically, this review focuses on the empowerment of the concepts of electronic health and artificial intelligence after the pandemic; which mainly depend on the efforts of countries to advance the notions of surgery. DESIGN The use of an online search engine was the most applied method. The publication years of all the studies included in the study ranged from 2013 to 2021. Out of the reviewed studies; forty-four qualified for inclusion in the review. DISCUSSION We evaluated the prevalence of the concepts in different continents such as the United States; Europe; Asia; the Middle East; and Africa. Our research reveals that the success of eHealth and artificial intelligence adoption primarily depends on the efforts of countries to advance the notions in surgery. CONCLUSIONS The study's primary limitation is insufficient information on eHealth and artificial intelligence concepts; particularly in developing nations. Future research should focus on establishing methods of handling eHealth and AI challenges around confidentiality and data security.
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Affiliation(s)
- Stephanie Taha-Mehlitz
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002 Basel, Switzerland;
| | - Ahmad Hendie
- Department of Computer Engineering, McGill University, Montreal, QC H3A 0C6, Canada;
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4321 Allschwil, Switzerland
- Correspondence: ; Tel.: +41-61-207-54-02
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van Lonkhuizen PJC, Vegt NJH, Meijer E, van Duijn E, de Bot ST, Klempíř J, Frank W, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Foley P, Chavannes NH, Heemskerk AW. Study Protocol for the Development of a European eHealth Platform to Improve Quality of Life in Individuals With Huntington's Disease and Their Partners (HD-eHelp Study): A User-Centered Design Approach. Front Neurol 2021; 12:719460. [PMID: 34589047 PMCID: PMC8476232 DOI: 10.3389/fneur.2021.719460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that affects the quality of life (QoL) of HD gene expansion carriers (HDGECs) and their partners. Although HD expertise centers have been emerging across Europe, there are still some important barriers to care provision for those affected by this rare disease, including transportation costs, geographic distance of centers, and availability/accessibility of these services in general. eHealth seems promising in overcoming these barriers, yet research on eHealth in HD is limited and fails to use telehealth services specifically designed to fit the perspectives and expectations of HDGECs and their families. In the European HD-eHelp study, we aim to capture the needs and wishes of HDGECs, partners of HDGECs, and health care providers (HCPs) in order to develop a multinational eHealth platform targeting QoL of both HDGECs and partners at home. Methods: We will employ a participatory user-centered design (UCD) approach, which focusses on an in-depth understanding of the end-users' needs and their contexts. Premanifest and manifest adult HDGECs (n = 76), partners of HDGECs (n = 76), and HCPs (n = 76) will be involved as end-users in all three phases of the research and design process: (1) Exploration and mapping of the end-users' needs, experiences and wishes; (2) Development of concepts in collaboration with end-users to ensure desirability; (3) Detailing of final prototype with quick review rounds by end-users to create a positive user-experience. This study will be conducted in the Netherlands, Germany, Czech Republic, Italy, and Ireland to develop and test a multilingual platform that is suitable in different healthcare systems and cultural contexts. Discussion: Following the principles of UCD, an innovative European eHealth platform will be developed that addresses the needs and wishes of HDGECs, partners and HCPs. This allows for high-quality, tailored care to be moved partially into the participants' home, thereby circumventing some barriers in current HD care provision. By actively involving end-users in all design decisions, the platform will be tailored to the end-users' unique requirements, which can be considered pivotal in eHealth services for a disease as complex and rare as HD.
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Affiliation(s)
- Pearl J. C. van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Niko J. H. Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Huntington Center Topaz Overduin, Katwijk, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Susanne T. de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Wiebke Frank
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | | | | | - Jennifer Hoblyn
- Bloomfield Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Peter Foley
- Department of Clinical Neurosciences, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
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40
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Versluis A, van Luenen S, Meijer E, Honkoop PJ, Pinnock H, Mohr DC, Neves AL, Chavannes NH, van der Kleij RMJJ. SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation. Eur J Gen Pract 2021; 26:140-145. [PMID: 33025820 PMCID: PMC7580793 DOI: 10.1080/13814788.2020.1826431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. Objectives We consider how evidence-based implementation strategies can be built to support eHealth implementation. Discussion What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Conclusion Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.
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Affiliation(s)
- Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands.,Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | | | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK.,Center for Health Technology and Services Research (CINTESIS)/Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
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Houwink EJF, Kasteleyn MJ, Alpay L, Pearce C, Butler-Henderson K, Meijer E, van Kampen S, Versluis A, Bonten TN, van Dalfsen JH, van Peet PG, Koster Y, Hierck BP, Jeeninga I, van Luenen S, van der Kleij RMJJ, Chavannes NH, Kramer AWM. SERIES: eHealth in primary care. Part 3: eHealth education in primary care. Eur J Gen Pract 2021; 26:108-118. [PMID: 32757859 PMCID: PMC7470053 DOI: 10.1080/13814788.2020.1797675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. OBJECTIVES In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. DISCUSSION We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by describing roles and required competencies. Alternatively, Kern's conceptual model can be used to design eHealth training programmes that match the educational needs of the stakeholders using eHealth. CONCLUSION Vocational and CPD training in General Practice needs to build on eHealth capabilities now. We strongly advise the incorporation of eHealth education into vocational training and CPD activities, rather than providing it as a separate single module. How learning goals and activities take shape and how competencies are evaluated clearly requires further practice, evaluation and study.
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Affiliation(s)
- Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Christopher Pearce
- Centre for Transformation in Digital Health, University of Melbourne, Melbourne, Australia.,Department of General Practice, Monash University, Melbourne, Australia
| | | | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Sanne van Kampen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Jens H van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Beerend P Hierck
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Teachers' Academy, Leiden University, Leiden, The Netherlands
| | - Ilke Jeeninga
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
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42
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Kasteleyn MJ, Versluis A, van Peet P, Kirk UB, van Dalfsen J, Meijer E, Honkoop P, Ho K, Chavannes NH, Talboom-Kamp EPWA. SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care - opportunities and challenges. Eur J Gen Pract 2021; 27:248-256. [PMID: 34432601 PMCID: PMC8405089 DOI: 10.1080/13814788.2021.1962845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Given the pressure on modern healthcare systems, eHealth can offer valuable opportunities. However, understanding the potential and challenges of eHealth in daily practice can be challenging for many general practitioners (GPs) and their staff. Objectives To critically appraise five widely used eHealth applications, in relation to safe, evidence-based and high-quality eHealth. Using these applications as examples, we aim to increase understanding of eHealth among GPs and highlight the opportunities and challenges presented by eHealth. Discussion eHealth applications can support patients while increasing efficiency for GPs. A three-way division (inform, monitor, track; interaction; data utilisation) characterises many eHealth applications, with an increasing degree of complexity depending on the domain. All applications provide information and some have extra functionalities that promote interaction, while data analysis and artificial intelligence may be applied to support or (fully) automate care processes. Applications in the inform domain are relatively easy to use and implement but their impact on clinical outcomes may be limited. More demanding applications, in terms of privacy and ethical aspects, are found in the data utilisation domain and may potentially have a more significant impact on care processes and patient outcomes. When selecting and implementing eHealth applications, we recommend that GPs remain critical regarding preconditions on safe, evidence-based and high-quality eHealth, particularly in the case of more complex applications in the data utilisation domain.
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Affiliation(s)
- Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ulrik Bak Kirk
- The Research Unit for General Practice, Aarhus, Denmark.,The European Society for Quality and Safety in Family Practice (EQuiP), Aarhus, Denmark
| | - Jens van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | | | - Kendall Ho
- Faculty of Medicine, eHealth Strategy Office, University of British Columbia, Vancouver, Canada
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Esther P W A Talboom-Kamp
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands.,Saltro Diagnostic Center, Utrecht, The Netherlands
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43
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Kraaijkamp JJM, van Dam van Isselt EF, Persoon A, Versluis A, Chavannes NH, Achterberg WP. eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability. J Med Internet Res 2021; 23:e24015. [PMID: 34420918 PMCID: PMC8414304 DOI: 10.2196/24015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/11/2021] [Accepted: 05/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. OBJECTIVE The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. METHODS We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. RESULTS In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. CONCLUSIONS eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.
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Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- ZZG Zorggroep, Nijmegen, Netherlands
| | | | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168435. [PMID: 34444182 PMCID: PMC8391274 DOI: 10.3390/ijerph18168435] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.
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45
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Meijer E, Korst JS, Oosting KG, Heemskerk E, Hermsen S, Willemsen MC, van den Putte B, Chavannes NH, Brown J. "At least someone thinks I'm doing well": a real-world evaluation of the quit-smoking app StopCoach for lower socio-economic status smokers. Addict Sci Clin Pract 2021; 16:48. [PMID: 34321088 PMCID: PMC8320182 DOI: 10.1186/s13722-021-00255-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking is more prevalent and persistent among lower socio-economic status (SES) compared with higher-SES groups, and contributes greatly to SES-based health inequities. Few interventions exist that effectively help lower-SES smokers quit. This study evaluated "De StopCoach", a mobile phone delivered eHealth intervention targeted at lower-SES smokers based on the evidence-based StopAdvisor, in a real-world setting (five municipalities) in The Netherlands in 2019-2020. METHOD We conducted individual semi-structured interviews with project leaders, healthcare professionals, and participating smokers (N = 22), and examined log data from the app (N = 235). For practical reasons, SES of app users was not measured. Qualitative data were analysed using the Framework Approach, with the Consolidated Framework for Implementation Research (CFIR) and Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical models. RESULTS Qualitative data showed that factors from the Intervention and Setting domains were most important for the implementation. StopCoach seemed suitable for lower-SES smokers in terms of performance and effort expectancy, especially when integrated with regular smoking cessation counseling (SCC). Key barriers to implementation of the app were limited integration of the app in SCC programs in practice, difficulty experienced by project leaders and healthcare professionals to engage the local community, and barriers to SCC more generally (e.g., perceived resistance to quitting in patients) that prevented healthcare professionals from offering the app to smokers. Quantitative data showed that 48% of app users continued using the app after the preparation phase and pre-quit day, and that 33% of app users had attempted to quit. Both app adherence and quit attempts were more likely if smokers also received SCC from a professional coach. Posthoc analyses suggest that adherence is related to higher likelihood of a quit attempt among participants with and without a professional coach. CONCLUSIONS Smokers, healthcare professionals and project leaders indicated in the interviews that the StopCoach app would work best when combined with SCC. It also appears from app log that app adherence and quit attempts by app users can be facilitated by combining the app with face-to-face SCC. As such, blended care appears promising for helping individual smokers quit, as it combines the best of regular SCC and eHealth. Further research on blended care for lower-SES smokers is needed.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke S. Korst
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Kristiene G. Oosting
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Heemskerk
- Pharos Dutch Center of Expertise On Health Disparities, Utrecht, The Netherlands
| | - Sander Hermsen
- OnePlanet Research Center, Imec NL, Wageningen, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Collaboration, London, UK
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Schönholzer TE, Pinto IC, Zacharias FCM, Gaete RAC, Serrano-Gallardo MDP. Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals. Rev Lat Am Enfermagem 2021; 29:e3447. [PMID: 34287545 PMCID: PMC8294795 DOI: 10.1590/1518-8345.4174.3447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand how the implementation of the e-SUS Primary Care system has been processed and its impact on the daily life of the health teams. METHOD a qualitative research study, conducted in a municipality in the inland of the state of São Paulo with professionals who work in Primary Health Care and use the e-SUS Primary Care system as a work tool. Semi-structured interviews and thematic data analysis were used with Kotter's three-phase approach. RESULTS a total of 17 professionals, nurses, physicians, dentists and community agents were interviewed. The implementation of e-SUS Primary Care and its impact on the daily life of health teams were understood in terms of mandatory implementation; weaknesses for implementation, such as absence of material resources and implicit imposition for the use of the system; fragile training for deployment and learning from experience. CONCLUSION a harmful incentive process was observed, conducted from the perspective of institutional pressure, use of the system to justify the work performed and, on the other hand, there was the creation of collaborative learning mechanisms between the teams.
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Affiliation(s)
- Tatiele Estefâni Schönholzer
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Ione Carvalho Pinto
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Fabiana Costa Machado Zacharias
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Rodrigo André Cuevas Gaete
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
This article reflects on the breadth of digital developments seen in primary care over time, as well as the rapid and significant changes prompted by the COVID-19 crisis. Recent research and experience have shone further light on factors influencing the implementation and usefulness of these approaches, as well as unresolved challenges and unintended consequences. These are considered in relation to not only digital technology and infrastructure, but also wider aspects of health systems, the nature of primary care work and culture, patient characteristics and inequalities, and ethical issues around data privacy, inclusion, empowerment, empathy and trust. Implications for the future direction and sustainability of these approaches are discussed, taking account of novel paradigms, such as artificial intelligence, and the growing capture of primary care data for secondary uses. Decision makers are encouraged to think holistically about where value is most likely to be added, or risks being taken away, when judging which innovations to carry forward. It concludes that, while responding to this public health emergency has created something of a digital 'big bang' for primary care, an incremental, adaptive, patient-centered strategy, focused on augmenting rather than replacing existing services, is likely to prove most fruitful in the longer term.
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Affiliation(s)
- Claudia Pagliari
- Global eHealth Group, Usher Institute, Edinburgh Global Health Academy & Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
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48
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E-healthonderwijs is een nieuwe uitdaging voor de huisartsopleiding. ACTA ACUST UNITED AC 2021; 64:19-22. [PMID: 34092805 PMCID: PMC8169429 DOI: 10.1007/s12445-021-1169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Om goed voorbereid te zijn op de toekomst moeten aiossen zich ook in e-health verdiepen. Bij de huisartsopleiding ligt de nadruk echter meer op praktijkleren, waardoor nieuwe ontwikkelingen als e-health niet altijd voldoende aandacht krijgen. Aiossen moeten ook maar net een opleider treffen die zich met e-health bezighoudt. E-health verdient meer aandacht tijdens de opleiding, wat zowel de aios, de opleider als de docent ten goede zal komen.
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Ndlovu K, Mars M, Scott RE. Interoperability frameworks linking mHealth applications to electronic record systems. BMC Health Serv Res 2021; 21:459. [PMID: 33985495 PMCID: PMC8120820 DOI: 10.1186/s12913-021-06473-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/04/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND mHealth presents innovative approaches to enhance primary healthcare delivery in developing countries like Botswana. The impact of mHealth solutions can be improved if they are interoperable with eRecord systems such as electronic health records, electronic medical records and patient health records. eHealth interoperability frameworks exist but their availability and utility for linking mHealth solutions to eRecords in developing world settings like Botswana is unknown. The recently adopted eHealth Strategy for Botswana recognises interoperability as an issue and mHealth as a potential solution for some healthcare needs, but does not address linking the two. AIM This study reviewed published reviews of eHealth interoperability frameworks for linking mHealth solutions with eRecords, and assessed their relevance to informing interoperability efforts with respect to Botswana's eHealth Strategy. METHODS A structured literature review and analysis of published reviews of eHealth interoperability frameworks was performed to determine if any are relevant to linking mHealth with eRecords. The Botswanan eHealth Strategy was reviewed. RESULTS Four articles presented and reviewed eHealth interoperability frameworks that support linking of mHealth interventions to eRecords and associated implementation strategies. While the frameworks were developed for specific circumstances and therefore were based upon varying assumptions and perspectives, they entailed aspects that are relevant and could be drawn upon when developing an mHealth interoperability framework for Botswana. Common emerging themes of infrastructure, interoperability standards, data security and usability were identified and discussed; all of which are important in the developing world context such as in Botswana. The Botswana eHealth Strategy recognises interoperability, mHealth, and eRecords as distinct issues, but not linking of mHealth solutions with eRecords. CONCLUSIONS Delivery of healthcare is shifting from hospital-based to patient-centered primary healthcare and community-based settings, using mHealth interventions. The impact of mHealth solutions can be improved if data generated from them are converted into digital information ready for transmission and incorporation into eRecord systems. The Botswana eHealth Strategy stresses the need to have interoperable eRecords, but mHealth solutions must not be left out. Literature insight about mHealth interoperability with eRecords can inform implementation strategies for Botswana and elsewhere.
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Affiliation(s)
- Kagiso Ndlovu
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Department of Computer Science, University of Botswana, Gaborone, Botswana.
| | - Maurice Mars
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard E Scott
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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50
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Tossaint-Schoenmakers R, Versluis A, Chavannes N, Talboom-Kamp E, Kasteleyn M. The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. J Med Internet Res 2021; 23:e27180. [PMID: 33970123 PMCID: PMC8145079 DOI: 10.2196/27180] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes. OBJECTIVE The aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators. METHODS A systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories. RESULTS Eleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)-all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely "deployment of human resources" (n=11), in the inner setting theme within the structure category; "ease of use" (n=16) and "technical issue" (n=10), both in the technology theme within the structure category; and "health logistics" (n=26), in the efficiency theme within the outcome category. CONCLUSIONS Three principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results.
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Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Utrecht, Netherlands.,National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands.,Unilabs Group, Geneva, Switzerland
| | - Marise Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
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