The use of E-health during the COVID-19 pandemic: a case study in China's Hubei province

Patients' Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study

BACKGROUND

In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions.

OBJECTIVE

We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients.

METHODS

This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology.

RESULTS

We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 "paths" through which adherence to telehealth may improve.

CONCLUSIONS

Our semiotic square illustrating patients' adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools.

Factors Explaining the Use of Web-Based Consultations With Physicians by Young and Middle-Aged Individuals in China: Qualitative Comparative Analysis

BACKGROUND

It was only upon the occurrence of the COVID-19 pandemic that the demand for web-based consultations with physicians grew at unprecedented rates. To meet the demand, the service environment developed rapidly during the pandemic.

OBJECTIVE

This study aimed to identify the current status of the use of web-based consultations with physicians among young and middle-aged Chinese individuals and explore users' perspectives on key factors that influence its use in terms of optimizing benefits and compensating for disadvantages.

METHODS

We conducted semistructured interviews with 65 individuals (aged 18 to 60 years) across China between September and October 2022. The interviewees were selected through snowball sampling. They described their experiences of using web-based physician consultations and the reasons for using or not using the service. Based on the Andersen Behavioral Model, a qualitative comparative analysis was used to analyze the factors associated with the use of web-based physician consultations and explore the combinations of these factors.

RESULTS

In all, 31 (48%) of the 65 interviewees used web-based consultation services. The singular necessary condition analysis revealed that the complementary role of the service and perceived convenience are necessary conditions for the use of web-based consultation services, and user's confidence in the service was a sufficient condition. Based on the Andersen Behavioral Model, the configuration analysis uncovered 2 interpretation models: an enabling-oriented model and a need-oriented model. The basic combination of the enabling-oriented model included income and perceived convenience. The basic combination of the need-oriented model included complementary role and user's confidence.

CONCLUSIONS

Among the factors associated with the use of web-based consultations, perceived convenience, complementary role, and user's confidence were essential factors. Clear instructions on the conduct of the service, cost regulations, provider qualifications guarantee, privacy and safety supervision, the consultations' application in chronic disease management settings, and subsequent visits can promote the positive development of web-based consultations.

The eHealth usage during COVID-19 pandemic 2020 year-Case of Poland

According to the DESI 2022 digital economy and society ranking, Poland still ranks in one of the last position. Although, in digitising healthcare Poland has made significant progress over the last five years, some inequities in the usage of eHealth have been recognised. This has become an especially important topic after the COVID-19 pandemic. Suddenly, eHealth innovations were much needed to maintain the accessibility of healthcare. Thus, the aim of this study was to explore determinants of eHealth usage by Poles and identify existing potential barriers. Data was collected from the databases of Statistic Poland and statistical methods were employed in this research. The results showed that five variables such as Internet access, Internet use, Internet skills and average monthly disposable income per capita in PLN, along with the number of practicing physicians per capita were important determinants explaining eHealth usage by the analysed Poles between the age of 16-74. The findings showed to increase the usage of eHealth, health policy makers should ensure that Poles acquire and improve Internet skills. Based on results of the research an extended model of eHealth development in Poland, consisting of a central governmental institution and local facilities coordinating remote electronic services, collecting statistical data and providing educational campaigns, was proposed as well.

Use of Digital Healthcare Communication to Improve Urologists' Surveillance of Lithiasis Patients Treated with Internal Urinary Drainage Pre- and Post-COVID-19 Period

The COVID-19 pandemic has greatly affected lithiasis patients, which has led to an increase in the number of internal stents that have been installed. In this paper, two studies were carried out, a clinical study and a quantitative study. The aim of the first study was to evaluate the incidence and the prevalence of bacterial urinary colonization in patients with obstructive urolithiasis who needed internal stents implanted. In the second study, a multiple linear regression was created to identify the opinion of urologists regarding the importance of using digital technologies to improve the communication process. The result of the clinical study illustrates that the prevalence of urinary colonization in patients with internal stents carried out for obstructive urolithiasis was 35%, with this value being influenced by co-infection with COVID-19. The results of the quantitative study illustrated the fact that urologists are open to using new online technologies to facilitate communication with patients. The results have high importance for both doctors and patients, illustrating the main factors that have the ability to influence the communication process. The hospital managers should take into account the results obtained in this study when they choose to use certain online communication technologies with patients.

The intention to use mHealth applications among Dutch older adults prior and during the COVID pandemic

Background

Mobile health (mHealth) applications are widely valued for their potential to increase self-management among older adults and reduce their healthcare demands. However, the intention to use mHealth of Dutch older adults before the COVID-19 pandemic was modest. Healthcare access was considerably reduced during the pandemic and mHealth services substituted for in person health services. As older adults utilize health services more frequently and have been particularly vulnerable to the pandemic, they can be viewed to have especially benefitted from the transition toward mHealth services. Furthermore, one might expect their intention to use these services and reap the potential benefits has increased, especially during the pandemic.

Objective

The aim of this study was to examine whether the intention of Dutch older adults to use medical applications increased during the COVID pandemic and how the explanatory power of the extended Technology Acceptance Model (TAM) developed for this purpose was affected by the onset of the pandemic.

Methods

We conducted a cross-sectional survey using two samples collected before (n = 315) and after (n = 501) the onset of the pandemic. Data was collected using questionnaires which were distributed digitally and on paper, by convenience sampling and snowballing. Participants were 65 years or older, lived independently or in a senior living facility, without cognitive impairment. A controlled analysis was performed to test for significant differences in the intention to use mHealth. The before and after differences in extended TAM variables and their relationship with intention to use (ITU) were analyzed using controlled (multivariate) logistic and linear regression models. These models were also used to explore whether the onset of the pandemic had an effect on ITU not captured by the extended TAM model.

Results

While the two samples differed in ITU (p = 0.017; uncontrolled) there was no statistically significant difference in ITU in the controlled logistic regression analysis (p = 0.107). The scores of the extended TAM variables explaining intention to use were all significantly higher, except for Subjective norm and Feelings of Anxiety. The relationships of these variables with intention to use before and after the onset of the pandemic were similar, except for Social relationships which lost its significance. We found no indications of effects of the pandemic on intention to use not captured by our instrument.

Conclusion

The intention to use mHealth applications of Dutch older adults has not changed since the onset of the pandemic. The extended TAM model has robustly explained intention to use, with only minor differences after the first months of the pandemic. Interventions targeting facilitation and support are likely to promote the uptake of mHealth. Follow-up studies are needed to investigate whether the pandemic has had long term effects on the ITU of the older adult.

Impact of COVID-19 fear on Hepatitis C management

Background/Aim: Hepatitis C virus (HCV) infection, a major cause of cirrhosis worldwide, is the most common cause of cirrhosis and hepatocellular carcinoma in Turkey. Today, HCV infection can be treated effectively and safely using direct-acting antiviral drugs, and therefore, the World Health Organization has announced elimination targets by 2030. During the pandemic, many social and personal restrictions were applied for fear of increasing the prevalence of coronavirus disease 2019 (COVID-19) infection. Here we investigate the effects of these restrictions on managing HCV infection in internal medicine departments that deal with both infections. Methods: Patients who applied to the internal medicine departments of our hospital and tested for anti-HCV between 11 March 2020 and 09 April 2022, which was the time interval when official restrictions were applied in Turkey during the COVID-19 pandemic, were included in the study. Patients who were not tested for anti-HCV were excluded from the study. The study was planned as a retrospective cohort study, and patients’ files tested for anti-HCV were scanned. Anti-HCV positivity, HCV RNA PCR testing, and treatment status in HCV RNA-positive patients were evaluated. Results: During the official pandemic period when social restrictions were applied, anti-HCV positivity was revealed in 400 (1.9%) of 21,501 patients for whom anti-HCV tests were performed in internal medicine departments. HCV RNA was not tested in 64 of 400 patients with positive anti-HCV test (16%), and 83 (24.7%) of 336 patients tested for HCV RNA were found to be positive. It was determined that 17 (20.5%) of the HCV RNA-positive patients did not receive antiviral treatment. Conclusion: In studies conducted in Turkey in the pre-pandemic period, it was determined that HCV RNA was not tested in approximately half of the anti-HCV-positive patients, while this rate was found to be only 16% during the pandemic period. This can be explained by the fact that patients infected with the COVID-19 virus were mostly followed-up by internal medicine clinics, where the awareness of viral hepatitis was high. It was determined that 20.5% of the patients with positive HCV RNA PCR tests remained untreated. This finding suggested that the social and personal restrictions applied during the pandemic led to patient follow-up and treatment disruptions.

Self-care for coronavirus disease through electronic health technologies: A scoping review

Background and Aims

Considering the rapid spread and transmission of COVID-19 and its high mortality rate, self-care practices are of special importance during this pandemic to prevent and control the spread of the virus. In this regard, electronic health systems can play a major role in improving self-care practices related to coronavirus disease. This study aimed to review the electronic health technologies used in each of the constituent elements of the self-care (self-care maintenance, self-care monitoring, and self-care management) during the COVID-19 pandemic.

Methods

This scoping review was conducted based on Arksey and O'Malley's framework. In this study, the specific keywords related to "electronic health," "self-care," and "COVID-19" were searched on PubMed, Web of Science, Scopus, and Google.

Results

Of the 47 articles reviewed, most articles (27 articles) were about self-care monitoring and aimed to monitor the vital signs of patients. The results showed that the use of electronic health tools mainly focuses on training in the control and prevention of coronavirus disease during this pandemic, in the field of self-care maintenance, and medication management, communication, and consultation with healthcare providers, in the field of self-care management. Moreover, the most commonly used electronic health technologies were mobile web applications, smart vital signs monitoring devices, and social networks, respectively.

Conclusion

The study findings suggested that the use of electronic health technologies, such as mobile web applications and social networks, can effectively improve self-care practices for coronavirus disease. In addition, such technologies can be applied by health policymakers and disease control and prevention centers to better manage the COVID-19 pandemic.

Mobile health community loyalty development process in China: an empirical study from information seeking perspective

Purpose

This study aims to investigate the process of developing loyalty in the Chinese mobile health community from the information seeking perspective.

Design/methodology/approach

A covariance-based structural equation model was developed to explore the mobile health community loyalty development process from information seeking perspective and tested with LISREL 9.30 for the 191 mobile health platform user samples.

Findings

The empirical results demonstrate that the information seeking perspective offers an interesting explanation for the mobile health community loyalty development process. All hypotheses in the proposed research model are supported except the relationship between privacy and trust. The two types of mobile health community loyalty—attitudal loyalty and behavioral loyalty are explained with 58 and 37% variance.

Originality/value

This paper has brought out the information seeking perspective in the loyalty formation process in mobile health community and identified several important constructs for this perspective for the loyalty formation process including information quality, communication with doctors and communication with patients.

Pregnancy Apps for Self-Monitoring: Scoping Review of the Most Popular Global Apps Available in Australia

Digital health tools, such as apps, have the potential to promote healthy behaviours, especially self-monitoring, which can facilitate pregnancy management and reduce the risk of associated pregnancy health conditions. While pregnancy apps are popular amongst pregnant women, there is limited information about the overall quality of their content or self-monitoring tools and the number of behaviour change techniques (BCTs) that they include. The aim of this study was thus to assess the quality of pregnancy apps for self-monitoring, and their usage of BCTs. We identified pregnancy apps by web scraping the most popular global apps for self-monitoring in the Apple App Store and Google Play Store available in Australia. The app quality was evaluated using the scorecard approach and the inclusion of BCTs was evaluated using the ABACUS tool. We identified 31 pregnancy apps that met our eligibility criteria. We found that pregnancy apps tended to score the highest in the domains of 'cost and time', 'usability', and 'technical', and lowest on 'clinical' and 'end-user requirements'. Additionally, the majority of apps contained minimal BCTs. Based on our findings, we propose a digital health scorecard visualisation that would break down app quality criteria and present them in a more accessible way to clinicians and pregnant users. We conclude that these findings highlight the shortcomings of available commercial pregnancy apps and the utility of a digital health scorecard visualisation that would empower users to make more informed decisions about which apps are the most appropriate for their needs.

Cut-off value of the eHEALS score as a measure of eHealth skills among rural residents in Gansu, China

Background

In this study, our aim was to quantify eHealth literacy and determine a cut-off value for eHEALS scores that signifies adequate eHealth literacy among rural residents in Gansu, China.

Methods

This cross-sectional investigation encompassed 18 rural areas across three cities-Lanzhou, Wuwei, and Dingxi-in Gansu. A total of 451 residents were recruited and underwent evaluations for both eHealth literacy and eHealth skills, utilizing the eHEALS and self-constructed tasks, respectively. A receiving operator characteristic curve was plotted with eHealth skills as the dependent variable and eHealth literacy levels as the independent variable, aiming to determine a cut-off value for eHEALS indicating adequate eHealth literacy and evaluate its predictive capacity.

Results

Among the 451 respondents, 10.9% did not possess a personal electronic device with Internet access, while 6.4% owned but had never used them. Within the remaining 373 residents, the mean eHealth literacy score was 25.85 (SD:10.93), item scores ranged from 3.12 (SD:1.45) to 3.42 (SD:1.60). Completion rates for three eHealth skills varied from 39.1% to 59.8%. The cut-off value was 29.5 determined by the Youden index. The area under the receiver operating curve was 0.829, with a sensitivity of 86.7%, and a specificity of 66.8%.

Conclusions

Our findings emphasized that eHealth literacy among rural residents remains at a low level. Moreover, we identified a cut-off value of 29.5 for eHEALS scores that signifies adequate eHealth literacy within this demographic.

Transplant Renal Artery Stenosis: Current Concepts

Transplant renal artery stenosis is an increasingly recognized vascular complication after renal transplant. It can result in posttransplant hypertension and graft dysfunction and eventually in graft loss. Timely diagnosis and appropriate intervention for clinically significant transplant renal artery stenosis can potentially halt or reverse these adverse effects, leading to better outcomes. Duplex ultrasonography is the imaging modality of choice to screen suspected cases. Some patients with transplant renal artery stenosis will require invasive treatment with endovascular intervention or surgery, whereas others can be safely treated with blood pressure control and follow-up. In this review, we aimed to discuss the epidemiology, clinical presentation, pathogenesis, diagnosis, and management of this common posttransplant complication.

COVID-19 and Internet Hospital Development in China

Since 2018, the access policy for Internet hospitals has been issued in China. So far, thousands of Internet hospitals have been approved to operate and have played a significant role during the COVID-19 pandemic. While front-line hospitals strive to treat patients, Internet hospitals take the responsibility to guide patients to seek appropriate medical treatment and meet the urgent needs of chronic patients through online medical follow-up, payment, and drug distribution. This paper is based on Internet medical policies and interviews with doctors working with Internet hospitals, aiming to study the development of Internet hospitals in China through the management of the COVID-19 outbreak and the Chinese healthcare strategy on the national level.

Social policy reform driven by crises: Promoting and reshaping social policy during the SARS and COVID-19 pandemics in China

This article focuses on one particular and under-investigated dimension in the study of social policy - crisis events and their special function in promoting and shaping social protection programs. Crises are usually regarded as negative social events that tempestuously challenge the pre-existing socio-economic order, triggering social conflicts and disruption, either temporarily or in a more enduring fashion. However, social crises may also foster new opportunities for social investment, public finance expansion and welfare state building after the outbreak of a crisis and even during the post-crisis period. This article first examines the SARS pandemic and analyzes its developmental trajectory, reconstructing the national debates and discourses on the negative consequences and lessons learned in the SARS and post-SARS period. I argue that this crisis event revealed many loopholes in the Chinese public health system, constituting a powerful driving force for rebuilding the medical insurance system and health governance in China, and strengthening public discourse on welfare state responsibility. Second, I explore how, during the COVID-19 pandemic, scholars and experts have constructed the 'short board' of Chinese social policy, calling for further social policy reforms to narrow the gaps in health protection resources among social classes and to eliminate the fragmentation of health resource distribution.

Demographic Characteristics and Digital Platforms for Physical Activity Among the Chinese Residents During the COVID-19 Pandemic: A Mediating Analysis

Background

Aim

Methods

Results

Conclusion

Measuring online health-seeking behaviour: Construction and initial validation of a new scale

OBJECTIVES

Online health-seeking behaviour (OHSB) such as information- and support-seeking encompasses a range of motivations and outcomes, but few studies consider the nuances of OHSB. The current study aimed to (1) develop and provide an initial validation of an OHSB measure, and (2) explore the role of demographic variables in OHSB among adult Internet users.

DESIGN

The study was a quantitative, cross-sectional online survey.

METHODS

The study consistent of two data collection waves, including 451 general Internet users (aged 18-73) and 204 online health groups users (aged 19-78) who completed online questionnaires.

RESULT

Exploratory Factor Analysis and Item Analysis in the two samples resulted in a final 37-item measure. The scale comprises three distinct factors: Support seeking (α = .97); information seeking (α = .89); and the Internet as a supplement or alternative to offline medical care (α = .88). Multiple regression analyses indicated that younger age, a higher number of people living in the household, and presence of a chronic condition significantly predicted all three aspects of OHSB. Poorer perceived health also predicted support-seeking online, while being male, employed and a general Internet user (vs. online health group member) also predicted using the Internet as a supplement or alternative to offline medical care.

CONCLUSION

The study presents a useful scale for future research to explore more complex psychosocial, contextual and health-related variables as potential contributors to health-seeking in the online domain.