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Almathami HKY, Win KT, Vlahu-Gjorgievska E. Empirical Evidence of Internal and External Factors Influencing Users' Motivation Toward Teleconsultation Use. Telemed J E Health 2024; 30:141-156. [PMID: 37343179 DOI: 10.1089/tmj.2022.0527] [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] [Indexed: 06/23/2023] Open
Abstract
Introduction: The use of teleconsultation systems has increased in recent years, which has improved patients' access to health care providers and enabled seamless interaction between them. The literature points out several factors that either facilitate or impede the use of teleconsultation. However, there is a lack of studies that provide empirical evidence of factors that influence consumers' motivation toward the use of teleconsultation systems. Aim and Objective: This study aimed to provide empirical evidence of the internal and external factors that influence consumers' motivation toward the use of teleconsultation systems. Methods: A cross-sectional survey was used to collect data from consumers who used a real-time teleconsultation system called the Sehha application in Saudi Arabia between March 13 and June 14, 2021. SPSS 27.0.1 was used for descriptive analysis. Results: Four hundred eighty-five participants completed the survey, 471 of whom were included in the analysis. The findings confirmed that internal and external factors exert an influence on consumers' motivation toward the use of teleconsultation systems. The findings indicated that the presence of factors such as saving time, saving cost, accessibility to health care, ease-of-use, reliable internet access, availability of devices, and appropriate places during the online connection would increase consumers' motivation toward teleconsultation systems use. Also, the findings indicated that users' familiarity with systems similar to teleconsultation systems, users' perception of teleconsultation convenience, the influence of others on users' decision to use teleconsultation, and user's skills and confidence in using teleconsultation easily, and their trust in the teleconsultation system would also increase their motivation to use it. Furthermore, the findings showed that demographic factors, including age, gender, level of education, and employment status, did not influence users' motivation toward the use of teleconsultation Conclusions: This study provided empirical evidence of a variety of internal and external factors that exert an influence on consumers' motivation toward the use of teleconsultation systems.
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Affiliation(s)
- Hassan Khader Y Almathami
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- College of Computers and Information Systems, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khin Than Win
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Elena Vlahu-Gjorgievska
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
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Negev M, Magal T, Kaphzan H. Attitudes of psychiatrists toward telepsychiatry: A policy Delphi study. Digit Health 2023; 9:20552076231177132. [PMID: 37312951 PMCID: PMC10259121 DOI: 10.1177/20552076231177132] [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: 11/10/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives To delineate areas of consensus and disagreements among practicing psychiatrists from various levels of clinical experience, hierarchy and organizations, and to test their ability to converge toward agreement, which will enable better integration of telepsychiatry into mental health services. Methods To study attitudes of Israeli public health psychiatrists, we utilized a policy Delphi method, during the early stages of the COVID pandemic. In-depth interviews were conducted and analyzed, and a questionnaire was generated. The questionnaire was disseminated amongst 49 psychiatrists, in two succeeding rounds, and areas of consensus and controversies were identified. Results Psychiatrists showed an overall consensus regarding issues of economic and temporal advantages of telepsychiatry. However, the quality of diagnosis and treatment and the prospect of expanding the usage of telepsychiatry to normal circumstances-beyond situations of pandemic or emergency were disputed. Nonetheless, efficiency and willingness scales slightly improved during the 2nd round of the Delphi process. Prior experience with telepsychiatry had a strong impact on the attitude of psychiatrists, and those who were familiar with this practice were more favorable toward its usage in their clinic. Conclusions We have delineated experience as a major impact on the attitudes toward telepsychiatry and the willingness for its assimilation in clinical practice as a legitimate and trustworthy method. We have also observed that the organizational affiliation significantly affected psychiatrists' attitude, when those working at local clinics were more positive toward telepsychiatry compared with employees of governmental institutions. This might be related to experience and differences in organizational environment. Taken together, we recommend to include hands-on training of telepsychiatry in medical education curriculum during residency, as well as refresher exercises for attending practitioners.
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Affiliation(s)
- Maya Negev
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamir Magal
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
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Hsieh HL, Lai JM, Chuang BK, Tsai CH. Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework. Healthcare (Basel) 2022; 10:2038. [PMID: 36292485 PMCID: PMC9601836 DOI: 10.3390/healthcare10102038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
Owing to the COVID-19 pandemic, many countries' physicians in the world have used telehealth to visit patients via telehealth. The study aimed to integrate the theory of planned behavior (TPB), the technology acceptance model (TAM), and self-determination theory (SDT) to explore the adoption behavior of a telehealth system. A convenient sample of residents was drawn from the population of Nantou County in Taiwan and analyzed via structural equation modeling. The findings revealed that attitude, perceived behavioral control, perceived usefulness, and perceived autonomy support jointly have significantly positive effects on continuance intention. Results also confirmed that perceived autonomy support, perceived ease of use, and perceived usefulness jointly have significantly positive effects on attitude. Furthermore, this study also showed that a crucial mediators' role is played by perceived ease of use, perceived usefulness, and attitude. The conclusions and practical implications of the research will hopefully provide health organizations and institutions with some innovative insights and foresights, which in turn will promote better practices and services of telehealth technology.
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Affiliation(s)
| | - Jhih-Ming Lai
- Department of Information Technology and Management, Tzu Chi University of Science and Technology, Hualien 973302, Taiwan
| | | | - Chung-Hung Tsai
- Department of Information Technology and Management, Tzu Chi University of Science and Technology, Hualien 973302, Taiwan
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4
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Knörr V, Dini L, Gunkel S, Hoffmann J, Mause L, Ohnhäuser T, Stöcker A, Scholten N. Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians. BMC PRIMARY CARE 2022; 23:92. [PMID: 35461212 PMCID: PMC9034069 DOI: 10.1186/s12875-022-01699-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany. METHODS The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians. RESULTS The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients. CONCLUSION The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.
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Affiliation(s)
- Vera Knörr
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Lorena Dini
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Gunkel
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Jan Hoffmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Laura Mause
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Arno Stöcker
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine at the University Hospital, University of Cologne, Cologne, Germany.
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deMayo R, Huang Y, Lin EJD, Lee JA, Heggland A, Im J, Grindle C, Chandawarkar A. Associations of Telehealth Care Delivery with Pediatric Health Care Provider Well-Being. Appl Clin Inform 2022; 13:230-241. [PMID: 35172372 PMCID: PMC8850009 DOI: 10.1055/s-0042-1742627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background
The rapid, large-scale deployment of new health technologies can introduce challenges to clinicians who are already under stress. The novel coronavirus disease 19 (COVID-19) pandemic transformed health care in the United States to include a telehealth model of care delivery. Clarifying paths through which telehealth technology use is associated with change in provider well-being and interest in sustaining virtual care delivery can inform planning and optimization efforts.
Objective
This study aimed to characterize provider-reported changes in well-being and daily work associated with the pandemic-accelerated expansion of telehealth and assess the relationship of provider perceptions of telehealth effectiveness, efficiency, and work–life balance with desire for future telehealth.
Methods
A cross-sectional survey study was conducted October through November 2020, 6 months after the outbreak of COVID-19 at three children's hospitals. Factor analysis and structural equation modeling (SEM) were used to examine telehealth factors associated with reported change in well-being and desire for future telehealth.
Results
A total of 947 nontrainee physicians, advanced practice providers, and psychologists were surveyed. Of them, 502 (53.0%) providers responded and 467 (49.3%) met inclusion criteria of telehealth use during the study period. Of these, 325 (69.6%) were female, 301 (65.6%) were physicians, and 220 (47.1%) were medical subspecialists. Providers were 4.77 times as likely (95% confidence interval [CI]: 3.29–7.06) to report improved versus worsened well-being associated with telehealth. Also, 95.5% of providers (95% CI: 93.2–97.2%) wish to continue performing telehealth postpandemic. Our model explains 66% of the variance in telehealth-attributed provider well-being and 59% of the variance for future telehealth preference and suggests telehealth resources significantly influence provider-perceived telehealth care effectiveness which in turn significantly influences provider well-being and desire to perform telehealth.
Conclusion
Telehealth has potential to promote provider well-being; telehealth-related changes in provider well-being are associated with both provider-perceived effectiveness of telemedicine for patients and adequacy of telehealth resources.
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Affiliation(s)
- Richelle deMayo
- Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States.,Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States
| | - Yungui Huang
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - En-Ju D Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Jennifer A Lee
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Andrew Heggland
- Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States.,Division of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States
| | - Jane Im
- Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States.,Division of Pediatric Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, United States
| | - Christopher Grindle
- Division of Clinical Informatics, Connecticut Children's Medical Center, Hartford, Connecticut, United States.,Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, United States.,Division of Otolaryngology, Connecticut Children's Medical Center, Hartford, Connecticut, United States
| | - Aarti Chandawarkar
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
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Garavand A, Aslani N, Nadri H, Abedini S, Dehghan S. Acceptance of telemedicine technology among physicians: A systematic review. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Peng X, Li Z, Zhang C, Wu Q, Gu J, You H. Assessing Determinants of Online Medical Services Adoption Willingness of General Hospital Physicians Using the Information-Motivation-Behavioral Skills Model: A Multi-Group Structural Equation Modeling Approach. J Multidiscip Healthc 2021; 14:3453-3462. [PMID: 34992374 PMCID: PMC8710087 DOI: 10.2147/jmdh.s346675] [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: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Physician adoption of online medical services (OMS) has been hastened by the COVID-19 pandemic, but their adoption willingness still requires to be improved. This study aims to construct a physician's OMS adoption willingness model based on the information-motivation-behavioral skill (IMB) theory, explore the determinants affecting adoption willingness and its influencing pathways, and evaluate the moderating effects of OMS use experience on willingness through multi-group analysis. PARTICIPANTS AND METHODS A cross-sectional survey was conducted among physicians in three public hospitals of Jiangsu province, China, from June to July 2020, using a multi-stage sampling method. Structural equation modeling was applied to analyze the valid data from 531 respondents. RESULTS Physicians' willingness to adopt OMS was at a moderate level, with an average score of 14.27±3.34 (range: 4-20). The behavior model for physician's OMS adoption willingness fitted well. Information (In), motivation (Mo), and behavioral skill (BS) explained 69% of the variance in adoption willingness (AW). Information could only exert completely indirect effect on willingness via behavioral skills (b = 0.202, 95% CI[0.122, 0.314]); motivation could both generate direct effect (β=0.368, p < 0.001) and partial indirect effect on willingness via behavioral skills (b = 0.160, 95% CI[0.092, 0.248]); and behavioral skills had a positive effect on willingness (β=0.424, p < 0.001). Furthermore, OMS use experience showed a significant moderating effect on the Mo → AW pathway, with inexperienced physicians' willingness being significantly stronger influenced by motivation compared to experienced ones. CONCLUSION Findings from this study revealed the role of IMB model in interpreting and predicting physicians' willingness to adopt OMS and the moderating effect of uptake experience, providing practitioners with a theoretical foundation and intervention framework for supporting OMS development efforts.
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Affiliation(s)
- Xueqing Peng
- School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
| | - Zhiguang Li
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Chi Zhang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
| | - Qifeng Wu
- School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
| | - Jinghong Gu
- College of Art and Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Hua You
- School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
- School of Nursing, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
- Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
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8
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Alvarado-Villa G, KuonYeng-Escalante C, Sagñay-Pinilla N, Vera Paz C, Cherrez-Ojeda I. Perceptions and knowledge of telemedicine in Ecuadorian practicing physicians: an instrument adaptation, validation and translation from English to Spanish. BMC Public Health 2021; 21:1781. [PMID: 34600498 PMCID: PMC8486965 DOI: 10.1186/s12889-021-11826-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, multiple countries have taken measures, such as isolation and quarantine, to prevent person-to-person spread of disease. These actions forced many physicians to adopt new techniques, such as telemedicine, to continue patient care, which has proven to be useful in continued care for those with non-COVID-19 pathologies. Various factors, such as security, confidentiality, cost-effectiveness, comfort, and the risk of malpractice, influence the perception of telemedicine among medical practitioners. The aim of this study was to adapt an existing instrument and validate it into a new Spanish version. The instrument is about the perceptions and knowledge of telemedicine in healthcare professionals. METHODS The original questionnaire surveyed 6 domains with 40 questions, and each question was measured with a five-point Likert scale ranging from very high [5] to very low [1]. The survey was translated to Spanish using machine translation. The translation was reviewed independently, and then, a consensus was achieved regarding minor changes in the syntax of the survey to facilitate understanding. After expert feedback and questionnaire review, the research team members proposed reducing the instrument to 13 items in 4 domains due to the similarity of some questions. The sample was divided into 2randomly selected groups. Eligibility criteria included physicians providing private or public services with active medical/clinical practice. RESULTS In total, 382 surveys were collected and separated into two random samples, S1 and S2 (198 and 184, respectively). In exploratory factor analysis (EFA), the 13 items were grouped into four theoretical domains, and item 7 presented cross loading between factors and was removed. Confirmatory factor analysis was performed to assess the scale reliability and interscale associations; three models were tested. Global Cronbach's alpha for internal consistency was 0.76 for the EFA. The goodness of fit measures root mean square error of approximation and comparative fit index were 0.009 and 0.999, respectively, for the best model. CONCLUSIONS The translated instrument was clear, with adequate internal consistency, readability, and appropriate for application in the physician setting. This validated questionnaire made it possible to evaluate physicians' knowledge of telemedicine to increase its use, especially during the COVID-19 pandemic.
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Pikkemaat M, Thulesius H, Milos Nymberg V. Swedish Primary Care Physicians' Intentions to Use Telemedicine: A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT). Int J Gen Med 2021; 14:3445-3455. [PMID: 34295177 PMCID: PMC8290350 DOI: 10.2147/ijgm.s319497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 02/02/2023] Open
Abstract
Background Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R2 = 0.54), chronic disease monitoring with digital tools (R2 = 0.47) and artificial intelligence (R2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
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Affiliation(s)
- Miriam Pikkemaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Linnaeus University, Kalmar, Sweden
| | - Veronica Milos Nymberg
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
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Jacob C, Sanchez-Vazquez A, Ivory C. Understanding Clinicians' Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks. JMIR Mhealth Uhealth 2020; 8:e18072. [PMID: 32442132 PMCID: PMC7381026 DOI: 10.2196/18072] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/15/2020] [Accepted: 04/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors. OBJECTIVE This review aimed to explore which frameworks are used the most, to understand clinicians' adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors. METHODS This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians' adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly. RESULTS The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34%), the diffusion of innovation theory (DOI; 8/50, 16%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6%), whereas others used the consolidated framework for implementation research (3/50, 6%) and sociotechnical systems (STS) theory (2/50, 4%). The factors cited by more than 20% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion. CONCLUSIONS Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians' adoption of mHealth, taking into account all three aspects.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020; 8:e15935. [PMID: 32130167 PMCID: PMC7059085 DOI: 10.2196/15935] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/31/2019] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom.,University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Jacob C, Sanchez-Vazquez A, Ivory C. Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review. JMIR Mhealth Uhealth 2020. [PMID: 32130167 DOI: 10.2196/preprints.15935] [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] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. OBJECTIVE The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians' adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. METHODS A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. RESULTS The technological factors impacting clinicians' adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
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Affiliation(s)
- Christine Jacob
- Anglia Ruskin University, Cambridge, United Kingdom
- University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
| | - Antonio Sanchez-Vazquez
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Chen SCI, Liu C. Factors Influencing the Application of Connected Health in Remote Areas, Taiwan: A Qualitative Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1282. [PMID: 32079241 PMCID: PMC7068356 DOI: 10.3390/ijerph17041282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022]
Abstract
This pilot study investigated factors influencing the application of connected health (CH) in Taiwanese remote areas. These factors cover issues of cost, infrastructure, technology, business sustainability, business model, collaboration, and communication. It aimed to explore the significance and to assess the feasibility of researching CH in Taiwan. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 18). The majority were healthcare providers as most of them are the CH end users. Their feedback was essential in reflecting the effectiveness of CH products and services. Therefore, understanding their views is significant in the design of a successful and user-friendly interactive system. A theoretical framework on the introduction of innovations in healthcare was employed to guide data collection and thematic analysis. Additionally, stakeholders proposed strategies for enhancing the implementation of CH in remote areas. This pilot study also contributed to identifying future directions and information for conducting the multi-stage interviews for collecting the data more effectively. Although the results reveal that the study of CH is meaningful, there is an issue of business sustainability which is obscured by some barriers that need to be addressed. These barriers will be further investigated in the first-stage interview and second-stage interview in future research. The research findings also suggest that strategies and sustainability for CH implementation should be included from the planning phase to benefit all the stakeholders in the CH ecosystem.
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Affiliation(s)
- Sonia Chien-I. Chen
- School of Economics and Finance, Huaqiao University, Quanzhou 362021, China;
| | - Chenglian Liu
- School of Computing, Neusoft Institute of Guangdong, Foshan 528225, China
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Ly BA, Labonté R, Bourgeault IL. The beliefs of Senegal's physicians toward the use of telemedicine. Pan Afr Med J 2019; 34:97. [PMID: 31934240 PMCID: PMC6945665 DOI: 10.11604/pamj.2019.34.97.20216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Telemedicine is seen as a potential solution to improve access to specialist services in underserved areas, but using telemedicine depends on physicians' beliefs regarding its use. Applying the theory of planned behaviour, there are three kinds of beliefs of relevance: behavioural, normative and control beliefs. This study aimed to determine the behavioural, normative and control beliefs of Senegal's physicians regarding the use of telemedicine. METHODS A qualitative descriptive study involving individual interviews with physicians was conducted between January and June 2014. It included 32 physicians working in public hospitals and 37 physicians working in district health centres. Interviews were taped, transcribed and their content coded thematically using the NVivo 10 software. RESULTS The most significant positive behavioural belief was that telemedicine makes experts' opinions accessible despite distance; the most important negative behavioural belief was that telemedicine can lead to medical errors. The positive normative belief mentioned most was that patients approve the use of telemedicine, but the negative normative belief mentioned most was that the patients would not approve it. The prevailing positive control belief was that physicians will use telemedicine if it is easy to use and the most cited negative control belief was that physicians will not use telemedicine if they have insufficient time. CONCLUSION The results of this study provide a better understanding of the beliefs of Senegal's physicians regarding telemedicine, which can help in designing interventions to promote its use. Such interventions may help improve access to healthcare in rural areas.
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Affiliation(s)
- Birama Apho Ly
- Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ronald Labonté
- Faculty of Medicine, University of Ottawa, Ontario, Canada
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Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the Intention of Senegal's Physicians to Use Telemedicine in Their Professional Activities. Telemed J E Health 2018; 24:897-898. [DOI: 10.1089/tmj.2017.0276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Birama Apho Ly
- Department of Public Health, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Elizabeth Kristjansson
- Population Health Program, University of Ottawa, Ontario, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ontario, Canada
| | - Ronald Labonté
- Population Health Program, University of Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Ivy Lynn Bourgeault
- Population Health Program, University of Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ontario, Canada
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