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Ärlebrant L, Dubois H, Creutzfeldt J, Edin-Liljegren A. Emergency care via video consultation: interviews on patient experiences from rural community hospitals in northern Sweden. Int J Emerg Med 2024; 17:109. [PMID: 39227787 PMCID: PMC11370045 DOI: 10.1186/s12245-024-00703-4] [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: 04/19/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and patients have a significant impact on the patient's experience of safety and inclusion. Understanding the patient perspective is crucial to developing good quality healthcare, but little is known about patient experiences of emergency care via VC in a rural context. The aim of this study was to explore patient experiences of emergency care via VC in northern rural Sweden. METHODS Using a qualitative approach, semi- structured interviews (n = 12) were conducted with individuals aged 18-89 who had received emergency care with a registered nurse (RN) on site and VC with a general practitioner (GP). The interviews were conducted between October 2021 and March 2023 at community hospitals (n = 7) in Västerbotten County, Sweden. Interviews were analysed with content analysis. RESULTS The analysis resulted in main categories (n = 2), categories (n = 5) and subcategories (n = 20). In the main category, "We were a team of three", patients described a sense of inclusion and ability to contribute. The patients perceived the interaction between the GP and RN to function well despite being geographically dispersed. Patients highly valued the opportunity to speak directly to the GP. In the main category, "VC was a two-sided coin", some experienced the emergency care through VC to be effective and smooth, while some felt that they received a lower quality of care and preferred face-to-face consultation with the GP. The quality of the VC was highly dependent on the RN's ability to function as the hub in the emergency room. CONCLUSION Patients in rural areas perceived being included in 'the team' during VC, however they experienced disadvantages with the system on individual basis. The nursing profession plays an important role, and a proper educational background is crucial to support RNs in their role as the hub of the visit. The GP's presence via VC was seen as important, but to fully enable them to fulfil their commitments as medical professionals, VC needs to be further improved with education and support from technical devices.
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Affiliation(s)
- Lina Ärlebrant
- Department of Epidemiology and Global Health, Umeå University, Centre for Rural Health, Region Västerbotten, Storuman, Sweden.
| | - Hanna Dubois
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anette Edin-Liljegren
- Department of Epidemiology and Global Health, Umeå University, Centre for Rural Health, Region Västerbotten, Storuman, Sweden
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Suero-Pineda A, Oliva-Pascual-Vaca Á, Durán MRP, Sánchez-Laulhé PR, García-Frasquet MÁ, Blanquero J. Response to Letter to the Editor On "Effectiveness of a Telerehabilitation Evidence-based Tablet App for Rehabilitation in Traumatic Bone and Soft-Tissue Injuries of the Hand, Wrist and Fingers". Arch Phys Med Rehabil 2024; 105:1212-1214. [PMID: 38522654 DOI: 10.1016/j.apmr.2024.02.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Alejandro Suero-Pineda
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain.
| | - Ángel Oliva-Pascual-Vaca
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain
| | | | | | | | - Jesús Blanquero
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Seville, Spain
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Söderberg D, Bonn SE, Sjöblom L, Dahlgren A, Muli I, Amer-Wåhlin I, Bertilson BC, Farrokhnia N, Hvitfeldt H, Taloyan M, Hägglund M, Trolle Lagerros Y. Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden. Telemed J E Health 2024; 30:1289-1296. [PMID: 38394275 DOI: 10.1089/tmj.2023.0351] [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: 02/25/2024] Open
Abstract
Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65-69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19-0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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Affiliation(s)
- Daniel Söderberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Stephanie E Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Linnea Sjöblom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Anna Dahlgren
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Irene Muli
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - Bo C Bertilson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hvitfeldt
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Norrtälje Hospital, Vårdbolaget Tiohundra, Stockholm, Sweden
| | - Marina Taloyan
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Hägglund
- Participatory e-Health and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Care Services, Stockholm, Sweden
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Loriot A, Larceneux F, Guillard V, Bertocchio JP. Patients' Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study. J Med Internet Res 2024; 26:e45702. [PMID: 38669676 PMCID: PMC11087856 DOI: 10.2196/45702] [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: 01/13/2023] [Revised: 05/08/2023] [Accepted: 12/19/2023] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Amélie Loriot
- Paris Dauphine-PSL (Paris Sciences & Lettres) University, Paris, France
| | - Fabrice Larceneux
- Paris Dauphine-PSL (Paris Sciences & Lettres) University, Paris, France
| | - Valérie Guillard
- Paris Dauphine-PSL (Paris Sciences & Lettres) University, Paris, France
| | - Jean-Philippe Bertocchio
- Service Thyroïde - Tumeurs Endocrines, Hôpital de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
- SKEZI, Annecy, France
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Wong AKC, Bayuo J, Wong FKY, Chow KKS, Wong SM, Wong BB, Law KHY. Experiences of receiving an mHealth application with proactive nursing support among community-dwelling older adults: a mixed-methods study. BMC Nurs 2024; 23:232. [PMID: 38584270 PMCID: PMC10999086 DOI: 10.1186/s12912-024-01909-w] [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: 05/12/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND As the population ages, a plethora of digital and mobile health applications for assistance with independent living have emerged. Still unknown, however, is how older adults sustain the use of these applications. AIM This study sought to explore the experiences of older adults following their participation in a programme that combined the use of an mHealth application with proactive telecare nursing support. METHODS We employed a concurrent mixed-methods design for this study. The quantitative strand included a survey, whereas the qualitative strand included open-ended questions as part of the survey to understand the participants' experiences. Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support. A convenience sampling approach was employed to recruit potential participants for this study. FINDINGS Fifty-five older adults participated. The majority expressed positive attitudes and satisfaction with the app and the nurses' support. The app and nurses' support helped participants to understand their health status and obtain health information. Reasons to halt app usage included technical issues and limited social support. CONCLUSION Mobile apps with professional follow-up support could potentially support older adults in the community, although emerging concerns need to be addressed to sustain long-term usage of these apps.
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Affiliation(s)
- Arkers Kwan Ching Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China.
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
| | | | - Siu Man Wong
- Hong Kong Lutheran Social Services, Homantin, Kowloon, Hong Kong, China
| | - Bonnie Bo Wong
- Hong Kong Lutheran Social Services, Homantin, Kowloon, Hong Kong, China
| | - Khloe Hau Yi Law
- School of Nursing, The Hong Kong Polytechnic University, 1 Cheong Wan Road, Hung Hom, Kowloon, Hong Kong, China
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Aslan A, Mold F, van Marwijk H, Armes J. What are the determinants of older people adopting communicative e-health services: a meta-ethnography. BMC Health Serv Res 2024; 24:60. [PMID: 38212713 PMCID: PMC10785477 DOI: 10.1186/s12913-023-10372-3] [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: 03/24/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Gradually, society has shifted more services online, with COVID-19 highlighting digital inequalities in access to services such as healthcare. Older adults can experience such digital inequalities, yet this group is also more likely to need medical appointments, compared to younger people. With the growing digitalisation of healthcare, it is increasingly important to understand how older people can best use communicative e-health services to interact with healthcare services. This is especially if older adults are to access, and actively interact with health professionals/clinicians due to their general health decline. This review aims to synthesise older adults' experiences and perceptions of communicative e-health services and, in turn, identify barriers and facilitators to using communicative e-health services. METHODS A meta-ethnography was conducted to qualitatively synthesise literature on older adults' experiences of using communicative e-health services. A systematic search, with terms relating to 'older adults', 'e-health', 'technology', and 'communication', was conducted on six international databases between January 2014 and May 2022. The search yielded a total of 10 empirical studies for synthesis. RESULTS The synthesis resulted in 10 themes that may impact older adults' perceptions and/or experiences of using communicative e-health services. These were: 1) health barriers, 2) support networks, 3) application interface/design, 4) digital literacy, 5) lack of awareness, 6) online security, 7) access to digital devices and the internet, 8) relationship with healthcare provider(s), 9) in-person preference and 10) convenience. These themes interlink with each other. CONCLUSION The findings suggest older adults' experiences and perceptions of communicative e-health services are generally negative, with many reporting various barriers to engaging with online services. However, many of these negative experiences are related to limited support networks and low digital literacy, along with complicated application interfaces. This supports previous literature identifying barriers and facilitators in which older adults experience general technology adoption and suggests a greater emphasis is needed on providing support networks to increase the adoption and usage of communicative e-health services.
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Affiliation(s)
- Ayse Aslan
- School of Health Sciences, University of Surrey, Guildford, UK.
| | - Freda Mold
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
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Wang P, Cheng L, Li Y, Zhang Y, Huang W, Li S, Wang Z, Shan L, Jiao M, Wu Q. Factors and key problems influencing insured's poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China. BMC Public Health 2023; 23:1066. [PMID: 37277834 DOI: 10.1186/s12889-023-15993-1] [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: 01/07/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the factors that affect insured's perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. METHODS We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. RESULTS Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267-5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612-3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036-3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129-1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. CONCLUSIONS This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.
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Affiliation(s)
- Peng Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Lixia Cheng
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Ye Li
- School of Public Health, Harbin Medical University, Harbin, 150081, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Yuchao Zhang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Weiqi Huang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Shuyi Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Zhizhen Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China
- School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Mingli Jiao
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.
- School of Public Health, Harbin Medical University, Harbin, 150081, China.
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Pullyblank K. A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization. West J Nurs Res 2023; 45:375-384. [PMID: 36324263 DOI: 10.1177/01939459221134374] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.
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Affiliation(s)
- Kristin Pullyblank
- Bassett Research Institute, Center for Rural Community Health, Cooperstown, NY, USA
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Rodríguez Sánchez-Laulhé P, Biscarri-Carbonero Á, Suero-Pineda A, Luque-Romero LG, Barrero García FJ, Blanquero J, Heredia-Rizo AM. The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:54-64. [PMID: 36633498 PMCID: PMC10035439 DOI: 10.23736/s1973-9087.22.07744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new delivery systems are needed to solve lack of adherence. AIM To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING Community health centers in rural southern Spain. POPULATION Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the CareHand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcomes.
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Affiliation(s)
- Pablo Rodríguez Sánchez-Laulhé
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain -
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain -
| | | | - Alejandro Suero-Pineda
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Luis G Luque-Romero
- Research Unit, Aljarafe-Sevilla North Health District, Andalusian Health Service, Seville, Spain
- Department of Normal and Pathological Cytology and Histology, University of Seville, Seville, Spain
| | | | - Jesús Blanquero
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Alberto M Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain
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10
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Kebede AS, Ozolins LL, Holst H, Galvin K. Digital Engagement of Older Adults: Scoping Review. J Med Internet Res 2022; 24:e40192. [PMID: 36477006 PMCID: PMC9773036 DOI: 10.2196/40192] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/21/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time. OBJECTIVE Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. METHODS We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability). CONCLUSIONS The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25616.
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Affiliation(s)
| | - Lise-Lotte Ozolins
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Hanna Holst
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Kathleen Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
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11
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Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
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12
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Saúde digital e enfermagem: ferramenta de comunicação na Estratégia Saúde da Família. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao020866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Morgan T, Duschinsky R, Barclay S. Dispensing care?: The dosette box and the status of low-fi technologies within older people's end-of-life caregiving practices. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:745-763. [PMID: 35266165 PMCID: PMC9314916 DOI: 10.1111/1467-9566.13455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Technology has been lauded as a solution to range of challenges presented by ageing population internationally. While the lion-share of scholarship has focussed on high-fi, digital technologies, there has been a recent shift to exploring the contributions mundane, low-fi technologies make to older people's daily lives and our understandings of health, illness and care more broadly. Drawing from serial narrative interview data collected with 19 married couples aged 70 and over living in the U.K., this article explores the way one medical technology-the dosette box-was taken-up and deployed in their end-of-life caring process. Informed by actor-network theory and critical feminist scholarship, this article considers how the dosette box played an active role in structuring relationships, scheduling daily care activities and enforcing medical compliance. In doing so, we suggest that the dosette box provided an unexpected companion and 'weapon of the weak' for older partner's attempting to assert their expertise and power while caring. We also explore how the dosette box demanded an even higher level of regular, vital care from older partner's once introduced into the home, thus entrenching the physical and emotional demands of dispensing care.
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Affiliation(s)
- Tessa Morgan
- School of NursingUniversity of AucklandAucklandNew Zealand
| | - Robbie Duschinsky
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Stephen Barclay
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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14
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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15
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What’s the Name of the Game? The Impact of eHealth on Productive Interactions in Chronic Care Management. SUSTAINABILITY 2021. [DOI: 10.3390/su13095221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic care management is dependent on productive interactions between patients and healthcare professionals. Digital health technologies (eHealth) open up new possibilities for improving the quality of care, but there is a limited understanding of what productive interactions entail. This study explores characteristics of productive interactions to support self-care and healthcare in the context of eHealth use in diabetes care. We collected qualitative data based on interviews with nurses and responses to open-ended survey questions from patients, prior to and post using an eHealth service for self-monitoring and digital communication. We found that eHealth’s influence on productive interactions was characterized by unconstrained access, health parameter surveillance, and data-driven feedback, with implications for self-care and healthcare. Our findings indicate that eHealth perforates the boundaries that define interactions under traditional, non-digital care. This was manifested in expressions of uncertainty and in blurred boundaries between self-care and healthcare. We conclude that the attainment of a sustainable eHealth ecosystem will require healthcare to acknowledge eHealth as a disruptive change that may require re-organization to optimally support the productive use of eHealth services for both patients and staff, which includes agreement on new routines, as well as social interaction rules.
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Kim M, Choi HJ. Digital Therapeutics for Obesity and Eating-Related Problems. Endocrinol Metab (Seoul) 2021; 36:220-228. [PMID: 33761233 PMCID: PMC8090472 DOI: 10.3803/enm.2021.107] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
In recent years, digital technologies have rapidly advanced and are being applied to remedy medical problems. These technologies allow us to monitor and manage our physical and mental health in our daily lives. Since lifestyle modification is the cornerstone of the management of obesity and eating behavior problems, digital therapeutics (DTx) represent a powerful and easily accessible treatment modality. This review discusses the critical issues to consider for enhancing the efficacy of DTx in future development initiatives. To competently adapt and expand public access to DTx, it is important for various stakeholders, including health professionals, patients, and guardians, to collaborate with other industry partners and policy-makers in the ecosystem.
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Affiliation(s)
- Meelim Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul,
Korea
- BK21 Plus Biomedical Science Project Team, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyung Jin Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul,
Korea
- BK21 Plus Biomedical Science Project Team, Seoul National University College of Medicine, Seoul,
Korea
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