Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital

National waiting time monitoring in oral healthcare - The role of triage dental nurses

OBJECTIVES

Our study analyzed dental nurses' use and use behavior determinants of electronic patient IS modules in telephone triage. The modules were implemented in public oral healthcare organizations' patient ISs to digitalize the national waiting time monitoring system.

METHODS

For the cross-sectional survey, we collected data from dental nurses using convenience sampling and applied a modified UTAUT as the theoretical framework.

RESULTS

The results indicate that using the module for different purposes varied, and the nurses used it sparsely in recording data for monitoring national waiting times. Using the module was laborious, and triage work was busy.

CONCLUSION

Dental nurses' low system usage resulted in poor-quality data for waiting time monitoring. As healthcare data is increasingly used for purposes other than clinical decision making, we must ensure that healthcare professionals performing clinical tasks perceive data recording for non-clinical purposes as meaningful and have time for proper data entry.

Understanding the predictors of health professionals' intention to use electronic health record system: extend and apply UTAUT3 model

BACKGROUND

The implementation of Electronic Health Record (EHR) systems is a critical challenge, particularly in low-income countries, where behavioral intention plays a crucial role. To address this issue, we conducted a study to extend and apply the Unified Theory of Acceptance and Use of Technology 3 (UTAUT3) model in predicting health professionals' behavioral intention to use EHR systems.

METHODS

A quantitative research approach was employed among 423 health professionals in Southwest Ethiopia. We assessed the validity of the proposed model through measurement and structural model statistics. Analysis was done using SPSS AMOS version 23. Hypotheses were tested using structural equation modeling (SEM) analysis, and mediation and moderation effects were evaluated. The associations between exogenous and endogenous variables were examined using standardized regression coefficients (β), 95% confidence intervals, and p-values, with a significance level of p-value < 0.05.

RESULTS

The proposed model outperformed previous UTAUT models, explaining 84.5% (squared multiple correlations (R2) = 0.845) of the variance in behavioral intention to use EHR systems. Personal innovativeness (β = 0.215, p-value < 0.018), performance expectancy (β = 0.245, p-value < 0.001), and attitude (β = 0.611, p-value < 0.001) showed significant associations to use EHR systems. Mediation analysis revealed that performance expectancy, hedonic motivation, and technology anxiety had significant indirect effects on behavioral intention. Furthermore, moderation analysis indicated that gender moderated the association between social influence, personal innovativeness, and behavioral intention.

CONCLUSION

The extended UTAUT3 model accurately predicts health professionals' intention to use EHR systems and provides a valuable framework for understanding technology acceptance in healthcare. We recommend that digital health implementers and concerned bodies consider the comprehensive range of direct, indirect, and moderating effects. By addressing personal innovativeness, performance expectancy, attitude, hedonic motivation, technology anxiety, and the gender-specific impact of social influence, interventions can effectively enhance behavioral intention toward EHR systems. It is crucial to design gender-specific interventions that address the differences in social influence and personal innovativeness between males and females.

Intention to use picture archiving and communication system and its predictors among physicians and nurses at specialized teaching hospitals in Amhara region, Northwest Ethiopia

Background

Picture archiving and communication system is an innovation system in the health information that reduces costs, facilitates access to medical image, and improves workflow in radiology department. However, studies indicated that intention and usage of picture archiving and communication system is limited in middle-income and developing countries.

Objective

This study aimed to assess the intention to use picture archiving and communication system and its predictors among physicians and nurses at specialized teaching hospitals in Amhara region, Northwest Ethiopia.

Method

Institution-based cross-sectional study design was conducted from October 11 to November 12, 2023. Proportional allocation and a simple random sampling were used to select participants of the study. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into Epi data 4.6 and exported to SPSS 26 and AMOS 23. Descriptive and structural equation modeling analysis was performed. The hypothesis was tested using a path coefficient and a p-value <0.05.

Results

About 54.7% (95%: CI: 50.9-58.4) of the participant intended to use picture archive and communication system with a 90.38% of response rate. Performance expectancy (β = 0.146, p-value <0.05), perceived enjoyment (β = 0.397, p-value <0.001), and computer literacy (β = 0.191, p-value <0.001) had positive influence on intention to use picture archiving and communication system.

Conclusions

Overall, more than half of physicians' and nurses' intention to use picture archiving and communication system were at hopeful stage for future. Performance expectancy, perceived enjoyment and computer literacy had direct positive effect on intention to use picture archiving and communication system among physicians and nurses. The designers, developers, and managers of the picture archiving and communication system should consider these variables. Furthermore, using this system can improve quality of health service through change workflow in to digital image, clinicians evaluate image more quickly and saving resources.

Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study

BACKGROUND

Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide.

OBJECTIVE

This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province.

METHODS

A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service.

RESULTS

Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption.

CONCLUSIONS

This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.

Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model

BACKGROUND

IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS.

OBJECTIVE

This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision.

METHODS

A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05.

RESULTS

A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS.

CONCLUSIONS

HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

Implementing Telehealth Among Occupational Therapists Working in the Health Care System: A Survey on the Current Practice and Experiences

Background: Occupational therapy services implemented via telehealth (Tele-OT) have declined since COVID-19, despite their well-known benefits. This study aimed to (1) compare the demographic and the clinical characteristics, attitudes, perceived usability, self-efficacy toward Tele-OT, and the factors affecting technology use for occupational therapists with and without Tele-OT experience; (2) describe the current practice and examine the factors associated with Tele-OT implementation; and (3) better understand the barriers and facilitators for implementing Tele-OT. Methods: An online survey invited ocupational therapists working in the health care system. The following measures were used: the Technical affinity-attitude (TA-EG) measured attitudes toward Tele-OT, the System Usability Scale measured perceived Tele-OT usability, and the Unified Theory of Acceptance and Use of Technology measured factors related to Tele-OT use and self-efficacy. An open-ended question requested ocupational therapists to describe one Tele-OT session. Results: We included 309 occupational therapists (mean [SD] age = 39.1 [9.9]): 181 with and 128 without Tele-OT experience. The groups significantly (p < 0.001) differed in age and years of OT experience. No between-group differences were found regarding attitudes, perspectives, and self-efficacy for Tele-OT. Occupational therapists used video platforms, apps, and phones to conduct the Tele-OT sessions. Descriptions of the Tele-OT sessions were qualitatively sorted into "perceived experience" (i.e., satisfaction and challenges) and "factors related to Tele-OT implementation" (e.g., infrastructure and technology). Conclusions: Occupational therapists with and without Tele-OT experience have similar attitudes and self-efficacy regarding Tele-OT. Thus, Tele-OT implementation may be affected by other personal and environmental factors. Health care organizations can possibly use these findings to promote Tele-OT and bridge the implementation gap.

Investigating allied health professionals' attitudes, perceptions and acceptance of an electronic medical record using the Unified Theory of Acceptance and Use of Technology

Objective This study aimed to investigate allied health professionals' (AHPs') perspectives pre- and post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods Data were collected pre- and post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann-Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption.

Technology adoption of electronic medical records in developing economies: A systematic review on physicians' perspective

Electronic Medical Records (EMRs) are a tool that could potentially improve the outcomes of patient care by providing physicians with access to up-to-date and accurate vital patient information. Despite this potential, EMR adoption in developing economies has been dilatory. This systematic review aims to synthesize the related literature on the adoption of EMRs in developing economies, with a focus on the perspective of physicians. With the aim to discern the key factors that impact EMR adoption as perceived by physicians and to offer guidance for future research on filling any gaps identified in the existing literature, this study utilized a systematic literature review by following the PRISMA guidelines. Out of 1160 initial articles, 21 were selected for analysis after eliminating duplicates and non-qualifying articles. Results show that common enablers of EMR adoption from physicians' perspective were identified to be computer literacy, education, voluntariness, and the system functionality including its features and user interface, implying that the provision of proper interventions focusing on the aspects of the health information system has an impact in maximizing the utilization and capabilities of EMRs among healthcare providers. The most prevalent barriers include the lack of training and IT usage experience along with resistance to changes associated with respondents' age and gender, the lack of time for learning complex EMR systems, and costs of the new technology. This indicates that a thorough planning and proper budget allocation is necessary prior to implementing and integrating EMR systems in healthcare institutions. From this synthesis of the common research conclusions, limitations, and recommendations from physicians' perspective, the result of this systematic review is expected to shed light on the optimal technology adoption of EMRs and its contribution to the health care systems of developing economies.

Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study

BACKGROUND

The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses' opinions of smart devices that provide integrated nursing for patients' urinary and bowel elimination needs.

OBJECTIVE

This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care.

METHODS

Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods.

RESULTS

A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia.

CONCLUSIONS

Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses' work efficiency, reduce their burden, and extend to caregivers and guardians.

Factors Influencing the Acceptability, Acceptance, and Adoption of Conversational Agents in Health Care: Integrative Review

BACKGROUND

Conversational agents (CAs), also known as chatbots, are digital dialog systems that enable people to have a text-based, speech-based, or nonverbal conversation with a computer or another machine based on natural language via an interface. The use of CAs offers new opportunities and various benefits for health care. However, they are not yet ubiquitous in daily practice. Nevertheless, research regarding the implementation of CAs in health care has grown tremendously in recent years.

OBJECTIVE

This review aims to present a synthesis of the factors that facilitate or hinder the implementation of CAs from the perspectives of patients and health care professionals. Specifically, it focuses on the early implementation outcomes of acceptability, acceptance, and adoption as cornerstones of later implementation success.

METHODS

We performed an integrative review. To identify relevant literature, a broad literature search was conducted in June 2021 with no date limits and using all fields in PubMed, Cochrane Library, Web of Science, LIVIVO, and PsycINFO. To keep the review current, another search was conducted in March 2022. To identify as many eligible primary sources as possible, we used a snowballing approach by searching reference lists and conducted a hand search. Factors influencing the acceptability, acceptance, and adoption of CAs in health care were coded through parallel deductive and inductive approaches, which were informed by current technology acceptance and adoption models. Finally, the factors were synthesized in a thematic map.

RESULTS

Overall, 76 studies were included in this review. We identified influencing factors related to 4 core Unified Theory of Acceptance and Use of Technology (UTAUT) and Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) factors (performance expectancy, effort expectancy, facilitating conditions, and hedonic motivation), with most studies underlining the relevance of performance and effort expectancy. To meet the particularities of the health care context, we redefined the UTAUT2 factors social influence, habit, and price value. We identified 6 other influencing factors: perceived risk, trust, anthropomorphism, health issue, working alliance, and user characteristics. Overall, we identified 10 factors influencing acceptability, acceptance, and adoption among health care professionals (performance expectancy, effort expectancy, facilitating conditions, social influence, price value, perceived risk, trust, anthropomorphism, working alliance, and user characteristics) and 13 factors influencing acceptability, acceptance, and adoption among patients (additionally hedonic motivation, habit, and health issue).

CONCLUSIONS

This review shows manifold factors influencing the acceptability, acceptance, and adoption of CAs in health care. Knowledge of these factors is fundamental for implementation planning. Therefore, the findings of this review can serve as a basis for future studies to develop appropriate implementation strategies. Furthermore, this review provides an empirical test of current technology acceptance and adoption models and identifies areas where additional research is necessary.

TRIAL REGISTRATION

PROSPERO CRD42022343690; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343690.

Nurses' Burden of Elimination Care: Sequential Explanatory Mixed-Methods Design

Background

Inpatients commonly experience problems with elimination due to incontinence, urinary retentions, and complications with indwelling catheters. Although elimination care (EC) is an important nursing area, few studies explore the burden of EC on nurses.

Aim

To identify the burden on EC by analyzing nurses' opinions using sequential explanatory mixed method.

Methods

This research was conducted using a sequential explanatory mixed-methods design. A total of 59 nurses at a tertiary hospital in South Korea participated in the study from January 1 to March 31, 2022. For quantitative analysis, information about number of delays of work due to EC, required time for serving bedpan or diaper changes, percentage of EC per shift, and percentage of patients who need EC was collected through a survey. For qualitative analysis, focus group interviews were conducted to identify factors that put a burden on EC. Important themes were derived by analyzing nurses' opinions on EC.

Results

For nurses in intensive care units, general wards, and integrated nursing care wards, the number of work delays due to EC was 3.6 ± 1.5, 2.3 ± 1.2, and 4.8 ± 2.4 (p<0.01), respectively. The mean percentage of EC work out of total nursing tasks per shift was 36.2 ± 19.0, 29.3 ± 14.4, and 43.8 ± 14.1 (p=0.02), respectively. The mean percentage of patients requiring EC out of patients a nurse cares was 85.4 ± 16.6, 41.3 ± 26.1, and 58.8 ± 21.9 (p<0.01), respectively. Following qualitative analysis, four themes related to nurses' EC burden were derived: physical burden, frequent care needs, delay of other jobs due to EC, and complications. Among them, frequent care needs were found to be the primary factor requiring consideration to reduce nurses' burden.

Conclusion

This research found that EC is one of the most burdensome tasks that nurses want to avoid. To alleviate their burden, effective EC protocol or smart medical devices assisting with EC should be developed.

An examination of large-scale electronic health records implementation in Primary Healthcare Centers in Saudi Arabia: a qualitative study

Introduction

Digital transformation has become a buzzword in almost every industry in the twenti first century. Healthcare is not an exception. In the healthcare industry, digital transformation includes the utilization of electronic health records (EHRs), telemedicine, health information exchange, mobile health, and other interactive platforms. The importance of digital transformation in healthcare cannot be overemphasized as it has proven to be critical in improving patient outcomes, making healthcare delivery more efficient, and reducing costs. The positive impact of electronic health records was noticed almost immediately in the field of primary healthcare. It has been suggested that implementing electronic health records will enhance the accessibility and the process of distribution of health records between authorized users. As part of Saudi vision 2030, all healthcare organizations in Saudi Arabia are going to shift to digital transformation.

Methods

This study follows a qualitative, semi-structure, face-to-face interview approach. The collected data were analyzed using NVivo V10 software. Inductive thematic analysis approach was used to analyse the collected data from the interviews.

Result

Seventeen project team members, from different positions and backgrounds were purposively chosen to be interviewed. Three main themes and 38 codes were generated from the analysis of transcripts. The informants describe the implementation of electronic health records in the PHCs based on two different experiences. The participants reported that a previous attempt failed due to inappropriate infrastructure, lack of technical support, and low level of user acceptance. Therefore, the policymakers adopted several steps to increase the level of success and avoid failure causes. They initially established well-defined requests for proposals followed by continuous commendation among the project team and conducted a consultation on multiple levels (country level; organizational level and individual level).

Conclusion

This study concluded that the main causes that lead to the failure of the large-scale project were lack of connectivity, lack of technical support, and staff changes, particularly those who occupied high-level positions in the Saudi ministry of Health. The success rate of EHRs implementation can be directly impacted by the size of the project. Large-scale projects are complicated and may be subject to numerous challenges compared with small projects. Significant factors such as training, support, legal issues, and organizational workflow and redesign were a concern of the project team during the pre-implementation phase. In addition, other factors related to technology and end-users were included in the EHRs implementation plan.

Acceptance of a Text Messaging Vaccination Reminder and Recall System in Malaysia's Healthcare Sector: Extending the Technology Acceptance Model

Malaysian healthcare institutions still use ineffective paper-based vaccination systems to manage childhood immunization schedules. This may lead to missed appointments, incomplete vaccinations, and outbreaks of preventable diseases among infants. To address this issue, a text messaging vaccination reminder and recall system named Virtual Health Connect (VHC) was studied. VHC simplifies and accelerates immunization administration for nurses, which may result in improving the completion and timeliness of immunizations among infants. Considering the limited research on the acceptance of these systems in the healthcare sector, we examined the factors influencing nurses' attitudes and intentions to use VHC using the extended technology acceptance model (TAM). The novelty of the conceptual model is the incorporation of new predictors of attitude, namely, perceived compatibility and perceived privacy and security issues. We conducted a survey among 121 nurses in Malaysian government hospitals and clinics to test the model. We analyzed the collected data using partial least squares structural equation modeling (PLS-SEM) to examine the significant factors influencing nurses' attitudes and intentions to use VHC. Moreover, we applied an artificial neural network (ANN) to determine the most significant factors of acceptance with higher accuracy. Therefore, we could offer more accurate insights to decision-makers in the healthcare sector for the advancement of health services. Our results highlighted that the compatibility of VHC with the current work setting of nurses developed their positive perspectives on the system. Moreover, the nurses felt optimistic about the system when they considered it useful and easy to use in the workplace. Finally, their attitude toward using VHC played a pivotal role in increasing their intention to use it. Based on the ANN models, we also found that perceived compatibility was the most significant factor influencing nurses' attitudes towards using VHC, followed by perceived ease of use and perceived usefulness.

Perceptions and Attitudes toward a Proposed Digital Health Physical Activity Program among Older Family Caregivers of Persons with Heart Failure: A Qualitative Study

Tailored physical activity (PA) programs using digital health technologies in the home can promote family caregivers' (FCGs) physical function and psychological wellbeing. However, there is a gap in research for digital health PA interventions targeting older FCGs of persons with HF (HF-FCGs). The burden of caregiving for persons with HF may displace the FCG's self-care, including PA. Therefore, we examined older HF-FCGs' perceptions and attitudes toward three technology components (video-conferencing, fitness tracker, text messaging) that would be most useful in delivering a digital health PA program. Interviews were conducted with 13 HF-FCGs (≥65 years old) between January and April 2021. Directed content analysis was used and the analysis was guided by the adapted unified theory of acceptance and use of technology (UTAUT) model. In addition to HF-FCGs' perceptions and attitudes toward each technology component in each construct of the adapted UTAUT model (ease of use, usefulness, facilitating conditions), three additional factors were associated with intention to use technology. These were: (1) HF patients' positive experience, (2) digital skills, and (3) quality of internet connectivity. The findings provide digital health requirements for design and modification of a technology-supported PA program that engages older FCGs who care for persons with HF.

Factors Predicting Older People's Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study

BACKGROUND

Mobile health (mHealth) services enable real-time measurement of information on individuals' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted.

OBJECTIVE

The study aims to identify the predictors of older people's intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions.

METHODS

A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method.

RESULTS

Of 477 participants, 278 (58.3%) had at least 1 chronic disease. Performance expectancy (β=.453; P=.003) and social influence (β=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions (β=.325; P=.006; 95% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=-2.165). Bootstrapping also confirmed that device trust (β=.122; P=.039; 95% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease.

CONCLUSIONS

This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users.

Allied health professionals' experiences and lessons learned in response to a big bang electronic medical record implementation: A prospective observational study

INTRODUCTION

There is limited evidence describing the impact of electronic medical record (EMR) implementation on allied health professionals' acceptance, expectations, and work efficiencies. This study aims to: A) identify clinician expectations and factors that influence EMR acceptance; B) evaluate perceived usability, technology proficiency and satisfaction; and C) assess the impact of EMR big bang implementation on allied health workflows at three Australian tertiary hospitals.

METHODS

Repeated measures study pre and six-months post EMR implementation. User acceptance was evaluated with online surveys: Unified Theory of Acceptance and Use of Technology (pre), System Usability Scale and open-ended questions (post). A four-hour time-motion study evaluated changes in allied health inpatient workflows.

RESULTS

Surveys were completed by 224 allied health clinicians (47% response rate) pre, and 196 (41%) post-implementation. Pre-implementation, 96% of respondents felt using the EMR was a good idea and they would find it useful. Six-months post-implementation 88% liked interacting with the EMR. 64% found it easy to use and most didn't require technical support (78%). While 68% of participants felt very confident, 51% believed they were not using the EMR's full potential. Post-implementation half of participants agreed significant upskilling was required and that EMR workflows were not quick to learn. Live demonstrations were considered the most helpful activity prior to training; hands-on practice in the training environment and superuser support were invaluable preparing for and during go-live. Time-motion data (mean difference (MD) (95% CI)) indicated that following implementation participants spent 2.27% (-3.53, 8.09, p = 0.731) more time in clinical tasks. More time was spent performing clinical documentation (5.39% (1.98, 8.8), p = 0.002).

CONCLUSIONS

Many factors can impact allied health professional's adoption of a new EMR. Institution-wide, simultaneous big bang EMR implementation, with strong allied health leadership, can lead to positive benefits, particularly in user experience. Ongoing evaluation will drive future improvements.

A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders

PURPOSE

Ultrasound biofeedback therapy (UBT) is a relatively new type of technology-assisted speech-language therapy and has shown promise in remediating speech sound disorders. However, there is a current lack of understanding of the barriers and benefits that may influence the usage behavior and clinical decision making for the implementation of UBT from a clinician perspective. In this qualitative study, we explore the perspectives of speech-language pathologists (SLPs) who have used ultrasound biofeedback in programs of speech sound therapy using the unified theory of acceptance and use of technology (UTAUT) model.

METHOD

Seven SLPs who had clinical experience treating speech sound disorders with UBT participated. Semistructured in-depth interviews were conducted and video-recorded. Two coders coded and categorized the transcribed data, with consensus established with a third coder. Using thematic analysis, the data were exploratorily grouped into themes along components of the UTAUT model.

RESULTS

The highest number of codes was sorted into the "effort expectancy" theme, followed by "performance expectancy," "social influence," and "facilitating conditions" themes of the UTAUT model. Clinicians identified multiple perceived barriers and benefits to the use of ultrasound technology. The top identified barrier was limited accessibility, and the top benefit was the ability to visualize a client's articulatory response to cues on a display.

CONCLUSIONS

Clinicians prioritized "effort expectancy" and "performance expectancy" when reflecting on the use of ultrasound biofeedback for speech sound disorders. Clinicians spoke favorably about using UBT for speech sound disorder treatment but acknowledged institutional barriers and limitations at organizational and social levels.

Healthcare professionals' knowledge, attitude and its associated factors toward electronic personal health record system in a resource-limited setting: A cross-sectional study

Introduction

Electronic personal health record (e-PHR) system enables individuals to access their health information and manage it themselves. It helps patient engagement management of health information that is accessed and shared with their healthcare providers using the platform. This improves individual healthcare through the exchange of health information between patients and healthcare providers. However, less is known about e-PHRs among healthcare professionals.

Objective

Therefore, this study aimed to assess Health professionals' Knowledge and attitude and its associated factors toward e-PHR at the teaching hospital in northwest Ethiopia.

Methods

An institution-based cross-sectional study design was used to determine healthcare professionals' knowledge and attitude and their associated factors toward e-PHR systems in teaching hospitals of Amhara regional state, Ethiopia, from 20 July to 20 August 2022. Pretested structured self-administered questionnaires were used to collect the data. Descriptive statistic was computed based on sociodemographic and other variables presented in the form of table graphs and texts. Bivariable and multivariable logistic analyses were performed with an adjusted odds ratio (AOR) and 95% CI to identify predictor variables.

Result

Of the total study participants, 57% were males and nearly half of the respondents had a bachelor's degree. Out of 402 participants, ~65.7% [61–70%] and 55.5% [50–60%] had good knowledge and favorable attitude toward e-PHR systems, respectively. Having a social media account 4.3 [AOR = 4.3, 95% CI (2.3–7.9)], having a smartphone 4.4 [AOR = 4.4, 95% CI (2.2–8.6)], digital literacy 8.8 [(AOR = 8.8, 95% CI (4.6–15.9)], being male 2.7 [AOR = 2.7, 95% CI (1.4–5.0)], and perceived usefulness 4.5 [(AOR = 4.5, 95% CI (2.5–8.5)] were positively associated with knowledge toward e-PHR systems. Similarly, having a personal computer 1.9 [AOR = 1.9, 95% CI (1.1–3.5)], computer training 3.9 [AOR = 3.9, 95% CI (1.8–8.3)], computer skill 19.8 [AOR = 19.8, 95% CI (10.7–36.9)], and Internet access 6.0 [AOR = 6.0, 95% CI (3.0–12.0)] were predictors for attitude toward e-PHR systems.

Conclusion

The findings from the study showed that healthcare professionals have good knowledge and a favorable attitude toward e-PHRs. Providing comprehensive basic computer training to improve healthcare professionals' expectation on the usefulness of e-PHR systems has a paramount contribution to the advancement of their knowledge and attitude toward successfully implementing e-PHRs.

Usability of a mobile application for health professionals in home care services: a user-centered approach

The use of mobile devices by healthcare professionals has led to rapid growth in the development of mobile healthcare applications designed to improve healthcare services. This study was conducted to assess the acceptability and usability of a mobile application for health professionals in relation to their work in hospitalization at home. A mixed methods approach was used. Acceptance, included the satisfaction of the professionals, attitudes toward using the application, and intention or willingness to continue using the application. Usability tests were performed in laboratory analyzing five controlled clinical tasks, and the interaction of the participants with the mobile application was based on the six basic facial expressions published by the American Psychological Association. Perceived satisfaction was assessed using the computer system usability questionnaire. Thirty-two participants completed the task scenarios and questionnaire. More than 90 per cent of participants were able to complete the tasks with only some difficult with vital signs. Satisfaction had a score of 6.18/7 (SD: 0.76), and recommendation of the mobile application had a score of 6.21/7 (SD: 0.81). This study showed a significant usability and acceptability of this mobile application, in terms of effectiveness, efficiency, and satisfaction.

What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors

BACKGROUND

The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition.

METHODS

This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity.

RESULTS

The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use.

CONCLUSION

This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.

Clinical Sensor-Based Fall Risk Assessment at an Orthopedic Clinic: A Case Study of the Staff's Views on Utility and Effectiveness

In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.

Acceptance of electronic medical records and associated factor among physicians working in University of Gondar comprehensive specialized hospital: A cross-sectional study

Objective

Electronic Medical Records (EMRs) are digitalized medical record systems that collect, store, and display patient data. It is individual patient clinical information electronically gathered and made instantly available to all physicians in the healthcare chain, assisting in the delivery of coherent and consistent care. However, the acceptance of the electronic medical record status of physicians in Ethiopia is limitedly known due to knowledge, attitude, and computer skill gaps. This study aims to assess the acceptance of electronic medical records and associated factors among physicians working in Ethiopia.

Methods

A cross-sectional study was conducted among physicians working in Gondar Comprehensive Specialized Hospital. A total of 205 physicians were included. Data were collected through a self-administered structured questionnaire. Descriptive and Logistic regression were conducted.

Result

A one hundred ninety-eight participants returned the questionnaire from the total yielding a response rate of 96.6%. The proportion of those who have good acceptance for EMR was 72.2% and about 48.5%, 78.3%, and 59.6%, were sufficient computer skills, Good knowledge, and a favorable attitude toward EMR respectively. Age ≤ 30 years (AOR =  0.13 (0.02, 0.57), working experience AOR = 0.15 (0.04, 0.54), working department AOR = 0.09 (0.01, 0.90), good computer skills AOR = 8.42 (6.45, 16.02), Good knowledge AOR = 5.21 (1.22, 12.28), and favorable attitude AOR = 15.24 (12.06, 25.94) were significantly associated towards EMR acceptance.

Conclusion

Generally, in this study, physicians' acceptance of electronic medical records was good. Age, year of experience, working department, good computer skills, good knowledge, and favorable attitude were significantly associated with physicians' acceptance of the electronic medical record. Improving computer skills, enhancing positive attitudes, and increasing the knowledge of the health care professionals are vital interventions to enhance and improve the acceptance of EMR system in the study area.

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Introduction

Atrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners' (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF.

Method

The research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs' intention to utilize WEDs to screen patients for AF, including performance expectancy (β = 0.121, p = 0.004), social influence (β = 0.356, p < 0.001), and price perception (β = 0.587, p < 0.001). Perception risk (β = -0.059, p < 0.001) decreased usage intention, while effort expectancy (β = -0.079, p = 0.155) and facilitating conditions (β = -0.014, p = 0.868) did not affect usage intention. Gender (β = -0.022, p = 0.179), age (β = 0.006, p = 0.699), education level (β = -0.22, p = 0.184) and training (β = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients.

Discussion

GPs' intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.

Technology acceptance of digital devices for home use: Qualitative results of a mixed methods study

Objective

Digital devices have demonstrated benefits to patients with chronic and neurodegenerative diseases. But when patients use medical devices in their homes, the technologies have to fit into their lives. We investigated the technology acceptance of seven digital devices for home use.

Methods

We conducted 60 semi-structured interviews with participants of a larger device study on their views on the acceptability of seven devices. Transcriptions were analysed using qualitative content analysis.

Results

Based on the unified theory of acceptance and use of technology, we evaluated effort, facilitating conditions, performance expectancy and social influence of each device.In the effort category, five themes emerged: (a) the hassle to use the device; (b) its usability; (c) comfort; (d) disturbance to daily life; and (e) problems during usage. Facilitating conditions consisted of five themes: (a) expectations regarding a device; (b) quality of the instructions; (c) insecurities with usage; (d) possibilities of optimization; and (e) possibilities to use the device longer. Regarding performance expectancy, we identified three themes: (a) insecurities with the performance of a device; (b) feedback; and (c) motivation for using a device. In the social influence category, three themes emerged: (a) reactions of peers; (b) concerns with the visibility of a device; and (c) concerns regarding data privacy.

Conclusions

We identify key factors that determine the acceptability of medical devices for home use from the participants' perspective. These include low effort of use, minor disruptions to their daily lives and good support from the study team.

Acceptance of clinical decision support system to prevent venous thromboembolism among nurses: an extension of the UTAUT model

Background

Venous thromboembolism has been a major public health problem and caused a heavy disease burden. Venous thromboembolism clinical decision support system was proved to have a positive influence on the prevention and management of venous thromboembolism. As the direct users, nurses' acceptance of this system is of great importance to support the successful implementation of it. However, there are few relevant studies to investigate nurses' acceptance and the associated factors are still unclear.

Objective

To investigate the determinant factors of nurses' acceptance of venous thromboembolism clinical decision support system with the modified Unified Theory of Acceptance and Use of Technology.

Methods

We designed a questionnaire based on the modified Unified Theory of Acceptance and Use of Technology and then a cross-sectional survey was conducted among nurses in a tertiary hospital in Nanjing, China. Statistically, a Structural Equation Modeling -Partial Least Squares path modeling approach was applied to examine the research model.

Results

A total of 1100 valid questionnaires were recycled. The modified model explained 74.7%, 83.0% and 86% of the variance in user satisfaction, behavioral intention and user behavior, respectively. The results showed that performance expectancy (β = 0.254, p = 0.000), social influence (β = 0.136, p = 0.047), facilitating conditions (β = 0.245, p = 0.000), self-efficacy (β = 0.121, p = 0.048) and user satisfaction (β = 0.193, p = 0.001) all had significant effects on nurses' intention. Although effort expectancy (β = 0.010, p = 0.785) did not have a direct effect on nurses' intention, it could indirectly influence nurses' intention with user satisfaction as the mediator (β = 0.296, p = 0.000). User behavior was significantly predicted by facilitating conditions (β = 0.298, p = 0.000) and user intention (β = 0.654, p = 0.001).

Conclusion

The research enhances our understanding of the determinants of nurses' acceptance of venous thromboembolism clinical decision support system. Among these factors, performance expectancy was considered as the top priority. It highlights the importance of optimizing system performance to fit the users' needs. Generally, the findings in our research provide clinical technology designers and administrators with valuable information to better meet users' requirements and promote the implementation of venous thromboembolism clinical decision support system.

Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study

Background

A computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user’s perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate.

Objective

The aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death.

Methods

This study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95% was chosen to support a significant association.

Results

In this study, 272 physicians responded to the survey; 184 (67.6%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as “using SINADEF avoids falsifying a death certificate” (P<.001), “using SINADEF reduces the risk of errors” (P<.001), and “using SINADEF allows for filling out a certificate in less time” (P<.001); and (2) perceived ease of use, expressed as “I think SINADEF is easy to use” (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF.

Conclusions

The behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates.

Adoption of mobile health services using the unified theory of acceptance and use of technology model: Self-efficacy and privacy concerns

Mobile health (mHealth) services have been widely used in medical services and health management through mobile devices and multiple channels, such as smartphones, wearable equipment, healthcare applications (Apps), and medical platforms. However, the number of the users who are currently receiving the mHealth services is small. In China, more than 70% of internet users have never used mHealth services. Such imbalanced situation could be attributed to users’ traditional concept of medical treatment, psychological factors (such as low self-efficacy) and privacy concerns. The purpose of this study is to explore the direct and indirect effects of mHealth users’ self-efficacy and privacy concerns on their intention to adopt mHealth services, providing guidelines for mHealth service providers to enhance users’ intention of adoption. A questionnaire was designed by the research team and 386 valid responses were collected from domestic participants in China. Based on the unified theory of acceptance and use of technology (UTAUT) model, a research model integrated self-efficacy and privacy concerns was constructed to investigate their effects on users’ intention to adopt mobile mHealth services. The results show that self-efficacy could facilitate users’ intention to adopt mHealth services, and had a significantly positive effect on perceived ubiquity, effort expectancy, performance expectancy and subjective norm. This study verifies the direct and indirect effects of self-efficacy and privacy concerns on users’ intention to adopt mHealth services, providing a different perspective for studying mHealth adoption behavior. The findings could provide guidelines for mHealth service providers to improve their service quality and enhance users’ intention of adoption.

The effects of expectancies and patriotism on Chinese use intention of 5G network

China leads the world in the development and rollout of 5G network, yet less research has been done on the drivers of Chinese people’s adoption of 5G network, especially the specific role of national sentiments, such as the influence of patriotism on their attitude toward 5G network. The study obtained 804 effective online questionnaires from the respondents of various ages, genders, areas, and educational levels. The results based on the structural equation modeling (SEM) analysis showed that patriotism was an antecedent to Chinese users’ cognition of the conditions provided by the government and telecom operators and the extent that users were influenced by media and surrounding people, which in turn increased users’ expectations of the performance of 5G network and their confidence in adapting to 5G network, and resulted in an increased willingness to use 5G network. This research helps to understand the role of patriotism, which is an emotional factor, in stimulating Chinese users’ attitudes toward 5G network at the time when 5G network is putting into large-scale commercial use in China.

Micro-Irrigation Technology Adoption in the Bekaa Valley of Lebanon: A Behavioural Model

Potato crops are one of the main sources of income for farmers living in the Bekaa Valley of Lebanon. Given the high sensitivity of potatoes to water stress, water shortages can cause considerable losses in terms of potato yield and quality. To overcome this challenge, the use of water-saving technologies such as micro-irrigation systems are very important. However, the adoption of this technique remains quite low among potato farmers in the Bekaa region, who still use ordinary sprinkler systems. In this study, the unified theory of acceptance and use of technology (UTAUT) serves as the conceptual framework for investigating these farmers’ behaviour in adopting a new micro-irrigation system. To achieve this objective, we extended the UTAUT model by considering farmers’ risk perception of the use of a new micro-irrigation technology. The moderators tested were age, previous experience, voluntariness of use, gross unit margin and educational level. Examining the standard regression coefficients, i.e., the β weights, the results indicate that performance expectancy raised behavioural intention for investment in micro-irrigation (β = 0.29) while for effort expectancy the β weight value was 0.24. Overall, an increase of 1 standard deviation of the behavioural intention strongly impacted investment in micro-irrigation systems, β = 0.8 standard deviation of the effective adoption of the technology. Risk perception (β = −0.08) negatively affected farmers’ performance expectancy, i.e., the higher the perceived risk, the lower the perceived performance of the investment, which in turn affected their intention to use micro-irrigation systems. Age (β = 0.11) exerted a significant effect on effort expectancy. Finally in this paper, the policy implications of the results are discussed.

Extending the UTAUT2 Model with a Privacy Calculus Model to Enhance the Adoption of a Health Information Application in Malaysia

This study validates and extends the latest unified theory of acceptance and use of technology (UTAUT2) with the privacy calculus model. To evaluate the adoption of healthcare and e-government applications, researchers have recommended—in previous literature—the application of technology adoption models with privacy, trust, and security-related constructs. However, the current UTAUT2 model lacks privacy, trust, and security-related constructs. Therefore, the proposed UTAUT2 with the privacy calculus model is incorporated into four constructs: privacy concern, perceived risk, trust in the smart national identity card (SNIC), and perceived credibility. Results from a survey data of 720 respondents show that habit, effort expectancy, performance expectancy, social influence, hedonic motivation, and price value are direct determinants that influence behavioral intentions to use. Results also revealed that behavioral intentions, facilitating conditions, habits, perceived risks, and privacy concerns are direct predictors of ‘use behavior’. The authors also analyzed the interrelationships among the research constructs. The extended model may lead toward establishing better innovative e-health services to cover the desires of the citizens through the use of health information applications embedded in an all-in-one card.

The Acceptance and Use of Electronic Medical Records in Developing Countries within the Unified Theory of Acceptance and Use of Technology Framework

BACKGROUND: The Indonesian Ministry of Health requires hospitals to record and report all activities in the Hospital Management Information System (SIMRS). However, the disruptive use of software, hardware, and Brainware has reduced its effective management and usability, which has become a separate workload. Electronic Medical Record (EMR) is one of the important implementations of SIMRS because it relates to the ability to identify information, results, history taking, examinations, and records of all patients. Furthermore, it has become a current global trend for most hospitals and has also been used as a substitute for paper medical records. AIM: This study aims to collect and identify the user characteristic, technology used, and other variables influencing the acceptance and use of information and technology systems based on the unified theory of acceptance and use of technology (UTAUT) model. METHOD: Secondary data were obtained from scientifically published journals online in the form of original articles that are accessed in full text with the help of search engines such as Springer link, Proquest, PubMed, and Prospero. RESULT: It was found that the most dominant technology system in hospitals outside the use of HIS, Electronic Health Record (EHR), physician assistants, E-Prescribing, Telemedicine, extended producer responsibility, and Technology solution for tuberculosis was EMR. It had the largest influence variable in several studies based on the UTAUT model. The most dominant characteristics of users were women between the ages of 20 and 30 years with 0 and 5 years working experience, and also 60% were nurses. The result also showed that 17 other variables had influenced the use of information and technology systems in the UTAUT model. Conclusion: Literature study provides evidence that acceptance and use of health information technology systems, especially RME in hospitals influenced by the main variable UTAUT. Variables related to technical aspects, behavior, and user characteristics as new endogenous and new exogenous mechanisms. Management of health service providers in increasing acceptance and use of EMR needs to pay attention to the availability of infrastructure, user factors are also an important concern in helping to deal with problems in developing countries.

Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials

BACKGROUND

Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine.

OBJECTIVE

This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers.

METHODS

In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use.

RESULTS

All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations.

CONCLUSIONS

The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-019-3726-4.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients’ usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24).

Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study

Background

Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association.

Objective

The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth.

Methods

A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence).

Results

The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%.

Conclusions

This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption.

Determinants of Intention to Use Artificial Intelligence-Based Diagnosis Support System Among Prospective Physicians

Background: This study aimed to develop a theoretical model to explore the behavioral intentions of medical students to adopt an AI-based Diagnosis Support System.

Methods: This online cross-sectional survey used the unified theory of user acceptance of technology (UTAUT) to examine the intentions to use an AI-based Diagnosis Support System in 211 undergraduate medical students in Vietnam. Partial least squares (PLS) structural equational modeling was employed to assess the relationship between latent constructs.

Results: Effort expectancy (β = 0.201, p < 0.05) and social influence (β = 0.574, p < 0.05) were positively associated with initial trust, while no association was found between performance expectancy and initial trust (p > 0.05). Only social influence (β = 0.527, p < 0.05) was positively related to the behavioral intention.

Conclusions: This study highlights positive behavioral intentions in using an AI-based diagnosis support system among prospective Vietnamese physicians, as well as the effect of social influence on this choice. The development of AI-based competent curricula should be considered when reforming medical education in Vietnam.

The factors influencing community nurses' usage of electronic health records: findings from focus groups

Electronic health records (EHRs) are integral to community nursing, and mobile access aids seamless, responsive care, prevents repetition and reduces hospital admissions. This saves time and money, enabling smoother workflows and increased productivity. Common practice among community nurses is to return to workbases to access EHRs. This research was conducted to explore what leads to inconsistency in EHR use. Focus groups were held with community nurses, and reflexive thematic analysis of the data was undertaken. Nurses who used EHRs during consultations described the practice as integrative and informed, promoting collaborative care. Those who did not described EHRs as time-consuming, template-laden and a barrier to nurse-patient communication. One barrier to mobile working is the threat to collegiate teamworking and the social and clinical supports it provides. This study suggests specific strategies could increase mobile EHR engagement: role-specific training for effective EHR use; clear organisational directives; innovative team communication; and peer-to-peer coaching.

Health Professionals' Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study

Background

Electronic medical records (EMRs) are integrated information sources generated by health care professionals (HCPs) from various health care information systems. EMRs play crucial roles in improving the quality of care and medical decision-making and in facilitating cross-hospital health information exchange. Although many hospitals have invested considerable resources and efforts to develop EMRs for several years, the factors affecting the long-term success of EMRs, particularly in the EMR infusion stage, remain unclear.

Objective

The aim of this study was to investigate the effects of technology, user, and task characteristics on EMR infusion to determine the factors that largely affect EMR infusion. In addition, we examined the effect of EMR infusion on individual HCP performance.

Methods

A questionnaire survey was used to collect data from HCPs with >6 months experience in using EMRs in a Taiwanese teaching hospital. A total of 316 questionnaires were distributed and 211 complete copies were returned, yielding a valid response rate of 66.8%. The collected data were further analyzed using WarpPLS 5.0.

Results

EMR infusion (R²=0.771) was mainly affected by user habits (β=.411), portability (β=.217), personal innovativeness (β=.198), technostress (β=.169), and time criticality (β=.168), and individual performance (R²=0.541) was affected by EMR infusion (β=.735). This finding indicated that user (habit, personal innovativeness, and technostress), technology (portability), and task (mobility and time criticality) characteristics have major effects on EMR infusion. Furthermore, the results indicated that EMR infusion positively affects individual performance.

Conclusions

The factors identified in this study can extend information systems infusion theory and provide useful insights for the further improvement of EMR development in hospitals and by the government, specifically in its infusion stage. In addition, the developed instrument can be used as an assessment tool to identify the key factors for EMR infusion, and to evaluate the extent of EMR infusion and the individual performance of hospitals that have implemented EMR systems. Moreover, the results can help governments to understand the urgent needs of hospitals in implementing EMR systems, provide sufficient resources and support to improve the incentives of EMR development, and develop adequate EMR policies for the meaningful use of electronic health records among hospitals and clinics.

Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study

Background

Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA_1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important.

Objective

The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations.

Methods

Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis.

Results

Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R² of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations.

Conclusions

To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians.

Modifying the Unified Theory of Acceptance and Use of Technology (UTAUT) Model for the Digital Transformation of the Construction Industry from the User Perspective

Inefficient and ineffective practices in the construction industry have hindered productivity even though it is considered as one of the largest sectors in any county. One best solution to overcome these inherent problems in the construction industry is to move forward with digital technologies. For that, organizational structure, technical aspects, and, most importantly, human factors need to be considered. The aim of this research is to find out human behaviors that affect the digital transformation of the construction industry based on the well-accepted model Unified Theory of Acceptance and Use of Technology (UTAUT). An in-depth literature review was carried out using fifty-five journal papers to develop a conceptual model for the acceptance of digital transformation, and it was validated and further reviewed using ten expert interviews. The model consists of seven constraints: Personal Benefits, Perceived Usefulness, Perceived Risk, Facility Conditions, Attitudes, and Subjective Norms. The analytical hierarchy process (AHP) was carried out to rank these seven factors according to individual priorities in the construction industry. Further, the model was extended and modified using factors derived from literature review and expert feedback. It is proved that “Perceived Personal Benefits” is the major consideration of an individual who is willing to move towards digital transformation. This research fulfills the lack of knowledge in the digitalization of the construction industry as per a human perspective, and it provides a prerequisite to finding the solutions for the issues which emerged within the industry towards digitalization. Further, the framework developed in the research can be used to systematically adopt the human factor for the digital transformation of the construction industry. In addition, this enables the analysis of changing demands for humans in digitally transformed environments, such as Industry 4.0 environments, and contributes towards a successful digital transformation that avoids the pitfalls of innovation performed without attention to human factors. The paper concludes by highlighting future research directions on the human factor in digital transformation as well as managerial implications for successful application in practice.

State of the practice of health information systems: a survey study amongst health care professionals in intellectual disability care

BACKGROUND

Care for people with an Intellectual Disability (ID) is complex: multiple health care professionals are involved and use different Health Information Systems (HISs) to store medical and daily care information on the same individuals. The objective of this study is to identify the HISs needs of professionals in ID care by addressing the obstacles and challenges they meet in their current HISs.

METHODS

We distributed an online questionnaire amongst Dutch ID care professionals via different professional associations and care providers. 328 respondents answered questions on their HISs. An inventory was made of HIS usage purposes, problems, satisfaction and desired features, with and without stratification on type of HIS and care professional.

RESULTS

Typical in ID care, two types of HISs are being used that differ with respect to their features and users: Electronic Client Dossiers (ECDs) and Electronic Patient Dossiers (EPDs). In total, the respondents mentioned 52 unique HISs. Groups of care professionals differed in their satisfaction with ECDs only. Both HIS types present users with difficulties related to the specifics of care for people with an ID. Particularly the much needed communication between the many unique HISs was reported a major issue which implies major issues with inter-operability. Other problems seem design-related as well.

CONCLUSION

This study can be used to improve current HISs and design new HISs that take ID care professionals requirements into account.

Technology Acceptance in Healthcare: A Systematic Review

Understanding the factors affecting the use of healthcare technologies is a crucial topic that has been extensively studied, specifically during the last decade. These factors were studied using different technology acceptance models and theories. However, a systematic review that offers extensive understanding into what affects healthcare technologies and services and covers distinctive trends in large-scale research remains lacking. Therefore, this review aims to systematically review the articles published on technology acceptance in healthcare. From a yield of 1768 studies collected, 142 empirical studies have met the eligibility criteria and were extensively analyzed. The key findings confirmed that TAM and UTAUT are the most prevailing models in explaining what affects the acceptance of various healthcare technologies through different user groups, settings, and countries. Apart from the core constructs of TAM and UTAUT, the results showed that anxiety, computer self-efficacy, innovativeness, and trust are the most influential factors affecting various healthcare technologies. The results also revealed that Taiwan and the USA are leading the research of technology acceptance in healthcare, with a remarkable increase in studies focusing on telemedicine and electronic medical records solutions. This review is believed to enhance our understanding through a number of theoretical contributions and practical implications by unveiling the full potential of technology acceptance in healthcare and opening the door for further research opportunities.

Adoption of electronic commerce by individuals in Bangladesh

With increased use of Internet and information technology platforms, e-commerce has experienced tremendous growth worldwide in the recent years. Although growing steadily in various digital services, Bangladesh has not been able to gain full advantages and benefits of e-commerce due to its poor adoption rate. This study aims at exploring the factors affecting e-commerce adoption in Bangladesh by applying an extended version of Unified Theory of Acceptance and Use of Technology (UTAUT) model which includes perceived risk, perceived cost and personal awareness with perceived usefulness, perceived ease of use, social influence, and facilitating conditions. This study applies a mixed methods research approach by combining qualitative field study and quantitative survey. A PLS based structural equation modeling is employed to a dataset of 253 individuals which are collected by applying a convenient sampling technique. The study results reveals that perceived usefulness, perceived cost, personal awareness and facilitating conditions affect consumer behavioral intention while facilitating conditions as well as behavioral intention have positive influence on actual use of e-commerce. This study also provides several implications that might be useful for the academic proponents, decision makers, and various stakeholders.

Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study

BACKGROUND

Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia.

OBJECTIVE

The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption.

METHODS

This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling.

RESULTS

Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present.

CONCLUSIONS

This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.

The importance of being external. methodological insights for the external validation of machine learning models in medicine

Background and Objective Medical machine learning (ML) models tend to perform better on data from the same cohort than on new data, often due to overfitting, or co-variate shifts. For these reasons, external validation (EV) is a necessary practice in the evaluation of medical ML. However, there is still a gap in the literature on how to interpret EV results and hence assess the robustness of ML models.

METHODS

We fill this gap by proposing a meta-validation method, to assess the soundness of EV procedures. In doing so, we complement the usual way to assess EV by considering both dataset cardinality, and the similarity of the EV dataset with respect to the training set. We then investigate how the notions of cardinality and similarity can be used to inform on the reliability of a validation procedure, by integrating them into two summative data visualizations.

RESULTS

We illustrate our methodology by applying it to the validation of a state-of-the-art COVID-19 diagnostic model on 8 EV sets, collected across 3 different continents. The model performance was moderately impacted by data similarity (Pearson ρ = 0.38, p< 0.001). In the EV, the validated model reported good AUC (average: 0.84), acceptable calibration (average: 0.17) and utility (average: 0.50). The validation datasets were adequate in terms of dataset cardinality and similarity, thus suggesting the soundness of the results. We also provide a qualitative guideline to evaluate the reliability of validation procedures, and we discuss the importance of proper external validation in light of the obtained results.

CONCLUSIONS

In this paper, we propose a novel, lean methodology to: 1) study how the similarity between training and validation sets impacts the generalizability of a ML model; 2) assess the soundness of EV evaluations along three complementary performance dimensions: discrimination, utility and calibration; 3) draw conclusions on the robustness of the model under validation. We applied this methodology to a state-of-the-art model for the diagnosis of COVID-19 from routine blood tests, and showed how to interpret the results in light of the presented framework.

The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study

BACKGROUND

Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses' workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses' well-being.

OBJECTIVE

This study aimed to examine the association between using a mobile version of the EHR and nurses' perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators.

METHODS

This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other).

RESULTS

Nurses who used the mobile version of their EHR had higher levels of time pressure (F_1,3537=14.96, P<.001) and stress related to information systems (F_1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F_1,3581=14.93, P<.001), ease of use (F_1,3577=10.16, P=.001), and technical quality (F_1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs.

CONCLUSIONS

According to our results, it seems that at present mobile device use is not beneficial for the nurses' well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses' workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses.

Safety first: extending UTAUT to better predict mobile payment adoption by incorporating perceived security, perceived risk and trust

Purpose

The purpose of this study is to investigate the antecedents of behavioral intention to use (BIU) mobile payment in Indonesia by extending unified theory of acceptance and use of technology (UTAUT) with user privacy constructs, namely, perceived security (PS), perceived risk (PR) and trust (Tr).

Design/methodology/approach

This is a quantitative research using the covariance-based structural equation modeling method, whereby the researchers conducted an online survey and distributed online questionnaires to users of mobile payment from all over Indonesia to obtain the data. The sample in this study consisted of 358 respondents.

Findings

This study found that social influence, facilitating conditions, PS, performance expectancy and Tr have a significant and direct influence on BIU mobile payment. PR was not found to have a significant and direct relationship with BIU, but it was indirectly affecting the latter through Tr as the mediating variable.

Originality/value

The researchers modified UTAUT by incorporating PS, PR and Tr to create a more comprehensive model in predicting mobile payment adoption, especially considering the risky nature of digital transactions in emerging economies like Indonesia. This extended model has never been thoroughly explored in previous studies.

Willingness to Adopt Health Information Among Social Question-and-Answer Community Users in China: Cross-sectional Survey Study

BACKGROUND

COVID-19 has spread around the world and has increased the public's need for health information in the process. Meanwhile, in the context of lockdowns and other measures for preventing SARS-CoV-2 spread, the internet has surged as a web-based resource for health information. Under these conditions, social question-and-answer communities (SQACs) are playing an increasingly important role in improving public health literacy. There is great theoretical and practical significance in exploring the influencing factors of SQAC users' willingness to adopt health information.

OBJECTIVE

The aim of this study was to establish an extended unified theory of acceptance and use of technology model that could analyze the influence factors of SQAC users' willingness to adopt health information. Particularly, we tried to test the moderating effects that different demographic characteristics had on the variables' influences.

METHODS

This study was conducted by administering a web-based questionnaire survey and analyzing the responses from a final total of 598 valid questionnaires after invalid data were cleaned. By using structural equation modelling, the influencing factors of SQAC users' willingness to adopt health information were analyzed. The moderating effects of variables were verified via hierarchical regression.

RESULTS

Performance expectation (β=.282; P<.001), social influence (β=.238; P=.02), and facilitating conditions (β=.279; P=.002) positively affected users' willingness to adopt health information, whereas effort expectancy (P=.79) and perceived risk (P=.41) had no significant effects. Gender had a significant moderating effect in the structural equation model (P<.001).

CONCLUSIONS

SQAC users' willingness to adopt health information was evidently affected by multiple factors, such as performance expectation, social influence, and facilitating conditions. The structural equation model proposed in this study has a good fitting degree and good explanatory power for users' willingness to adopt health information. Suggestions were provided for SQAC operators and health management agencies based on our research results.

A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study

BACKGROUND

The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread.

OBJECTIVE

This study aims to understand people's intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform.

METHODS

From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from "strongly disagree" (1 point) to "strongly agree" (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software.

RESULTS

A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income

CONCLUSIONS

From the perspective of the populace, this study explored the factors affecting the use of MHB and constructed an interpretation model with a strong goodness of fit. The results of our analysis are consistent with the technology acceptance model. Through the diverse value-added services of MHB, Taiwan's experience in pandemic prevention with smart technology can facilitate future responses to unknown, emerging infectious diseases.

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Key Words

• COVID-19
• electronic health record
• electronic medical record
• intention
• literacy
• model
• my health bank
• personal health record
• privacy
• protection
• security
• structural equation model
• survey
• technology acceptance model
• usage

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MESH Headings

• Adult
• COVID-19/epidemiology
• COVID-19/prevention & control
• COVID-19/transmission
• Cross-Sectional Studies
• Disease Transmission, Infectious/prevention & control
• Female
• Humans
• Internet
• Male
• Masks
• Pandemics
• SARS-CoV-2
• Surveys and Questionnaires
• Taiwan/epidemiology
• Technology
• Young Adult

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Affiliation(s)

Wen-Hsun Tsai Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Medical Administration Office, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
Yi-Syuan Wu Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
Chia-Shiang Cheng Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
Ming-Hao Kuo Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
Yu-Tien Chang School of Public Health, National Defense Medical Center, Taipei, Taiwan
Fu-Kang Hu Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Medical Informatics Office, Tri-Service General Hospital, Taipei, Taiwan
Chien-An Sun Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Chi-Wen Chang School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
Ta-Chien Chan Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
Chao-Wen Chen Trauma and Critical Care Service Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Chia-Cheng Lee Medical Informatics Office, Tri-Service General Hospital, Taipei, Taiwan Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
Chi-Ming Chu Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan School of Public Health, National Defense Medical Center, Taipei, Taiwan Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

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