Assessment of willingness to Tele-monitoring interventions in patients with type 2 diabetes and/or hypertension in the public primary healthcare setting

Nurses' perspectives on the use of telemonitoring in the management of people with diabetes and hypertension

OBJECTIVES

to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.

METHODS

this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.

RESULTS

according to the nurses, telemonitoring enhances users' knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.

FINAL CONSIDERATIONS

the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.

Hypertension in Adults With Diabetes in Southeast Asia: A Systematic Review

Diabetes is one of the most pressing health issues in the Southeast Asian region, and hypertension has been commonly reported as a comorbidity in adults with diabetes. This systematic review aimed to synthesize evidence on the prevalence and management of hypertension in adults with diabetes in Southeast Asian countries. A literature search was conducted in Ovid MEDLINE and Embase Classic + Embase from database inception until March 15, 2024. Studies were included if (1) they were conducted in Southeast Asian countries, (2) the study populations were adults with diabetes, and (3) there was information related to hypertension or blood pressure (BP) in the study results. Of the 7486 abstracts found, 90 studies qualified for this review. Most studies reported a hypertension prevalence of 70% or higher (ranging from 29.4% to 93.4%). Despite this high prevalence, a substantial proportion of these populations did not receive adequate BP control, with most studies indicating a control rate of less than 40%. There was limited evidence on the prescription of antihypertensive therapies and medication adherence. There was a lack of studies from 4 of the 11 countries in the region. This review highlights that BP control in adults with diabetes remains a significant challenge in Southeast Asia. Given the ongoing epidemiological transition, and the increasing older population in this region who are likely to accumulate multiple chronic conditions complicating medication strategies, this review highlights the urgent need to improve BP management in those with diabetes.

Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study

Background

Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies.

Objective

This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it.

Methods

This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM.

Results

In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35-150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39-21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62-47.44; P=.007).

Conclusions

Participation in RBPM is likely to increase with increased awareness, health providers' recommendations, and tailoring RBPM services to patients' preferred electronic communication channels.

Theory-based behaviour modification of Asian adults with type-2 diabetes mellitus after participating in a novel telemonitoring system: a qualitative research study

OBJECTIVE

Telemonitoring (TM) remotely monitors individuals' health. Awareness of personal clinical data has resulted in improved glycaemic control in adults with type-2 diabetes mellitus (T2DM). However, its effects on their health-seeking behaviour remain unclear. This study aims to explore and understand the effects of a multicomponent TM system on self-efficacy in adults with T2DM.

DESIGN

A qualitative study using semistructured interviews.

SETTING

A public primary care clinic which is located at an estate in north-eastern Singapore with a population of about 300 000 multiethnic Asian residents.

PARTICIPANTS

21 participants who completed 6 months of TM intervention which included immediate feedback on glucose and blood pressure readings, educational videos on exercise and nutrition, and personalised support with TM nurse when clinical parameters met high glucose or blood pressure thresholds.

RESULTS

The health belief model was used to explain the participants' behaviour change, including (1) immediate feedback from TM clinical parameters (blood pressure and glucose), raised their awareness of their health status and disease control to motivate behaviour change; (2) notification of higher glucose through TM allowed patients to reflect on their recent food consumption and nudged them to select healthier food options; (3) App teleeducation improved health literacy and supported lifestyle changes; (4) cues for action through personalised engagement with TM nurse and via automated reminders and (5) the TM system enhanced self-efficacy by modifying their multifaceted self-care behaviours.

CONCLUSION

TM heightened understanding among adults with T2DM of their potential for health complications and increased awareness of the benefits of proper diabetes management. It also helped lower the barriers to self-management and further enhanced their self-efficacy in self-care. The system and care team provided users with cues for health which was perceived to lead to adapting their lifestyle in order to achieve better health outcomes.

CLINICAL TRIALS REGISTRATION NUMBER

NCT04306770.

Phone-based telemonitoring of arterial hypertension versus usual care: the HOROSCOPE study

The Horoscope trial aimed to assess the efficacy of home blood pressure (BP) telemonitoring (TLM) in controlling BP reduction in hypertensive patients compared with usual care. This is a multi-center, prospective randomized, parallel-group trial comparing TLM with usual care during a period of 6 months in patients with hypertension. We included 525 patients randomly assigned in a 1-1 ratio to telemonitoring (TLM group; n = 260) or usual care (control group; n = 265). After 6 months of follow up, mean values of 24-h systolic and diastolic blood pressure decreased in both TLM and control groups. The mean decrease was significantly greater in the TLM group vs control group (-3.29 mmHg Vs -1.19; p = 0.009) and (-2.9 mmHg Vs, -0.07; p = 0.002) for systolic and diastolic blood pressure, respectively. This study shows that TLM results in significant BP reduction compared to usual care in a Tunisian population of patients with hypertension. Our findings highlight the importance of integrating telemedicine in the management of hypertensive patients; it has the potential to improve the quality of the delivered care and to prevent cardiovascular consequences of uncontrolled BP.

The Role of Telemedicine in Improving Hypertension Management Outcomes: A Systematic Review

Telehealth has been proven to be effective in a variety of healthcare settings and has enhanced patient utilization of healthcare services. Little is known about the use of telehealth in the treatment of hypertension. This study aimed to categorize and identify data related to various telehealth technologies and intervention types used in the management of hypertension. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to search the literature based on predetermined inclusion and exclusion criteria. These databases contained 1,483 relevant articles, which were screened for duplication using Endnote software. After a careful full-text article evaluation, only 42 of these articles were found to be relevant. The Newcastle-Ottawa Scale was used to assess the risk of bias in each included study. The majority of studies (23.8%) were conducted in urban areas (33.3%), were from the United States, and used a quantitative study approach (69%), according to the proportions of studies displaying different patterns over the past 10 years. Telemonitoring and teleconsultation are the two most used telehealth techniques for managing hypertension. Asynchronous telehealth is quickly becoming the most popular technique for controlling hypertension. In hypertension management, telehealth refers to the use of communication technologies to remotely monitor and regulate blood pressure as well as offer medical advice and counseling.

Perspective of smokers and healthcare professionals toward real-time video counseling smoking cessation program in general out-patient clinics in Hong Kong: a qualitative study

OBJECTIVE

This study aimed to explore the perceptions and experiences of individuals that currently smoke and healthcare professionals on using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong.

DESIGN

This was a qualitative study using face-to-face semi-structured interviews based on the extended technology acceptance model. All interviews were audiotaped and transcribed verbatim. Two investigators coded the transcripts independently. Thematic analysis was adopted.

PARTICIPANTS

Individuals that currently smoke and healthcare professionals who had experience using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong were recruited. Purposive sampling was adopted. 18 participants were interviewed to reach data saturation.

MAIN OUTCOME MEASURES

Themes that emerged from thematic analysis of data were the main outcome measures. The emerged themes were refined and verified via inductive and then deductive processes until data saturation was reached.

RESULTS

Two core themes, which were in coherence with the extended technology acceptance model, namely (i) perceived ease of use and (ii) perceived usefulness, were identified. Under perceived ease of use, we identified 2 subthemes: (i) convenience and (ii) measures to facilitate the use of real-time video counseling. Three subthemes were identified under perceived usefulness: (i) empathy and rapport, (ii) measures for pandemics, and (iii) service outcome.

CONCLUSION

Our study provided a culture-specific perspective of users towards real-time video counseling. It identified users' opinions on the easiness and usefulness of the service. Those could provide clues for future improvement and development of using real-time video counseling in healthcare services.

Empowering patients in primary care: a qualitative exploration of the usability and utility of an online diabetes self-management tool

BACKGROUND

Despite the potential advantages of Internet-based diabetes self-management education, its adoption was not widespread among Singapore's public primary care clinics (polyclinics). An interactive online tool was thus developed to help educate patients with Type 2 diabetes mellitus (T2DM), and was now ready for user testing before implementation.

AIM

To explore the perceived utility and usability of the educational tool in patients with suboptimally-controlled T2DM in a Singapore primary care setting.

METHODS

In-depth interviews were used to gather qualitative data from multi-ethnic Asian adults who had suboptimally-controlled T2DM. A total of 17 IDIs were conducted between April 2022 to March 2023, audio-recorded, transcribed, and analyzed to identify emergent themes via thematic analysis.

RESULTS

Regarding utility, users found the educational tool useful because it provided them with information that was comprehensive, accessible, reliable, and manageable. Regarding usability, the majority of users reported that the educational tool was easy to use, and suggested ways to improve navigational cues, visual clarity, readability and user engagement.

CONCLUSION

Participants generally found the educational tool useful and easy to use. A revised educational tool will be developed based on their feedback and implemented in clinical practice.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

Patients' perspectives on video consultation for non-communicable diseases: a qualitative study in Singapore

BACKGROUND

The COVID-19 pandemic increased the use of telemedicine in primary care services. Understanding patients' perspectives on telemedicine is pivotal for its wider adoption in managing non-communicable diseases (NCDs) in the community.

AIM

To explore the views and concerns of patients who have yet to use video consultation (VC) for NCD management in Singapore.

DESIGN & SETTING

This qualitative study was conducted in a primary care clinic in Singapore.

METHOD

In total, 16 patients participated in individual in-depth interviews. The participants had type 2 diabetes mellitus and/or hypertension and/or hyperlipidaemia without prior VC experience. They were purposively enrolled in the polyclinic. Audited transcripts were independently coded by two investigators. Thematic analysis was performed to identify perspectives on telemedicine based on the health, information, and technology zones of the Health Information Technology Acceptance Model.

RESULTS

The following three themes emerged: perceived benefits of VC utility; perceived barriers of VC adoption; and potential challenges of VC. Participants viewed VC as safe and convenient if they had stable NCD. They voiced concerns on possible suboptimal care owing to the absence of physical examination, network connectivity, and personal medical data security. Participants highlighted challenges of VC uptake such as digital health familiarity, availability of their own mobile and telemonitoring devices, and healthcare costs consideration.

CONCLUSION

Addressing the concerns and challenges highlighted by non-VC users can help physicians and policymakers explore ways to scale up telemedicine in Singapore. A hybrid clinical care model comprising in-person visits and VC may be the way forward for NCD management.

Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians

BACKGROUND

While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic.

OBJECTIVE

This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic.

METHODS

We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations.

RESULTS

A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60).

CONCLUSIONS

Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.

Telemedicine in non-communicable chronic diseases care during the COVID-19 pandemic: exploring patients' perspectives

Purpose

This study aimed to explore challenges facing patients using Telemedicine consultations in non-communicable chronic disease clinics in primary care settings and to evaluate their satisfaction and willingness to use this service in the future.

Methods

This is an analytical cross-sectional study enrolling participants who were randomly selected from representative primary care centers in Bahrain and providing Telemedicine consultations. A semi-structured questionnaire permitted data collection using telephone interviews.

Results

A total of 251 individuals participated in the study of whom the majority were Bahraini (90.04%), and the mean age was 54.48 ± 10.78 years. Most of the participants 231 (92.03%) were satisfied with the Telemedicine consultation while only 142 (56.80%) were willing to use this service in the future. The main perceived challenges related to Teleconsultations were the lack of physical examination, inadequate time of TM consultation, fear of medical errors, and lack of privacy. The willingness to use TM consultation in the future was mainly determined by the degree of comfort to tell private information (p < 0.01) and to less extent the ease of the communication tool (p = 0.005) on multivariate analysis.

Conclusion

TM consultations could be a good complement to conventional consultation formats in the future. The sustainability of this innovative healthcare delivery tool requires addressing acceptability by users, ease of use, patient-centeredness, and technological advances to ensure privacy.

Implementation and use of technology-enabled blood pressure monitoring and teleconsultation in Singapore's primary care: a qualitative evaluation using the socio-technical systems approach

BACKGROUND

Telemedicine is becoming integral in primary care hypertension management, and is associated with improved blood pressure control, self-management and cost-effectiveness. This study explored the experiences of patients and healthcare professionals and their perceived barriers and facilitators in implementing and using a technology-enabled blood pressure monitoring intervention with teleconsultation in the Singapore primary care setting.

METHODS

This was a qualitative study embedded within the Primary Technology-Enhanced Care Hypertension pilot trial. Patients were selected purposively and invited to participate by telephone; healthcare professionals involved in the trial were invited to participate by email. Individual semi-structured interviews were conducted in English or Mandarin with thirteen patients and eight healthcare professionals. Each interview was audio-recorded and transcribed verbatim. Data were analyzed inductively to identify emergent themes which were then grouped into the dimensions of the socio-technical systems model to study the interactions between the technical, individual and organizational factors involved in the process.

RESULTS

Several emergent themes were identified. The factors involved in the implementation and use of the intervention are complex and interdependent. Patients and healthcare professionals liked the convenience resulting from the intervention and saw an improvement in the patient-provider relationship. Patients appreciated that the intervention helped form a habit of regular blood pressure monitoring, improved their self-management, and provided reassurance that they were being monitored by the care team. Healthcare professionals found that the intervention helped to manage workload by freeing up time for other urgent matters. Nevertheless, participants highlighted challenges with usability of the equipment and management portal, data access, and some expressed technology anxiety. Participants suggested patient segmentation for the intervention to be more targeted, wished for a more user-friendly equipment and proposed allocating more resources to the intervention.

CONCLUSIONS

The implementation and use of telemedicine for hypertension management can engender various benefits and challenges to patients, healthcare professionals and the healthcare system. Stakeholder feedback gathered on the sociotechnical aspects of the technology should be taken into consideration to guide the design, implementation and evaluation of future telemedicine interventions in primary care.

TRIAL REGISTRATION

This study was registered on ClinicalTrials.gov on October 9, 2018. ID: NCT03698890.

Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study

Background

Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring.

Objective

The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF).

Methods

This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis.

Results

Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance.

Conclusion

Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.

Treating acutely ill patients at home: Data from Singapore

INTRODUCTION

Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes.

METHODS

We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge.

RESULTS

A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again.

CONCLUSION

Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.

Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting

Background:

Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore.

Objectives:

This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance.

Methods:

An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance.

Results:

Respondents ( n = 278; mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71–10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30–8.97).

Conclusion:

Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients.

Awareness and attitude of primary healthcare patients towards telehealth in Cairo, Egypt

BACKGROUND

Telehealth is delivering health care services remotely from healthcare facilities using telecommunications and virtual technology. Egypt is aiming to reach Universal Health Coverage; this increases the demand for telehealth in routine health services. Telehealth helps in increasing access to areas with no available medical services as patients can be monitored remotely.

OBJECTIVE

To measure the awareness of telehealth among attendees of primary health care units and their acceptance of applying telehealth.

METHODOLOGY

This was a cross-sectional study among attendees of primary health units. Ethical issues were considered.

RESULTS

A sample size was calculated to be 162 and 170 valid Arabic interview questionnaires were filled by attendees. The awareness percentage of telehealth among attendees was 64.7% while the willingness to implement telehealth was 78%. Both awareness and willingness were significantly associated with age groups, residence, socioeconomic status, and presence of computer with internet access. Age, residence, and possession of a PC were the only adjusted predictive factors for knowledge about telehealth among patients in the multivariable analysis.

CONCLUSION

Large percentages of attendees to primary health care centers are aware of telehealth and are willing to implement it. The major cause of refusal to implement telehealth was ignorance of using telecommunication devices and the desire to be in close contact with the physicians.

Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis

BACKGROUND

Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration.

OBJECTIVE

The aim of this review was to systematically investigate the literature to understand the factors affecting patients' adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives).

METHODS

A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes.

RESULTS

The technical factors affecting patients' adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team's role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients' insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them.

CONCLUSIONS

This review builds on the growing body of research that investigates patients' adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools' fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.

Patient Readiness for Remote Healthcare Services in the Context of the COVID-19 Pandemic: Evidence From European Countries

Despite the fact that remote services were successfully implemented in most European social and health systems before 2020, the COVID-19 pandemic has led to an unprecedented development of health and social care services provided in this form. This paper compares the readiness of patients to use the digital solutions in healthcare systems implemented in EU countries, in response to the current pandemic situation. In the study, technological, health insurance, and demographic variables were selected on the basis of substantive criteria. Next, the linear ordering method was applied to make a ranking of the analyzed countries according to the level of patients' readiness to use digital healthcare services. The main findings show that the Netherlands and Ireland are characterized by the highest level of patients' readiness for using remote healthcare services. On the other hand, Romania and Bulgaria are among the countries with the lowest readiness. The study also made it possible to group European countries according to the level of patients' preparedness.

A qualitative evidence synthesis of users' experience of mobile health applications in the self-management of type 2 diabetes

AIM

The aim of this qualitative evidence synthesis was to identify and synthesise qualitative research relating to experiences of using mobile health (mHealth) applications to aid self-management of Type 2 Diabetes.

METHODS

Using a systematic search strategy, 11 databases were searched (Medline, CINAHL, PsychInfo, PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest A&1, ProQuest UK & Ireland, Mednar). "Best fit" framework synthesis was used guided by the Health Information Technology Acceptance Model (HITAM). Assessment of methodological limitations was conducted using Critical Appraisal Skills Programme (CASP) and confidence in the review findings were guided by GRADE-CERQual.

RESULTS

Fourteen eligible studies were included in the synthesis (7 qualitative and 5 mixed methods). Key themes identified under the health, information and technology zones of the HITAM revealed the benefits of mHealth apps, barriers to their use, their perceived usefulness and ease of use.

DISCUSSION

Most people used the apps for feedback on their self-management and found them helpful in their communication with health care providers. Some embraced the technology and found it easy to use while others found mHealth apps to be counterintuitive.

Development of a framework to promote rural health workforce capability through digital solutions: A qualitative study of user perspectives

A high-quality, sustained, health workforce contributes to a healthy population. However, a global reality is that rural health services, and the workforces that provide those services, are under unprecedented pressure. It is posited that improving a rural health practitioners' capability could help to retain them working rurally for longer. Capability refers to skills and experience and the extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance. With rapidly increasing access to, and use of, digital technology worldwide, there are new opportunities to build capability and leverage personal and professional support for those who are working rurally. In 2021, semi-structured interviews were conducted in rural Australia with thirteen General Practitioners and allied health professionals. Thematic analysis was adopted to analyse the data and map it to the Health Information Technology Acceptance Model. Whilst it could be assumed that low technology literacy would act as a barrier to the use of digital tools, the study demonstrated that this was not a significant impediment to participants' willingness to adopt digital tools when social and professional networks weren't available face to face to address their capability challenges. The findings provide insight into the concept of health workforce capability and important considerations when designing capability support. This includes key features of health apps or digital tools to support the capability of the rural health workforce. Understanding the factors that make up a health professionals' capability and the motivations or cues to act to build or maintain their capability may have a positive effect on their retention in a rural location.

Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

INTRODUCTION

Early diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals.

RESEARCH DESIGN AND METHODS

Participants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test.

RESULTS

Among 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples.

CONCLUSION

Self-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.

What is the acceptance of video consultations among orthopedic and trauma outpatients? A multi-center survey in 780 outpatients

INTRODUCTION

The purpose of the present study was to assess orthopedic and orthopedic trauma patients' willingness to perform hypothetical remote video consultations, possible advantages as well as concerns.

METHODS

Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted.

RESULTS

In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r²=0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in "part-time"-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was "communication of medical findings" (67.8%). The most stated advantage was the "reduction of physical consultations" (66.4%). "No physical examination" was the most frequently stated disadvantage (75.9%).

CONCLUSION

The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation.

Mixed methods protocol to examine the acceptability and clinical characteristics of a remote monitoring programme for delivery of COVID-19 care, among healthcare staff and patients

INTRODUCTION

The use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff.

METHODS AND ANALYSIS

Discharged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.

Perception of telemedicine among medical practitioners in Malaysia during COVID-19

The novel Coronavirus Disease 2019 (COVID-19) has brought unprecedented changes in the way conventional health care is delivered. This study examined if clinicians' perceptions regarding telemedicine and its barriers to implementation in Malaysia have changed during this pandemic. A cross-sectional survey was conducted among Malaysian medical doctors of various specialties in four urban healthcare facilities between June 2020 and July 2020. A total of 146 (41.7%) out of 350 responses were obtained. 62% of doctors reported a reduction greater than 50% in outpatient visits during the COVID-19 pandemic. The majority of doctors either found telemedicine useful in situations similar to COVID-19 (34.2%) or that it is essential to their daily practice (42.5%). However, only 22% reported using telemedicine for consultation during the COVID-19 pandemic. 74% of doctors felt that telemedicine would only benefit up to 30% of their patient population. Significantly more female doctors (80%) felt that telemedicine would benefit their patients compared to male doctors (45.8%) (P=0.03). Physicians (51.3%) were more inclined to adopt telemedicine in comparison to surgeons (32.4%) (P=0.03). The majority cited medico-legal issues and consent (80.6%), billing and charges (66.7%) and insurance reimbursement (62.5%), technical difficulties (62.5%) as their barrier to the adoption of telemedicine. Female doctors and physicians were more willing to adopt telemedicine when compared to male doctors and surgeons. Although the COVID-19 pandemic appeared to improve the perception, significant barriers should be resolved before many can incorporate it into their practice.

Understanding patients' views and willingness toward the use of telehealth in a cancer genetics service in Asia

Telehealth is a growing field, its pertinence magnified by COVID-19 causing the accelerated digitalization of the world. Given the significant global demand to provide telehealth services, it is important to explore patient receptiveness toward this alternative service model, particularly from regions where it has yet to be implemented. We conducted a cross-sectional study to understand the views and willingness of patients toward the use of telehealth for cancer genetic counseling. A survey was completed by 160 patients of the National Cancer Centre Singapore, and descriptive statistics were used to analyze the data. The study found that 95.6% (n = 153/160) of participants did not have prior telehealth experience. Most participants were willing or neutral toward having genetic counseling by phone (n = 114/160, 71.3%) and video (n = 106/160, 66.3%). However, majority prefer in-person appointments for first (n = 127/160, 79.4%) and follow-up (n = 97/160, 60.6%) visits over telehealth. Majority agreed that a phone/video consultation would meet most of their needs but voiced concerns regarding privacy and sharing of information (n = 79/160, 49.4% for phone; n = 74/160, 46.3% for video) and whether their emotional needs could be met (n = 61/160, 38.1%). Participants' age, employment status, income, mode of transportation to the appointment, and whether special arrangements were made to attend the in-person appointment were associated with receptivity to telehealth genetic counseling (p ≤ .05 for all). This study adds diversity to existing literature and demonstrates that patients from Asia are generally willing and accepting of the use of telehealth in a cancer genetics service. This will help meet increasing global demand of telehealth consultations in the post-pandemic new norm. Furthermore, it will also provide services for underserved populations and patients requiring urgent testing in a timely manner. Further studies are needed to explore the cost-effectiveness and fair billing methods, as well as willingness and acceptability of telehealth genetic counseling in post-COVID times.

Evaluating the effectiveness and utility of a novel culturally-adapted telemonitoring system in improving the glycaemic control of Asians with type-2 diabetes mellitus: a mixed method study protocol

Background

Regular supervision of patients with type-2 diabetes mellitus (T2DM) by healthcare providers is essential to optimise their glycaemic control but is challenging to achieve in current care models. Telemonitoring is postulated to bridge this gap by leveraging on internet-of-things and mobile-health technology. This study aims to determine the effectiveness of a novel telemonitoring system (OPTIMUM) in improving the glycaemic control of patients with T2DM compared with standard of care alone.

Methods

This mixed-method study comprises an initial randomised controlled trial involving 330 Asian adults with T2DM, aged 26–65 years old with an HbA1c of 7.5–10%, with 115 in the intervention and control arms each. Those in the intervention arm will use standardised Bluetooth-enabled devices to transmit their capillary glucose, blood pressure and weight measurements to the OPTIMUM system. Primary care physicians and nurses will remotely supervise them according to an embedded management algorithm for 6 months, including tele-education via weekly videos over 8 weeks and asynchronous tele-consultation if abnormal or absent parameters are detected. Patients in both arms will be assessed at baseline, 6, 12 and 24 months post-recruitment. The primary outcome will be their HbA1c difference between both arms at baseline and 6 months. Blood pressure and weight control; quality of life, medication adherence, confidence in self-management, diabetic literacy and related distress and healthcare utilisation using validated questionnaires; and incident retinal, renal, cardiac and cerebrovascular complications will be compared between the two arms as secondary outcomes at stipulated time-points. Intervention arm patients will be interviewed using qualitative research methods to understand their experience, acceptance and perceived usefulness of the OPTIMUM system.

Discussion

Overall, this study seeks to evaluate the effectiveness of cultural-adapted telemonitoring system in improving glycaemic control of Asians with type-2 diabetes mellitus compared to standard of care. The results of this trial will better inform policy makers in adopting telemedicine for population health management.

Trial registration

ClinicalTrials.gov NCT04306770. Registered on March 13, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05240-6.

Effects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis

Background

Noncommunicable diseases (NCDs) are associated with the burden of premature deaths and huge medical costs globally. There is an increasing number of studies combining a multiple health behavior change (MHBC) intervention paradigm with eHealth approaches to jointly promote weight-related health behaviors among people with NCD; yet, a comprehensive summary of these studies is lacking.

Objective

This review aims to meta-analyze the effectiveness and systematically summarize the characteristics of the relevant intervention studies for improving the outcomes of physical activity, healthy diet, and weight among people with NCD.

Methods

Following PRISMA guidelines, 4 electronic databases (PsycINFO, PubMed, Scopus, SPORTDiscus) were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Article selection, quality assessment, and data extraction were independently performed by 2 authors. The standardized mean difference (SMD) was calculated to evaluate the effectiveness of interventions for 3 intervention outcomes (physical activity, healthy diet, and weight), and subsequent subgroup analyses were performed for gender, age, intervention duration, channel, and theory. Calculations were conducted, and figures were produced in SPSS 22 and Review Manager 5.3.

Results

Of the 664 original hits generated by the systematic searches, 15 eligible studies with moderate to high quality were included. No potential publication bias was detected using statistical analyses. Studies varied in intervention channel, intensity, and content. The meta-analysis revealed that the eHealth MHBC interventions significantly promoted physical activity (SMD 0.85, 95% CI 0.23 to 1.47, P=.008) and healthy diet (SMD 0.78, 95% CI 0.13 to 1.43, P=.02), but did not contribute to a healthy weight status (SMD –0.13, 95% CI= –0.47 to 0.20, P=.43) among people with NCDs, compared to the control conditions. Results from subgroup analysis indicated that theory-based interventions achieved greater effect than nontheory-based interventions in promoting physical activity, and interventions with traditional approaches (SMS, telephone) were more effective than those with modern internet-based approaches in promoting healthy diet.

Conclusions

The results of this review indicates that eHealth MHBC interventions achieve preliminary success in promoting physical activity and healthy diet behaviors among people with NCD. Future studies could improve the intervention design to achieve better intervention effectiveness.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42019118629; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=118629

The Ideal Patient for Teleconsultation and Saving Resources

Objectives: The main objectives of the study were to evaluate the level of patients' acceptance of teleconsultation (TC) and to define the ideal patient profile for this type of service. The secondary objectives were to estimate the impact in time and financial resources for the patient in relation to face-to-face medicine. Materials and Methods: This is a prospective, nonprobabilistic, and random sampling study using an uncontrolled selection process consisting of a 19-question survey for health care users in the general population, in which the patients' acceptance of TC was analyzed through the question: "If your doctor suggested that you have a video conference consultation, how attractive would the proposal be for you?" Results: Of the 400 patients, 73.8% were in favor of a TC service. The variables that were associated with the acceptance of TC were health care users who had previously purchased on the internet (odds ratio [OR] = 2.6 confidence interval [CI] 95% 1.31; 5.05) and whether they were willing to assume the economic cost for a TC (OR = 7.8 CI 95% 3.26; 18.6). In terms of face-to-face consultations per year, 50% of the patients spent 5 h (standard deviation [SD] 10.7) going to see the doctor, and on average they requested 8.9 h (SD 16.1) of time off work permission and assumed an economic cost of €29.8 (SD 82.9) on journey time. Conclusion: A high number of health care users accept the use of TC, and this percentage increases in patients who had previously purchased online and were willing to assume an economic cost for this service.

Factors influencing healthcare providers' attitude and willingness to use information technology in diabetes management

BACKGROUND

The use of information technologies could help to improve communications between patients and care providers, might improve overall patient management practice. However, the potential for implementing these patient management options in Ethiopia has not been well documented. This institution-based survey aimed to describe the attitude and willingness of care providers towards the use of information technologies for managing diabetes patients, and factors influencing their interest.

METHODS

A cross-sectional quantitative survey was conducted on 423 study participants from February to March 2020 at two teaching hospitals in Northwest Ethiopia, where remote monitoring patients had not been implemented. A pretested self-administered questionnaire was used to collect the required data. Other than descriptive statistics, the binary logistic regression analysis method was used to identify factors associated with attitude. Also, the negative binomial regression method was used to identify factors associated with willingness to use information technologies.

RESULT

A total of 406 participants (69.7%, n = 283 nurses and 30.3%, n = 123 physicians) were completed survey. Overall, 64% of respondents had a favorable attitude towards remote monitoring, and the majority of them were willing to use voice call (74.4%), text message (62.1%), video conference (61.3%), e-mail (60.6%), and social media (57.4%) as a source of communication to support patients. The result of regression analysis shows that having a computer (AOR = 2.3, 95% CI: [1.3, 3.8]), innovativeness (AOR = 2.8, 95% CI: [1.8, 4.3]), and practice of supporting patient by electronic technologies (AOR = 1.7, 95% CI: [1.1, 2.6]) were significantly associated with attitude to remote monitoring. Attitude towards remote monitoring (IRR = 2.3, 95% CI: 1.1-4.7), computer use (IRR = 1.3, 95% CI: 1.162-3.023), frequently searching health-related information (IRR = 1.7, 95% CI: 1.459-6.570), gender (IRR = 1.2, 95% CI: 1.0-5.1), awareness towards remote monitoring (IRR = 1.4, 95% CI: 1.1-2.7) were significantly associated with willingness to use information technologies.

CONCLUSION

Improving the intention and skill of using computers should be a major point of attention for teaching hospitals who wish to improve their care providers' attitudes to remote monitoring and willingness in using information technologies. Besides, the awareness of professionals is crucial for improving willingness.