Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study

BACKGROUND

A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors.

OBJECTIVE

The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs.

METHODS

We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05.

RESULTS

About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=-.066; P=.07).

CONCLUSIONS

Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use.

Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis

BACKGROUND

Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care.

OBJECTIVE

This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services).

METHODS

In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion.

RESULTS

In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward.

CONCLUSIONS

This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.

Patients' Intentions to Use Telemedicine for Ophthalmic Medical Care During the COVID-19 Pandemic

Background This study aimed to examine the factors predicting participants' intention to use telemedicine during the COVID-19 pandemic. Interest in health information technologies (HITs) has increased due to COVID-19. Most studies have focused on the acceptance of HIT by physicians and nurses, while there is a lack of studies on patients' perception and acceptance of such systems in ophthalmology. Methodology In the first year of the COVID-19 pandemic, a survey comprising 19 items was conducted at an ophthalmic center in Greece. The participants included 77 patients diagnosed with various eye diseases. The survey aimed to evaluate variables related to the Technology Acceptance Model (TAM), such as perceived usefulness, perceived ease of use, facilitating conditions, and intention to use telemedicine. The statistical analyses included intercorrelations, internal consistency reliability tests, and multiple linear regression analysis to examine the predictors of intention to use telemedicine. Results The multiple linear regression analysis revealed that perceived usefulness and facilitating conditions emerged as significant predictors of eye patients' intentions to use HIT. Interestingly, while perceived ease of use did not exhibit a significant predictive relationship with use intentions, the influence of perceived usefulness and facilitating conditions within the healthcare context underscores the pivotal role of perceived utility and external support in shaping patients' willingness to engage with HIT for eye care. Conclusions Empirical data on patient acceptance offer a better understanding of the limiting factors and the variables that facilitate intentions to use services that may improve medical diagnoses, patient communication, and treatment adherence processes. Related interventions and communication efforts should highlight the benefits of HIT in ophthalmology and provide the appropriate support and means to facilitate its use during and after the pandemic.

Acceptance factors of telemedicine technology during Covid‐19 pandemic among health professionals: A qualitative study

Objective

Health professionals are the main users of telemedicine systems, and their acceptance will contribute to the successful implementation of this technology. The objective of this study is to provide a better understanding of the issues surrounding the acceptance of telemedicine technology by Moroccan health professionals in the public sector, in the preparation for a possible generalization of this technology in Morocco.

Method

Following a literature review, the authors mobilized a modified version of the unified model of technology acceptance and use, to explain and understand the determinants of health professionals' intention to accept telemedicine technology. The authors' methodology is based on a qualitative analysis and is primarily based on data obtained through semi-structured interviews with health professionals, who the authors believe are the primary actors in the acceptance of this technology within Moroccan hospitals.

Results

The authors' results suggest that performance expectancy, effort expectancy, compatibility, facilitating conditions, perceived incentives, and social influence have a significant positive impact on health professionals' behavioural intention to accept telemedicine technology.

Practical implications

From a practical point of view, the results of this study can help the government, organizations responsible for the implementation of telemedicine, and policymakers to understand the key factors that may affect the behaviour of future users of this technology, and to develop very specific strategies and policies for a successful generalization.

Understanding the determinants of adoption of mHealth services among older women’s perspective in Bangladesh

Purpose

The purpose of this study was to explore the factors affecting adoption of mHealth services among the older women in Bangladesh. As this portion of the total population is rapidly increasing in Dhaka City.

Design/methodology/approach

Using the technology acceptance model as a theoretical framework, this study introduces perceived reliability, price value and technology anxiety as new factor reflecting the user’s reliability, beliefs and monetary concerns in the acceptance of mHealth services. A structured survey was conducted to collect the required data from convenience sampling of 271 mHealth end users from Dhaka city in Bangladesh.

Findings

The study confirmed that perceived usefulness, perceived reliability; price value and technology anxiety had a significant impact on mHealth adoption. Ease of use did not influence on the adoption of mHealth services.

Originality/value

To the best of the authors’ knowledge, this study is one of the first to investigate the determinant of mHealth adoption among older Women. Moreover, the insights from this study could benefit mHealth services providers and policymakers in implementing more effective marketing strategies to increase the acceptability of mHealth services.

The Experience of 3D Total-Body Photography to Monitor Nevi: Results From an Australian General Population-Based Cohort Study

BACKGROUND

Digital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi.

OBJECTIVE

We aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi.

METHODS

A population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants' reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed.

RESULTS

A total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years; n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively; albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91; P=.01). Almost all participants (n=140, 94%) would consider using this technology if it were to become commercially available, and this did not change during the two study time points. Half of the participants (n=74) cited barriers to participating in 3D total-body photography, including trust in the ability of this technology to detect and monitor suspicious lesions, digital privacy, cost, and travel requirements.

CONCLUSIONS

The majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.

Provider Perspectives on Telemental Health Usage After COVID-19: A Retrospective Analysis (Preprint)

Background

Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift.

Objective

This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions.

Methods

We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic.

Results

Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ≥50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (β=.10; P=.005), perceived usefulness in general (β=.10; P=.008), ease of use (β=.08; P=.04), social influence (β=.68; P<.001), and facilitating conditions (β=.08; P=.047).

Conclusions

Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption.

An empirical study of factors influencing e-health services adoption among public in Saudi Arabia

Until now most of the studies concerning eHealth in Saudi Arabia are about the exploration of the national benefits from eHealth and the technical and infrastructural challenges in implementing eHealth rather than finding the factors influencing the users in adopting eHealth services. Further, the eHealth adoption rate in Saudi Arabia is low despite the scope of potential growth for the eHealth market. In this study, the authors added Trust, Privacy and System Quality factors to Technology Acceptance Model by considering the research context to examine the factors influencing eHealth services adoption. The proposed model was empirically tested based on the data collected, through survey questionnaire from 314 responses in Saudi Arabia. Structural Equation Modelling was followed to analysis and validates the proposed model based on partial least squares method using SmartPLS. Based on the findings, Perceived Usefulness in addition to Privacy significantly affect eHealth adoption. Moreover, Perceived Ease of Use factor has indirect effect on people perception toward eHealth services. Furthermore, the results show that System Quality and Trust are not influencing factors. This study is important for the healthcare policymakers for getting direction for future studies to avail the maximum benefits of eHealth in Saudi Arabia.

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.

Acceptance of Teledermoscopy by General Practitioners and Dermatologists in Denmark

Background

Teledermoscopy can be used to triage referrals of suspected skin cancers, thereby reducing waiting time and number of face-to-face consultations with a dermatologist. However, the success of the implementation of this technology in part relies on the acceptance of the providers.

Objectives

This study assessed the attitudes towards teledermoscopy of referring general practitioners and consultant dermatologists.

Methods

General practitioners from 48 practices and 3 dermatologists in the region of Southern Denmark, who had previous experience with teledermoscopy, were invited to answer questionnaires on their acceptance of the technology.

Results

General practitioners from 23 practices responded. All domains of the questionnaire received high scores, indicating a high degree of acceptance of teledermoscopy among respondents. All 3 dermatologists agreed that teledermoscopy was useful for triaging referrals, but they were less confident in their diagnoses and management plans proposed by teledermoscopy than in traditional face-to-face evaluations of patients. Two of the 3 dermatologists were satisfied with using teledermoscopy as a consult method.

Conclusions

This study reports high levels of provider acceptance of teledermoscopy. However, a low response rate among general practitioners may limit its generalizability.

Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study

Background

Clinical pathways (CPs) can improve patient outcomes but can be complex to implement. Technologies, such as clinical decision support (CDS) tools, can facilitate their use, but require end-user testing in clinical settings.

Objective

This study applied the Technology Acceptance Model to evaluate the individual, organizational, and technological contexts impacting application of a portal to facilitate a CP for anxiety and depression (the ADAPT Portal) in a metropolitan cancer service. The ADAPT Portal triggers patient screening on patient reported outcomes, alerts staff to high scores, recommends evidence-based management, and triggers review and rescreening at set intervals.

Methods

Quantitative and qualitative data on portal activity, data accuracy, and health service staff perspectives were collected. Quantitative data were analyzed descriptively, and thematic analysis was applied to qualitative data.

Results

Overall, 15 (100% of those invited) health service staff agreed to be interviewed. During the pilot, 73 users (36 health service staff members and 37 patients) were registered on the ADAPT Portal. Of the 37 patients registered, 16 (43%) completed screening at least once, with seven screening positive and triaged appropriately. In total, 34 support requests were lodged, resulting in 17 portal enhancements (technical issues). Health service staff considered the ADAPT Portal easy to use and useful; however, some deemed it unnecessary or burdensome (individual issues), particularly in a busy cancer service (organizational issues).

Conclusions

User testing of a CDS to facilitate screening and assessment of anxiety and depression in cancer patients highlighted some technological issues in implementing the ADAPT CDS, resulting in 17 enhancements. Our results highlight the importance of obtaining health service staff feedback when piloting specialized CDS tools and addressing contextual factors when implementing them.

A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation

Purpose of Review

Telemedicine use in dermatology, termed “teledermatology”, offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research.

Recent Findings

Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated.

Summary

This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13671-020-00323-0.

Understanding Clinicians' Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks

BACKGROUND

Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors.

OBJECTIVE

This review aimed to explore which frameworks are used the most, to understand clinicians' adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors.

METHODS

This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians' adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly.

RESULTS

The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34%), the diffusion of innovation theory (DOI; 8/50, 16%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6%), whereas others used the consolidated framework for implementation research (3/50, 6%) and sociotechnical systems (STS) theory (2/50, 4%). The factors cited by more than 20% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion.

CONCLUSIONS

Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians' adoption of mHealth, taking into account all three aspects.

Acceptance and use of a smartphone application in cirrhosis

BACKGROUND AND AIMS

The development of cirrhosis-related smartphone applications for remote monitoring is increasing. Whether patients with cirrhosis will welcome such new technology, however, is uncertain.

METHODS

We prospectively enrolled patients with cirrhosis (N = 102) to determine predictors of acceptance and utilization of a smartphone application for cirrhosis management using a 12-item Technology Acceptance Model (TAM) survey. Patients were then shown the EncephalApp© and evaluated for their willingness to download and use the application.

RESULTS

Patients had a median age of 61.3 years and 63.7% had a history of hepatic decompensation. Intention to use the hypothetical application was associated with perceived usefulness (β: 0.4, 95% CI: 0.3-0.5) and the presence of a caregiver (β: 1.1, 95% CI: 0.2-2.0). Of the eligible participants, 71% agreed to download the EncephalApp© and the decision was influenced by computer anxiety, behavioural intent, caregiver presence and disease state factors. Actual usage was 32% and not associated with baseline characteristics or the technology acceptance model.

CONCLUSIONS

Patient acceptance of smartphone applications for the management of cirrhosis is high and related to their attitudes towards technology and the presence of a caregiver. However, usage was low. Future research must employ behavioural interventions to optimize uptake and utilization of remote monitoring technology.

Primary Care Professionals' Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician’s acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as “Excellent” or “Good” (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g., by providing training), in order to ensure the use of these services in the future.

Teledermatology in Belgium: a pilot study

Background: Teledermatology, the application of telemedicine in the field of dermatology, can be a valuable tool to improve the efficiency of care in general practice.Objectives: In this pilot study, we implemented a teledermatology programme in Belgian context to assess the effect on referral rate and to evaluate the acceptability of teledermatology by clinicians and patients.Material and methods: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3-6 months. Clinicians and patients were questioned about satisfaction, benefits and barriers.Results: In total, 54 teledermatologic consultations were performed. The referral rate was reduced. Thirty-one teleconsulations were performed instead of physical referral, of which nine patients were actually referred. In 23 cases, performed for a second opinion, two more patients were referred on the dermatologist's advice.All clinicians want to continue working with teledermatology. GPs highlighted the educational benefit, whereas dermatologists were interested in the triage effect and reduced referral rate. Patients indicated that teledermatology would encourage them to consult a GP sooner when experiencing dermatologic problems.Conclusion: Teledermatology proved to be a feasible and acceptable tool for both clinicians and patients. It also shows to be a valuable for triage and reducing unnecessary referrals. Considering the emergent pressure on health care in the next decades, teledermatology following GP selection could be useful for the Belgian health care system and deserves further elaboration in the search for effective tools to strengthen first line health care and streamline referral to secondary care.

Validation of a Short Questionnaire to Assess Healthcare Professionals' Perceptions of Asynchronous Telemedicine Services: The Catalan Version of the Health Optimum Telemedicine Acceptance Questionnaire

Telemedicine is both effective and able to provide efficient care at a lower cost. It also enjoys a high degree of acceptance among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and is comprised of three dimensions: the individual context, the technological context and the implementation or organizational context. At present, no short, validated questionnaire exists in Catalonia to evaluate the acceptance of telemedicine services amongst healthcare professionals using a technology acceptance model. This article aims to statistically validate the Catalan version of the EU project Health Optimum telemedicine acceptance questionnaire. The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation with construct (exploratory factor analysis), consistency (Cronbach’s alpha) and stability (test–retest) analysis. After deleting incomplete responses, calculations were made using 33 participants. The internal consistency measured with the Cronbach’s alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79–0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852–0.964). The Kaiser–Meyer–Olkin test of sampling showed to be adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl = 28; p < 0.001). The questionnaire had two dimensions which accounted for 61.2% of the total variance: quality and technical difficulties relating to telemedicine. The findings of this study suggest that the validated questionnaire has robust statistical features that make it a good predictive model of healthcare professional’s satisfaction with telemedicine programs.

Is Teledermoscopy Ready to Replace Face-to-Face Examinations for the Early Detection of Skin Cancer? Consumer Views, Technology Acceptance, and Satisfaction with Care

BACKGROUND

Previous cross-sectional research indicates high acceptance of mobile teledermoscopy-enhanced skin self-examination (SSE) by consumers based on the technology acceptance model (TAM) domains: perceived usefulness, ease of use, compatibility, attitude and intention, subjective norms, facilitator, and trust. However, no study has assessed this outcome longitudinally among people who actually used the technology in their own homes.

METHODS

Participants were living in Brisbane, Australia, aged 18 years or older, and at high risk of skin cancer. Participants randomly assigned to the intervention group (n = 98) completed a self-administered questionnaire on mobile teledermoscopy acceptance for skin cancer detection both before use and after performing mobile teledermoscopy-enhanced SSE in their homes. The survey included a 25-item scale assessing seven TAM domains. Item scores ranged from 5 (strongly agree) to 1 (strongly disagree). Participants also answered survey questions on satisfaction with use of teledermoscopy, and a 9-item "thoughts about melanoma" scale that measures cancer worry.

RESULTS

Participants were 19-73 years old, had high skin cancer risk, blue or grey eyes (53.1%), fair or very fair skin (88.8%), and previous skin cancer treatments (61.2%). Participants were more accepting of mobile teledermoscopy at baseline: mean TAM score of 4.15 (SE 0.05); their level of acceptance decreased significantly after teledermoscopy use: mean score 3.94 (SE 0.05; p = 0.001). In linear regression analysis, the decrease in TAM scores was similar across demographic and skin cancer risk categories. Ninety-two percent (n = 90) of participants agreed that mobile teledermoscopy was easy to use. The mean score of the "thoughts about melanoma" scale did not change significantly from baseline to follow-up.

CONCLUSION

Consumers had high TAM scores before they used mobile teledermoscopy within a randomised control trial. At the end of the intervention period, TAM scores decreased, although participants' average score still indicated "agreement" that mobile teledermoscopy was acceptable.

Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review

Background

There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success.

Objective

The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives.

Methods

A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process.

Results

The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them.

Conclusions

The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.

Social, Organizational, and Technological Factors Impacting Clinicians' Adoption of Mobile Health Tools: Systematic Literature Review

BACKGROUND

There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success.

OBJECTIVE

The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians' adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives.

METHODS

A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process.

RESULTS

The technological factors impacting clinicians' adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them.

CONCLUSIONS

The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.

Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: protocol for a randomised controlled trial

INTRODUCTION

Melanoma is Australia's fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies. However, a skin surveillance approach targeting high-risk individuals could improve the cost-benefit ratio.

METHODS AND ANALYSIS

This paper describes a 2-year longitudinal randomised controlled trial (RCT) to compare routine clinical care (control) with an intensive skin surveillance programme (intervention) consisting of novel three-dimensional (3D) total-body photography (TBP), sequential digital dermoscopy and melanoma-risk stratification, in a high-risk melanoma cohort. Primary outcomes will evaluate clinical, economic and consumer impact of the intervention. Clinical outcomes will evaluate differences in the rate of lesion excisions/biopsies per person, benign to malignant ratio for excisions and thickness of melanomas diagnosed. A health economic analysis using government data repositories will capture healthcare utilisation and costs relating to skin surveillance. Consumer questionnaires will examine intervention acceptability, the psychological impact, and attitudes towards melanoma risk and sun protective behaviour. Secondary outcomes include the development of a holistic risk algorithm incorporating clinical, phenotypic and genetic factors to facilitate the identification of those most likely to benefit from this surveillance approach. Furthermore, the feasibility of integrating the intervention with teledermatology to enhance specialist care in remote locations will be evaluated. This will be the first RCT to compare a targeted surveillance programme utilising new 3D TBP technology against current routine clinical care for individuals at high risk of melanoma.

ETHICS AND DISSEMINATION

This study has received Human Research Ethics Committee (HREC) approval from both Metro South Health HREC (HREC/17/QPAH/816) and The University of Queensland HREC (2018000074).

TRIAL REGISTRATION NUMBER

ANZCTR12618000267257; Pre-results.

Investigating Factors Impelling the Adoption of e-Health: A Perspective of African Expats in China

The purpose of the study was to analyze the factors affecting the acceptance and adoption of e-Health applications among African expats in China from the patient’s perspective. This research used extended technology acceptance model (TAM) with the addition of privacy and trust. The survey method with the structured questionnaire was used to collect data from more than 300 African expats in three Tier 1 cities of China. Hypotheses were tested using partial least squares (PLS) method, a structural equation modeling (SEM) based statistical technique. The results show that perceived usefulness, perceived ease of use (PEU), and privacy have significant effects on intention to use (INT) e-Health technologies. Moreover, PEU endorses positive impact on perceived usefulness. The results also revealed that gender was partially associated with the acceptance and use of e-Health technologies. However, surprisingly, trust had an insignificant effect on INT of e-Health. The results of the current research provide the foundation for the development of policies and strategies for the enhancement of e-Health services to African expats in China. Moreover, the acceptance model of current study can be modified easily because of its generic approach for the investigation of adoption of e-Health services among other developing countries’ expats in China.

Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review

BACKGROUND

Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users.

OBJECTIVE

The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine.

METHODS

An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies.

RESULTS

Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models.

CONCLUSIONS

The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group's social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.

Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer

Objective

The aim of the study is to evaluate healthcare practitioners’ views on and satisfaction with (i) digital image acquisition and storage and (ii) store-and-forward teledermoscopy services for the diagnosis of skin cancer in their clinical practice.

Methods

An online survey was conducted among 59 healthcare practitioners (GPs (n=17), dermatologists (n=22), dermatology registrars (n=18), a dermatology research fellow (n=1) and a plastic surgeon (n=1)) to assess usability of digital image acquisition and storage for when the imaging process is conducted by the healthcare practitioners themselves, or by their patients. The study identifies the enablers and barriers of this emerging mode of medical practice. A thematic analysis was used to extract key themes from open-ended responses, which involved identifying themes and patterns within and across participants.

Results

Thirty-four healthcare practitioners (58%) had previously used a mobile dermatoscope within their practice. Participants most appreciated its use in their practice for lesion monitoring (59%) and record keeping (39%). Challenges reported were the increased time to support the additional workload (45%), technical issues (33%) and cost of equipment (27%). Practitioners were unsure (36%) or did not advocate teledermoscopy for direct-to-consumer use (41%). Only 23% supported the use of direct-to-consumer teledermoscopy.

Conclusion

While most practitioners are receptive to mobile teledermoscopy, there was less support for patient-initiated use, whereby the patient controls the imaging process. As technology improves rapidly it is important to evaluate practitioners’ acceptance and satisfaction of evolving telehealth services, moving forward with models of practice where healthcare practitioners and other healthcare providers will feel comfortable engaging in telehealth services.

[Factors that determine the intention to use telemedicine in a healthcare organisation]

INTRODUCTION

There are numerous factors and barriers that hinder the use of telemedicine, among which some aspects of the organisation stand out. Thus, it would be interesting to determine its intention to use it in a health institution. The objective of this paper was to identify the factors that influence the intent to use telemedicine by the group of professionals of the Andalusian Health Service and the type of professionals based on the use and expectations of (information and communications technology (ICT).

METHODS

A specific questionnaire was designed based on an extended Model of Technological Acceptance that was distributed to a sample of 2,847 professionals of all the categories of this institution. A univariate analysis, exploratory factor analysis and logistic regression were carried out to determine those explanatory variables that are related to the use of telemedicine.

RESULTS

A total of 424 responses were obtained. The study determined that the institution's support, perceived usefulness and ease of use (P<.05) were factors that influence the use of telemedicine. The support of the workers and the technological profile of the professionals (P<.05) were significant.

CONCLUSIONS

Due to there being a high number of factors in health services, it is possible to find differences between the explanatory models in each specific organisation. For this reason, studies need to be carried out before the implantation and use of telemedicine systems in order to identify which of the possible variables influence favourable adoption as a prerequisite for the generalised use of telemedicine.

Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma

BACKGROUND

Mobile teledermoscopy may facilitate skin self-examinations (SSEs) and further improve monitoring and detection of melanoma.

OBJECTIVE

To assess consumer acceptability and expectations of a mobile health app used to: (i) instruct SSE and (ii) conduct consumer-performed mobile teledermoscopy.

METHODS

People aged 18 years and above were invited to participate in either (i) an online survey or (ii) focus group in Brisbane, Australia. Participants were asked about their SSE practices, mobile teledermoscopy acceptance, and app design and functionality. The online survey responses and focus group discussions were coded by two researchers who conducted thematic analysis.

RESULTS

Four focus groups were held with a total of 28 participants; 88 participants completed the online survey. The mean ages of participants in the focus group and online survey were 46 and 38 years, respectively. There were more males in the focus groups (61%, 17/28) compared to the online survey (19%, 17/88). Regular SSEs were conducted by 56 (64%) of the online survey participants. Barriers to SSE were forgetfulness (44%), low self-perceived risk of melanoma (25%) and low confidence in conducting SSEs (25%). The large majority of online survey participants (95%) would consider sending photos of their skin lesions to a medical practitioner via an app. Focus group participants reported that they would accept using mobile teledermoscopy; however, they would prefer to use it to monitor lesions between face-to-face consultations.

CONCLUSIONS

Overall, participants had positive views on using mobile teledermoscopy to send images of skin lesions to a dermatologist or other medical practitioner.

'Mind your Moles' study: protocol of a prospective cohort study of melanocytic naevi

INTRODUCTION

Having many melanocytic naevi or 'moles' on the skin is the strongest predictor of melanoma; thus, much can be learnt from investigating naevi in the general population. We aim to improve the understanding of the epidemiology and biology of naevi by conducting a 3-year prospective study of melanocytic naevi in adults.

METHODS AND ANALYSIS

This is a population-based cohort study of melanocytic naevi in 200 adults aged 20-69 years recruited via the Australian electoral roll. At baseline, participants will complete a questionnaire on their sun behaviour and health and undergo a clinical examination. Three-dimensional (3D) total-body photography will be used to record the images of skin lesions. Pigmented naevi will be analysed in terms of number, diameter, colour and border irregularity using automated analysis software (excluding scalp, beneath underwear and soles of feet). All naevi ≥5 mm will be recorded using the integrated dermoscopy photographic system. A saliva sample will be obtained at baseline for genomic DNA analysis of pigmentation, naevus and melanoma-associated genes using the Illumina HumanCoreExome platform. The sun behaviour and health follow-up questionnaire, clinical examination and 3D total-body photography will be repeated every 6 months for 3 years. The first 50 participants will also undergo manual counts of naevi ≥2 mm and ≥5 mm at baseline, 6-month and 12-month follow-ups. Microbiopsy and excision of naevi of research interest is planned to commence at the 18-month time point among those who agree to donate samples for detailed histopathological and molecular assessment.

ETHICS AND DISSEMINATION

This study was approved by the Metro South Health Human Research Ethics Committee in April 2016 (approval number: HREC/16/QPAH/125). The findings will be disseminated through peer-reviewed and non-peer-reviewed publications and presentations at conferences.

mHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping

Background

mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology.

Objective

The purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum.

Methods

A systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis.

Results

Of the 18 studies, 5 (28%) evaluated prevention interventions, 6 (33%) assessed diagnostic accuracy, and 7 (39%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research.

Conclusions

This review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews.

Patients' perception of using telehealth for type 2 diabetes management: a phenomenological study

Background

There is a growing body of evidence that supports the uses of telehealth to monitor and manage people with diabetes at a distance. Despite this, the uptake of telehealth has been low. The objective of this study is to explore patients’ perceptions of using telehealth for type 2 diabetes management.

Methods

Semi-structured interviews were undertaken with 10 patients from the NHS Newham area in London, UK. Data were collected using recorded semi-structured interviews. The interviews were transcribed verbatim and the analysis was guided by the phenomenological analysis approach.

Results

We identified three main themes for facilitating positive patient experience or acceptance of telehealth and these included: technology consideration, service perceptions and empowerment. All patients asserted that they were pleased with the technology and many also proclaimed that they could not see themselves being without it. Moreover, very few negative views were reported with respect to the use of telehealth.

Conclusion

The patients’ perceived telehealth as a potential to enhance their quality of life, allow them to live independently at home as well as help them take and be in more control over their own health state. The findings of this study therefore supports the use of telehealth for the routine care of people with type 2 diabetes. However, one must interpret the results with caution due to limitations identified in the sample.

A Systematic Review of the Technology Acceptance Model in Health Informatics

BACKGROUND

One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM).

OBJECTIVE

This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction.

METHOD

An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM.

RESULTS

The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered.

CONCLUSION

Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Changes in User Perceptions of a Telemedicine System Over Time: From Initial Implementation to Everyday Use

BACKGROUND

Benefits associated with telemedicine are contingent upon positive user perceptions. Despite this, research on user perceptions of telemedicine remains limited.

INTRODUCTION

Usability approaches offer a robust way to assess user perceptions, but have rarely been applied in telemedicine. In this study, a usability approach was employed to examine how user perceptions toward a telemedicine system changed over the course of everyday use.

MATERIALS AND METHODS

A telemedicine system was introduced to a hospital in the home service. Ten mobile nurses completed the System Usability Scale (SUS) after initial use, then again after 18 months of everyday use. Results were compared. Analysis included Bangor et al.'s (2009) adjective rating scale.

RESULTS

The initial SUS mean was 83 (standard deviation [SD] = 7.98), indicating "excellent" usability. After 18 months, the SUS mean was 64.38, indicating "OK" usability (SD = 14.25, p < 0.05, 95% confidence interval [CI]). Over time, users had lower desire to use the system frequently (p < 0.05, 95% CI), found it more complex (p < 0.05, 95% CI), and perceived greater inconsistency in its design (p < 0.05, 95% CI).

DISCUSSION

Considered with existing evidence, our usability findings indicate that a temporary period of positive user perceptions occurs when new telemedicine systems are used for the first few months. This fades with everyday use, with design inconsistency and perceived complexity becoming more noticeable. Although other factors such as user satisfaction and efficiency may also contribute, further studies are needed for confirmation.

CONCLUSIONS

User perceptions of telemedicine vary with time. To help maximize the benefits and longevity of telemedicine systems, responding to intermittent user appraisal is desirable.

"Like Holding an Umbrella Before It Rains": Acceptability of Future Rectal Microbicides Among Men Who Have Sex With Men in India-A Modified Technology Acceptance Model

Topical rectal microbicides (RMs) are a new prevention technology in development that aims to reduce the risk of HIV acquisition from anal sex. We examined RM acceptability among men who have sex with men (MSM) in India. We conducted a qualitative exploratory study guided by a modified Technology Acceptance Model, with 10 focus groups ( n = 61) of MSM and 10 key informant interviews. Data were explored using framework analysis. RM acceptability was influenced by technological contexts: perceived usefulness of RMs, perceived ease of use of RM and applicator, and habits around condom and lubricant use; individual and interpersonal contexts: perceived relevance and preferences for product formulation and dosing frequency; and MSM community/social contexts: perceived social approval, RM-related stigma, social support. Implementation of RMs for MSM in India may be supported by multi-level interventions that engage community-based organizations in destigmatizing and distributing RMs, ideally gel-based products that enable on-demand use before sex.

A systematic review of satisfaction with teledermatology

Background The two most commonly used modalities of teledermatology (TD) are store-and-forward (SF) and live-interactive (LI) TD. Existing studies have not compared these tools with respect to patient and provider satisfaction. Objective To systematically review all published studies of patient and provider satisfaction with SF and LI TD. Methods PubMed, EMBASE, and Cochrane databases were systematically searched for studies on provider or patient satisfaction with SF or LI TD between January 2000 and June 2016. Results Forty eligible studies were identified: 32 with SF TD, 10 with LI TD, and 2 evaluating both. With SF TD, 96% of studies assessing patient satisfaction and 82% of studies assessing provider satisfaction demonstrated satisfaction ( n = 24 and 17, respectively). With LI TD, 89% of studies assessing patient satisfaction and all studies assessing provider satisfaction revealed satisfaction (n = 9 and 6, respectively). Conclusion Patients and providers are satisfied with both SF and LI TD. Studies assessing satisfaction with LI have not been conducted in recent years, and have only been conducted in limited geographic patient populations. Further research assessing satisfaction with TD will help address any dissatisfaction with its uses and allow for increased support and funding of future programmes.

Theoretical frameworks in telemedicine research

The purposive use of theory is a foundational component of research, which underpins the design, methodology, measures, interventions, and interpretation of the research project. This should be considered from the time the nascent idea of the research is born, until the final interpretation of results and write up of the discussion. Several theories relevant to telemedicine are described, discussed, and linked to typical research questions in the field.

Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems

Teledermatology, originating in 1995, has been one of the first telemedicine services to see the light of day. Two decades of teledermatology research is summarized in this review. A literature search was conducted in PubMed. Search terms included “teledermatology,” “teledermoscopy,” “tele wound care,” “telederm*,” “(dermatology OR dermoscopy OR wound care OR skin) AND (telemedicine OR ehealth or mhealth OR telecare OR teledermatology OR teledermoscopy).” Inclusion criteria were (i) Dutch or English written papers and (ii) publication year from 2011 to present or (iii) (systematic) reviews with publication year before 2011. One hundred fourteen publications and 14 (systematic) reviews were included for full text reading. Focus of this review is on the following outcomes: (i) actors (primary, secondary, tertiary), (ii) purposes (consultation, triage, follow-up, education) and subspecialties (tele-wound care, burn care, teledermoscopy (teledermatoscopy), teledermatopathology, and mobile teledermatology), (iii) delivery modalities and technologies (store and forward, real-time interactive, and hybrid modalities using web-based systems, email, mobile phones, tablets, or videoconferencing equipment), (iv) business models, (v) integration of teledermatology into national healthcare systems, (vi) preconditions and requirements for implementation (security, ethical issues, responsibility, reimbursement, user satisfaction, technique, and technology standards), and (vii) added value.

To conclude, teledermatology is an efficient and effective healthcare service compared to in-person care. Teledermatology reduces patients’ travel time and waiting time, avoids (unnecessary) dermatologic visits, and improves access of care to underserved patients.

Investigating factors influencing the adoption of e-Health in developing countries: A patient's perspective

PURPOSE

The aim of the study was to investigate factors that influence the adoption and use of e-Health applications in Bangladesh from citizens' (patients') perspectives by extending the technology acceptance model (TAM) to include privacy and trust.

METHODS

A structured questionnaire survey was used to collect data from more than 350 participants in various private and public hospitals in Dhaka, the capital city of Bangladesh. The data were analyzed using the partial least-squares (PLS) method, a statistical analysis technique based on structural equation modeling (SEM).

RESULTS

The study determined that perceived ease of use and perceived usefulness and trust (p < 0.05) were significant factors influencing the intention to adopt e-Health. Privacy (p > 0.05) was identified as a less significant factor in the context of e-Health in Bangladesh. The findings also revealed that gender was strongly associated with the adoption and use of e-Health services.

CONCLUSIONS

The findings of the present study contribute to the development of strategies and policies to enhance e-Health services in Bangladesh. Furthermore, as a result of the generic approach used in this study, the acceptance model developed can be easily modified to investigate the adoption of e-Health in other developing countries.

The acceptance of mobile teledermoscopy by primary care nurse practitioners in the state of Arizona

PURPOSE

To conduct a pilot survey to assess acceptance of mobile teledermoscopy (MTD) by primary care nurse practitioners (NPs) working in Arizona.

DATA SOURCES

Sixty-two participants recruited from NP and academic listservs in Arizona completed an online survey prefaced by a MTD definition, device photographs, and a practice case, followed by 33 items measuring Teledermatology Technology Acceptance Model (TeleTAM) constructs.

CONCLUSIONS

Participants were highly interested in using MTD to assess skin lesions. They perceived MTD utility to greatly improve diagnosis and positively impact their practice. Most participants had never used MTD, but had high mean scores for MTD attitude and moderate scores for MTD perceived ease of use, perceived use, and facilitators of MTD. They had moderate scores for intention to use MTD. The construct facilitators (organizational infrastructure) were most strongly associated with intention to use MTD. Cronbach alphas were 0.70 or higher for all subscales except compatibility and habit.

IMPLICATIONS FOR PRACTICE

Moderate acceptance of MTD may reflect NPs' knowledge of the technology, self-confidence for using it, or MTD financial constraints. Future research will address these factors to foster use of MTD by NPs, thereby improving patients' access to early skin lesion assessment and diagnosis.

Beyond technology acceptance to effective technology use: a parsimonious and actionable model

OBJECTIVE

To develop and test a parsimonious and actionable model of effective technology use (ETU).

DESIGN

Cross-sectional survey of primary care providers (n = 53) in a large integrated health care organization that recently implemented new medication reconciliation technology.

METHODS

Surveys assessed 5 technology-related perceptions (compatibility with work values, implementation climate, compatibility with work processes, perceived usefulness, and ease of use) and 1 outcome variable, ETU. ETU was measured as both consistency and quality of technology use.

RESULTS

Compatibility with work values and implementation climate were found to have differential effects on consistency and quality of use. When implementation climate was strong, consistency of technology use was high. However, quality of technology use was high only when implementation climate was strong and values compatibility was high. This is an important finding and highlights the importance of users' workplace values as a key determinant of quality of use.

CONCLUSIONS

To extend our effectiveness in implementing new health care information technology, we need parsimonious models that include actionable determinants of ETU and account for the differential effects of these determinants on the multiple dimensions of ETU.

The relationship between telehealth and information technology ranges from that of uneasy bedfellows to creative partnerships

The relationship between the clinical and technical aspects of a telehealth operation is frequently problematic, and technically-driven projects often fail to achieve sustainability. Qualitative data from a study of 37 Australian telehealth services were analysed to understand how the relationship between telehealth providers and information technology (IT) departments helps or hinders the development of telehealth. The most frequent difficulties reported were between telehealth services and the internal IT departments of health services, rather than with external vendors. The difficulties included barriers to installing telehealth over IT networks, a lack of priority given to telehealth services, and IT departments insisting on standardised approach. Alternatively, when IT staff were assigned to supporting clinical staff and had a close working relationship with them, they were major enablers of telehealth services. Authorising dedicated IT support and encouraging joint problem solving should provide a strong foundation for a healthy relationship which contributes to the growth and sustainability of telehealth.

Questionnaire survey about use of an online appointment booking system in one large tertiary public hospital outpatient service center in China

Background

As a part of nationwide healthcare reforms, the Chinese government launched web-based appointment systems (WAS) to provide a solution to problems around outpatient appointments and services. These have been in place in all Chinese public tertiary hospitals since 2009.

Methods

Questionnaires were collected from both patients and doctors in one large tertiary public hospital in Shanghai, China.Data were analyzed to measure their satisfaction and views about the WAS.

Results

The 1000 outpatients randomly selected for the survey were least satisfied about the waiting time to see a doctor. Even though the WAS provided a much more convenient booking method, only 17% of patients used it. Of the 197 doctors surveyed, over 90% thought it was necessary to provide alternative forms of appointment booking systems for outpatients. However, about 80% of those doctors who were not associated professors would like to provide an ‘on-the-spot’ appointment option, which would lead to longer waits for patients.

Conclusions

Patients were least satisfied about the waiting times. To effectively reduce appointment-waiting times is therefore an urgent issue. Despite the benefits of using the WAS, most patients still registered via the usual method of queuing, suggesting that hospitals and health service providers should promote and encourage the use of the WAS. Furthermore, Chinese health providers need to help doctors to take others’ opinions or feedback into consideration when treating patients to minimize the gap between patients’ and doctors’ opinions. These findings may provide useful information for both practitioners and regulators, and improve recognition of this efficient and useful booking system, which may have far-reaching and positive implications for China’s ongoing reforms.

Clinician acceptance is the key factor for sustainable telehealth services

Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.

Understanding the mediating effects of relationship quality on technology acceptance: an empirical study of e-appointment system

This study extends the Technology Acceptance Model (TAM) by incorporating relationship quality as a mediator to construct a comprehensive framework for understanding the influence on continuance intention in the hospital e-appointment system. A survey of 334 Taiwanese citizens who were contacted via phone or the Internet and Structural Equation Modeling (SEM) is used for path analysis and hypothesis tests. The study shows that perceived ease of use (PEOU) and perceived usefulness (PU) have significant influence on continuance intention through the mediation of relationship quality, consisting of satisfaction and trust. The direct impact of relationship quality on continuance intention is also significant. The analytical results reveal that the relationship between the hospital, patients and e-appointment users can be improved via enhancing the continued usage of e-appointment. This paper also proposes a general model to synthesize the essence of PEOU, PU, and relationship quality for explaining users' continuous intention of e-appointment.

The views of health-care personnel about video consultation prior to implementation in primary health care in rural areas

Aim

The aim of this study was to describe the views of health-care personnel about video consultation (VC) prior to implementation in primary health care in rural areas.

Background

For people living in rural areas, it is often a long distance to specialist care, and VC could be an opportunity for increased access to care. Therefore, this study was to investigate what views primary health-care personnel had on VC as a working method in the distance between primary and specialist care. The development of technology in society and the introduction of technology in health care mean that the working methods must be adapted to a new approach. It is therefore important that in the initial phase of the introduction of new working methods to capture the personnel views regarding this.

Methods

Focus group (FG) discussions with health-care personnel from five primary health-care centres in northern Sweden. The transcribed FG discussions were analysed with qualitative content analysis.

Findings

The analysis revealed four main categories: a patient-centred VC; the importance of evaluating costs and resources; new technology in daily work; technology gives new possibilities in future health care.

Evaluating acceptance and user experience of a guideline-based clinical decision support system execution platform

This study aims to determine what the initial disposition of physicians towards the use of Clinical Decision Support Systems (CDSS) based on Computerised Clinical Guidelines and Protocols (CCGP) is; and whether their prolonged utilisation has a positive effect on their intention to adopt them in the future. For a period of 3 months, 8 volunteer paediatricians monitored each up to 10 asthmatic patients using two CCGPs deployed in the-GuidesMed CDSS. A Technology Acceptance Model (TAM) questionnaire was supplied to them before and after using the system. Results from both questionnaires are analysed searching for significant improvements in opinion between them. An additional survey was performed to analyse the usability of the system. It was found that initial disposition of physicians towards e-GuidesMed is good. Improvement between the pre and post iterations of the TAM questionnaire has been found to be statistically significant. Nonetheless, slightly lower values in the Compatibility and Habit variables show that participants perceive possible difficulties to integrate e-GuidesMed into their daily routine. The variable Facilitators shows the highest correlation with the Intention to Use. Usability of the system has also been rated very high and, in this regard, no fundamental flaw has been detected. Initial views towards e-GuidesMed are positive, and become reinforced after continued utilisation of the system. In order to achieve an effective implementation, it becomes essential to facilitate conditions to integrate the system into the physician's daily routine.