Internet-based developmental screening: a digital divide between English- and Spanish-speaking parents

Consumers' Mobile Health Adoption Intention Prediction Utilizing an Extended Version of The Theory of Planned Behavior

The proliferation and adoption of phones and other emerging technologies in health care is significantly growing in Ghana. Though tapping into this technology innovation could tremendously improve health care in resource deficient settings, there is a dearth of research on adoption antecedents. Drawing strength from behavior studies anchored on the theory of planned behavior (TPB), our study proposed a model, and further sampled 386 respondents to predict mobile health adoption behavior. Empirical results of our study revealed that attitude, subjective norm, perceived behavior control, personal moral norm, and language all had a significant positive relationship with adoption intention. Furthermore, adoption intention was also revealed to have a significant positive relationship with behavior. And finally, Internet bandwidth was revealed to significantly moderate the relationship between adoption intention and actual adoption behavior. Based on the results, further insights for stakeholders and policy, implications for accelerating mobile health adoption, and suggestions for future research are subsequently delineated.

When Do Clinicians Decide to Screen Children for Mental Health-Behavioral-Developmental Delays/Disorders: Is it Time to Reconsider Policy Recommendations?

OBJECTIVES

To determine at which ages providers choose to screen for mental, behavioral, and developmental disorder/delay (MBDD), and what they find; and which, if any, public and professional guidelines are most effective at identification.

STUDY DESIGN

Naturalistic retrospective cohort study of 215 general pediatric and family practice clinics within 24 US states involving 160 634 encounters during which MBDD screening tests were administered.

RESULTS

Almost all clinicians (96%) administered screens at ages targeted by the American Academy of Pediatrics (AAP), that is, 9, 18, 24, and/or 30 months of age, but also at younger and older ages: 57% opted to screen at ≥5 years of age. Of the 8% of children at risk for probable MBDD, 27% were detected at American Academy of Pediatrics-targeted ages-71% across the birth to 5-year age range and an additional 29% at ≥5 years of age. Children >30 months of age were 3 times more likely to have probable MBDD than were younger children, and those >5 years of age were almost 4 times more likely to have probable MBDD. Older children were more likely to have psychosocial risk factors, but age itself was the most powerful predictor.

CONCLUSIONS

Most clinicians preferred to screen across the birth to 8-year age range and their findings revealed that most MBDDs cannot be detected in the earliest years of life. Policies regarding the timing of screening should be expanded to include all well visits and between visits if needed.

Patients' understanding of telemedicine terms required for informed consent when translated into Kiswahili

Background

In Africa, where access to specialist medical services is often limited, telemedicine, the use of information and communication technologies for the provision of healthcare at a distance, can contribute towards enhancing access to healthcare. Informed consent is considered the cornerstone of ethical practice, especially when technology and techniques are considered new and or unproven. It is advised that informed consent should be gained in the patient’s mother tongue. However, many African languages have not kept pace with technology and lack the words and terms needed to describe computing and technical terms. Additionally, even when present, patients may not understand these words and terms. This affects the validity of informed consent given.

Methods

Forty relevant computer terms and words used when explaining telemedicine during the consent process were selected and translated into Kiswahili. Patients at the outpatient department of the Kilifi County Hospital in Kenya participated. The study consisted of two phases. In the first, 50 people were asked whether they understood the translated words and terms and were able to explain their meaning. In the second (n = 42) they were asked to explain the meaning of the translated word, the original English word, and those words that could not be translated.

Results

Of the 40 terms, 14 could not be translated (35%). A total of 92 people attending the Kilifi County Hospital participated. Their average age was 31.2 ± 10.6 y, 70.7% were female and 55.4% were from rural areas. More than half of the respondents did not understand videoconference, store and forward, digital photograph, wireless, World Wide Web, antivirus or email in either language. No-one understood the words telemedicine, firewall, encryption, decryption and tele-diagnosis.

Conclusions

Currently it is unlikely that valid informed consent can be obtained for a telemedicine encounter in Kiswahili. Innovative solutions are required to overcome the barrier of languages failing to keep pace with technology and their effect on consent.

Parental preference and ability to participate in web-based developmental screening and surveillance: preliminary evidence for preterm infants after NICU discharge

OBJECTIVES

The objectives of this article were (a) to describe prevalence of Internet and email access among parents of preterm infants attending high-risk follow-up, (b) to describe parent preference for completing developmental questionnaires online versus on paper, and (c) to examine predictors of access and preference.

DESIGN/METHODS

We surveyed 270 parents of preterm infants attending a high-risk follow-up clinic about Internet and email access, preference for completing a developmental questionnaire online versus on paper.

RESULTS

Median (interquartile range) gestational age was 28 (26, 30) weeks, and birth weight was 970 (765, 1230) grams. Ninety-five percent of parents had Internet and email access, and 71% preferred completing a developmental questionnaire online versus on paper or were indifferent. Less maternal education, lower family income, and Hispanic ethnicity were associated with less Internet and email access.

CONCLUSIONS

Most families attending a high-risk preterm infant follow-up clinic had Internet and email access and preferred completing developmental questionnaires online to on paper or were indifferent.

Latinos' Access to Online and Formal Mental Health Support

Research on mental health services disparities affecting minority populations of the USA tends to neglect online mental health support (OMHS). The main objective of this study was to investigate online mental health support and help-seeking of Latino citizens living in US communities by estimating associations linking OMHS with a selection of individual and community variables. In addition, the extent to which unmet mental health treatment needs among adults are associated with key variables was examined. Variables of interest included economic resources, health insurance and coverage, confidentiality, perceived stigma, and accessibility. Data are from 39,630 Latino adult participants in the National Surveys on Drug Use and Health (NSDUH), 2004-2010. Results indicate that for every 10,000 US Latino adults, fewer than 25 individuals received recent OMHS, as compared to a recently published estimate of 270-330 per 10,000 for the US population generally. Among Latinos with self-described unmet mental health needs, an estimated 40% identified cost of treatment as a prominent barrier that explained why they had not received formal mental health treatment services. Research and policy health disparities implications are discussed.