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Saouadogo I, Massom DM, Kabore SS, Fomete Djatsa RK, Seu J, Ngangue P. Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso. Int J MCH AIDS 2024; 13:e002. [PMID: 38694895 PMCID: PMC11008583 DOI: 10.25259/ijma_650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/28/2024] [Indexed: 05/04/2024] Open
Abstract
Background and Objective Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. Methods We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Results Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. Conclusion and Global Health Implications The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.
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Affiliation(s)
- Issaka Saouadogo
- Institute for Interdisciplinary Research Training in Health Sciences and Education, Ouagadougou, Burkina Faso
| | - Douglas Mbang Massom
- Epidemiology, Intervention and Training Department, Epicentre, Yaounde, Cameroon
| | - Soutongnoma Safiata Kabore
- Institute for Interdisciplinary Research Training in Health Sciences and Education, Ouagadougou, Burkina Faso
| | - Ronny Kevin Fomete Djatsa
- Laboratory for Research on Economic and Social Transformations, Research Laboratory on Economic and Social Transformations, Cheikh Anta Diop University of Dakar, Senegal
| | - Josiane Seu
- Faculty of Nursing, Laval University, Quebec, Canada
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Camacho-Leon G, Faytong-Haro M, Carrera K, Molero M, Melean F, Reyes Y, Mautong H, De La Hoz I, Cherrez-Ojeda I. A Narrative Review of Telemedicine in Latin America during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:1361. [PMID: 35893183 PMCID: PMC9330433 DOI: 10.3390/healthcare10081361] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic greatly impacted traditional health structures, posing new challenges in an unprecedented health crisis. Telemedicine services were implemented in countries with robust digital platforms to reduce hospital attendance while continuing to provide medical care. This study aims to determine how telemedicine services have been used as a tool to ensure the right to health in Latin America during the pandemic. MATERIALS AND METHODS We conducted a narrative review in which words such as telemedicine, COVID-19, Latin America, access, and right to health, were searched on scientific medical datasets such as PubMed and SciELO. Additionally, we reviewed legislation in the Latin American health domain regarding the administration and transmission of digital data. RESULTS AND CONCLUSIONS Several countries have used telemedicine to reduce the saturation of healthcare systems and increase patient access. Issues such as broadband access for low-income populations and adequate legal regulations for transmitting and storing confidential data must be addressed to improve telemedicine use in Latin America.
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Affiliation(s)
- Genesis Camacho-Leon
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela; (G.C.-L.); (I.D.L.H.)
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Marco Faytong-Haro
- Sociology and Demography Department, The Pennsylvania State University, University Park, PA 16802, USA
- Ecuadorian Development Research Lab, Daule, Guayas 090656, Ecuador
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
| | - Keila Carrera
- Gastroenterology, Universidad de Oriente, El Tigre, Anzoátegui 6050, Venezuela;
| | - Marlyn Molero
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Franhe Melean
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Yuliana Reyes
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Hans Mautong
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
| | - Ivonne De La Hoz
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela; (G.C.-L.); (I.D.L.H.)
| | - Ivan Cherrez-Ojeda
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
- Respiralab Research Group, Guayaquil, Guayas 090512, Ecuador
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3
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Alvarado-Villa G, KuonYeng-Escalante C, Sagñay-Pinilla N, Vera Paz C, Cherrez-Ojeda I. Perceptions and knowledge of telemedicine in Ecuadorian practicing physicians: an instrument adaptation, validation and translation from English to Spanish. BMC Public Health 2021; 21:1781. [PMID: 34600498 PMCID: PMC8486965 DOI: 10.1186/s12889-021-11826-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, multiple countries have taken measures, such as isolation and quarantine, to prevent person-to-person spread of disease. These actions forced many physicians to adopt new techniques, such as telemedicine, to continue patient care, which has proven to be useful in continued care for those with non-COVID-19 pathologies. Various factors, such as security, confidentiality, cost-effectiveness, comfort, and the risk of malpractice, influence the perception of telemedicine among medical practitioners. The aim of this study was to adapt an existing instrument and validate it into a new Spanish version. The instrument is about the perceptions and knowledge of telemedicine in healthcare professionals. METHODS The original questionnaire surveyed 6 domains with 40 questions, and each question was measured with a five-point Likert scale ranging from very high [5] to very low [1]. The survey was translated to Spanish using machine translation. The translation was reviewed independently, and then, a consensus was achieved regarding minor changes in the syntax of the survey to facilitate understanding. After expert feedback and questionnaire review, the research team members proposed reducing the instrument to 13 items in 4 domains due to the similarity of some questions. The sample was divided into 2randomly selected groups. Eligibility criteria included physicians providing private or public services with active medical/clinical practice. RESULTS In total, 382 surveys were collected and separated into two random samples, S1 and S2 (198 and 184, respectively). In exploratory factor analysis (EFA), the 13 items were grouped into four theoretical domains, and item 7 presented cross loading between factors and was removed. Confirmatory factor analysis was performed to assess the scale reliability and interscale associations; three models were tested. Global Cronbach's alpha for internal consistency was 0.76 for the EFA. The goodness of fit measures root mean square error of approximation and comparative fit index were 0.009 and 0.999, respectively, for the best model. CONCLUSIONS The translated instrument was clear, with adequate internal consistency, readability, and appropriate for application in the physician setting. This validated questionnaire made it possible to evaluate physicians' knowledge of telemedicine to increase its use, especially during the COVID-19 pandemic.
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The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective. Dermatol Ther (Heidelb) 2021; 11:1521-1540. [PMID: 34449071 PMCID: PMC8395384 DOI: 10.1007/s13555-021-00595-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Adoption of control tools for atopic dermatitis (AD) in Latin America (LA) is currently very limited. Clinical assessment tools represent a practical method to measure the impact of treatment on disease activity and on the quality of life of patients. However, the use of these tools in the LA clinical practice setting is limited. Methods A selected panel of Latin American experts in fields related to atopic dermatitis were provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved. Results The panel proposes specific and realistic recommendations for implementing control tools for AD care in LA. In creating these recommendations, the authors strove to address all barriers to the widespread use of these tools. Conclusion This article includes a narrative analysis of barriers to AD control in LA and provides necessary recommendations to integrate and increase the use of validated AD control assessment tools throughout the region.
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Cherrez-Ojeda I, Vanegas E, Cherrez A, Felix M, Weller K, Magerl M, Maurer RR, Mata VL, Kasperska-Zajac A, Sikora A, Fomina D, Kovalkova E, Godse K, Rao ND, Khoshkhui M, Rastgoo S, Criado RF, Abuzakouk M, Grandon D, Van Doorn MBA, Oliveira Rodrigues Valle S, De Souza Lima EM, Thomsen SF, Ramón GD, Matos Benavides EE, Bauer A, Giménez-Arnau AM, Kocatürk E, Guillet C, Larco JI, Zhao ZT, Makris M, Ritchie C, Xepapadaki P, Ensina LF, Cherrez S, Maurer M. How are patients with chronic urticaria interested in using information and communication technologies to guide their healthcare? A UCARE study. World Allergy Organ J 2021; 14:100542. [PMID: 34141048 PMCID: PMC8190491 DOI: 10.1016/j.waojou.2021.100542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 11/03/2022] Open
Abstract
Background Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. Methods In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. Results Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. Conclusions Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Annia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Markus Magerl
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Rasmus Robin Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Valeria L Mata
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Sikora
- European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland
| | - Daria Fomina
- City Center of Allergy and Immunology, Clinical City Hospital #52, Moscow, Russia.,Department of Allergology and Clinical Immunology, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8/2, Moscow, 119991, Russian Federation
| | - Elena Kovalkova
- City Center of Allergy and Immunology, Clinical City Hospital #52, Moscow, Russia
| | - Kiran Godse
- Department of Dermatology, D Y, Patil University School of Medicine and Hospital, Mumbai, India
| | - Nimmagadda Dheeraj Rao
- Department of Dermatology, D Y, Patil University School of Medicine and Hospital, Mumbai, India
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Allergy and Immunology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Rastgoo
- Department of Allergy and Immunology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roberta Fj Criado
- Department of Dermatology, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Mohamed Abuzakouk
- Allergy and Immunology Department, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Deepa Grandon
- Allergy and Immunology Department, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | | | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Biomedical Sciences, Copenhagen, Denmark
| | - German D Ramón
- Instituto de Alergia e Inmunología del Sur, Bahía Blanca, Prov. De Buenos Aires, Argentina
| | - Edgar E Matos Benavides
- Centro de Referencia de Alergia, Asma e Inmunología - Instituto Nacional del Niño, Lima, Perú
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
| | - Emek Kocatürk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Switzerland
| | | | - Zuo-Tao Zhao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian, University of Athens, "Attikon" University Hospital, Greece
| | - Carla Ritchie
- Allergy Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Greece
| | | | - Sofia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Department of Dermatology, SRH Zentralklinikum Suhl, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
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Chen J, Wang Y. Social Media Use for Health Purposes: Systematic Review. J Med Internet Res 2021; 23:e17917. [PMID: 33978589 PMCID: PMC8156131 DOI: 10.2196/17917] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 01/29/2021] [Accepted: 04/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages and research gaps that emerge in recent years. Objective This study aimed to provide a systematic review of social media uses for health purposes that have been identified in previous studies. Methods The researchers searched for peer-reviewed journal articles published between 2006 and 2020 in 12 databases covering medicine, public health, and social science. After coding the articles in terms of publication year, journal area, country, method, social media platform, and social media use for health purposes, the researchers provided a review of social media use for health purposes identified in these articles. Results This study summarized 10 social media uses for various health purposes by health institutions, health researchers and practitioners, and the public. Conclusions Social media can be used for various health purposes. Several new usages have emerged since 2013 including advancing health research and practice, social mobilization, and facilitating offline health-related services and events. Research gaps exist regarding advancing strategic use of social media based on audience segmentation, evaluating the impact of social media in health interventions, understanding the impact of health identity development, and addressing privacy concerns.
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Affiliation(s)
- Junhan Chen
- Department of Communication, University of Maryland, College Park, MD, United States
| | - Yuan Wang
- Department of Communication, University of Maryland, College Park, MD, United States
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Silva MM, Penha JCD, Barbosa ICFJ, Carneiro CT, Borges JWP, Bezerra MAR. Construção e validação de tecnologia educacional para promoção do aleitamento materno no período neonatal. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Resumo Objetivo Este estudo teve como objetivos construir e validar um pacote de mensagens de texto e figuras para promoção do aleitamento materno no período neonatal. Métodos tratou-se de um estudo metodológico, realizado em quatro etapas: revisão integrativa da literatura, construção de pacote de mensagens e figuras, análise de legibilidade e validação de conteúdo e aparência. Para validação, participaram 11 juízes com expertise em aleitamento materno. O critério para validação foi concordância superior a 80%, analisada por meio dos índices de validação de conteúdo e aparência. Resultados a versão final do pacote de mensagens e figuras apresentou índice de validade de conteúdo de 0,86, índice de validade de aparência de 0,85 e validade convergente com correlação de 0,73 entre o conteúdo e a aparência (p<0,01). Conclusões e implicações para a prática o pacote de mensagens de texto e figuras foi considerado válido em conteúdo, aparência e convergência para promoção do aleitamento materno, no período neonatal, constituindo tecnologia educacional adequada para ser compartilhada via mensagens telefônicas, com intuito de se aproximar das nutrizes, ajudando-as a reagir frente aos problemas comuns no período neonatal.
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Chérrez-Ojeda I, Vera C, Vanegas E, Gallardo JC, Felix M, Espinoza-Fuentes F, Chedraui P, Gavilanes AWD, Mata VL. The use of information and communication technologies in Latin American dentists: a cross-sectional study from Ecuador. BMC Oral Health 2020; 20:146. [PMID: 32429887 PMCID: PMC7236194 DOI: 10.1186/s12903-020-01137-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of information and communication technologies (ICTs) provide the tools for enabling fast and reliable real-time communications, as well as the transfer of information between dental professionals and their patients. However, little is known about the frequency and preference of ICTs among Latin-American dentists. Our study aims to fill this gap by assessing different aspects related to ICTs, mainly the frequency of use, perceptions, and barriers among Ecuadorian dentists. METHODS An anonymous, cross-sectional survey-based study was conducted among 342 Ecuadorian dentists. The final questionnaire included 13 items related to the frequency of use, perceptions, and barriers of ICTs. Bivariate analysis was performed by using chi-squared testing to explore the association between the independent variables and the intended use of ICTs, as well as to characterize the perceptions and barriers related to ICTs. RESULTS In general, most participants reported the use of ICTs to communicate with colleagues (99.7%), and patients (96.2%), while only 63.5% reported using ICTs to obtain academic information in their daily practice. WhatsApp was rated as the most used ICT for communicating with colleagues and patients. A majority of participants considered that ICTs can be useful for facilitating continuing dental education (92.1%), searching new work opportunities (91.5%), promoting health (90.1%), working with colleagues and other health professionals (91.2%), promoting their professional services (90.6%), and for resolving clinical cases (87.7%). On the subject of barriers, privacy and security concerns about personal and/or patient information was the biggest concern among dentists (65%), followed by lack of time to learn how to use and/or use ICTs (48%), lack of mobile internet access (28.1%), and lack of internet access at work (24.9%). CONCLUSION In our study, we found that Ecuadorian dentists had a high usage rate of ICTs, mainly for communicating with other colleagues and patients, while the academic use of technology remains a comparatively underused application. Most of the participants surveyed had a positive perception towards ICTs, while privacy and security concerns were identified as the main barrier. Older age was associated with a less favourable perception toward ICTs, as well as an increased likelihood of reporting barriers related to the use of technology.
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Affiliation(s)
- Ivan Chérrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador. .,Respiralab Research Group, Guayaquil, Ecuador.
| | - Carlos Vera
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Juan Carlos Gallardo
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | | | - Peter Chedraui
- Facultad De Ciencias Médicas, Instituto De Investigación e Innovación En Salud Integral, Universidad Católica De Santiago De Guayaquil, Guayaquil, Ecuador.,Facultad De Ciencias De La Salud, Universidad Católica "Nuestra Señora De La Asunción", Asunción, Paraguay
| | - Antonio W D Gavilanes
- School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Valeria L Mata
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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