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Amiri P, Pirnejad H, Bahaadinbeigy K, Baghini MS, Khazaee PR, Niazkhani Z. A qualitative study of factors influencing ePHR adoption by caregivers and care providers of Alzheimer's patients: An extension of the unified theory of acceptance and use of technology model. Health Sci Rep 2023; 6:e1394. [PMID: 37425233 PMCID: PMC10323167 DOI: 10.1002/hsr2.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Aims As the nowadays provision of many healthcare services relies on technology, a better understanding of the factors contributing to the acceptance and use of technology in health care is essential. For Alzheimer's patients, an electronic personal health record (ePHR) is one such technology. Stakeholders should understand the factors affecting the adoption of this technology for its smooth implementation, adoption, and sustainable use. So far, these factors have not fully been understood for Alzheimer's disease (AD)-specific ePHR. Therefore, the present study aimed to understand these factors in ePHR adoption based on the perceptions and views of care providers and caregivers involved in AD care. Methods This qualitative study was conducted from February 2020 to August 2021 in Kerman, Iran. Seven neurologists and 13 caregivers involved in AD care were interviewed using semi-structured and in-depth interviews. All interviews were conducted through phone contacts amid Covid-19 imposed restrictions, recorded, and transcribed verbatim. The transcripts were coded using thematic analysis based on the unified theory of acceptance and use of technology (UTAUT) model. ATLAS.ti8 was used for data analysis. Results The factors affecting ePHR adoption in our study comprised subthemes under the five main themes of performance expectancy, effort expectancy, social influence, facilitating conditions of the UTAUT model, and the participants' sociodemographic factors. From the 37 facilitating factors and 13 barriers identified for ePHR adoption, in general, the participants had positive attitudes toward the ease of use of this system. The stated obstacles were dependent on the participants' sociodemographic factors (such as age and level of education) and social influence (including concern about confidentiality and privacy). In general, the participants considered ePHRs efficient and useful in increasing neurologists' information about their patients and managing their symptoms in order to provide better and timely treatment. Conclusion The present study gives a comprehensive insight into the acceptance of ePHR for AD in a developing setting. The results of this study can be utilized for similar healthcare settings with regard to technical, legal, or cultural characteristics. To develop a useful and user-friendly system, ePHR developers should involve users in the design process to take into account the functions and features that match their skills, requirements, and preferences.
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Affiliation(s)
- Parastoo Amiri
- Student Research CommitteeKerman University of Medical SciencesKermanIran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Mahdie Shojaei Baghini
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | | | - Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Health Care Governance, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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Leung T, Agrawal L, Sharman R. The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study. J Med Internet Res 2022; 24:e41972. [PMID: 36574284 PMCID: PMC9832356 DOI: 10.2196/41972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused. OBJECTIVE We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients' usage of their portals. METHODS Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage. RESULTS Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities (β=.52; P<.001), patient-provider interaction capabilities (β=.24, P=.006), and patient-personal health information interaction capabilities (β=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party (β=-.43, P=.005), but not for those involving patient-provider interaction (β=.05, P=.76) or patient-personal health information interaction (β=-.15, P=.19). CONCLUSIONS These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction.
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Affiliation(s)
| | - Lavlin Agrawal
- State University of New York, University at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- State University of New York, University at Buffalo, Buffalo, NY, United States
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Mavragani A, Gouw SC, Beestrum M, Cronin RM, Fijnvandraat K, Badawy SM. Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review. J Med Internet Res 2022; 24:e43086. [PMID: 36548034 PMCID: PMC9816956 DOI: 10.2196/43086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. OBJECTIVE We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. METHODS We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. RESULTS Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. CONCLUSIONS The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.
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Affiliation(s)
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Molly Beestrum
- Galter Health Sciences Library at Northwestern University, Chicago, IL, United States
| | - Robert M Cronin
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.,Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Division of Hematology, Oncology, and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Chiang TW, Chiang DL, Chen TS, Lin FYS, Shen VRL, Wang MC. Novel Lagrange interpolation polynomials for dynamic access control in a healthcare cloud system. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:9200-9219. [PMID: 35942755 DOI: 10.3934/mbe.2022427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The authority of user personal health records (PHRs) is usually determined by the owner of a cloud computing system. When a PHR file is accessed, a dynamic access control algorithm must be used to authenticate the users. The proposed dynamic access control algorithm is based on a novel Lagrange interpolation polynomial with timestamps, mainly functioning to authenticate the users with key information. Moreover, the inclusion of timestamps allows user access within an approved time slot to enhance the security of the healthcare cloud system. According to the security analysis results, this healthcare cloud system can effectively resist common attacks, including external attacks, internal attacks, collaborative attacks and equation-based attacks. Furthermore, the overall computational complexity of establishing and updating the polynomials is O(n*m* (log m)2), which is a promising result, where m denotes the degree of $ polynomial~G\left(x, y\right) $ and n denotes the number of secure users in the hierarchy.
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Affiliation(s)
- Te-Wei Chiang
- Department of Information Management, National Taiwan University, Taipei City 106, Taiwan
| | - Dai-Lun Chiang
- Financial Technology Applications Program, Ming Chuan University, Taoyuan City 330, Taiwan
| | - Tzer-Shyong Chen
- Department of Information Management, Tunghai University, Taichung City 407, Taiwan
| | - Frank Yeong-Sung Lin
- Department of Information Management, National Taiwan University, Taipei City 106, Taiwan
| | - Victor R L Shen
- Department of Computer Science and Information Engineering, National Taipei University, Sanxia District, New Taipei City 237, Taiwan
- Department of Information Management, Chaoyang University of Technology, 168 Jifeng E. Rd., Wufeng District, Taichung City 413, Taiwan
| | - Min-Chien Wang
- Department of Information Management, Tunghai University, Taichung City 407, Taiwan
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Kinouchi K, Ohashi K. Assessing Engagement With Patient-Generated Health Data Recording and Its Impact on Health Behavior Changes in Multicomponent Interventions: Supplementary Analysis. JMIR Form Res 2022; 6:e35471. [PMID: 35503411 PMCID: PMC9115657 DOI: 10.2196/35471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients’ decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients’ health behavior changes remains unclear. Objective This study aimed to assess patients’ engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. Methods This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients’ engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). Results The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). Conclusions The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients’ engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.
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Affiliation(s)
- Kaori Kinouchi
- Department of Children and Women's Health, Area of integrated Health and Nursing Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Ruhi U, Chugh R. Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis. J Med Internet Res 2021; 23:e26877. [PMID: 33866308 PMCID: PMC8120425 DOI: 10.2196/26877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care. Objective This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels. Methods Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study. Results We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies. Conclusions PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.
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Affiliation(s)
- Umar Ruhi
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Ritesh Chugh
- School of Engineering & Technology, Central Queensland University, Melbourne, Australia
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Kwon H, Kim HH, An J, Lee JH, Park YR. Lifelog Data-Based Prediction Model of Digital Health Care App Customer Churn: Retrospective Observational Study. J Med Internet Res 2021; 23:e22184. [PMID: 33404511 PMCID: PMC7817354 DOI: 10.2196/22184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 01/22/2023] Open
Abstract
Background Customer churn is the rate at which customers stop doing business with an entity. In the field of digital health care, user churn prediction is important not only in terms of company revenue but also for improving the health of users. Churn prediction has been previously studied, but most studies applied time-invariant model structures and used structured data. However, additional unstructured data have become available; therefore, it has become essential to process daily time-series log data for churn predictions. Objective We aimed to apply a recurrent neural network structure to accept time-series patterns using lifelog data and text message data to predict the churn of digital health care users. Methods This study was based on the use data of a digital health care app that provides interactive messages with human coaches regarding food, exercise, and weight logs. Among the users in Korea who enrolled between January 1, 2017 and January 1, 2019, we defined churn users according to the following criteria: users who received a refund before the paid program ended and users who received a refund 7 days after the trial period. We used long short-term memory with a masking layer to receive sequence data with different lengths. We also performed topic modeling to vectorize text messages. To interpret the contributions of each variable to model predictions, we used integrated gradients, which is an attribution method. Results A total of 1868 eligible users were included in this study. The final performance of churn prediction was an F1 score of 0.89; that score decreased by 0.12 when the data of the final week were excluded (F1 score 0.77). Additionally, when text data were included, the mean predicted performance increased by approximately 0.085 at every time point. Steps per day had the largest contribution (0.1085). Among the topic variables, poor habits (eg, drinking alcohol, overeating, and late-night eating) showed the largest contribution (0.0875). Conclusions The model with a recurrent neural network architecture that used log data and message data demonstrated high performance for churn classification. Additionally, the analysis of the contribution of the variables is expected to help identify signs of user churn in advance and improve the adherence in digital health care.
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Affiliation(s)
- Hongwook Kwon
- Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Ho Heon Kim
- Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jaeil An
- Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.,Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea
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