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

AI for IMPACTS Framework for Evaluating the Long-Term Real-World Impacts of AI-Powered Clinician Tools: Systematic Review and Narrative Synthesis

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize health care by enhancing both clinical outcomes and operational efficiency. However, its clinical adoption has been slower than anticipated, largely due to the absence of comprehensive evaluation frameworks. Existing frameworks remain insufficient and tend to emphasize technical metrics such as accuracy and validation, while overlooking critical real-world factors such as clinical impact, integration, and economic sustainability. This narrow focus prevents AI tools from being effectively implemented, limiting their broader impact and long-term viability in clinical practice.

OBJECTIVE

This study aimed to create a framework for assessing AI in health care, extending beyond technical metrics to incorporate social and organizational dimensions. The framework was developed by systematically reviewing, analyzing, and synthesizing the evaluation criteria necessary for successful implementation, focusing on the long-term real-world impact of AI in clinical practice.

METHODS

A search was performed in July 2024 across the PubMed, Cochrane, Scopus, and IEEE Xplore databases to identify relevant studies published in English between January 2019 and mid-July 2024, yielding 3528 results, among which 44 studies met the inclusion criteria. The systematic review followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews. Data were analyzed using NVivo through thematic analysis and narrative synthesis to identify key emergent themes in the studies.

RESULTS

By synthesizing the included studies, we developed a framework that goes beyond the traditional focus on technical metrics or study-level methodologies. It integrates clinical context and real-world implementation factors, offering a more comprehensive approach to evaluating AI tools. With our focus on assessing the long-term real-world impact of AI technologies in health care, we named the framework AI for IMPACTS. The criteria are organized into seven key clusters, each corresponding to a letter in the acronym: (1) I-integration, interoperability, and workflow; (2) M-monitoring, governance, and accountability; (3) P-performance and quality metrics; (4) A-acceptability, trust, and training; (5) C-cost and economic evaluation; (6) T-technological safety and transparency; and (7) S-scalability and impact. These are further broken down into 28 specific subcriteria.

CONCLUSIONS

The AI for IMPACTS framework offers a holistic approach to evaluate the long-term real-world impact of AI tools in the heterogeneous and challenging health care context and lays the groundwork for further validation through expert consensus and testing of the framework in real-world health care settings. It is important to emphasize that multidisciplinary expertise is essential for assessment, yet many assessors lack the necessary training. In addition, traditional evaluation methods struggle to keep pace with AI's rapid development. To ensure successful AI integration, flexible, fast-tracked assessment processes and proper assessor training are needed to maintain rigorous standards while adapting to AI's dynamic evolution.

TRIAL REGISTRATION

reviewregistry1859; https://tinyurl.com/ysn2d7sh.

Attitudes of the general population and mental health practitioners towards blended therapy in Austria

INTRODUCTION

Mental health problems are steadily increasing worldwide. In Austria, the overall supply of mental health services is low, especially in rural areas. Mobile technology and a blended care approach have the potential to overcome problems with service provision. The aim of this study was to map the attitudes of practitioners and people living in Austria towards blended therapy.

METHOD

Two individual online questionnaires (including the Unified Theory of Acceptance and Use of Technology, advantages and disadvantages, useful features) were distributed to practitioners and the general population in Austria.

RESULTS

The questionnaires were answered by 152 members of the general public and 129 practitioners. The general population and practitioners seem to be cautious, but slightly positive about blended therapy. Previous experience of practitioners with blended therapy was low. Practitioners are most worried about the therapeutic process and their work-life balance, while the general population is worried about being overwhelmed by the concept, mainly due to the time investment. Tracking, recording and reminding functions (e.g., for mood, homework) were seen as especially valuable features and accessibility was deemed the biggest advantage by both samples.

CONCLUSION

Practitioners' attitudes are important for implementation of blended therapy. More awareness might help against the cautiousness as well as implementing digital health applications in Austrian health policies.

Barriers and Facilitators in Implementing a Telemonitoring Application for Patients With Chronic Kidney Disease and Health Professionals: Ancillary Implementation Study of the NeLLY (New Health e-Link in the Lyon Region) Stepped-Wedge Randomized Controlled Trial

BACKGROUND

The use of telemonitoring to manage renal function in patients with chronic kidney disease (CKD) is recommended by health authorities. However, despite these recommendations, the adoption of telemonitoring by both health care professionals and patients faces numerous challenges.

OBJECTIVE

This study aims to identify barriers and facilitators in the implementation of a telemonitoring program for patients with CKD, as perceived by health care professionals and patients, and to explore factors associated with the adoption of the program. This study serves as a process evaluation conducted alongside the cost-effectiveness NeLLY (New Health e-Link in the Lyon Region) trial.

METHODS

A mixed methods approach combining a quantitative questionnaire and semistructured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 CKD across 10 renal care centers in France that have implemented telemonitoring. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to design the questionnaires and interview guides. The dimensions investigated included ease of use, perceived usefulness, and intention to use (TAM), as well as characteristics of the intervention, local and general context, individual factors, and processes (CFIR). The adoption of telemonitoring was assessed based on the frequency with which patients connected to the telemonitoring device. Determinants of telemonitoring use were analyzed using nonparametric tests, specifically the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Thematic analysis was conducted on the transcriptions of semistructured interviews. Both quantitative and qualitative results, including data from patients and professionals, were integrated to provide a comprehensive understanding of the factors associated with the use of remote monitoring in CKD.

RESULTS

A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients participated in interviews. Nurses, who were responsible for patient follow-up, regularly used telemonitoring (8/13, 62%, at least once a month), while nephrologists, who were responsible for prescribing it, were primarily occasional users (5/8, 63%, using it less than once a month). Among professionals, the main obstacles identified were the heavy workload generated by telemonitoring, lack of training, and insufficient support for nurses. Among the 128 patients, 46 (35.9%) reported using the application at least once a week. The main barriers for patients were issues related to computer use, as well as the lack of feedback and communication with health care professionals. The main facilitators identified by both professionals and patients for using telemonitoring were the empowerment of patients in managing their health and the reduction of the burden associated with CKD.

CONCLUSIONS

Improving adherence to telemonitoring in the context of CKD requires collaborative efforts from both professionals and patients. Our results provide insights that can inform the design of effective, theory-driven interventions aimed at improving telemonitoring adoption and usage.

mHealth knowledge and usage in maternal healthcare delivery: perspectives and experiences of healthcare practitioners in Ghana

OBJECTIVES

This study explored the knowledge and experiences of health practitioners regarding the use of mobile health (mHealth) for maternal healthcare delivery.

DESIGN

Underpinned by the Unified Theory of Acceptance and Use of Technology, this study was an exploratory qualitative design involving in-depth interviews. Data collection occurred between July 2023 and January 2024.

SETTING

The study was conducted in three administrative regions in Ghana: Ashanti, Northern and Upper West regions. In each of these regions, one urban and one rural setting were selected to ascertain pertinent data from a wide range of maternity health practitioners and directors of health services operating within these regions.

PARTICIPANTS

Purposive sampling technique was used to recruit 32 participants, who fall into two primary groups: directors of health services (n=9) and maternity health practitioners (23).

RESULTS

The findings revealed that maternal healthcare providers were familiar with and frequently used mHealth technologies (typically video calls/conferences and text messages). mHealth was considered a useful tool in maternal healthcare as it enhanced the efficiency of service delivery and improved practitioners' performance. mHealth facilities eased access to digital medical information, user-friendly interfaces and the ability to facilitate remote consultations. The willingness and ability of health professionals to use mHealth were conditioned by the nature of organisational and infrastructural support they received, including technical guidance and equipment availability. Thus, mHealth knowledge and use among maternal healthcare providers are predicated on personal, social and institutional conditions.

CONCLUSIONS

Maternal healthcare providers are generally aware of the benefits of mHealth and are ready to use it when available. Thus, it is imperative that the Government of Ghana prioritise incorporation of mHealth into the existing and future maternal healthcare model to enhance care delivery and increase the prospects of achieving the first and second targets of the third Sustainable Development Goals. To ascertain greater gains from mHealth, it is worth acknowledging the varying factors that drive the adoption and effective use of mHealth, such as performance expectancy, ease of use, social influences and organisational support. Interventions aimed at enhancing mHealth integration should address these factors in a context-specific manner.

Factors Impacting the Adoption and Potential Reimbursement of a Virtual Reality Tool for Pain Management in Switzerland: Qualitative Case Study

Background

Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs.

Objective

The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital.

Methods

Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study.

Results

According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement.

Conclusions

This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Practical Recommendations for Navigating Digital Tools in Hospitals: Qualitative Interview Study

BACKGROUND

The digitalization of health care organizations is an integral part of a clinician's daily life, making it vital for health care professionals (HCPs) to understand and effectively use digital tools in hospital settings. However, clinicians often express a lack of preparedness for their digital work environments. Particularly, new clinical end users, encompassing medical and nursing students, seasoned professionals transitioning to new health care environments, and experienced practitioners encountering new health care technologies, face critically intense learning periods, often with a lack of adequate time for learning digital tools, resulting in difficulties in integrating and adopting these digital tools into clinical practice.

OBJECTIVE

This study aims to comprehensively collect advice from experienced HCPs in Switzerland to guide new clinical end users on how to initiate their engagement with health ITs within hospital settings.

METHODS

We conducted qualitative interviews with 52 HCPs across Switzerland, representing 24 medical specialties from 14 hospitals. The interviews were transcribed verbatim and analyzed through inductive thematic analysis. Codes were developed iteratively, and themes and aggregated dimensions were refined through collaborative discussions.

RESULTS

Ten themes emerged from the interview data, namely (1) digital tool understanding, (2) peer-based learning strategies, (3) experimental learning approaches, (4) knowledge exchange and support, (5) training approaches, (6) proactive innovation, (7) an adaptive technology mindset, (8) critical thinking approaches, (9) dealing with emotions, and (10) empathy and human factors. Consequently, we devised 10 recommendations with specific advice to new clinical end users on how to approach new health care technologies, encompassing the following: take time to get to know and understand the tools you are working with; proactively ask experienced colleagues; simply try it out and practice; know where to get help and information; take sufficient training; embrace curiosity and pursue innovation; maintain an open and adaptable mindset; keep thinking critically and use your knowledge base; overcome your fears, and never lose the human and patient focus.

CONCLUSIONS

Our study emphasized the importance of comprehensive training and learning approaches for health care technologies based on the advice and recommendations of experienced HCPs based in Swiss hospitals. Moreover, these recommendations have implications for medical educators and clinical instructors, providing advice on effective methods to instruct and support new end users, enabling them to use novel technologies proficiently. Therefore, we advocate for new clinical end users, health care institutions and clinical instructors, academic institutions and medical educators, and regulatory bodies to prioritize effective training and cultivating technological readiness to optimize IT use in health care.

A New Research Model for Artificial Intelligence-Based Well-Being Chatbot Engagement: Survey Study

BACKGROUND

Artificial intelligence (AI)-based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being.

OBJECTIVE

This study aimed to identify the factors that impact individuals' intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness.

METHODS

We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach.

RESULTS

The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior.

CONCLUSIONS

The new extended model provides a theoretical basis for studying users' AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users.

Exploration of the barriers and facilitators influencing use of telehealth for orthotic/prosthetic services in the United States of America: An orthotist/prosthetists perspective

Innovative models of healthcare, such as telehealth, are required to meet the growing demand for orthotic/prosthetic (O&P) services. While O&P users report being very satisfied with telehealth, many clinical facilities have reverted to in-person modes of care as COVID-19 restrictions have eased. As such, there is a disconnect between benefits of telehealth to O&P users, and the clinical services being delivered in-person. The aim of this study was to explore the orthotist/prosthetist's perspective of the barriers and facilitators influencing use of telehealth in the United States of America (USA). O&P practitioners were recruited from across the USA. In-depth, semi-structured interviews were used to document practitioner demographics, the services being provided using telehealth, and practitioners' perspective of the barriers and facilitators influencing use of telehealth. Data describing participant demographics and services were summarised. Interviews were transcribed verbatim and analysed using thematic analysis. 30 practitioners from across the USA participated. Telehealth was used to deliver a range of O&P services including: initial evaluations, routine follow-ups, and delivery of a device in rare circumstances. Barriers to using telehealth included: poor phone/internet connection and lack of access to technology. Facilitators to using telehealth included: a patient-focussed attitude, and recognition of the benefit of telehealth. Telehealth is being used across the entire spectrum of O&P care. Once the significant barriers were resolved, like access to reliable internet/phone reception, telehealth was feasible. An outstanding telehealth experience was facilitated by practitioners who focused on the benefits that telehealth can provide (not the limitations), as well as giving O&P users agency over the choice to use telehealth. There are opportunities to improve access to safe and effective O&P telehealth services by adopting a right-touch approach to practitioner regulation, and advocating for reimbursement that supports better systems and procedures within clinical facilities.

Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience

BACKGROUND

Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, "DiGA") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to "free and non-transparent" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.

METHODS

Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).

RESULTS

A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).

CONCLUSIONS

As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.

Assessing women's and health professionals' views on developing a midwifery-led mobile health app intervention in pregnancy: A descriptive qualitative study

AIMS

To explore women's and health professionals' views on the development of a midwifery-led mHealth app intervention in antenatal care and their demands for app functionality.

DESIGN

Descriptive qualitative research was utilized.

METHODS

In total, 15 pregnant or postpartum women were interviewed via in-depth interviews and 10 health professionals including obstetricians, midwives and obstetric nurses were invited to participate in a focus group discussion (FGD). All interviews and the FGD were analysed using qualitative content analysis.

RESULTS

Four key themes emerged from the data, including (1) limitations of current maternity care services; (2) potential benefits for mHealth app-based midwifery care; (3) possible challenges for providing midwifery care through mHealth apps and (4) suggestions and needs for developing a midwifery-led mHealth app. Participants agreed on the potential need of developing a midwifery-led mHealth app in antenatal care to increase access to midwifery care services and to meet women's diverse needs. Participants preferred to develop professional, reliable, full-featured and interactive mobile applications. The main functions of midwifery-led mHealth apps included personalized assessment and health education, self-monitoring and feedback, data sharing and interactive functions. Women mentioned that online communication and consultation with midwives could help them receive continuous support outside facilities. Health professionals expressed it would be of great convenience and timeliness to send personalized messages to women and to inform them of healthy lifestyles during pregnancy. The challenges included a shortage of human resources, medico-legal risks associated with mHealth and data security risks.

CONCLUSIONS

This study explores the individual views and functional needs of target users and healthcare providers for developing a midwifery-led mHealth app in antenatal care, which will serve as a reference for future application development.

IMPACT

Our study has important and practical implications for guiding the development of future midwifery-led mHealth app interventions.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

GPs' attitudes towards and experiences of using the Dermabuddy health app for the management of patients with dermatological conditions: a descriptive cross-sectional study

BACKGROUND

Dermatological presentations are common in primary care. The digital health space is growing in investment, revenue, and in usership numbers. Doctors utilise mobile health apps for referencing, communicating, and for clinical decision making. Dermabuddy is a secure mobile health app by which information and expertise around skin problems can be shared among a group of medical professionals with the aim of finding the best treatment and management plan.

AIM

To assess the utility of the Dermabuddy health app for GPs and associated trainees in the Republic of Ireland.

DESIGN & SETTING

This is a descriptive cross-sectional study, which involved a survey link distributed by email to GPs with Irish Medical Council membership.

METHOD

GPs were surveyed on their experiences of using the dermatology mobile application, Dermabuddy.

RESULTS

In total, 203 members took this questionnaire (13.5% response rate). Ninety-six per cent who responded to the statement, 'The app was easy to use', agreed it was 'easy' or 'very easy'. Eighty-seven per cent of those who responded to the statement, 'I would use this app again', agreed they 'definitely would'. Fifty-eight per cent of those who responded to the statement, 'The app is useful for my healthcare practice', gave it a five-star rating. The content of 36 comments included advice for improvement and positive feedback.

CONCLUSION

The Dermabuddy app was well received by participants in this study. Across all sections of the questionnaire looking at aspects of the app, including ease of use, interface and satisfaction, and usefulness, there was a positive response. Mobile health apps, such as Dermabuddy, may provide alternative solutions to meet the rising challenge of managing patients with dermatological conditions in primary care.

Acceptance and use of mobile health technology in post-abortion care

BACKGROUND

Abortion and its complications have always been associated with challenges such as the lack of awareness, high cost of receiving in-person services, lack of access to the skilled healthcare workers, distance from healthcare centers in remote areas, and cultural sensitivities. Therefore, the use of mobile health technology in post-abortion care has been suggested. This study aimed to investigate factors influencing the acceptance and use of mhealth technology in post-abortion care.

METHOD

A mixed-methods study was completed in 2023. Initially, a literature review was conducted. Then, a five-point Likert-scale questionnaire was designed based on the results of the literature review. The research participants were gynecologists (n = 24), midwives (n = 38), and women who had experience of abortion (n = 183). Data were analyzed using descriptive and inferential statistics.

RESULTS

The findings revealed that the participants had different opinions about the importance of motivating and inhibiting factors which included individual, technical, economic, organizational, and ethico-legal aspects. It seems that the individual, organizational, economic, and ethico-legal motivating factors as well as the ethico-legal inhibiting factors were more important than other factors and had higher mean values. In addition, there was a statistically significant difference between the mean values of gynecologists and patients regarding the individual motivating (P = 0.014) and technical inhibiting factors (P = 0.016). The gynecologists' opinions regarding the technical motivating factors were also significantly different from midwives (P = 0.044) and patients (P = 0.010).

CONCLUSION

Multiple factors may influence the acceptance and use of mhealth technology in post-abortion care. Therefore, mhealth service developers must consider these factors to improve the quality of services and increase technology adoption. This will lead to saving costs, improving health, reducing abortion complications, and ultimately improving quality of life for women. However, further research in patient engagement and health interventions tailored to diverse cultural contexts are recommended.

Exploring clinicians' insertion experience with a new peripheral intravenous catheter in the emergency department

BACKGROUND

Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting.

METHODS

The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged.

RESULTS

The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians' acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning.

CONCLUSION

Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings.

Discipline-level differences in mental health provider perceptions of video and phone telehealth

COVID-19 led to a rapid increase in telemental health care via video or phone. It is important to examine contributors to the choice of video versus phone, as video may be more effective and preferred by patients. Medical mental health (MH) providers (e.g., psychiatrists) may conduct more phone and less video visits than nonmedical MH providers (e.g., psychologists). This study examined whether medical and nonmedical providers' perceptions of the quality and complexity of phone and video MH care may contribute to differences in use. A 32-item survey of 414 providers (79.5% response rate) assessed perceptions of care quality, factors contributing to modality choice, and telehealth challenges. The types of visits completed by providers in the months prior to the survey were extracted from administrative data. Medical and nonmedical providers generally viewed video care as higher quality and more preferred than phone, although to a lesser extent among medical providers. Nonmedical providers' decision making was more impacted by research regarding the modalities' relative effectiveness. Medical providers more frequently endorsed video challenges, including patient technical difficulties and lack of patient training. Administrative data demonstrated that medical providers conducted fewer video appointments than nonmedical providers. Medical providers may be less aware of research demonstrating that video care is effective and preferred by patients, and the complexity of video visits may be a barrier to use. Streamlining video processes, increasing technical support, and disseminating research that compares the quality of video and phone care may increase video use among medical providers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Harnessing technology for infectious disease response in conflict zones: Challenges, innovations, and policy implications

Epidemic outbreaks of infectious diseases in conflict zones are complex threats to public health and humanitarian activities that require creativity approaches of reducing their damage. This narrative review focuses on the technology intersection with infectious disease response in conflict zones, and complexity of healthcare infrastructure, population displacement, and security risks. This narrative review explores how conflict-related destruction is harmful towards healthcare systems and the impediments to disease surveillance and response activities. In this regards, the review also considered the contributions of technological innovations, such as the improvement of epidemiological surveillance, mobile health (mHealth) technologies, genomic sequencing, and surveillance technologies, in strengthening infectious disease management in conflict settings. Ethical issues related to data privacy, security and fairness are also covered. By advisement on policy that focuses on investment in surveillance systems, diagnostic capacity, capacity building, collaboration, and even ethical governance, stakeholders can leverage technology to enhance the response to infectious disease in conflict settings and, thus, protect the global health security. This review is full of information for researchers, policymakers, and practitioners who are dealing with the issues of infectious disease outbreaks in conflicts worn areas.

Mobile health management among end stage renal disease patients: a scoping review

Aims

The health management of end-stage renal disease patients is a complicated process, and mobile health management technology provides a new choice for the health management of end-stage renal disease patients. The scope of clinical studies on mobile health management for patients with end-stage renal disease was reviewed, and found that about mobile health management problems existing in the literature were identified to provide ideas for subsequent mobile health management research.

Methods

The databases Web of Science, PubMed, The Cochrane Library, Embase, CNKI, Wan Fang Data, BMJ, and VIP were systematically searched for studies on Mobile health management among end-stage renal disease in adult and adolescent patients or children undergoing kidney replacement therapy. The search covered the period from the inception of the databases to June 20, 2023. Two independent reviewers conducted the literature screening process. Following eligibility screening, a total of 38 papers were included for data extraction and descriptive analysis.

Results

A total of 38 studies from 14 countries were finally included. The majority of which were interventional trials. The platforms used in these studies included remote monitoring systems, apps, websites, mobile phones or tablets, and social platforms. These platforms provided patients with a wide range of services, including disease management, behavioral intervention, social support, and follow-up care. Most studies focused on patient clinical indicators, patient experience, quality of life, and healthcare costs.

Conclusion

Our findings that mobile health management has been widely used in disease management of end-stage renal disease patients, with rich management content and many evaluation indicators. Future studies should strengthen the evaluation of patients' mental health, quality of life, and healthcare costs. Additionally, developing a clinical decision support system would enable mobile health management to play a more effective role in end-stage renal disease patients.

A technology-focused service within a rehabilitation setting: exploring the experiences and current technology demands of people with disabilities

PURPOSE

To understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand.

MATERIALS AND METHODS

Referral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis.

RESULTS

Most attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future.

CONCLUSIONS

This study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating.

Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews

OBJECTIVES

Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs.

DESIGN

Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline.

ELIGIBILITY CRITERIA

Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal.

DATA EXTRACTION AND SYNTHESIS

Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators.

RESULTS

Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33).

CONCLUSIONS

The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.

Doctors' Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study

BACKGROUND

Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients' mobile app adoption behavior; however, they offer limited insights into doctors' personal preferences among a variety of choices of mobile apps.

OBJECTIVE

This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps?

METHODS

We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals.

RESULTS

In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees' perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors' affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues.

CONCLUSIONS

Our findings contribute to a nuanced understanding of doctors' adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns.

Combining user-centered design and behavioral theory to enhance health technologies: A personas-based approach for a primary-care based multifactorial falls risk assessment tool

INTRODUCTION

Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the 'Valanalyse').

METHODS

Survey data from HCPs (n = 31) was used to construct personas of the 'Valanalyse.' To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the 'Valanalyse,' respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation.

RESULTS

Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the 'Valanalyse' in Dutch geriatric, primary care settings.

CONCLUSION

The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.

Use of Patient-Generated Health Data From Consumer-Grade Devices by Health Care Professionals in the Clinic: Systematic Review

BACKGROUND

Mobile health (mHealth) uses mobile technologies to promote wellness and help disease management. Although mHealth solutions used in the clinical setting have typically been medical-grade devices, passive and active sensing capabilities of consumer-grade devices like smartphones and activity trackers have the potential to bridge information gaps regarding patients' behaviors, environment, lifestyle, and other ubiquitous data. Individuals are increasingly adopting mHealth solutions, which facilitate the collection of patient-generated health data (PGHD). Health care professionals (HCPs) could potentially use these data to support care of chronic conditions. However, there is limited research on real-life experiences of HPCs using PGHD from consumer-grade mHealth solutions in the clinical context.

OBJECTIVE

This systematic review aims to analyze existing literature to identify how HCPs have used PGHD from consumer-grade mobile devices in the clinical setting. The objectives are to determine the types of PGHD used by HCPs, in which health conditions they use them, and to understand the motivations behind their willingness to use them.

METHODS

A systematic literature review was the main research method to synthesize prior research. Eligible studies were identified through comprehensive searches in health, biomedicine, and computer science databases, and a complementary hand search was performed. The search strategy was constructed iteratively based on key topics related to PGHD, HCPs, and mobile technologies. The screening process involved 2 stages. Data extraction was performed using a predefined form. The extracted data were summarized using a combination of descriptive and narrative syntheses.

RESULTS

The review included 16 studies. The studies spanned from 2015 to 2021, with a majority published in 2019 or later. Studies showed that HCPs have been reviewing PGHD through various channels, including solutions portals and patients' devices. PGHD about patients' behavior seem particularly useful for HCPs. Our findings suggest that PGHD are more commonly used by HCPs to treat conditions related to lifestyle, such as diabetes and obesity. Physicians were the most frequently reported users of PGHD, participating in more than 80% of the studies.

CONCLUSIONS

PGHD collection through mHealth solutions has proven beneficial for patients and can also support HCPs. PGHD have been particularly useful to treat conditions related to lifestyle, such as diabetes, cardiovascular diseases, and obesity, or in domains with high levels of uncertainty, such as infertility. Integrating PGHD into clinical care poses challenges related to privacy and accessibility. Some HCPs have identified that though PGHD from consumer devices might not be perfect or completely accurate, their perceived clinical value outweighs the alternative of having no data. Despite their perceived value, our findings reveal their use in clinical practice is still scarce.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/39389.

Experiences of Electronic Health Records' and Client Information Systems' Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study

BACKGROUND

The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today's era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients' homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities.

OBJECTIVE

This study aims to analyze practical nurses' experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device.

METHODS

A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings.

RESULTS

The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses' office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not.

CONCLUSIONS

To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use.

Evolving Adult ADHD Care: Preparatory Evaluation of a Prototype Digital Service Model Innovation for ADHD Care

BACKGROUND

Given the prevalence of ADHD and the gaps in ADHD care in Australia, this study investigates the critical barriers and driving forces for innovation. It does so by conducting a preparatory evaluation of an ADHD prototype digital service innovation designed to help streamline ADHD care and empower individual self-management.

METHODS

Semi-structured interviews with ADHD care consumers/participants and practitioners explored their experiences and provided feedback on a mobile self-monitoring app and related service innovations. Interview transcripts were double coded to explore thematic barriers and the enablers for better ADHD care.

RESULTS

Fifteen interviews (9 consumers, 6 practitioners) revealed barriers to better ADHD care for consumers (ignorance and prejudice, trust, impatience) and for practitioners (complexity, sustainability). Enablers for consumers included validation/empowerment, privacy, and security frameworks, tailoring, and access. Practitioners highlighted the value of transparency, privacy and security frameworks, streamlined content, connected care between services, and the tailoring of broader metrics.

CONCLUSIONS

A consumer-centred approach to digital health service innovation, featuring streamlined, private, and secure solutions with enhanced mobile tools proves instrumental in bridging gaps in ADHD care in Australia. These innovations should help to address the gaps in ADHD care in Australia. These innovations should encompass integrated care, targeted treatment outcome data, and additional lifestyle support, whilst recognising the tensions between customised functionalities and streamlined displays.

The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review

BACKGROUND

Champions play a critical role in implementing technology within healthcare services. While prior studies have explored the presence and characteristics of champions, this review delves into the experiences of healthcare personnel holding champion roles, as well as the experiences of healthcare personnel interacting with them. By synthesizing existing knowledge, this review aims to inform decisions regarding the inclusion of champions as a strategy in technology implementation and guide healthcare personnel in these roles.

METHODS

A systematic mixed studies review, covering qualitative, quantitative, or mixed designs, was conducted from September 2022 to March 2023. The search spanned Medline, Embase, CINAHL, and Scopus, focusing on studies published from 2012 onwards. The review centered on health personnel serving as champions in technology implementation within healthcare services. Quality assessments utilized the Mixed Methods Appraisal Tool (MMAT).

RESULTS

From 1629 screened studies, 23 were included. The champion role was often examined within the broader context of technology implementation. Limited studies explicitly explored experiences related to the champion role from both champions' and health personnel's perspectives. Champions emerged as promoters of technology, supporting its adoption. Success factors included anchoring and selection processes, champions' expertise, and effective role performance.

DISCUSSION

The specific tasks and responsibilities assigned to champions differed across reviewed studies, highlighting that the role of champion is a broad one, dependent on the technology being implemented and the site implementing it. Findings indicated a correlation between champion experiences and organizational characteristics. The role's firm anchoring within the organization is crucial. Limited evidence suggests that volunteering, hiring newly graduated health personnel, and having multiple champions can facilitate technology implementation. Existing studies predominantly focused on client health records and hospitals, emphasizing the need for broader research across healthcare services.

CONCLUSIONS

With a clear mandate, dedicated time, and proper training, health personnel in champion roles can significantly contribute professional, technological, and personal competencies to facilitate technology adoption within healthcare services. The review finds that the concept of champions is a broad one and finds varied definitions of the champion role concept. This underscores the importance of describing organizational characteristics, and highlights areas for future research to enhance technology implementation strategies in different healthcare settings with support of a champion.

The use of medical health applications by primary care physicians in Israel: a cross-sectional study

BACKGROUND

The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated.

METHODS

From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them.

RESULTS

From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps.

CONCLUSIONS

mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.

Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden

BACKGROUND

Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics.

METHODS

We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents.

CONCLUSION

Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health.

Mobile health for mental health support: a survey of attitudes and concerns among mental health professionals in Poland over the period 2020-2023

Introduction

Mobile health (mHealth) has emerged as a dynamic sector supported by technological advances and the COVID-19 pandemic and have become increasingly applied in the field of mental health.

Aim

The aim of this study was to assess the attitudes, expectations, and concerns of mental health professionals, including psychiatrists, psychologists, and psychotherapists, towards mHealth, in particular mobile health self-management tools and telepsychiatry in Poland.

Material and methods

This was a survey conducted between 2020 and 2023. A questionnaire was administered to 148 mental health professionals, covering aspects such as telepsychiatry, mobile mental health tools, and digital devices.

Results

The majority of professionals expressed readiness to use telepsychiatry, with a peak in interest during the COVID-19 pandemic, followed by a gradual decline from 2022. Concerns about telepsychiatry were reported by a quarter of respondents, mainly related to difficulties in correctly assessing the patient's condition, and technical issues. Mobile health tools were positively viewed by professionals, with 86% believing they could support patients in managing mental health and 74% declaring they would recommend patients to use them. Nevertheless, 29% expressed concerns about the effectiveness and data security of such tools. Notably, the study highlighted a growing readiness among mental health professionals to use new digital technologies, reaching 84% in 2023.

Conclusion

These findings emphasize the importance of addressing concerns and designing evidence-based mHealth solutions to ensure long-term acceptance and effectiveness in mental healthcare. Additionally, the study highlights the need for ongoing regulatory efforts to safeguard patient data and privacy in the evolving digital health landscape.

Understanding inherent influencing factors to digital health adoption in general practices through a mixed-methods analysis

Extensive research has shown the potential value of digital health solutions and highlighted the importance of clinicians' adoption. As general practitioners (GPs) are patients' first point of contact, understanding influencing factors to their digital health adoption is especially important to derive personalized practical recommendations. Using a mixed-methods approach, this study broadly identifies adoption barriers and potential improvement strategies in general practices, including the impact of GPs' inherent characteristics - especially their personality - on digital health adoption. Results of our online survey with 216 GPs reveal moderate overall barriers on a 5-point Likert-type scale, with required workflow adjustments (M = 4.13, SD = 0.93), inadequate reimbursement (M = 4.02, SD = 1.02), and high training effort (M = 3.87, SD = 1.01) as substantial barriers. Improvement strategies are considered important overall, with respondents especially wishing for improved interoperability (M = 4.38, SD = 0.81), continued technical support (M = 4.33, SD = 0.91), and improved usability (M = 4.20, SD = 0.88). In our regression model, practice-related characteristics, the expected future digital health usage, GPs' digital affinity, several personality traits, and digital maturity are significant predictors of the perceived strength of barriers. For the perceived importance of improvement strategies, only demographics and usage-related variables are significant predictors. This study provides strong evidence for the impact of GPs' inherent characteristics on barriers and improvement strategies. Our findings highlight the need for comprehensive approaches integrating personal and emotional elements to make digitization in practices more engaging, tangible, and applicable.

Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review

OBJECTIVE

To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care.

METHODS

A scoping review was conducted. A systematic search for articles published in 2000-2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included 'telemedicine', 'telehealth' and 'nursing homes'.

RESULTS

Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks.

CONCLUSION AND IMPLICATIONS

Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers' perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.

Big 5 Personality Traits and Individual- and Practice-Related Characteristics as Influencing Factors of Digital Maturity in General Practices: Quantitative Web-Based Survey Study

BACKGROUND

Various studies propose the significance of digital maturity in ensuring effective patient care and enabling improved health outcomes, a successful digital transformation, and optimized service delivery. Although previous research has centered around inpatient health care settings, research on digital maturity in general practices is still in its infancy.

OBJECTIVE

As general practitioners (GPs) are the first point of contact for most patients, we aimed to shed light on the pivotal role of GPs' inherent characteristics, especially their personality, in the digital maturity of general practices.

METHODS

In the first step, we applied a sequential mixed methods approach involving a literature review and expert interviews with GPs to construct the digital maturity scale used in this study. Next, we designed a web-based survey to assess digital maturity on a 5-point Likert-type scale and analyze the relationship with relevant inherent characteristics using ANOVAs and regression analysis.

RESULTS

Our web-based survey with 219 GPs revealed that digital maturity was overall moderate (mean 3.31, SD 0.64) and substantially associated with several characteristics inherent to the GP. We found differences in overall digital maturity based on GPs' gender, the expected future use of digital health solutions, the perceived digital affinity of medical assistants, GPs' level of digital affinity, and GPs' level of extraversion and neuroticism. In a regression model, a higher expected future use, a higher perceived digital affinity of medical assistants, a higher digital affinity of GPs, and lower neuroticism were substantial predictors of overall digital maturity.

CONCLUSIONS

Our study highlights the impact of GPs' inherent characteristics, especially their personality, on the digital maturity of general practices. By identifying these inherent influencing factors, our findings support targeted approaches to drive digital maturity in general practice settings.

Sleep well, worry less: A co-design study for the development of the SMILE app

Objective

With the coronavirus disease 2019 pandemic exacerbating mental health concerns, the prevalence rates of anxiety and sleep problems have increased alarmingly among youth. Although 90% of patients with anxiety experience sleep problems, current interventions for anxiety often do not target sleep problems in youth. Given this lack, we designed the SMILE app, an intervention that addresses both anxiety and sleep problems simultaneously.

Methods

As users' perspectives are essential to ensure app engagement and uptake, the features, designs, and functions of the SMILE app were evaluated using a participatory app design approach. Participants (N = 17) were youth aged 15 to 25 who reported co-morbid anxiety and sleep issues above clinical thresholds. After completing an online screening survey assessing demographics, anxiety, and sleep problems, participants shared app feedback through group-based, semi-structured co-design sessions. Qualitative analyses were conducted to identify common themes from participants' feedback.

Results

While participants expressed enthusiasm for the SMILE app's features, particularly the Visualization, Journaling, and Psychoeducation features, and their variety, they criticized the design aspects of the app, such as the font and text amount. Most participants stated they would use the SMILE app or recommend it to a friend.

Conclusion

By actively involving the target population in the design process, the SMILE app has the potential to notably improve the mental well-being of youth, though further research and development are required to realize this potential fully.

Mental health provider and youth service users' perspectives regarding implementation of a digital mental health platform for youth: A survey study

Background

For youth and young adults (YYAs) with mental health concerns, digital mental health (dMH) can improve access to care and support collaboration with providers. Measurement-based care using a dMH platform may further optimize YYA outcomes by individualizing treatment approaches. Engaging service providers and YYA provides an opportunity to better understand how to mitigate implementation challenges.

Aim

Explore the experiences of mental health care providers and YYAs regarding the implementation of a dMH platform for YYAs accessing mental health care in multiple care settings.

Methods

Mental health care providers and YYA service users completed an electronic survey exploring their experiences and perceptions of implementing a dMH platform. Survey design, data analysis, and reporting were informed by the Consolidated Framework for Implementation Research (CFIR).

Results

A total of 195 individuals (100 providers, 95 YYAs) responded. Of those, 48 providers and 79 YYAs reported using the platform at least once. Both groups identified several important factors supporting implementation including collaborative relationships between providers and YYAs, the ability to monitor mental health outcomes, and increased YYA engagement in care. The need for increased provider training and automatic reminders for YYAs to use the platform were common barriers. Each group perceived the other to be uninterested in using the platform, highlighting the importance of using all stakeholder views to inform implementation planning.

Conclusions

Successful implementation of dMH for care of YYA requires ongoing, user-informed training, integration into existing workflows, and alignment with YYA priorities for care. Future work exploring provider and youth perceptions of the others' "buy-in" is needed to inform future implementation strategies.

A sociotechnical framework to assess patient-facing eHealth tools: results of a modified Delphi process

Among the thousands of eHealth tools available, the vast majority do not get past pilot phases because they cannot prove value, and only a few have been systematically assessed. Although multiple eHealth assessment frameworks have been developed, these efforts face multiple challenges. This study aimed to address some of these challenges by validating and refining an initial list of 55 assessment criteria based on previous frameworks through a two-round modified Delphi process with in-between rounds of interviews. The expert panel (n = 57) included participants from 18 countries and 9 concerned parties. A consensus was reached on 46 criteria that were classified into foundational and contextual criteria. The 36 foundational criteria focus on evaluating the eHealth tool itself and were grouped into nine clusters: technical aspects, clinical utility and safety, usability and human centricity, functionality, content, data management, endorsement, maintenance, and developer. The 10 contextual criteria focus on evaluating the factors that vary depending on the context the tool is being evaluated for and were grouped into seven clusters: data-protection compliance, safety regulatory compliance, interoperability and data integration, cultural requirements, affordability, cost-benefit, and implementability. The classification of criteria into foundational and contextual helps us assess not only the quality of an isolated tool, but also its potential fit in a specific setting. Criteria subscales may be particularly relevant when determining the strengths and weaknesses of the tool being evaluated. This granularity enables different concerned parties to make informed decisions about which tools to consider according to their specific needs and priorities.

Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives

BACKGROUND

Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown.

OBJECTIVE

We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation.

METHODS

We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis.

RESULTS

Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it.

CONCLUSIONS

Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed.

Medical practitioner perspectives on AI in emergency triage

Introduction

A proposed Diagnostic AI System for Robot-Assisted Triage ("DAISY") is under development to support Emergency Department ("ED") triage following increasing reports of overcrowding and shortage of staff in ED care experienced within National Health Service, England ("NHS") but also globally. DAISY aims to reduce ED patient wait times and medical practitioner overload. The objective of this study was to explore NHS health practitioners' perspectives and attitudes towards the future use of AI-supported technologies in ED triage.

Methods

Between July and August 2022 a qualitative-exploratory research study was conducted to collect and capture the perceptions and attitudes of nine NHS healthcare practitioners to better understand the challenges and benefits of a DAISY deployment. The study was based on a thematic analysis of semi-structured interviews. The study involved qualitative data analysis of the interviewees' responses. Audio-recordings were transcribed verbatim, and notes included into data documents. The transcripts were coded line-by-line, and data were organised into themes and sub-themes. Both inductive and deductive approaches to thematic analysis were used to analyse such data.

Results

Based on a qualitative analysis of coded interviews with the practitioners, responses were categorised into broad main thematic-types, namely: trust; current practice; social, legal, ethical, and cultural concerns; and empathetic practice. Sub-themes were identified for each main theme. Further quantitative analyses explored the vocabulary and sentiments of the participants when talking generally about NHS ED practices compared to discussing DAISY. Limitations include a small sample size and the requirement that research participants imagine a prototype AI-supported system still under development. The expectation is that such a system would work alongside the practitioner. Findings can be generalisable to other healthcare AI-supported systems and to other domains.

Discussion

This study highlights the benefits and challenges for an AI-supported triage healthcare solution. The study shows that most NHS ED practitioners interviewed were positive about such adoption. Benefits cited were a reduction in patient wait times in the ED, assistance in the streamlining of the triage process, support in calling for appropriate diagnostics and for further patient examination, and identification of those very unwell and requiring more immediate and urgent attention. Words used to describe the system were that DAISY is a "good idea", "help", helpful, "easier", "value", and "accurate". Our study demonstrates that trust in the system is a significant driver of use and a potential barrier to adoption. Participants emphasised social, legal, ethical, and cultural considerations and barriers to DAISY adoption and the importance of empathy and non-verbal cues in patient interactions. Findings demonstrate how DAISY might support and augment human medical performance in ED care, and provide an understanding of attitudinal barriers and considerations for the development and implementation of future triage AI-supported systems.

An Exploratory Study on the Utility of Patient-Generated Health Data as a Tool for Health Care Professionals in Multiple Sclerosis Care

BACKGROUND

Patient-generated health data (PGHD) are data collected through technologies such as mobile devices and health apps. The integration of PGHD into health care workflows can support the care of chronic conditions such as multiple sclerosis (MS). Patients are often willing to share data with health care professionals (HCPs) in their care team; however, the benefits of PGHD can be limited if HCPs do not find it useful, leading patients to discontinue data tracking and sharing eventually. Therefore, understanding the usefulness of mobile health (mHealth) solutions, which provide PGHD and serve as enablers of the HCPs' involvement in participatory care, could motivate them to continue using these technologies.

OBJECTIVE

The objective of this study is to explore the perceived utility of different types of PGHD from mHealth solutions which could serve as tools for HCPs to support participatory care in MS.

METHOD

A mixed-methods approach was used, combining qualitative research and participatory design. This study includes three sequential phases: data collection, assessment of PGHD utility, and design of data visualizations. In the first phase, 16 HCPs were interviewed. The second and third phases were carried out through participatory workshops, where PGHD types were conceptualized in terms of utility.

RESULTS

The study found that HCPs are optimistic about PGHD in MS care. The most useful types of PGHD for HCPs in MS care are patients' habits, lifestyles, and fatigue-inducing activities. Although these subjective data seem more useful for HCPs, it is more challenging to visualize them in a useful and actionable way.

CONCLUSION

HCPs are optimistic about mHealth and PGHD as tools to further understand their patients' needs and support care in MS. HCPs from different disciplines have different perceptions of what types of PGHD are useful; however, subjective types of PGHD seem potentially more useful for MS care.

Standardising the role of a digital navigator in behavioural health: a systematic review

As the number and availability of digital mental health tools increases, patients and clinicians see benefit only when these tools are engaging and well integrated into care. Digital navigators-ie, members of health-care teams who are dedicated to supporting patient use of digital resources-offer one solution and continue to be piloted in behavioural health; however, little is known about the core features of this position. The aims of this systematic review were to assess how digital navigators are implemented in behavioural health, and to provide a standardised definition of this position. In January, 2023, we conducted a systematic literature search resulting in 48 articles included in this systematic review. Results showed high heterogeneity between four attributes of digital navigators: training specifications, educational background, frequency of communication, and method of communication with patients. Reported effect sizes for depression and anxiety were medium to large, but could not be synthesised due to study heterogeneity and small study sample size. This systematic review was registered with PROSPERO (CRD42023391696). Results suggest that digital navigator support can probably increase access to, engagement with, and clinical integration of digital health technology, with standards for training and defined responsibilities now emerging.

Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review

BACKGROUND

During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented.

OBJECTIVE

The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic.

METHODS

A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

RESULTS

The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines.

CONCLUSIONS

This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic.

TRIAL REGISTRATION

PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu.

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

BACKGROUND

The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.

METHODS

An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.

RESULTS

Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.

CONCLUSIONS

Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

Variation in telehealth use for endocrine care: Patterns and predictors under the "new normal"

INTRODUCTION

Use of telehealth for outpatient endocrine care remains common since onset of the COVID-19 pandemic, though the context for its use has matured. We aimed to describe the variation in telehealth use for outpatient endocrine visits under these "new normal" conditions and examine the patient, clinician-, and organization-level factors predicting use.

METHODS

Retrospective cross-sectional study using data from the U.S. Department of Veterans Affairs (VA) Corporate Data Warehouse on 167,017 endocrine visits conducted between 3/9/21 and 3/8/22. We used mixed effects logistic regression models to examine 1) use of telehealth vs. in-person care among all visits and 2) use of telephone vs. video among the subsample of telehealth visits.

RESULTS

Visits were in person (58%), by telephone (29%), or by video (13%). Unique variability in telehealth use at each level of the analysis was 56% patient visit, 24% clinician, 18% facility. The strongest predictors were visit type (first vs. follow up) and clinician and facility characteristics. Among telehealth visits, unique variability in telephone (vs. video) use at each level was 44% patient visit, 24% clinician, 26% facility. The strongest predictors of telephone vs. video were visit type, patient age, and percent of the facility's population that was rural.

CONCLUSIONS

We found wide variation in use of telehealth for endocrinology under the "new normal". Future research should examine clinician and facility factors driving variation, as many may be amenable to influence by clinical leaders and leveraged to enhance the availability of telehealth for all clinically appropriate patients.

Female youth and mental health service providers' perspectives on the JoyPop™ app: a qualitative study

Introduction

Mobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers.

Method

A qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach.

Results

All youth (n = 6 females; Mage = 14.60, range 12-17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers (n = 7 females; Mage = 43.75, range 32-60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app.

Discussion

Results support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Barriers and facilitators to utilizing digital health technologies by healthcare professionals

Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.

Health Providers' Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis

BACKGROUND

Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential.

OBJECTIVE

This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs.

METHODS

A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach.

RESULTS

A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth.

CONCLUSIONS

This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs.

Assessing Health Students' Attitudes and Usage of ChatGPT in Jordan: Validation Study

BACKGROUND

ChatGPT is a conversational large language model that has the potential to revolutionize knowledge acquisition. However, the impact of this technology on the quality of education is still unknown considering the risks and concerns surrounding ChatGPT use. Therefore, it is necessary to assess the usability and acceptability of this promising tool. As an innovative technology, the intention to use ChatGPT can be studied in the context of the technology acceptance model (TAM).

OBJECTIVE

This study aimed to develop and validate a TAM-based survey instrument called TAME-ChatGPT (Technology Acceptance Model Edited to Assess ChatGPT Adoption) that could be employed to examine the successful integration and use of ChatGPT in health care education.

METHODS

The survey tool was created based on the TAM framework. It comprised 13 items for participants who heard of ChatGPT but did not use it and 23 items for participants who used ChatGPT. Using a convenient sampling approach, the survey link was circulated electronically among university students between February and March 2023. Exploratory factor analysis (EFA) was used to assess the construct validity of the survey instrument.

RESULTS

The final sample comprised 458 respondents, the majority among them undergraduate students (n=442, 96.5%). Only 109 (23.8%) respondents had heard of ChatGPT prior to participation and only 55 (11.3%) self-reported ChatGPT use before the study. EFA analysis on the attitude and usage scales showed significant Bartlett tests of sphericity scores (P<.001) and adequate Kaiser-Meyer-Olkin measures (0.823 for the attitude scale and 0.702 for the usage scale), confirming the factorability of the correlation matrices. The EFA showed that 3 constructs explained a cumulative total of 69.3% variance in the attitude scale, and these subscales represented perceived risks, attitude to technology/social influence, and anxiety. For the ChatGPT usage scale, EFA showed that 4 constructs explained a cumulative total of 72% variance in the data and comprised the perceived usefulness, perceived risks, perceived ease of use, and behavior/cognitive factors. All the ChatGPT attitude and usage subscales showed good reliability with Cronbach α values >.78 for all the deduced subscales.

CONCLUSIONS

The TAME-ChatGPT demonstrated good reliability, validity, and usefulness in assessing health care students' attitudes toward ChatGPT. The findings highlighted the importance of considering risk perceptions, usefulness, ease of use, attitudes toward technology, and behavioral factors when adopting ChatGPT as a tool in health care education. This information can aid the stakeholders in creating strategies to support the optimal and ethical use of ChatGPT and to identify the potential challenges hindering its successful implementation. Future research is recommended to guide the effective adoption of ChatGPT in health care education.

Electronic Patient-Reported Outcome Data Collection Systems in Oncology Clinical Trials: A Survey of Clinical Research Professionals (an Alliance Study)

PURPOSE

To describe clinical research professionals (CRPs)' experiences with electronic patient-reported outcome (ePRO) data collection systems in oncology clinical trials and identify correlates of CRPs' attitude toward technology.

METHODS

An online survey was conducted among 210 CRPs from 125 National Cancer Institute-funded research sites. Measures included CRPs' demographic characteristics, working years, employment locations, and previous experiences with various types of ePROs. Their attitude toward technology was measured by the Technology Attitude Scale-Adapted. The Wilcoxon signed-rank test was used to compare two subdomains of attitude (perceived usefulness [PU] and perceived ease of use [PEU]). Multiple linear regression was used to explore correlates of (1) overall attitude, (2) PU, and (3) PEU. The significance level was 5%.

RESULTS

Participants' median age was 41 years (range, 21-67). Most were female (90%) and White (82%). More than half of the participants had previous experiences with web-based ePROs using patients' own devices (72%) or site-/sponsor-provided on-site devices (eg, kiosks or tablets; 64%). CRPs who were 60 years or older (β = -0.32, P < .05) or worked for 10-20 years (β = -0.11, P < .05) had relatively negative attitudes, controlling for other factors. Previous experiences with more ePRO types were associated with more positive attitudes (β = 0.08, P = .02). Similar correlates were found with PU but not with PEU.

CONCLUSION

This study revealed that CRPs had various experiences with ePRO systems and attitudes toward technology. Age, working years, and previous experiences with ePROs were correlates of overall attitude toward technology and PU. These findings suggest necessary targeted training to facilitate ePRO use in oncology clinical trials by improving CRPs' awareness and attitude toward technology.

End-User Perspectives of the Importance of Rehabilitation Technologies and Related Values for Implementation

Despite the increased availability of rehabilitation technologies (such as robotics) and evidence to support their use, their adoption is still limited in practice. To begin to address this issue, we sought to better understand the perspectives of end-users regarding the implementation of rehabilitation technologies through an online survey. Fifty unique responses across Client (e.g., people with disability and carers), Allied Health (e.g., occupational and physical therapists, podiatrists, psychologists, dieticians, audiologists, exercise physiologists), and Medical (i.e., physicians and nurses) groups were analyzed. Respondents considered rehabilitation technologies to be important (median across groups of 9 out of 10). Across groups, value statements related to the implementation of rehabilitation technologies ranked from most to least important related to: benefits of technology to its intended end-user with disability, practical use of technologies, the technologies themselves (e.g., innovative, established, stand-alone), and their impact on health professionals or the health system as a whole. There were similarities and differences in ranking within and across end-user groups. The prioritization of statements indicates where development efforts can be focused to address end-user goals, and disparity in results across groups supports rich stakeholder engagement during rehabilitation technology development.

The Constrained-Disorder Principle Assists in Overcoming Significant Challenges in Digital Health: Moving from "Nice to Have" to Mandatory Systems

The success of artificial intelligence depends on whether it can penetrate the boundaries of evidence-based medicine, the lack of policies, and the resistance of medical professionals to its use. The failure of digital health to meet expectations requires rethinking some of the challenges faced. We discuss some of the most significant challenges faced by patients, physicians, payers, pharmaceutical companies, and health systems in the digital world. The goal of healthcare systems is to improve outcomes. Assisting in diagnosing, collecting data, and simplifying processes is a "nice to have" tool, but it is not essential. Many of these systems have yet to be shown to improve outcomes. Current outcome-based expectations and economic constraints make "nice to have," "assists," and "ease processes" insufficient. Complex biological systems are defined by their inherent disorder, bounded by dynamic boundaries, as described by the constrained disorder principle (CDP). It provides a platform for correcting systems' malfunctions by regulating their degree of variability. A CDP-based second-generation artificial intelligence system provides solutions to some challenges digital health faces. Therapeutic interventions are held to improve outcomes with these systems. In addition to improving clinically meaningful endpoints, CDP-based second-generation algorithms ensure patient and physician engagement and reduce the health system's costs.

Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned?

Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients.

The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis

Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies' effect on health-care workers' competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers' performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers' performance (10·9% [95% CI 5·3-22·5]), improvement of clinical practice and management (9·8% [3·9-24·2]), and improvement of care delivery and access to care (9·2% [4·1-20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings' generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.