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Jiang J, Zheng Z. Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis. JMIR Mhealth Uhealth 2024; 12:e55061. [PMID: 38904994 PMCID: PMC11226934 DOI: 10.2196/55061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/23/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. OBJECTIVE In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. METHODS We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. RESULTS The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9%, SD 24.2%) lagged behind general PI protection (mean 90.4%, SD 14.7%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9%, SD 24.2%). Although most apps (n=41, 79%) committed to supervising subcontractors, only a quarter (n=13, 25%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2%, SD 29.3%) and incident management (mean 71.8%, SD 36.6%), half of the assessed apps (n=27, 52%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77%) and instances of PI deletion or anonymization (n=41, 79%), but fewer (n=20, 38.5%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42%) or to refuse advertisement based on automated decision-making (n=13, 25%). Significant deficiencies remained in regular compliance audits (mean 11.5%, SD 37.8%), impact assessments (mean 13.5%, SD 15.2%), and PI officer disclosure (mean 48.1%, SD 49.3%). CONCLUSIONS Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages.
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Affiliation(s)
- Jiayi Jiang
- Law School, Central South University, Changsha, China
| | - Zexing Zheng
- Law School, Central South University, Changsha, China
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Chen H, Li HX, Li L, Zhang XH, Gu JW, Wang Q, Wu CM, Wu YQ. Factors Associated with Intention to Use Telerehabilitation for Children with Special Needs: A Cross-Sectional Study. Telemed J E Health 2024; 30:1425-1435. [PMID: 38346325 DOI: 10.1089/tmj.2023.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background: Children with special health care needs (CSHCN) require long-term and ongoing rehabilitation interventions supporting their development. Telerehabilitation can provide continuous rehabilitation services for CSHCN. However, few studies have explored the intention of CSHCN and their caregivers to use telerehabilitation and its impact on them. Objective: The objective of this study was to identify factors that influence the intention to use telerehabilitation among CSHCN and their caregivers. Methods: This study was a cross-sectional study. Based on the unified theory of acceptance and use of technology, extended with additional predictors (trust and perceived risk [PR]), this study developed a research model and proposed 10 hypotheses. A structured questionnaire was distributed to 176 caregivers. Data were analyzed and research hypotheses were tested using partial least squares structural equation modeling to better understand the factors influencing the use of telerehabilitation. Results: A total of 164 valid questionnaires were collected. CSHCN and their caregivers were overall satisfied with this telerehabilitation medical service. The results of the structural model analysis indicated that social influence (SI), facilitating conditions (FC), and trust had significant effects on behavioral intention (BI) to use telerehabilitation, while the paths between performance expectancy (PE), effort expectancy (EE), and PR and BI were not significant. PE, EE, and SI had a significant effect on trust. Moreover, EE and SI had indirect effects on BI, with trust as the mediator. Conclusions: The results indicated that SI, FC, and trust are significant factors influencing CSHCN and their caregivers' use of telerehabilitation. Trust is also an important mediator for the intention and highly influenced by PE, EE, and SI.
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Affiliation(s)
- Hong Chen
- Department of Pediatric Rehabilitation, Shaanxi Rehabilitation Hospital, Xi'an, China
| | - Hong-Xia Li
- Department of Pediatric Rehabilitation, Shaanxi Rehabilitation Hospital, Xi'an, China
| | - Ling Li
- Department of Pediatric Rehabilitation, Shaanxi Rehabilitation Hospital, Xi'an, China
| | - Xiao-Hong Zhang
- Department of Pediatric Rehabilitation, Shaanxi Rehabilitation Hospital, Xi'an, China
| | - Jun-Wang Gu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Qi Wang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Chun-Mei Wu
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Yong-Qiang Wu
- Department of Rehabilitation, Xi'an Children's Hospital, Xi'an, China
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Liu Y, Ouyang L, Wu W, Zhou X, Huang K, Wang Z, Song C, Chen Q, Su Z, Zheng R, Wei Y, Lu W, Wu W, Liu Y, Yan Z, Wu Z, Fan J, Zhou M, Fu J. Validation of an established TW3 artificial intelligence bone age assessment system: a prospective, multicenter, confirmatory study. Quant Imaging Med Surg 2024; 14:144-159. [PMID: 38223047 PMCID: PMC10784042 DOI: 10.21037/qims-23-715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/12/2023] [Indexed: 01/16/2024]
Abstract
Background In 2020, our center established a Tanner-Whitehouse 3 (TW3) artificial intelligence (AI) system using a convolutional neural network (CNN), which was built upon 9059 radiographs. However, the system, upon which our study is based, lacked a gold standard for comparison and had not undergone thorough evaluation in different working environments. Methods To further verify the applicability of the AI system in clinical bone age assessment (BAA) and to enhance the accuracy and homogeneity of BAA, a prospective multi-center validation was conducted. This study utilized 744 left-hand radiographs of patients, ranging from 1 to 20 years of age, with 378 boys and 366 girls. These radiographs were obtained from nine different children's hospitals between August and December 2020. The BAAs were performed using the TW3 AI system and were also reviewed by experienced reviewers. Bone age accuracy within 1 year, root mean square error (RMSE), and mean absolute error (MAE) were statistically calculated to evaluate the accuracy. Kappa test and Bland-Altman (B-A) plot were conducted to measure the diagnostic consistency. Results The system exhibited a high level of performance, producing results that closely aligned with those of the reviewers. It achieved a RMSE of 0.52 years and an accuracy of 94.55% for the radius, ulna, and short bones series. When assessing the carpal series of bones, the system achieved a RMSE of 0.85 years and an accuracy of 80.38%. Overall, the system displayed satisfactory accuracy and RMSE, particularly in patients over 7 years old. The system excelled in evaluating the carpal bone age of patients aged 1-6. Both the Kappa test and B-A plot demonstrated substantial consistency between the system and the reviewers, although the model encountered challenges in consistently distinguishing specific bones, such as the capitate. Furthermore, the system's performance proved acceptable across different genders and age groups, as well as radiography instruments. Conclusions In this multi-center validation, the system showcased its potential to enhance the efficiency and consistency of healthy delivery, ultimately resulting in improved patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Yanqi Liu
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liujian Ouyang
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuelian Zhou
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhihua Wang
- Department of Endocrinology and Metabolism, Xi’an Children’s Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
| | - Cui Song
- Department of Endocrinology and Genetic Metabolism Disease, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Qiuli Chen
- Department of Pediatric, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Wei
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Lu
- Department of Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Wei Wu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Ziye Yan
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhaoyuan Wu
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jitao Fan
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co. Ltd, Beijing, China
| | - Mingzhi Zhou
- Clinical Research and Translational Center, Second People’s Hospital of Yibin City, Yibin, China
| | - Junfen Fu
- Department of Endocrinology, Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Shao H, Liu C, Tang L, Wang B, Xie H, Zhang Y. Factors Influencing the Behavioral Intentions and Use Behaviors of Telemedicine in Patients With Diabetes: Web-Based Survey Study. JMIR Hum Factors 2023; 10:e46624. [PMID: 38153781 PMCID: PMC10784981 DOI: 10.2196/46624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/01/2023] [Accepted: 10/16/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Telemedicine has great potential for diabetes management. The COVID-19 pandemic has boosted the development of telemedicine. However, the factors influencing the behavioral intentions to use and use behaviors of telemedicine in patients with diabetes in China are not clear. OBJECTIVE We aimed to understand the determinants of behavioral intention to use telemedicine based on an extended Unified Theory of Acceptance and Use of Technology model and to identify demographic factors associated with telemedicine use in patients with diabetes in China. METHODS Patients with diabetes who are aged ≥18 years were surveyed from February 1 to February 7, 2023. We distributed the survey link in 3 WeChat groups including a total of 988 patients with diabetes from the outpatient department or patients discharged from Changsha Central Hospital. Structural equation modeling was used to understand the determinants of behavioral intention. A multivariate logistic regression analysis was used to identify the demographic factors associated with telemedicine use. RESULTS In total, 514 questionnaires were collected. Of the respondents, 186 (36.2%) were diagnosed with COVID-19. The measurement model showed acceptable reliability, convergent validity, discriminant validity, and data fit indices. The model explained 63.8% of the variance in behavioral intention. Social influence, performance expectancy, and facilitating conditions positively influenced behavioral intention (β=.463, P<.001; β=.153, P=.02; and β=.257, P=.004, respectively). Perceived susceptibility, perceived severity, and effort expectancy had no significant impact on behavioral intention (all P>.05). The overall use of telemedicine was 20.6% (104/514). After adjusting for the behavioral intention score, the multivariate regression analysis showed that age, education, and family income were associated with telemedicine use. Telemedicine use was higher in the 40 to 59 years and 18 to 39 years age groups than in the ≥60 years age group (odds ratio [OR] 4.35, 95% CI 1.84-10.29, P=.001; OR 9.20, 95% CI 3.40-24.88, P<.001, respectively). Telemedicine use was higher in the senior high school and the university and more groups than in junior high school education and less group (OR 2.45, 95% CI 1.05-5.73, P=.04; OR 2.63, 95% CI 1.11-6.23, P=.03, respectively). Patients with a higher family income used telemedicine more often than the patients who had an annual family income ≤¥10,000 (CNY ¥1=US $0.1398; ¥10,000-¥50,000 group: OR 3.90, 95% CI 1.21-12.51, P=.02; ¥50,000-¥100,000 group: OR 3.91, 95% CI 1.19-12.79, P=.02; >¥100,000 group: OR 4.63, 95% CI 1.41-15.27, P=.01). CONCLUSIONS Social influence, performance expectancy, and facilitating conditions positively affected the behavioral intention of patients with diabetes to use telemedicine. Young patients, highly educated patients, and patients with high family income use telemedicine more often. Promoting behavioral intention and paying special attention to the needs of older adult patients, patients with low income, and patients with low levels of education are needed to encourage telemedicine use.
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Affiliation(s)
- Huige Shao
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Tang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Bian Wang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hebin Xie
- Science and Education Department, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Yiyu Zhang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Wu Q, Ngien A, Jiang S. Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study. HEALTH COMMUNICATION 2023:1-12. [PMID: 38148390 DOI: 10.1080/10410236.2023.2297120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.
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Affiliation(s)
- Qiaofei Wu
- Department of Communications and New Media, National University of Singapore
| | - Annabel Ngien
- Department of Communications and New Media, National University of Singapore
| | - Shaohai Jiang
- Department of Communications and New Media, National University of Singapore
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Zhang Y, Zhang Y, Huang J, Dong L. Application of Internet hospitals for first-visit patients with COVID-19 during the pandemic in China. Eur J Public Health 2023; 33:789-795. [PMID: 37550253 PMCID: PMC10567245 DOI: 10.1093/eurpub/ckad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND There has been controversy over whether to carry out online medical inquiries and electronic prescription for first-visit patients. While Internet hospitals have become crucial to ensure providing online diagnosis and prescription needs for first-visit COVID-positive patients. OBJECTIVE We describe the results and advantages of online medical treatment during the coronavirus disease 2019 (COVID-19) outbreak and analyse the results and advantages of online medical treatment. METHODS Data were collected from the patients who received online medical inquiry services through the COVID-19 Special Section of our Internet hospital. The user demographic characteristics, user behaviour, clinical symptoms and medical records were collected. Baseline data of offline outpatient patients were also collected. RESULTS A total of 16 173 online medical inquiries were included. The daily online outpatient service volume reached a peak of 2446 person-times. The median age was 29.92 years (SD 15.59), ranging from 20-39 years (n = 8870, 54.84%). A total of 89.20% (n = 14 426/16 173) patients had epidemic-related symptoms. Moreover, 23.35% of the people were diagnosed as COVID-19-positive through antigen or nucleic acid testing. Furthermore, 86.61% (14 008/16 173) of the patients visited our hospital for the first time or had no offline physical outpatient service record within the past 3 months. The demand for medical inquiries was mainly for drug dispensing, followed by medication guidance and disease diagnosis. And 2.07% (334/16 173) of the patients needed to go to the offline hospital for further treatment. CONCLUSION The service model of the COVID-19 Special Section based on Internet hospitals provided the public with the necessary medical support during the COVID-19 outbreak. It provides a reference for future pandemics or public health emergencies.
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Affiliation(s)
- Ye Zhang
- Department of General Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ye Zhang
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China
| | - Jie Huang
- Department of General Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Liang Dong
- Department of Information, Affiliated Hospital of Jiaxing University, Jiaxing, China
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Wei S, Ge P, Zhang J, Xu S, Wang Y, Li Q, Feng B, Yu W, Suo B, Zhang Y, Wang M, Sun X, Song Z, Wu Y. Exploring factors that influence the behavioural intention of medical students to use 3D gastroscopic model to learn how to operate gastroscope using UTAUT Model. BMC MEDICAL EDUCATION 2023; 23:554. [PMID: 37550684 PMCID: PMC10408095 DOI: 10.1186/s12909-023-04532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration. METHODS All methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM). RESULTS The results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified. CONCLUSIONS This study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.
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Affiliation(s)
- Shuting Wei
- Translational Medicine Research Center, Medical Innovation Research Division, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Pu Ge
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jinzi Zhang
- College of Humanities and Social Sciences, Harbin Medical University, Heilongjiang, China
| | - Shuxian Xu
- China Pharmaceutical University, Nanjing, China
| | - Yujia Wang
- College of Humanities and Social Sciences, Harbin Medical University, Heilongjiang, China
| | - Qiyu Li
- School of Humanities and health management, Jinzhou Medical University, Jinzhou, China
| | - Bojunhao Feng
- School of Medicine, Macau University of Science and Technology, Macao, China
| | - Wenli Yu
- School for Sports Humanities and Social Science, Jilin Sport University, Changchun, China
| | - Baojun Suo
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Yueyang Zhang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing, China
| | - Mingxing Wang
- The Third Clinical Medical College, Harbin Medical University, Heilongjiang, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
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Koo JH, Park YH, Kang DR. Factors Predicting Older People's Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study. JMIR Aging 2023; 6:e41429. [PMID: 37342076 DOI: 10.2196/41429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) services enable real-time measurement of information on individuals' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. OBJECTIVE The study aims to identify the predictors of older people's intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. METHODS A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. RESULTS Of 477 participants, 278 (58.3%) had at least 1 chronic disease. Performance expectancy (β=.453; P=.003) and social influence (β=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions (β=.325; P=.006; 95% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=-2.165). Bootstrapping also confirmed that device trust (β=.122; P=.039; 95% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. CONCLUSIONS This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users.
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Affiliation(s)
- Jun Hyuk Koo
- National Health BigData Clinical Research Institute, Yonsei University Wonju Industry-Academic Cooperation Foundation, Wonju, Republic of Korea
| | - You Hyun Park
- Department of Biostatics, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Dae Ryong Kang
- Department of Biostatics, Yonsei University Graduate School, Wonju, Republic of Korea
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Bian D, Xiao Y, Song K, Dong M, Li L, Millar R, Shi C, Li G. Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory. J Med Internet Res 2023; 25:e37671. [PMID: 36897630 PMCID: PMC10039406 DOI: 10.2196/37671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/15/2022] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. OBJECTIVE This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. METHODS A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. RESULTS The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=-.083, P<.001), and perceived value negatively correlated with employee burnout (β=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001). CONCLUSIONS Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.
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Affiliation(s)
- Dongsheng Bian
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyin Xiao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keyu Song
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minye Dong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Ross Millar
- Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
| | - Chenshu Shi
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Jiang Y, Lau AKW. Understanding Post-Adoption Behavioral Intentions of Mobile Health Service Users: An Empirical Study during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3907. [PMID: 36900918 PMCID: PMC10001414 DOI: 10.3390/ijerph20053907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
This study aims to understand the post-adoption behaviors of mobile health (m-Health) service users during the COVID-19 pandemic. Drawing on the stimulus-organism-response framework, we examined the effects of user personality traits, doctor characteristics, and perceived risks on user continuance intentions and positive word of mouth (WOM) when using m-Health, as mediated by cognitive and emotional trust. The empirical data were collected via an online survey questionnaire from 621 m-Health service users in China and were verified with partial least squares structural equation modeling. The results showed that personal traits and doctor characteristics were positively associated and the perceived risks were negatively associated with both cognitive and emotional trust. Both cognitive and emotional trust significantly influenced users' post-adoption behavioral intentions in terms of continuance intentions and positive WOM, with different magnitudes. This study provides new insights for the promotion of the sustainable development of m-Health businesses after or during the pandemic.
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Affiliation(s)
- Yanmei Jiang
- The School of Business, Anhui University of Technology, Ma’anshan 243032, China
- Key Laboratory of Multidisciplinary Management and Control of Complex Systems of Anhui Higher Education Institutes, Anhui University of Technology, Ma’anshan 243032, China
| | - Antonio K. W. Lau
- The School of Management, Kyung Hee University, Seoul 02447, Republic of Korea
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11
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Digital transformation of healthcare during the COVID-19 pandemic: Patients’ teleconsultation acceptance and trusting beliefs. TECHNOVATION 2023; 120. [PMCID: PMC9108035 DOI: 10.1016/j.technovation.2022.102547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The COVID-19 pandemic boosted the digital transformation of many services, including healthcare, and access to medical care using teleconsultation has increased rapidly. Thus, a growing number of online platforms have been developed to accommodate patients’ needs. This paper examines the factors that predict the intention to use medical teleconsultation by extending the unified theory of acceptance and use of technology (UTAUT2) with the three dimensions of trusting beliefs and self-efficacy. A survey was administered to patients who had used a teleconsultation platform during the pandemic period. As one of the largest studies to date, a sample of 1233 respondents was collected and analyzed using a partial least squares approach, often mobilized in the information systems (IS) domain. Furthermore, a deep analysis using all recommended metrics was performed. The results highlight the significance of trusting beliefs, and self-efficacy in the adoption of digital healthcare services. These findings contribute to both theory and practice in COVID-19 research.
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12
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Evaluating Internet hospitals by a linguistic Z-number-based gained and lost dominance score method considering different risk preferences of experts. Inf Sci (N Y) 2023. [DOI: 10.1016/j.ins.2023.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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13
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Ma Q, Sun D, Tan Z, Li C, He X, Zhai Y, Wang L, Cui F, Li M, Gao J, Wang L, Zhao J. Usage and perceptions of telemedicine among health care professionals in China. Int J Med Inform 2022; 166:104856. [PMID: 36037593 DOI: 10.1016/j.ijmedinf.2022.104856] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To explore health care professionals' usage and perceptions of telemedicine, including their experience, evaluation and attitude towards telemedicine, and the factors affecting their satisfaction, using intention, and willingness to recommend telemedicine. METHODS A nationwide and web-based survey was conducted. Statistical charts were used to describe the usage and perceptions of telemedicine by health care professionals. And the ordinal logistic regression was applied to analyze the influencing factors. RESULTS A total of 1349 valid questionnaires were collected. In the survey, 74.0 % of Chinese health care professionals used telemedicine once a week. The average duration of participating in telemedicine services lasted mainly 11-30 min (64.0 %). More than half (52.5 %) of participants' hospitals adopted fee subsidy measures, followed by the award for excellent evaluation (36.4 %). The majority (92.5 %) believed that telemedicine could reduce patient referral rates. More than 95 % were satisfied with telemedicine, were willing to continue, and would recommend telemedicine for patients, respectively. The main problems existing were: incomplete system equipment, insufficient timeliness, high costs, inability to reimburse medical insurance, non-standardized medical records, inadequate publicity, cumbersome processes and long waiting time. Ordinal logistic regression showed that too short service duration (≤10 min) could significantly reduce medical professionals' overall satisfaction, using intention and willingness to recommend (P = 0.026, P = 0.017 and P = 0.040 respectively), while the convenience of the operating system had a significant positive impact (P = 0.005, P = 0.003 and P = 0.001 respectively). And cost subsidy incentive and the promotion of professional titles could significantly enhance their overall satisfaction(P = 0.006, P = 0.030), using intention (P = 0.011, P = 0.001), and willingness to recommend (P = 0.040, P = 0.004). CONCLUSIONS The usage of telemedicine is relatively insufficient. Most health care professionals have fairly positive opinions toward telemedicine. The most mentioned issues and expectations for telemedicine can be roughly divided into four categories: infrastructure, service process, charge and cost, and popularity. It is possible to improve their evaluation by improving system convenience, enhancing service punctuality, avoiding excessively short service duration and adopting incentive measures.
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Affiliation(s)
- Qianqian Ma
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongke Tan
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchen Li
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; School of Management Engineering, Zhengzhou University, Zhengzhou, China
| | - Linlin Wang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingyuan Li
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinghong Gao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Wang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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14
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Stimuli Influencing Engagement, Satisfaction, and Intention to Use Telemedicine Services: An Integrative Model. Healthcare (Basel) 2022; 10:healthcare10071327. [PMID: 35885854 PMCID: PMC9318589 DOI: 10.3390/healthcare10071327] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022] Open
Abstract
Telemedicine ensures quality, cost-effective, and equally accessible healthcare services for everyone. Nonetheless, a poor usage rate could curb its progression in developing cultures like Bangladesh. Therefore, this research examines how external stimuli promote the continuous usage intentions of synchronous telemedicine services through engagement and satisfaction by deploying the stimulus-organism-response framework. A final sample of 312 telemedicine users was analyzed using the structural equation modeling in AMOS. The average age of the participants was 26.28 (std. deviation 5.53), and their average use of telemedicine was 2.39 times (std. deviation 1.31) over the last six months. This study empirically endorsed that the stimuli, including performance expectancy, information quality, and contamination avoidance, as well as organismic factors such as engagement and satisfaction, directly impacted the continuance desires for telemedicine use. In addition, the analyses validated the mediation roles of engagement and satisfaction. Furthermore, performance and effort expectancies influenced engagement, which affected satisfaction along with performance expectancy, functionality, and information quality. Accordingly, telemedicine facilitators should integrate these critical attributes into the system to sustain engagement, satisfaction, and usage intentions. This study has pioneered the effects of performance and effort expectancies on continuous usage intentions facilitated by engagement and satisfaction in the telemedicine landscape.
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15
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Mahmoud K, Jaramillo C, Barteit S. Telemedicine in Low- and Middle-Income Countries During the COVID-19 Pandemic: A Scoping Review. Front Public Health 2022; 10:914423. [PMID: 35812479 PMCID: PMC9257012 DOI: 10.3389/fpubh.2022.914423] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background COVID-19 has impacted the capacity of healthcare systems worldwide, particularly in low- and middle-income countries (LMICs), which are already under strain due to population growth and insufficient resources. Since the COVID-19 pandemic's emergence, there has been an urgent need for a rapid and adequate reaction to the pandemic's disruption of healthcare systems. To this end, telemedicine has been shown in prior research to be a feasible approach. The overarching objective of this scoping review was to determine the extent and acceptance of telemedicine in healthcare in low- and middle-income countries (LMICs) during the COVID-19 pandemic. Methods This scoping review followed PRISMA guidelines and Arksey and O'Malley's five-stage framework to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between January 2020 and April 2021: Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for grey literature. Results The search identified 54 articles with 45,843 participants, including 6,966 healthcare professionals and 36,877 healthcare users. We identified a range of reasons for introducing telemedicine in LMICs during COVID-19, most notably to maintain non-emergency healthcare, enhance access to healthcare providers, and reduce the risk of infection among health users and providers. Overall, healthcare providers and users have shown a high level of acceptance for telemedicine services. During the COVID-19 pandemic, telemedicine provided access to healthcare in the majority of included articles. Nonetheless, some challenges to accepting telemedicine as a method of healthcare delivery have been reported, including technological, regulatory, and economical challenges. Conclusion Telemedicine was found to improve access to high-quality healthcare and decrease infection risk in LMICs during COVID-19. In general, infrastructure and regulatory barriers found to be the most significant barriers to wider telemedicine use, and should be considered when implementing telemedicine more broadly. There appears to be a need to prioritize patient data safety, as many healthcare practitioners utilized commercial apps and services as telemedicine systems. Additionally, it appears as though there is a need to increase capacity, skill, and transparency, as well as to educate patients about telemedicine.
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16
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Lassarén P, Tewarie IA, Gerstl JVE, Florman JE, Smith TR, Broekman MLD. Telemedicine and the right to health: A neurosurgical perspective. J Clin Neurosci 2022; 102:71-74. [PMID: 35738183 DOI: 10.1016/j.jocn.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
Neurosurgical task force is limited and unevenly distributed. Telemedicine has become increasingly popular, and could help neurosurgical centers meet patient right to care. This scoping review aims to evaluate the impact and feasibility of telemedicine on the right to neurosurgical care, using the AAAQ toolbox. The AAAQ toolbox consists of Availability, Accessibility, Acceptability and Quality. Neurosurgical availability is limited by the number of neurosurgeons, but by using task shifting and -sharing via telemedicine, the number of patients receiving neurosurgical care could increase without increasing the number of neurosurgeons. Telemedicine can improve geographic accessibility to neurosurgical care, but may also introduce technological literacy barriers. Acceptability of telemedicine is a double-edged sword; while a useful service, telemedicine also creates ethical concerns regarding privacy and confidentiality. Regulations and adaptations for vulnerable patient groups are key considerations for deploying telemedicine. Finally, there is emerging evidence that the quality of remote neurosurgical diagnostics and care can keep high standards. Overall, telemedicine has the potential of taking neurosurgery one step closer to meeting patient right to health, globally.
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Affiliation(s)
- Philipp Lassarén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Ishaan A Tewarie
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Faculty of Medicine, Erasmus University Rotterdam/Erasmus Medical Center Rotterdam, The Netherlands
| | - Jakob V E Gerstl
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Jeffrey E Florman
- Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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17
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Mensah IK. Understanding the Drivers of Ghanaian Citizens' Adoption Intentions of Mobile Health Services. Front Public Health 2022; 10:906106. [PMID: 35774576 PMCID: PMC9237369 DOI: 10.3389/fpubh.2022.906106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Mobile health (m-health) application development and diffusion in developing countries have always been a challenge; therefore, research that seeks to provide an elucidation of the drivers of m-Health adoption is vital. Mobile health information systems and applications can contribute to the delivery of a good healthcare system. This study examined the factors influencing citizens' adoption of mobile health services. The Technology Acceptance Model (TAM) was used as the research underpinning for this study, while the data gathered were analyzed with SmartPLS through the use of the structural equation modeling technique. The results showed that perceived usefulness and ease of use were both significant predictors of the behavioral intention to use and recommend the adoption of mobile health services. Also, perceived risk was negative but significant in predicting the intention to use and recommend adoption. Mobile self-efficacy was found to significantly determine the behavioral intention to use, intention to recommend, perceived usefulness, and perceived ease of use of mobile health services. Besides, word-of-mouth showed a positive impact on both the intention to use and recommend. Contrary to expectations, the intention to use had no significant impact on the recommendation intention. The theoretical and practical implications of these findings are thoroughly examined.
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Affiliation(s)
- Isaac Kofi Mensah
- Department of Business Administration, School of Economics and Management, Jiangxi University of Science and Technology, Ganzhou, China
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18
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Impact of Actual Use Behavior of Healthcare Wearable Devices on the Quality of Life: A Cross-Sectional Survey of People with Dementia and Their Caregivers in Ghana. Healthcare (Basel) 2022; 10:healthcare10020275. [PMID: 35206890 PMCID: PMC8872618 DOI: 10.3390/healthcare10020275] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/17/2022] Open
Abstract
The increasing prevalence of dementia has necessitated the introduction and use of healthcare wearable devices to augment the healthcare services delivered to people with dementia (PWDs). Unfortunately, evidence on user feedback and the real impact of the actual use of these devices on the quality of life of PWDs has not been fully explored, especially in the context of developing countries. This study, therefore, seeks to evaluate the impact of actual use behavior (AUB) of healthcare wearable devices on the quality of life (QoL) of PWDs in Ghana by using constructs from the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model and the SF-36 quality of life instrument. Data were collected from people with dementia and, in some cases, caregivers (acting as proxies) in three administrative regions of Ghana using structured questionnaires. Of the 420 questionnaires distributed, 356 were returned, giving a response rate of (356/420, 84.8%). Three hundred and twenty (320) responses were used for further analysis, employing the Partial Least Squares based on Structural Equation Modeling. The results showed a significant positive relationship between AUB and QoL (p < 0.001). Other predictors such as behavioral intention, facilitating conditions, effort expectancy and social influence were also found to significantly impact the actual use behavior of healthcare wearable devices among PWDs. The study also revealed that 4% (14) of patients rated their reported health transition associated with the use of healthcare wearable devices as excellent, 42.5% (136) as very good, and 39.4% (126) as good, respectively at the time of the study compared to a year ago. This study provided empirical evidence of the positive impact of the actual use of healthcare wearable devices on the quality of life of PWDs and further highlighted the factors that drive actual use behavior among PWDs in Ghana. Based on the findings of this study, stakeholders need to create the necessary conditions that will facilitate the adoption and use of healthcare wearable devices, as this will help improve the quality of life, reduce the burden of the disease on caregivers, and enable independent living of PWDs.
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19
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Schomakers EM, Lidynia C, Vervier LS, Calero Valdez A, Ziefle M. Applying an Extended UTAUT2 Model to Explain User Acceptance of Lifestyle and Therapy Mobile Health Apps: Survey Study. JMIR Mhealth Uhealth 2022; 10:e27095. [PMID: 35040801 PMCID: PMC8808343 DOI: 10.2196/27095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/09/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Mobile health (mHealth) care apps are a promising technology to monitor and control health individually and cost-effectively with a technology that is widely used, affordable, and ubiquitous in many people’s lives. Download statistics show that lifestyle apps are widely used by young and healthy users to improve fitness, nutrition, and more. While this is an important aspect for the prevention of future chronic diseases, the burdened health care systems worldwide may directly profit from the use of therapy apps by those patients already in need of medical treatment and monitoring. Objective We aimed to compare the factors influencing the acceptance of lifestyle and therapy apps to better understand what drives and hinders the use of mHealth apps. Methods We applied the established unified theory of acceptance and use of technology 2 (UTAUT2) technology acceptance model to evaluate mHealth apps via an online questionnaire with 707 German participants. Moreover, trust and privacy concerns were added to the model and, in a between-subject study design, the influence of these predictors on behavioral intention to use apps was compared between lifestyle and therapy apps. Results The results show that the model only weakly predicted the intention to use mHealth apps (R2=0.019). Only hedonic motivation was a significant predictor of behavioral intentions regarding both app types, as determined by path coefficients of the model (lifestyle: 0.196, P=.004; therapy: 0.344, P<.001). Habit influenced the behavioral intention to use lifestyle apps (0.272, P<.001), while social influence (0.185, P<.001) and trust (0.273, P<.001) predicted the intention to use therapy apps. A further exploratory correlation analysis of the relationship between user factors on behavioral intention was calculated. Health app familiarity showed the strongest correlation to the intention to use (r=0.469, P<.001), stressing the importance of experience. Also, age (r=–0.15, P=.004), gender (r=–0.075, P=.048), education level (r=0.088, P=.02), app familiarity (r=0.142, P=.007), digital health literacy (r=0.215, P<.001), privacy disposition (r=–0.194, P>.001), and the propensity to trust apps (r=0.191, P>.001) correlated weakly with behavioral intention to use mHealth apps. Conclusions The results indicate that, rather than by utilitarian factors like usefulness, mHealth app acceptance is influenced by emotional factors like hedonic motivation and partly by habit, social influence, and trust. Overall, the findings give evidence that for the health care context, new and extended acceptance models need to be developed with an integration of user diversity, especially individuals’ prior experience with apps and mHealth.
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Affiliation(s)
| | - Chantal Lidynia
- Human-Computer Interaction Center, RWTH Aachen University, Aachen, Germany
| | | | | | - Martina Ziefle
- Human-Computer Interaction Center, RWTH Aachen University, Aachen, Germany
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20
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Cui W, Zhu W, Li X, Wu D, He P, Yu G. Attitudes and perspectives of 534 Chinese pediatricians toward internet hospitals. Front Pediatr 2022; 10:948788. [PMID: 36245742 PMCID: PMC9554531 DOI: 10.3389/fped.2022.948788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet hospitals introduced in China have effectively reduced service time and space, promoted high-quality pediatric medical resources to grassroots areas, solved the contradiction between supply and demand of pediatric medical resources, and met patients' increasing multi-level and diversified medical service needs. However, pediatricians' attitudes toward and satisfaction with the use of internet hospitals remain unknown. OBJECTIVE This study aimed to investigate pediatricians' knowledge of, use of, and satisfaction with internet hospitals in order to identify major issues in internet hospital development, and to understand pediatricians' attitudes and opinions on the construction, development, and use of internet hospitals. MATERIALS AND METHODS A total of 625 pediatricians in 17 public tertiary hospitals in Shanghai were surveyed from November 1-30, 2021. Five hundred and thirty four pediatricians completed the survey, and the response rate was 85.44%. Pediatricians' baseline demographic data were collected and information about their use of and satisfaction with internet hospitals. RESULTS About 70.22% (375/534) of pediatricians knew about internet hospitals and about 54.68% (292/534) use internet hospitals for patient consultation, diagnosis, and treatment. Utilized services mainly focused on online consultation (271/292, 92.81%), online follow-up consultation (174/292, 59.59%), and health sciences (111/292, 38.01%). Online services were provided by 69.18% (202/292) of pediatricians for less than 1 h a day, and 75.00% (219/292) responded to fewer than five patient consultations online every day. Pediatricians' overall satisfaction with internet hospitals was low (3.59 ± 0.92 points), user experience, systems functions, operation processes, service prices, and performance rewards of internet hospitals were main influencing factors. Pediatricians are enthusiastic about further development of internet hospitals, with 87.83% (469/534) willing to provide services on the internet hospital platform. CONCLUSION Most pediatricians view internet hospitals favorably and are eager to contribute to the development of online diagnosis and treatment services. The development of internet hospitals will be more strongly supported by improving pediatricians' satisfaction and mobilizing their enthusiasm and initiative to participate in internet medical services.
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Affiliation(s)
- Wenbin Cui
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Hospital Development Center, Shanghai, China
| | - Weijun Zhu
- Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojie Li
- Shanghai Hospital Development Center, Shanghai, China
| | - Danmai Wu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping He
- Shanghai Hospital Development Center, Shanghai, China
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Alexandra S, Handayani PW, Azzahro F. Indonesian hospital telemedicine acceptance model: the influence of user behavior and technological dimensions. Heliyon 2021; 7:e08599. [PMID: 34977414 PMCID: PMC8693256 DOI: 10.1016/j.heliyon.2021.e08599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 12/09/2021] [Indexed: 12/05/2022] Open
Abstract
Since the COVID-19 pandemic hit, several hospitals in Indonesia have started to develop teleconsultation services to expand the reach of health services and prevent the spread of the COVID-19 virus. Therefore, this study was conducted with the aim of analyzing the influence of user and technological dimensions on the acceptance of the use of hospital teleconsultation applications by users. The research was conducted using quantitative methods with data from questionnaires distributed online. The respondent criteria for this study were Indonesians aged 17 years and over who knew about or had used a hospital's teleconsultation application, and this resulted in 534 respondents. Data processing was carried out using the covariance-based structural equation modeling method with the AMOS 24 application. The user behavior and technology dimensions are influence intention to use telemedicine applications. Furthermore, the results showed that contamination avoidance, safety, reliability, professionalism, perceived ease of use, perceived usefulness, and information quality have a significant positive influence on the behavioral intention to use hospital telemedicine applications. Meanwhile, facilitating conditions and social influence were not shown to have a significant positive effect on the behavioral intention to use such applications. Finally, behavioral intention to use significantly and positively influences actual use. This research can help hospitals and the government in providing guidance in terms of developing telemedicine applications.
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Affiliation(s)
| | | | - Fatimah Azzahro
- Faculty of Computer Science, Universitas Indonesia, Indonesia
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22
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Nguyen NX, Tran K, Nguyen TA. Impact of Service Quality on In-Patients' Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country. Patient Prefer Adherence 2021; 15:2523-2538. [PMID: 34819722 PMCID: PMC8607125 DOI: 10.2147/ppa.s333586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/20/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Recent literature on healthcare quality demands more contextualized and patient-perspective research, as models from developed countries are not suitable for developing countries. Moreover, research on private healthcare services in Vietnam has long been underestimated by academia, but it has significant economic and commercial value. Hence, this study explores the dimensions of service quality in private healthcare and how they impact in-patient satisfaction, perceived value, and customer loyalty in Vietnam. METHODS This mixed-method study had a sample size of five inpatients for the qualitative phase and 368 inpatients for the quantitative phase from hospitals in Vietnam. The qualitative analysis explores service quality dimensions in private healthcare and incorporates them with the literature to develop a conceptual model. The quantitative phase tests the relationship between each construct in the conceptual model via structural equation modeling. RESULTS The four dimensions of service quality were emotion, function, social influence, and trust. Most of these dimensions have a significant impact on customer perceived value and satisfaction. However, emotion does not significantly influence customer perceived value, and function does not considerably impact customer satisfaction. In addition, social influence is an underrepresented variable in the service quality literature, but it has the most substantial impact on customer perceived value and customer satisfaction. The quantitative results also confirm that customer satisfaction and customer perceived value significantly impact customer loyalty (word-of-mouth and revisit intention); however, customer perceived value does not significantly impact customer satisfaction. CONCLUSION The study suggests that private healthcare providers and the government in Vietnam should allocate resources to improve service quality. Practitioners should invest in social branding and e-services to reach out to their customers. Future research should focus on a cost-benefit analysis and compare the effectiveness of service quality dimensions on customer behavioral intention.
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Affiliation(s)
- Nhi Xuan Nguyen
- Faculty of Business Administration, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Khoa Tran
- Faculty of Business Administration, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tuyet Anh Nguyen
- Department of Business, Minerva University, San Francisco, CA, USA
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23
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Pagaling GT, Espiritu AI, Dellosa MAA, Leochico CFD, Pasco PMD. The practice of teleneurology in the Philippines during the COVID-19 pandemic. Neurol Sci 2021; 43:811-819. [PMID: 34729643 PMCID: PMC8563298 DOI: 10.1007/s10072-021-05705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/27/2021] [Indexed: 01/15/2023]
Abstract
Background and objectives The practice of teleneurology provided an accessible and safe method of consultation during the COVID-19 pandemic. We aimed to describe the practice of teleneurology among Filipino neurologists and determine the factors affecting its adoption using the unified theory of acceptance and use of technology (UTAUT) model and its constructs, namely performance expectancy, effort expectancy, social influence, and facilitating conditions. Methods This was a cross-sectional survey conducted online last October 2020 involving adult and pediatric neurologists in the Philippines. The internal consistency of the questionnaire adapted from UTAUT model was determined using Cronbach’s alpha. We performed logistic regression analysis to determine which constructs of the UTAUT model were significant factors on the intent to practice teleneurology. Results The study yielded a 28.8% response rate. Among the respondents (n1 = 147), 95.2% (n2 = 140) practiced teleneurology during the pandemic, and 77.6% (n1 = 147) planned to continue it after the pandemic. Teleneurology was mostly done on an outpatient basis on social media platforms via videoconferencing due to easier access for both end-users. The UTAUT model explained 80.9% (95% CI 0.76, 0.86a) of the total variation. Performance expectancy and facilitating conditions affect the intent to use teleneurology. Conclusions Due to the limited resources and knowledge of its practice, infrastructural support and benefit awareness campaigns would be beneficial to increase its adoption, especially in developing countries.
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Affiliation(s)
- Gerald T Pagaling
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Carl Froilan D Leochico
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.,Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global and Quezon City, Philippines
| | - Paul Matthew D Pasco
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Shi J, Yan X, Wang M, Lei P, Yu G. Factors Influencing the Acceptance of Pediatric Telemedicine Services in China: A Cross-Sectional Study. Front Pediatr 2021; 9:745687. [PMID: 34733810 PMCID: PMC8558490 DOI: 10.3389/fped.2021.745687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pediatrician workforce shortages have aroused great attention from health authorities in China. Telemedicine services have been known to enhance the management of children's health, yet the rate of adoption and usage in Chinese hospitals still at a quite low level, and the factors influencing the acceptance of telemedicine services remains unclear. Objective: The purpose of this empirical study was to evaluate the reliability and validity of a technology acceptance measurement instrument applied in healthcare, to investigate the perception of telemedicine services on the provider-side and demand-side, and to determine the factors that may drive individuals to adopt telemedicine services. Methods: A cross-sectional survey study based at Shanghai Children's Hospital, Shanghai Jiao Tong University, was conducted in March 2020. A total of 456 valid responses were obtained by convenience sampling. The internal consistency of items was assessed by Cronbach's alpha (α), composite reliability (CR) and average variance extracted (AVE) to evaluate both the reliability and validity of the questionnaire. Structural equation modeling analysis was used to test and verify the interrelationships among relevant variables. Results: Price value is the strongest predictor (β = 0.30, p = 0.02), facilitating conditions (β = 0.28, p = 0.01) and hedonic motivation (β = 0.13, p = 0.04) also have significantly positive direct effects on telemedicine acceptance. The results showed the perception of child patients' families were significantly more acceptable to telemedicine services than pediatricians (t = -2.99, p < 0.01). Participants with no prior experience and lower education may be more willing to adopt telemedicine. Conclusion: Telemedicine will likely continue to have an integral role in pediatric health care delivery, and the findings can assist policy makers and hospital administrators in determining the more valued characteristics of telemedicine services from a behavioral perspective. Future attention will be paid to the pricing, training and service quality of telemedicine in China.
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Affiliation(s)
- Jingjin Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xueming Yan
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Miao Wang
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Lei
- Institut Franco-Chinois pour la Santé, Chambéry, France
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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