What explains usage of mobile physician-rating apps? Results from a web-based questionnaire

Consumers' Preferences for Purchasing mHealth Apps: Discrete Choice Experiment

Background

There is growing interest in mobile health apps; however, not all of them have been successful. The most common issue has been users' nonadoption or abandonment of health apps because the app designs do not meet their preferences. Therefore, to facilitate design-preference fit, understanding consumers' preferences for health apps is necessary, which can be accomplished by using a discrete choice experiment.

Objective

This study aims to examine consumer preferences for health apps and how these preferences differ across individuals with different sociodemographic characteristics and health app usage and purchase experiences.

Methods

A cross-sectional discrete choice experiment questionnaire survey was conducted with 593 adults living in Hong Kong. A total of 7 health app attributes that might affect consumers' preferences for health apps were examined, including usefulness, ease of use, security and privacy, health care professionals' attitudes, smartphone storage consumption, mobile data consumption, and cost. Mixed-effect logit regressions were used to examine how these attributes affected consumer preferences for health apps. Fixed effects (coefficient β) of the attributes and random effects of individual differences were modeled. Subgroup analyses of consumer preferences by sex, age, household income, education level, and health app usage and purchase experiences were conducted.

Results

Cost was the attribute that had the greatest effect on consumers' choice of health apps (compared to HK $10 [US $1.27]-HK $50 [US $6.37]: β=-1.064; P<.001; HK $100 [US $12.75]: β=-2.053; P<.001), followed by security and privacy (compared to no security insurance-some security policies: β=.782; P<.001; complete security system: β=1.164; P<.001) and usefulness (compared to slightly useful-moderately useful: β=.234; P<.001; very useful: β=.979; P=.007), mobile data consumption (compared to data-consuming-a bit data-consuming: β=.647; P<.001; data-saving: β=.815; P<.001), smartphone storage consumption (compared to >100 MB-around 38 MB: β=.334; P<.001; <10 MB: β=.511; P<.001), and attitudes of health care professionals (compared to neutral-moderately supportive: β=.301; P<.001; very supportive: β=.324; P<.001). In terms of ease of use, consumers preferred health apps that were moderately easy to use (compared to not easy to use-moderately easy to use: β=.761; P<.001; very easy to use: β=.690; P<.001). Our results also showed that consumers with different sociodemographic characteristics and different usage and purchase experiences with health apps differed in their preferences for health apps.

Conclusions

It is recommended that future health apps keep their mobile data and phone storage consumption low, include a complete security system to protect personal health information, provide useful content and features, adopt user-friendly interfaces, and involve health care professionals. In addition, health app developers should identify the characteristics of their intended users and design and develop health apps to fit the preferences of the intended users.

The Credibility of Physician Rating Websites: A Systematic Literature Review

OBJECTIVES

Increasingly, the credibility of online reviews is drawing critical attention due to the lack of control mechanisms, the constant debate about fake reviews and, last but not least, current developments in the field of artificial intelligence. For this reason, the aim of this study was to examine the extent to which assessments recorded on physician rating websites (PRWs) are credible, based on a comparison to other evaluation criteria.

METHODS

Referring to the PRISMA guidelines, a comprehensive literature search was conducted across different scientific databases. Data were synthesized by comparing individual statistical outcomes, objectives and conclusions.

RESULTS

The chosen search strategy led to a database of 36,755 studies of which 28 were ultimately included in the systematic review. The literature review yielded mixed results regarding the credibility of PRWs. While seven publications supported the credibility of PRWs, six publications found no correlation between PRWs and alternative datasets. 15 studies reported mixed results.

CONCLUSIONS

This study has shown that ratings on PRWs seem to be credible when relying primarily on patients' perception. However, these portals seem inadequate to represent alternative comparative values such as the medical quality of physicians. For health policy makers our results show that decisions based on patients' perceptions may be well supported by data from PRWs. For all other decisions, however, PRWs do not seem to contain sufficiently useful data.

The role of self-efficacy, entrepreneurial passion, and creativity in developing entrepreneurial intentions

Although studies aimed at understanding entrepreneurship have analyzed passion, creativity, and entrepreneurial self-efficacy, few studies include these antecedents in the same model. In this sense, this study aims to assess the relationship between passion, self-efficacy, and creativity with entrepreneurial intention. The data was collected through a survey and the questionnaires were applied to university students who formed a sample of 190 respondents, and such data was analyzed using structural equation modeling based on partial least square technique. Regarding our results, the relationship between creativity and entrepreneurial intention has not been confirmed. The multigroup analysis revealed that the level of education influences men's entrepreneurial intention and creativity only influence entrepreneurial intention when mediated by entrepreneurial passion. This study contributes by highlighting the roles of analyzed passion, creativity, and entrepreneurial self-efficacy in entrepreneurs from one of the largest emerging economies in the world. Moreover, it also contributes to academia as it confirms the explanatory power of the Theory of Planned Behavior as a tool to understand the cognitive foundations of entrepreneurship. It also offers a practical contribution by signaling to public policymakers which features should be incentivized to boost entrepreneurship in emerging economies.

STYLCONNECT Study: An Assessment of Automatic Data Collection Devices by People Living with Diabetes and Using an Insulin Pen

INTRODUCTION

The use of devices to connect insulin pens could facilitate management and improve glycaemic control in people with type 1 (PwT1D) and type 2 diabetes (PwT2D). However, their acceptance seems little studied. We conducted an online survey with the main objective of assessing the level of interest among insulin-treated people with diabetes (PwD) in a device connected to a disposable pen and secondary objectives of assessing the perceived benefits and important features expected of a connected device and identifying factors associated with interest scores.

METHODS

An ad-hoc questionnaire, validated by PwD, was used. Responses from 1798 PwD (975 PwT1D and 823 PwT2D) were analysed.

RESULTS

The mean interest rating was 7.4/10 (PwT1D: 7.2 vs PwT2D: 7.7; p < 0.001). PwD perceived that the device would make it easier to record their diabetes-related information (7.7/10) and keep all insulin and diabetes data in a single location (7.7/10). It was particularly important for PwD that this type of device could integrate data from glucose-measuring devices (7.8/10) and could set an alarm when all insulin in the body had been metabolised (7.7/10).

CONCLUSION

Our study highlighted PwD's strong interest in automating the collection of their insulin therapy data, with significantly more interest among PwT2D than PwT1D, and the importance of interoperability between glucose measurement devices and interchangeability between the different brands of insulin. More generally, for the first time and on a large scale, our study provided a greater understanding of the expectations of PwD regarding these devices.

Awareness of and interaction with physician rating websites: A cross-sectional study in Austria

To date, the digital assessment of service experiences represents a decisive process step of a feedback culture in numerous economic areas. In view of this digitalization of service assessments, the importance of Physician Rating Websites (PRWs) has also increased steadily in recent years. Even though these websites could be perceived as a powerful communication tool for the exchange of health specific information, the knowledge about whether and how different population segments use these portals has been limited so far. For this reason, our aim was to investigate the level of awareness regarding PRWs among the study population and to discover how users interact with this specific type of online portals. We performed an online survey including 558 participants. To ensure the attention and integrity of participants, attention checks were included in the questionnaire. Study participants who did not exceed the mentioned security levels were excluded from the study. Statistical analyses were carried out, using IBM SPSS Statistics 27. To illustrate the relationship between demographic variables and dependent variables, two tailed chi square tests were performed. Comparison of means and t-testing was used to investigate the relationship between psychographic variables and the dependent variables. In addition to that, the awareness levels regarding different rating portals were evaluated using descriptive methods. Our results suggest that the general awareness regarding PRWs is relatively high (75.6%, 423/558), especially among female (x21 = 9.880, P = .002), middle-aged (x29 = 26.810, P = .002), more highly educated (x24 = 19.038, P = .001), urban (x21 = 6.274, P = .012), digitally literate (t203 = 2.63, P = .009) individuals and particularly among respondents with a higher eHealth literacy (t203 = 2.37, P = .019). Even though more than three quarters of the respondents know that PRWs exist, compared to other rating platforms, they are only in the lower midfield. The upper ranks are taken by websites on which restaurant visits (98.9%, 552/558), hotel stays (97.7%, 545/558) or movies (95.5%, 533/558) can be rated. The most popular PRWs in Austria include Docfinder.at (31.3%, 175/558; 77.8%, 434/558) followed by the evaluation tools provided by Google.at (8.24%, 46/558; 70.3%, 392/558) and Herold.at (1.61%, 9/558; 44.8%, 250/558). In Austria, PRWs seem to be characterized by a high degree of interaction (89.2%, 498/558) with a wide variety of different types of interactions. While many respondents use PRWs to retrieve general information (83.2%, 464/558), there are significantly fewer who read physicians' reviews (60.9%, 340/558) and use this portal to select a physician (60.6%, 338/558). Respondents who have already rated a doctor themselves belong to the smallest group accounting for just 14.7% (82/558). Significant effects regarding the interaction with PRWs exist between different genders, ages, education levels, marital statuses, occupations and areas of living. In addition to that, respondents with better feelings towards the internet, greater digital literacy as well as a higher eHealth literacy were also characterized with a higher interaction rate regarding PRWs. According to the high level of awareness of and interaction with PRWs within our study population, PRWs appear to be a successful medium for health-related communication. Especially for female, middle-aged, more highly educated, urban and more technology savvy population segments, PRWs seem to represent an effective tool to support the health-specific decision-making process.

The Impact of Social Influence on the Intention to Use Physician Rating Websites: Moderated Mediation Analysis Using a Mixed Methods Approach

BACKGROUND

Physician rating websites (PRWs) have become increasingly important in the cross-section between health and digitalization. Social influence plays a crucial role in human behavior in many domains of life, as can be demonstrated by the increase in high-profile influential individuals such as social media influencers (SMIs). Particularly in the health-specific environment, the opinion of family and friends has a significant influence on health-related decisions. However, so far, there has been little discussion about the role of social influence as an antecedent of behavioral intention to use PRWs.

OBJECTIVE

On the basis of theories of social psychology and technology acceptance and theories from the economic perspective, this study aimed to evaluate the impact of social influence on the behavioral intention to use PRWs.

METHODS

We conducted 2 studies by applying a mixed methods approach including a total of 712 participants from the Austrian population. The impact of social influence on the behavioral intention to use PRWs was investigated through linear regression and mediation and moderated mediation analysis using the PROCESS macro 4.0 in SPSS 27 (IBM Corp).

RESULTS

The 2 studies show similar results. In study 1, an experiment, no direct effect of social influence on the behavioral intention to use PRWs could be detected. However, an indirect effect of social influence on the behavioral intention to use PRWs via credibility (b=0.572; P=.005) and performance expectancy (b=0.340; P<.001) could be confirmed. The results of study 2, a cross-sectional study, demonstrate that social influence seems to have a direct impact on the behavioral intention to use PRWs (b=0.410; P<.001). However, when calculating the proposed mediation model, it becomes clear that this impact may partly be explained through the 2 mediator variables-credibility (b=0.208; P<.001) and performance expectancy (b=0.312; P<.001). In contrast to the observed direct and indirect effect, neither demographic nor psychographic variables have a significant moderating impact on the influencing chain in study 2.

CONCLUSIONS

This study provides an indication that social influence has at least an indirect impact on the behavioral intention to use PRWs. It was observed that this impact is exerted through credibility and performance expectancy. According to the findings of both studies, social influence has the potential to boost the use of PRWs. As a result, these web-based networks might be a promising future interface between health care and digitalization, allowing health care practitioners to gain a beneficial external impact while also learning from feedback. Social influence nowadays is not just limited to friends and family but can also be exerted by SMIs in the domain of PRW use. Thus, from a marketing perspective, PRW providers could think of collaborating with SMIs, and our results could contribute to stimulating discussion in this vein.

Moderating Role of Initiative on the Relationship Between Intrinsic Motivation, and Self-Efficacy on Entrepreneurial Intention

The growing population of new graduates and the increasing scarcity of employment opportunities have made entrepreneurship an unavoidable option for employment and self-sustenance. This study investigates the effect of the initiative in moderating the relationship between intrinsic motivation, self-efficacy, and entrepreneurship intention through the integrated framework of theory of planned behaviour, self-determination, and humanism. This study contributes insights to how these factors moderated by initiative influence entrepreneurial intention among graduating students of tertiary institutions in Nigeria. This study adopted a cross-sectional design to examine the moderating role of initiative on the relationship between intrinsic motivation, and self-efficacy on entrepreneurial intention among Nigerian graduates. A total number of 688 graduate students, including 266 (38.6%) males and 422 (61.4%) females with a mean age of 24.30 years (SD = 3.69), participated in the study. Participants responded to a self-report questionnaire containing Initiative, Intrinsic motivation, self-efficacy, and entrepreneurial intention scales. Results showed that all the variables correlated positively with entrepreneurial intention. Furthermore, initiative moderated the relationship between self-efficacy and entrepreneurial intention [value and start-ups/operations (OPS)], such that high self-efficacy with high initiative showed higher entrepreneurial intention (value). While to those with low self-efficacy and low initiative, high self-efficacy with high initiative showed higher entrepreneurial intention (OPS) compared to low self-efficacy and low initiative. The study highlighted the role of initiative in transforming young graduates' entrepreneurial intention into full-fledged entrepreneurs.

Factors Associated with the Patient/Client Use of Report Cards, Physician Rating Websites, Social Media, and Google for Hospital and Physician Selection: A Nationwide Survey

Objective: To explore the factors associated with the different uses of report cards, physician rating websites, social media, and Google, including awareness, physician finding, and decision-making based on reviews from the patient/client perspective. Methods: We used computer-assisted telephone interviews to conduct a nationwide representative survey in Taiwan. Results: The urbanization level of the area, income, and long-term health conditions were not associated with the three kinds of usage of the websites studied. Seeking health information was an important factor in the three kinds of website use. The employment industry was associated with awareness, and education level was associated with physician seeking and actions based on reviews. Conclusions: Different factors influenced the three kinds of usage: awareness, actual use (i.e., finding an appropriate physician), and decision-making based on reviews. Seeking health information is of primary importance regardless of how the websites are used. Practical implications: Policy-makers should focus on educating individuals working outside the health care sector to increase awareness of these websites and to assist individuals with low levels of education in increasing their use of these websites.

The addiction behavior of short-form video app TikTok: The information quality and system quality perspective

TikTok has one of the most advanced algorithm systems and is the most addictive as compared to other social media platforms. While research on social media addiction is abundant, we know much less about how the TikTok information system environment affects users' internal states of enjoyment, concentration, and time distortion (which scholars define as the flow experience), which in turn influences their addiction behavior. To fill this gap, this study collects responses from 659 adolescents in China aged between 10 and 19 years old, and the data is then analyzed using Partial Least Square (PLS). We find that the system quality has a stronger influence than information quality in determining adolescents' experience with TikTok and that the flow experience has significant direct and indirect effects on TikTok addiction behavior. Notably, this study finds that TikTok addiction is determined by users' mental concentration on the medium and its content. Several theoretical insights from the stimulus-organism-response (S-O-R) model and the flow theory are used to explain the findings.

Impact of Inclusive Leadership on Innovation Performance During Coronavirus Disease 2019 Outbreak: Mediating Role of Employee Innovation Behavior and Moderating Role of Psychological Empowerment

This study investigates the effect of inclusive leadership on innovation performance with a mediating role of employee innovation behavior and the moderating role of psychological empowerment (PE). Supervisors and employees of Saudi manufacturing firms are the participants of this study. This study used a quantitative research technique with a cross-sectional approach and a self-administrative survey questionnaire to collect the data. The data were analyzed by using the Smart PLS 3 software. The results depict that inclusive leadership has a significant positive impact on the firm's innovation performance. Employees' innovation behavior has a significant mediating effect on the association of inclusive leadership and innovation performance. Findings revealed that PE has an important moderating role in the association of inclusive leadership and innovation performance. The findings of this study contribute to the body of knowledge by finding that inclusive leadership has a significant effect on the firm's innovative performance and PE is crucial to enhance innovation performance.

Green Innovation, Corporate Environmental Ethics, and Competitive Advantages of Chinese Automobile Industry During COVID-19: Corporate Environmental Management as Moderator

Objective

The main purpose of this study is to investigate the impact of green product and process innovation on the competitive advantages of the Chinese automobile industry during coronavirus disease 2019 (COVID-19). This study also examined the mediating role of corporate environmental ethics (CEE) and the moderating role of corporate environmental management in the relationship between the green product and process innovation on the competitive advantages of the Chinese automobile industry during COVID-19.

Methods

This study used a quantitative approach of research with the cross-sectional method for the collection of data. This study also used purposive sampling for the collection of data from the production managers of the automobile industry of China. The structural equation modeling-partial least squares (SEM-PLS) is used to analyze the data.

Results

The results of direct effects indicated that green product innovation has a significant and positive effect on the corporate advantages (β = 0.294, t = 2.868) and green process innovation also has a significant and positive effect on the corporate advantages (β = 0.350, t = 3.276). Moreover, green product innovation has also a significant effect on corporate advantages (β = 0.334, t = 4.258) and green product innovation has also a significant effect on corporate advantages (β = 0.269, t = 3.202).

Significance

The research in this domain about the antecedents of green innovation is still minimal in the previous literature. One of the antecedents of the green innovation, corporate environmental ethics is discussed in this study; thus, it provides the understanding of green innovation as the mediator which would mediate the relationship between corporate environmental ethics and competitive advantage in the auto manufacturing industry of China.

Novelty

This study is among very few to examine the relationship between green innovation, corporate environmental ethics, corporate environmental management, and competitive advantages of the Chinese automobile industry during COVID-19.

An empirical investigation of firm performance through corporate governance and information technology investment with mediating role of corporate social responsibility: Evidence from Saudi Arabia telecommunication sector

This study intended to examine the effect of information technology (IT) investment and corporate governance mechanism on the performance of the Saudi telecommunication sector with mediating role of corporate social responsibility (CSR). A survey method was used to collect data from the targeted Saudi telecom firm. Results show that corporate governance practices, i.e., internal audit, internal audit committee, and internal board size, have a significant and positive relationship with firm performance. Furthermore, IT investment positively affects the performance of Saudi telecommunication firms. Moreover, CSR mediates the relationship among internal audit, internal audit committee, internal board size, IT investment, and firm performance. This study contributes to the body of knowledge regarding IT investment, corporate governance mechanism, corporate social responsibilities, and firm performance of telecommunication firms in emerging markets. Furthermore, this study will help the top management of the telecom firms to improve corporate governance and IT investment, which will be beneficial to enhance firm performance.

Analyzing the Role of Corporate Social Responsibility for Sustainable Environmental Performance: Mediating Roles of Environmental Strategy and Environmental Outcomes

This study examines the relationship between corporate social responsibility (CSR) and environmental performance, utilizing data from 415 small and medium-sized enterprises (SMEs) in China as a case study. We found that CSR has a direct and significant impact on environmental performance (EP) and is positively correlated to environmental strategy (ES) and environmental outcomes (EO), both of which improve environmental performance, i.e., they serve as a significant mediating factor between CSR and environmental performance. Our study will help general managers and policy maker of SMEs, provides a beneficial model for managing CSR, ES, and EO to achieve sustainable environmental performance. Specifically, it can assist general managers of SMEs in strengthening their internal resources such as CSR, ES, and EO in order to improve long-term environmental performance.

Nexus of Ethical Leadership, Career Satisfaction, Job Embeddedness, and Work Engagement in Hospitality Industry: A Sequential Mediation Assessment

The paper proposes a research model explaining the sequential mediation effect of job embeddedness (JE) and work engagement (WENG) between ethical leadership (EL) and career satisfaction (CS). The model also examines whether JE heightens WENG, a factor indirectly influenced by ethical practices ending in employee satisfaction. The study used a time-lagged data collection procedure and survey responses of 247 hotel workers in China. Data were analyzed through structural equation modeling. The results showed that EL directly and indirectly (through sequential mediation effect of JE and WENG) contributes to employee CS. The present empirical framework extends the hospitality industry literature by explaining the precise mechanism (i.e., JE and WENG) through which EL generates CS among hospitality workers in China. The paper offers theoretical and practical implications and future research directions.

Untying Moral Efficacy and Meaningfulness in Promoting Students' Social Entrepreneurial Intentions: The Mediating Role of Positive Reciprocity

This study chooses to describe social entrepreneurship as a social mission that enables business students to identify opportunities to launch start-ups and social enterprises by understanding the nature of social responsibility and fostering a reciprocal attitude to solve social issues. We collected data on students from different business schools in mainland China through a structured questionnaire (n = 326) and analyzed them through structural equation modeling (SEM). The results show that moral efficacy and meaningfulness are positively related to positive reciprocity, which leads to students' social entrepreneurial intentions. The study concluded that potential social entrepreneurs should take ethical courses as part of their training to help them develop a responsible mentality and social entrepreneurial aspirations. On this basis, the practical and theoretical significance of this study is proposed, and its limitations and future development directions are pointed out.

Impact of Interpersonal Competition on Knowledge Hiding Behavior Among the Employees: Mediating Role of Moral Disengagement and Work Overload

The knowledge hiding behavior (KHB) can obstruct the stream of information to decrease the creativity in the organization. This study examines the effect of interpersonal competition on KHB, moral disengagement (MD), and work overload (WO). Moreover, this study also examines the impact of MD and WO on KHB. Also, the study examines the mediating role of MD and WO between interpersonal competition and KHB. The study was carried out by quantitative methodology, and 361 employees were engaged to fill the questionnaires employed in manufacturing companies from China. A convenient sampling technique had used for data collection. The findings of this study indicate that interpersonal competition positively and significantly affects KHB, MD, and WO. Moreover, this study established that MD and WO positively and significantly impact KHB. According to the results, MD WO significantly mediates interpersonal competition and KHB. This research is valuable for government, policymakers, and executives of manufacturing companies to establish the appropriate strategies for employees and provide a sustainable environment. This research also offers new visions to managers to know the current events and predict the possible causes that lead to the KHB and what is the possible strategies to eliminate this kind of behavior.

Predicting the Intention to Pursue Certified Professional Accountancy Qualification Among the Accounting Students

The global progress empowers the development of new business and expansion of existing business. The availability of sufficient accounting professional are necessary to manage and document the business activities. However, youth are less inclined to purse accounting as profession to keep the progress of global and local economic development. The current study aimed to explore the formation of the intention to pursue Certified Professional Accountancy Qualification (CPAQ) with factor of capabilities, career opportunities, job security with respect to the extended theory of planned behavior (TPB), i.e., attitude, subjective norms and perceived behavioral control. The study adopted a cross-sectional design and collected quantitative data from a total of 339 accounting students from Malaysia using an online survey. The finding revealed that capabilities and career opportunities influenced the students' intention to pursue CPAQ. Meanwhile, perceived behavioral control had significantly affect the students' decision to pursue CPAQ, which is in line with the TPB. The study concentrated on the importance of these factors in influencing the students' intention and decision to pursue CPAQ. The study offered vital implications for accounting educators and educational institutions to promote the accounting profession as choice and students engage in pursuing CPAQ. The Malaysian government should encourage and support accounting students financially for pursuing CPAQ by providing job security and enhancing subjective norms that may enable these students to complete the required professional qualifications. The study's limitations and future research opportunities are documented at the end of this article.

Developing Future-Ready University Graduates: Nurturing Wellbeing and Life Skills as Well as Academic Talent

Higher education is starting to embrace its role in promoting student wellbeing and life skills, especially given the concerning levels of poor mental health and uncertainties in the future job market. Yet, many of the published studies evaluating positive educational teaching methods thus far are limited to interventions delivered to small student cohorts and/or imbedded within elective wellbeing courses, and are focussed on developed Western countries. This study addressed this gap by investigating the effectiveness of an institution-wide compulsory course informed by the principles of Seligman's Wellbeing Theory. The course was delivered at a British university in a developing country in Southeast Asia. It purposefully sought to nurture growth-oriented outcomes (including self-awareness, positive emotions, and personal effectiveness) and was taken by an entire cohort of year one undergraduate students. We tested the effectiveness of the curriculum content and staff coaching style in achieving life skills, and evaluated how these perceptions influenced students' subjective wellbeing. A convergent mixed-methods design was used with 350 survey respondents and 11 interviewees. Perceived life skills scores showed a 2.5% improvement at the end of the course. Partial Least Squares Structural Equation Modelling tested the predicted relationships between variables. All relationships were statistically significant, but the influence of course design and educators' style on life skills acquisition (50.8% of the variance) was moderate, while the effect on subjective happiness and life satisfaction (4-5% of the variance) was very weak. Qualitative data indicated that while quantifiable benefits to wellbeing might not be immediate, students did anticipate longer-term benefits for happiness and life satisfaction. This finding suggests that such a novel educational approach is well-received by Asian students and may sow the seeds for future benefit by positively impacting on their skills, behaviours, attitudes, and values. To achieve optimal flourishing at university, we recommend exploring teaching practises that combine positive education with coaching psychology practises.

Social Entrepreneurship Orientation and Enterprise Fortune: An Intermediary Role of Social Performance

Social entrepreneurship orientation (SEO) is a behavioral construct of social entrepreneurship (SE); therefore, we examined the influence of SEO of the organization on social and financial performance. A random sample of 810 employees was drawn from social enterprises of Pakistan during the COVID-19 pandemic. Although increasing research focuses on SE, the discipline continues to disintegrate, and this has led to appeals for a careful investigation of the associations of firms' SE. In the recent decade, "social entrepreneurship" has earned its importance as a segment of entrepreneurship. Instead of mixed activity, firms are more likely to engage in either for-profit or non-profit activities. The causes for and consequences of this conduct has been mainly studied using objective measures of SEO, social performance, and financial performance, with little attention paid to the subjective experiences of social enterprises. We rely on the theory of stakeholder and mixed structuring to postulate that social performance intermediates the SEO-financial performance relation. By assessing a sample of 810 employees from active enterprises, we discover that social performance mediates positively and partially between SEO and financial performance, and both direct and indirect paths are in the same direction and significant. Our findings exhibit that social performance variance explained 74% of the mediating role, and the remaining 26% of the effect is because of SEO. We consider the functions by which an SEO influences enterprise performance and delivers more prominent understanding into multiple spectrums of performance. We discuss the prospective suggestions of our research and foster an encouraging pathway for more enquiry on the SEO paradigm. The study adds contribution to the literature, which has not been testified before on hybrid firms. SEO is a newly defined construct and requires more prospective research. This research gives the researchers/scholars new directions to address related disciplines and further explore this domain.

Malaysian School Counselor's Self-Efficacy: The Key Roles of Supervisor Support for Training, Mastery Experience, and Access to Training

The concept of self-efficacy has been widely studied and shown to contribute to individuals' job satisfaction. For counselors, the concept measures their belief in their ability to conduct counseling sessions. However, it is an understudied area. As Bandura states, self-efficacy and its sources should be investigated and measured within its domain, which in this case is school counseling. This study examined the impact on school counselors' self-efficacy and job satisfaction of the personal and environmental factors: (a) mastery experience, (b) social persuasion, (c) vicarious learning, (d) physiological and affective state, (e) the access to training, and (f) perceived supervisor support of training. The cross-sectional study involved 541 Malaysian secondary school counselors nationwide via a random sampling-distributed questionnaire. Results which were analyzed using PLS-SEM, with importance-performance functionality embedded in it, indicated that mastery experience, access to training, and perceived supervisor support of training explained 45.6% variance in counseling self-efficacy and together with counseling self-efficacy, contributed 13.2% variance in job satisfaction among the school counselors. The importance-performance map analysis revealed supervisor support of training as of greatest importance in shaping counseling self-efficacy. Counseling self-efficacy partially mediated the relationship between mastery experience, access to training, supervisor support toward training, and job satisfaction Arising from this finding is a proposed theoretical framework in which efficacy information (i.e., mastery experience), environmental determinants (i.e., access to training and supervisor support of training) and cognitive determinant (i.e., counseling self-efficacy) corresponded together congruently and lead to higher job satisfaction. Suggestions are also made for training providers, content developers, and policymakers to include these factors in professional development training and continuous education, to sustain the wellbeing of school counselors.

Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity

Background

As health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process.

Objective

This study aims to examine validity evidence based on relations to other variables—using data collected with the known-groups approach—to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales.

Methods

A Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia.

Results

Responses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect –0.37; P<.001), followed by 1. Using technology to process health information (total effect –0.32; P<.001), 5. Motivated to engage with digital services (total effect –0.21; P=.01), and 7. Digital services that suit individual needs (total effect –0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups.

Conclusions

By using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people’s eHealth literacy needs to help optimize access and use of digital health and promote health equity.

Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study

BACKGROUND

An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps.

OBJECTIVE

The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications.

METHODS

The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS-SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant.

RESULTS

The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%).

CONCLUSIONS

mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users' symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender.

Servant Leadership, Innovative Capacity and Performance in Third Sector Entities

This paper analyses the relationship between servant leadership, innovative capacity and performance in Third Sector entities and proposes a mediation model. This research is based on a two-fold theoretical approach: the servant leadership approach and the resource-based approach. The data have been obtained through a survey sent to territorial and functional managers of Third Sector entities. The fieldwork ran from June to September 2019. At the end of the entire process, 85 valid questionnaires were obtained. For the analysis of the results, a double methodology has been used: (1) a method of second order structural equations (PLS-SEM) and, (2) qualitative comparative analysis (QCA). The main contributions of this work are: 1) a double theoretical approach has been applied in this work, which has allowed to adequately define the relationships between servant leadership, innovation capacity and performance in Third Sector entities; (2) the application of a double data analysis methodology has allowed us to obtain robust and reliable results; (3) the measures of the three composites used (servant leadership, innovative capacity and performance) have adequate reliability and validity values; (4) the servant leadership positively influences the performance of Third Sector entities being able to explain the 35.6% of the variation of the performance of these entities and besides, it is a necessary condition for this performance to take place, (5) the average innovative capacity in the influence of the servant leadership in the performance of the entities of the Third Sector, being a necessary condition. Mediation is total, eliminating the direct effect of servant leadership on the performance of third Sector entities and increasing the capacity to explain the variation in the performance of Third Sector entities up to 44.7%.

What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Data

BACKGROUND

Customer-oriented health care management and patient satisfaction have become important for physicians to attract patients in an increasingly competitive environment. Satisfaction influences patients' choice of physician and leads to higher patient retention and higher willingness to engage in positive word of mouth. In addition, higher satisfaction has positive effects on patients' willingness to follow the advice given by the physician. In recent years, physician-rating websites (PRWs) have emerged in the health care sector and are increasingly used by patients. Patients' usage includes either posting an evaluation to provide feedback to others about their own experience with a physician or reading evaluations of other patients before choosing a physician. The emergence of PRWs offers new avenues to analyze patient satisfaction and its key drivers. PRW data enable both satisfaction analyses and implications on the level of the individual physician as well as satisfaction analyses and implications on an overall level.

OBJECTIVE

This study aimed to identify linear and nonlinear effects of patients' perceived quality of physician appointment service attributes on the overall evaluation measures that are published on PRWs.

METHODS

We analyzed large-scale survey data from a German PRW containing 84,680 surveys of patients rating a total of 7038 physicians on 24 service attributes and 4 overall evaluation measures. Elasticities are estimated from regression models with perceived attribute quality as explanatory variables and overall evaluation measures as dependent variables. Depending on the magnitude of the elasticity, service attributes are classified into 3 categories: attributes with diminishing, constant, or increasing returns to overall evaluation.

RESULTS

The proposed approach revealed new insights into what patients value when visiting physicians and what they take for granted. Improvements in the physicians' pleasantness and friendliness have increasing returns to the publicly available overall evaluation (b=1.26). The practices' cleanliness (b=1.05) and the communication behavior of a physician during a visit (b level between .97 and 1.03) have constant returns. Indiscretion in the waiting rooms, extended waiting times, and a lack of modernity of the medical equipment (b level between .46 and .59) have the strongest diminishing returns to overall evaluation.

CONCLUSIONS

The categorization of the service attributes supports physicians in identifying potential for improvements and prioritizing resource allocation to improve the publicly available overall evaluation ratings on PRWs. Thus, the study contributes to patient-centered health care management and, furthermore, promotes the utility of PRWs through large-scale data analysis.

The Predictors of Consumer Behavior in Relation to Organic Food in the Context of Food Safety Incidents: Advancing Hyper Attention Theory Within an Stimulus-Organism-Response Model

Despite the rapid development of China's organic food industry in recent years, the market size of this industry remains relatively small. Since the organic food market started late in China, consumer groups are mainly concentrated in large cities at present. It is, therefore, urgent to take effective measures to promote the development of China's organic food market. The current study focuses on the direct and indirect relationships between food safety incidents and organic food purchases by considering the Chinese context, using stimulus-organism-response model and information use environment theory, and introducing a hyper attention cognitive model. The results show that external stimulus (food safety incidents) and internal stimulus (consumer environment orientation) can significantly affect consumers' response (namely, consumer organic cognition), and the enhancement of consumer organic cognition can promote consumer organic purchase. In addition, consumers' information environment (the information relating to food safety incidents and environment) can significantly affect their organic food purchase. Moreover, food safety incidents can attract consumers' hyper attention and thus has a positive impact on consumers' cognition of organic food. These findings have important implications for research and practice.

Using online patient feedback to improve NHS services: the INQUIRE multimethod study

Background

Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care.

Objectives

To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts.

Design

A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations.

Setting

The UK.

Methods

We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site.

Results

Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible).

Limitations

This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites.

Conclusions

Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients.

Future work

Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.

Study registration

The ethnographic case study work was registered as Current Controlled Trials ISRCTN33095169.

Funding

This project was funded by the National institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 38. See the NIHR Journals Library website for further project information.

Determinants of individuals’ intention to use mobile health: insights from India

Purpose

This study aims to examine the determinants of mobile health technology and applications use intention. The factors are delineated from prior literature and theories of individual traits and adoption characteristics, technology acceptance and health belief.

Design/methodology/approach

Data from 409 respondents were collected from Indian participants through a questionnaire survey. The construct “use intention” was measured using individual traits to mobile services, subjective norm, health consciousness, awareness and perceived usefulness, and the model was tested.

Findings

The study found that mobile health technology and the applications awareness and personal innovativeness influence intention to use.

Originality/value

Previous studies have often looked at technology adoption and acceptance models separately and are less adequately discussed in the Indian context. The components that determine mobile health technology and the applications’ acceptance by literature and theories of individual traits and adoption characteristics, technology acceptance and health beliefs were also inadequately discussed. The significant contribution of this research also includes policy recommendations for improving mobile health acceptance in India.

[Citizen perspectives on doctor-prescribed mobile health apps and information and communication technology usage within the Andalusian Healthcare System]

BACKGROUND

As eHealth and mHealth are expanding the concerns about the guarantees that must surround these technologies are increasing.

OBJECTIVE

To get to know the opinion of the public on the use and willingness towards communication with health professionals based on new technologies and the use of health apps recommended by those professionals, while identifying the sociodemographic or health differences within the population.

MATERIAL AND METHODS

A cross-sectional descriptive study conducted within the Andalusian Barometer about Mobile Health Apps based on telephone surveys (2016) focused on Andalusian citizens over 18 years old. A combined multi-stage random sample was used, proportionally distributed by province, type of home, gender, and age group. Sample size n=1069 individuals. Frequency distribution analysis, contingency tables and chi-squared test were performed using SPSS software.

RESULTS

Only 0.7% of citizens, especially those with higher education, have communicated with health professionals using information and communication technologies (ICT). Just over half (55%) of the population who has never communicated in that way would like to do so. Only 1.3% of citizens have ever received any recommendation on health apps given by any health professional, whereas 73.8% would be willing to use a health app recommended by professionals. The population groups that show greater willingness in both issues are those citizens under 44 years old, students or citizens with secondary or higher education, active working population, citizens with good or very good health condition, and those without any chronic disease diagnosed. No significant differences were found as regards the variables of gender, type of home, or living with people with disabilities.

CONCLUSIONS

Although there is a high willingness by citizens to use ICT in professional-patient relationships, and to receive recommendations on health apps, they are still not very common. The results obtained are consistent with previous studies, especially regarding the influence of sociodemographic factors in the use and willingness to use of ICTs and recommended apps.

Public Awareness, Usage, and Predictors for the Use of Doctor Rating Websites: Cross-Sectional Study in England

BACKGROUND

With the advent and popularity of social media and consumer rating websites, as well as the emergence of the digitally engaged patient, there has been an increased interest in doctor rating websites or online patient feedback websites, both inside and outside academia. However, there is very little known about how the public across England views such rating websites as a mode to give patient experience feedback.

OBJECTIVE

The aim of the overall study was to measure and understand public awareness, usage, and attitudes towards doctor rating websites as a mode to give experiential feedback about GPs in general practice in England. This paper reports on the findings of one of the aims of the study, which was to measure public awareness, current usage and future consideration of usage of online patient feedback websites, within the context of other feedback methods, This could allow the value of online patient feedback websites to be determined from the patients' perspective.

METHODS

A mixed methods population questionnaire was designed, validated and implemented face-to-face using a cross-sectional design with a representative sample of the public (n=844) in England. The results of the questionnaire were analyzed using chi-square tests, binomial logistic regressions, and content analysis. The qualitative results will be reported elsewhere.

RESULTS

Public awareness of online patient feedback websites as a channel to leave experiential feedback about GPs was found to be low at 15.2% (128/844). However, usage and future consideration to use online patient feedback websites were found to be extremely low, with current patient usage at just 0.4% (3/844), and patient intention to use online patient feedback in the future at 17.8% (150/844). Furthermore, only 4.0-5.0% of those who would consider leaving feedback about a GP in the future selected doctor rating websites as their most preferred method; more than half of patients said they would consider leaving feedback about GPs using another method, but not using an online patient feedback website.

CONCLUSIONS

The findings suggest that online patient feedback websites may not be an effective channel for collecting feedback on patient experience in general practice. Feedback on online patient feedback websites is not likely to be representative of the patient experience in the near future, challenging the use of online patient feedback not just as a mode for collecting patient experience data, but for patient choice and monitoring too. We recommend the National Health Service channels its investment and resources towards providing more direct and private feedback methods in general practice (such as opportunities for face-to-face feedback, email-based feedback, and web-based private feedback forms), as these are currently much more likely to be used by the majority of patients in England.

Intention to Use mHealth in Older Adults With Heart Failure

BACKGROUND

mHealth, or the use of mobile technology in healthcare, is becoming increasingly common. In heart failure (HF), mHealth has been associated with improved self-management and quality of life. However, it is known that older adults continue to lag behind their younger counterparts when it comes to mobile technology adoption.

OBJECTIVE

The primary aim of this study was to examine factors that influence intention to use mHealth among older adults with HF.

METHODS

An adapted Technology Acceptance Model was used to guide this cross-sectional, correlational study. Convenience sampling was used to identify participants from a large university hospital and online.

RESULTS

A total of 129 older adults with HF participated in the study. Social influence (β = 0.17, P = .010), perceived ease of use (β = 0.16, P < .001), and perceived usefulness (β = 0.33, P < .001) were significantly associated with intention to use mHealth even after controlling for potential confounders (age, gender, race, education, income, and smartphone use). Perceived financial cost and eHealth literacy were not significantly associated with intention to use mHealth.

CONCLUSIONS

Researchers should consider using the participatory approach in developing their interventions to ensure that their mHealth-based interventions will not only address the patient's HF self-management needs but also be easy enough to use even for those who are less technology savvy.

Systematic Review of Data Mining Applications in Patient-Centered Mobile-Based Information Systems

Objectives

Smartphones represent a promising technology for patient-centered healthcare. It is claimed that data mining techniques have improved mobile apps to address patients’ needs at subgroup and individual levels. This study reviewed the current literature regarding data mining applications in patient-centered mobile-based information systems.

Methods

We systematically searched PubMed, Scopus, and Web of Science for original studies reported from 2014 to 2016. After screening 226 records at the title/abstract level, the full texts of 92 relevant papers were retrieved and checked against inclusion criteria. Finally, 30 papers were included in this study and reviewed.

Results

Data mining techniques have been reported in development of mobile health apps for three main purposes: data analysis for follow-up and monitoring, early diagnosis and detection for screening purpose, classification/prediction of outcomes, and risk calculation (n = 27); data collection (n = 3); and provision of recommendations (n = 2). The most accurate and frequently applied data mining method was support vector machine; however, decision tree has shown superior performance to enhance mobile apps applied for patients’ self-management.

Conclusions

Embedded data-mining-based feature in mobile apps, such as case detection, prediction/classification, risk estimation, or collection of patient data, particularly during self-management, would save, apply, and analyze patient data during and after care. More intelligent methods, such as artificial neural networks, fuzzy logic, and genetic algorithms, and even the hybrid methods may result in more patients-centered recommendations, providing education, guidance, alerts, and awareness of personalized output.

eHealth literacy research-Quo vadis?

The concept of electronic health (eHealth) literacy evolved from the social and information sciences and describes competencies necessary to use electronic health services. As it is a rather new topic, and as there is no current overview of the state of the art in research, it is not possible to identify research gaps. Therefore, the objective of this viewpoint article is to increase knowledge on the current state of the art of research in eHealth literacy and to identify gaps in scientific research which should be focused on by the research community in the future. The article provides a current viewpoint of the concept of eHealth literacy and related research. Gaps can be found in terms of a missing "gold standard" regarding both the definition and the measurement of eHealth literacy. Furthermore, there is a need for identifying the implications on eHealth developers, which evolve from the measurement of eHealth literacy in eHealth users. Finally, a stronger inclusion of health professionals, both in the evolving concept and in the measurement of eHealth literacy, is needed in the future.

A meta-analysis of e-health applications acceptance

Purpose

The increasing importance of electronic health (e-health) has raised the significance of exploring the factors influencing the users’ acceptance of e-health applications. There has been an extensive usage of the technology acceptance model (TAM) in e-health applications acceptance research. However, not all TAM relationships are borne out in all the studies. There is a variation in predicted effects in several studies with different user type and application type. The purpose of this paper is to bridge a research gap by providing a holistic view of the e-health applications acceptance research by integrating the findings of existing relevant literature.

Design/methodology/approach

A statistical meta-analysis of the effect size of causal relationships between common TAM constructs was conducted on 111 peer-reviewed academic studies published in various journals.

Findings

The results confirm the validity and robustness of the TAM in e-health applications acceptance research. Further, a moderator analysis based on user type and e-health application type demonstrated that the effect size of causal relationships between TAM constructs majorly depends on the user type, but not on e-health application type.

Research limitations/implications

This research provides a ready reference of the existing studies on e-health applications acceptance to the researchers. Further, if researchers or practitioners want to learn more about the particular user or application type, they may find the results valuable.

Practical implications

This research suggests that the general public can be used as the surrogates for patients in e-health applications acceptance research. The implementation strategy found successful for medical staff may not work for general public and patients. This research also suggests ways to enhance acceptance of e-health applications among different user groups.

Originality/value

The research is original and is based on the existing literature and its interpretation.

Exploring Patients' Views Toward Giving Web-Based Feedback and Ratings to General Practitioners in England: A Qualitative Descriptive Study

Background

Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback.

Objective

The aim of this study was to explore patients’ views toward giving Web-based feedback and ratings to general practitioners (GPs), within the context of other feedback methods available in primary care in England, and in particular, paper-based feedback cards.

Methods

A descriptive exploratory qualitative approach using face-to-face semistructured interviews was used in this study. Purposive sampling was used to recruit 18 participants from different age groups in London and Coventry. Interviews were transcribed verbatim and analyzed using applied thematic analysis.

Results

Half of the participants in this study were not aware of the opportunity to leave feedback for GPs, and there was limited awareness about the methods available to leave feedback for a GP. The majority of participants were not convinced that formal patient feedback was needed by GPs or would be used by GPs for improvement, regardless of whether they gave it via a website or on paper. Some participants said or suggested that they may leave feedback on a website rather than on a paper-based feedback card for several reasons: because of the ability and ease of giving it remotely; because it would be shared with the public; and because it would be taken more seriously by GPs. Others, however, suggested that they would not use a website to leave feedback for the opposite reasons: because of accessibility issues; privacy and security concerns; and because they felt feedback left on a website may be ignored.

Conclusions

Patient feedback and rating websites as they currently are will not replace other mechanisms for patients in England to leave feedback for a GP. Rather, they may motivate a small number of patients who have more altruistic motives or wish to place collective pressure on a GP to give Web-based feedback. If the National Health Service or GP practices want more patients to leave Web-based feedback, we suggest they first make patients aware that they can leave anonymous feedback securely on a website for a GP. They can then convince them that their feedback is needed and wanted by GPs for improvement, and that the reviews they leave on the website will be of benefit to other patients to decide which GP to see or which GP practice to join.

What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship

Background

Substantial research has focused on patients’ health information–seeking behavior on the Internet, but little is known about the variables that may predict patients’ willingness to undergo online treatment and willingness to pay additionally for online treatment.

Objective

This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP).

Methods

An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models.

Results

Exploratory factor analyses revealed that the disposition of patients’ personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information–seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by health-related information–seeking personality (B=.127, P=.07), PU (B=–.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03).

Conclusions

Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information–seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP.

General Practitioners' Concerns About Online Patient Feedback: Findings From a Descriptive Exploratory Qualitative Study in England

Background

The growth in the volume of online patient feedback, including online patient ratings and comments, suggests that patients are embracing the opportunity to review online their experience of receiving health care. Very little is known about health care professionals’ attitudes toward online patient feedback and whether health care professionals are comfortable with the public nature of the feedback.

Objective

The aim of the overall study was to explore and describe general practitioners’ attitudes toward online patient feedback. This paper reports on the findings of one of the aims of the study, which was to explore and understand the concerns that general practitioners (GPs) in England have about online patient feedback. This could then be used to improve online patient feedback platforms and help to increase usage of online patient feedback by GPs and, by extension, their patients.

Methods

A descriptive qualitative approach using face-to-face semistructured interviews was used in this study. A topic guide was developed following a literature review and discussions with key stakeholders. GPs (N=20) were recruited from Cambridgeshire, London, and Northwest England through probability and snowball sampling. Interviews were transcribed verbatim and analyzed in NVivo using the framework method, a form of thematic analysis.

Results

Most participants in this study had concerns about online patient feedback. They questioned the validity of online patient feedback because of data and user biases and lack of representativeness, the usability of online patient feedback due to the feedback being anonymous, the transparency of online patient feedback because of the risk of false allegations and breaching confidentiality, and the resulting impact of all those factors on them, their professional practice, and their relationship with their patients.

Conclusions

The majority of GPs interviewed had reservations and concerns about online patient feedback and questioned its validity and usefulness among other things. Based on the findings from the study, recommendations for online patient feedback website providers in England are given. These include suggestions to make some specific changes to the platform and the need to promote online patient feedback more among both GPs and health care users, which may help to reduce some of the concerns raised by GPs about online patient feedback in this study.

Evaluation of Mobile Health Applications Developed by a Tertiary Hospital as a Tool for Quality Improvement Breakthrough

Objectives

To evaluate the mobile health applications (apps) developed by a single tertiary hospital in Korea with a particular focus on quality and patient safety.

Methods

Twenty-three mobile health apps developed by Asan Medical Center were selected for analysis after exclusion of the apps without any relationship with healthcare or clinical workflow, the apps for individual usage, and the mobile Web apps. Two clinical informaticians independently evaluated the apps with respect to the six aims for quality improvement suggested by the United States Institute of Medicine. All discrepancies were resolved after discussion by the two reviewers. The six aims observed in the apps were reviewed and compared by target users.

Results

Eleven apps targeted patients, the other 12 were designed for healthcare providers. Among the apps for patients, one app also had functions for healthcare providers. 'My cancer diary' and 'My chart in my hand' apps matched all the six aims. Of the six aims, Timeliness was the most frequently observed (20 apps), and Equity was the least observed (6 apps). Timeliness (10/11 vs. 10/12) and Patient safety (10/11 vs. 9/12) were frequently observed in both groups. In the apps for patients, Patient-centeredness (10/11 vs. 2/12) and Equity (6/11 vs. 0/12) were more frequent but Efficiency (5/11 vs. 10/12) was less frequent.

Conclusions

Most of the six aims were observed in the apps, but the extent of coverage varied. Further studies, evaluating the extent to which they improve quality are needed.

Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How Men and Women Differ and Why

BACKGROUND

Many studies have shown that women use the Internet more often for health-related information searches than men, but we have limited knowledge about the underlying reasons. We also do not know whether and how women and men differ in their current use of the Internet for communicating with their general practitioner (GP) and in their future intention to do so (virtual patient-physician relationship).

OBJECTIVE

This study investigates (1) gender differences in health-related information search behavior by exploring underlying emotional, motivational, attitudinal as well as cognitive variables, situational involvement, and normative influences, and different personal involvement regarding health-related information searching and (2) gender differences in the virtual patient-physician relationship.

METHODS

Gender differences were analyzed based on an empirical online survey of 1006 randomly selected German patients. The sample was drawn from an e-panel maintained by GfK HealthCare. A total of 958 usable questionnaires were analyzed. Principal component analyses were carried out for some variables. Differences between men (517/958) and women (441/958) were analyzed using t tests and Kendall's tau-b tests. The survey instrument was guided by several research questions and was based on existing literature.

RESULTS

Women were more engaged in using the Internet for health-related information searching. Gender differences were found for the frequency of usage of various Internet channels for health-related information searches. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship.

CONCLUSIONS

Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor's notes/certificates of health.

The development of online doctor reviews in China: an analysis of the largest online doctor review website in China

BACKGROUND

Since the time of Web 2.0, more and more consumers have used online doctor reviews to rate their doctors or to look for a doctor. This phenomenon has received health care researchers' attention worldwide, and many studies have been conducted on online doctor reviews in the United States and Europe. But no study has yet been done in China. Also, in China, without a mature primary care physician recommendation system, more and more Chinese consumers seek online doctor reviews to look for a good doctor for their health care concerns.

OBJECTIVE

This study sought to examine the online doctor review practice in China, including addressing the following questions: (1) How many doctors and specialty areas are available for online review? (2) How many online reviews are there on those doctors? (3) What specialty area doctors are more likely to be reviewed or receive more reviews? (4) Are those reviews positive or negative?

METHODS

This study explores an empirical dataset from Good Doctor website, haodf.com—the earliest and largest online doctor review and online health care community website in China—from 2006 to 2014, to examine the stated research questions by using descriptive statistics, binary logistic regression, and multivariate linear regression.

RESULTS

The dataset from the Good Doctor website contained 314,624 doctors across China and among them, 112,873 doctors received 731,543 quantitative reviews and 772,979 qualitative reviews as of April 11, 2014. On average, 37% of the doctors had been reviewed on the Good Doctor website. Gynecology-obstetrics-pediatrics doctors were most likely to be reviewed, with an odds ratio (OR) of 1.497 (95% CI 1.461-1.535), and internal medicine doctors were less likely to be reviewed, with an OR of 0.94 (95% CI 0.921-0.960), relative to the combined small specialty areas. Both traditional Chinese medicine doctors and surgeons were more likely to be reviewed than the combined small specialty areas, with an OR of 1.483 (95% CI 1.442-1.525) and an OR of 1.366 (95% CI 1.337-1.395), respectively. Quantitatively, traditional Chinese medicine doctors (P<.001) and gynecology-obstetrics-pediatrics doctors (P<.001) received more reviews than the combined small specialty areas. But internal medicine doctors received fewer reviews than the combined small specialty areas (P<.001). Also, the majority of quantitative reviews were positive-about 88% were positive for the doctors' treatment effect measure and 91% were positive for the bedside manner measure. This was the case for the four major specialty areas, which had the most number of doctors—internal medicine, gynecology-obstetrics-pediatrics, surgery, and traditional Chinese medicine.

CONCLUSIONS

Like consumers in the United States and Europe, Chinese consumers have started to use online doctor reviews. Similar to previous research on other countries' online doctor reviews, the online reviews in China covered almost every medical specialty, and most of the reviews were positive even though all of the reviewing procedures and the final available information were anonymous. The average number of reviews per rated doctor received in this dataset was 6, which was higher than that for doctors in the United States or Germany, probably because this dataset covered a longer time period than did the US or German dataset. But this number is still very small compared to any doctor's real patient population, and it cannot represent the reality of that population. Also, since all the data used for analysis were from one single website, the data might be biased and might not be a representative national sample of China.

Sources of traffic and visitors' preferences regarding online public reports of quality: web analytics and online survey results

Background

In the context of the Affordable Care Act, there is extensive emphasis on making provider quality transparent and publicly available. Online public reports of quality exist, but little is known about how visitors find reports or about their purpose in visiting.

Objective

To address this gap, we gathered website analytics data from a national group of online public reports of hospital or physician quality and surveyed real-time visitors to those websites.

Methods

Websites were recruited from a national group of online public reports of hospital or physician quality. Analytics data were gathered from each website: number of unique visitors, method of arrival for each unique visitor, and search terms resulting in visits. Depending on the website, a survey invitation was launched for unique visitors on landing pages or on pages with quality information. Survey topics included type of respondent (eg, consumer, health care professional), purpose of visit, areas of interest, website experience, and demographics.

Results

There were 116,657 unique visitors to the 18 participating websites (1440 unique visitors/month per website), with most unique visitors arriving through search (63.95%, 74,606/116,657). Websites with a higher percent of traffic from search engines garnered more unique visitors (P=.001). The most common search terms were for individual hospitals (23.25%, 27,122/74,606) and website names (19.43%, 22,672/74,606); medical condition terms were uncommon (0.81%, 605/74,606). Survey view rate was 42.48% (49,560/116,657 invited) resulting in 1755 respondents (participation rate=3.6%). There were substantial proportions of consumer (48.43%, 850/1755) and health care professional respondents (31.39%, 551/1755). Across websites, proportions of consumer (21%-71%) and health care professional respondents (16%-48%) varied. Consumers were frequently interested in using the information to choose providers or assess the quality of their provider (52.7%, 225/427); the majority of those choosing a provider reported that they had used the information to do so (78%, 40/51). Health care professional (26.6%, 115/443) and consumer (20.8%, 92/442) respondents wanted cost information and consumers wanted patient narrative comments (31.5%, 139/442) on the public reports. Health care professional respondents rated the experience on the reports higher than consumers did (mean 7.2, SD 2.2 vs mean 6.2, SD 2.7; scale 0-10; P<.001).

Conclusions

Report sponsors interested in increasing the influence of their reports could consider using techniques to improve search engine traffic, providing cost information and patient comments, and improving the website experience for both consumers and health care professionals.

Using patient experiences on Dutch social media to supervise health care services: exploratory study

Background

Social media has become mainstream and a growing number of people use it to share health care-related experiences, for example on health care rating sites. These users’ experiences and ratings on social media seem to be associated with quality of care. Therefore, information shared by citizens on social media could be of additional value for supervising the quality and safety of health care services by regulatory bodies, thereby stimulating participation by consumers.

Objective

The objective of the study was to identify the added value of social media for two types of supervision by the Dutch Healthcare Inspectorate (DHI), which is the regulatory body charged with supervising the quality and safety of health care services in the Netherlands. These were (1) supervision in response to incidents reported by individuals, and (2) risk-based supervision.

Methods

We performed an exploratory study in cooperation with the DHI and searched different social media sources such as Twitter, Facebook, and healthcare rating sites to find additional information for these incidents and topics, from five different sectors. Supervision experts determined the added value for each individual result found, making use of pre-developed scales.

Results

Searches in social media resulted in relevant information for six of 40 incidents studied and provided relevant additional information in 72 of 116 cases in risk-based supervision of long-term elderly care.

Conclusions

The results showed that social media could be used to include the patient’s perspective in supervision. However, it appeared that the rating site ZorgkaartNederland was the only source that provided information that was of additional value for the DHI, while other sources such as forums and social networks like Twitter and Facebook did not result in additional information. This information could be of importance for health care inspectorates, particularly for its enforcement by risk-based supervision in care of the elderly. Further research is needed to determine the added value for other health care sectors.

Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a systematic review and meta-analysis

Emerging telemedicine programs offer potential low-cost solutions to the management of chronic disease. We sought to evaluate the clinical effectiveness and cost effectiveness of telemedicine approaches on glycemic control in patients with type 2 diabetes mellitus. Using terms related to type 2 diabetes and telemedicine, MEDLINE, Cochrane, EMBASE, and CINAHL Plus were searched to identify relevant studies published through February 28, 2014. Data from identified clinical trials were pooled according to telemedicine approach, and evaluated using conventional meta-analytical methods. We identified 47 articles, from 35 randomized controlled trials, reporting quantitative outcomes for hemoglobin A1c (HbA1c). Twelve of the 35 studies provided intervention via telephone, either in the form of a call or a text message; 19 studies tested internet-based programs, employing video-conferencing and/or informational websites; and four studies used interventions involving electronically transmitted recommendations made by clinicians in response to internet-based reporting by patients. Overall, pooled results from these studies revealed a small, but statistically significant, decrease in HbA1c following intervention, compared to conventional treatment (pooled difference in means=-0.37, 95% CI=-0.49 to -0.25, Z=-6.08, P<0.001). Only two of the 35 studies included assessment of cost-effectiveness. These studies were disparate, both in terms of overall expense and relative cost-effectiveness. Optimization of telemedicine approaches could potentially allow for more effective self-management of disease in type 2 diabetes patients, though evidence to-date is unconvincing. Furthermore, significant publication bias was detected, suggesting that the literature should be interpreted cautiously.