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Algera E, Leusink P, Gerrits T, Pols J, Ravesloot JH. mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice. Eur J Gen Pract 2024; 30:2302435. [PMID: 38264977 PMCID: PMC10810654 DOI: 10.1080/13814788.2024.2302435] [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: 05/23/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. OBJECTIVES To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. METHODS We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. RESULTS In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. CONCLUSION To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.
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Affiliation(s)
- Ellen Algera
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
- Institute for Interdisciplinary Studies, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Trudie Gerrits
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Anthropology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Ethics, Law & Medical Humanities, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam University Medical Centers, Faculty of Medicine, University of Amsterdam, The Netherlands
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Liaqat M, Mushtaq M, Jamil A, Mushtaq MM, Ali H, Anwar R, Raza A, Aslam A, Tariq T, Hussain M, Bakht D, Bokhari SFH. Mobile Health Interventions: A Frontier for Mitigating the Global Burden of Cardiovascular Disease. Cureus 2024; 16:e62157. [PMID: 38993461 PMCID: PMC11238762 DOI: 10.7759/cureus.62157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Mobile health (mHealth) interventions have emerged as a promising approach for cardiovascular disease (CVD) prevention and management. The proliferation of smartphones and wearable devices enables convenient access to health monitoring tools, educational resources, and communication with healthcare providers. mHealth interventions encompass mobile apps, wearables, and telehealth services that empower users to monitor vital signs, adhere to medication, and adopt healthier lifestyles. Their effectiveness hinges on user engagement, leveraging behavioral science principles and gamification strategies. While mHealth offers advantages such as personalized support and increased reach, it faces challenges pertaining to data privacy, security concerns, and resistance from healthcare providers. Robust encryption and adherence to regulations like the Health Insurance Portability and Accountability Act (HIPAA) are crucial for safeguarding sensitive health data. Integrating mHealth into clinical workflows can enhance healthcare delivery, but organizational adjustments are necessary. The future of mHealth is closely intertwined with artificial intelligence (AI), enabling remote monitoring, predictive algorithms, and data-driven insights. Tech giants are incorporating advanced health-tracking capabilities into their devices, paving the way for personalized wellness approaches. However, mHealth grapples with ethical dilemmas surrounding data ownership, privacy breaches, and inadvertent data capture. Despite its potential, mHealth necessitates a concerted effort to overcome obstacles and ensure ethical, secure, and practical implementation. Addressing technical challenges, fostering standardization, and promoting equitable access are pivotal for unlocking the transformative impact of mHealth on cardiovascular health and reducing the global burden of CVD.
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Affiliation(s)
- Maryyam Liaqat
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Maham Mushtaq
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Ahmed Jamil
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | | | - Husnain Ali
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Rahma Anwar
- Medicine and Surgery, King Edward Medical University, Lahore, PAK
| | - Ahmad Raza
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Asma Aslam
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Tamseer Tariq
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | | | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
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Gamarel KE, Rodriguez-Bañuelos A, Ubong IA, Best JN, Jadwin-Cakmak L, Mitchell JW. Understanding the potential implementation determinants of Our Plan: a couples-based digital human immunodeficiency virus prevention intervention for same-gender male couples. Mhealth 2024; 10:16. [PMID: 38689615 PMCID: PMC11058597 DOI: 10.21037/mhealth-23-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/31/2023] [Indexed: 05/02/2024] Open
Abstract
Background There has been a proliferation of digital health interventions (DHIs) focused on addressing human immunodeficiency virus (HIV) prevention and treatment outcomes, including couples-based interventions with same-gender male couples. However, the barriers and facilitators of implementing couples-based HIV and sexually transmitted infection (STI) prevention interventions using digital platforms in community-based organizations remains largely unknown. The goal of this study was to explore the implementation determinants of Our Plan, a couples-based DHI designed for new relationships of same-gender male couples and dyadic, sexual partnerships. Methods Qualitative interviews were conducted with 40 organization leaders, healthcare providers, and staff at acquired immunodeficiency syndrome (AIDS)-service and community-based organizations in 13 states serving populations in Ending the HIV Epidemic jurisdictions. Interview items and follow-up questions were guided by the Consolidated Framework for Implementation Research (CFIR) to inquire about implementation determinants of Our Plan. Results Most participants highlighted several relative advantages of Our Plan: increasing capacity to support couples, potential synergy with existing programs, and opportunities to increase patient engagement. Participants also discussed relative disadvantages: misalignment with organizational values in the provision of patient-centered models of care and low interest from some priority populations. Participants emphasized the need for adaptability of Our Plan to fit within their local contexts, which encompassed support for both implementers and end-users, cultural tailoring, and privacy and security features. The desired evidence needed to implement Our Plan focused on data on impact, acceptability, and usability and functionality from communities most heavily impacted by the HIV epidemic. The majority of participants described how Our Plan could be integrated within service delivery and aligned with their organization's aspirational values; however, some noted that their organizational culture valued in-person interactions, particularly among patients experiencing structural vulnerabilities. Finally, participants discussed how the implementation of Our Plan would require additional training and funding for staff to support end-users and a relationship with the developers so that they could demonstrate their investment in the communities that their organizations served. Conclusions Our Plan was deemed a promising tool among potential implementers. To ensure optimal implementation and organizational fit, Our Plan refinement and evaluation must include implementers and end-users most impacted by the HIV epidemic throughout the entire process.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Adrian Rodriguez-Bañuelos
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ini-Abasi Ubong
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Janae N. Best
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jason W. Mitchell
- Department of Health Promotion and Disease Prevention, Florida International University Robert Stempel College of Public Health & Social Work, Miami, FL, USA
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Allan LP, Beilei L, Cameron J, Olaiya MT, Silvera-Tawil D, Adcock AK, English C, Gall SL, Cadilhac DA. A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice. Stroke 2023; 54:2935-2945. [PMID: 37800373 DOI: 10.1161/strokeaha.123.043794] [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: 10/07/2023]
Abstract
Secondary prevention is a major priority for those living with stroke and may be improved through the use of mobile Health (mHealth) interventions. While evidence for the effectiveness of mHealth interventions for secondary prevention of stroke is growing, little attention has been given to the translation of these interventions into real-world use. In this review, we aimed to provide an update on the effectiveness of mHealth interventions for secondary prevention of stroke, and investigate their translation into real-world use. Four electronic databases and the gray literature were searched for randomized controlled trials of mHealth interventions for secondary prevention of stroke published between 2010 and 2023. Qualitative and mixed-methods evaluations of the trials were also included. Data were extracted regarding study design, population, mHealth technology involved, the intervention, and outcomes. Principal researchers from these trials were also contacted to obtain further translational information. From 1151 records, 13 randomized controlled trials and 4 evaluations were identified; sample sizes varied widely (median, 56; range, 24-4298). Short message service messages (9/13) and smartphone applications (6/13) were the main technologies used to deliver interventions. Primary outcomes of feasibility of the intervention were achieved in 4 trials, and primary outcomes of changes in risk factors, lifestyle behaviors, and adherence to medication improved in 6 trials. Only 1 trial had a hard end point (ie, stroke recurrence) as a primary outcome, and no significant differences were observed between groups. There was evidence for only 1 intervention being successfully translated into real-world use. Further evidence is required on the clinical effectiveness of mHealth interventions for preventing recurrent stroke, and the associated delivery costs and cost-effectiveness, before adoption into real-world settings.
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Affiliation(s)
- Liam P Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Lin Beilei
- The Nursing and Health School, Zhengzhou University, Henan, China (L.B.)
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian Centre for Heart Health, Royal Melbourne Hospital, Victoria, Australia (J.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
| | - David Silvera-Tawil
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Amelia K Adcock
- Cerebrovascular Division, Department of Neurology, West Virginia University, Morgantown (A.K.A.)
| | - Coralie English
- School of Health Sciences, University of Newcastle, New South Wales, Australia (C.E.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New South Wales, Australia (C.E.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia (S.L.G.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (D.A.C.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
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Sidek NN, Tengku Ismail TA, Kamalakannan S, Chen XW, Romli MH, Mat Said MZ, Papachristou Nadal I, Ibrahim KA, Musa KI. A mixed-methods study on the implementation of a mobile health application (mHealth app) for stroke caregivers in Malaysia: healthcare providers' perspective. Front Neurol 2023; 14:1222260. [PMID: 37905189 PMCID: PMC10613485 DOI: 10.3389/fneur.2023.1222260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Recognizing the burden experienced by caregivers of stroke survivors, an intervention using mobile health applications (mHealth apps) has been proposed to support and empower stroke caregivers. This study aimed to assess the acceptability and expectations of healthcare providers, who play a vital role as gatekeepers in the healthcare system, to ensure the effectiveness and sustainability of the intervention. Methods This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool. Results In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients. Conclusion Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.
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Affiliation(s)
- Norsima Nazifah Sidek
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Sureshkumar Kamalakannan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Social Work, Education, and Community Well-being, Northumbria University, Coach Lane Campus, Newcastle upon Tyne, United Kingdom
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, UPM Teaching Hospital, Faculty of Medicine and Health Sciences, Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | | | - Khairul Azmi Ibrahim
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
- Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Kuala Terengganu, Terengganu, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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van Kessel R, Srivastava D, Kyriopoulos I, Monti G, Novillo-Ortiz D, Milman R, Zhang-Czabanowski WW, Nasi G, Stern AD, Wharton G, Mossialos E. Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping. JMIR Mhealth Uhealth 2023; 11:e49003. [PMID: 37773610 PMCID: PMC10576236 DOI: 10.2196/49003] [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: 05/14/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. OBJECTIVE This study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. METHODS We mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts. RESULTS Our search strategy yielded a total of 1559 records, of which 40 (2.57%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health-specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic. CONCLUSIONS Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Divya Srivastava
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organisation Regional Office for Europe, Copenhagen, Denmark
| | - Ran Milman
- Digital Health Division, Israeli Ministry Of Health, Jerusalem, Israel
| | | | - Greta Nasi
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Ariel Dora Stern
- Harvard Business School, Harvard University, Boston, MA, United States
- Harvard-MIT Center for Regulatory Science, Harvard University, Boston, MA, United States
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Gu Y, Guan Y, Meng Z. Health Providers' Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis. J Med Internet Res 2023; 25:e45437. [PMID: 37698902 PMCID: PMC10523226 DOI: 10.2196/45437] [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: 01/01/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential. OBJECTIVE This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. METHODS A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach. RESULTS A total of 18,242 studies were identified, of which 24 (0.13%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth. CONCLUSIONS This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs.
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Affiliation(s)
- Yu Gu
- Yanjing Medical College, Capital Medical University, Beijing, China
| | - Yushan Guan
- School of Nursing, Capital Medical University, Beijing, China
| | - Zhaolin Meng
- School of Nursing, Capital Medical University, Beijing, China
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van Kessel R, Roman-Urrestarazu A, Anderson M, Kyriopoulos I, Field S, Monti G, Reed SD, Pavlova M, Wharton G, Mossialos E. Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review. J Med Internet Res 2023; 25:e48000. [PMID: 37490322 PMCID: PMC10410406 DOI: 10.2196/48000] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Samantha Field
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Schroeder T, Seaman K, Nguyen A, Gewald H, Georgiou A. Enablers and inhibitors to the adoption of mHealth apps by patients - A qualitative analysis of German doctors' perspectives. PATIENT EDUCATION AND COUNSELING 2023; 114:107865. [PMID: 37356116 DOI: 10.1016/j.pec.2023.107865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Germany is the first country that approved validated mobile health apps (called DiGA) for prescription by doctors and psychotherapists. The aim of this study is to investigate doctors' perspectives towards these mobile health apps and their intentions to prescribe them. Additionally, we investigated the influence of different roles and expectations of outcomes. METHODS We used a qualitative study design to determine doctors' viewpoints on prescribing DiGAs. We conducted 28 semi-structured interviews and used the grounded theory method for analysis. We adopted a classical conceptualist approach to gain theoretical insights. RESULTS The results show that doctors' acceptance and support of DiGAs are critical in mobile health uptake and utilisation. Although mobile health is seen to be supportive of patient management and patient education doctors nevertheless need to adopt a motivating and persuasive role in the process. CONCLUSIONS Doctors consider DiGAs complementary to their role in patient management and are predominantly positive about DiGAs. A trusted relationship with patients must be developed to ensure the appropriate support of DiGAs. PRACTICE IMPLICATIONS Our study suggests that targeted education, user-centred DiGAs, consideration of social presence and user engagement, and co-development with doctors can improve longer-term DiGA use and effectiveness.
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Affiliation(s)
- Tanja Schroeder
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Research on Service Sciences (CROSS), University of Applied Sciences Neu-Ulm, Neu-Ulm, Germany.
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Heiko Gewald
- Centre for Research on Service Sciences (CROSS), University of Applied Sciences Neu-Ulm, Neu-Ulm, Germany
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Sushko K, Menezes HT, Wang QR, Nerenberg K, Fitzpatrick-Lewis D, Sherifali D. Patient-reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: A Scoping Review. Can J Diabetes 2023; 47:102-113. [PMID: 36182614 DOI: 10.1016/j.jcjd.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES For women with pre-existing and gestational diabetes, pregnancy involves specialized and intensive medical care to optimize maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. COVID-19-induced barriers to face-to-face care have identified the need for high-quality, patient-centred virtual health-care modalities, such as mobile health (mHealth) technologies. Our aim in this review was to identify the patient-reported benefits and limitations of mHealth technologies among women with diabetes in pregnancy. We also aimed to determine how the women's experiences aligned with the best practice standards for patient-centred communication. METHODS The framework presented by Arksey and O'Malley for conducting scoping reviews, with refinements by Levac et al, was used to guide this review. Relevant studies were identified through comprehensive database searches of MEDLINE, Embase, Emcare and PsycINFO. Thomas and Harden's methods for the thematic synthesis of qualitative research in systematic reviews guided the synthesis of patient-reported benefits and limitations of mHealth technology. RESULTS Overall, 19 studies describing the use of 16 unique mHealth technologies among 742 women were included in the final review. Patient-reported benefits of mHealth included convenience, support of psychosocial well-being and facilitation of diabetes self-management. Patient-reported limitations included lack of important technological features, perceived burdensome aspects of mHealth and lack of trust in virtual health care. CONCLUSIONS Women with diabetes report some benefits from mHealth use during pregnancy. Codesigning future technologies with end users may help address the perceived limitations and effectiveness of mHealth technologies.
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Affiliation(s)
- Katelyn Sushko
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
| | - Holly Tschirhart Menezes
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Qi Rui Wang
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Fitzpatrick-Lewis
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, School of Nursing, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, The Boris Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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11
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Luo Y, Ding Y, Chen Y. The role of IL-31 and IL-34 in the diagnosis and treatment of chronic periodontitis. Open Life Sci 2023; 18:20220563. [PMID: 36879647 PMCID: PMC9985446 DOI: 10.1515/biol-2022-0563] [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: 07/05/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023] Open
Abstract
This study was devoted to demonstrating the role of IL-31 and IL-34 in the diagnosis and treatment of chronic periodontitis (CP). From the results, we found that the IL-31 and IL-34 levels were significantly increased in GCF and serum of CP patients compared with healthy controls or obese patients. Meanwhile, the area under the curve results further verified the diagnostic potential of IL-31 and IL-34 in terms of discriminating CP from obese patients at the GCF and serum levels. Finally, after 1 year of continuous treatment, we found that IL-31 and IL-34 levels were decreased in CP, suggesting their potential as biomarkers in CP treatment response. Monitoring GCF and serum levels of IL-31 and IL-34 contributed to CP detection and treatment response.
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Affiliation(s)
- Ying Luo
- Outpatient Department of Xiqu, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Ding
- Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yaduo Chen
- Outpatient Department of Xiqu, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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12
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Rossmaier LWS. Commercial mHealth Apps and Unjust Value Trade-offs: A Public Health Perspective. Public Health Ethics 2022; 15:277-288. [PMID: 36727099 PMCID: PMC9883713 DOI: 10.1093/phe/phac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mobile health (mHealth) apps for self-monitoring increasingly gain relevance for public health. As a mobile technology, they promote individual participation in health monitoring with the aim of disease prevention and the mitigation of health risks. In this paper, I argue that users of mHealth apps must engage in value trade-offs concerning their fundamental dimensions of well-being when using mobile health apps for the self-monitoring of health parameters. I particularly focus on trade-offs regarding the user's self-determination as well as their capacity to form personal attachments. Depending on the user's level of advantage or disadvantage, value trade-offs can pose a threat to the users' sufficient fulfillment of the dimensions of well-being. As such, value trade-offs can entrench existing structural injustices and prevent disadvantaged users to benefit from this technology. I argue that value trade-offs are, to some, a type of injustice that can drive disadvantaged users away from a sufficiency threshold of well-being, risk users to fall below the threshold, or have an accumulative effect on different dimensions of the user's well-being.
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Affiliation(s)
- Leon W S Rossmaier
- Corresponding author: Leon W. S. Rossmaier, Faculty of Behavioural, Management and Social Sciences, Section of Philosophy, University of Twente, Hallenweg 17, 7522NH, Enschede, The Netherlands. Tel.: +31534899357;
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13
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Liu Y, Lu X, Zhao G, Li C, Shi J. Adoption of mobile health services using the unified theory of acceptance and use of technology model: Self-efficacy and privacy concerns. Front Psychol 2022; 13:944976. [PMID: 36033004 PMCID: PMC9403893 DOI: 10.3389/fpsyg.2022.944976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Mobile health (mHealth) services have been widely used in medical services and health management through mobile devices and multiple channels, such as smartphones, wearable equipment, healthcare applications (Apps), and medical platforms. However, the number of the users who are currently receiving the mHealth services is small. In China, more than 70% of internet users have never used mHealth services. Such imbalanced situation could be attributed to users’ traditional concept of medical treatment, psychological factors (such as low self-efficacy) and privacy concerns. The purpose of this study is to explore the direct and indirect effects of mHealth users’ self-efficacy and privacy concerns on their intention to adopt mHealth services, providing guidelines for mHealth service providers to enhance users’ intention of adoption. A questionnaire was designed by the research team and 386 valid responses were collected from domestic participants in China. Based on the unified theory of acceptance and use of technology (UTAUT) model, a research model integrated self-efficacy and privacy concerns was constructed to investigate their effects on users’ intention to adopt mobile mHealth services. The results show that self-efficacy could facilitate users’ intention to adopt mHealth services, and had a significantly positive effect on perceived ubiquity, effort expectancy, performance expectancy and subjective norm. This study verifies the direct and indirect effects of self-efficacy and privacy concerns on users’ intention to adopt mHealth services, providing a different perspective for studying mHealth adoption behavior. The findings could provide guidelines for mHealth service providers to improve their service quality and enhance users’ intention of adoption.
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Affiliation(s)
- Yizhi Liu
- College of Management, Guizhou University, Guiyang, China
| | - Xuan Lu
- College of Management, Guizhou University, Guiyang, China
| | - Gang Zhao
- School of Engineering, University of Tasmania, Hobart, TAS, Australia
| | - Chengjiang Li
- College of Management, Guizhou University, Guiyang, China
- School of Engineering, University of Tasmania, Hobart, TAS, Australia
- *Correspondence: Chengjiang Li,
| | - Junyi Shi
- School of Humanities and Social Sciences, Xi’an Jiaotong-Liverpool University, Suzhou, China
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14
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Teleconsultation adoption since COVID-19: comparison of barriers and facilitators in primary care settings in Hong Kong and the Netherlands. Health Policy 2022; 126:933-944. [PMID: 36050194 PMCID: PMC9356914 DOI: 10.1016/j.healthpol.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic. A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review. Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.
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Nishimwe A, Conco DN, Nyssen M, Ibisomi L. A mixed-method study exploring experiences, perceptions, and acceptability of using a safe delivery mHealth application in two district hospitals in Rwanda. BMC Nurs 2022; 21:176. [PMID: 35787679 PMCID: PMC9251926 DOI: 10.1186/s12912-022-00951-w] [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: 01/14/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovative use of mobile health (mHealth) technology in timely management of childbirth complications is a promising strategy, but its evidence base is limited. The Safe Delivery mHealth Application (SDA) is one of the recent mhealth applications (loaded in smartphones) which is a clinical decision support and training tool for basic emergency obstetric and newborn care (BEmONC). This paper describes, the health providers' experiences, perceptions, and acceptability of using the SDA, as well as the perceptions of key stakeholders. METHODS A mixed-methods approach was utilized. Quantitative methods consisted of a self-reported acceptability survey, administered to 54 nurses and midwives, including questions on their usage and perceptions of the SDA. Descriptive statistics were employed to analyze the survey data. Qualitative methods included two focus group discussions with 24 nurses and midwives, and six key informant interviews with stakeholders (maternity matrons, responsible for maternal and child health, and district hospital managers). Thematic analysis was performed and selected quotations used to illustrate themes. The study took place in two district hospitals in Rwanda. RESULTS Quantitative results found that 31 (57.4%) participants used the SDA four to six times per week. Many participants felt more confident (53.7%) and better at their job (40.7%) since having the SDA. Likert scale survey responses (1-5, 1 = Strongly Disagree, 5 = Strongly Agree) indicated general agreement that SDA is easy to use (Mean = 4.46), is an effective decision support tool (4.63), and training tool (4.65). Qualitative results included themes on perceived usefulness; professional growth acquired through the use of the SDA; SDA, an empowering, intuitive, and user-friendly technology; desired SDA features and functions; benefits of SDA as perceived by key informants, and future use of the SDA. CONCLUSIONS The nurses and midwives perceive the SDA as having improved their ability to manage childbirth complications. Key stakeholders also perceive the SDA as a useful tool with a reasonable cost and recommend its implementation in routine practices. This study deepens the understanding of the potential benefits of mHealth such as the SDA in low-income settings, like Rwanda. It also provides more evidence on the impact of mHealth in assuring quality BEmONC.
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Affiliation(s)
- Aurore Nishimwe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, 2000, Braamfontein, South Africa. .,School of Public Health, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.
| | - Daphney Nozizwe Conco
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, 2000, Braamfontein, South Africa
| | - Marc Nyssen
- Department of Biomedical Statistics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Latifat Ibisomi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, 2000, Braamfontein, South Africa.,Nigerian Institute of Medical Research, 6 Edmund Cres, Yaba, Lagos, Nigeria
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16
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Marengo LL, Kozyreff AM, Moraes FDS, Maricato LIG, Barberato-Filho S. [Mobile technologies in healthcare: reflections on development, application, legal aspects, and ethicsTecnologías sanitarias móviles: reflexiones sobre desarrollo, aplicación, legislación y ética]. Rev Panam Salud Publica 2022; 46:e37. [PMID: 35620177 PMCID: PMC9128660 DOI: 10.26633/rpsp.2022.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
The association between fast-growing mobile technologies and increasingly more mobile devices has allowed the introduction of virtual environments into daily activities. That includes the health care domain, where concepts such telemedicine, telehealth, eHealth, and mHealth have emerged. In addition to presenting these new concepts, this article aims to discuss the advancements and challenges of mobile health technologies stemming from considerations regarding development, application, legal aspects, and ethics. Because of their innovative nature, mobile health technologies entail the engagement of many actors in the journey to reach end users, covering conception, technical development, sanitary regulations, and design of clinical guidelines, having raised a great deal or interest in terms of monitoring and care across a variety of clinical conditions. However, assessment of the effectiveness and safety of mobile health technologies does not seem to involve the same methodological rigor imposed for clinical trials of drugs and other health products; still, the enthusiasm produced by this innovation counters some of the regulatory and ethics concerns relating to data protection, privacy, access to mobile devices, and technological or social inequality. Despite possible limitations, mobile technologies, as well as other telehealth resources, have produced promising results. Digital healthcare has great potential for expansion and represents an opportunity for the review of traditional practices with selection of mobile technologies for incorporation into the health care system whenever evidence-based benefits are verified.
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Affiliation(s)
- Lívia Luize Marengo
- Universidade de Sorocaba (UNISO) Programa de Pós-Graduação em Ciências Farmacêuticas Sorocaba (SP) Brasil Universidade de Sorocaba (UNISO), Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba (SP), Brasil
| | - Alan Martinez Kozyreff
- Universidade de Sorocaba (UNISO) Programa de Pós-Graduação em Ciências Farmacêuticas Sorocaba (SP) Brasil Universidade de Sorocaba (UNISO), Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba (SP), Brasil
| | - Fabio da Silva Moraes
- Universidade de Sorocaba (UNISO) Programa de Pós-Graduação em Ciências Farmacêuticas Sorocaba (SP) Brasil Universidade de Sorocaba (UNISO), Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba (SP), Brasil
| | - Laura Inês Gomes Maricato
- Universidade de Sorocaba (UNISO) Programa de Pós-Graduação em Ciências Farmacêuticas Sorocaba (SP) Brasil Universidade de Sorocaba (UNISO), Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba (SP), Brasil
| | - Silvio Barberato-Filho
- Universidade de Sorocaba (UNISO) Programa de Pós-Graduação em Ciências Farmacêuticas Sorocaba (SP) Brasil Universidade de Sorocaba (UNISO), Programa de Pós-Graduação em Ciências Farmacêuticas, Sorocaba (SP), Brasil
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17
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Achieving the potential of mHealth in medicine requires challenging the ethos of care delivery. Prim Health Care Res Dev 2022; 23:e18. [PMID: 35314016 PMCID: PMC8991074 DOI: 10.1017/s1463423622000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mobile Health (mHealth) interventions have received a mix of praise and excitement, as well as caution and even opposition over recent decades. While the rapid adoption of mHealth solutions due to the COVID-19 pandemic has weakened resistance to integrating these digital approaches into practice and generated renewed interest, the increased reliance on mHealth signals a need for optimizing development and implementation. Despite an historically innovation-resistant medical ethos, mHealth is becoming a normalized supplement to clinical practice, highlighting increased demand. Reaching the full potential of mHealth requires new thinking and investment. The current challenge to broaden mHealth adoption and to ensure equity in access may be overcoming a “design purgatory,” where innovation fails to connect to practice. We recommend leveraging the opportunity presented by the COVID-19 pandemic to disrupt routine practice and with a new focus on theory-driven replicability of mHealth tools and strategies aimed at medical education and professional organizations.
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18
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Chen N. Stakeholder Power Analysis of the Facilitators and Barriers for Telehealth Solution Implementation in China: A Qualitative Study of Individual Users in Beijing and Interviews With Institutional Stakeholders. JMIR Form Res 2022; 6:e19448. [PMID: 35044321 PMCID: PMC8811689 DOI: 10.2196/19448] [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: 04/17/2020] [Revised: 01/01/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Facing COVID 19, the use of telehealth solutions grows exponentially. However, despite the large investments made into telehealth solutions, the implementation process remains slow and sluggish. Moreover, during COVID-19, older people experienced difficulties and had the highest mortality rates, and those lucky enough to survive faced tremendous pressure to use QR code-based health monitoring systems. Objective This paper aims to determine the barriers and incentives for the implementation of telehealth solutions via a case study about telehealth implementation in China. Methods We conducted 8 semi-structured interviews following the design of the interactive learning framework (research question defining, participant recruitment, exploratory stage, consultation stage, integration stage, and follow-up interview). One interview with a government official from the National Health Commission and another interview with a government official from the China Center for Disease Control and Prevention was conducted in the exploratory stage. The consultation stage comprised one interview with a business manager from the Huawei Wearable Unit, one interview with a business manager from Alibaba Health Brain Unit, and one interview with a business manager from Xiaomi. Two interviews with doctors from Fudan University-affiliated Huashan Hospital and Fudan University-affiliated Zhongshan hospital were conducted in the integration stage. In addition, 8 focus group studies with 64 participants from rural and urban Beijing were conducted. Finally, another telephone interview with a business manager of the Xiaomi Wearable Unit was conducted in the follow-up stage. Results Telehealth solutions are designed to assist health care providers in realizing the quadruple aim of better health outcomes, lowering health care costs, improved health care quality, and improved doctor and patient experiences. Governments have high incentives to improve health care efficiency via telehealth solutions. However, they have limited resources to make the necessary infrastructure transformation. Conclusions To fully realize the potential of telehealth devices, heavy infrastructure investment in the telecommunication network is required beforehand to resolve the interoperability issue occurring during the data collection process for telehealth solutions. The industry also demands a mature business model incorporating collaboration between various stakeholders and industrial partners to invest in infrastructure. Governments have high interest and significant influence on building the necessary infrastructure for telehealth solution implementation in China. Industrial actors have a high interest and a medium level of power for telehealth solution implementation. Users have high interest but a lower level of power for the usage of telehealth solutions, and doctors have low interest and a medium level of power for telehealth solutions implementation.
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Affiliation(s)
- Nuoya Chen
- Faculty of Global Studies, Justice and Rights, University of Macerata, Macerata, Italy
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19
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Singh H, Tahsin F, Nie JX, McKinstry B, Thavorn K, Upshur R, Harvey S, Wodchis WP, Gray CS. Exploring the perspectives of primary care providers on use of the electronic Patient Reported Outcomes tool to support goal-oriented care: a qualitative study. BMC Med Inform Decis Mak 2021; 21:366. [PMID: 34965860 PMCID: PMC8714873 DOI: 10.1186/s12911-021-01734-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers' usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs. METHODS This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5-6 months after ePRO implementation) and end-point (i.e. 9-12 months after ePRO implementation) of the trial. Interviews explored providers' experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study. RESULTS Three core themes were identified: (1) Perceived usefulness: perceptions of the tool's alignment with providers' typical approach to care, impact and value and fit with existing workflows influenced providers' intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool's perceived ease of use may improve usage behaviour. CONCLUSIONS Multiple refinements/iterations of the ePRO tool (e.g. enhancing the tool's alignment with provider workflows and functions) may be needed to enhance providers' usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers' usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care. TRIAL REGISTRATION Clinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954.
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Affiliation(s)
- Hardeep Singh
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Canada.
- March of Dimes Canada, Toronto, Canada.
| | - Farah Tahsin
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B 1B8, Canada
| | - Brian McKinstry
- Usher Institute, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Harvey
- Logibec Inc., 1751, Richardson Street, Suite 1.060, Montréal, QC, H3K 1G6, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B 1B8, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M6, Canada
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20
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Zakerabasali S, Ayyoubzadeh SM, Baniasadi T, Yazdani A, Abhari S. Mobile Health Technology and Healthcare Providers: Systemic Barriers to Adoption. Healthc Inform Res 2021; 27:267-278. [PMID: 34788907 PMCID: PMC8654335 DOI: 10.4258/hir.2021.27.4.267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Despite the growing use of mobile health (mHealth), certain barriers seem to be hindering the use of mHealth applications in healthcare. This article presents a systematic review of the literature on barriers associated with mHealth reported by healthcare professionals. Methods This systematic review was carried out to identify studies published from January 2015 to December 2019 by searching four electronic databases (PubMed/MEDLINE, Web of Science, Embase, and Google Scholar). Studies were included if they reported perceived barriers to the adoption of mHealth from healthcare providers’ perspectives. Content analysis and categorization of barriers were performed based on a focus group discussion that explored researchers’ knowledge and experiences. Results Among the 273 papers retrieved through the search strategy, 18 works were selected and 18 barriers were identified. The relevant barriers were categorized into three main groups: technical, individual, and healthcare system. Security and privacy concerns from the category of technical barriers, knowledge and limited literacy from the category of individual barriers, and economic and financial factors from the category of healthcare system barriers were chosen as three of the most important challenges related to the adoption of mHealth described in the included publications. Conclusions mHealth adoption is a complex and multi-dimensional process that is widely implemented to increase access to healthcare services. However, it is influenced by various factors and barriers. Understanding the barriers to adoption of mHealth applications among providers, and engaging them in the adoption process will be important for the successful deployment of these applications.
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Affiliation(s)
- Somayyeh Zakerabasali
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azita Yazdani
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahabeddin Abhari
- Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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21
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Abstract
Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics 'intervention', 'context of use' and 'user' were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
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Affiliation(s)
| | - Peter Eh Schwarz
- Technische Universität Dresden, Germany; German Center for Diabetes Research (DZD), Germany
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Cohen Rodrigues TR, de Buisonjé DR, Keesman M, Reijnders T, van der Geer JE, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AWM. Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care. J Med Internet Res 2021; 23:e25646. [PMID: 34652280 PMCID: PMC8556639 DOI: 10.2196/25646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/21/2021] [Accepted: 08/10/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers. OBJECTIVE This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD. METHODS In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care. RESULTS We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth. CONCLUSIONS HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care.
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Affiliation(s)
- Talia R Cohen Rodrigues
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - David R de Buisonjé
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Mike Keesman
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Human-Centered Design, Faculty of Industrial Design Engineering, Technical University of Delft, Delft, Netherlands
| | - Jessica E van der Geer
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands.,Vital10, Amsterdam, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrea W M Evers
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.,Medical Delta, Leiden-Delft-Erasmus Universities, Delft, Netherlands
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23
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Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010820. [PMID: 34682565 PMCID: PMC8535372 DOI: 10.3390/ijerph182010820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/22/2021] [Accepted: 10/06/2021] [Indexed: 12/24/2022]
Abstract
Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media-related intervention for HPVST. Methods: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW.
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Wattanapisit A, Amaek W, Wattanapisit S, Tuangratananon T, Wongsiri S, Pengkaew P. Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qualitative Study. Int J Gen Med 2021; 14:3821-3831. [PMID: 34335048 PMCID: PMC8318008 DOI: 10.2147/ijgm.s317241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction A mobile health (mHealth) technology has the potential to facilitate personalized physical activity (PA) counselling. We aimed to explore the feasibility and challenges of implementing a newly developed mHealth application (PAC app) for personalized PA counselling. Material and Methods A qualitative design employed a descriptive phenomenology approach. Data were collected through focus group discussions (FGDs) with primary health care (PHC) providers and were analyzed using a deductive thematic approach. Results A total of 16 participants participated in four FGDs. Four major themes were found: application for personalized PA counselling, barriers to the use of the application by providers, patient involvement, and impact on PHC services. Discussion The results showed that the new mHealth application can potentially facilitate PA counselling. However, its use in PHC settings requires an understanding of the context of service delivery; the challenges faced by providers and patients and effects on services must be considered. Conclusion Future research should focus on the long-term use of PAC app and its impact on behavioral and health outcomes.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Waluka Amaek
- College of Graduate Studies, Walailak University, Nakhon Si Thammarat, Thailand
| | | | | | - Sunton Wongsiri
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prasert Pengkaew
- School of Informatics, Walailak University, Nakhon Si Thammarat, Thailand
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25
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Firet L, Teunissen TAM, Kool RB, van Doorn L, Aourag M, Lagro-Janssen ALM, Assendelft WJJ. Women's adoption of a web-based intervention for stress urinary incontinence: a qualitative study. BMC Health Serv Res 2021; 21:574. [PMID: 34118900 PMCID: PMC8199839 DOI: 10.1186/s12913-021-06585-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/21/2021] [Indexed: 02/01/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is common among women and affects their quality of life. Pelvic floor muscle training is an effective conservative therapy, but only a minority of women seek help. E-health with pelvic floor muscle training is effective and increases access to care. To implement an e-Health intervention in a sustainable way, however, we need to understand what determines adoption. The aim is to investigate the barriers and facilitators to adopting an e-Health intervention among Dutch women with stress urinary incontinence. Methods Semi-structured telephonic interviews were carried out among participants of the Dutch e-Health intervention for women with stress urinary incontinence. Women were purposively sampled. The ‘Fit between Individuals, Task and Technology’ (FITT) framework was used for both the data collection and data analysis, to gain a more in-depth insight into the adoption of the intervention. Results Twenty women were interviewed, mean age 51 years and mostly highly educated. The adoption of e-Health for women with SUI mainly depends on the interaction between users and e-Health, and users and pelvic floor muscle training exercises. Facilitators for the adoption were the preference for an accessible self-management intervention, having a strong sense of self-discipline and having the ability to schedule the exercises routinely. Women needed to possess self-efficacy to do this intervention independently. Barriers to the adoption of e-Health were personal circumstances restricting time for scheduling pelvic floor muscle training and lacking skills to perform the exercises correctly. Despite guidance by technical features several women remained uncertain about their performance of the exercises and, therefore, wanted additional contact with a professional. Conclusions For stress urinary incontinence e-Health is an appropriate option for a target audience. Use of the FITT framework clearly demonstrates the conditions for optimal adoption. For a subgroup it was a suitable alternative for medical care in person. For others it identified the need for further support by a health care professional. This support could be provided by improvements of technical features and incorporating modes for digital communication. The additional value of integration of the e-Health intervention in primary care might be a logical next step. Trial registration The study was prospectively registered in the Netherlands Trial Registry (NTR) NTR6956. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06585-z.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands.
| | - Theodora Alberta Maria Teunissen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Rudolf Bertijn Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lukas van Doorn
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Manal Aourag
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Antoinette Leonarda Maria Lagro-Janssen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Willem Jan Jozef Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
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26
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Sangers TE, Wakkee M, Kramer-Noels EC, Nijsten T, Lugtenberg M. Views on mobile health apps for skin cancer screening in the general population: an in-depth qualitative exploration of perceived barriers and facilitators. Br J Dermatol 2021; 185:961-969. [PMID: 33959945 PMCID: PMC9291092 DOI: 10.1111/bjd.20441] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 01/04/2023]
Abstract
Background Mobile health (mHealth) applications (apps) incorporating artificial intelligence for skin cancer screening are increasingly reimbursed by health insurers. However, an in‐depth exploration of the general public’s views towards these apps is lacking. Objectives To explore the perceived barriers and facilitators towards mHealth apps for skin cancer screening among the Dutch general population. Methods A qualitative study consisting of four focus groups with 27 participants was conducted. A two‐stage purposive sampling method was used to include information‐rich participants from the Dutch general population with varying experience of mHealth. A topic guide was used to structure the sessions. All focus group meetings were transcribed verbatim and analysed in thematic content analysis by two researchers using several coding phases, resulting in an overview of themes and subthemes, categorized as (sub‐)barriers and (sub)facilitators. Results Main barriers to using mHealth apps included a perceived lack of value, perception of untrustworthiness, preference for a doctor, privacy concerns, a complex user interface, and high costs. The main factors facilitating the use of mHealth among the general population were a high perceived value, a transparent and trustworthy identity of app developers, endorsement by healthcare providers and government regulating bodies, and ease and low costs of use. Conclusions To increase successful adoption in skin cancer screening apps, developers should create a transparent identity and build trustworthy apps. Collaboration between app developers, general practitioners and dermatologists is advocated to improve mHealth integration with skin cancer care. Special attention should be given to the development of low‐cost, privacy‐friendly, easy‐to‐use apps. What is already known about this topic?Mobile health (mHealth) smartphone apps, which provide users with a risk indication of skin cancer using artificial intelligence, are increasingly reimbursed by health insurers. An in‐depth understanding of the views of the general public towards these apps is currently lacking. To increase the functionality and successful adoption and integration of mHealth with skin cancer care, insight into perceived barriers and facilitators towards the use of this technology is advocated.
What does this study add?Our qualitative exploration shows that perceived value, trustworthiness, privacy, app design and costs act as important barriers or facilitators towards the use of mHealth apps for skin cancer screening among the Dutch general population. The preference for a human doctor acted as an additional important barrier towards using mHealth apps. Additional main facilitators were a transparent identity of the app developer, and endorsement from healthcare providers and government regulating bodies.
What are the clinical implications of this work?Adoption of mHealth for skin cancer can be improved by clear communication regarding the reliability of the provided screening, its associated benefits and drawbacks, and by ensuring low cost of use. Design and functionality can be improved by developing privacy‐friendly, easy‐to‐use apps that are usable by all ages. Integration with existing healthcare systems can be improved by collaboration with and endorsement from healthcare professionals and government regulating bodies.
Linked Comment: R.M. Hewitt and C. Bundy. Br J Dermatol 2021; 185:880–881. Plain language summary available online
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Affiliation(s)
- T E Sangers
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - E C Kramer-Noels
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - M Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
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27
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Staras S, Tauscher JS, Rich N, Samarah E, Thompson LA, Vinson MM, Muszynski MJ, Shenkman EA. Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study. JMIR Mhealth Uhealth 2021; 9:e18534. [PMID: 33626016 PMCID: PMC8047797 DOI: 10.2196/18534] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/16/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow-the sequence and personnel needed to undertake a series of tasks for clinical care. Our central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation. This paper aims to provide an introductory tutorial on when and how to use a clinical workflow analysis to guide the implementation of eHealth interventions. The tutorial includes a step-by-step guide to conducting a clinical workflow analysis in planning for eHealth implementation. We began with a description of why a clinical workflow analysis is best completed before the implementation of eHealth interventions. Next, we described 4 steps needed to perform the clinical workflow analysis: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation. Finally, we presented a case study of a clinical workflow analysis, which was conducted during patient visits of patients aged 11 or 12 years from 4 diverse pediatric or family medicine clinics to plan the implementation of a tablet-based app for adolescent vaccination. Investigators planning the implementation of new eHealth interventions in health care settings can use the presented steps to assess clinical workflow, thereby maximizing the match of their intervention with the clinical workflow. Conducting a prospective workflow study allows for evidence-based planning, identifying potential pitfalls, and increasing stakeholder buy-in and engagement. This tutorial should aid investigators in increasing the successful implementation of eHealth interventions.
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Affiliation(s)
- Stephanie Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
| | - Justin S Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry, University of Washington, Seattle, WA, United States
| | - Natalie Rich
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Esaa Samarah
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
- College of Social Work, Florida State University, Tallahassee, FL, United States
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Michelle M Vinson
- Department of Clinical Sciences, Florida State University College of Medicine Orlando Regional Campus, Orlando, FL, United States
| | - Michael J Muszynski
- Department of Clinical Sciences, Florida State University College of Medicine Orlando Regional Campus, Orlando, FL, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
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Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Acceptability, Barriers and Facilitators of Mobile Text Message Reminder System Implementation in Improving Child Vaccination: A Qualitative Study in Northwest Ethiopia. J Multidiscip Healthc 2021; 14:605-616. [PMID: 33727823 PMCID: PMC7955748 DOI: 10.2147/jmdh.s298167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background Mobile phone text message-based mHealth interventions have shown promise in improving health service delivery. Despite the promising findings at a small scale and few contexts, implementing new technologies as part of changes to health care services is inherently challenging. Though there is a potential to introduce mHealth initiatives to health systems of developing countries, existing evidence on the barriers and facilitators of implementation in different contexts is not adequate. Therefore, this study aimed to explore the acceptability, barriers and facilitators of implementing mobile text message reminder system for child vaccination in Ethiopia. Methods This study applied a phenomenological study design. The study was conducted in north-west, Ethiopia between July 28 and August 19, 2020. A total of 23 participants were purposively selected for the in-depth and key informant interviews. We used an interview guide to collect data and audio-records of interviews were transcribed verbatim. Coding was done to identify patterns and thematic analysis was conducted using ATLAS ti7 software. Results The findings indicated that mothers were receptive to mobile text message reminders for their child’s vaccination. Low mobile phone ownership, access to mobile network, access to electricity and illiteracy among the target population were identified as barriers that would affect implementation. Confidentiality and security-related issues are not barriers to implementation of text message reminders for child vaccination service. Facilitators for implementation include stakeholder collaboration, providing orientation/training to users, and willingness to pay by clients. Conclusion In this study, using mobile phone text message reminders for child vaccination services are acceptable by clients. Barriers identified were related to inadequate ICT infrastructure and other technical issues. Addressing the potential barriers and leveraging the existing opportunities could optimize the implementation in resource-limited settings. Before actual implementation, program implementers should also consider providing orientation to users on the proposed mHealth program.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Health System Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, 37232, USA
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sarradon-Eck A, Bouchez T, Auroy L, Schuers M, Darmon D. Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e21795. [PMID: 33661123 PMCID: PMC7974757 DOI: 10.2196/21795] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients' care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients' use of mHealth apps that could impact their willingness to recommend the apps to patients. OBJECTIVE The aim of this qualitative study is to investigate French GPs' attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs' perceptions and expectations of mHealth technologies. METHODS A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. RESULTS Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients' compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). CONCLUSIONS A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs' digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow.
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Affiliation(s)
- Aline Sarradon-Eck
- Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,Institut Paoli-Calmettes, CanBios UMR1252, Marseille, France
| | | | - Lola Auroy
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, Sciences Po Grenoble, Pacte, Grenoble, France
| | - Matthieu Schuers
- Department of General Medicine, Rouen University Hospital, Rouen, France.,Department of Biomedical Informatics, Rouen University Hospital, Rouen, France.,INSERM, U1142, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), Sorbonne Université, Paris, France
| | - David Darmon
- Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,Université Côte d'Azur, Rétines, Healthy, DERMG, Nice, France
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