Impact of digital services on healthcare and social welfare: An umbrella review

BACKGROUND

Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare.

METHODS

The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers.

RESULTS

A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management.

CONCLUSIONS

Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.

Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies

BACKGROUND

Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings.

OBJECTIVES

To identify patients' experiences of PCC in hospital settings.

METHODOLOGICAL DESIGN

This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis.

SETTING AND PARTICIPANTS

Studies were included if they had explored adult patient experiences of PCC in hospital settings.

RESULTS

A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person.

CONCLUSIONS AND IMPLICATIONS

This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals.

The effects of digitalisation on health and social care work: a qualitative descriptive study of the perceptions of professionals and managers

BACKGROUND

Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work. Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals.

METHODS

We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach.

RESULTS

Digitalisation was perceived to have changed professionals' 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems.

CONCLUSIONS

The findings suggest that some of the effects of digitalisation on professionals' work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals' well-being and adaptation to changes, as well as the provision of quality health and social services.

Hospital nurse leaders' experiences with digital technologies: A qualitative descriptive study

AIM

To describe hospital nurse leaders' experiences with digital technologies.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured focus group interviews in one university-affiliated hospital in Finland. Data were collected from October to November 2021 and analysed using content analysis an e-leadership framework.

RESULTS

A total of 20 frontline nurse leaders and middle-managers participated. Leaders had different kinds of experiences that concerned their traits, cognition, affect and behaviour with digital technologies. Leaders experienced that they needed to be open-minded towards digitalization, which sometimes eased their work by making it more efficient. Occasionally, they also got frustrated with digitalization, which caused them stress. Leading digital technologies required collaboration with several different stakeholders, and leaders were especially responsible for ensuring nurses' digital competence. Also, leaders own digital capability was highlighted, although some leaders experienced that their digital capability was low.

CONCLUSION

The e-leadership framework is useful for describing the conduct of leadership roles in the context of digital services. Digitalization has transformed leadership, yet nurse leaders' education and training do not seem to have been sufficiently modified to these rapid changes. In addition, more attention should be given to how nurse leaders can be distressed by digitalization.

IMPACT

This study provides insight into leadership in the context of digitalized specialized medical care based on nurse leaders' direct statements. Furthermore, the results highlight nurse leaders' educational needs concerning digitalization. Adequately educating nurse leaders to become e-leaders is crucial to successful digitalization in the nursing domain.

PATIENT OR PUBLIC CONTRIBUTION

The study focused on nurse leaders' experiences.

Paljon palveluita tarvitsevien asiakkaiden kokemuksia terveydenhuollon etäpalveluiden mahdollisuuksista terveyden ja hyvinvoinnin edistämisessä ja hoidossa COVID-19 aikana: Laadullinen haastattelututkimus

Koronaviruksen leviäminen Suomeen vuonna 2020 joudutti jo käynnissä olevaa terveyspalveluiden digitalisointia. Digitalisaation leviäminen on nostanut riskiä eriarvoisuuden lisääntymiseen eri potilasryhmissä. Tämän haastattelututkimuksen tarkoituksena oli kuvata paljon palveluita tarvitsevien asiakkaiden kokemuksia terveydenhuollon etäpalveluiden mahdollisuuksista terveyden ja hyvinvoinnin edistämisessä sekä hoidossa COVID-19 aikana. Tutkimuksen tuottamaa tietoa voidaan hyödyntää etäpalveluiden kehittämisessä ja johtamisessa sekä ammattilaisten koulutuksessa. Tutkimus toteutettiin kuvailevana laadullisena haastattelututkimuksena, joka koostui paljon palveluita tarvitsevien asiakkaiden (n=30) puolistrukturoiduista yksilöhaastatteluista. Haastateltavat valittiin satunnaisotannalla yhden keskisuuren kaupungin asiakasrekisteristä. Haastattelut toteutettiin puhelimitse helmikuun ja toukokuun 2021 välisenä aikana. Litteroidut tekstit analysoitiin induktiivisella sisällönanalyysillä. Tuloksista muodostui neljä pääluokkaa ja yhdeksän yläluokkaa. Paljon palveluita tarvitsevat toivat esiin etäpalveluiden terveyttä ja hyvinvointia edistäviä mahdollisuuksia, kuten omahoidon mahdollistuminen ja terveyden ja hyvinvoinnin edistäminen etäpalveluilla. Haastateltavien kokemusten mukaan etäpalveluiden saavutettavuuteen vaikuttavia tekijöitä olivat etäpalveluiden helppokäyttöisyys ja saatavuus sekä palveluihin pääsyä edistävät toimenpiteet. Etäpalveluihin liittyvään osaamiseen vaikuttavat tekijät olivat taitoihin tai sairauteen liittyvät haasteet, ohjelmien käytettävyyteen liittyvät haasteet sekä etäpalveluiden koulutuksen ja ohjauksen puuttuminen. Etäpalveluiden käyttöön liittyvät mieltymykset liittyivät henkilökohtaisiin syihin sekä fyysistä läsnäoloa vaativiin asiakkaisiin ja käynteihin. Johtopäätöksenä voidaan todeta, että etäpalveluiden saatavuus ja käytettävyys sekä paljon palveluita tarvitsevien asiakkaiden digitaalinen osaaminen vaikuttavat etäpalveluiden käyttöön. Etäpalveluita pitäisi kehittää helppokäyttöisemmiksi ja tarjota palveluita monipuolisesti erityisesti niille, joiden digitaalinen osaaminen on riittävä etäpalveluiden käyttöön. Etenkin videovastaanoton mahdollistaminen koettiin tärkeäksi. Lähipalveluita on tärkeää edelleen tarjota niitä tarvitseville.

Nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence in specialized medical care: An interview study

AIM

To describe nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence (AI) in specialized medical care.

BACKGROUND

Use of AI has rapidly increased in health care. However, nurse leaders' and developers' perceptions of AI and its future in specialized medical care remain under-researched.

METHOD

Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis.

RESULTS

The data yielded 25 sub-categories, 10 categories and three main categories of participants' perceptions. The main categories were designated AI transforming: work, care and services and organizations.

CONCLUSIONS

According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians' and leaders' work as well as for organizations and patients.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians' workflows.

Primary healthcare managers' perceptions of management competencies at different management levels in digital health services: secondary analysis

PURPOSE

The purpose of this study is to describe primary health-care managers' perceptions of management competencies at different management levels in digital health services using the management competency assessment program as a framework.

DESIGN/METHODOLOGY/APPROACH

A secondary analysis study involving 21 semi-structured individual interviews was conducted among Finnish primary health-care managers at different management levels (frontline, middle and senior). The deductive framework method was used to analyze the data.

FINDINGS

Similarities and differences were found in management competencies between different levels of management. Competencies related to the use of digitalization were highlighted by managers at all management levels. Managers at all management levels were involved in developing digital solutions and supporting employees in using digital solutions in their work. Frontline and middle managers emphasized more issues related to day-to-day management and communication with employees, whereas senior managers highlighted the management of large entities.

RESEARCH LIMITATIONS/IMPLICATIONS

In the secondary analysis, data were used for purposes other than originally intended. Therefore, the data are subject to limitations of the methodology applied and should be transferred to other contexts with caution.

PRACTICAL IMPLICATIONS

Identifying the management competencies needed to manage digital health services is important to target managers' training according to needs in the future.

SOCIAL IMPLICATIONS

The results could be used to develop the management of digital health services, as well as improve digital health services and their deployment.

ORIGINALITY/VALUE

Previous literature mostly examined managers' informatics competencies and paid little attention to other management competencies. This study discusses more broadly the management competencies that digital health services require from managers at different levels of management.

Leadership in the Context of Digital Health Services: A Concept Analysis

AIM

To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model.

BACKGROUND

Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research.

METHOD

Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO), and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents, or consequences of leadership in the study context. A total of 4,037 references were identified; 23 were included.

RESULTS

Leadership attributes concerned leaders' behavior, roles, and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity, and education. Consequences related to organization, professionals, and patient and care.

CONCLUSION

Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth, and benefit clinicians and patients.

Health and social care frontline leaders’ perceptions of competence management in telemedicine in Finland: An interview study

AIM

This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders.

BACKGROUND

The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices.

METHODS

The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis.

RESULTS

The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals' competence in telemedicine.

CONCLUSIONS

Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations.

IMPLICATIONS FOR NURSING MANAGEMENT

Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community.

Identified gamification opportunities for digital patient journey solution during an arthroplasty journey: secondary analysis of patients' interviews

Aim

The use of gameful design for supporting health‐related behaviours has been one of the major trends in health technology. An opportunity to increase engagement and motivation in a given health behaviour and the possibility of reaching improved outcomes through continued or consistent behaviour could be provided by gamification. This study aimed to identify gamification opportunities for digital patient journey solutions to increase patients' engagement and motivation for health‐related behaviour during an arthroplasty journey.

Design

A secondary analysis.

Method

Semistructured interviews were performed among 20 elective primary total hip and knee arthroplasty patients in a single joint‐replacement centre in Finland during autumn 2018. NVivo software was used for deductive content analysis. The study was conducted among 20 patients in a single joint replacement centre during 2018.

Results

Several opportunities for gamification were identified for digital patient journey solutions, which could be used in advanced care to increase patients' engagement and motivation for health‐related behaviour during the arthroplasty journey. These opportunities were identified related to five dimensions: accomplishment, challenge, guided, playfulness and social experience. Clear, scheduled, progressive and personalized goals with an activity tracking, real‐time timespan visualization and social networking with peers, support networks and healthcare providers could be provided. Opportunities for competition and immersion were not identified.

How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals

BACKGROUND

Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals' routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more.

OBJECTIVE

The aim of this study is to examine health and social care professionals' experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals' routine work.

METHODS

A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory.

RESULTS

Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals' routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals' work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals' work tasks.

CONCLUSIONS

We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services.

Leaders' support for using online symptom checkers in Finnish primary care: Survey study

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders' support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders' support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders' support for the service (β ranging from 0.41 to 0.44, p < 0.001). Leaders' support for the service was also associated with how well the leaders provided information about the service to their subordinates (β =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals' work. The developers of SCs should focus more on features that decrease health professionals' workload as well as how the solution can benefit patients.

Adult patients' experiences of patient-professional communication in patient portals: a qualitative systematic review protocol

Objective:

The objective of the review is to identify, critically appraise, and synthesize the best available evidence on adult patients’ experiences of patient-professional communication in patient portals.

Introduction:

Alongside face-to-face communication, patient portals can improve care quality and patients’ self-management of chronic diseases. It is important to examine how patients experience patient-professional communication in patient portals because this digital environment inherently lacks non-verbal messages, which can lead to misunderstandings.

Inclusion criteria:

Qualitative studies that describe patients’ experiences of reciprocal patient-professional communication in patient portals will be included. Patients must be over the age of 18 years and have a need for long-term care delivered by a health care professional (eg, patients with chronic diseases, such as cancer or diabetes). The health care professionals considered for inclusion are the members of the patient's health care team who communicate with the patient using patient portals. A patient portal is defined as a personal health record, which is either an independent webpage or interconnected with an electronic health record.

Methods:

The following databases will be searched: MEDLINE (PubMed), CINAHL (EBSCO), ProQuest (Abi/Inform), Scopus, Medic, Google Scholar, Science Direct and Cochrane CENTRAL. Gray literature will be searched in MedNar. Studies published in English, Finnish, or Swedish will be considered, and there is no date limitation. Studies will be screened and critically appraised for methodological quality by two independent researchers. Data will be extracted using a standardized tool from JBI SUMARI. Data synthesis will be conducted according to the meta-aggregation approach. Confidence in the evidence will be assessed using the ConQual approach.

Systematic review registration number:

PROSPERO CRD42021286177

Remote leadership in health care: a scoping review

Purpose

The degree of remote working has increased in the health-care sector, but remote leadership in health-care contexts has not been systematically studied. Thus, the purpose of this review was to map existing literature and research themes of remote leadership in health care and identify potential research gaps to guide future studies.

Design/methodology/approach

A scoping review with narrative synthesis was conducted, covering all published literature addressing remote, virtual, online or distance leadership practices. The ABI/INFORM Collection, CINALH, PsycArticles, Scopus and Web of Science, MedNar, Open Grey and PQDT Open databases were searched electronically, and Finnish Journal of eHealth and eWelfare was searched manually.

Findings

In total 15 articles were included in the review. Most literature concerning remote leadership in health care has been published during the past three decades. The main themes discerned in this research stream are related to interactions, work environments, leadership in practice, use of technology and needs for more study of remote leadership and guidance for remote leaders.

Research limitations/implications

Research on remote leadership in health care is limited, patchy and associated concepts vary substantially. More comprehensive research on the phenomenon is needed, with more systematic attention to, and coverage of, relevant populations, concepts, contexts and the identified themes.

Originality/value

To the best of the authors’ knowledge, this appears to be the first review to map research on remote leadership in health care and identify research gaps, which is important as its prevalence has rapidly increased.

The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study

BACKGROUND

The use of information systems takes up a significant amount of nurses' daily working time. Increased use of the systems requires nurses to have adequate competence in nursing informatics and is known to be a potential source of stress. However, little is known about the role of nursing informatics competence and stress related to information systems (SRIS) in the well-being of nurses. Moreover, the potential impact of nurses' career stage on this matter is unknown. This study examined whether SRIS and nursing informatics competence are associated with stress and psychological distress in newly graduated nurses (NGNs) and experienced nurses.

METHODS

A cross-sectional study was conducted in Finland between October and December 2018. The participants were NGNs (n = 712) with less than two years of work experience and experienced nurses (n = 1226) with more than two years of work experience. The associations of nursing informatics and SRIS with nurses' stress and psychological distress were analyzed with linear regression analysis. Analyses were conducted separately for NGNs and experienced nurses. Models were adjusted for age, gender, and work environment.

RESULTS

SRIS was associated with stress / psychological distress for both NGNs (β = 0.26 p < 0.001 / β = 0.22 p < 0.001) and experienced nurses (β = 0.21 p < 0.001/ β = 0.12 p < 0.001). Higher nursing informatics competence was associated with lower stress (β = 0.20 p < 0.001) and psychological distress (β = 0.16 p < 0.001) in NGNs, but not among experienced nurses.

CONCLUSIONS

SRIS appears to be an equal source of stress and distress for nurses who are starting their careers and for more experienced nurses, who are also likely to be more experienced users of information systems. However, informatics competence played a more important role among NGNs and a lack of adequate competence seems to add to the strain that is already known to be high in the early stages of a career. It would be important for educational institutions to invest in nursing informatics so that new nurses entering the workforce have sufficient skills to work in increasingly digital health care.

The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study

BACKGROUND

Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses' workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses' well-being.

OBJECTIVE

This study aimed to examine the association between using a mobile version of the EHR and nurses' perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators.

METHODS

This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other).

RESULTS

Nurses who used the mobile version of their EHR had higher levels of time pressure (F_1,3537=14.96, P<.001) and stress related to information systems (F_1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F_1,3581=14.93, P<.001), ease of use (F_1,3577=10.16, P=.001), and technical quality (F_1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs.

CONCLUSIONS

According to our results, it seems that at present mobile device use is not beneficial for the nurses' well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses' workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses.

Customer value creation in the development of digital health services: discourse analysis

The study’s aim was to describe how customer value creation is reflected in the development of digital health services. To this end, we used discourse analysis to evaluate documentation from the ODA (Self-Treatment and Digital Value Services) project, which provides national-scale digital health services. Three main discourses emerged: 1) a discourse on the active role of the customer, 2) a discourse on technology that activates the customer to create value, and 3) a discourse on the benefits of customer value creation. The research provided new insight into customer value creation in digital health service development. Speech about customer value creation was a part of the social reality of the digital health service’s development. The customer appeared as an active player and a key resource within the service. The role of the active customer was considered demanding and responsible. Our findings suggest that the new digital service changed customer behavior, with technology acting as an enabler of this change. Customer activity and information sharing were seen as enablers of value creation and the associated benefits, and there was a willingness to strengthen the customer’s role as a need determiner.

Muutos psykiatristen avohoitokäyntien toteutuksessa ja johtajien kokemukset etäasiointia estävistä ja edistävistä tekijöistä COVID-19 aikakaudella

Psykiatrisia avohoidon palveluita on digitalisoitu aktiivisesti jo ennen koronavirusepidemiaa, mutta varsinkin epidemian käynnistymisen jälkeen etäasioinnin merkitys on kasvanut. Tämän poikkileikkaustutkimuksen tavoitteena oli selvittää, kuinka koronaepidemia on vaikuttanut psykiatristen avohoitokäyntien toteutusmuotoon ja kuvailla psykiatristen erikoissairaanhoidon palveluiden johtajien kokemuksia etäasioimisesta. Tutkimuksen tuloksia voidaan hyödyntää psykiatristen avohoitopalveluiden arvioinnissa sekä kehittämisessä sekä jatkotutkimuksessa. Kyselyaineisto kerättiin osana COVID-19 tilannekuvaseurantaa sähköisellä kyselylomakkeella koronaepidemian käynnistymisen jälkeen toukokuussa 2020. Kyselyssä oli sekä strukturoituja että avoimia kysymyksiä. Kyselyyn vastasi 39 aikuispsykiatrian, nuorisopsykiatrian ja lasten psykiatrian toimialojen esimiestä ja johtajaa 19 eri sairaanhoitopiiristä. Kvantitatiiviset kysymykset avohoitokäyntien toteutusmuotojen määrästä raportoitiin prosenttiosuuksina ja avointen kysymysten vastaukset analysointiin induktiivisella sisällönanalyysillä. Tulosten perusteella etäasioinnin suhteellinen osuus kaikista asiointitavoista kasvoi voimakkaasti koronaepidemian käynnistymisen jälkeen. Psykiatrisista avohoitokäynneistä toteutettiin puhelimitse tai etäyhteydellä tammikuussa 9% ja toukokuussa 48% (39 prosenttiyksikön kasvu). Etäasiointia haastoivat välineiden riittämättömyys ja toimimattomat ohjelmat, asiakkaiden puuttuvat laitteet, yhteydet ja tilat, etäasioinnin soveltumattomuus kaikkeen toimintaan, ammattihenkilöiden ja asiakkaiden negatiivinen asennoituminen, riittämätön osaaminen etäasioinnin käyttöön ja organisatoriset ongelmat. Etäasiointia edistivät asiakkaiden ja ammattihenkilöiden myönteinen asenne ja ilmapiiri, koronaepidemian aiheuttama tarve etäasioinnille, etäasioinnin soveltuvuus ja tuttuus psykiatrisissa avohoitopalveluissa, asiakkaiden aikaisempi tuntemus, pitkät välimatkat, toimivat etäverkostot ja ajansäästö, toimiva tekniikka, ohjelmistot ja välineet sekä riittävä tuki. Etäasiointi on mahdollistanut epidemiatilanteessa psykiatristen avohoitopalveluiden tarjoamisen niille asiakkaille, joille etäasiointi soveltuu ja jotka kykenevät etäasiointiin. Etäasioinnin merkitys koronaepidemian aikana on ollut tärkeä, mutta etäasioinnin lisäksi on tärkeää innovoida ratkaisuja, kuinka psykiatrisia avohoitopalveluita voitaisiin toteuttaa niille asiakkaille, joille etäasiointi ei syystä tai toisesta sovellu.

Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions

INTRODUCTION

The use of eHealth is rapidly -->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth.

OBJECTIVE

Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency.

METHODS

We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model.

RESULTS

This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation.

CONCLUSIONS

We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and user-centered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.

Leadership in Digital Health Services: Protocol for a Concept Analysis

Background

Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research.

Objective

The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services.

Methods

The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar.

Results

An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021.

Conclusions

A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25495

Health Care Professionals' Experiences of Patient-Professional Communication Over Patient Portals: Systematic Review of Qualitative Studies

Background

The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals’ experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care.

Objective

This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals.

Methods

Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals’ experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute’s quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers.

Results

A total of 6 analytical themes concerning health care professionals’ experiences of web-based patient-professional communication were identified. The themes were related to health care professionals’ work, change in communication over patient portals, patients’ use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles.

Conclusions

Health care professionals’ experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals’ negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.

The association of nurses’ informatics competence with distress and information system-related stress

Background

Ability to use information systems is a crucial part of nurses' competence, but evidence on whether this competence is associated with stress among nurses is lacking. As part of the 'Towards socially inclusive digital society: Transforming service culture' (DigiIN, funded by the Strategic Research Council, project 327145), we examined the associations of registered nurses' informatics competence with distress and information systems related stress.

Methods

The data was collected in Finland with an electronic survey at the end of 2018. The sample comprised 1639 nurses. Analyses of covariance were used to examine whether the nurses' informatics competence was associated with distress and information system-related stress. In addition to overall informatics competence, we also examined the associations of four dimensions of informatics competence (terminology based documentation; e-documentation according to structured national headings; general IT competency; patient-related digital work) with dependent variables. Models were adjusted for age, gender and employment sector.

Results

Nurses' overall informatics competence was associated with lower distress (F = 9.90 p = 0.002), but not with information system-related stress. The analyses with four competence dimensions showed that patient-related digital work competence was associated both with lower distress (F = 3.95 p = 0.047) and information system-related stress (F = 4.63 p = 0.032). In addition, general IT competency was associated with information system-related stress (F = 12.6 p &lt; 0.001).

Conclusions

Especially lack of patient-related digital work competence seems to stress nurses. Supporting nurses in patient-related digital work and improving nurses' general IT competency by training could decrease their stress related to information systems and improve their wellbeing.

Key messages

Nurses should be supported more in patient-related digital work. Nurses’ high IT competency is associated with lower stress, and thus, healthcare organizations may benefit from providing more IT training for nurses to decrease their stress levels.

Informatics competences of registered nurses – does the graduation year matter?

Background

Digital services have become an essential part of nurse's work and nursing informatics competence a prerequisite for nurses to carry out their professional roles. Urgent investments are needed in informatics competence development and integrating informatics into nursing curricula. However, this has shown to be a challenge in many countries. In 2015, Finnish eHealth strategies emphasised the importance of investing more in informatics education for health professionals. This study evaluated whether these strategies have succeeded in increasing the informatics competences of registered nurses.

Methods

The data were collected in Finland with an electronic survey (end of 2018). The sample comprised 1639 nurses who were categorised in eight groups based on their graduation year. Analysis of covariance was used to examine whether the graduation year was associated with nurses' overall informatics competence and four specific competences (terminology based documentation; patient-related digital work; general IT competency; e-documentation according to structured national headings). Models were adjusted for age, gender, work setting and geographical area.

Results

Graduation year was associated with the nurses' overall informatics competence (F = 4.91 p &lt; 0.001) and specific competences related to terminology based documentation (F = 5.27 p &lt; 0.001), patient-related digital work (F = 4.00 p &lt; 0.001) and general IT competency (F = 3.63 p = 0.001). Nurses graduated after the 2015 strategies (between 2016 and 2018) had the highest competence. The earlier the nurses' graduation year was the lower the nursing informatics competences.

Conclusions

Existing eHealth strategies may have urged Finnish nursing programs to add more informatics training in their curricula. Nurses' informatics competence affects the quality of health care, thus, more training should be provided especially for nurses with earlier graduation years who have not had formal nursing informatics education.

Key messages

Results highlight the importance of having eHealth strategies with educational initiatives stating the directions and objectives of education programs. Healthcare organisations should invest in providing more in-service education in nursing informatics especially for those nurses who have not had informatics included in their undergraduate studies.

Identifying the Roles of Healthcare Leaders in HIT Implementation: A Scoping Review of the Quantitative and Qualitative Evidence

Despite major investment, health information technology (HIT) implementation often tends to fail. One of the reasons for HIT implementation failure is poor leadership in healthcare organisations, and thus, more research is needed on leaders' roles in HIT implementation. The aim of the review was to identify the role of healthcare leaders in HIT implementation. A scoping review with content analysis was conducted using a five-step framework defined by Arksey and O'Malley. Database searches were performed using CINAHL, Business Source Complete, ProQuest, Scopus and Web of Science. The included studies were written either in English or Finnish, published between 2000 and 2019, focused on HIT implementation and contained leadership insight given by various informants. In total, 16 studies were included. The roles of healthcare leaders were identified as supporter, change manager, advocate, project manager, manager, facilitator and champion. Identifying healthcare leaders' roles in HIT implementation may allow us to take a step closer to successful HIT implementation. Yet, it seems that healthcare leaders cannot fully realise these identified roles and their understanding of HIT needs enforcement. Also, healthcare leaders seem to need more support when actively participating in HIT implementation.

Consumer-led health-related online sources and their impact on consumers: An integrative review of the literature

The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers' 'voice'. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources.