Technological Challenges and Solutions in Emergency Remote Teaching for Nursing: An International Cross-Sectional Survey

OBJECTIVES

With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education.

METHODS

We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions.

RESULTS

We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap.

CONCLUSIONS

Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.

ICT for All: Where Do We Stand?

Although its importance is undeniable, designing in a more inclusive way is not yet fully adopted in the field of design and planning, whose reference continues to be the standard man. An approach which not only excludes people with disabilities, but also other categories that diverge from the physical and cognitive characteristics of the standard human model, such as women, the elderly, and children. This problem affects different contexts and can be observed especially in the area of Information and Communication Technologies (ICTs), which are often designed without taking into account the peculiarities that distinguish these categories of users. Referring to the categories affected by the digital divide, the article reflects on the need to promote specific methodologies, such as Universal Design and User-centered Design, so that attitudinal and psychological issues related to different categories of users are considered.

Digital Inclusion as a Lens for Equitable Parent Engagement

Digital inclusion (DI) represents a framework for educational leaders to address ongoing digital access and participation divides for adult caretakers (e.g., parents) of school-aged children, as schools continue adopting new education technology tools. This preliminary research investigates teacher perceptions of different DI needs for parents during the pandemic. This research examines teacher perceptions of parents' knowledge and use of online tools in providing supervision to support home-based learning for their student children. A sample of K-12 teachers in the United States responded to open-ended survey questions relating to their observation and evaluation of student learning, parent involvement, and DI needs in their classes. The researchers used a framework drawn from Maslow's Hierarchy of Needs to categorize key DI components teachers identified, finding both digital access and digital participation needs existed in their students' homes. Ultimately, the framework of DI recognizes that household digital access alone does not create equitable opportunities for online instruction without holistic consideration of digital literacy training, technical support, and relevant online tools for parents and caretakers.

[Digitalisation in a haste?]

The Covid 19 pandemic hit the Austrian school system in spring 2020, bringing a range of new challenges. The following phases of school closures and distance learning also promoted digitalisation processes in schools. In this context, technical equipment and digital competences of students gain importance, which bears the risk that a digital divide deepens already existing inequalities in education. This article therefore examines digitalisation in schools during the pandemic and takes a closer look at digital inequalities during distance learning. We use data from an interview study with teachers, school administrators, employees of psychosocial support systems at schools, as well as students. The findings of this study show that Covid-related school closures and distance learning go along with an expansion and a certain consolidation of teaching and learning by digital means. Yet, we see persisting problems which are linked with structural inequalities. There were no catch-up processes for socially disadvantaged students as a result of digitalisation. Rather, the factors that were already decisive for the profound inequalities in the Austrian education system before the pandemic, such as socioeconomic status, educational level of the parents, and cultural capital, continue to be of major importance for distance learning and the use of digital media in schools.

Post-Pandemic Telehealth Policy for Primary Care: An Equity Perspective

National telehealth policy thus far has focused on broadening access to service, specialties, and originating sites. Yet telehealth policy can further equity by providing system-level change needed to reduce structural determinants that hamper telehealth access in historically marginalized, low income, and limited English-speaking populations. The authors propose policy solutions for states and CMS to help address these structural determinants of telehealth care. A telehealth "ecosystem" grounded in the following core components would ensure equitable access to care: use of technology inclusive of economically marginalized patients, access to the technology and broadband for completing virtual visits, and concrete support for patients as they develop their digital and telehealth skills.

Disparities in Use of Patient Portals Among Adults in Family Medicine

OBJECTIVE

This study examined patient portal utilization by analyzing the pattern of time and feature use of patients, and thus to identify functionalities of portal use and patient characteristics that may inform future strategies to enhance communication and care coordination through online portals.

METHODS

We conducted a retrospective study of patients at 18 family medicine clinics over a 5-year period using access log records in the electronic health record database. Dimensionality reduction analysis was applied to group portal functionalities into 4 underlying feature domains: messaging, health information management, billing/insurance, and resource/education. Negative binomial regression analysis was used to evaluate how patient and practice characteristics affected the use of each feature domain.

RESULTS

Patients with more chronic conditions, lab tests, or prescriptions generally showed greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, although Medicare patients showed greater portal usage on health information management features, and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features.

CONCLUSION

Efforts to enroll patients in online portals do not guarantee patients will use the portals to manage their health. When considering the use of patient portals for improving telehealth, clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients.

'Intel Acat' Assistive Platform for Arabic Speaking Disabled People: a Complete Integration

BACKGROUND

The Intel Assistive Context-Aware Toolkit (ACAT) is the highly configurable platform used by Dr. Stephen Hawking to communicate with his environment. After being released freely to the public, we, at the Embedded Systems Laboratory - UBMA, have been working on integrating the Arabic language on the different packages of the platform in order to make it accessible for disabled people from Arabic countries and decrease their communication limitations.

OBJECTIVE

This subproject concerns the Arabic Text-to-speech engine implementation and comes as a final step toward the full integration of the Arabic language into Intel ACAT assistive platform.

METHODS

The text to speech conversions was integrated by implementing a mapping between the Arabic words and their phonetic spelling using Microsoft Text-To-Speech Synthesis on Intel ACAT modules and extensions. A full compilation was then executed and tested gathering all the modules and the features of the platform.

RESULTS

Over this final integration step (which is freely accessible and open sourced for the public), people with severe disabilities from Arabic-speaking countries will have fully access to all the features of the ACAT platform and will be able communicate and interact easily with their computers.

CONCLUSION

The Arabic language Text-to-speech engine integration on 'Intel ACAT' Assistive Platform is the final milestone of our project toward making the platform fully accessible for Arabic-Speaking users and comes after our previous integrations of the Arabic language into the keyboard, the intelligent predictive text engine and all panels and interfaces of the platform.

Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic

AIMS

This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care.

METHODS

We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published.

RESULTS

Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology.

CONCLUSIONS

Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.

Building Bridges Between Community Health Centers and Academic Medical Centers in a COVID-19 Pandemic

The threat to the public health of the United States from the COVID-19 pandemic is causing rapid, unprecedented shifts in the health care landscape. Community health centers serve the patient populations most vulnerable to the disease yet often have inadequate resources to combat it. Academic medical centers do not always have the community connections needed for the most effective population health approaches. We describe how a bridge between a community health center partner (Roots Community Health Center) and a large academic medical center (Stanford Medicine) brought complementary strengths together to address the regional public health crisis. The 2 institutions began the crisis with an overlapping clinical and research faculty member (NKT). Building on that foundation, we worked in 3 areas. First, we partnered to reach underserved populations with the academic center's newly developed COVID test. Second, we developed and distributed evidence-based resources to these same communities via a large community health navigator team. Third, as telemedicine became the norm for medical consultation, the 2 institutions began to research how reducing the digital divide could help improve access to care. We continue to think about how best to create enduring partnerships forged through ongoing deeper relationships beyond the pandemic.

Disparities in Health Care and the Digital Divide

PURPOSE OF REVIEW

Disparities in health outcomes are a well documented and worrisome part of our health care system. These disparities persist in spite of, and are occasionally exacerbated by, new technologies that are intended to improve health care. This results in a "digital divide" in which populations that have poorer health outcomes continue to have poorer health outcomes despite technological improvements.

RECENT FINDINGS

In many ways, the digitical divide is already shrinking via improved access to internet and technology/process improvements. For example, people with schizophrenia, PTSD, and bipolar disorder have had their care successfully augmented by new technology. However, problems persist- being impoverished, female, and black all correlate with decreased probability of completing a telehealth visit, and millions of americans have insufficient internet access to complete telehealth visits. We must continue to utilize new technology in health care to improve outcomes, but we must also be wary to ensure those outcomes are equitable across different populations.

World librarians: A socio-technical system providing library search services to offline schools and libraries in Malawi

World Librarians is a socio-technical system that strives to solve the information access problem many remote offline schools and libraries have in lesser developed contexts. In this Case Report, we describe the system we have developed over the course of three years, where we first establish solar-powered computer labs in remote schools and libraries in Malawi, and then provide them digital information that they want, rather than what we in the Global North think they need. After providing background on these issues, we describe the socio-technical underpinnings and workflow in the World Librarians program. This involves the establishment of "Requester nodes" in the offline schools and libraries, the management of these deployments using a cloud-based WL app, and the operations of the WL "Searcher node" at the University of Massachusetts Amherst, as well as a novel micro-payment system that enables the transfer of large digital datasets through the use of teacher or librarian cell phones and data plans. We close the report with findings from a preliminary survey suggesting that the WL program is making a positive impact on the schools and libraries served. At its core, WL represents a global librarian support system working to remove the barriers to educational information for all global citizens, with central attention and awareness to Global North/South information power dynamics.

Impact of Digital Divide on the Adoption of Online Patient Portals for Self-Motivated Patients

OBJECTIVE

Our study aimed to determine the effect of the digital divide in the adoption of online patient portals by motivated patients who wish to improve their health outcomes through the use of the Internet and information technology to assess determinants of low adoption rates of online portals and to explore social media use as a correlation to patient portal use.

METHODS

We utilized data from the Health Information National Trends Survey (HINTS) 2017 and 2018. We performed a cross-sectional study analyzing the outcome variable of patient portal use with several predictor variables, namely, age, marital status, gender, mental health, education, Medicaid, income, number of people in household, trust, social media, chronic disease, and health app use. Basic descriptive statistics and logistic regression were performed using SPSS version 25.

RESULTS

Our study found that low adoption rates go beyond the digital divide. A correlation exists between social media use and patient portal use, and the impact of previously identified factors on patients with self-motivation for health improvement.

CONCLUSION

Self-motivation is an important factor in patient portal use and access. Behavioral and motivational interventions geared towards the adoption of health information technology tools, such as online portals, can assist with improving the public health significance of these tools.

Digital Divide and Health Disparities in China: Data from a National Longitudinal Survey of CHARLS

The China Health and Retirement Longitudinal Study (CHARLS, 2013) data was used to investigate internet use and mobile phone ownership in older Chinese adults and examine digital divide and social economic status and mobile technology adoption and health outcomes associations. Results suggest a significant digital divide associated with not only individual characteristics, but also neighborhood resources. Future eHealth programs should consider the accessibility of mobile tools and develop culturally appropriate programs for different social groups.

The Role of Internet Engagement in the Health-knowledge Gap

The current research posits that education leads to differential levels of Internet engagement, which moderate the association between Internet use for health information and general health knowledge. Using a nationally representative survey that covers adults between the ages of 40 and 70 in the United States, it is found that education is positively related to Internet engagement. Also, Internet use has stronger associations with health knowledge for people exhibiting high Internet engagement than for people exhibiting low Internet engagement. The implications of these findings for research on both Internet use and knowledge gaps are discussed.