Patient-targeted education (ePRO-E) to increase ePRO intent within an Alliance clinical trial (A221805-SI1).

BACKGROUND: The Patient Cloud ePRO app was adopted by the National Cancer Institute National Clinical Trials Network (NCTN) to facilitate capturing electronic patient-reported (ePRO) outcome data, but use has been low. The study objectives were to test whether a patient-targeted ePRO educational resource (ePRO-E) would increase ePRO intent (number of users) and improve data quality (high quality: ≥80% of the required surveys submitted) within an ongoing NCTN study. METHODS: The ePRO-E intervention, a patient-targeted educational resource (written material and 6-minute animated YouTube video), was designed to address ePRO barriers. ePRO intent and data quality were compared between 2 groups (N = 69): a historical control group and a prospectively recruited intervention group exposed to ePRO-E. Covariates included technology attitudes, age, sex, education, socioeconomic status, and comorbidity. RESULTS: Intervention group ePRO intent (78.8%) was statistically significantly higher than historical control group intent (47.1%) (P = .03). Patients choosing ePRO versus paper surveys had more positive and higher technology attitudes scores (P = .03). The odds of choosing ePRO were 4.7 times higher (95% Confidence Interval [CI] = 1.2 to 17.8) (P = .02) among intervention group patients and 5.2 times higher (95% CI = 1.3 to 21.6) (P = .02) among patients with high technology attitudes scores, after controlling for covariates. However, the 80% submission rate (percentage submitting ≥80% of required surveys) in the ePRO group (30.6%) was statistically significantly lower than in the paper group (57.9%) (P = .05). CONCLUSIONS: ePRO-E exposure increased ePRO intent. High technology attitudes scores were associated with ePRO selection. Since the ePRO survey submission rate was low, additional strategies are needed to promote high-quality data submission.

Effects of the pandemic on adolescent and caregiver attitudes towards telemedicine use.

BACKGROUND: Telemedicine use increased during the COVID-19 pandemic. We compared both adolescent/caregiver attitudes towards telemedicine pre- and intra-pandemic. MATERIALS AND METHODS: In a tertiary care setting with a large remote catchment area, we conducted qualitative analysis of structured interviews with dyads of 11 to 18-year-old patients and their caregivers using NVivo during the pandemic and compared the findings to our previous research [1]. RESULTS: We enrolled 14 dyads (35 ± 27 in-person visits and 4 ± 3 telemedicine visits per participant) and compared these with 11 dyads before the pandemic. Adolescents' mean age was 15.2 ± 2.1 years (range 11.2 - 18.2). The median distance to our medical center was 184.8 km (range 3.9 - 1,214 km, 6 dyads > 100 km). While the preferred ratio of telemedicine to in-person visits was 2 : 1 in caregivers (like pre-pandemic), many emphasized telemedicine as the safer option. Interestingly, adolescents preferred more in-person visits during the pandemic (1 : 1 ratio) compared to pre-pandemic (2 : 1 ratio). Qualitative analysis identified two main themes: consultation-specific factors and contextual factors. Consultation-specific factors were more valued during in-person visits, especially by adolescents. Consultation-specific factors remained the same pre- and post-pandemic, however, adolescents more often emphasized comfort, communication, and personal connection for in-person visits during the pandemic. Contextual factors were valued for telemedicine by adolescents and caregivers, and telemedicine was identified as the norm during the pandemic. Interestingly, the two main contextual themes pre-pandemic: frustration with technological aspects of telemedicine and adolescents not taking telemedicine seriously, disappeared during the pandemic. No disadvantages for telemedicine in the contextual factors were identified during the pandemic. CONCLUSION: The COVID-19 pandemic changed the user-expressed attitudes (especially among adolescents) on the transfer to telemedicine for chronic care.

Understanding the influencing factors and mechanism of social compensation for Chinese older adults using social media in the context of smart home: a qualitative analysis.

As a new generation of necessary terminals for future homes, smart homes have become one of the essential mediums for smart aging at home. This paper aims to explore how older adults who age at home can overcome the digital divide of the new medium and achieve social participation in the home context to realize active aging. Based on the theory of social compensation, we select the smart-home smart screen, a representative new medium product in China, and carry out open coding, spindle coding, selective coding, and theoretical construction of the original interview data through the grounded theory research method. The results show that the main factors affecting the social compensation of older adults to smart home social media include user interface quality, interaction quality, content quality, and service quality, and these four factors are used as external variables to compensate older adults socially, thereby stimulating the emotional experience and perception changes at the cognitive level of older adults and then affecting the adoption and acceptance of smart home social media by older adults. This study refines the factors influencing the older adults' use of smart home social media from the perspective of social compensation. It explains the mechanism of acceptable behavior of older adults, bridging the gap in previous literature on the influencing factors and behavioral mechanisms of older adults of smart home social media. This paper provides a theoretical basis and guidance for the subsequent academic research and software development practice of social media under new technological devices to further help older adults in China achieve active and healthy aging.

Nursing Students' Computer Anxiety and Attitudes Before and During the COVID-19 Pandemic.

Purpose of this research was to investigate how the COVID-19 pandemic affected the level of computer anxiety of nursing students and also their attitude related to computer use. A cross-sectional study was conducted in two periods, one before the COVID-19 pandemic (1st period) and the second during the COVID-19 pandemic (2nd period). The research instrument consisted of three parts, a questionnaire with questions about demographic and educational characteristics such as gender and semester of study, the Computer Anxiety Rating Scale (CARS), that used to assess the nursing students' levels of computer anxiety and the Computer Attitude Scale (CAS) that used to measure nursing students' positive and negative attitudes towards computers. Data from 957 undergraduate nursing students were obtained. Specifically, in the 1st period, 370 nursing students participated (38.66%), while in the 2nd period 587 (61.34%) undergraduates participated. The anxiety of participants during COVID-19 pandemic period was reduced compared to that of participants before the COVID-19 period. Respondents during the COVID-19 pandemic have fewer negative feelings towards computers, based on their answers in contrast to the participants in the study before the COVID-19 pandemic. Computer anxiety and attitudes have change among nursing students among COVID-19 pandemic. Nursing students after the implementation of online training are reporting positive feeling towards computer use and are more confident for their ICT skills.

Workers' Acceptance of Digital Procedures: An Application of the Technology Acceptance Model.

OCCUPATIONAL APPLICATIONSThere are increasing numbers of organizations that are implementing digital procedures (e.g., standard operating procedures). These efforts are often assumed to be a positive development but can be quite costly-both in terms of money and training for a digital rollout. As a result, organizations and practitioners may find themselves at risk for failure when implementing digital procedures. The results of the current study suggest that if workers perceive digital procedures as useful and easy to use, this perception translates into positive attitudes, which subsequently result in fewer deviations. Since acceptance is relatively easy to assess, practitioners can benefit from using these assessments prior to a digital transition/roll-out to both compare competing hardware and software applications, and to initiate and continuously monitor the development of digital procedures. We consider this approach as advantageous to having management develop a system and fully deploying digital procedures without any consideration of worker acceptance.

Background: There is increasing prevalence of digital procedures being introduced in the process safety industries. Presumably, this increase is due to a desire to take advantage of the technology afforded to workers that otherwise is not inherent to traditional paper-based procedures. A critical question that has not been addressed, though, is to what extent do workers accept this new technology in a new digital procedure rollout? Furthermore, does acceptance lead to procedure-related behavior, such as procedure deviations?Purpose: We used the technology acceptance model (TAM), which includes two dimensions of technology acceptance­perceived usefulness (PU) and perceived ease of use (PEU)­as the focal antecedent constructs. We hypothesized that these constructs would predict more proximal attitudes toward procedures, which in turn predict procedure deviations.Method: We used path analyses to test six study hypotheses developed from the TAM. Data were collected from 16 workers at a large, international chemical corporation that worked in logistics. Specific measures obtained were from multi-item, Likert-scale measures of the TAM-PU and PEU dimensions, utility and compliance attitudes toward procedures, and procedure deviation frequency.Results: Four of the six study hypotheses were supported. TAM-PU and TAM-PEU both significantly predicted (positively) utility attitudes toward procedures (71% variance explained), whereas only TAM-PU significantly predicted (positively) compliance attitudes toward procedures (63% variance explained). In turn, only compliance attitudes significantly predicted (negatively) how frequently workers deviated from procedures (27% variance explained).Conclusions: These results suggest that workers were generally accepting of the digital procedures and that worker perceptions of perceived usefulness perceptions likely have an indirect effect on procedure deviation frequency. We see this study as a novel contribution to the process safety and procedures research domain. Limitations and future research directions will be discussed.

Perceptions of Learning Activities in Electronic Health Record Transition.

Learning activities are at the front-line of first impressions. In this paper, the education and training program for a large electronic health record transition project is presented. Management, and staff were interviewed before, during, and after implementation on their perception, reception, and benefit of various learning activities. Daily clinical work and obligations complicate adherence to learning programs, and the clinical professions differ in their approach to mandatory activities. Local learning activities empower staff, and planners should consider embedding room for adjustment of learning program during implementation.

Going digital in Germany: An exploration of physicians' attitudes towards the introduction of electronic prescriptions - A mixed methods approach.

PURPOSE: Digitalization of medical prescriptions is a core element for the digitalization of healthcare. While some countries have introduced electronic prescriptions over 20 years ago and nearly reached 100 % penetration, physicians in Germany have only been able to use electronic prescriptions since mid-2021 and currently only 0.1 % of prescriptions are transmitted electronically. This study investigates German physicians' viewpoint towards electronic prescriptions as a potential reason for the low penetration and investigates levers to drive adoption. BASIC PROCEDURES: We conducted a two-stage sequential mixed methods study consisting of semi-structured interviews followed by an online survey among 1136 physicians testing the main dimensions of the Unified Theory of Acceptance and Use of Technology model. MAIN FINDINGS: Our initial interviews suggested that there was a high technology acceptance by physicians, but due to technical barriers, they were not able to use the system, explaining the low penetration. However, with the larger sample size of the survey, we identified, that while physicians see barriers for introducing electronic prescriptions, such as unclear cost reimbursement or lack of time to deal with the implementation, the majority believes these can be overcome within twelve months. Furthermore, we found that only one third of physicians is in favor of replacing paper-based prescriptions with electronic prescriptions and most physicians considers it unlikely that they will issue more than half of their prescriptions electronically within the next twelve month. Additionally, respondents perceived limited usefulness and expect high effort for using electronic prescriptions. PRINCIPAL CONCLUSION: Low electronic prescription penetration in Germany seems to be driven by low technology acceptance, not technical barriers. This can be linked to low perceived usefulness, high effort expectancy and low perceived patient demand. Improving technical stability, system functionality and increasing physicians' level of information were seen as main levers to drive electronic prescription adoption.

What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors.

BACKGROUND: The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition. METHODS: This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity. RESULTS: The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use. CONCLUSION: This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.

[THE DEVELOPMENT OF TELEMEDICINE TECHNOLOGIES AND THE ATTITUDE OF SENIOR CITIZENS TO THEIR USE].

The purpose of the study presented in this paper is to consider the attitude of senior citizens (aged 65 years and older) to telemedicine technologies and their readiness to use them.Telemedicine has become widespread in recent years, and its use will expand in the near future. Telemedicine technologies have proved to be an effective tool for solving a number of problems: providing access to medical consultations, prompt response of medical workers to patient requests, monitoring of health indicators, etc. However, the prevalence of the use of these technologies is differentiated in different age groups. Due to the fact that elderly citizens are not active users of digital gadgets, the introduction of telemedicine technologies into their daily practice of taking care of their own health is in many ways difficult.

Satisfied or not satisfied? Electronic health records system implementation in Ghana: Health leaders' perspective.

BACKGROUND: Electronic Health Records (EHR) has been espoused to be an innovation from the paper-based system, with benefits such as fast access to patient information thereby facilitating healthcare provider communication, healthcare continuity and improved quality of care. However, it is the extent of the quality of the electronic health records that determines the access to these stated benefits. The quality of health care records indirectly contributes to patient safety because inaccurate patient data can lead to improper diagnosis and consequently wrong treatment of patients. Most hospitals in Ghana, have recently transitioned into the EHR system, hence, there is a need to assess its accuracy, impact on workflow, staff training on usage, support from the EHR team, and the overall satisfaction of the EHR system. As health leaders are at the frontline of its implementation, their views on the challenges and successes of the EHR system are imperative. METHOD: This qualitative study sought to explore the views of the health leaders on the implemented electronic health records system in nine (9) hospitals within three (3) regions in Ghana. Following ethical approval, GHS-ERC:007/04/21, focus group discussions were conducted with a minimum of 10 hospital leaders in each facility. These included quasi, government and private hospitals. Data was collected between September and November 2021. RESULTS: The study found poor quality of records, lack of involvement of frontline clinicians in the development of the EHR system, inadequate training of staff and limited workstations as some of the challenges associated with the use of EHR in hospitals. Health leaders were generally not satisfied with the EHR system. CONCLUSION: It is recommended that addressing inputs from end-users as well as circulating more computers will motivate EHR usage and acceptance. Provision of additional workstations for the various units and involvement of staff in the system development would be most prudent to enable health workers to accept the EHR system in improving the quality of care.

Implementation of an integrated home internet of things system for vulnerable older adults using a frailty-centered approach.

Although integrated home internet of things (IoT) services can be beneficial, especially for vulnerable older adults, the hurdle of usability hinders implementation of the technology. This study aimed to evaluate the practical usability of home IoT services in older adults, by frailty status, and to determine the potential obstacles. From August 2019 to July 2020, we randomly selected 20 vulnerable older adults (prefrailty group [n = 11], and frailty group [n = 9]) who had already been identified as needing home IoT services in a community-based prospective cohort study, the Aging Study of the Pyeongchang Rural Area. Integrated home IoT services were provided for 1 year, and a face-to-face survey evaluating usability and satisfaction of each service was conducted. The usability of the integrated home IoT services declined gradually throughout the study. However, prefrail participants showed higher usability than frail older adults (difference-in-difference = - 19.431, p = 0.012). According to the frailty status, the change in usability for each service type also showed a different pattern. During the 12-month study period, the service with the highest satisfaction converged from various service needs to light control by remote control (77.8%) in the prefrailty group and automatic gas circuit breaker (72.7%) in the frailty group. For wider implementation of home IoT services, organizing services expected to have high usability and satisfaction based on user's frailty status is crucial. Also, providing education before service implementation might help older adults coping with digital literacy.

Conservatism predicts aversion to consequential Artificial Intelligence.

Artificial intelligence (AI) has the potential to revolutionize society by automating tasks as diverse as driving cars, diagnosing diseases, and providing legal advice. The degree to which AI can improve outcomes in these and other domains depends on how comfortable people are trusting AI for these tasks, which in turn depends on lay perceptions of AI. The present research examines how these critical lay perceptions may vary as a function of conservatism. Using five survey experiments, we find that political conservatism is associated with low comfort with and trust in AI-i.e., with AI aversion. This relationship between conservatism and AI aversion is explained by the link between conservatism and risk perception; more conservative individuals perceive AI as being riskier and are therefore more averse to its adoption. Finally, we test whether a moral reframing intervention can reduce AI aversion among conservatives.

Society for Vascular Surgery best practice recommendations for use of social media.

The use of social media (SoMe) in medicine has demonstrated the ability to advance networking among clinicians and other healthcare staff, disseminate research, increase access to up-to-date information, and inform and engage medical trainees and the public at-large. With increasing SoMe use by vascular surgeons and other vascular specialists, it is important to uphold core tenets of our commitment to our patients by protecting their privacy, encouraging appropriate consent and use of any patient-related imagery, and disclosing relevant conflicts of interest. Additionally, we recognize the potential for negative interactions online regarding differing opinions on optimal treatment options for patients. The Society for Vascular Surgery (SVS) is committed to supporting appropriate and effective use of SoMe content that is honest, well-informed, and accurate. The Young Surgeons Committee of the SVS convened a diverse writing group of SVS members to help guide novice as well as veteran SoMe users on best practices for advancing medical knowledge-sharing in an online environment. These recommendations are presented here with the goal of elevating patient privacy and physician transparency, while also offering support and resources for infrequent SoMe users to increase their engagement with each other in new, virtual formats.

Patient and general public attitudes towards clinical artificial intelligence: a mixed methods systematic review.

Artificial intelligence (AI) promises to change health care, with some studies showing proof of concept of a provider-level performance in various medical specialties. However, there are many barriers to implementing AI, including patient acceptance and understanding of AI. Patients' attitudes toward AI are not well understood. We systematically reviewed the literature on patient and general public attitudes toward clinical AI (either hypothetical or realised), including quantitative, qualitative, and mixed methods original research articles. We searched biomedical and computational databases from Jan 1, 2000, to Sept 28, 2020, and screened 2590 articles, 23 of which met our inclusion criteria. Studies were heterogeneous regarding the study population, study design, and the field and type of AI under study. Six (26%) studies assessed currently available or soon-to-be available AI tools, whereas 17 (74%) assessed hypothetical or broadly defined AI. The quality of the methods of these studies was mixed, with a frequent issue of selection bias. Overall, patients and the general public conveyed positive attitudes toward AI but had many reservations and preferred human supervision. We summarise our findings in six themes: AI concept, AI acceptability, AI relationship with humans, AI development and implementation, AI strengths and benefits, and AI weaknesses and risks. We suggest guidance for future studies, with the goal of supporting the safe, equitable, and patient-centred implementation of clinical AI.

Barriers to learning a new technology to go online among older adults during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of using information and communication technology (ICT) to address daily and healthcare needs. The barriers for older adults in the United States to learn a new technology to go online during the pandemic remain to be studied. METHODS: Using data from the 2019-2020 National Health and Aging Trends Study (NHATS), a nationally representative survey of older Medicare beneficiaries aged 65 years and older in the United States, we used multivariable logistic regression models to identify sociodemographic and clinical factors associated with learning a new technology to go online during the COVID-19 pandemic. RESULTS: Our sample represented 23,547,688 older adults nationally, of which the majority (60.2%) increased ICT use during the COVID-19 pandemic. However, most older adults (71.8%) did not report learning a new technology to go online. Those who did not learn a new technology to go online had less of an increase in ICT use than those who learned either with help or by themselves (50.7% vs. 78.4% or 89.2% respectively, p < 0.01). The odds of learning a new technology decreased with increasing age (aOR [95%CI] = 0.96 [0.94-0.98]), being male (aOR [95%CI] = 0.56 [0.45-0.72]), having lower than high school educational attainment (aOR [95%CI] = 0.38 [0.29-0.50]), decreasing income levels (aORs ranged from 0.28 to 0.54), and self-reported fair or poor general health (aOR [95%CI] = 0.65 [0.47-0.90]). CONCLUSION: The identified sociodemographic and clinical factors could inform targeted intervention strategies to improve ICT use among older adults during the evolving COVID-19 pandemic and in the future.

Managing the tension between caring and charting: Labor and delivery nurses' experiences of the electronic health record.

Over a decade following the nationwide push to implement electronic health records (EHRs), the focus has shifted to addressing the cognitive burden associated with their use. Most research and discourse about the EHR's impact on clinicians' cognitive work has focused on physicians rather than on nursing-specific issues. Labor and delivery nurses may encounter unique challenges when using EHRs because they also interact with an electronic fetal monitoring system, continuously managing and synthesizing both maternal and fetal data. This grounded theory study explored labor and delivery nurses' perceptions of the EHR's impact on their cognitive work. Data were individual interviews and participant observations with twenty-one nurses from two labor and delivery units in the western U.S. and were analyzed using dimensional analysis. Nurses managed the tension between caring and charting using various strategies to integrate the EHR into their dynamic, high-acuity, specialty practice environment while using EHRs that were not designed for perinatal patients. Use of the EHR and associated technologies disrupted nurses' ability to locate and synthesize information, maintain an overview of the patient's status, and connect with patients and families. Individual-, group-, and environmental-level factors facilitated or constrained nurses' integration of the EHR. These findings represent critical safety failures requiring comprehensive changes to EHR designs and better processes for responding to end-user experiences. More research is needed to develop EHRs that support the dynamic and relationship-based nature of nurses' work and to align with specialty practice environments.

Systematic review automation tools improve efficiency but lack of knowledge impedes their adoption: a survey.

OBJECTIVE: We investigated systematic review automation tool use by systematic reviewers, health technology assessors and clinical guideline developerst. STUDY DESIGN AND SETTING: An online, 16-question survey was distributed across several evidence synthesis, health technology assessment and guideline development organizations. We asked the respondents what tools they use and abandon, how often and when do they use the tools, their perceived time savings and accuracy, and desired new tools. Descriptive statistics were used to report the results. RESULTS: A total of 253 respondents completed the survey; 89% have used systematic review automation tools - most frequently whilst screening (79%). Respondents' "top 3" tools included: Covidence (45%), RevMan (35%), Rayyan and GRADEPro (both 22%); most commonly abandoned were Rayyan (19%), Covidence (15%), DistillerSR (14%) and RevMan (13%). Tools saved time (80%) and increased accuracy (54%). Respondents taught themselves to how to use the tools (72%); lack of knowledge was the most frequent barrier to tool adoption (51%). New tool development was suggested for the searching and data extraction stages. CONCLUSION: Automation tools will likely have an increasingly important role in high-quality and timely reviews. Further work is required in training and dissemination of automation tools and ensuring they meet the desirable features of those conducting systematic reviews.

Searching for New Model of Digital Informatics for Human-Computer Interaction: Testing the Institution-Based Technology Acceptance Model (ITAM).

The fourth industrial revolution has produced new information technology (IT) that is widely used in the healthcare industry. Although the nature of the institution affects IT adoption, the Technology Acceptance Model (TAM), a dominant theory, has dismissed its role and influence. Our research investigates how institutions influence the adoption of new IT by using the Institution-based Technology Acceptance Model (ITAM). We conducted an empirical test by using survey data collected from 300 employees in the public sector. Structural equation modeling was applied to test the proposed hypotheses. The results showed the total effect of institutions on the intention to use new IT is positive and significant. Second, IT adoption is not only affected by external institutions but also by type of institution; the external institution takes a greater role in inducing perceived usefulness, perceived ease of use, and intention to use than does the internal. Third, perceived ease of use and perceived usefulness play mediating roles between institution and IT adoption. Fourth, an alternative expanded model to which more individual and organizational factors were added confirmed the results of the base model. We concluded that institutions have a strong impact on the level of intention for IT use through perceived ease of use and perceived usefulness.