Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review.

Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious viral infection. Hospitals worldwide have decreased face-to-face visits to reduce the exposure to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Prenatal and postpartum care are essential for the health of women and their fetuses. Therefore, many hospitals have incorporated telehealth into their protocols. Objectives: The aim of this review was to determine how health care organizations are responding to the COVID-19 pandemic by incorporating telehealth visits into their protocols for obstetrics care, what services were converted to telehealth, and its benefits and barriers. Method: A computerized literature search was performed using PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases using terms, including "telehealth," "virtual visits," "obstetric," "pregnancy," "postpartum," and "COVID-19" for articles published before October 2020. Peer reviewed articles and guidelines were included in this review. Results: A total of 25 articles were identified. Fifteen articles reported protocols. During this pandemic, protocols developed replaced some in-person visits with telehealth visits, when no testing or vaccinations are required. The main reported benefits were minimizing exposure to SARS-CoV-2 and the continuity to provide high-quality and safe care. Lack of access to high-speed internet and hardware and inaccessibility to patients were the most reported barriers. Conclusion: Telehealth provided the opportunity for reducing in-person visits during the COVID-19 pandemic. Some prenatal services could be completely provided through telehealth and others require medical equipment to be delivered. Health care organizations recognized that using telehealth could be continued beyond this pandemic, as they provided many benefits for patients, medical staff, and the organizations themselves.

The Development of a Telemedicine Planning Framework Based on Needs Assessment.

Providing equitable access to healthcare services in rural and remote communities is an ongoing challenge that faces most governments. By increasing access to specialty expertise, telemedicine may be a potential solution to this problem. Regardless of its potential, many telemedicine initiatives do not progress beyond the research phase, and are not implemented into mainstream practice. One reason may be that some telemedicine services are developed without the appropriate planning to ascertain community needs and clinical requirements. The aim of this paper is to report the development of a planning framework for telemedicine services based on needs assessment. The presented framework is based on the key processes in needs assessment, Penchansky and Thomas's dimensions of access, and Bradshaw's types of need. This proposed planning framework consists of two phases. Phase one comprises data collection and needs assessment, and includes assessment of availability and expressed needs; accessibility; perception and affordability. Phase two involves prioritising the demand for health services, balanced against the known limitations of supply, and the implementation of an appropriate telemedicine service that reflects and meets the needs of the community. Using a structured framework for the planning of telemedicine services, based on need assessment, may help with the identification and prioritisation of community health needs.

Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study.

BACKGROUND: Health misinformation can adversely affect individuals' quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. OBJECTIVE: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. METHODS: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants' ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. RESULTS: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants' abilities to identify misinformation in WhatsApp messages (z=-6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the "forwarded" label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). CONCLUSIONS: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants' abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions.

Utilization of remote e-prescription (Anat) in Saudi Arabia during COVID-19: Factors associated with primary adherence and antibiotic prescription.

Background: The COVID-19 pandemic has affected healthcare systems globally. Various health care technologies have been used to mitigate the risk of disease transmission. Telemedicine is one such technology, and remote consulting and prescribing comprise one of its key aspects. In Saudi Arabia, telephone health services have been widely used through the free Medical Consultation Call Center (937). This platform facilitates medical consultations for all citizens, residents, and visitors. After consultations, healthcare providers are able to issue authenticated e-prescriptions using the Anat platform. Objectives: To explore the utilization of the Anat remote prescription system in Saudi Arabia during the COVID-19 pandemic and to identify the factors associated with antibiotic prescription and primary medication adherence. Methods: This retrospective analysis included data from the Anat e­prescription system using a stratified random sample of 25000 prescriptions issued in Saudi Arabia in 2020. Predictive factors related to the patients, practitioners, and prescriptions were identified through bivariate and multivariate logistic regression analyses. Results: Out of 25,000 e-prescriptions, 8885 were dispensed, resulting in a 35.5% primary medication adherence rate. The significant predictors of primary adherence were children, respiratory diseases, and antibacterial drugs. In addition, antibiotics made up 32.1% of the e-prescriptions. The prescription of antibiotics was significantly associated with male sex, children, genitourinary system diseases, and being treated by radiologists. Conclusions: Almost two thirds 62.2% of e-prescriptions were undispensed, with antibiotic eprescriptions at 32.1%. Findings emphasize the need to enhance primary medication adherence and antibiotic prescription interventions. These findings could aid decision-makers in improving patient-centered e-prescribing practices.

Pathologists' acceptance of telepathology in the Ministry of National Guard Health Affairs Hospitals in Saudi Arabia: A survey study.

Introduction: Evaluating users' attitudes and acceptance of telemedicine in the early phases of implementation is critical in predicting a successful adoption and utilization of the service. Telepathology does not require a patient's presence for intercommunication; therefore, it is essential to focus on the acceptance of the main occupational groups that are involved. This study aimed to assess the attitude and acceptance of telepathology in the pathology departments of the Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia. Method: A cross-sectional survey was distributed among pathologists and laboratory technologists in the pathology departments of MNGHA hospitals (N = 78). The data collection instrument was built upon the technology acceptance model's (TAM's) constructs of perceived usefulness (PU), perceived ease of use (PEU), attitude (ATT), and intention to use (ITU). Results: In total, 64 questionnaires were completed (response rate of 82%). The acceptance levels represented by the median responses to the TAM constructs, varied from 5.5 (slightly agree) to 6 (agree). The availability of digital pathology services in the workplace was significantly correlated with the participants' acceptance of telepathology. There was a strong correlation between ITU and PU and a moderate correlation between PEU and PU. Conclusion: Results suggest that telepathology is more likely to be adopted if it is considered helpful, therefore, it is recommended to focus on its usefulness and direct benefits during the training period. The participants who were familiar with the concept of digital pathology were more receptive to using telepathology, which might emphasize the importance of introducing and familiarizing the resident with digital health during their training period.

The Saudi Ministry of Health's Twitter Communication Strategies and Public Engagement During the COVID-19 Pandemic: Content Analysis Study.

BACKGROUND: During a public health crisis such as the current COVID-19 pandemic, governments and health authorities need quick and accurate methods of communicating with the public. While social media can serve as a useful tool for effective communication during disease outbreaks, few studies have elucidated how these platforms are used by the Ministry of Health (MOH) during disease outbreaks in Saudi Arabia. OBJECTIVE: Guided by the Crisis and Emergency Risk Communication model, this study aimed to explore the MOH's use of Twitter and the public's engagement during different stages of the COVID-19 pandemic in Saudi Arabia. METHODS: Tweets and corresponding likes and retweets were extracted from the official Twitter account of the MOH in Saudi Arabia for the period of January 1 through August 31, 2020. Tweets related to COVID-19 were identified; subsequently, content analysis was performed, in which tweets were coded for the following message types: risk messages, warnings, preparations, uncertainty reduction, efficacy, reassurance, and digital health responses. Public engagement was measured by examining the numbers of likes and retweets. The association between outbreak stages and types of messages was assessed, as well as the effect of these messages on public engagement. RESULTS: The MOH posted a total of 1393 original tweets during the study period. Of the total tweets, 1293 (92.82%) were related to COVID-19, and 1217 were ultimately included in the analysis. The MOH posted the majority of its tweets (65.89%) during the initial stage of the outbreak. Accordingly, the public showed the highest level of engagement (as indicated by numbers of likes and retweets) during the initial stage. The types of messages sent by the MOH significantly differed across outbreak stages, with messages related to uncertainty reduction, reassurance, and efficacy being prevalent among all stages. Tweet content, media type, and crisis stage influenced the level of public engagement. Engagement was negatively associated with the inclusion of hyperlinks and multimedia files, while higher level of public engagement was associated with the use of hashtags. Tweets related to warnings, uncertainty reduction, and reassurance received high levels of public engagement. CONCLUSIONS: This study provides insights into the Saudi MOH's communication strategy during the COVID-19 pandemic. Our results have implications for researchers, governments, health organizations, and practitioners with regard to their communication practices during outbreaks. To increase public engagement, governments and health authorities should consider the public's need for information. This, in turn, could raise public awareness regarding disease outbreaks.

A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities.

BACKGROUND: The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services. METHODS: Computerised literature searches of bibliographic databases were performed using the MeSH terms for "Telemedicine" and "Hospital Services" or "Hospital", for papers published up to May 2016. RESULTS: A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n=61, 44.5%). Almost two thirds of the services (n=86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n=81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n=83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy. CONCLUSION: Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable across studies, reducing the generalisability. The reporting of service implementation and planning strategies should be encouraged. Given the fast paced technology driven environment of telemedicine, this may enable others to learn and understand how to implement sustainable services. The key component of planning was underreported in these studies. Studies applying and reporting more rigorous methodology would contribute greatly to the evidence for telemedicine.