Registered Nurses' Digital Client Work and Associating Factors: A Cross-Sectional Study.

AIMS: To describe the frequency of digital client work among Finnish registered nurses, including video consultations, secured messaging and digital promotion of care without direct contact with the client. In addition, the study examines the association between various factors related to nurses' characteristics and work environment with digital client work and its frequency. DESIGN: A cross-sectional survey study. METHODS: A total of 2970 nurses responded to a nationwide survey in spring 2023. Descriptive statistics were used to characterise the frequency of different types of digital client work. Binary logistic regression analyses were used to examine the associations. RESULTS: One-third of the respondents reported digital client work during the last 6 months. The majority had worked digitally with their clients daily or weekly. Secured messaging was the most frequently used type of digital client work, whereas video consultations were less frequent. Nurses working in acute care, home-based care or other environments worked more frequently digitally with their clients than those working in inpatient care. Nurses with higher digital dedication and collegial support had greater odds of digital client work than those with lower dedication. Among those who reported frequent digital client work, lower skills in information security were observed. CONCLUSIONS: Given the significant variation in the frequency of digital client work among nurses across different environments, assessing broader digitalisation adoption opportunities is essential. Organisations must ensure that nurses have sufficient skills for secure handling of client data, and efforts should be made in creating motivational and supportive work environments to facilitate digital client work. IMPLICATIONS: By understanding the factors influencing nurses' digital client work, organisations can create stronger structures to support their work. Enhancing digital service availability across different healthcare settings would offer clients more care options, thereby potentially improving their access to healthcare. IMPACT: This research addresses a knowledge gap regarding the current extent of nurses' digital client work in various healthcare environments and explores potential influencing factors. As governments aim to significantly expand the provision of digital healthcare services, understanding the variation in nurses' digital client work is crucial. This information can guide targeted interventions, such as continuous education, and organisational and collegial support, facilitating dedication to use digital technologies and ensuring secure and impactful advancements in digital healthcare. Our research will benefit healthcare organisations, decision-makers, nursing professionals and educational institutions. REPORTING METHOD: Our study adheres to the relevant EQUATOR guidelines and follows the STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments.

BACKGROUND: Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how. OBJECTIVE: This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. METHODS: The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. RESULTS: A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. CONCLUSIONS: Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.

Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study.

BACKGROUND: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. OBJECTIVE: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. METHODS: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. RESULTS: Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. CONCLUSIONS: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly.

Continuing Education in Digital Skills for Healthcare Professionals - Mapping of the Current Situation in EU Member States.

The rapid advancement of technology in healthcare is creating new competency requirements for professionals, such as skills for data management and the adoption of new technologies, understanding the effect of digitalisation on clinical processes, and evaluating clinical safety and ethics within the context of digitalisation. These requirements call for improved educational curricula and ongoing continuing education in digital skills. This study, as part of the Digital Skills Training for Health Care Professionals in Oncology (DigiCanTrain) project, aims to map and describe the existing continuing education in digital skills for healthcare professionals (HCPs) in European Union (EU) Member States. Using a mapping study methodology, data was collected from experts in 25 EU countries through surveys and from online sources. Qualitative content analysis was used for categorising the data. The results show variations between countries in policy strategies, training organisation, and funding mechanisms. Educational institutions, employers, third parties, and national/regional authorities were found to be the main organisers of the digital skills training. Comprehensive accreditation systems seemed to be scarce, and practices also varied between countries. The study highlights the importance of adopting a systematic approach to enhancing continuous professional development in digital skills, which would ensure that professionals have equitable access to education, resulting in consistent, quality patient care across countries and regions. The findings offer valuable insights for policymakers, educators, healthcare institutions, and professionals.

Patterns of acceptance and use of digital health services among the persistent frequent attenders of outpatient care: A qualitatively driven multimethod analysis.

Objective: Utilising digital health services in the treatment of patients who frequently attend outpatient care could be beneficial for patients' health and the sustainability of health systems but carries the risk of digital exclusion. This study aimed to explore the patterns of acceptance and use of digital health services among frequent attenders (FAs), which may help in the assessment of patients' digital suitability. Methods: Persistent FAs (N = 30) were recruited by random sampling from one Finnish municipality. The semistructured interviews were conducted in February-May 2021. We analysed the data with qualitative content analysis using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Additionally, we quantified the data for two-step cluster analyses to create separate cluster models that grouped FAs based on acceptance and use of (a) digital services for self-management of health and (b) telemedicine services. Results: Based on digital self-management, FAs were defined as Self-Managers, Supported Self-Managers, and Non-Self-Managers. Based on telemedicine use, they were grouped into Telemedicine Users, Doubtful Telemedicine Users, and Telemedicine Refusers. The clusters described different opportunities, awareness, and interest in using digital health services. Referral from professionals seemed to promote digital service use. For some, digital services were not accessible. Conclusions: Our findings emphasise the importance of assessing the suitability of FAs to digital health services, as their readiness to use may vary. Professionals should recommend digital services that support individual health to suitable patients. More accessible digital services could promote digital suitability despite functional limitations.

Perceived benefits of digital health and social services among older adults: A population-based cross-sectional survey.

Objective: The aim of this study was to describe the benefits of digital health and social services perceived by older adults and to examine factors associated with perceiving these benefits. Several factors related to (a) sociodemographic characteristics, (b) area of residence, (c) physical, cognitive, psychological, and social functioning, and (d) Internet use, were examined. Methods: The present sample included 8019 respondents aged between 75 and 99 years. The inverse probability weighting method was used to correct for bias. Linear regression analyses were used to examine the associations. Results: The ease of use of the services regardless of the time and location was perceived as the most beneficial. Convenient distance to local health or social services (parameter estimate = 0.15 [0.08-0.23]), good functional ability (PE = 0.08 [0.01-0.14]), good vision (PE = 0.15 [0.04-0.25]), ability to learn (PE = 0.05 [0.01-0.10]) and living with someone (PE = 0.08 [95% CI 0.04-0.13]) were associated with perceiving more benefits. In addition, access to the Internet (PE = 0.12 [0.06-0.19]) and independent use of the Internet (PE = 0.23 [0.17-0.29]) were associated with perceiving more benefits. Conclusions: Older adults who are healthier, have a social relationship in their everyday life or have easier access to traditional services seem to perceive more benefits from digital health and social services. Digital services should be developed to correspond with special needs caused by disadvantages in health and the social environment. To facilitate the use of digital health and social services, more efforts should be made to enhance older adults' perceptions of their benefits.

Perceptions of Finns with chronic diseases about factors affecting their eHealth literacy: A qualitative interview study.

Objective: This study aims to describe the factors related to the individual, the system and their interaction, which can affect eHealth literacy from the perspective of people living with one or multiple chronic diseases. As digital solutions are increasingly used in healthcare, perspectives of patients with chronic diseases must be considered. Methods: The study design was a qualitative, descriptive interview study, gathering the insights of people living in Finland with chronic disease. The individual semi-structured interviews (n = 17) were conducted via telephone. The eHealth Literacy Framework was used in the data analysis, with a deductive-inductive approach. Results: The range of skills included in the eHealth Literacy Framework was widely applied by participants who described themselves as adept at using eHealth environments to manage health-related needs. The participants evaluated online information and took an active role in self-management of their chronic disease. Most importantly, even participants possessing many of the skills in the eHealth Literacy Framework experienced difficulties in using eHealth environments, and the accessibility of eHealth environments was highlighted. Conclusions: eHealth environments could be useful for health promotion and self-management for people with chronic diseases, but only presuming the environments are adapted to their level of eHealth literacy skills.

The Mediating Role of Digital Competence in the Associations Between the Factors Affecting Healthcare Utilization and Access to Care.

Objectives: To examine with a population-based longitudinal survey design whether poor health, longstanding activity limitation, impaired cognitive functioning, mental distress, or loneliness predict poor access to healthcare and whether digital competence mediates these associations. Methods: The data were from the longitudinal FinHealth -survey gathered in Finland in 2017 and 2020 including 3,771 respondents (57.1% women). Linear regression analyses were used to examine the associations of factors affecting healthcare utilization with access to care adjusted for age, sex, and education. Counterfactual causal mediation framework was used to examine the mediating role of digital competence in the relationships among these factors and access to healthcare. Results: Factors affecting healthcare utilization were associated with poor access to care and these associations were partly mediated by low digital competence. Low digital competence mediated 12%, 9% and 8%, of the associations of impaired cognitive functioning, longstanding activity limitation, and loneliness with poor access to care, respectively. Conclusion: According to our results, one way to improve the access to healthcare among vulnerable groups could be to improve their digital competence.

Psychometric Properties of an Instrument to Measure the Quality of Family-Centered Care in NICUs.

OBJECTIVE: To examine the psychometric properties of the Digi Family-Centered Care-Parent Version (DigiFCC-P), which was developed to measure parents' perceptions of family-centered care (FCC) in NICUs. DESIGN: Cross-sectional psychometric study. SETTING: Twenty-three NICUs in 15 countries in Europe, Canada, and Australia. PARTICIPANTS: Mothers (n = 565) and fathers (n = 406) of preterm infants hospitalized in NICUs. METHODS: Participants reported their perceptions of the quality of FCC during their infants' hospitalizations by answering one DigiFCC-P question delivered to their mobile phones every evening. Nine questions rotated in random order. Participants responded on a 7-point Likert scale. We evaluated the instrument's internal consistency, construct and concurrent validity, and sensitivity. RESULTS: The internal consistency of the DigiFCC-P was satisfactory; the Cronbach's alpha coefficient was .74 (95% confidence interval [.71, .77]), and all the corrected item-total correlations were greater than .30. We identified that the items formed two factors, support from staff and the parent's active participation, and observed no strong item cross-loadings on the two factors. We discovered some items with weak interitem correlations, and the two factors explained 35.2% of the variance. Scores on the DigiFCC-P and Family-Centered Care Questionnaire were significantly correlated (r = .59, p < .001) and supported the convergent validity of the instrument. In addition, changes were discovered in the participants' ratings over time, which indicated that the instrument was sensitive to detect changes in their evaluations. CONCLUSION: The psychometric testing of the DigiFCC-P provided initial support for the convergent validity and reliability of the instrument. The instrument was also sensitive in detecting changes in the evaluations of FCC over time. However, there is a need for further development of the content validity of the instrument.

The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey.

BACKGROUND: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. OBJECTIVE: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. METHODS: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. RESULTS: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. CONCLUSIONS: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public's confidence in the protection of their confidential data.

Effects of single family room architecture on parent-infant closeness and family centered care in neonatal environments-a single-center pre-post study.

OBJECTIVE: The aim of this study was to evaluate the effects of a single family room architecture in a neonatal intensive care unit (SFR-NICU) on parents' presence, parent-infant skin-to-skin contact (SSC) and the quality of family centered care. STUDY DESIGN: Two cohorts of parents of preterm infants were compared: those in the unit before and after the move to SFR-NICU. The parents used daily diaries to report their presence and SSC, and they responded to daily text message questions about the quality of family centered care. RESULTS: Parents spent more time in the SFR-NICU, but no significant change was found in SSC. Parents rated the quality of family centered care highly in both unit architectures, without a change in rating after the move. CONCLUSION: The SFR-NICU increased parents' presence but not SSC. The change in architecture did not affect parents' evaluations of the quality of family centered care, which was already highly rated before the move.