Empirical Evidence of Internal and External Factors Influencing Users' Motivation Toward Teleconsultation Use.

Introduction: The use of teleconsultation systems has increased in recent years, which has improved patients' access to health care providers and enabled seamless interaction between them. The literature points out several factors that either facilitate or impede the use of teleconsultation. However, there is a lack of studies that provide empirical evidence of factors that influence consumers' motivation toward the use of teleconsultation systems. Aim and Objective: This study aimed to provide empirical evidence of the internal and external factors that influence consumers' motivation toward the use of teleconsultation systems. Methods: A cross-sectional survey was used to collect data from consumers who used a real-time teleconsultation system called the Sehha application in Saudi Arabia between March 13 and June 14, 2021. SPSS 27.0.1 was used for descriptive analysis. Results: Four hundred eighty-five participants completed the survey, 471 of whom were included in the analysis. The findings confirmed that internal and external factors exert an influence on consumers' motivation toward the use of teleconsultation systems. The findings indicated that the presence of factors such as saving time, saving cost, accessibility to health care, ease-of-use, reliable internet access, availability of devices, and appropriate places during the online connection would increase consumers' motivation toward teleconsultation systems use. Also, the findings indicated that users' familiarity with systems similar to teleconsultation systems, users' perception of teleconsultation convenience, the influence of others on users' decision to use teleconsultation, and user's skills and confidence in using teleconsultation easily, and their trust in the teleconsultation system would also increase their motivation to use it. Furthermore, the findings showed that demographic factors, including age, gender, level of education, and employment status, did not influence users' motivation toward the use of teleconsultation Conclusions: This study provided empirical evidence of a variety of internal and external factors that exert an influence on consumers' motivation toward the use of teleconsultation systems.

Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients' Homes: Systematic Literature Review.

BACKGROUND: Health care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to communicate with health care professionals; in this case, the patient communicates with the health care professional for a follow-up or for a consultation about his or her health condition. This communication process is referred to as an e-consultation. In this paper, telemedicine services refer to health care services that use ICTs, which enable patients to share, transfer, and communicate data or information in real time (ie, synchronous) from their home with a care provider-normally a physician-at a clinical site. However, the use of e-consultation services can be positively or negatively influenced by external or internal factors. External factors refer to the environment surrounding the system as well as the system itself, while internal factors refer to user behavior and motivation. OBJECTIVE: This review aims to investigate the barriers and the facilitators that influence the use of home consultation systems in the health care context. This review also aims to identify the effectiveness of Home Online Health Consultation (HOHC) systems in improving patients' health as well as their satisfaction with the systems. METHODS: We conducted a systematic literature review to search for articles-empirical studies-about online health consultation in four digital libraries: Scopus, Association for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 45. A qualitative content analysis was performed to identify barriers and facilitators to HOHC systems, their effectiveness, and patients' satisfaction with them. RESULTS: The systematic literature review identified several external and internal facilitators and barriers to HOHC systems that were used in the creation of a HOHC framework. The framework consists of four requirements; the framework also consists of 17 facilitators and eight barriers, which were further categorized as internal and external influencers on HOHC. CONCLUSIONS: Patients from different age groups and with different health conditions benefited from remote health services. HOHC via video conferencing was effective in delivering online treatment and was well-accepted by patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as a result of online consultation facilitators that promoted effective and convenient remote treatment. However, some patients preferred face-to-face consultation and showed resistance to online consultation. Resistance to online consultation was influenced by some of the identified barriers. Overall, the framework identified the facilitators and barriers that positively and negatively influenced the uptake of HOHC systems, respectively.

Connected-Health Algorithm: Development and Evaluation.

Nowadays, there is a growing interest towards the adoption of novel ICT technologies in the field of medical monitoring and personal health care systems. This paper proposes design of a connected health algorithm inspired from social computing paradigm. The purpose of the algorithm is to give a recommendation for performing a specific activity that will improve user's health, based on his health condition and set of knowledge derived from the history of the user and users with similar attitudes to him. The algorithm could help users to have bigger confidence in choosing their physical activities that will improve their health. The proposed algorithm has been experimentally validated using real data collected from a community of 1000 active users. The results showed that the recommended physical activity, contributed towards weight loss of at least 0.5 kg, is found in the first half of the ordered list of recommendations, generated by the algorithm, with the probability > 0.6 with 1 % level of significance.

Persuasive features for patient engagement through mHealth applications in managing chronic conditions: A systematic literature review and meta-analysis.

Patient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement is focused on personalized care to consumers through providing knowledge, skills and confidence. Mobile health (mHealth) applications are an innovative means to facilitate patient engagement. Nevertheless, the extent to which the current mHealth applications are designed to engage patients in managing their chronic diseases is unclear. This paper aims to identify the Persuasive System Design (PSD) features present in current mHealth applications that increased the engagement of patients with chronic diseases. This review also aims to identify patient engagement-related outcomes of these features. This paper conducted a systematic literature review and meta-analysis to find relevant studies published from all years up to 2020 through six databases: PubMed, Scopus, Web of Science, Cinahl plus with full text, MEDLINE with full text, and Cochrane Library (Central register of controlled trials). The database search returned 4939 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 13. A qualitative content analysis was performed to identify PSD model features and their patient engagement-related outcomes. The quality assessment has been done through the Cochrane Risk of Bias tool for RCTs. The systematic literature review and meta-analysis identified eleven PSD features that can increase patient engagement through using mHealth applications. The identified PSD features have been shown to have various patient engagement-related outcomes. Behavior Change Techniques (BCTs) were combined with the identified PSD features. This paper identified persuasive features of mHealth application design that influence the engagement of patients with chronic diseases toward changing their behavior. The impact of these features is also analyzed in this review. The results show that an mHealth technology-mediated patient engagement model is needed.

mHealth Apps Targeting Obesity and Overweight in Young People: App Review and Analysis.

BACKGROUND: Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low. OBJECTIVE: The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs). METHODS: A search for apps was conducted in Google Play Store using the following search string: ["best weight loss app for obese teens 2020"] OR ["obesity applications for teens"] OR ["popular weight loss applications"]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app. RESULTS: The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app "Morphe," intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings. CONCLUSIONS: The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness.

Prevalence and Predictors of Knowledge and Attitudes Toward Eye Donation Among the General Population: A Systematic Review.

PURPOSE: The purpose of this systematic review was to investigate knowledge and attitudes toward eye donation and sources of eye donation information among the general population. METHODS: A search was conducted using MEDLINE through Ovid and Scopus; CINAHL through EBSCOhost and ProQuest; and Embase through Ovid database entries from January 2010 to March 2021. Quantitative studies were selected if they included participants aged 16 years or older from the general population (nonhealthcare) and had a sample size of >200. Studies were included if they measured knowledge and attitudes toward eye donation and sources of eye donation information. Methodological quality was assessed using JBI criteria, and the data were analyzed using SUMARI software. RESULTS: A total of 25 studies were included in this review. Pooled data from 6 studies demonstrated that 30.8% of participants [95% confidence interval (CI) = 11.0-55.4] had some knowledge of eye donation. Seventeen studies reported that 40.6% (95% CI = 39.8-41.3) were willing to donate their eyes, and 5 of these studies found that 7.3% (95% CI = 6.5-8.3) had already pledged their eyes. Eleven studies reported on the source of eye donation information, indicating 50.9% of participants (95% CI = 49.8-52.1) received information from mass media. CONCLUSIONS: The results of this review indicate that understanding eye donation knowledge and attitudes is crucial for developing interventions or tools to increase eye donation rates. Further studies in different populations are required.

An empirical study on factors influencing consumers' motivation towards teleconsultation system use. A preliminary report about the Sehha application from Saudi Arabia.

BACKGROUND: The use of the teleconsultation system has increased in recent years, which enabled healthcare providers and patients to share, communicate and transfer information in real-time via different types of telemedicine services and applications. However, there is a lack of studies that underpin factors that motivate patients to use teleconsultation systems. AIM AND OBJECTIVE: This study aimed to identify factors that influence consumers' motivation to use teleconsultation systems by developing a theoretical framework and empirically testing the developed framework with a real-world teleconsultation system. METHODS: A cross-sectional study was used for this research to empirically validate the proposed model. The online survey consisted of 51 items, which were developed by the researchers. Partial least squares structural equation modelling (PLS-SEM) was used to analyze the measurement model and structural model. RESULTS: 485 participants completed the online survey, 471 of which were included in the model analysis. The measurement analysis indicated that convergent validity was achieved as all items' outer lording were well above the threshold of 0.70, all indicators reliability and AVEs were well above the threshold of 0.50. Also, the measurement analysis indicated that discriminate validity was achieved as the Heterotrait-Monotrait ratio of correlations for all constructs were below the threshold of 0.90. In the structural model analysis, the inner constructs of the model, autonomy, competence and relatedness explained 60.1% of the variance in users' motivation toward the use of the teleconsultation system. The outer constructs of the model, subjective norm, external and internal facilitating conditions, explained 67.3% of the variance in users' autonomy, whereas attitude, performance expectancy, external and internal facilitating conditions explained 51.9% of the variance in the users' competence, and subjective norm explained 25.6% of the variance in the users' relatedness. CONCLUSIONS: The developed framework can explain why consumers are motivated to use teleconsultation systems for online medical consultations. The model indicated that a variety of internal and external factors can positively or negatively influence consumers' perceived autonomy, competence and relatedness, which can impact their motivation toward the use of teleconsultation systems.

Development and validation of a new tool to identify factors that influence users' motivation toward the use of teleconsultation systems: A modified Delphi study.

BACKGROUND: Healthcare providers have improved consumer access to healthcare services by the adoption of information communication technology and the use of telemedicine. With the current COVID-19 pandemic, consumers are shifting to remote teleconsultation. There are several studies regarding consumers' acceptance and satisfaction with telemedicine among healthcare providers and a few among patients at healthcare facilities. However, studies about patients' motivation toward the use of teleconsultation systems are very few. AIM: The aim of this study was to validate an instrument of a newly developed framework to identify factors that motivate patients to use a teleconsultation system. METHOD: This study used a modified eDelphi method incorporating content validity index and content validity ratio procedures to validate the instrument among fifteen experts from different disciplines. The eDelphi consisted of three rounds to review each item's relevance, clarity, importance and the overall validity of the instrument. RESULT: The result showed a significant level of agreement among experts for individual items' relevance, clarity and importance. For relevance, all items had excellent I-CVI above 0.889, except one item with I-CVI = 0.78, which is still acceptable. For clarity, all items had an excellent I-CVI > 0.889, except one with I-CVI = 0.667. For importance, most items had CVR above the threshold value of 0.778, except 5 items. Also, the result showed moderate to high content validity of the overall instrument (S-CVI/UA = 0.694; S-CVI/Ave = 0.996). DISCUSSION: These findings support the validity and reliability of the developed instrument, which can be used to identify factors that motivated patients to use a teleconsultation system. Future testing of the instrument should be conducted with a larger population that uses a teleconsultation system. CONCLUSION: An instrument was developed to identify factors that motivated consumers to use teleconsultation, using a modified eDelphi method among experts. The eDelphi method consisted of three rounds and the results showed that the instrument is a valid and reliable tool.

Design and content validation of an instrument measuring user perception of the persuasive design principles in a breastfeeding mHealth app: A modified Delphi study.

BACKGROUND: Persuasive design principles are increasingly employed in mHealth apps for motivating users and promoting healthy behaviours among individuals. However, how the persuasive design principles are perceived by the mHealth app users remains unclear. AIM: To develop and validate the content validity of an instrument designed to measure the user's perceptions of the persuasive design principles assimilated in a breastfeeding mHealth app. METHODS: A critical review of the literature guided the development of the research instrument. The developed instrument was refined and validated through a two-round modified Delphi process. Ten experts drawn from academic and clinical settings evaluated the items through two content validity indicators, relevance, and clarity and provided narrative feedback. The content validity of the instrument was determined by calculating the Content Validity Index (CVI). Content validity indicators at the scale-level (S-CVI) and item-level (I-CVI) were calculated. RESULTS: The results demonstrated high content validity index of individual items in the instrument. All items in the instrument reached an excellent I-CVI ≥ 0.78 for both relevance and clarity except one item. The overall content validity index of the instrument using the average approach was moderate to high (S-CVI/Ave was 0.89 and 0.92 for relevance and clarity, respectively). The developed research instrument is composed of 5 constructs representing 24 items: (1) primary task support, (2) dialogue support, (3) system credibility support, (4) social support and (5) perceived persuasiveness. CONCLUSIONS: Using a modified Delphi approach, the development and validation of the research instrument demonstrated moderate to high content validity for measuring users' perceptions of the persuasive design principles assimilated in a breastfeeding mHealth app. The evidence from this study supports that the research instrument is valid, relevant, and clear.

Healthcare data warehouse system supporting cross-border interoperability.

The free movement of European citizens across member states of the European Union adds an important level of complexity to strategic efforts of health interoperability. The use of electronic health data has been marked as an important strategic activity and policy to improve healthcare in European countries. Cross-border healthcare depends on the ability to set up shared practices with respect to patient data exchange across the countries. Data flow must comply with demanding security, legal and interoperability requirements, as defined by the European Patients Smart Open Services project specifications. The aim of this article is to propose a novel design of healthcare data warehouse based on the restructured Extract-Transform-Load process. We describe a portal framework that offers a comprehensive set of interoperability services to enable national e-Health platforms to set up cross-border health information networks compliant with European Patients Smart Open Services. The presented approach incorporates the technical and organizational interoperability by interconnecting Health Level Seven standard and Open National Contact Points framework in order to provide a modular, scalable and inter-operating architecture.

mHealth Applications: A Tool for Behaviour Change in Weight Management.

Obesity has become a public concern all over the world and weight management is of interest to consumers. Heavy intake of food and lack of exercise are the foremost factors for obese condition. Self-management programs are essential for the prevention and treatment of obesity and weight management. Mobile health (m-Health) applications for weight management can be a useful tool in monitoring behaviour and self-management programs, thus engaging consumers in lifestyle changes to mitigate the risk of obesity. The aim of this review is to identify and compare the features supported in mHealth applications for weight management.

Analysis of introducing e-services: a case study of Health Insurance Fund of Macedonia.

Purpose - Information systems play a significant role in the improving of health and healthcare, as well as in the planning and financing of health services. Fund's Information System is an essential component of the information infrastructure that allows assessment of the impact of changes in health insurance and healthcare for the population. The purpose of this paper is to give a brief overview of the affection of e-services and electronic data exchange (between Fund's information systems and other IT systems) at the quality of service for insured people and savings funds. Design/methodology/approach - The authors opted for an exploratory study using the e-services implemented in Health Insurance Fund (HIF) of Macedonia and data which were complemented by documentary analysis, including brand documents and descriptions of internal processes. In this paper is presented an analysis of the financial aspects of some e-services in HIF of Macedonia by using computer-based information systems and calculating the financial implications on insured people, companies and healthcare providers. Findings - The analysis conducted in this paper shows that the HIF's e-services would have a positive impact for the insured people, healthcare providers and companies when fulfilling their administrative obligations and exercising their rights. Originality/value - The analysis presented in this paper can serve as a valuable input for the healthcare authorities in making decisions related to introducing e-services in healthcare. These enhanced e-services will improve the quality service of the HIF.