Validation study of a Chinese version of Partners in Health in Hong Kong (C-PIH HK).

BACKGROUND: The Partners in Health (PIH) scale is a measure designed to assess the generic knowledge, attitudes, behaviors, and impacts of self-management. A cross-cultural adaptation of the PIH for use in Hong Kong was evaluated in this study. This paper reports the validity and reliability of the Chinese version of PIH (C-PIH[HK]). METHOD: A 12-item PIH was translated using forward-backward translation technique and reviewed by individuals with chronic diseases and health professionals. A total of 209 individuals with chronic diseases completed the scale. The construct validity, internal consistency, and test-retest reliability were evaluated in two waves. RESULTS: The findings in Wave 1 (n = 73) provided acceptable psychometric properties of the C-PIH(HK) but supported the adaptation of question 5 to improve the cultural relevance, validity, and reliability of the scale. An adapted version of C-PIH(HK) was evaluated in Wave 2. The findings in Wave 2 (n = 136) demonstrated good construct validity and internal consistency of C-PIH(HK). A principal component analysis with Oblimin rotation yielded a 3-factor solution, and the Cronbach's alphas of the subscales ranged from 0.773 to 0.845. Participants were asked whether they perceived the self-management workshops they attended and education provided by health professionals as useful or not. The results showed that the C-PIH(HK) was able to discriminate those who agreed and those who disagreed related to the usefulness of individual health education (p < 0.0001 in all subscales) and workshops (p < 0.001 in the knowledge subscale) as hypothesized. The test-retest reliability was high (ICC = 0.818). CONCLUSION: A culturally adapted version of PIH for use in Hong Kong was evaluated. The study supported good construct validity, discriminate validity, internal consistency, and test-retest reliability of the C-PIH(HK).

Moderating effects of voluntariness on the actual use of electronic health records for allied health professionals.

BACKGROUND: Mandatory versus voluntary requirement has moderating effect on a person's intention to use a new information technology. Studies have shown that the use of technology in health care settings is predicted by perceived ease of use, perceived usefulness, social influence, facilitating conditions, and attitude towards computer. These factors have different effects on mandatory versus voluntary environment of use. However, the degree and direction of moderating effect of voluntariness on these factors remain inconclusive. OBJECTIVE: This study aimed to examine the moderating effect of voluntariness on the actual use of an electronic health record (EHR) designed for use by allied health professionals in Hong Kong. Specifically, this study explored and compared the moderating effects of voluntariness on factors organized into technology, implementation, and individual contexts. METHODS: Physiotherapists who had taken part in the implementation of a new EHR were invited to complete a survey. The survey included questions that measured the levels of voluntariness, technology acceptance and use, and attitude towards technology. Multiple logistic regressions were conducted to identify factors associated with actual use of a compulsory module and a noncompulsory module of the EHR. RESULTS: In total, there were 93 participants in the study. All of them had access to the noncompulsory module, the e-Progress Note, to record progress notes of their patients. Out of the 93 participants, 57 (62%) were required to use a compulsory module, the e-Registration, to register patient attendance. In the low voluntariness environment, Actual Use was associated with Effort Expectancy (mean score of users 3.51, SD 0.43; mean score of non-users 3.21, SD 0.31; P=.03). Effort Expectancy measured the perceived ease of use and was a variable in the technology context. The variables in the implementation and individual contexts did not show a difference between the two groups. In the high voluntariness environment, the mean score of Actual Use was associated with Performance Expectancy (P=.03), Organization Facilitating Condition (P=.02), and Interest in Internet and Computer (P=.052) in univariate analyses. The only variable left in the logistic regression model was Organization Facilitating Conditions (mean score of users 3.82, SD 0.35; mean score of non-users 3.40, SD 0.48; P=.03), a variable in the implementation context. The factors affecting actual use were different in mandatory and voluntary environments, indicating a moderating effect of voluntariness. CONCLUSIONS: The results of this study have provided preliminary supports of moderating effects of voluntariness on the use of EHR by allied health professionals. Different factors were identified to be associated with actual use: (1) Ease of Use in mandatory environment, and (2) Organization Facilitating Conditions in voluntary environment. More studies are needed to examine the direction of moderating effects. The findings of this study have potential practical implications. In sum, voluntariness can be a highly relevant and important moderating factor not to be ignored in the design and evaluation of EHR.

Theorizing the health service usage behavior of family caregivers: a qualitative study of an internet-based intervention.

PURPOSE: The purpose of this qualitative study was to improve understanding of family caregivers' use of Web-based intervention support by integrating three theoretical models. The study applied the Anderson's model of health service utilization, Venkatesh's theory of technology acceptance, and Chatman's and Wilson's information behavior theories. METHODS: This qualitative study is part of a larger study. An interpretive grounded theory approach was used to conduct in-depth interviews with Chinese caregivers of family members with dementia. The caregivers received Internet-based information support and personalized e-mail intervention. A purposive sample of fourteen caregivers was selected to participate in the interviews. Constant comparison, analytic memoing, case analysis, and concept mapping were used to conduct theoretical triangulation analysis. RESULTS: Three main factors influenced the use of the intervention: (a) caregiver needs, which are influenced by personal capacity, social support available, and caregiving belief; (b) information communication technology (ICT) factors, including accessibility barriers and perceived efforts to use the technology; and (c) style of using the technology, such as preference for using e-mail or the customized Website. The personal capacity of caregivers was influenced by many factors, including computer and language proficiency, health service knowledge, caregiving competence and competing roles and responsibilities. Social support available for caregivers included available computer, language or caregiving support and health service knowledge. Caregiving belief included traditional belief of giving care, and health belief of the illness. New caregivers needed a different kind of support intervention compared with experienced caregivers. Caregivers with different amounts of experience tended to have different learning styles, with new caregivers preferring interactive intervention and more experienced caregivers preferring more reflective learning. CONCLUSIONS: This study reinforced the findings of the larger quantitative study that it is important to address both care-giving needs and technology factors in Internet-based intervention. The quantitative study found that less competent caregivers with more positive attitudes towards technology tended to use the intervention more frequently. In this qualitative research, the findings revealed that caregiver needs, ICT factors, and style of use explained the pattern of intervention use. This new conceptualization has integrated information acceptance, health service utilization, and information behavior theories. More studies will be needed to confirm if the proposed concept can explain or predict the usage behavior in other Web-based interventions.

Research lessons learned: occupational therapy with culturally diverse mothers of premature infants.

BACKGROUND: Evaluation studies of the effectiveness of home-based occupational therapy are scarce but are needed to justify the impact of occupational therapy intervention. When the intervention is for persons from diverse cultural backgrounds, additional research challenges arise. PURPOSE: To share lessons learned in conducting home-based occupational therapy research with Canadian, and immigrant South Asian and Chinese mothers of premature infants in a large Canadian city. KEY ISSUES: Lessons learned were to implement a culturally sensitive recruitment process, change the research design to include more interviews and focus groups, and be aware of the need for culturally appropriate instruments. IMPLICATIONS: Researchers need to be sensitized to the Western cultural values upon which most research designs and instrumentation are constructed. Involvement of a culturally diverse research team, openness to feedback, adaptability, and critical reflection on what is important to the cultural groups are among the suggestions for researchers planning home-based occupational therapy research with culturally diverse populations.

Stages of use: consideration, initiation, utilization, and outcomes of an internet-mediated intervention.

BACKGROUND: Attrition, or nonuse of the intervention, is a significant problem in e-health. However, the reasons for this phenomenon are poorly understood. Building on Eysenbach's "Law of Attrition", this study aimed to explore the usage behavior of users of e-health services. We used two theoretical models, Andersen's Behavioral Model of Health Service Utilization and Venkatesh's Unified Theory of Acceptance and Use of Technology, to explore the factors associated with uptake and use of an internet-mediated intervention for caregivers taking care of a family member with dementia. METHODS: A multiphase, longitudinal design was used to follow a convenience sample of 46 family caregivers who received an e-health intervention. Applying the two theories, usage behavior was conceptualized to form four stages: consideration, initiation, utilization (attrition or continuation), and outcome. The variables and measurement scales were selected based on these theories to measure the sociodemographic context, technology aptitudes, and clinical needs of the caregivers. RESULTS: In the Consideration Stage, caregivers who felt that the information communication technology (ICT)-mediated service was easy to use were more likely to consider participating in the study (p = 0.04). In the Initiation Stage, caregivers who showed greater technology acceptance were more likely to initiate service earlier (p = 0.02). In the Utilization Stage, the frequent users were those who had a more positive attitude toward technology (p = 0.04) and a lower perceived caregiver competence (p = 0.04) compared with nonusers. In the Outcome Stage, frequent users experienced a decline in perceived burden compared with an escalation of perceived burden by nonusers (p = 0.02). CONCLUSIONS: We illustrate a methodological framework describing how to develop and expand a theory on attrition. The proposed framework highlighted the importance of conceptualizing e-health "use" and "adoption" as dynamic, continuous, longitudinal processes occurring in different stages, influenced by different factors to predict advancement to the next stage. Although usage behavior was influenced mainly by technological factors in the initial stages, both clinical and technological factors were equally important in the later stages. Frequency of use was associated with positive clinical outcomes. A plausible explanation was that intervention benefits motivated the caregivers to continue the service and regular use led to more positive clinical outcome.

Living environments for people with moderate to severe acquired brain injury.

OBJECTIVES: This study examines the issue of living environments for persons with acquired brain injury (ABI), with the aim of identifying factors that enable or act as barriers to appropriate living environments. METHODS: A qualitative study involving 31 semi-structured interviews conducted with 56 key informants representing various relevant sectors: institutional, community, residential and non-residential, consumer/advocacy and government/policy from six regions in the province of Ontario, Canada. RESULTS: The study identified such barriers as lack of ABI-specific facilities, beds and trained staff and a poorly coordinated system in many areas, with long wait lists for specialized residential settings. Clients with ABI need individualized treatment, making development of a standardized model of care difficult, particularly for those with co-morbid conditions. Solutions such as more flexible options for clients and better trained staff emerged. CONCLUSIONS: The study presents solutions to challenges and limitations in addressing appropriate living environments for persons with ABI.

Internet-based caregiver support for Chinese Canadians taking care of a family member with alzheimer disease and related dementia.

ABSTRACTThe aim of this study was to assess the usability of a new Internet-based Caregiver Support Service (ICSS) and evaluate its effects on health outcomes of Chinese Canadians who cared for a family member with dementia. Demographic and questionnaire data were collected from 28 participants, and in-depth interviews were conducted with 10 participants. Results showed that non-users reported higher levels of burden post-intervetion, and frequent users showed post-intervention reduction in experienced burden. Traditional beliefs shaped caregivers' needs; also, ethno-cultural-linguistic contexts affected system usability and were associated with usage behaviour. This study indicates that caregivers can benefit from receiving professional support via asynchronous e-mails and a dedicated information web site. The ICSS is a feasible approach for supporting caregivers who prefer an alternative service model. This emerging service requires more research in: enhanced technology design, service delivery models for immigrant caregivers, and evaluation of effectiveness and cost-effectiveness.

A systematic review of networked technologies supporting carers of people with dementia.

We conducted a systematic review of the effectiveness of networked ICT interventions in supporting carers of people with dementia. Five bibliographic databases were searched and a total of 1456 abstracts were identified as potentially relevant. From these we identified 15 papers describing five interventions: ComputerLink, AlzOnline, Caring for Others and two studies from the REACH project (TLC and CTIS). The interventions reviewed were multifaceted with elements of networked peer support. Outcomes were inconsistent but suggested that the interventions had moderate effects on improving carer stress and depression. Treatment effects were found to vary with caregiver characteristics such as ethnic groups, formal support and baseline burden. Further evaluation is needed in robust trials with good follow-up.

Outcomes of an occupational therapy school-based consultation service for students with fine motor difficulties.

PURPOSE: This paper reports on a study that was conducted to address the perceived occupational performance changes among school-aged children who received occupational therapy services for fine motor difficulties. It also addressed teacher awareness and the degree of implementation of occupational therapy recommendations by teachers. METHODS: The study sample included 91 school-aged children referred for occupational therapy services for fine motor difficulties. The children were assessed, before and after intervention. Outcome measures used were the Canadian Occupational Performance Measure (COPM) and the Teacher Awareness Scale (TAS). RESULTS: Significant change scores in both scales of the COPM were (Performance = 1.50, p < 0.001; Satisfaction = 1.92, p < 0.001). Regression analyses showed that lower teacher ratings of the students'performance and satisfaction of performance on the initial COPM resulted in significantly greater COPM change scores in the students'performance and satisfaction of performance at reassessment. The greater the degree of implementation of occupational therapy strategies by the teacher, the greater the COPM performance and satisfaction change scores. The greater the degree of teacher awareness of students'special needs resulted in greater COPM performance change scores. PRACTICE IMPLICATIONS: Teachers may benefit from more education regarding fine motor difficulties in children and how the implementation of occupational therapy strategies are helpful to improve children's fine motor difficulties.

Evaluation of occupational therapy school-based consultation service for students with fine motor difficulties.

PURPOSE: This paper describes a 2-year study that addressed the perceived occupational performance changes among students with fine motor difficulties receiving occupational therapy school-based consultation (OTSBC) services. METHOD: The sample included 52 stakeholders of students with fine motor difficulties who received occupational therapy services. Six exploratory focus groups and one participatory and action-based focus group were conducted with parents, teachers, occupational therapists, and Community Care Access Centre case managers. RESULTS: Results supported the benefits of OTSBC. Key concerns identified were the wait for service, confusion about service expectations, inadequate communication among stakeholders, school board issues, and constraints in the health care system. Recommendations identified were to train teachers, provide early intervention, address service delivery issues related to health and education systems, and promote awareness of occupational therapy service and its effectiveness. PRACTICE IMPLICATIONS: Occupational therapists working with students with fine motor difficulties could consider providing formal education programs for teachers, promoting early intervention of fine motor problems, and communicating to stakeholders regarding the expectations and effectiveness of OTSBC.