Technology implementation in care practices for community-dwelling older adults with mild cognitive decline: Perspectives of professional caregivers in Quebec and Brussels.

Objective: As worldwide population aging is accelerating, innovative technologies are being developed to support independent living among community-dwelling older adults with mild cognitive decline. However, the successful implementation of these interventions is often challenging. Until now, literature on implementation issues related to the specific context of older adults with mild cognitive decline is lacking and the few studies available do not focus specifically on the perspective of professional caregivers. Yet the perspective of these caregivers is important as they can be considered a key facilitator for technology implementation among this population. Therefore, this study was the first to examine technology implementation among community-dwelling older adults with mild cognitive decline from the broader perspective of professional caregivers. Methods: In this qualitative study, two focus groups consisting of a heterogeneous pool of professional caregivers were conducted: one in Quebec (Canada, n = 6) and one in Brussels (Belgium, n = 8). Braun and Clarke' method for thematic analysis, guided by a qualitative descriptive approach was applied to inductively identify themes from the data. Results: We identified factors influencing technology implementation in older adults with mild cognitive decline on three levels: an individual level (e.g., characteristics of older adults with mild cognitive decline and professional caregivers' attitude), an organizational level (e.g., lack of training among professional caregivers) and a level referring to the broader context (e.g., ethical considerations). Conclusions: This study contributes to the research gap in knowledge on the needs of professional caregivers to facilitate technology implementation among the population of older adults with cognitive decline. Future directions for research, practice, and policy are given, more specifically to improve knowledge among caregivers and on the development of decision support to retrieve safe and effective technologies that suit patient-centered care.

[Beyond benefit evaluation: Considering the unintended consequences of telehealth]. / Au-delà de l'évaluation des bénéfices : réflexion sur les conséquences inattendues de la télésanté.

Telehealth is seen as a key lever in health policy choices. However, many challenges remain in terms of its successful integration into clinical practices. To date, many telehealth initiatives are struggling to move beyond the pilot project stage. This is partly due to a culture of innovation that is mainly focused on the expected benefits of the technology and less on the changes and transformations it can generate. Telehealth is used in health care organizations with complex social dynamics, to say the least. Its introduction has unintended consequences that can affect patients, communities, professionals, organizations, health systems and society as a whole. The aim of this article is to discuss some of the unintended consequences of using telehealth in health care organizations and systems.

Sociocultural determinants of nomadic women's utilization of assisted childbirth in Gossi, Mali: a qualitative study.

BACKGROUND: In sub-Saharan Africa (SSA), nomads account for 30 to 60 million people. Their mobility, due to a constant search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women. METHODS: We conducted a qualitative research in the health area of Gossi (Mali), mainly populated by nomads. Data were collected through a literature review, 26 semi-structured interviews, a non-participant observation, and a logbook. Nomadic women who gave birth in the past three months were included in the study, whether they used assisted delivery or not. A thematic content analysis was performed with QDA Miner software. RESULTS: The study identified a complex combination of determinants resulting in the use or non-use of assisted childbirth by the nomads of Gossi. Several participants recognized the value of assisted delivery but gave birth at home. They identified sociocultural determinants related to their representations and bodily experiences; the risks and emotions (fear, stress, anxiety) associated with pregnancy; the onset of labor and delivery; and their weak autonomy in terms of movement, decision-making, and economic agency. Nomadic women are not free in their movements, and in order to seek care, they require the permission and support of a man (husband, brother, or father). Furthermore, the participants are housewives, and men control family resources and make decisions regarding all financial matters. Assisted delivery is often only considered when there are complications. CONCLUSION: This research has made it possible to understand the sociocultural determinants of the use of assisted childbirth among nomadic women, which should be taken into account when organizing health services for these populations.

Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study.

BACKGROUND: Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway. METHODS: We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data. RESULTS: Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified. CONCLUSIONS: This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems.

Determinants of Physicians' Intention to Collect Data Exhaustively in Registries: an Exploratory Study in Bamako's Community Health Centres.

BACKGROUND: The incomplete collection of health data is a prevalent problem in healthcare systems around the world, especially in developing countries. Missing data hinders progress in population health and perpetuates inefficiencies in healthcare systems. OBJECTIVE: This study aims to identify the factors that predict the intention of physicians practicing in community health centres of Bamako, Mali, to collect data exhaustively in medical registries. DESIGN: A cross sectional study. METHOD: In January and February 2011, we conducted a study with a random sample of thirty two physicians practicing in community health centres of Bamako, using a questionnaire. Data was analyzed by using descriptive statistics, correlations and linear regression. MAIN OUTCOMES MEASURES: Trained investigators administered a questionnaire measuring physicians' sociodemographic and professional characteristics as well as constructs from the Theory of Planned Behaviour. RESULTS: Our results showed that physicians' intention to collect data exhaustively is influenced by subjective norms and by the physician's number of years in practice. CONCLUSIONS: the results of this study could be used as a guide for health workers and decision makers to improve the quality of health information collected in community health centers.

A systematic review of interventions promoting clinical information retrieval technology (CIRT) adoption by healthcare professionals.

PURPOSE: This paper presents the evidence on the effectiveness of interventions promoting the use of clinical information retrieval technologies (CIRTs) by healthcare professionals. METHODS: We electronically searched articles published between January 1990 and March 2008 using following inclusion criteria: (1) participants were healthcare professionals; (2) specific intervention promoted CIRT adoption; (3) studies were randomised controlled trials, controlled clinical trials, controlled before and after studies or interrupted time series analyses; and (4) they objectively reporting measured outcomes on CIRT use. RESULTS: We found nine studies focusing on CIRT use. Main outcomes measured were searching skills and/or frequency of use of electronic databases by healthcare professionals. Three studies reported a positive effect of the intervention on CIRT use, one showed a positive impact post-intervention, and four studies failed to demonstrate significant intervention effect. The ninth study examined financial disincentives, and found a significant negative effect of introducing user fees for searching MEDLINE in clinical settings. A meta-analysis showed that educational meetings were the only type of interventions reporting consistent positive effects on CIRT adoption. CONCLUSION: CIRT is an information and communication technology commonly used in healthcare settings. Interventions promoting CIRT adoption by healthcare professionals have shown some success in improving searching skills and use of electronic databases. However, the effectiveness of these interventions remains uncertain and more rigorous studies are needed.

Preparing for success: readiness models for rural telehealth.

BACKGROUND: Readiness is an integral and preliminary step in the successful implementation of telehealth services into existing health systems within rural communities. METHODS AND MATERIALS: This paper details and critiques published international peer-reviewed studies that have focused on assessing telehealth readiness for rural and remote health. Background specific to readiness and change theories is provided, followed by a critique of identified telehealth readiness models, including a commentary on their readiness assessment tools. RESULTS: Four current readiness models resulted from the search process. The four models varied across settings, such as rural outpatient practices, hospice programs, rural communities, as well as government agencies, national associations, and organizations. All models provided frameworks for readiness tools. Two specifically provided a mechanism by which communities could be categorized by their level of telehealth readiness. DISCUSSION: Common themes across models included: an appreciation of practice context, strong leadership, and a perceived need to improve practice. Broad dissemination of these telehealth readiness models and tools is necessary to promote awareness and assessment of readiness. This will significantly aid organizations to facilitate the implementation of telehealth.

The impact of new antiretroviral treatments on college students' intention to use a condom with a new sexual partner.

The aim of this study was to evaluate possible changes in predisposing factors in sexual preventive behaviors that could result from the availability of an efficient new antiretroviral therapy. A total of 136 young adults were randomly assigned a vignette to read describing AIDS as a lethal or chronic disease. After reading the vignette, the participants completed a self-administered questionnaire assessing the psychosocial determinants of intention to use a condom with a new sexual partner. The variables were measured according to Ajzen's (1985, 1988, 1991) theory of planned behavior and Triandis's (1977) theory of interpersonal behavior. The experimental manipulation was more successful when the disease was described as lethal (66 of the 68 subjects) rather than chronic (30 of the 68 subjects). For the 96 participants who correctly identified the expected outcome of the disease presented in the vignette, a significant difference in intention was found between the two experimental situations (p < .05). Regression of intention to use condoms on the psychosocial variables yielded an adjusted R2 of .62. Perceived behavioral control, social norms, personal normative belief and anticipated affective reaction were the significant variables explaining this intention. The results suggest that intention to use condoms with a new sexual partner is likely to be modified by the expected outcome of the disease, that is, whether lethal or chronic. Thus, it is suggested that interventions aimed at young adults take into account the impacts the new antiretroviral treatments are likely to have on preventive behaviors.

Young adults and HIV vaccine: determinants of the intention of getting immunized.

The aim of this study was to evaluate the acceptability of a hypothetical HIV vaccine and to identify the psychosocial determinants of the intention of receiving HIV immunization, based upon Ajzen's Theory of Planned Behaviour (TPB). Of the 136 young adults surveyed, 120 (88%) had a moderate to high intention to receive the HIV vaccine. A logistic regression was performed and two psychosocial factors from the TPB were significant predictors of the young adults' intention of getting HIV immunization: their attitude towards getting HIV immunization (OR = 4.80, CI 95% = 2.08; 13.05) and the perceived behavioural control of getting HIV immunization (OR = 2.52, CI 95% = 1.17; 6.05). These results show that HIV immunization is well accepted by young adults. This finding is particularly relevant because the effectiveness of HIV immunization programs will depend on an individual's acceptance of this vaccine. Also, our results suggest that psychosocial determinants can influence a young adult's decision to receive the HIV vaccine once it becomes available.