Digital diffusion in the clinical trenches : findings from a Telemedicine Needs Assessment

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Architecture, 2002.Includes bibliographical references (leaves 105-110).Broadly stated, this dissertation focuses on how practitioners and provider organizations integrate the computer and web into healthcare delivery. The opportunity that afforded this research was a Telemedicine Needs Assessment commissioned by a Massachusetts-based provider organization, consisting of two hospitals and 29 community group practices (CGP). The Telemedicine Needs Assessment incorporated qualitative and quantitative research programs to include: 1. cross-sectional, institution-wide, in-depth interviews; 2. participant observation at administrative and clinical day-to-day operations, and lastly, 3. a 68 item, closed-ended survey distributed to all 586 clinical practitioners to assess the access, use, and perceived needs of current computer, web, and telemedicine technologies. Data from the survey, (72% response rate), established a computer and web enablement baseline against which the success, failure, or potential usefulness of any future medical informatics implementation would be evaluated. Findings included: 1. Computer and web enablement within the organization is not ubiquitous. Access is high, use is low; 2. Practitioner status, practice location, and gender affect enablement. Non-MDs, CGP-based practitioners, and female practitioners report lowest access and use. 3. No differences were reported specific to home access to computers and use of e-mail. 4. Hospital-based practitioners report greater access and use. CGP-based practitioners report greater perceived needs for teletechnologies.(cont.) 5. Hospital-based and CGP-based male MDs emerge as the most polarized subgroups due to differences in computer and web use and perceived needs. 6. Female practitioners are more successful than male practitioners securing tech support at home and at work. 7. With regard to technology uptake, female MDs constitute a more homogeneous group than male MDs. Also, four products emerged from the Telemedicine Needs Assessment: 1. a needs assessment theory and methodology derived from Process Architecture which promulgates that discussions specific to the end users' work must always be inextricably linked with their work practice; 2. a typology of barriers to the integration of computer and web-based technologies into healthcare delivery stratified by practitioner, administration, organization, and industry; 3. a framework which defines and integrates real and virtual healthcare delivery services, products, and technologies, and finally; 4. a systems-based model of clinical and telecommunications integrated delivery networks providing IS, IT, and administrative infrastructure support for the framework.by Verlé Margaret Harrop.Ph.D

An empirical evaluation of m-health service users’ behaviours: A case of Bangladesh

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.Mobile health (m-health) services are revolutionising healthcare in the developing world by improving accessibility, affordability, and availability. Although these services are revolutionising healthcare in various ways, there are growing concerns regarding users' service quality perceptions and overall influence on satisfaction and usage behaviours. In developing countries, access to healthcare and low healthcare costs are insufficient if users lack confidence in healthcare service quality. Bangladesh's Directorate General of Health Services (DGHS) provides the only government-sponsored m-health service available to the entire population. DGHS's m-health service, available since 2009, is yet to be evaluated in terms of users' perceptions of the quality of service and its impact on satisfaction and usage. Hence, this study developed a conceptual model for evaluating the associations between overall DGHS m-health service quality, satisfaction, and usage behaviours. This study operationalised overall m-health service quality as a higher-order construct with three dimensions- platform quality, information quality, and outcome quality, and nine corresponding subdimensions-privacy, systems availability, systems reliability, systems efficiency, responsiveness, empathy, assurance, emotional benefit, and functional benefit. Moreover, researchers in various service domains, including- healthcare, marketing, environmental protection, and information systems, evaluated and confirmed the influence of social and personal norms on satisfaction and behavioural outcomes like- intention to use. Despite this, no research has been conducted to determine whether these normative components affect m-health users' service satisfaction and usage behaviours. As a result, this study included social and personal norms along with overall service quality into the conceptual model to assess the influence of these variables on users' satisfaction and m-health service usage behaviours. Data was collected from two districts in Bangladesh- Dhaka and Rajshahi, utilising the online survey approach. A total of 417 usable questionnaires were analysed using partial least squares structural equation modelling to investigate the relationships between the constructs in Warp PLS. The study confirms that all three dimensions of service quality and their corresponding subdimensions influence users' overall perceptions of DGHS m-health service quality. Moreover, overall DGHS m-health service quality has a significant direct association with satisfaction and an indirect association with usage behaviours through satisfaction. While social norms do not influence satisfaction and usage behaviours within the DGHS m-health context, personal norms directly influence users' satisfaction and indirectly influence usage behaviours through satisfaction. Theoretically, the study contributes by framing the influence of users' overall m-health service quality perceptions, social and personal norms on their actual usage behaviours rather than the intention to use. It also extends the existing knowledge by assessing and comparing m-health users' continuous and discontinuous behaviours. Methodologically this study confirms the usefulness of partial least squares structural equational modelling to analyse a complex model including a higher order construct (i.e., overall perceived service quality). Practically, the study demonstrates the importance of users' satisfaction in addition to service quality, as service quality only affects usage behaviours through satisfaction in the current study context. Additionally, knowing that personal norms significantly influence service satisfaction motivates providers of m-health services to strive to enhance users' personal norms toward m-health service to enhance service satisfaction and usage. Overall, the study will help enhance patient outcomes and m-health service usage