Measuring the 'success' of telehealth interventions

Despite substantial investment over recent years in telehealth there appears to be little consensus regarding what a successful implementation should achieve. However, defining success is often controversial and complex due to differing views from the large number of stakeholders involved, the local environment where telehealth is deployed and the scope, or size, of any planned initiative. Nevertheless, a number of generic measures are proposed in this paper which then provides a framework for the measurement of success. The local context can then be applied to determine the exact emphasis on specific measures, but it is proposed that all of the measures should be included in the holistic measurement of success. Having considered what constitutes success attention is then given to how success should be quantified. Robust evaluation is fundamental and there is much debate as to whether the �gold standard� Randomised Control Trial (RCT) is the most appropriate methodology for telehealth. If the intervention, technology and system, can be maintained in a stable state then the RCT may well provide the most authoritative evidence for decision makers. However, ensuring such stability, in what is still a novel combination of technology and service, is difficult and consequently other approaches may be more appropriate when stability is unlikely to be maintained

Enhancing the Performance of Healthcare Organizations: An Applied Analysis of Digital Technologies and Sustainability

Over the last two decades, scholars attempted to implement models to evaluate the effectiveness of digital technologies management in healthcare organizations balanced by its compliance with sustainability. However, a managerial framework for assessing digital technologies’ contribution to healthcare organizations’ performance is still lacking. Evidence-based research on digital and mobile technologies applied in the daily life environments of people over 65 in Italy has been implemented. Results were investigated by a) SWOT analysis and b) identifying the key performance indicators to evaluate the performance of healthcare organizations by following the implementation of digital technologies in healthcare processes in a sustainable perspective. The analysis reveals that some weaknesses can be overcome (e.g., the availability of GPs to be involved in the enrollment of the patients) while others cannot (e.g., systematic limitations of digital methodologies). At the same time, some threats can be tackled (e.g., users’ and operators’ difficulty adapting to technological developments) while others can only approximately be solved. Evidenced key performance indicators can be leveraged to carry out standardized assessments related to the digital practices implemented by healthcare organizations to achieve a fully developed sustainable relational ecosystem and generate a more efficient and effective healthcare organization system

Developing and evaluating MindMax: promoting mental wellbeing through an Australian Football League-themed app incorporating applied games (including gamification), psychoeducation, and social connectedness

Gamification is increasingly being used as a behavioural change strategy to increase engagement with apps and technologies for mental health and wellbeing. While there is promising evidence supporting the effectiveness of individual gamification elements, there remains little evidence for its overall effectiveness. Furthermore, a lack of consistency in how ‘gamification’ and related terms (such as ‘applied games’, an umbrella term of which gamification is one type) are used has been observed within and across multiple academic fields. This contributes to the difficulty of studying gamification and decreases its accessibility to people unfamiliar with applied games. Finally, gamification has also been critiqued by both game developers and by academics for its reliance on extrinsic motivators and for the messages that gamified systems may unintentionally convey. In this context, the aims of this thesis were fourfold: 1) to iteratively co-design and develop a gamified app for mental health and wellbeing, 2) to evaluate the eventuating app, 3) to consolidate literature on gamification for mental health and wellbeing, and 4) to synthesise findings into practical guidelines for implementing gamification for mental health and wellbeing. Chapter 2 reports the first study which addresses the first aim of this thesis. Six participatory design workshops were conducted to support the development of MindMax, an Australian Football League (AFL)-themed mobile phone app aimed at AFL fans (particularly male ones) that incorporates applied games, psychoeducation, and social connectedness. Findings from these workshops were independently knowledge translated and fed back to the software development team, resulting in a MindMax prototype. This prototype was further tested with 15 one-on-one user experience testing interviews at three separate time points to iteratively refine MindMax’s design and delivery of its content. The findings of this study suggest that broadly, participants endorsed a customisable user experience with activities requiring active user participation. These specifications were reflected in the continual software updates made to MindMax. Chapters 3 and 4 report the second and third studies which address the second aim of this thesis. As regular content, performance, and aesthetic updates were applied to MindMax (following the model of the wider tech industry), a naturalistic longitudinal trial, described in Chapter 3, was deemed to be the most appropriate systematic evaluation method. In this study, participants (n=313) were given access to MindMax and asked to use it at their leisure, and surveys were sent out at multiple time points to assess their wellbeing, resilience, and help-seeking intentions. Increases in flourishing (60-day only), sense of connection to MindMax, and impersonal help-seeking intentions were observed over 30 and 60 days, suggesting that Internet-based interventions like MindMax can contribute to their users’ social connectedness and encourage their help-seeking. The third study, described in Chapter 4, reports a secondary analysis of data collected for Chapter 3, and further explores participants’ help-seeking intentions and their links to wellbeing, resilience, gender, and age. An explanatory factor analysis was conducted on Day 1 General Help-Seeking Questionnaire (GHSQ) data (n=530), with the best fitting solution resulting in three factors: personal sources, health professionals, and distal sources. In addition to providing more evidence that younger people aged 16–35 categorise apps and technologies for mental health and wellbeing like MindMax alongside other distal social sources such as phone helplines and work or school, our findings also suggest that the best way to target individuals who are least likely to seek help, particularly men, may be through these distal sources as well. Chapter 5 reports the fourth study, which addresses the third aim. In order to consolidate literature on gamification for mental health and wellbeing, this systematic review identified 70 papers that collectively reported on 50 apps and technologies for improving mental health and wellbeing. These papers were coded for gamification element, mental health and wellbeing domain, and researchers’ justification for applying gamification to improving mental health and wellbeing. This study resulted in two major findings: first, that the current application of gamification for mental health and wellbeing does not resemble the heavily critiqued mainstream application that relies on extrinsic motivators; and second, that many authors of the reviewed papers provided little or no justification for why they applied gamification to their mental health and wellbeing interventions. While the former finding is encouraging, the latter suggests that the gamification of mental health and wellbeing is not theory-driven, and is a cause for concern. Finally, to address the final aim of this thesis, all study learnings were synthesised into practical guidelines for implementing gamification for mental health and wellbeing. First, it is important to assess the suitability of implementing gamification into the intervention. Second, this implementation should ideally be integrated at a deeper, systemic level, with the explicitly qualified intention to support users, evidence-based processes, and user engagement with these processes. Third, it is important to assess the acceptability of this gamified intervention throughout its development, involving all relevant stakeholders (particularly representative end user populations). Fourth, it is important to evaluate the impact of this gamified intervention. Fifth, and finally, comprehensive and detailed documentation of this process should be provided at all stages of this process. This thesis contributes to a growing literature on the increasing importance and relevance of Internet-based resources and apps and technologies for mental health and wellbeing, particularly for young people. Given the dominance of games in society and culture across history, and the increasing contemporary prominence of digital games (also known as video games) in particular, gamification is uniquely positioned to have the potential to make large contributions to mental health and wellbeing research. In this context, this thesis contributes a systematically derived operationalisation of gamification, an evaluation of a gamified app for mental health and wellbeing, and best practice guidelines for implementing gamification for mental health and wellbeing, thereby providing frameworks that future implementations of gamified mental health and wellbeing interventions and initiatives may find useful

Business Case and Technology Analysis for 5G Low Latency Applications

A large number of new consumer and industrial applications are likely to change the classic operator's business models and provide a wide range of new markets to enter. This article analyses the most relevant 5G use cases that require ultra-low latency, from both technical and business perspectives. Low latency services pose challenging requirements to the network, and to fulfill them operators need to invest in costly changes in their network. In this sense, it is not clear whether such investments are going to be amortized with these new business models. In light of this, specific applications and requirements are described and the potential market benefits for operators are analysed. Conclusions show that operators have clear opportunities to add value and position themselves strongly with the increasing number of services to be provided by 5G.Comment: 18 pages, 5 figure

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Hospital Fall Prevention Using Interactive Patient Care Technology

The impact of patient engagement in hospital fall prevention using interactive patient care technology is not known. The purpose of this investigation was to examine the engagement of hospitalized patients in a computer-based, interactive patient care fall prevention pathway, comprised of a self-assessment of fall risk questionnaire and a fall prevention video, and hospital fall outcomes. The aims were to 1) formulate an interactive patient care technology conceptual framework to guide the study, 2) provide reliability and validity evidence for a patient self-assessment of fall risk questionnaire, and 3) explore the relationship between the fall prevention pathway engagement characteristics and a fall outcome. A conceptual framework for interactive patient care technology was developed and applied to the research investigation. The methodology included a retrospective, cross-sectional design using a convenience sample of 120 subjects to establish preliminary reliability and validity evidence for the patient self- assessment of fall risk questionnaire, and a matched 1:4 case-control design using 73 cases and 292 controls to examine the relationship between the fall prevention pathway engagement characteristics and a fall outcome. Findings indicated the patient self-assessment of fall risk questionnaire is reliable, with a Cronbach\u27s alpha of .73, and valid, with a statistically significant correlation to the nurses fall risk assessment tool, r (118) = .45, p \u3c .001. Using conditional logistic regression, length of stay, number of automatic video prompts, and fall prevention video completion status were significantly associated with a hospital fall. As length of stay increased by one day, the odds of a fall were 11% higher. With each additional automatic video prompt, the odds of a fall increased by a factor of 1.58. Cases were .38 times less likely to complete the fall prevention video than to complete it. Conclusions included an interactive fall prevention pathway promoted engagement and engagement at the empowerment level (video completion) prevented a fall. Limitations of this investigation included the use of secondary data, subject related assumptions, and the inability to generalize due to site, technology, and sample. This investigation contributes new knowledge regarding patient engagement in hospital fall prevention using interactive patient care technology

E-Health information seeking behavior of older Finnish adults from the value-based care point of view

Health information seeking behavior is a widely discussed topic in the field of information studies. However, the current study is about observing and evaluating the efficiency of health information seeking behavior through E-Health service and devices. The main reason that motivated the researcher to carry out the current research was high cost of healthcare services in Finland. It is expected that health information obtained through electronic or online sources would help people to improve their health conditions. Therefore, this thesis is an empirical study on observing E-Health information seeking behavior and evaluating the efficiency of E-Health service and devices. In order to estimate the efficiency of E-Health service and products, this study considered some criteria generated by previous studies. These criteria were employed in the current study as indicators of the health information seeking efficiency. The current study developed a customized model of health information seeking behavior based on the general model of information seeking behavior. The model contains some further criteria to measure the efficiency of the information seeking process. The primary tool to collect data were a multiple-choice questionnaire. The questionnaires were distributed through two main methods, namely hard copy and online. The participants in this study were either Finnish older adults who were over 50 years old, or other persons who were responsible for providing health information for them. The results of this study show that using E-Health service and products has neither a positive effect on improving the health condition of patients, nor does it motivate people to a healthier lifestyle, or make them feel more satisfied. However, it is expected that the results provide a framework for further studies to develop more efficient E-Health-related tools and services