Empirical Testing of Resistance and Misuse Factors Contributing to Instructors’ Use of E-Learning Systems in Saudi Arabia

The purpose of this study was to conceptually replicate the model proposed by Bhatnagar, Madden, and Levy (2016) in a new context of e-learning systems usage and to examine the underlying resistance, misuse, and computer self-efficacy constructs that may contribute to instructors’ usage of e-learning systems in Saudi Arabia. For this study, the original instrument was adapted, the Institutional Review Board (IRB) approval was obtained, data from 187 instructors that use e-learning systems were collected, and the model was analyzed using the Partial Least Squares (PLS). This study demonstrates higher overall model predictability than the original model and has stronger relationships between the constructs. The results show that computer self-efficacy and resistance to use the system contribute significantly to system usage, which are contrary to the original study’s results that were in the context of secured medical teleconferencing. Additionally, computer self-efficacy appears to demonstrate a significant positive impact on ethical severity of misusing the systems, which is also a contrary to the original study’s results. The results of this study indicate that context matters in IS usage, especially when there is a difference between IS used for exchange of private and personal information like medical teleconferencing, compared with an IS used as a productivity tool. However, both studies indicate that the ethical severity of misusing the systems has no significant impact on system usage, which may suggest that such relationship may be mediated by another construct and may call for further research. Discussions and conclusions are provided

Distance Education and Dementia Caregivers: A Comparison of Three Methods

The purpose of the research is to examine the family experience of dementia caregiving and design an educational intervention to assist family members in the caregiving role. Stress results when a caregiver confronts environmental demands (dementia behaviors) that threaten personal well-being. The perception of threat is the process of primary stress appraisal. Caregivers evaluate coping options, a process of secondary stress appraisal. Positive secondary appraisal (view the situation as amenable to change) has the potential to trigger re-appraisal of the primary threat, and to reduce overall stress. Education is one way to affect secondary appraisal. Adult learners benefit from progressive (problem solving) approaches using self-directed learning principles. With self-directed learning, the educator facilitates the learner’s access to the information. Distance education is a form of self-directed learning. Distance techniques include postal mail, facsimile, telephone, video, teleconferencing, satellite conferencing, and the Internet. The research question is: to what extent can distance education (by postal mail, passive Internet, and multimedia, interactive Internet) alter the primary and secondary stress appraisals of dementia caregivers? A total of 189 caregivers participated in the study. The study design, Switching Replications, includes three waves of measurement over a two month period. With the design, some participants receive the intervention upon entry into the study, while others wait until after the second wave of measurement. Three study hypotheses relate to the construct of primary appraisal and the dependent variable of threat perception. Analysis of Variance (ANOVA) results do not support hypotheses that posit the form of education affects threat perception. Four hypotheses address the construct of secondary appraisal and the dependent variable of home modifications. ANOVA results support hypotheses that posit the form of education affects home modifications. Active web education is statistically better than receiving no education or receiving information by postal mail. Assuming no cure or effective treatment, the number of people diagnosed with dementia will increase to 8.6 million by 2040 (General Accounting Office,1998). Despite the stress, families are and will likely remain the primary caregivers. Distance education merits further study as a way to reach and help family caregivers

Researching Across Two Cultures: Shifting Positionality

Embodied and creative research methods provoke honesty, emotion, and vulnerability in participants, which add to the richness of the stories they tell and are willing to share. The positionality of the researcher is less of “interviewer” and more “co-producer” or participant in a dialogue. Visual and creative approaches invite participants to share in ways in which they are not able or willing through words alone. The data and outputs they produce, with film, art, or objects, can in turn affect those who see it more than written text and need to be analysed and disseminated along with more traditional transcripts, articles, and presentations. In the context of investigating sensitive issues such as those around embodied identity, these methods, which use embodied methods to explore embodied research questions, may feel the most appropriate. These approaches lie along the boundary of therapy and research, asking much of researchers who are unlikely to have received therapeutic training or ongoing support. Due to this deficit, the researched may find that their experience is not held or contained in a way that the content would demand. Similarly, the data themselves lie on the boundary of art and research, in that they can be seen as more than a tool to facilitate reflection, but as artifacts in their own right. What are the implications in this scenario? Where should we position ourselves and our work along these boundaries? Who holds the space for the researcher and the researched if both are made vulnerable

Co-designing patient-centred technology for chronic kidney disease : supporting the patient journey

Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids.Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids

Smarter choices - changing the way we travel

Summary: In recent years, there has been growing interest in a range of initiatives, which are now widelydescribed as 'soft' transport policy measures. These seek to give better information and opportunities,aimed at helping people to choose to reduce their car use while enhancing the attractiveness ofalternatives. They are fairly new as part of mainstream transport policy, mostly relativelyuncontroversial, and often popular. They include:. Workplace and school travel plans;. Personalised travel planning, travel awareness campaigns, and public transport information andmarketing;. Car clubs and car sharing schemes;. Teleworking, teleconferencing and home shopping.This report draws on earlier studies of the impact of soft measures, new evidence from the UK andabroad, case study interviews relating to 24 specific initiatives, and the experience of commercial,public and voluntary stakeholders involved in organising such schemes. Each of the soft factors isanalysed separately, followed by an assessment of their combined potential impact.The assessment focuses on two different policy scenarios for the next ten years. The 'high intensity'scenario identifies the potential provided by a significant expansion of activity to a much morewidespread implementation of present good practice, albeit to a realistic level which still recognisesthe constraints of money and other resources, and variation in the suitability and effectiveness of softfactors according to local circumstances. The 'low intensity' scenario is broadly defined as aprojection of the present (2003-4) levels of local and national activity on soft measures.The main features of the high intensity scenario would be. A reduction in peak period urban traffic of about 21% (off-peak 13%);. A reduction of peak period non-urban traffic of about 14% (off-peak 7%);. A nationwide reduction in all traffic of about 11%.These projected changes in traffic levels are quite large (though consistent with other evidence onbehavioural change at the individual level), and would produce substantial reductions in congestion.However, this would tend to attract more car use, by other people, which could offset the impact ofthose who reduce their car use unless there are measures in place to prevent this. Therefore, thoseexperienced in the implementation of soft factors locally usually emphasise that success depends onsome or all of such supportive policies as re-allocation of road capacity and other measures toimprove public transport service levels, parking control, traffic calming, pedestrianisation, cyclenetworks, congestion charging or other traffic restraint, other use of transport prices and fares, speedregulation, or stronger legal enforcement levels. The report also records a number of suggestionsabout local and national policy measures that could facilitate the expansion of soft measures.The effects of the low intensity scenario, in which soft factors are not given increased policy prioritycompared with present practice, are estimated to be considerably less than those of the high intensityscenario, including a reduction in peak period urban traffic of about 5%, and a nationwide reductionin all traffic of 2%-3%. These smaller figures also assume that sufficient other supporting policies areused to prevent induced traffic from eroding the effects, notably at peak periods and in congestedconditions. Without these supportive measures, the effects could be lower, temporary, and perhapsinvisible.Previous advice given by the Department for Transport in relation to multi-modal studies was that softfactors might achieve a nationwide traffic reduction of about 5%. The policy assumptionsunderpinning this advice were similar to those used in our low intensity scenario: our estimate isslightly less, but the difference is probably within the range of error of such projections.The public expenditure cost of achieving reduced car use by soft measures, on average, is estimated atabout 1.5 pence per car kilometre, i.e. £15 for removing each 1000 vehicle kilometres of traffic.Current official practice calculates the benefit of reduced traffic congestion, on average, to be about15p per car kilometre removed, and more than three times this level in congested urban conditions.Thus every £1 spent on well-designed soft measures could bring about £10 of benefit in reducedcongestion alone, more in the most congested conditions, and with further potential gains fromenvironmental improvements and other effects, provided that the tendency of induced traffic to erodesuch benefits is controlled. There are also opportunities for private business expenditure on some softmeasures, which can result in offsetting cost savings.Much of the experience of implementing soft factors is recent, and the evidence is of variable quality.Therefore, there are inevitably uncertainties in the results. With this caveat, the main conclusion isthat, provided they are implemented within a supportive policy context, soft measures can besufficiently effective in facilitating choices to reduce car use, and offer sufficiently good value formoney, that they merit serious consideration for an expanded role in local and national transportstrategy.AcknowledgementsWe gratefully acknowledge the many contributions made by organisations and individuals consultedas part of the research, and by the authors of previous studies and literature reviews which we havecited. Specific acknowledgements are given at the end of each chapter.We have made extensive use of our own previous work including research by Lynn Sloman funded bythe Royal Commission for the Exhibition of 1851 on the traffic impact of soft factors and localtransport schemes (in part previously published as 'Less Traffic Where People Live'); and by SallyCairns and Phil Goodwin as part of the research programme of TSU supported by the Economic andSocial Research Council, and particularly research on school and workplace travel plans funded bythe DfT (and managed by Transport 2000 Trust), on car dependence funded by the RAC Foundation,on travel demand analysis funded by DfT and its predecessors, and on home shopping funded byEUCAR. Case studies to accompany this report are available at: http://eprints.ucl.ac.uk/archive/00001233

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces

An exploration of factors affecting participation in U.S. health information exchange networks : a dual network participation theory based case study.

Background: Failure to achieve their goals of over 200 U.S. Health Information Exchange Networks (HIENs) which formed or operated in the U.S. from 2004 to 2010, lost time, capital and opportunity at individual, organizational and societal levels, and a lack of theory driven research on HIENs underscores a need for research to better understand factors affecting development of these kinds of large, complex collaborations. Purpose: A new dual network participation theory is developed by combining three source theories. The new theory supports integrated consideration of organizational and technological factors which affect participation by individuals and their affiliated organizations in complex collaborations like HIENs. Research questions are formulated focused on advancing knowledge about: types of participation in HIENs; validity of variables used to operationalize the theory; barriers and enablers to participation in HIENs; and implications for theory and research. Method: A retrospective, theory-driven, multi-level, multi-case, mixed methods case study is done using a convenience sample of 6 HIEN sites (network level), 109 individuals (individual level) and 125 organizations (organizational level). Qualitative data is analyzed to develop valid ordinal variables and test hypotheses for each case. Valid ordinal variables are entered into SPSS. A principle component analysis is done to create combined predictor variables. An OLS regression analysis supports identification of predictor effects on intent to participate. Network level analyses identify key influences on the predictors. Findings: Network level barriers to participation include heterogeneity of participants, lack of HIEN resources, lack of qualified leadership, lack of training and education and lack of stable Network IT. Individual/organizational level barriers include lack of support from influential others, low benefit expectancy, lack of knowledge, and high cost expectancy. Recommendations are made for future research studies with enough statistical power for hypothesis testing across larger populations of sites/participants (e.g., 100-300 sites; 1,000 - 3,000 participants). Conclusions: While the use of a small, non-random sample of sites/subjects implies caution regarding generalization, the research yields new insights with implications for both practice and theory. These include preliminary recommendations for improving the success of HIENs and new opportunities for research on barriers and enablers of participation in large scale collaborations

A qualitative examination of best practices in the provision of specialized mental health services to individuals with a dual-diagnosis in London and Middlesex County

This study explores the perceptions of prevalence of dually-diagnosed individuals in London/Middlesex County, collaboration between service providers, gaps in service, and models of practice related to best practice literature. Results from a sample of 11 qualitative interviews suggests the following: an abundance of services in the region; limited capacity; lack of service coordination and formal centralized access mechanisms; need for front-line education and cross-training; issues between the Ministries and the LHIN; and unclear roles and expectations between community service providers and inpatient facilities. Key informant\u27s reports of best practices include: person-centred strategies; specialized services; community-based teams of multi-disciplinary staff; flexible service structure; collaboration and coordination in service provision; and sharing of expertise. Implications for social work practice are discussed, as well as a proposed model of treatment and recommendations for future studies

A Qualitative Study of the Lived Experiences of Unarmed Police Officers

The purpose of this study was to describe the lived experiences of unarmed law enforcement officers managing workplace violence while performing their duties in New York City at various agencies. The three research questions asked, how do unarmed police officers describe their experiences performing their job duties without a lethal weapon? How do unarmed police officers describe their expectations regarding their likelihood of experiencing workplace violence? How do unarmed police officers describe how they navigate workplace violence? The theory guiding this qualitative descriptive study was prospect theory, a concept that was originally used to study how the bias of money managers influences the way they invest funds for clients. Prospect theory is appropriate for research involving police officers as they are often accused of biases, both implicit and explicit. Virtual snowball sampling was used to recruit 12 officers who perform their duties within the five boroughs of New York City. Allegations of bias against specific constituents are frequent, most often against African Americans, the mentally ill, and anyone who is the subject of a police action. The data were collected during semi-structured interviews with volunteer-participants who work as unarmed law enforcement officers. Interviews were conducted via Zoom teleconferencing software and ran between 45–90 minutes in length from which a narrative for each was created. The interviews were transcribed via temi.com. All coding and thematic analysis used to examine the data were completed manually. Ten main themes were identified regarding how workplace violence is managed by unarmed officers: (a) potentially injurious items encountered, (b) negative experiences, (c) positive experiences, (d) potential for violence, (e) view of work conditions, (f) support, (g) training, (h) use of force, (i) capacity to manage violence, and (j) response to work conditions

Delivery of parent-child interaction therapy in a telehealth format: Reducing disruptive behaviors in pediatric traumatic brain injury

Traumatic brain injuries (TBIs) in childhood have been associated with disruptive behaviors and attentional problems that may worsen over time and are often experienced as challenging for those in caregiving roles. Parents of children with TBI may evoke negative interactions to manage their child’s behavior through reliance on ineffective parenting practices. This results in increasingly maladaptive parent-child interactions that maintain or worsen problem behaviors of the child and further disrupt family functioning. Despite the importance of family functioning on child post-injury outcomes, the availability of family-based treatments for children with TBI is extremely limited. Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for young children with oppositional and disruptive behaviors. Although children with TBI experience similar deficits in attention and behavioral regulation, research is lacking in supporting PCIT outcomes specifically for children with TBI. This research evaluated adaptations to the standard PCIT protocol that may benefit treatment of parents and their children with TBI. Using a multiple-baseline design, the current study examined the effectiveness of telehealth-delivered PCIT in the home setting for a 9-year-old child with TBI and co-occurring behavioral and attentional difficulties. Adaptations were consistent with the recommendations set forth by Eyberg (2005) and maintained the conceptual integrity of PCIT by keeping the theoretical and empirical foundation while adding components to target the unique challenges of the pediatric TBI population. Meaningful, observable changes were shown in parent behaviors in addition to improved parent-child interactions. Positive changes in the child’s compliance to parent directions were observed and reported by parents. A reduction in parent perception of behavior problem frequency and parent-reported satisfaction with treatment goals, procedures, and outcomes also support clinically meaningful results