If You Build It, Will They Use It? Challenges in Adoption and Use of Patient-centered E-health

Preventive healthcare services require consumers to coordinate and manage several healthcare activities with multiple service providers. In this paper, we explore the adoption and use of a patient-centered e-health system for managing personal healthcare requirements. Specifically, using the patient-centered e-health (PCEH) framework, we analyzed the data we collected from a qualitative study of consumers who participated in a preventive care program called the Health Enhancement Program (HEP) in Connecticut in the United States and the accompanying e-health service the program offered. Data from the interviews of 15 participants revealed that users found several challenges in adopting and using the e-health system when examined in the context of their lifestyle even though the system had a patient-centric design. These findings provide implications for designing and assessing patient-centered e-health to ensure that users effectively adopt and continue to use them and insights for expanding PCEH theory and practice

Group External Memory Aid Treatment for Mild Cognitive Impairment

Short-term memory deficits associated with mild cognitive impairment (MCI) make complex daily activities challenging. External memory aids (EMA) could help compensate for impairments. The study purpose was to examine the effects of group EMA treatment for individuals with MCI on functional EMA use, cognitive abilities, maintenance of skills, and EMA preference. Six participants (divided into wait-list control and treatment groups) completed six weekly group treatment sessions. Post-treatment participants slightly increased or maintained functional EMA use and cognitive abilities. Mixed results related to maintenance of skills indicated the importance of treatment to reinforce EMA use. Clinical implications and research directions will be discussed

Supporting individual time management through the capture and display of temporal structures

This thesis work examines the time management strategies of individuals in an academic institution and gathers information on the complex temporal structures they experience and manage. Its focus is on understanding the relationship between the quality of individual time management and an individual\u27s understanding and use of temporal structures. This work consists of an exploratory field study to gather data on how people use temporal structures with electronic tools. It is followed by a survey that is given to a larger group of respondents in the same subject population examined with the field study. The survey examines the hypotheses developed from a literature review on the impact and role of time in people\u27s work lives coupled with the information uncovered in the filed study on time management practices. A research model is developed using partial least squares to examine the relationships between the key survey constructs. This study demonstrates that the use and understanding of temporal structures is an important component for good individual time management. Four properties of individual time management quality were identified and utilized to characterize who are good time managers. These four properties include planning, meeting deadlines, sensing a lack of time control and engaging in procrastination. Significant differences are found in the use of explicit temporal structures, creation of temporal structures and understanding of temporal structure relationships between good time managers and poor time managers. A research model was built to understand the interacting variable relationships. Significant differences in the relationships between quality of individual time management and various temporal structures were discovered among students, faculty and staff members in the university studied. Students mostly use and understand a range of explicit and implicit temporal structures in their personal time management. Faculty members focus on using explicit temporal structures and creating their own temporal structures to support their time management. Staff members only utilize the temporal structures to do time planning. Implicit temporal structure understanding helps them avoid procrastination in their work. We explain these results as follows. The students are greatly entrained by a large number of tight and short deadlines which they do not have power to adjust, e.g., assignment due dates. Faculty members have much more time control and flexibility to create their own temporal structures. Except for meeting classes and turning in grades, they set their own schedules. Staff members are not concerned with meeting deadlines. They have constantly shifting instantaneous demands, part of which is responding to others temporal structure needs. Thus, their temporal structures only support their time planning, and avoid potential work delay. This research concludes that people exhibit different time experience based on their professions. Furthermore, good time managers demonstrate more skill in capturing and using their temporal structures than poor time managers. Because the current information technologies do not provide much support to capture temporal structures explicitly, this study also implies that it is likely to be a valuable exercise to integrate temporal structure features into personal time management systems such as electronic calendar tools

Doctor of Philosophy

dissertationTreatment adherence remains a major challenge in tuberculosis (TB) control. Mobile phone text messaging is a promising tool to support TB treatment adherence. The purpose of this study was to develop a text messaging intervention to promote TB treatment adherence, assess feasibility and acceptability, and to explore initial efficacy. A collaborative team of clinicians, administrators and patients in treatment developed the intervention. Content analysis, based on the Information-Motivation-Behavioral Skills (IMB) model, guided educational message selection. To identify considerations for a larger trial a socio-technical evaluation model adapted from Conford, and Barber and associates was applied. The intervention was implemented as a mixed-method, randomized controlled pilot-study at a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were18 or older, without drug resistance or HIV, and had access to a mobile phone were recruited. Participants were randomized to usual care plus either medication calendar (n=19) or text messaging intervention (n=18) for the first 2 months of treatment. Data were obtained through interviews, field notes, self-reported adherence, sputum microscopy, and treatment outcomes. Most potential participants had access to mobile phones and knew how to send a text, supporting feasibility of the intervention. The majority of the participants (60%) indicated not being adequately informed about disease or treatment. Participants identified themes of feeling cared for, responsible for their treatment and valued the option to ask questions and receive quick answers. Texting group participants reported adherence 77% of the days (SD 23.5, range 22-100), whereas only 53% in the control group returned calendars. Sputum conversion and treatment outcomes were similar in both groups. Considerations for conducting a larger trial included reducing cost, improving the automated features, and strengthening capacity to return patients to treatment. A collaborative approach and application of the IMB model to guide development was supported. Overall the texting intervention was well accepted and feasible, daily reporting was superior, and adherence was monitored in real time. Although there was not clear evidence that the texting intervention was more efficacious, feasibility and acceptability results suggest that there is value in assessing this interactive intervention in a larger-scale study

Collaboration, Coordination and Computer Support: An Activity Theoretical Approach to the Design of Computer Supported Cooperative Work. Ph.D. Thesis

This thesis is written in partial satisfaction of the requirements for a Ph.D. in Computer Science performed within the Industrial Research Education Programme established between the University of Aarhus, Kommunedata and Aarhus University Hospital. The initial focus of the project was to investigate ways of supporting the extensive cooperation taking place within a hospital. The theoretical objective of this work is to apply activity theory as a theoretical foundation for CSCW research and to focus on the issue of design within CSCW

Human factors in mental healthcare : A work system analysis of a community-based program for older adults with depression and dementia

Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes

Assessing the Need for Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative

Abstract Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety. Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment after presentation of written material, numerous follow-up telephone calls, and uncertainty about techniques to self-manage symptoms and side effects. Evidence shows that when done appropriately, providing multiple methods of pre-chemotherapy education is effective in preventing and reducing anxiety, improvement in health literacy recall, and ability to self-mange side effects in patients receiving chemotherapy for the first time. Process: This evidence-based practice project was built on the foundation of the Ace Star Model of Knowledge Transformation framework and the gate control pain theory. An integrated literature review was piloted to examine the best methods of providing chemotherapy education in the effort to improve patient’s health literacy, self-management of treatment side effects, patient satisfaction, and the reduction of anxiety. Outcomes: The implementation of standardized procedure in methods of pre-chemotherapy education are pending. Conclusion: Standardizing the process of chemotherapy education can provide measurable improvement in quality of care, productivity, adherence to treatment, and morale for chemotherapy patients by enhancing their level of health care literacy and sills for self-management of chemotherapy-related side effects

A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center

[EN] Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.Morell-Santandreu, O.; Santandreu Mascarell, C.; García Sabater, JJ. (2021). A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. International Journal of Environmental research and Public Health (Online). 18(6):1-33. https://doi.org/10.3390/ijerph18062876S13318

GeoHealth:a location-based service for home healthcare workers

We describe a map-based location-based service ‘GeoHealth ’ for home healthcare workers who attend patients at home within a large geographical area. Informed by field studies of work activities and interviews with care providers, we have designed a mobile location-based service prototype supporting collaboration through information sharing and distributed electronic patient records. The GeoHealth prototype gives the users live contextual information about patients, coworkers, current and scheduled work activities and alarms adapted to their geographical location. The application is web-based and uses Google Maps, Global Positioning System (GPS) and Web 2.0 technology to provide a lightweight, dynamic and interactive representation of the work domain supporting distributed collaboration, communication and peripheral awareness among nomadic workers. Through a user-based evaluation, we found that the healthcare workers were positive towards the use of location-based services in their work, and that the dynamic and interactive geospatial representation of the work domain provided by GeoHealth supported distributed collaboration, communication and peripheral awareness. We also identified areas for improvements