Perceptions of Adult Patients Accessing Telehealth in an Urban Medical Group

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future? Methods: A qualitative study design was used to collect data through semi-structured open-ended interviews from 21 patients in a primary care practice. Interviews were transcribed and analyzed using grounded theory methodology. Results: The theory of weighing options emerged from the data. The process of weighing options explains how patients balance factors of urgency, timing/scheduling, relationships, distance, convenience, and various technical aspects before selecting a telehealth encounter or not. If all the factors show a benefit, then the decision is made to use telehealth. Information obtained from the patient perspective may identify strategies to support increased use of telehealth. Conclusion: The benefit of this study will be to facilitate awareness among patients about telehealth options. This information can be used by providers and nurses to maintain caring while supporting patients who choose virtual care

Virtual Clinical Trials: One Step Forward, Two Steps Back

Virtual clinical trials have entered the medical research landscape. Today’s clinical trials recruit subjects online, obtain informed consent online, send treatments such as medications or devices to the subjects’ homes, and require subjects to record their responses online. Virtual clinical trials could be a way to democratize clinical research and circumvent geographical limitations by allowing access to clinical research for people who live far from traditional medical research centers. But virtual clinical trials also depart dramatically from traditional medical research studies in ways that can harm individuals and the public at large. This article addresses the issues presented by virtual clinical trials with regard to: (1) recruitment methods; (2) informed consent; (3) confidentiality; (4) potential risks to the subjects; and (5) the safety and efficacy of treatments that are approved

Using Gamification to Support Positive Health Behaviour Change: A Kaupapa Māori Approach

As our lives become increasingly technology-dependent, healthcare practitioners and researchers recognise the opportunities to deliver effective digital healthcare initiatives to improve patient outcomes. Gamification is one such technological approach to consider. While some important work has been done in gamification, to date, there have been few gamified healthy lifestyle intervention studies undertaken within an Indigenous or minority population. Therefore, this research extends the current knowledge of gamification with a focus on an Indigenous population. Māori are the Indigenous People of New Zealand, and as in many other colonised countries, Māori are over-represented in obesity statistics; a factor which contributes to significant health inequities, such as a higher incidence of chronic illness among Māori people. Gamification may be an effective means of supporting positive lifestyle choices (e.g., increased physical activity) to reduce the prevalence of chronic illness. This research takes a Kaupapa Māori approach to address the research question: How can gamification support positive health behaviour change? Kaupapa Māori is a philosophical Māori-centric approach that ensures tino rangatiratanga (the right to self-determination). The research approach follows Māori tikanga (customary practices) and recognises the importance of Te Reo Māori (Māori language) and Te Ao Māori (a Māori worldview). This research followed a design science research (DSR) process and consisted of two phases: Phase One was a prototype design phase, and Phase Two evaluated the prototype. Phase One involved a series of co-design hui (focus groups) to explore the social context and health aspirations of Māori and to ideate potential solutions. Phase One found that normative beliefs strongly influence effective gamification design preference for Māori and that culturally-tailored design is effective for Māori; a notion that contradicts previous Western-oriented gamification implementations. Phase Two consisted of a cross-sectional survey and regression analysis to evaluate the prototype designed during Phase One. Major findings from Phase Two show that three critical factors predict whether Māori users would use the gamified intervention: Perceived Ease-of-Use; Māori-Centric Design; and the use of Whakataetae (competitive) persuasive design strategies. This research contributes to gamification literature by identifying the gamification elements that most significantly impact behavioural intention toward gamified health applications for Māori; knowledge that may be transferable to other Indigenous populations. The importance of implementing a competitive strategy contradicts previous literature on collectivist cultures and guides the development of future gamified interventions. This research also contributes to theoretical and practical knowledge by demonstrating that effective persuasive strategies are not universal; Māori-centric design is a self-determined approach that keeps the needs of the target audience central to the design of a solution. This research provides theory-driven practical guidelines for design processes and design decisions that are driven by the needs and aspirations of Māori

Anticipatory Mobile Computing: A Survey of the State of the Art and Research Challenges

Today's mobile phones are far from mere communication devices they were ten years ago. Equipped with sophisticated sensors and advanced computing hardware, phones can be used to infer users' location, activity, social setting and more. As devices become increasingly intelligent, their capabilities evolve beyond inferring context to predicting it, and then reasoning and acting upon the predicted context. This article provides an overview of the current state of the art in mobile sensing and context prediction paving the way for full-fledged anticipatory mobile computing. We present a survey of phenomena that mobile phones can infer and predict, and offer a description of machine learning techniques used for such predictions. We then discuss proactive decision making and decision delivery via the user-device feedback loop. Finally, we discuss the challenges and opportunities of anticipatory mobile computing.Comment: 29 pages, 5 figure

Empowering vulnerable people with serious games and gamification

Although many people will associate games with entertainment and leisure, games can also aim more serious purposes, such as training or education. Games with such goals are called serious games. In addition, gamification means that a (serious) task is enhanced with game elements. Examples of serious games and gamification can be seen in many aspects of daily life. Loyalty programs of stores, educational games in schools, fitness wearables and their gamified applications, rehabilitation games, and so on. In this dissertation, the focus is on a specific domain in which serious games and gamification can create societal benefit, namely by using them to empower vulnerable target groups. In the first part of this dissertation, a literature review is performed to understand the domain of serious games and gamification for vulnerable target groups. Based on this review, research gaps can be identified. Moreover, the review resulted in a taxonomy that is used throughout the dissertation to classify different games and applications. In the following parts of the dissertation, projects addressing two different target groups and in total three vulnerabilities are discussed. The first target group is older adults, who are vulnerable in different ways. In this dissertation, safety risks for doorstep scams and health risks through malnutrition are addressed. The first vulnerability is addressed by a serious game using interactive scenarios of doorstep scams. A diet tracking system that was used to support participants in a diet trial addressed the latter vulnerability. The second target group is young adults, which is an age group with a vulnerable mental well-being. The last part of this dissertation aims to study how gamification can be used to enhance self-compassion among young adults via an online 6-weeks training program, to increase their resilience in the face of mental well-being difficulties. Artificial Intelligence (AI) technologies can be used to personalize and adapt the experience of a game to users. Tone of voice analysis was used to influence the progression in scenarios of the serious game about doorstep scams, and it gave players the possibility to assess the assertiveness of their voice. Machine learning algorithms were used to create personalized meal recommendations that can be used to improve the user experience of the diet tracking system for older adults. These algorithms base their recommendations on information about the historical intake of users to suggest meals and to additional items during meal editing. This makes the process of registering a meal less time-consuming. Sentiment analysis is used to adapt responses of the system in an exercise from the self-compassion training program. In addition, a topic detection algorithm was designed to assign one topic from a predefined set of topics to a note by a user of the training program. With this information, users can choose different types of situations to use in the exercises: frequently or rarely discussed topics. Aside from those techniques, knowledge representation is used in all projects, which is important for serious games/gamified applications since they are often based on expert and/or domain knowledge. This dissertation contributes to understanding the domain of serious games and gamification to empower vulnerable groups. The work also contributes to the research on the development of applications within that domain. On top of that, it contributes to understanding how AI techniques can be used to offer (personalized) features that enrich serious games or gamified applications. Finally, for each of the project centered parts, the results that are found in those parts contribute to the research in those specific fields

Investing In America's Health 2015

In 2015, BCBS companies continued investing in America's health throughhundreds of community-based grants, sponsorships, educational programsand health initiatives. BCBS employees themselves reinforced this collectivecommitment with nearly 400,000 volunteer hours and $10 million in personaldonations. Our local investments last year targeted a wide rangeof health-related needs important to individual communities, including severaltopics that are top-of-mind in all communities. Among them were combatingchildhood obesity and diabetes, meeting growing demand for behavioraland mental health services, tackling the devastating opioid abuse epidemic,strengthening school-based health education and filling gaps in care throughsafety-net clinics.The following pages provide just a sampling of the many ways BCBS companiesare addressing these and other critical issues through hands-on efforts toincrease access to care, improve healthcare quality and affordability and enablehealthier living. That's what the Power of Blue is all about -- advancing theoverall health and well-being of every community in America