Transnational comparison : A retrospective study on e-health in sparsely populated areas of the northern periphery

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Citizens Participating in their Healthcare – Challenges for Nurses

In Finland, health and welfare is taken care under the common health and social services system that consists of independent private, public and third sector actors. Through taxation, municipalities finance most of the healthcare and the government provides additional support. Functionality and effectiveness of the overall system is vitally important to guarantee today’s good healthcare services. For instance, in social services and healthcare, digital health supports the quality of life, care, dignity and sovereignty. The necessary technology is equally, fairly and easily accessible due to the widespread technological infrastructure. For example, in healthcare, use of technology is agreed with the citizen when preparing the healthcare service plan. The documentation of patient data is carried out virtually at all levels of care. Technology offers options that can paradoxically mean both freedom and slavery depending on how and where technology is used, and who has the right to use it. Furthermore, the digital divide has narrowed, but it still exists. Due to the ageing of people, there is a growing need for healthcare staff who are digitally knowledgeable in order to support citizens and their families in health issues. When studying different digital health related strategies from 1995 to 2020, the vital role of healthcare staff is recognised and their technological competence and skills need to be updated along with the development of technology. During the last decade, in the latest strategies, the role of the citizen as a key part of the healthcare service chain has grown significantly.  Simultaneously, the development of a digital society offers possibilities to participate and the advanced digital expertise of citizens promotes their participation in healthcare. In principle, everyone has possibilities to access health data and gather health related data via Internet databases. This article discusses the elements of citizen or patient and nurse interactions, and how and whether this challenges nurses

E-health and e-welfare of Finland : Check Point 2022

The report provides an overview of progressive nationwide activities towards better e-services in Finland. The information system services of social welfare and health care are monitored by systematic gathering, analysis, and use of data, which allows the tracking of the progress of operations and the realisation of goals. In 2020 and 2021, six data collections were carried out to produce data for the monitoring of the Finnish ‘Information to support well-being and service renewal, eHealth and eSocial Strategy’. Some of the results presented in the report are also openly available in database cubes

Behavior change techniques to promote healthcare professionals' eHealth competency : A systematic review of interventions

Introduction: The use of eHealth is rapidly ->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. Objective: Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. Methods: We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. Results: This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. Conclusions: We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and usercentered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.Peer reviewe

Older people and eHealth service use An exploration of a complex learning and care ecosystem in the rural areas of Finnish Lapland

Tämä väitöskirja kohdistuu ikäihmisten (yli 60-vuotiaiden) arkeen digitalisoituvien sosiaali- ja terveyspalveluiden näkökulmasta. Tutkimuksen yleisenä tavoitteena on selvittää, kuinka harvaan asutuilla alueilla asuvat ikäihmiset ja heidän sosiaaliset verkostonsa käyttävät kotihoidon tarjoamia eTerveyspalveluita (eHealth services) oppimisen ja hoivan ekosysteemissä. eTerveyspalveluiden käytön tavoitteena on tukea ja helpottaa ikäihmisten sekä heidän hoitajiensa ja läheistensä terveyttä, hyvinvointia ja arkea parantamalla sosiaali- ja terveyspalveluiden saavutettavuutta ja laatua sekä vähentämällä niiden kustannuksia. eTerveyspalveluiden käyttö herättää myös suuren määrään inhimillisiä eettisiä kysymyksiä. Yksityiskohtaisemmin tutkimuksen tavoitteena on (1) lisätä tietoisuutta digitaalisesta osaamisesta eTerveyspalveluiden käytön oppimisessa ja käytössä, (2) selventää, millä tavalla oppimisprosessi on osa eTerveyspalveluiden kotouttamista, (3) rakentaa teoreettis-käsitteellinen malli eTerveyspalveluiden oppimiseen ja käyttöön, ja (4) antaa kehitysehdotuksia eTerveyspalveluiden suunnittelulle ja toteuttamiselle. Nämä tavoitteet saavutetaan kolmen teoreettisen lähestymistavan kautta. Oppimisen ja hoivan ekosysteemi muodostaa tutkimukselle perustan, hahmottaen ikäihmisten eTerveyspalveluiden oppimista ja käyttöä neljästä eri näkökulmasta: käytännön, sosiaalisen, kulttuurisen ja symbolisen kontekstin kautta. Digitaalisen osaamisen ja teknologian kotouttamisen käsitteet keskittyvät siihen prosessiin, miten ikäihmiset oppivat käyttämään ja käyttävät eTerveyspalveluita arjessaan. Sosiaalisen konstruktivismin paradigmasta ohjaa tutkimuksen suunnittelua soveltuvin osin. Tutkimuksen metodologinen lähestymistapa on laadullinen, sisältäen kirjallisuuskatsauksen ja empiirisiä aineistoja. Väitöskirja perustuu kolmeen osatutkimukseen, joista jokainen on julkaistu erillisenä artikkelina. Ensimmäinen osatutkimus on systemaattinen kirjallisuuskatsaus. Se sisältää 31 empiiristä tutkimusta ikäihmisten erilaisten eTerveyspalveluiden käytöstä ja käytön oppimisesta 12 eri maassa harvaan asutuilla alueilla ja niiden ulkopuolella. Toinen ja kolmas osatutkimus sijoittuvat Suomen Lapin harvaan asutuille alueille. Lääkeannostelupalvelun (osatutkimus II) sekä ikäihmisille seuraa tarjoavan puhelin- ja videoneuvottelupalvelun (osatutkimus III) käyttöä ja käytön oppimista tutkin tapaustutkimuksen keinoin. Lääkeannostelupalvelututkimukseen osallistui palvelua käyttäviä ikäihmisiä (n=2), lähihoitajia (n=4) ja muita terveydenhuollon ammattilaisia (n=2). Lääkeannostelupalvelun tutkimisessa hyödynnettiin etnografista tutkimusotetta: semi-strukturoitujen haastatteluiden lisäksi palvelun käyttöä havainnoitiin ja palveluun kuuluvasta lääkeannostelurobotista otettiin kuvia ikäihmisten kotona. Puhelin- ja videoneuvottelupalvelua koskeviin semi-strukturoituihin haastatteluihin osallistui palvelua käyttäviä ikäihmisiä (n=2), vapaaehtoistyöntekijöitä (n=2) sekä palvelun koordinaattori. Osatutkimusten aineistot analysoitiin induktiivisen ja deduktiivisen temaattisen lähestymistavan avulla. Väitöskirjan kokoavat havainnot syntyivät osatutkimusten keskeisten tulosten metasynteesistä. Metasynteesin tuloksena saatiin selville, että oppimisen ja hoivan ekosysteemin käytännön kontekstiin liittyen eTerveyspalveluiden kotouttamiseen vaikuttaa eniten niiden käytettävyys ja toimivuus sekä palveluiden yhteensopivuus käyttäjien kulttuurisesti rakentuneiden yhteisöllisten käytäntöjen kanssa. Tutkimuksessa havaittiin, että oppimisen ja hoivan ekosysteemin sosiaalisen kontekstin keskiössä on oppimisyhteisö, jonka ikäihmiset muodostavat yhdessä läheisasiantuntijoiden, ammattilaisten ja eTerveysteknologioiden kanssa. Oppimisyhteisö mahdollistaa eTerveyspalveluiden oppimiseen ja käyttöön tarvittavan digitaalisen osaamisen jaettuna, sosiaalisena osaamisena sekä eTerveyspalveluiden kotouttamisen sosiaalisena prosessina. eTerveyspalveluiden kotouttamisen myötä sosiaali- ja terveydenhuollon ammattilaiset ja vapaaehtoistyöntekijät ovat saaneet uuden roolin eTerveyspalveluita käyttävien ikäihmisten oppimisen ohjaajina. Pedagoginen tuki eTerveyspalveluiden kotouttamisen suunnitteluun olisi tarpeen. Oppimisen ja hoivan ekosysteemin kulttuuriseen kontekstiin liittyvät tulokset osoittivat, että ikäihmisten kulttuuritaustan merkitys eTerveyspalveluiden oppimiselle ja käytölle on kaksijakoinen. Toisaalta tulokset osoittavat kulttuurisesti yhteensopivia käytäntöjä harvaan asutuilla alueilla asuvien lappilaisten eTerveyspalveluiden oppimisesta ja käytöstä. Toisaalta jokainen maaseudulla asuva eTerveyspalvelun käyttäjä on yksilö riippumatta hänen kulttuuritaustastaan, ja täten he yhdessä muodostavat hyvin heterogeenisen ryhmän eTerveyspalveluiden käyttäjiä. eTerveyspalveluiden käyttäjien lisäksi tutkimuksessa havaittiin myös ikäihmisiä, jotka eivät käytä eTerveyspalveluita. Heitä tulisi tutkia tarkemmin oppimisen ja hoivan ekosysteemissä. Havainnot oppimisen ja hoivan ekosysteemin symboliseen kontekstiin liittyen osoittavat, että eTerveyspalvelut ovat uusia ja hyödyllisiä palveluita maaseudulle, mutta saman aikaisesti ne aiheuttavat haittaa ja huolta ikäihmisille. eTerveyspalveluiden oppiminen ja käyttö tuottaa ikäihmisille sekä positiivisia että negatiivisia tunteita. Tämän tutkimuksen teoreettiset löydökset osoittavat, että oppimisen ja hoivan ekosysteemi on soveltuva lähetymistapa eTerveyspalvelujen käytön tutkimukseen. Lisäksi löydäkset vahvistavat ajatusta siitä, että eTerveyspalveluiden käyttö oppimisen ja hoivan ekosysteemissä ei ole kertaluonteista, ainoastaan palvelun käyttöönoton yhteydessä tapahtuva asia, vaan se jatkuu läpi koko kotouttamisprosessin vaatien monentyyppistä digitaalista osaamista ja sosiaalista tukea. Tästä syystä eTerveyspalvelujen kotouttamisprosessi tulee tunnistaa samanaikaisesti jaetuksi, sosiaaliseksi oppimisprosessiksi. Tässä väitöskirjassa käytetyn teoreettisen viitekehyksen ja kokoavien tulosten pohjalta esitellään uusi teoreettis-käsitteellinen eTerveyspalveluiden oppimisen ja käytön malli. Malli havainnollistaa eTerveyspalveluiden oppimisen ja käytön moniulotteisuutta, ja sitä voidaan hyödyntää eTerveyspalveluiden suunnittelussa ja kotouttamisessa sekä analyyttisenä työkaluna tutkimustarkoituksiin. Väitöskirjan kokoavien tulosten pohjalta on asetettu myös käytännöllisiä ja poliittisia kehitysehdotuksia eTerveyspalveluiden sunnitteluun ja toteuttamiseen palveluiden kehittäjille ja tarjoajille sekä sosiaali- ja terveysalan päättäjille.The general aim of the current dissertation is to explore digital home-care service use (eHealth) from the perspective of rural older people and their social networks in a complex learning and care ecosystem. The use of eHealth services aims to support and facilitate the health, well-being, and everyday lives of older people and their caregivers by improving the accessibility, quality, and affordability of social and health care services. The use of eHealth services also raises many ethical questions related to human dignity. In particular, the current research aims to (1) increase the knowledge of digital competence in eHealth learning and use, (2) clarify in what way the learning process is part of eHealth service domestication, (3) construct a theoretical-conceptual model for eHealth learning and use, and (4) set development proposals for eHealth design and implementation. The aims are achieved through three theoretical approaches. The learning and care ecosystem provides the basis for the research, constructing older people’s eHealth learning and use through practical, social, cultural, and symbolic contexts. The concepts of digital competence and technology domestication focus on the process of how older people learn to use and use eHealth services in everyday situations. A social constructivism paradigm guides the research design as applicable. The methodological approach of the research is qualitative and includes a literature review and empirical data. The dissertation is based on three substudies, each of which is reported in a separate article. The systematic literature review (substudy I) included 31 empirical studies of older people’s learning and use of different eHealth services in 12 different countries in rural and nonrural settings. It provided background information for the research. The other two substudies took place in rural Finnish Lapland. Learning and use of a robotic medication-dispensing service (substudy II) and a phone and video conferencing service (substudy III) were investigated through a case study approach. For substudy II, older people (n = 5), practical nurses (n = 4), and other health care professionals (n = 2) participated. Substudy II utilized ethnography: in addition to semistructured interviews, the use of the service was observed, and photographs of a medication-dispensing robot were taken at older people’s homes. For substudy III, semistructured interviews with older people (n = 2), volunteer workers (n = 2), and a service coordinator were conducted. The gathered data were analyzed through inductive and deductive thematic approaches. The overarching findings of the dissertation were formed through a metasynthesis of the key findings of the substudies. Based on the findings, in terms of the practical context of the learning and care ecosystem, the eHealth domestication process is most affected by the usability and functionality of eHealth services and their compatibility of the service with users’ culturally situated social practices. According to the findings, in the center of the social context of the learning and care ecosystem, there is a learning community that older people form together with warm experts, professionals, and eHealth technologies. The learning community enables the digital competence required for eHealth learning and use as a distributed social activity and the domestication of eHealth services as a social process. With the domestication of eHealth services, social and health care professionals and volunteer workers have taken on a new role as learning instructors for older eHealth users. Pedagogical support for planning eHealth domestication would be necessary. The findings related to the cultural context of the learning and care ecosystem demonstrated that the meaning of the older people’s cultural backgrounds for eHealth service use in the learning and care ecosystem is twofold. On the one hand, culturally congruent practices can be found in the rural Lappish older people’s learning and use of eHealth services. On the other hand, despite older people’s cultural backgrounds, each rural eHealth service user is an individual, and together, they form a very heterogenous group of eHealth service users. In addition to eHealth users, the study also identified eHealth nonusers, who should be further investigated in the learning and care ecosystem. Finally, the overarching findings related to the symbolic context of the learning and care ecosystem indicate that eHealth services are new and needed services for rural areas yet also a source of inconvenience and concern for older people. Learning and use of eHealth services generated both positive and negative emotions for older people. The theoretical findings of the research showed that learning and care ecosystem framework is an applicable approach for the study of the use of eHealth. In addition, the reseach demonstrated that learning to use eHealth services in the learning and care ecosystem is not a one-time experience that only happens when the service is introduced, but continues throughout the entire domestication process, requiring different types of digital competence and social support. Thus, the domestication process of eHealth services should be recognized simultaneously a distributed social learning process. Based on the theoretical framework utilized in the present research and the overarching findings, a new theoretical-conceptual model of eHealth learning and use, called Learning and Care Ecosystem in eHealth Use, was introduced. The model demonstrates the complex nature of eHealth learning and use and can be utilized when designing and domesticating eHealth services or as an analytical tool for research purposes. Finally, the overarching findings allowed the setting of several practical and political development proposals for eHealth design and implementation for eHealth service developers and providers and for social and health care policy makers

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) - Operational Guidelines for ICT-supported Integrated Care and Independent Living

The guidelines in this report have been developed as part of the Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) project. Twenty-four ICT-supported integrated care initiatives in the EU were identified which supported integrated care and/or independent living and were either deployed or promising large scale pilots. The aim of this report is to define a set of recommendations to guide the process of developing and implementing ICT-supported integrated care and independent living, based on the experiences made in these 24 initiatives. The intended audience for this guidance document are those who work on the development and implementation of initiatives at an operational level, such as professionals, managers in healthcare organisations, regional managers of health or social care, health insurers, professionals’ organisations, etc.JRC.J.3-Information Societ

The Management of Medication Information – Data Collection on a Physicians\u27 Internet Discussion Board

The healthcare sector is highly information intensive. Information on patient specific medication is usually essential for clinicians when treating patients. However, information is not always available when required. Electronic patient records (EPRs) have in many cases enhanced the situation but there is often a need for exchanging information across various organisations. In Finland, there is a plan to integrate healthcare providers’ information systems into a single national system. To study physicians’ perceptions on this forthcoming development, in particular the management of medication information, a data collection was organised on a closed internet discussion board for physicians. The results show that the physicians were not convinced of the usability of the national system because they already have problems with slow EPRs within one organisation. According to them, another basic problem is patients\u27 general lack of knowledge about their own medication regimen. The discussion on the discussion board was not extremely active but the data collection provided fruitful answers and was a useful experiment to keep in mind for possible future data collection

Perspectives on participation in dementia prevention clinical trials

Dementia is an enormous global health challenge with a rapid increase in the number of people affected. There is an urgent need for research to find effective treatments and preventive strategies. Dementia prevention research is undergoing rapid development with novel approaches and techniques used. Both pharmacological and multimodal lifestyle randomized controlled trials (RCTs) have become longer, more complex, and target people earlier in the disease continuum. For the participants in clinical trials, this means new challenges. The overall aim of this thesis was to explore the experiences of participation in dementia prevention clinical trials among study participants, study partners, and specialized personnel/ staff. Furthermore, the aim was to further understand their attitudes and knowledge about dementia and related diagnoses. All studies used qualitative method. Data from different kind of RCTs was collected with questionnaires including open-ended questions, focus groups and individual interviews. Content analysis and Grounded theory were used. Study I Questionnaire with open-ended questions to 19 participants and 20 study partners in immunotherapy Alzheimer ́s disease (AD) phase I-II RCTs and group interview with eight staff members in the clinical trial unit were used. Staff members highlighted the high burden for the participants. The main motives for participation were a willingness to help research and the benefits of access to specialized care. The main disadvantages were that participating was time-consuming and perceived distress in connection to some investigations. Study II Focus group interviews were conducted within the Healthy Ageing Through Internet Counselling in the Elderly (HATICE) study with expert nurses (n=13) in cardiovascular disease (CVD) prevention in Finland and in the Netherlands. The purpose was to describe nurses' best experiences and practices with supporting CVD prevention and describe their suggestions on how to integrate their experiences into an online eHealth platform. Important aspects were to establish a relationship of trust, awareness and expectation management, and appropriate time and monitoring. Study III Focus groups interviews with older “at risk” adults (presence of CVD risk factors) in Finland, The Netherlands, and France were conducted as part of the HATICE study (n=44). The purpose was to explore attitudes of older adults at increased risk of CVD and dementia and engagement in an eHealth self-management prevention program as well as facilitators and barriers. The results were represented in three categories: access to reliable information about CVD and dementia, trust in the healthcare provider, and burden and stigma of dementia. Study IV Individual interviews with participants in multimodal dementia prevention MIND-ADMINI trial among persons with prodromal AD (n=8) were conducted. The participants' experience of participating in the trial is presented as a dynamic process. Previous knowledge, their motives, and the received information guide the participants' decision to take part in the trial. The trial was well tolerated and received even though the participants initially experienced high burden and difficulties managing information provided. Conclusions: Despite differences in the trials and target populations, the participants presented similar motives for participating in dementia prevention trials including altruistic, hope for personal benefits of the interventions, and access to specialized care. There are differences in the participants' preferences and need for support in a trial, between the participating countries, and along the disease continuum. To address this, a more person- centred approach in the conduction of the trials is suggested. This may improve participant ́s situation and the quality of RCTs which is important given the increasing complexity and new methods used in dementia prevention trials