Attitudes towards the use and acceptance of eHealth technologies : a case study of older adults living with chronic pain and implications for rural healthcare

Acknowledgements The research described here is supported by the award made by the RCUK Digital Economy programme to the dot.rural Digital Economy Hub; award reference: EP/G066051/1. MC’s time writing the paper is funded by the Scottish Government’s Rural and Environmental Science and Analytical Services Division (RESAS) under Theme 8 ‘Vibrant Rural Communities’ of the Food, Land and People Programme (2011–2016). MC is also an Honorary Research Fellow at the Division of Applied Health Sciences, University of Aberdeen. The input of other members of the TOPS research team, Alastair Mort, Fiona Williams, Sophie Corbett, Phil Wilson and Paul MacNamee who contributed to be wider study and discussed preliminary findings reported here with the authors of the paper is acknowledged. We acknowledge the feedback on earlier versions of this paper provided by members of the Trans-Atlantic Rural Research Network, especially Stefanie Doebler and Carmen Hubbard. We also thank Deb Roberts for her comments.Peer reviewedPublisher PD

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MOSAIC roadmap for mobile collaborative work related to health and wellbeing.

The objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments. For that purpose MOSAIC develops visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. One of the application domains where MOSAIC is active is health and wellbeing. This paper builds on another paper submitted to this same conference, which presents and discusses health care and wellbeing specific scenarios. The aim is to present an early form of a roadmap for validation

Dissertation: Examining and investigating home modifications and smart home technologies to reduce fall injury among older adults.

Nearly one in six U.S. residents are over the age of 65. The proportion of older adults in the U.S. is anticipated to grow to 22.1% of the total population by 2050. The cost of treating age related conditions and injuries is expensive, government programs including Medicaid paid over $550 Billion in 2017, and makes up between 14-16% of the federal budget each year. With the high cost of treating age related conditions and injuries, and the proportion of older adults continuing to increase every year, it is imperative that researchers and government entities find and invest in preventative measures in order to reduce injury and related healthcare costs. Among the many age-related injuries older adults suffer, falls are arguably the most important to address. It is estimated that one in three older adults has a fall every year. In 2016, falls were the seventh leading cause of death among older adults. Approximately one third of all fallers require medical attention after experiencing a fall. Over 800,000 older adults are hospitalized each year due to fall related injuries. Injuries sustained as a result of a serious fall include various fractures, traumatic brain injuries, and other cuts and bruises.Home modifications, and more recently smart home technologies, can help increase the safety of older adults living in the community. With older adults wanting to “age in place”, installing these modifications and technologies before an accident happens may lower rates of injury. Today, dozens of companies sell various smart home devices for the consumer market. Bud despite the high demand for these technologies by the American consumer, the ability of these devices to keep older adults safe, and how older adults value these technologies, remains uncertain. These home technologies may be particularly beneficial to older adults living in rural areas due to the increased isolation and limited access to healthcare resources. Previous research indicates rural populations have a greater proportion of older adults compared to urban areas, yet lack the infrastructure to provide specialty care to this population. It is estimated that more than 60 million family members provide some sort of informal care to an older adult relative. Of all of these family members, nearly 40% report spending 20 or more hours a week providing this unpaid care. Previous research has failed to examine how these family members feel about home modifications and technologies for their older adult relative. Finding ways to ease the burden of caring for older family members will significantly better the situations of many family relatives.This dissertation aims to cover three areas. 1. Identify people at risk of suffering subsequent fall injuries. Find the average time between an initial fall injury and a subsequent fall injury, and find average time between an initial fall injury and death.2. Examine the preferences of older adults living in a rural area towards various smart home technologies and home modifications.3. Examine the preferences of family members of older adults regarding smart home technologies and home modifications

Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: The case of international normalised ratio self-testing

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. - Copyright @ 2012 Dove Medical Press LtdThis article has been made available through the Brunel Open Access Publishing Fund.Purpose: To identify factors that determine patients' intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods: A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results: The participants were mainly male (64%) and aged ≥ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients' intention to use INR self-testing were the perception of technology (β = 0.92, P < 0.001), trust in doctor (β = −0.24, P = 0.028), and affordability (β = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (β = 0.43, P = 0.002), age (β = −0.32, P < 0.001), and affordability (β = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (β = 0.40), age (β = −0.29), and affordability (β = 0.21) via the perception of technology. Conclusion: Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients' perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing.This study is funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC grant EP/GO12393/1)

Technology for Older Adults: Maximising Personal and Social Interaction : Exploring Opportunities for eHealth to Support the Older Rural Population with Chronic Pain

Funding The TOPS project is supported by an award made by the RCUK Digital Economy programme to the dot.rural Digital Economy Hub, award reference EP/G066051/1.Peer reviewedPublisher PD

The Ethical Implications of Personal Health Monitoring

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations

Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public

Storying meaning in hospice patient biographies : a thesis submitted to Massey University of Palmerston North in partial fulfilment of the requirements for the degree of Masters of Arts and Psychology

The importance of meaning in life has been emphasised in the writings of many existentialists. Furthermore, serious repercussions have been associated with loss of meaning. Postulated life-enhancing qualities of discovering meaning in life make this an especially critical issue for the dying. A sense of meaning in late-stage disease is an important focus for therapeutic exchange. A notable method which has been shown to facilitate this is the production of a life story (Lewis. 1989). Narrative is a natural instrument which facilitates expression of personal meaning. Engaging in storying life clarifies meaning of experience by affording closure (Lashley, 1993). The present study employed narrative inquiry, a subset of qualitative research designs, to examine hospice patient biographies (N=7) to determine how the process of constructing a biographical account facing death contributes to meaning formation. It has been argued that approaching death disrupts one's personal narrative resulting in loss of meaning. This activity is said to compel reconstruction of one's story in order to restore meaning in life. Lichter. Mooney and Boyd (1993) argued that recounting experiences enables individuals to resolve unfinished business, an important element for promoting closure, which engenders meaning. Two methods of analysis were adopted: analysis of narrative and storying meaning. Analysis of narrative was based on Polkinghorne's (1995) methods of narrative configuration. Storying meaning was carried out as a means of making sense and showing the significance of thoughts and actions in the context of an unfolding plot. With analysis of narrative a variety of inquiries were undertaken. This included examining the biographies for narrative typologies. Given the importance of goals in meaning formation, we focused on the plot structure before and after illness to establish the influence this experience had upon goal direction. Narrative devices which contribute to meaning formation were also explored. This included: roles, epiphany, closure, and metaphor. These features were examined for patterns, themes, and regularities across biographies. Considering the detrimental impact death anxiety has upon meaning construction, inquiry also focuscd on this concept and its association with selected narrative devices. With storying meaning, knowledge about a particular situation is produced. In this study we concentrated on how meaning is constructed through storying a life facing death. This encompassed searching for processes of meaning-making within the biographies. Analysis of narrative revealed goal-focused progressive narratives. Storying lives in this coherent fashion enabled meaning to be constructed. Narrative devices assisted in production of a coherent stoty which promoted closure to storied life Adoption of these devices also positively reframcd the narrator's viewpoint toward this experience, which enabled individuals to make sense of events and happenings in the story. Surprisingly, death anxiety assumed a peripheral concern; it did not feature as a critical issue in meaning construction within these accounts. Storying meaning revealed processes of meaning-making in these stoned accounts. Unfolding of these stories revealed meaningful lives interrupted by adversity, which were then overcome. Prior to the disruption these accounts were replete with sources of personal meaning. Disruption ensued with evidence of loss of meaning. Restoring meaning involved reconstructing one's personal narrative. Analysis revealed evidence of processes of meaning- making within these stories. Methods of meaning formation included: making sense of illness, changing the life scheme, changing one's perception of the event, and methods of self- transcendence. Similar processes have been established in other studies examining meaning construction. These processes were found to promote closure in storied accounts, an important element which facilitates meaning. This finding supports Lichter and associates' (1993) argument regarding the value of narrative, particularly for those facing death where meaning in life has been lost. Results indicated individuals construct meaning by reconstructing personal narratives in order to make sense of these experiences and integrate these into their storied lives. As Williams (1984) argued it is in this activity of reconstructing one's personal life narrative that illness and its consequences arc ascribcd meaning in the context of one's life. The value of narrative for those approaching death and those experiencing serious loss is emphasised

Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials