Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models

BACKGROUND: Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways, ranging from measuring outcomes such as clinical efficacy or behavior change of patients or professionals to measuring the perceptions of various stakeholders or in economic terms. OBJECTIVE: The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between two contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the "value" concept in the evaluation of eHealth interventions. METHODS: The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini-Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. RESULTS: The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. CONCLUSIONS: Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices

Determination of vertical phase separation in a polyfluorene copolymer:fullerene derivative solar cell blend by X-ray photoelectron spectroscopy

A vertical phase separation is evidenced using high-kinetic-energy X-ray photoelectron spectroscopy at different photon energies in a polyfluorene copolymer:C(60) derivative blend relevant for photovoltaic application

New determination of the core-level life-time broadenings in mercury

Previously recorded and published photoelectron spectroscopic data for mercury in the gas phase has been reanalyzed. The life-time broadenings have been determined for a large number of core levels. It is then seen that a recent detailed derivation of core-level line-widths based on X-ray emission spectroscopy give life-time widths that are generally too large. The 4d(3/2)4d(5/2)nd Coster-Kronig (CM) transition is also discussed. We find that the additional broadening Of the 4d(3/2) level for mercury metal is indeed due to a CM decay, in contrast to recent claims. In atomic mercury, however, the CM process in energetically forbidden. In spite of this we find that the 4d(3/2) level is broadened also in this case. We propose that this is due to a mixing between the 4d(3/2) hole state and discrete 4d(5/2)nd states.UBj

Teaching Project Courses in Large Scale Using Industry Like Methods - Experiences After Ten Years

A Design-Build-Test (DBT) project course in electronics is presented. The course was developed during the first years of the CDIO Initiative, and it has been given successfully for almost ten years within two engineering programs at Linköping University. More than 2000 students have passed the course, and it is considered to be one of the most popular and also demanding courses within these programs. The key factors that have contributed to the success of the course are: Clearly defined learning outcomes. A suitable and well working course organization. A systematic method for project management. Challenging project tasks of sufficient complexity. Laboratory workspaces with modern equipment and high availability. The aim of the paper is to describe these key factors in more detail based on the experiences that have been gained during the almost ten years the course has been given

Electron spectroscopy using ultra brilliant synchrotron X-ray sources

The development of photoelectron spectroscopy since the early days of the technique is discussed. The focus is on the interaction between instrumental development and scientific achievements. In particular the opportunities provided by the increasingly brilliant synchrotron radiation sources are discussed. The contribution is focused on core level studies. The recent development is demonstrated by using selected examples obtained at today's most advanced synchrotron radiation facilities. The spectral resolution and intensity that can be reached at these facilities reveal new effects and provide detailed information on the investigated systems. The examples are mainly taken from studies of atoms and molecules where different effects can be most accurately identified and separated.UBj

Mega-sport football events’ influence on destination images : A study of the 2016 UEFA European Football Championship in France, the 2018 FIFA World Cup in Russia, and the 2022 FIFA World Cup in Qatar

The purpose of this study is to examine whether mega-sport events influence visitors' destination images and to explore which factors influence their perceptions of and intentions to attend a mega-sport event in certain destinations. We examine visitors' perceptions of the 2016 UEFA European Football Championship in France, the 2018 FIFA World Cup in Russia, and the upcoming 2022 FIFA World Cup in Qatar through a structured questionnaire published on the Facebook group Camp Sweden, a community of Swedish football supporters. We find differences among supporters’ destination image after they attended the mega-sport football events. The study also shows that positive destination images after visits were based on whether the destinations were able to satisfy important factors for supporters when visiting the destination. Qatar will be challenged to improve its destination image, as supporters do not connect factors important for visiting destinations with their current perceptions of Qatar. © 2020 Elsevier Lt