M-health adoption by healthcare professionals : a systematic review

Objective The aim of this systematic review was to synthesize current knowledge of the factors influencing healthcare professional adoption of mobile health (m-health) applications. Methods Covering a period from 2000 to 2014, we conducted a systematic literature search on four electronic databases (PubMed, EMBASE, CINAHL, PsychInfo). We also consulted references from included studies. We included studies if they reported the perceptions of healthcare professionals regarding barriers and facilitators to m-health utilization, if they were published in English, Spanish, or French and if they presented an empirical study design (qualitative, quantitative, or mixed methods). Two authors independently assessed study quality and performed content analysis using a validated extraction grid with pre-established categorization of barriers and facilitators. Results The search strategy led to a total of 4223 potentially relevant papers, of which 33 met the inclusion criteria. Main perceived adoption factors to m-health at the individual, organizational, and contextual levels were the following: perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management). Conclusion This systematic review provides a set of key elements making it possible to understand the challenges and opportunities for m-health utilization by healthcare providers

Déterminants psychosociaux et organisationnels de l'adoption des technologies de télémédecine dans le Réseau québécois de télésanté élargi (RQTE)

La télémédecine constitue un outil en soutien à la prestation de services de santé et présente une solution potentielle à certains problèmes rencontrés dans les systèmes de santé. Cette étude visait l’analyse conjointe des facteurs individuels et organisationnels associés à l’adoption de la télémédecine dans le Réseau québécois de télésanté élargi (RQTE). Le premier article présente une analyse des facteurs psychosociaux associés à l’intention des médecins d’utiliser la télémédecine, basée sur la Théorie des comportements interpersonnels. Un questionnaire a été distribué à l’ensemble des médecins pratiquant dans les hôpitaux du RQTE. La modélisation par équations structurales a permis de tester le modèle théorique. Ce modèle expliquait 81% (p < .001) de la variance dans l’intention des médecins d’utiliser la télémédecine. L’intention était prédite par un facteur normatif composite, comprenant les normes personnelles et sociales, (β = 1.08; p < .001) et par l’identité personnelle (β = —.33; p < .001). Ainsi, les médecins possédant une forte perception des responsabilités professionnelles et sociales associées à l’utilisation de la télémédecine démontrent une intention plus élevée d’adopter celle-ci. Cependant, l’effet de suppression de la variable d’identité personnelle suggère que la perception individuelle des médecins en tant qu’utilisateurs de la télémédecine influence également leur intention. Le deuxième article porte sur les caractéristiques organisationnelles influençant l’adoption de la télémédecine. À partir d’un cadre intégrateur, combinant des concepts de différentes théories, une étude exploratoire a été menée dans les 32 hôpitaux du RQTE par le biais d’un questionnaire. Des analyses de contingence ont permis d’identifier les facteurs organisationnels influençant l’adoption de la télémédecine. Ensuite, une étude de cas multiple a été conduite dans neuf hôpitaux. Des entrevues avec des informateurs-clés ont permis d’enrichir la compréhension du contexte dans lequel cette technologie était implantée. Enfin, la triangulation des résultats a fait ressortir certaines caractéristiques organisationnelles ayant influencé l’adoption de la télémédecine. Ainsi, la localisation de l’hôpital, de même que les équipements et les ressources humaines disponibles ont eu un impact sur l’adoption de la télémédecine. La participation des administrateurs et des médecins aux décisions concernant la télémédecine est également associée à son adoption.Telemedicine is considered as a tool to support healthcare delivery that can potentially answer some of the problems facing healthcare systems. This study was aimed at analyzing conjointly individual and organizational factors affecting the adoption of telemedicine in the Extended Telehealth Network of Quebec (RQTE). The first article presents an analysis of the psychosocial determinants of physicians’ intention to use telemedicine, based upon the Theory of interpersonal behavior. All of the physicians involved in the RQTE were mailed a questionnaire. Structural equation modelling was applied to test the theoretical model. The theoretical model explained 81% (p < .001) of variance in physicians’ intention to use telemedicine. The main predictors of intention were a composite normative factor, comprising personal as well as social norms (β = 1.08; p < .001) and self identity (β = —.33; p < .001). Thus, physicians who perceived professional and social responsibilities regarding adoption of telehealth in their clinical practice had stronger intention to use this technology. However, the suppression effect of the personal identity construct may indicate that physicians’ self-perception as telemedicine users also influence their intention. The second article deals with organisational characteristics influencing telemedicine adoption. Based upon an integrated framework that combined concepts from different theories, an exploratory study was first conducted among the 32 healthcare centres involved in the RQTE. Then, a multiple case study was conducted among nine hospitals. In-depth interviews were conducted with key-informants in order to enrich the understanding of the context in which telemedicine was implemented. Triangulation of the results has permitted to underline some of the organizational dimensions that have influenced the adoption of telemedicine. Hence, hospital’s localization as well as the availability of equipment and human resources have affected telemedicine adoption. Participation of administrators and physicians in telemedicine decision making has also influenced its adoption

Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

BACKGROUND: The quest for greater efficiency in the provision of primary healthcare services and the implementation of a "health-promoting school" approach encourage the optimal redefinition of the role of school nurses. School nurses are viewed as professionals who might be significant actors in the promotion of youth health. The aim of this study was to identify the determinants of the intention of elementary school nurses to adopt a new health-promotion role as a strategic option for the health-promoting school. METHODS: This study was based on an extended version of the theory of planned behaviour (TPB). A total of 251 respondents (response rate of 70%) from 42 school health programs across the Province of Québec completed a mail survey regarding their intention to adopt the proposed health-promotion role. Multiple hierarchical linear regression analyses were performed to assess the relationship between key independent variables and intention. A discriminant analysis of the beliefs was performed to identify the main targets of action. RESULTS: A total of 73% of respondents expressed a positive intention to accept to play the proposed role. The main predictors were perceived behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β = 0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of the variance. The underlying beliefs distinguishing nurses who had a high intention from those who had a low intention referred to their feelings of being valued, their capacity to overcome the nursing shortage, the approval of the school nurses' community and parents of the students, their leadership skills, and their gaining of a better understanding of school needs. CONCLUSIONS: Results suggest that leadership is a skill that should be addressed to increase the ability of school nurses to assume the proposed role. Findings also indicate that public health administrators need to ensure adequate nurse staffing in the schools in order to increase the proportion of nurses willing to play such a role and avoid burnout among these human resources

Tertiary Study on the Use of Artificial Intelligence for Service Delivery: A Bibliometric Analysis of Systematic Literature Reviews

Despite the large number of systematic literature reviews (SLRs) on the use of artificial intelligence (AI) for service delivery, scholars suggest more scientific evidence. However, the direction that these reviews will take depends on the knowledge accumulated in the existing literature. Therefore, the objective of this research is to explore SLRs that have synthesized the use of AI for service delivery. We conducted a tertiary study, which consists of a bibliometric analysis of SLRs. We searched SLRs published over the last ten years in six bibliographic databases. Sixty-six studies meeting the inclusion criteria were processed through a bibliometric analysis in which we combined article metadata with data extracted from the full-text review. The results describe the publication trends of SLRs, their application domains, and the particularities of the private and public sectors. Recommendations for future SLRs on the use of AI for service delivery are proposed

Telehealth in Light of Cloud Computing: Clinical, Technological, Regulatory and Policy Issues

In the health sector, information and communications technologies (ICT) are transforming the modes of practice and service delivery. Telehealth, which is the use of ICT to provide care and health services, is an example of this new model of services. However, telehealth is accompanied by many questions regarding the terms of exchange, archiving, control and security of medical and administrative patient data. These may be very useful but also harmful to patients, healthcare professionals, organizations and even countries. Indeed, with the globalization of information, national data protection policies are being overtaken by this new reality where the "regulatory sovereignty" of a country is challenged. The increasing use of Cloud Computing, as a form of exchange, management and storage of data in the practice of telehealth, is an illustrative example of such challenges

Dimensions psychologiques de la régulation du poids : modèles théoriques et implications thérapeutiques

L'obésité constitue actuellement un des principaux enjeux en santé publique. L'accroissement des taux de prévalence du surplus de poids et de l'obésité menace la santé et la qualité de vie des populations au niveau mondial (Organisation Mondiale de la Santé, 1998; Statistique Canada, 2005). Jusqu'à maintenant, des efforts empiriques consistants ont permis le développement d'une compréhension intégrée des aspects biologiques et environnementaux du problème. Cependant, considérant les études initiales ne montrant pas de différence entre le fonctionnement psychologique des individus obèses et celui des individus de poids normal, les dimensions psychologiques de la régulation du poids ont été considérablement moins documentées au profit d'une vision presque strictement physiologique de l'obésité. Or, en réinterprétant les résultats de ces études, les chercheurs d'aujourd'hui concluent plutôt que l'absence de différence significative reflète en fait la grande hétérogénéité de la population obèse. En effet, il semble de plus en plus clair que la régulation du poids est un processus physiologique sous-tendu par des facteurs comportementaux eux-mêmes influencés par des caractéristiques psychologiques variant grandement d'un sous-groupe à l'autre parmi la population obèse. Il s'avère ainsi capital de développer une meilleure compréhension des facteurs psychologiques qui influencent les comportements susceptibles de contribuer au développement et au maintien d'un surplus de poids pour élargir les cibles de traitement de l'obésité et en améliorer l'efficacité. Le volet descriptif de la thèse vise à décrire un échantillon de femmes préoccupées par leur poids présentant un surplus de poids ou étant obèses en se basant sur les variables psychologiques associées à la suralimentation (insatisfaction corporelle, personnalité, affects négatifs, restriction) à l'aide du modèle à double-voie de la suralimentation (Stice, 1994). Il est également proposé que les femmes de l'échantillon puissent être catégorisées selon les deux dimensions du modèle (restriction et affects négatifs), formant des sous-groupes distincts sur les plans alimentaires et psychologiques. Le volet clinique de la thèse vise à discuter de l'intégration des variables psychologiques au traitement, d'abord d'un point de vue théorique en faisant la revue des traitements proposés, puis d'un point de vue empirique en évaluant l'efficacité d'un traitement visant à prendre en compte les aspects psychologiques discutés

The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

INTRODUCTION: Appraising the quality of studies included in systematic reviews combining qualitative and quantitative evidence is challenging. To address this challenge, a critical appraisal tool was developed: the Mixed Methods Appraisal Tool (MMAT). The aim of this paper is to present the enhancements made to the MMAT. DEVELOPMENT: The MMAT was initially developed in 2006 based on a literature review on systematic reviews combining qualitative and quantitative evidence. It was subject to pilot and interrater reliability testing. A revised version of the MMAT was developed in 2018 based on the results from usefulness testing, a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts to identify core criteria. TOOL DESCRIPTION: The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes five core quality criteria for each of the following five categories of study designs: (a) qualitative, (b) randomized controlled, (c) nonrandomized, (d) quantitative descriptive, and (e) mixed methods. CONCLUSION: The MMAT is a unique tool that can be used to appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more efficient appraisal

A learning organization in the service of knowledge management among nurses: A case study

AbstractIt becomes critical for health care organizations to develop strategies that aim to design new work practices and to manage knowledge. The introduction of learning organizations is seen as a promising choice for better knowledge management and continuing professional development in health care. This study analyzes the effects of a learning organization on nurses’ continuing professional development, knowledge management, and retention in a health and social services centre in Quebec, Canada. The learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital centre. These changes were particularly pronounced with respect to knowledge transfer, support for nursing practices, and quality of health care, objectives that the learning organization had sought to meet since its inception. However, it seemed to have a limited effect on nurse retention