Health Seekers’ Acceptance and Adoption Determinants of Telemedicine in Emerging Economies

This study investigates health seekers’ acceptance and adoption determinants of telemedicine services in a rural public hospital setting in an emerging economy using an adapted, extended Technology Acceptance Model. The present study pursued synthesising a plethora of existing literature and contextualised the significance of seven broad categories of potential determinants that significantly affect patients’ acceptance and adoption intentions: perceived usefulness, perceived ease of use, self-efficacy, service quality, privacy and data security, social influence, and facilitating conditions. The partial least square structural equation modeling technique was employed to test the conceptual model and research hypotheses. A cross-sectional survey was administered among 500 telemedicine users in randomly selected rural and remote areas of Bangladesh. Excluding self-efficacy and ease of use, five determinants expressively contributed to patients’ acceptance of telemedicine adoption, explaining 65% of the variance (R2) in behavioural Intention. The empirical findings have the quality of rigour obtained from rich data sets in health informatics and can contribute to build telemedicine into an institutionalised health infrastructure in Bangladesh and similar settings. Pertinent implications, limitations and future research directions were recommended to secure the long-term sustainability of telemedicine healthcare projects.

The validation of four published algorithms to predict the need for pacemaker implantation after TAVR

Background The identification of patients with high risk for PPMI after TAVR might change our decision as regard the type of the prosthesis and allow more patients' acceptance for this complication. Objective: we investigated the predictors of PPMI after TF-TAVR and validated the accuracy of four published algorithms in this group of patients. Methods and results We retrospectively examined all patients who were in need for pacemaker implantation during the index hospitalisation after TAVR between 2016 and 2019. We searched for the predictors of the new PPMI after TAVR in this group of patient and compared it with a matched group of patients. Moreover, we tested the accuracy of four published algorithms. The first tested algorithm from Kaneko et al had positive predictive value (PPV), negative predictive value (NPV) and accuracy from 50%, 65% and 60% consecutively. The second tested algorithm from Jilaihawi et al had PPV, NPV and accuracy from 13.6%, 100% and 26.9% consecutively. The third tested algorithm from Maeno et al had PPV, NPV and accuracy from 37%, 56% and 45% consecutively. The forth tested algorithm from Fujiti et al had PPV, NPV and accuracy from 42%, 65% and 50% consecutively. In this study, 3 ECG-predictors (RBBB, the presence of AF and LAHB) and 3 CT-predictors (Aortic valve calcification Volume >500mm3, eccentricity index >0.25, deep valve implantation in relation to the length of membranous septum) were independent predictors of PPMI. Moreover, the rate of preimplantation ballon valivuloplasty was higher in the group with new PPMI. Using these independent predictors, the new 7 points score was developed by assigning 1 point for each one. AUC of the new score in the derivation cohort was 0.809 (95% CI 0.758–0.86), with an optimal cut-off threshold of 4 points. All other scores had AUC from 0.6 or lower. In a validation cohort of 100 patients, the predictive value of the score was confirmed (AUC, 0.72; 95% CI, 0.70–0.87; P<0.001). Conclusion The four studied score systems had low accuracy to predict new PPMI after TAVR in our cohort of patients. The new score is more complex but might be more accurate. FUNDunding Acknowledgement Type of funding sources: None.

Patients Acceptance and Comprehension to Written and Verbal Consent (PAC-VC)

Background:Acute myocardial infarction (AMI) research is challenging as it requires enrollment of acutely ill patients. Patients are generally in a suboptimal state for providing informed consent. Patients’ understanding to verbal assents have not been previously examined in AMI research. Patients Acceptance and Comprehension to Written and Verbal Consent (PAC-VC) compared patients’ understanding and attitudes to verbal and written consents in AMI RCTs.Methods: PAC-VC recruited patients from 3 AMI trials using both verbal N=12 and written N=6 consents. We compared patients’ understanding using two survey questionnaires. The first questionnaire used open-ended questions with multiple choice answers. The second questionnaire used a 5-point Likert scale to measure patients understanding and attitudes to the consent process. Overall answers average scores were categorized into three groups: Adequate understanding (71-100) %, Partial understanding (41-70)% and Inadequate understanding (0-40)%. Results:Responses showed patients with verbal assent had adequate understanding to most components of informed consent, close to those of written consent. Most patients did not read written information entirely and believed that it is not important to make a final decision. Patients favoured to have written information be part of the consent but not necessarily presented during the initial consent process. Patients felt less pressured in the verbal assent arm than those of written consent.Conclusion: Patients had adequate understanding to most components of verbal assent and comparable to those of written consent. Utilizing verbal assents in the acute care setting should be further assessed in larger trials.

A Survey To Evaluate Patients’ Acceptance To Various Fixed Functional Appliance

Fixed functional appliances correct class II malocclusion by bringing the mandible forward into a new position. Patients using Fixed Functional Appliances complain of difficulty in oral hygiene, soft-tissue irritation, appliance breakage, and difficulty in mastication. Hence, the aim of this study was to conduct a survey evaluating patients’ acceptance of various fixed functional appliances in a university set up. This questionnaire-based study was a university-based setting which consisted of 10 closed-ended and open-ended questions out of which 2 were open-ended questions and 8 were close-ended. It covered discomfort, difficulty in speech, brushing, mastication, oral hygiene and fracture of the appliance. Descriptive statistics were performed. Chi-square test was used to determine the discomfort experienced due to the duration of wear. The significance level for the p-value was set at 0.05. Chi-square test reported that statistically, the insignificant association observed between duration of wear and level of discomfort (p>0.31). All functional appliances have their own disadvantages and discomfort, which is dependent on the intricate fabrication as well as their implementation. Within the limits of the study, it was observed that discomfort was more in the initial few days but reduced over a period of time as the patients got adapted to the appliance.

Factors impacting on inpatient portal acceptance and use in a tertiary hospital in Saudi Arabia: A cross-sectional survey (Preprint)

BACKGROUND Inpatient portal have potential to increase cancer patient engagement and enhance their communication with healthcare providers inside tertiary hospitals. However, their adoption is still poor. Also, there is a knowledge gap about what factors influence their acceptance and use of this technology. OBJECTIVE The aim of the study was to examine the factors predicting acceptance and use of an inpatient portal by cancer patients in a tertiary hospital in Saudi Arabia. METHODS Eight independent factors were hypothesised as the predicting factors for cancer patients’ acceptance of an inpatient portal. These included perceived usefulness, ease of use, attitude, social influence, self-efficacy, preference to seek health information, functional ability and perceived health threat. These factors, together with demographic variables (i.e. gender, age, and education), were examined in regard to their impact on cancer patients’ acceptance and use of an inpatient portal. A self-administered questionnaire was developed based on the validated items from the prior research surveys to measure each factor. The empirical data was collected in a cross-sectional survey of cancer patients using a convenience sampling method conducted in a tertiary hospital in Saudi Arabia. The structural equation modelling method was used to test the reliability, validity and the causal-relationships of the model constructs. RESULTS The cancer patients’ attitude, perceived health threat, preference to seek health information and demographic factors (i.e., age and gender) were the most significant predictors of their intention to use the inpatient portal. Their attitude towards using the portal was significantly determined by perceived usefulness and ease of use of the portal. Perceived ease of use, social influence and preference to seek health information had statistically significant, positive impacts on perceived usefulness. While, patients’ self-efficacy and functional ability did not influence patients’ perceived usefulness of the portal. Patients’ perceived self-efficacy to use the portal, perceived functional ability and preference to seek health information influenced their perception of ease of use of the portal. Notably, despite patients’ positive intention to use the portal, this intention was not impacted by the social influence factor and did not translate into actual portal use for these critically ill cancer patients during hospitalization. CONCLUSIONS The study developed a theoretical model to predict cancer patients’ acceptance and use of inpatient portal during hospitalization. The results suggest considering a patients’ physical and cognitive ability to design the digital solutions to meet their critical information and communication needs. The promotion strategy should focus on introducing the most valuable features and services of the portal that increase patients’ engagement in the care process.

Can cognitive behavioral therapy (CBT) intervention in patients diagnosed with stage 3/4 gastric cancer increase patients’ acceptance of palliative care earlier in the cancer continuum?

Background and Hypothesis: Palliative care, though designed improve quality of life in patients diagnosed with a grave illness, is widely stigmatized as an “end of life” service. Cancer diagnosis has been known to cause mental stress on patients; the added stigmatization of palliative care with death is a barrier to care, especially in gastric cancer patients whose delay in treatment can result in poor cancer prognosis and outcomes. Cognitive Behavior Therapy (CBT) intervention is promising is an ideal intervention in this case, yet, understudied in palliative oncology. Successful CBT intervention can combat guilt, denial and stigma, leading to more positive outlook on life and palliative care. We hypothesize that CBT intervention will increase stage 3/4 gastric cancer patients’ acceptance to start palliative care early in their cancer treatment by decreasing associated stigma. Experimental Design and Results: Study will be an interventional, unblinded, randomized clinical trial with an experimental and control group. A CBT video intervention will be used, preceded and followed by a pre-/post session questionnaire generated from IU’s RedCap. Full intervention will have 4 sessions, with experimental groups divided into those receiving <2, 3 or full 4 sessions. All individuals age 18+ with a recent stage 3/4 gastric cancer diagnosis, who have the ability to provide consent/comprehend the CBT video will be illegible to participate in the study. A spearman’s correlation will be used to test significance of CBT. A negative trend is predicted between CBT intervention and palliative care stigma; as the number of CBT sessions increase, palliative care stigma should decrease accordingly. Potential Impact: CBT’s effectiveness in alleviating stigma faced by patients with advanced gastric cancer can suggest more psychosocial training for physicians to move away from disease centered approach to one that implements ways that eradicate social barriers to care.