This article investigates potential barriers to telemedicine adoption in centres hosted by rural public hospitals in Bangladesh. Little is known of the barriers related to telemedicine adoption in this context. Analysis of data collected from rural telemedicine patients identified seven broad categories of barriers: lack of organisational effectiveness, information and communication technology infrastructure, quality of care, allocation of resources, health staff motivation, patient satisfaction and trustworthiness. Their significance is explored. This research is based on the quantitative analysis of a data set of 500 telemedicine patients, from rural areas in Bangladesh. A conceptual model showing the interaction of pre-determined classes of barriers was established and hypotheses set up and tested using partial least squares structural equation modelling. Exemplary barriers to telemedicine adoption were identified and confirmed (p<.01) namely, lack of organisational effectiveness, health staff motivation, patient satisfaction, and trustworthiness collectively explaining 62% of the variance in barriers to adoption and providing for the first-time empirical support of their existence. These barriers offer considerable resistance to the adoption and maintenance of current telemedicine projects in rural Bangladesh. Further, lack of information and communication technology infrastructure, allocation of resources and quality of care are indirect barriers affecting successful deployment of telemedicine in rural settings. These findings illuminate adoption impediments faced by existing telemedicine projects and institutionalise favourable policy guidelines to improve Bangladesh’s and similar emerging economies’ healthcare industries. Policy interventions and recommendations are provided, including current research limitations leading to opportunities for future research.

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Do maternal depression and self-esteem moderate and mediate the association between intimate partner violence after childbirth and postpartum suicidal ideation?

Background Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear. Objectives The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD. Methods Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum. Results Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support. Conclusions Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother’s screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

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.

Many individuals visit rural telemedicine centres to obtain safe and effective health remedies for their physical and emotional illnesses. This study investigates the antecedents of patients’ satisfaction relating to telemedicine adoption in rural public hospitals settings in Bangladesh through the adaptation of Expectation Disconfirmation Theory extended by Social Cognitive Theory. This research advances a theoretically sustained prediction model forecasting patients’ satisfaction with telemedicine to enable informed decision making. A research model explores four potential antecedents: expectations, performance, disconfirmation, and enjoyment; that significantly contribute to predicting patients’ satisfaction concerning telemedicine adoption in Bangladesh. This model is validated using two-staged structural equation modeling and artificial neural network approaches. The findings demonstrate the determinants of patients’ satisfaction with telemedicine. The presented model will assist medical practitioners, academics, and information systems practitioners to develop high-quality decisions in the future application of telemedicine. Pertinent implications, limitations and future research directions are endorsed securing long-term telemedicine sustainability.

Mapping opportunities and challenges of telemedicine adoption in an emerging economy has always been presumptive due to the scarcity of empirical evidence. Only recently the potential influencing factors of both issues in the rural context of emerging economies (using Bangladesh as a cases study) were investigated. Analysis of existing literature identified seven broad categories of challenges (e.g., deficient organisational commitment, inadequate technological infrastructure, insufficient resource allocations, deficient service quality, clinicians demotivation, patients' dissatisfaction, and patients' distrust) and six broad categories of opportunities (e.g., service usefulness, service assurance, secured patient privacy, adequacy of services, peer influence on use of services, and environmental conditions) concerning telemedicine adoption. Their significance is outlined. These findings contribute to the literature by distinguishing significant factors, which can positively favour or deter telemedicine implementation in developing countries and similar settings.

Considering the importance of political economy in implementing Disaster Risk Reduction (DRR), this research investigates the significance of political economy in the distribution of DRR funding in Bangladesh. The study analysed data from self-reported surveys from 133 members of the sub-district level disaster management committee and government officials working with DRR. Employing the Partial Least Squares Structural Equation Modeling (PLS-SEM) method, we find that political economy factors explain 68% of the variance in funding allocations. We also show that four categories of political economy factors—power and authority, interest and incentives, institutions, and values and ideas—are significantly influential over the distribution of DRR funding across subdistricts of Bangladesh. Our findings offer important policy implications to reduce the potential risks surrounding political economy influences in fund allocation and advance climate finance literature.