Abstract:BackgroundMobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented.ObjectiveOur objective was to examine a large-scale government-sponsored mobile he… Show more
“…The process of adoption and diffusion of an mHealth solution was reported in a case review from Denmark [ 72 ]. Adoption of telehealth for community-dwelling older adults at a national level was reportedly triggered by demonstrated successes of a municipal project that simultaneously met the interests of major government stakeholders looking for fiscal efficiencies in health care delivery.…”
BackgroundThe current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations.ObjectivesThe purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults.MethodsA 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data.ResultsWe identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies.ConclusionsThere is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are importa...
“…The process of adoption and diffusion of an mHealth solution was reported in a case review from Denmark [ 72 ]. Adoption of telehealth for community-dwelling older adults at a national level was reportedly triggered by demonstrated successes of a municipal project that simultaneously met the interests of major government stakeholders looking for fiscal efficiencies in health care delivery.…”
BackgroundThe current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations.ObjectivesThe purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults.MethodsA 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data.ResultsWe identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies.ConclusionsThere is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are importa...
“…Another explanation is uncertainty about whether mHealth solutions can meet expectations of saving time and maintaining high-quality care, and thus have an added value in delivering health services. Building end-user trust in mHealth solutions, preferably by providing evidence-based information on app credibility, is an important enabler to increase promotion of mHealth solutions by GPs (45,52,53). This includes information on perceived usefulness, ease of use, risks associated with accessing and communicating personal health data and a measure of trust in the developers of the mHealth technologies (54,55).…”
Section: Discussionmentioning
confidence: 99%
“…A second strategy is for the government or health insurer to provide incentives for pioneers to make mHealth adoption more attractive. Several studies found strong stakeholder collaboration in which financial support is assured to initiate and energize the mHealth adoption process (47,52,57). A crucial facilitator is therefore to create collaborative platforms including key stakeholders, such as end-users, health insurers and industry players to make a sound business case shaping the adoption process.…”
Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views.Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis.Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers.Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.
“…A pitfall of such a development approach is that it might become 'messy' because many different types of data are collected and results can be conflicting. In order to structure the development and decision-making process, a multidisciplinary project team coordinated the project, which is in line with recommendations on eHealth development [3,28,36,37]. Also, to deal with the large amounts of data, this project's approach consisted of systematic and structured research activities.…”
In development, implementation and evaluation of eHealth it is essential to account for stakeholders' perspectives, opinions and values, which are statements that specify what stakeholders want to achieve or improve via a technology. The use of values enables developers to systematically include stakeholders' perspectives and the context of use in an eHealth development process. However, there are relatively few papers that explain how to use values in technology development. Consequently, in this paper we show how we formulated values during the multi-method, interdisciplinary and iterative development process of a VR application for a complex setting: forensic mental healthcare. We report the main foundations for these values: the outcomes of an online questionnaire with patients, therapists and other stakeholders (n=146) and interviews with patients and therapists (n=18). We show how a multidisciplinary project team used these qualitative results to formulate and adapt values and create lo-fi prototypes of a VR application. We discuss the importance of a systematic development process with multiple formative evaluations for eHealth and reflect on the role of values within this.
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