Digital Healthcare Services Research Articles

Digital health and patient adherence: A qualitative study in older adults.

Computer confidence and computer self-efficacy can impact an individual's perceived ease of use and usefulness of technology, ultimately determining adherence to digital healthcare services. However, few studies focus on assessing the impact of non-clinical factors on the efficacy and adherence to digital healthcare platforms. We aimed to analyse the role of non-clinical factors (i.e. computer confidence and computer self-efficacy) in the interaction experience (IX) and the feasibility of a digital neuropsychological platform called NeuroVRehab.PT in a group of older adults with varying levels of computer confidence. Eight older adults (70.63 ± 6.1 years) evaluated the platform, and data was collected using the Think-Aloud method and a semi-structured interview. Sessions were audio-recorded and analysed through an inductive-deductive informed Thematic Analysis protocol. This study was conducted according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Three main themes were identified (Interaction Experience, Digital Literacy, and Attitudes toward NeuroVRehab.PT). Computer anxiety and fear of making errors were not uncommon, even among older adults who perceive themselves as confident in technology use, and negatively impacted IX. Moreover, some game elements (e.g. three-star system, progression bar) were not intuitive to all participants, leading to misleading interpretations. On the other hand, human support and the platform's realism seemed to impact participants' IX positively. This study shed light on the barriers raised by non-clinical factors in adopting and using digital healthcare services by older adults. Furthermore, a critical analysis of the platform's features that promote user adoption is done, and suggestions for overcoming limitations are presented.

Fog-Enabled Secure and Efficient Fine-Grained Searchable Data Sharing and Management Scheme for IoT-Based Healthcare Systems

In recent times, fog computing has emerged as a helpful extension of cloud computing. It can efficiently handle the prevalent issue of managing silos of data generated by today's digital healthcare services. Moreover, the application of the Internet of Things (IoT) in the development of smart healthcare systems further adds tons of data tirelessly to these silos, thus making the cloud congested. To manage such continuously growing data, the concept of adding a fog layer between the cloud and the end-users (EUs) proved to be beneficial. These intermediary fog nodes (FNs) can handle and store data, and thus facilitate the cloud and alleviate the burden from the EUs. Most of the existing search schemes for encrypted data have been developed for the cloud platform and ignored this helpful extension, which can improve the scheme's efficiency by delegating most of the heavy computations to the intermediary FNs. In this article, a fine-grained searchable data sharing scheme has been proposed using the fog computing platform. The resulting scheme is efficient and lightweight because the FN facilitates EUs by performing computationally intensive tasks on their behalf. A significant reduction in storage and computational cost has been achieved by the proposed scheme at the data owner's end, representing the resource-constrained IoT devices. The storage cost has been reduced to two source group elements, and the computational cost has been reduced to three exponent operations in the source group and one hash operation. Furthermore, the proposed scheme is secure against the selectively chosen keyword attack in the generic bilinear group model.

Blockchain-Based Data Access Security Solutions for Medical Wearables.

Digital healthcare services have become an integral part of our lives. There is an increasing number of healthcare professionals and patients using medical wearables for diagnosis and treatment, which simplifies and improves the diagnostic and therapeutic process. However, inappropriate use of medical data may result in the disclosure of private patient information. For protecting patients' privacy when using medical wearables, we propose a new blockchain-based data access security scheme. Specifically, the elliptic curve encryption algorithm and zero-knowledge authentication method are used to authenticate the identity of patients and doctors in the blockchain network. Furthermore, we develop a smart recommendation method based on deep reinforcement learning to recommend appropriate doctors for patients. Next, patients allow recommended doctors to access their medical data, and smart contracts specifically designed for secure data access to medical wearables will regulate subsequent data access. The security analysis and experimental results demonstrate that the proposed scheme can effectively protect patients' privacy during treatment through secure authentication and data access for medical wearables.

Sociodemographic factors and health digital divide among urban residents: Evidence from a population-based survey in China.

The deep integration of digital technology and healthcare services has propelled the healthcare system into the era of digital health. However, vulnerable populations in the field of information technology, they face challenges in benefiting from the digital dividends brought by digital health, leading to the emerging phenomenon of the "health digital divide." This study utilized the sample of 3547 urban from the 2021 Chinese Social Survey data for analysis. Models were constructed with digital access divide, digital usage divide, and digital outcome divide for urban residents, and structural equation modeling was implemented for analysis. The impact β coefficients (95% CI) of urban residents' digital access on the frequency of digital use, internet healthcare utilization, and patient experience were (β = 0.737, P < 0.001), (β = 0.047, P < 0.05), and (β = 0.079, P < 0.001), respectively. Urban elderly groups were at a disadvantage in digital access and usage (β = -0.007, β = -0.024, and β = -0.004), as well as those with lower educational levels (β = 0.109, β = 0.162, and β = 0.045). However, these two factors did not have a significant direct impact on the patient experience in urban areas. The health digital divide of urban residents exhibits a cascading effect, primarily manifested in the digital access and usage divide. To bridge health digital divide among urban residents, efforts must be made to improve digital access and usage among the elderly and those with lower educational levels.

Digital healthcare framework for patients with disabilities based on deep federated learning schemes

Utilizing digital healthcare services for patients who use wheelchairs is a vital and effective means to enhance their healthcare. Digital healthcare integrates various healthcare facilities, including local laboratories and centralized hospitals, to provide healthcare services for individuals in wheelchairs. In digital healthcare, the Internet of Medical Things (IoMT) allows local wheelchairs to connect with remote digital healthcare services and generate sensors from wheelchairs to monitor and process healthcare. Recently, it has been observed that wheelchair patients, when older than thirty, suffer from high blood pressure, heart disease, body glucose, and others due to less activity because of their disabilities. However, existing wheelchair IoMT applications are straightforward and do not consider the healthcare of wheelchair patients with their diseases during their disabilities. This paper presents a novel digital healthcare framework for patients with disabilities based on deep-federated learning schemes. In the proposed framework, we offer the federated learning deep convolutional neural network schemes (FL-DCNNS) that consist of different sub-schemes. The offloading scheme collects the sensors from integrated wheelchair bio-sensors as smartwatches such as blood pressure, heartbeat, body glucose, and oxygen. The smartwatches worked with wearable devices for disabled patients in our framework. We present the federated learning-enabled laboratories for data training and share the updated weights with the data security to the centralized node for decision and prediction. We present the decision forest for centralized healthcare nodes to decide on aggregation with the different constraints: cost, energy, time, and accuracy. We implemented a deep CNN scheme in each laboratory to train and validate the model locally on the node with the consideration of resources. Simulation results show that FL-DCNNS obtained the optimal results on the sensor data and minimized the energy by 25%, time 19%, cost 28%, and improved the accuracy of disease prediction by 99% as compared to existing digital healthcare schemes for wheelchair patients.

REGULATION OF DIGITAL HEALTHCARE SERVICES – (NOT) COVERED UNDER THE DIGITAL SERVICES ACT?

The regulation of digital services is currently experiencing significant growth, primarily due to the adoption of new legal regulation at the European Union level, specifically the Digital Services Act. Digital services play a pivotal role in a country's economy by facilitating cross-border trade and enabling entrepreneurs to reach a vast user base, often comprising consumers. Despite their advantages, these services also entail substantial risks, particularly in relation to their widespread and more challenging-to-regulate usage. Alongside their positive impact, they also contribute significantly to the dissemination of illegal and harmful information. In recent years, there has been a notable development and utilization of new electronic information systems within the healthcare sector, accompanied by electronic healthcare services. This connection is not limited to the Covid-19 pandemic but is also a result of the dynamic evolution of information and communication technologies and their potential in healthcare provision. In this paper, the author analyzes the research question regarding which digital healthcare services in the Slovak Republic fall within the scope of the new European legislation. The author examined European regulations, focusing on the types of electronic healthcare services existing in Slovakia. By synthesizing and applying available information and rules to selected electronic healthcare services, the study concludes that the Digital Services Act has only a limited impact on the functioning of these selected digital healthcare services.

Framework analysis on the adoption of digital healthcare services among senior citizens by using the extended technology acceptance model (ETAM)

Over the years, the digital healthcare sector has started taking shape across the world with the intention to deliver social benefits to all citizens. In Malaysia, a lot of effort has taken place to improve the healthcare system to be more efficient and accessible. SELangkah mobile application developed by Selgate Corporation for instance provided multi-step health features for users. Besides the proliferation of mobile technology, the aging population is one of the key drivers that cause healthcare-related stakeholders in Malaysia to start making considerable improvements toward digital healthcare services. Thus, senior citizens are considered one of the more important age-groups for service providers to focus on. However, the adoption of the health technology in Malaysia is relatively low and as of the year 2020, only 10.7% of Malaysia’s senior citizens aged 60 years and above have adopted digital healthcare services. This number may grow as the population of Malaysia’s senior citizen are expected to rise to 14.5% of the total population by 2040. Therefore, this study utilizes framework analysis in identifying potential challenges for senior citizens to adopt to technology alongside framework analysis method to assess framework models that uses the extended technology acceptance model (ETAM) to measure user adoption of digital healthcare services. The framework analysis consists of five stages which includes familiarization, identifying framework, indexing, charting, mapping and interpretation. The findings show the relationship between users’ acceptance model with senior citizens’ actual use of the digital healthcare system in addition to the main challenges being information quality, privacy and security, trust, and health literacy. This will contribute to the foundation for future research aimed at improving digital healthcare services and bridge the gap in technology access to be the opportunity to use digital means as a tool for a healthier life.

Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study.

As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.

Digital health care service reform and health inequity for older people: a quasi-natural experiment in China.

Addressing health inequity (HI) for older people is a pivotal global public health concern, as it impedes the process of healthy ageing. The digital health care service reform (DHSR) emerges as a progressive public health approach to enhance the health and well-being of older adults by providing comprehensive and equitable medical services. This study elucidates the association between DHSR and HI for older individuals to augment comprehension of DHSR implementation. The initiation of the action plan for smart health and eldercare (SHE) in 2017 serves as a quasi-natural experiment. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, a propensity score matching (PSM) method was used to select samples, and a difference-in-differences (DID) regression was used to ascertain the net effect of DHSR on HI for older individuals in China. This methodology mitigates selection bias and segregates the DHSR effect from temporal shifts or other occurrences. The PSM-DID analysis reveals that DHSR reduced the HI index for older individuals by 0.301 (p < 0.01). Heterogeneity analyses indicate that the effect of DHSR was more pronounced in older males (-0.333, p < 0.01) than females (-0.251, p < 0.05). The impact of DHSR was notably higher for older population in the western (-0.557, p < 0.01) and central regions (-0.318, p < 0.05) compared to the eastern region, where the relationship was statistically non-significant. The results demonstrate that DHSR plays a vital role in diminishing HI, fostering inclusive growth in public health. The study underscores the imperative of sustained DHSR endeavours and allocating resources to key older demographics to substantially mitigate HI.

Examining Ethnic Disparities in Digital Healthcare Services Utilization: Insights from Israel.

The purpose of this study was to examine ethnic disparities in the utilization of digital healthcare services (DHS) in Israel and explore the characteristics and factors influencing DHS use among the Arab minority and Jewish majority populations. A cross-sectional correlational design was employed to collect data from 606 Israeli participants, 445 Jews, and 161 Arabs. Participants completed a digital questionnaire that assessed DHS utilization, digital health literacy, attitudes towards DHS, and demographic variables. The findings reveal significant disparities in DHS utilization and attitudes between these ethnic groups, with Jewish participants demonstrating higher rates of utilization and positive attitudes toward DHS. The study also explores the predictive role of digital health literacy and attitudes in DHS use while considering ethnicity as a potential moderator. Significant predicting factors related to DHS utilization among Jews include positive attitudes and high health literacy. Among the Arabs, only attitudes towards DHS significantly predict the extent of DHS use. Digital health literacy affects the extent of use through attitudes at the two groups of the moderator significantly, but it is stronger among the Arab group. To improve healthcare outcomes and reduce disparities, efforts should focus on ensuring equitable access to DHS for the Arab minority population. Targeted interventions, including digital literacy education, removing technology access barriers, offering services in Arabic, and collaborating with community organizations, can help bridge the gap and promote equal utilization of DHS.

Digital Twins for Healthcare 4.0—Recent Advances, Architecture, and Open Challenges

Recent trends have shown a widespread increase in the landscape of digital healthcare (i.e., Healthcare 4.0) services, such as personalized healthcare, intelligent rehabilitation, telemedicine, and smart diet management, among others. These healthcare services are based on a variety of diverse requirements. Fulfilling these requirements require proactive intelligent analytics and self-sustainability of networks. Self-sustainability enables the operation of a network with minimum possible interaction from the end-users/network operators, whereas proactive intelligent analytics enables efficient management of resources in response to users' requests. To enable healthcare 4.0 with proactive online analytics and self-sustainability, one can leverage digital twins. In this article, we present an overview and recent advances of digital twins for healthcare 4.0. An architecture of digital twins for healthcare is also proposed. Furthermore, we present several use cases of digital twins. Finally, we present open research challenges with possible solutions.

Recommendations for improving digital health literacy in patients with cancer receiving care in the Deep South.

202 Background: As technological advances are developed and implemented in healthcare, cancer patients with low digital health literacy may be at increased risk of health inequities. This study explored recommendations for improving digital health literacy related to electronic patient-reported outcome (ePRO) based remote symptom monitoring (RSM). Methods: This qualitative study, conducted December 2021-May 2023, included (1) patients with cancer and oncology providers from University of Alabama at Birmingham and University of South Alabama Mitchell Cancer Institute participating in RSM, and (2) community health workers (CHWs) who serve communities experiencing care access barriers across Alabama. Semi-structured interviews were conducted via phone, Zoom, or in-person. Recordings were transcribed and inductively content coded using Nvivo software for recurring themes and exemplary quotes by two independent coders. Results: Patients with cancer (n=19), providers (n=15), and community health workers (n=13) participated. Among patients and providers participating in RSM, recommendations included additional tech-focused training opportunities and in-person tech guidance. CHWs expanded upon this with four key recommendations involving provider-facing interventions. The first was to engage in communication-focused interventions that encourage use of lay language, developing cultural competency among providers, and “meeting patients where they are,” because as one CHW explained “if you don't actually understand the actual language, then you're never going to be able to really understand what's going on with your health.” A second recommendation was to focus on individual and community needs, such as lobbying to bring Wi-Fi to rural locations and developing subsidized cost programs for individuals who need them. CHWs then highlighted the existence of community partnerships and technology-focused training programs that largely go underutilized by local populations. Further developing these partnerships would also serve to emphasize the connection to the local community and legitimization of digital healthcare services. Finally, CHWs encouraged providers to emphasize to patients that technology in healthcare is a tool to facilitator greater connection and communication between patients and providers and that there is a “face behind the screen.” Conclusions: This study identifies key recommendations on how to address digital health literacy gaps and communicate the importance of the technologization of the American healthcare system to local communities in Alabama.

Exploring the Operational and Technical Changes in the Healthcare Sector During the COVID-19 Pandemic.

The COVID-19 pandemic has affected the healthcare sector globally including Sweden, creating subsequent operational and technical changes to the wide range of digital healthcare services utilized by healthcare professionals or end consumers. A qualitative study using a self-assessment survey based on the national health services digital maturity assessment was used to study these changes from the perspective of personnel working in Swedish healthcare-related organizations. The number of 30 respondents was selected using purposive sampling, out of them 11 responded. The study highlighted positively perceived changes such as boosting digitalization, improving the procurement process, and introducing crisis management teams. Improving the offered digital services, the tools' effectiveness, efficiency, and technical support were also some of the results. On the contrary, the negatively perceived changes were limiting access to the services, limiting technical support, and reprioritizing non-essential services and projects.

Digital Mental Health and its Challenges: An Interdisciplinary Approach to Mental Health in a Crisis

Abstract Background: Mental health studies indicate that digital mental health care can alleviate the symptoms of those struggling with mental disorders. We have seen Extended Reality (XR) systems, mental health apps, and other digital tool applications employed in mental healthcare settings to help service users cope with their emotions. Nonetheless, research has questioned the effectiveness of those findings and non-usage by immigrant groups. The calls to tackle this issue, chiefly the effectiveness of digital tools, prompted us to take an interdisciplinary approach. Methods: In this research, we use the theoretical concept of mental disorders beyond classical and critical approaches as a theoretical conduit to demonstrate how this issue of effectiveness is linked with the concept of mental disorders. Also, we process interviews with digital mental healthcare service users in three European countries, namely, the United Kingdom, Spain and Ireland, to gauge the effectiveness of digital tools in mental healthcare to improve the quality of care provided in the sector. Results: Answering this question from the position we put forward leads to an integrative approach where digital mental health care can be applied to reduce the symptoms of mental conditions along with other mental healthcare approaches. Conclusions: Our findings support mental disorders as a multidimensional concept, consistent with non-reductionistic approaches, and provide a foundation for further studies in the emerging field

Closing the gap: Technology access and telehealth use among older adults in the U.S. Medicare beneficiaries

The use of digital technology offers numerous benefits for older individuals. However, failure to access technology could result in missed resources and opportunities, with some in this age group being hesitant to adopt new technology due to unfamiliarity or fear. Telehealth, as a form of digital technology, holds the potential to overcome geographic and temporal limitations, enabling socially isolated and physically homebound older adults to access a broader spectrum of healthcare options. Despite the potential advantages, the availability, acceptability, and accessibility of telehealth interventions for aging care remain unclear. This study aims to examine the impact of digital technologies on access to health and social care for older adults while identifying socioeconomic factors that may hinder access to services. We utilized the 2021 Medicare Current Beneficiary Survey COVID-19 Winter Supplement Public Use File dataset and the total sample size was 10,592 Medicare beneficiaries aged 65 years and above. Several statistical analyses, including multivariable logistic regression, were conducted. Our findings revealed that individuals from Black non-Hispanic and Hispanic racial and ethnic groups, as well as those with lower income and residing in non-metro areas, had lower odds of using technology devices and accessing the internet, This highlights the need for targeted interventions and policies to promote equitable access to digital resources and healthcare services for all seniors. Moreover, seniors who possess technology devices and have internet access are more inclined to engage with primary care providers (PCPs) who provide telehealth consultations. The study discussed future directions and limitations, providing valuable insights into the intersection of digital technology, healthcare access, and socioeconomic factors for older adults.

디지털 기반의 생애주기별 건강관리서비스의 핵심 영역

디지털 기반의 생애주기별 건강관리서비스의 핵심 영역

Digital primary care visits designed for different patient segments in the pre-pandemic era: A scoping review

Digital healthcare services have been implemented increasingly during and after the COVID-19 pandemic. They have been expected to improve access, reduce inefficiencies, improve the quality of care, lower the cost of healthcare, and provide more personalised care. This study focuses on digital visits: digital health care services that replace a general practitioner (GP) appointment in primary care. The aim of this review is to assess the perspectives used in studying digital visits, and to describe the services studied in terms of modalities used and patient segments targeted. We aim to find how digital visits were studied prior to their becoming a necessity during the COVID-19 pandemic. This is a scoping review of English language papers published between 1.1.2010-31.5.2020. The papers were eligible for the review if they focused on a digital primary care visit which replaced a face-to-face appointment with a GP. In total, 36 papers were included. Ten of the studies described services tailored to the needs of a patient segment. The rest of the studies (26/36) did not differentiate between patient segments. The most often-used perspective was that of the clinician (16/36 studies). Fifteen studies were descriptive. The costs and outcomes were rarely utilised as a perspective: the costs were used in only one study and outcomes in six. Patient experience was the perspective chosen in 11 studies. Among all the interventions, the most common modality was by phone call (20), and the second most common was asynchronous messaging and video consultation (10 each). Prior to the COVID-19 pandemic, digital visits had mostly been developed for the entire population instead of a particular segment of patients. We argue that developing them to fit the needs of a patient segment would help make them more acceptable and suitable for patients. More studies from the patient perspective are needed to develop these services to better fit the needs of patients. The situation is likely to have changed during the pandemic, as a large number of studies has been published since May 2020.

The local environment matters: Evidence from digital healthcare services for patient engagement

AbstractThe creation and delivery of healthcare services are being transformed through patient-engaging digital services. However, their effects on hospital performance are unclear. We build on the theoretical foundations of resource dependency and environmental munificence to identify two characteristics of the hospital’s regional environment, the population’s access to digital computing resources (computing access) and health insurance coverage (service access), that condition the effects of hospitals’ patient-engaging digital services on patient satisfaction and readmissions. We argue that these omitted environmental contingencies may help explain the inconclusive findings reported in prior empirical studies on digital services. Analysis of data collated from a national sample of 941 hospitals nested within 157 regions shows that computing access in the environment strengthens the effect of a hospital’s digital services on readmissions and patient satisfaction. By contrast, service access dampens the moderated effect of digital services and computing access on readmissions, but the effect is not the same for patient satisfaction. Our study offers theoretical and practical implications underscoring the role of environmental heterogeneity in the value hospitals realize from patient-engaging digital services.

Equity in digital healthcare - the case of Denmark.

As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens' access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system.

Drivers and Frictions in Accelerating the Adoption of Digital Healthcare Services

Drivers and Frictions in Accelerating the Adoption of Digital Healthcare Services