E-health Services Research Articles

Understanding Consumer Intentions to Engage with Artificial Intelligence and Voice Assistants: A Conceptual Framework

Artificial Intelligence (AI) has grown extensively in recent times and is becoming integrated into human lives. This progression opens diverse opportunities in e-health, facilitating healthcare accessibility globally. Voice assistants are AI-driven technologies, which are becoming increasingly important with the growing prominence of e-health services. This study offers an integrated model that assimilates AI attributes with relevant constructs from various theories such as Technology Acceptance Model (TAM) and Health Belief Model (HBM). Key variables under scrutiny include perceived anthropomorphism, perceived intelligence, perceived ease of use, perceived usefulness, perceived enjoyment, attitude, perceived severity, and perceived susceptibility. The article adds to the current research by reviewing the literature about AI in healthcare, and proposing a conceptual framework that binds technological, AI-specific, and health factors, offering implications for policymakers, healthcare administrators, and marketers seeking effective utilization of voice assistant technology.

Effect of the i2TransHealth e-health intervention on psychological distress among transgender and gender diverse adults from remote areas in Germany: a randomised controlled trial

Transgender and gender diverse (TGD) people in remote areas face challenges accessing health-care services, including mental health care and gender-affirming medical treatment, which can be associated with psychological distress. In this study, we aimed to evaluate the effectiveness of a 4-month TGD-informed e-health intervention to improve psychological distress among TGD people from remote areas in northern Germany. In a randomised controlled trial done at a single centre in Germany, adults (aged ≥18 years) who met criteria for gender incongruence or gender dysphoria and who lived at least 50 km outside of Hamburg in one of the northern German federal states were recruited and randomly assigned (1:1) to i2TransHealth intervention or a wait list control group. Randomisation was performed with the use of a computer-based code. Due to the nature of the intervention, study participants and clinical staff were aware of treatment allocation, but researchers responsible for data analysis were masked to allocation groups. Study participants in the intervention group (service users) started the i2TransHealth intervention immediately after completing the baseline survey after enrolment. Participants assigned to the control group waited 4 months before they were able to access i2TransHealth services or regular care. The primary outcome was difference in the Brief Symptom Inventory (BSI)-18 summary score between baseline and 4 months, assessed using a linear model analysis. The primary outcome was assessed in the intention-to-treat (ITT) population, which included all randomly assigned participants. The trial was registered with ClinicalTrials.gov, NCT04290286. Between May 12, 2020, and May 2, 2022, 177 TGD people were assessed for eligibility, of whom 174 were included in the ITT population (n=90 in the intervention group, n=84 in the control group). Six participants did not provide data for the primary outcome at 4 months, and thus 168 people were included in the analysis population (88 participants in the intervention group and 80 participants in the control group). At 4 months, in the intervention group, the adjusted mean change in BSI-18 from baseline was -0·65 (95% CI -2·25 to 0·96; p=0·43) compared with 2·34 (0·65 to 4·02; p=0·0069) in the control group. Linear model analysis identified a significant difference at 4 months between the groups with regard to change in BSI-18 summary scores from baseline (between-group difference -2·98 [95% CI -5·31 to -0·65]; p=0·012). Adverse events were rare: there were two suicide attempts and one participant was admitted to hospital in the intervention group, and in the control group, there was one case of self-harm and one case of self-harm followed by hospital admission. The intervention was clinically significant in averting worsening psychological distress in service users, outperforming the wait list control group. These findings support the effectiveness of e-health services in TGD health care, specifically for people from remote areas. Innovation Committee at the Federal Joint Committee. For the German translation of the abstract see Supplementary Materials section.

Assessing Patient Use of and Attitudes toward eHealth Services for Communication with Primary Care Centers in Saudi Arabia and Factors Affecting Usage.

This study investigates patients' use of eHealth services, their awareness of the availability of these services, and their intention to use them in primary care. It also examines patient characteristics and factors that influence the use of these services. A cross-sectional design using questionnaires was conducted. Based on the unified theory of acceptance and use of technology (UTAUT), the participants rated the two most common services. Descriptive analyses and linear correlation analyses were performed. A simple linear regression was conducted to identify factors influencing the participants' intention to use eHealth services. In total, 1203 participants with an average age of 43.7 years were surveyed. The participants' usage rates varied, with the lowest at 2.4%, for measuring vital signs, and the highest at 47.4%, for booking appointments. The intentions to use the services ranged from 22.5%, for video consultations, to 46.6%, for prescription refill requests. Approximately 20% of the respondents were unaware of each service's availability. Positive associations were found between all the constructs and the intention to use online services, with a younger age being the most significant factor. The use of and intention to use eHealth services varied greatly. The participants were often unaware of the availability of these services. Promoting the availability and benefits of eHealth services could enhance patient engagement in primary care settings.

The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review

BackgroundIn recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries.The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era.MethodsThe databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including ‘eHealth’, ‘workload’, and ‘general practice’. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 – 2020, before the start of the COVID-19 pandemic.ResultsIn total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload.ConclusionsThe impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services.Study registration numberPROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897.

Determinants of the implementation of eHealth-based long-term follow-up care for young cancer survivors: a qualitative study

BackgroundeHealth may help closing gaps in the long-term follow-up care of former young age cancer patients. While its introduction to medical aftercare appears promising, it also faces obstacles in the course of its implementation. This study explored what prospective eHealth applications have to achieve and what facilitating and hindering factors are associated with the implementation of them.MethodsA qualitative, explorative-descriptive design involving semi-structured interviews was used in this study. General practitioners (GPs) from urban and rural areas as well as former cancer patients were recruited and interviewed. The interview guide focused on expectations of telemedical care services for the patient group of children and adolescents as well as potential facilitating and hindering factors of the implementation of telemedical care services for former cancer patients. Interviews were recorded, transcribed and analyzed on the basis of qualitative content analysis as described by Kuckartz.ResultsEmpiric saturation was reached after 25 interviews, respectively. The age of the physicians surveyed at the time of the interviews ranged from 27 to 71 years, with an average of 42 years. The former patients ranged in age from 21 to 43 at the time of participation, with an average age of 34. The age at diagnosis ranged from 3 to 31 years. eHealth services were considered an effective way to maintain continuity of care and improve the health literacy of cancer survivors. Cooperation with health insurance companies and gamification-elements were regarded as beneficial for the introduction of eHealth structures. Poor interface compatibility, insufficient network coverage and lack of digital literacy were valued as potential barriers.ConclusionsIf properly introduced, eHealth shows the potential to provide stakeholders with tools that increase their self-efficacy and ability to act. As the technology continues to advance, our data provides application-oriented factors for tailored implementation strategies to bring eHealth into the field.

Factors Influencing the Successful Implementation of eHealth in Healthcare Facilities in Developing Countries: A Scoping Review

eHealth is the leveraging of Information and Communication Technologies (ICT) in health. Its use in complementing health services has risen substantially in the previous 20 years. The study explored the factors that influence the implementation of eHealth in healthcare delivery in developing countries. Three scientific bibliographical databases: PubMed, EBSCO Host, and Google Scholar were reviewed. Titles and abstracts were assessed using predefined inclusion and exclusion criteria. An exploratory study was done to assess the factors (facilitators and barriers) influencing the successful implementation of eHealth in developing countries. The searches yielded 11,001 resources, with 33 articles meeting the inclusion criterion of being in English and describing eHealth implementation in developing countries in the period January 2016 to December 2023. These were included in the study and thoroughly analyzed. Some key factors that influence the successful implementation of eHealth services were presented with computer literacy having the highest frequency in eHealth implementation. It is worth noting that barriers are factors that have a negative impact on implementation; nevertheless, by addressing barriers early on, they can be viewed as facilitators.

Exploring the impact of digital distrust on user resistance to e-health services among older adults: the moderating effect of anticipated regret

This study investigates the factors influencing user resistance to e-health services among older adults, focusing on the role of information inequality, digital distrust, low self-efficacy, perceived risk, and social influence. Structured questionnaires were used to gather data from 301 older adult participants, and the structural equation modeling method was used to analyze the results. The results show that digital distrust, perceived risk, and user resistance have a significant positive relationship, underscoring the significance of resolving trust and risk concerns in e-health interventions. The study also finds that the association between digital distrust and user resistance is moderated by anticipated regret, indicating that people who anticipate regretting not adopting electronic health services are less likely to oppose digital technologies despite their distrust. Surprisingly, the study did not find support for the hypothesized relationship between information inequality and user resistance, indicating the need for further exploration of this complex relationship. The study contributes to a better understanding of the factors influencing user resistance to e-health services among older adults, offering valuable insights for policymakers and practitioners seeking to promote the adoption of digital health technologies in aging populations.

Loss Aware Federated Learning for Service Migration in Multimodal E-Health Services

Loss Aware Federated Learning for Service Migration in Multimodal E-Health Services

Factors influencing use of eHealth services during and after the COVID-19 pandemic.

The rapid advancement of information and communication technologies has made eHealth applications increasingly available and accessible. The COVID-19 pandemic has accelerated the need for remote health service provision. This research aims to explore the usage, perceptions, and knowledge of eHealth interventions during and after the COVID-19 pandemic. A cross-sectional survey was conducted in 2021 (during the pandemic) and 2023 (post-pandemic) using a structured questionnaire based on the Technology Acceptance Model (TAM) and the eHealth Literacy Scale (eHEALS). The survey, conducted in Greece, included 638 participants in total (277 in 2021 and 361 in 2023). Structural equation modeling was employed to assess the factors influencing eHealth adoption. The findings indicate a slight increase in positive perceptions of eHealth usefulness, intention to use, and actual usage over the 2years. However, concerns remain regarding the ease of use and eHealth literacy. eHealth literacy significantly predicts the perceived usefulness and ease of use of eHealth services, both of which predict the intention to use them. Additionally, higher education levels are positively associated with eHealth literacy, while older age is negatively associated with ease of use. Gender did not significantly impact these factors. These findings were consistent across both surveys. Policy-makers should focus on simplifying eHealth services, removing technical barriers, and enhancing the population's eHealth literacy to promote wider adoption of eHealth services.

Unveiling the heterogeneous utilisation of the same digital patient management platform: case studies in primary healthcare in Sweden

BackgroundThe utilisation of digital technology in primary healthcare, particularly digital patient management platforms, has gained prominence, notably due to the global pandemic. These platforms are positioned as substitutes for face-to-face consultations and telephone triage. They are seen as a potential solution to the escalating costs associated with an aging population, increasing chronic conditions, and a shrinking healthcare workforce. However, a significant knowledge gap exists concerning the practical aspects of their implementation and their effect on the utilisation of digital patient management in primary healthcare.MethodsThis study addresses this gap by conducting a comprehensive analysis of three case studies involving the implementation of a specific digital patient management platform. Over a period of three years, we examine how the practicalities of implementation shape the adoption and utilisation of a digital patient management platform in three different clinics.ResultsOur findings revealed that differences in implementation strategies directly influenced variations in utilisation. The successful utilisation of the platform was achieved through a bottom-up decision-making process that involved the employees of the primary healthcare clinics. Onsite training, close collaboration with the eHealth provider, and a structured patient onboarding process played crucial roles in this utilisation. In contrast, a top-down approach at two of the primary healthcare clinics led to limited utilisation of the platform into daily workflows. Furthermore, making the platform a part of everyday work meant putting accessibility, by working as a team of physicians, at the forefront of continuity of care, with patients being managed by their designated physician. Additionally, it was observed that digital patient management proved most effective for addressing simple patient issues such as skin rashes, rather than complex cases, and did not reduce the demand for phone triage.ConclusionOnly one of the three clinics studied effectively integrated digital patient management into its daily operations, and did so by aligning objectives among management and all categories of healthcare professionals, employing a bottom-up decision-making process, collaborating with the eHealth service provider for regular platform adjustments to clinic needs, and implementing active patient onboarding. This sociotechnical integration resulted in high platform utilisation. In contrast, the other two clinics faced challenges due to incoherent objectives among diverse healthcare professional employees and top management, a top-down decision-making approach during implementation, limited collaboration with the eHealth service provider, and passive patient onboarding. The findings indicate that these factors negatively affected utilisation and led to low platform adoption as well as disrupted the sociotechnical balance.

A Novel Data Analysis Architectural Framework for Data Reduction on Edges for Smart City Healthcare

The most difficult task is managing and digesting the massive amount of heterogeneous data created by IoT. It questioned the efficiency and computational storage capacity of today's infrastructure resources. Furthermore, because there is so much data, it becomes difficult to give the user enough information to make a decision. A technology known as Complex Event Processing (CEP) has been created to glean important insights from massive real-time data streams. The goal of this research is to create a system that can extract complicated events from large amounts of sensor data and only transmit those events to a cloud server. Global healthcare services have been expanding at an exponential rate because of the vast amount of data that clinical and medical organizations generate daily. Healthcare systems can use e-health services to meet the medical and assistive requirements of people. Edge technology is proven in this direction. Mixing the old classic concepts with the innovative we have proposed the Novel data analysis architecture for smart heart disease prediction. We have created the fuzzy-based inference system at the edges for the data analysis and used the resulting Complex Events at the end predictions.

The Role of Management Information Systems in the Healthcare Industry in E-Health and E-Hospital Programs

This study aims to determine the role of management information systems in the health industry in e-health and e-hospital programs. In the era of globalization, technological developments have had an impact on business progress, including the health industry. E-health and e-hospital as one of the internet-based technology applications require strategies to improve business efficiency and productivity. This study uses a qualitative method with a descriptive approach and a literature study method. The results of the study indicate that E-Health and E-Hospital services can make it easier for people to access health services easily and efficiently. It is hoped that in the future it can provide more complete services, such as adding several Hospitals and Health Centers to its website, giving customers access to the various Hospitals they need.

Development of the Huntington Support App (HD-eHelp study): a human-centered and co-design approach.

eHealth seems promising in addressing challenges in the provision of care for Huntington's disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients' home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people's experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app's prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app's prototype are provided.

Legislative mechanisms of personal data protection in the health care system

Human rights and freedoms, guarantees of their observance and protection should be the basis of the activities of any democratic country in the world. The issue of information security becomes particularly relevant in modern conditions, because medical institutions collect and store personal data of persons who contact them, the results of laboratory and instrumental research, diagnoses, medical histories, etc. Endless reforms, changes in legislation, introduction of an electronic system in the field of health care cause a lot of discussions about individual mechanisms of its functioning and ensuring the protection of personal data. The collection of personal data must be lawful, subject to strict requirements and for a legitimate purpose. In addition, persons or organizations engaged in the collection and processing of personal information must protect it from abuse and respect the rights of data owners guaranteed by law. The reform of legislation in the field of data protection should take place in parallel with the dynamic process of development of Internet technologies, including the creation of a formalized system of legislation in the field of privacy. In addition, considerable attention should be paid to the level of awareness of citizens about how their personal data may be collected and used. In particular, the request for consent to the processing of personal data must be clear; access to own data should be simplified and their mobility should be increased for easier transfer of data from one service to another; companies and organizations must report serious security breaches in a timely manner. And of course, ensuring the appropriate level of responsibility and reporting of all those involved in personal data processing. Health care is increasingly reliant on information technology. More and more hospitals and healthcare institutions are using information and communication technologies to support and improve their work. Digital technologies are widely used in the public health care sector, including electronic prescriptions, appointments with a family doctor, records of services rendered, hospitalization, hospital discharge, etc. In this context, a wide range of eHealth tools and services have emerged. Electronic medical records are created in such a way that it is possible to transfer patient data between different medical professionals. Although digital health technologies have so many important functions, their high dependence on sensitive patient health information can cause information security issues. At the same time, a significant part of personal health data is often collected without informing patients about it.

The Experiences and Perceptions of Older Adults with Multimorbidity Toward E-Health Care: A Qualitative Evidence Synthesis.

Background: Given the growing population of older adults globally, e-Health plays an indispensable role in the chronic disease management of multimorbidity. However, qualitative evidence that synthesizes the experiences of older adults with multimorbidity using e-Health service is currently lacking. The objective was to explore the experiences and perceptions of e-Health care in community-based settings among the older adults with multimorbidity. Methods: Seven electronic databases including PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, China National Knowledge Infrastructure, and Chinese BioMedical Literature were searched, and the search was limited to studies from inception to September 1, 2023. Screening, data extraction, and quality appraisal were conducted independently by two reviewers. Thomas and Harden's thematic synthesis methodology was applied to synthesize the original themes. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and the confidence of synthesized themes was evaluated by the Confidence in the Evidence from Reviews of Qualitative Research approaches. Results: Ten studies with moderate methodological quality met eligibility criteria and were included finally. Studies were conducted in four countries with 235 participants who were living with multiple chronic conditions. Among the 10 included studies, 37 credible findings were extracted and interpreted into 3 synthesized themes and 12 subthemes: (1) advantages and benefits perceived during e-Health service, (2) multidimensional challenges and negative experience posed by e-Health service, and (3) preferences, suggestions, and expectations for future e-Health improvement. The confidence in the majority of the three final synthesized themes was rated between "low" and "moderate" scales. Conclusions: The findings of this study provide new insights into implementing tailored e-Health care for older adults with multimorbidity. Further research should emphasize on realizing the potential value of e-Health service based on users' needs and perspectives to promote age-friendliness in geriatric practice.

Exploring the resistance to e-health services in Nigeria: an integrative model based upon the theory of planned behavior and stimulus-organism-response

Despite the evident advantages of electronic health services (eHS), there is a noticeable opposition to their acceptance, which has raised a crucial question about why people, particularly in developing nations, oppose the acceptance of eHS. This study was designed to obtain a comprehensive understanding of the factors that influence the rigid opposition to eHS by integrating two theoretical models: the Stimulus-Organism-Response theory and the Theory of Planned Behavior. In our detailed survey, 543 respondents over 18 years old from various regions of Nigeria participated. We evaluated the proposed model using partial least squares structural equation modeling (PLS-SEM). The findings indicated that lower health literacy was associated with a greater opposition to using eHS. In addition, communication and choice overload and perceived risk contributed to a negative attitude toward eHS. Subjective norms played a significant role in influencing the intention not to use eHS, which highlights social pressure’s effect. Further, a greater perception of behavioral control reduced the intention not to use eHS. Ultimately, the intention not to use eHS affected eHS rejection behavior significantly, which makes resistance to it a substantial problem. This research unveils factors that contribute to this behavior and provides insights for policymakers in the health field, with the goal to improve people’s acceptance of eHS. Further research is recommended in different geographical samples and contexts to gain a better understanding of the factors related to eHS rejection behavior.

The Steps on the Path of Digital Transformation in Greek Public Healthcare: Challenges and Prospects

Globally, the tremendous growth of Information and Communication Technology (ICT) has led to a great expan- sion of the information produced, emerging new terms such as E-government (EG), Digital Governance (DG), and Digital Transformation (DT) that brought revolutionary changes in public administration and other sectors such as telecommunication, industry, and energy but not enough in public healthcare area. This study set out to explore the level of development of DT of Greek Public Healthcare (GPH) since 2000, focusing on the e-Health and Digital Health (DH) applications and services, and highlighting its accelerated development due to COVID-19 pandemic and its main problems in its application. A review of compara- tive studies published from 2000 to date was conducted. Search was demonstrated on Organisation for Economic Co-operation and Development (OECD), European Com- mission and Open Data Institute (ODI) databases, and Greek Legislation Framework. Keywords we used: «Digital Transformation», “Digital Governance”, “e-Health”, “Digi- tal Health”, “Electronic Health Record”, “e-prescription”, “Health Information Systems”, “Health Atlas”, “m- Health/Mobile Health”, “Telemedicine”, “Telehealth”, “ICT Action Plan”. During the first decade, there were many advances in DG and DT, like the Integrated Health Infor- mation Systems (IHIS), which in the majority of their implementation have not adequately fulfilled their role remaining as isolated HIS. The second decade, marked by the memorandum and the economic crisis, brought many significant changes in the context of the organization and rational administration of the GPH, especially in the field of DT, DG, and e-Health such as e-prescription, ESY.net, e-inventories, e-warehouses, e-invoicing of hospital charges, electronic Statements of Detailed Health Documents (eDAPY), the United4Health project, the National Telemedicine Network and the partially developed Individual Electronic Health Record (IEHR). Taken together, these results suggest that, Greece still lags in the field of e- Health and significant steps are needed to make GPH cost-effective, accessible, and inclusive, such as among others the integration of IEHR and the import of Laboratory Infor- mation System (LIS) and Picture Archiving and Communi- cation System (PACs) data into the IEHR.

Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain.

The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually.

Behavioral responses resulting from e-health services and the role of user satisfaction: the case of the online diabetes test

PurposeThe advancement of technologies has made it possible for health-care organizations to provide convenient online services that enable people to manage their health conditions. Although many studies have investigated the adoption and benefits of e-health services, there has been little focus on health-oriented behaviors after adoption, particularly in relation to service quality and user satisfaction.Design/methodology/approachThis paper is based on the SOR model and service quality theories to investigate behavioral responses, including word-of-mouth, intention to use and intention to act. The authors use a partial least squares structural equation modeling analysis with 194 participants and the diabetes risk test survey in Finland.FindingsThe results show that people are willing to engage in health self-management behaviors if they intend to use the e-health service and are satisfied with it. User satisfaction can be enhanced by improving the visual appeal of the website presentation, the quality of the presented information, as well as the usability of the website, all as components of e-health services.Originality/valueThe authors contribute by creating a construct “intention to act,” referring to health-oriented behaviors resulting from e-health service use. In addition, this study is among the first to apply the SOR model to investigate how user satisfaction leads to intention to use, intention to act and word-of-mouth.

Co-creating a service ecosystem for supporting digitalization in health and welfare

Health and welfare services are increasingly striving towards data-driven, digital and patient-centric approaches to service management and delivery. The growing digitalization and amount of eHealth services introduced are part of a sociotechnical change in health and social care, where different sectors collaborate in ecosystems. This study focuses on ecosystemic collaboration in health and welfare and its potential in value creation, with a particular interest in how multistakeholder co-creation can be enabled and orchestrated. The study draws on research on service ecosystem design, open innovation and co-creation. The aim of this study is to explore how service ecosystems are co-created by public, private and third-sector organizations in the health and welfare sector. To achieve this aim, our study has two research objectives. First, the study explores current ecosystemic practices in health and welfare. Second, the study identifies factors that affect these practices. This study presents the findings of a qualitative study conducted in Finland in spring 2023 with key informants from the health and welfare sector. The study context revolves around a HEI that provides university level teaching in social and health care and adopts a problem-based pedagogy that is firmly grounded in working-life collaboration with cross-sectoral actors and professional practice in the field. The findings reveal different factors that have an effect on ecosystem collaboration. The findings support the argument that working in ecosystems is beneficial and digitalization has been a key driver of innovation in the health care and welfare sector in Finland. Based on these findings, we discuss the potential of orchestrators, such as HEIs, to co-create service ecosystems that enable digitalization of health and welfare.