Individual User Level Research Articles

A new era for stress research: supporting user performance and experience in the digital age

Stress is both a driver of objective performance impairments and a source of negative user experience of technology. This review addresses future directions for research on stress and ergonomics in the digital age. The review is structured around three levels of analysis. At the individual user level, stress is elicited by novel technologies and tasks including interaction with AI and robots, working in Virtual Reality, and operating autonomous vehicles. At the organisational level, novel, potentially stressful challenges include maintaining cybersecurity, surveillance and monitoring of employees supported by technology, and addressing bias and discrimination in the workplace. At the sociocultural level, technology, values and norms are evolving symbiotically, raising novel demands illustrated with respect to interactions with social media and new ethical challenges. We also briefly review the promise of neuroergonomics and emotional design to support stress mitigation. We conclude with seven high-level principles that may guide future work.

Polarized social media networks: a novel approach to quantify the polarization level of individual users

ABSTRACT This paper presents a novel methodology to quantify users’ polarization within social media networks, focusing on network structure instead of content. We model polarized networks as directed graphs, collecting users’ follower/following connections data, and propose a simple algorithm to compute a Connectivity Score for each node in sub-graphs associated with identified contrary groups of the polarized network. Our method has several advantages: it relies solely on users’ follower/following connections data, which is objective, often public and easy to obtain. Also, this input data is usually memory-efficient, unlike the input data of content-based methods which may require a whole corpus. The algorithm's performance is assessed through application to Twitter's 116th Congressmembers network, comparing against a content analysis method: Sentiment score (using VADER), and two political behavior-based methods: Ideology score (based on co-sponsorship frequency) and Roll Call score (based on bill-voting similarity). The results demonstrate that: (1) users’ choice of connections on the social media can represent polarization behavior; (2) a meaningful correlation between Connectivity Scores and Ideology or Roll Call Scores shows that the political behavior of users is reflected in their social media connections; (3) Democrats’ Twitter following behavior and their bill-voting and bill co-sponsorship behavior (represented by Roll Call and Ideology) are all significantly more correlated than that of Republicans. We believe applying our algorithm in conjunction with other methods is a valuable contribution resulting in more comprehensive analysis of the social media polarization space.

Can social enterprises achieve resilience and at what price?

AbstractSocial enterprises (SEs) are claimed to be able to address “wicked social problems1” in various policy instruments and governance models. However, doubts have been raised about whether the hybrid nature results in fundamental challenges that could prevent SEs from becoming ideal and sustainable public service organizations. Drawing upon organizational resilience literature, this article reveals two trade‐offs between social and business service qualities when SEs seek long‐term solutions to the challenges in delivering public services. This article argues that SEs—employing different hybrid models, emphasizing social or business service quality—jointly can overcome the trade‐offs to deliver sustainable and accountable public services at the public service contract level and the individual user's level.

Network topology facilitates internet traffic control in autocracies.

Recent years have seen an increase in governmental interference in digital communication. Most research on this topic has focused on the application level, studying how content is manipulated or removed on websites, blogs, or social media. However, in order for governments to obtain and maintain control of digital data flows, they need to secure access to the network infrastructure at the level of Internet service providers. In this paper, we study how the network topology of the Internet varies across different political environments, distinguishing between control at the level of individual Internet users (access) and a higher level in the hierarchy of network carriers (transit). Using a novel method to estimate the structure of the Internet from network measurements, we show that in autocratic countries, state-owned (rather than privately owned) providers have a markedly higher degree of control over transit networks. We also show that state-owned Internet providers often provide Internet access abroad, with a clear focus on other autocratic countries. Together, these results suggest that in autocracies, the network infrastructure is organized in a way that is more susceptible to the monitoring and manipulation of Internet data flows by state-owned providers both domestically and abroad.

Revealing Interaction Dynamics: Multi-Level Visual Exploration of User Strategies with an Interactive Digital Environment.

We present a visual analytics approach for multi-level visual exploration of users' interaction strategies in an interactive digital environment. The use of interactive touchscreen exhibits in informal learning environments, such as museums and science centers, often incorporate frameworks that classify learning processes, such as Bloom's taxonomy, to achieve better user engagement and knowledge transfer. To analyze user behavior within these digital environments, interaction logs are recorded to capture diverse exploration strategies. However, analysis of such logs is challenging, especially in terms of coupling interactions and cognitive learning processes, and existing work within learning and educational contexts remains limited. To address these gaps, we develop a visual analytics approach for analyzing interaction logs that supports exploration at the individual user level and multi-user comparison. The approach utilizes algorithmic methods to identify similarities in users' interactions and reveal their exploration strategies. We motivate and illustrate our approach through an application scenario, using event sequences derived from interaction log data in an experimental study conducted with science center visitors from diverse backgrounds and demographics. The study involves 14 users completing tasks of increasing complexity, designed to stimulate different levels of cognitive learning processes. We implement our approach in an interactive visual analytics prototype system, named VISID, and together with domain experts, discover a set of task-solving exploration strategies, such as "cascading" and "nested-loop', which reflect different levels of learning processes from Bloom's taxonomy. Finally, we discuss the generalizability and scalability of the presented system and the need for further research with data acquired in the wild.

A-386 Performance assessment of Point of care testing for blood glucose: a 5 year review of EQA data

Abstract Introduction WEQAS is the largest External Quality Assessment (EQA) provider for the Point of Care Testing (POCT) market within the UK supplying samples and assessment to over 30 000 sites per month with over 20 Programmes across the entire Health care sector. All the Programmes are accredited to ISO 17043.The aim of the programme is to provide support to POCT co-ordinators, to identify non compliant sites and improve the analytical performance of users. Most of the programmes are designed to allow the full assessment of all the devices within the organisation at either monthly, bimonthly or quarterly intervals. A Co-ordinator in each organisation is given a Group Administrator function for the EQA website and maintains the database for its own organisation. The role of performance surveillance is therefore devolved to each individual Co-ordinator at a local level and monitored nationally by the EQA organiser. The powerful database gives POCT Co-ordinators a wealth of information on method and analyser performance both within their own organisation and between organisations. Organisation performance summary reports, distribution letters, non-compliance reports, poor performance reports and cumulative reports are generated from one system. The POCT Users are also provided with a simple traffic light system with clear action limits. For the POCT glucose programme one sample is distributed each month with samples covering a range of 2 to 28 mmol/l annually. Methods A review of performance was undertaken between January 2018 and January 2023 for the POCT glucose Programmes for a selection of devices. Devices that were no longer available were excluded as were devices with <50 users in the group. This represented data from 10 360 devices per month in 2018 and 12 277 in 2023. Performance was assessed as the coefficient of variation (CV%) for the device group after outlier exclusion and calculated for a wide range of glucose concentrations. Results For devices with CV less than 5% in 2018 there was generally no further improvement in performance, however at a glucose of 2 mmol/L an improvement in performance of 0.5to 3.5% was observed for the other devices. In 2018 CVs ranged from 3.7 to 12% and 3.1 to 8.3%% at 2.5 and 26 mmol/L respectively compared with 4 to 10.3% and 3.3 to 7.2% in 2022. Conclusion Although there were numerous examples where EQA identified poor performance at an individual user level, there was little evidence to suggest that the performance of POCT glucose devices had improved significantly over the last 5 years.

Digital Twin: A Conceptualization of the Task-Technology Fit for Individual Users in the Building Maintenance Sector

There have been numerous research studies on understanding buildings better and finding ways to improve water and energy consumption while making them more comfortable for occupants. With technologies such as Building Automation Systems, IoT devices, mobile applications and BIM software, more data can be generated and stored for intelligence and more effective facility management. The next big thing is the digital twin concept, where a virtual model is created from the physical building that brings together real-time information from all data capture devices, allows monitoring, historical analysis, predictive analytics, and simulation as well as interaction and intervention to be carried out. Many research studies have covered the characteristics, architecture, and benefits of digital twins and examined the potential implementation issues. However, the literature on evaluating return on investment (ROI) and acceptance of digital twins for the built environment at the individual user level is limited. This study aims to develop a conceptual model to examine the motivational intent and behavioural choice by individual users to utilise the digital twin technology to improve their performance. The objectives of this study are to examine technology acceptance theories and develop a conceptual model that measures the relationship between the tasks involved and the digital twin technology characteristics.

Acceptability of an intravaginal ring for simultaneously preventing HIV infection and pregnancy: Qualitative findings of the Kisumu Combined Ring Study, 2019

Multipurpose prevention technology intravaginal rings (MPT IVRs) may offer a promising solution for addressing women's multiple sexual and reproductive health needs. We describe MPT IVR acceptability perspectives and examine user experiences of 25 cisgender women aged 18–34 years enrolled in a phase IIa randomized, partially blinded, placebo-controlled evaluation of tenofovir-based IVRs with and without contraceptive co-formulation. All took part in an individual, audio-recorded, semi-structured qualitative interview. A thematic analysis of transcribed interviews was completed in MaxQDA. Participants shared little to no knowledge of or experience with IVRs prior to joining the study. Four MPT IVR themes were identified: physical well-being, method reliability, personal management, and societal endorsement. Commonly cited of concern, but less described as being experienced, were physical discomforts (e.g., painful insertion/removal; inability to carry out daily activities/chores; foreign body sensation; expulsion; sexual interference, or debilitating side effects). Uncertainty regarding efficacy influenced perspectives about intended prevention benefits. Personal choices in managing reproduction and sexual behaviors had to be congruent with sociocultural values and norms for acceptance beyond the individual user level. Participants viewed broader community acceptance as likely to be mixed given community opposition to the use of modern family planning methods. They also shared concerns that IVR use could lead to infertility, especially among nulliparous women, or that it would encourage premarital sex or high-risk sexual behaviors among adolescent and young women. While a MPT IVR may not be suitable for all women, first-hand testimonials could help influence collective receptivity. Additional community acceptability research is needed.Clinical Trial RegistrationThe study is registered at http://ClinicalTrials.gov under the identifier NCT03762382.

When Does an Individual Accept Misinformation? An Extended Investigation Through Cognitive Modeling

A new phenomenon is the spread and acceptance of misinformation and disinformation on an individual user level, facilitated by social media such as Twitter. So far, state-of-the-art socio-psychological theories and cognitive models focus on explaining how the accuracy of fake news is judged on average, with little consideration of the individual. In this paper, a breadth of core models are comparatively assessed on their predictive accuracy for the individual decision maker, i.e., how well can models predict an individual’s decision before the decision is made. To conduct this analysis, it requires the raw responses of each individual and the implementation and adaption of theories to predict the individual’s response. Building on methods formerly applied on smaller and more limited datasets, we used three previously collected large datasets with a total of 3794 participants and searched for, analyzed and refined existing classical and heuristic modeling approaches. The results suggest that classical reasoning, sentiment analysis models and heuristic approaches can best predict the “Accept” or “Reject” response of a person, headed by a model put together from research by Jay Van Bavel, while other models such as an implementation of “motivated reasoning” performed worse. Further, hybrid models that combine pairs of individual models achieve a significant increase in performance, pointing to an adaptive toolbox.

Beyond self-selection: the multilayered online review biases at the intersection of users, platforms and culture

PurposeOnline review bias research has predominantly focused on self-selection biases on the user’s side. By collecting online reviews from multiple platforms and examining their biases in the unique digital environment of “Chinanet,” this paper aims to shed new light on the multiple sources of biases embedded in online reviews and potential interactions among users, technical platforms and the broader social–cultural norms.Design/methodology/approachIn the first study, online restaurant reviews were collected from Dianping.com, one of China's largest review platforms. Their distribution and underlying biases were examined via comparisons with offline reviews collected from on-site surveys. In the second study, user and platform ratings were collected from three additional major online review platforms – Koubei, Meituan and Ele.me – and compared for possible indications of biases in platform's review aggregation.FindingsThe results revealed a distinct exponential-curved distribution of Chinese users’ online reviews, suggesting a deviation from previous findings based on Western user data. The lack of online “moaning” on Chinese review platforms points to the social–cultural complexity of Chinese consumer behavior and online environment that goes beyond self-selection at the individual user level. The results also documented a prevalent usage of customized aggregation methods by review service providers in China, implicating an additional layer of biases introduced by technical platforms.Originality/valueUsing an online–offline design and multi-platform data sets, this paper elucidates online review biases among Chinese users, the world's largest and understudied (in terms of review biases) online user group. The results provide insights into the unique social–cultural cyber norm in China's digital environment and bring to light the multilayered nature of online review biases at the intersection of users, platforms and culture.

Green Smart Technology for Water (GST4Water): Water Loss Identification at User Level by Using Smart Metering Systems

A real-time household water consumption monitoring and processing system aimed at leakage identification at user level is presented here. The system, developed within the GST4Water project, allows consumption data sent by a generic smart meter installed in a user’s house to be received and transferred to a cloud platform. Here, the consumption data are stored and processed through an empirical algorithm able to automatically identify leakage at the individual user level by looking for non-consumption in certain periods of the day. With reference to a real-life case study, the results obtained show that the algorithm enables leakages on users’ properties to be identified with an accuracy of more than 90%. Therefore, the implementation of this algorithm within a highly innovative smart metering system can represent an efficient tool for reducing water losses at user level.

The Analysis of E-Government Services Adoption and Use in Slovenian Information Society between 2014 and 2017

With the increasing role of information and communication technology (ICT) in the society, ICT’s role is gaining importance in the aspect of provision and use of the public sector services for the citizens. Especially in the European Union different activities have been conducted through the years to promote ICT use in the society. It has been mainly based on the Digital Agenda for Europe (DAE), which underlines the key role of ICT in the efforts to achieve its strategic objectives. Slovenia as an EU member state follows these directions but positions itself among less successful states in the EU. The well-known European Digital Economy and Society Index ranks Slovenia to the lower half of member states indicating possibilities for improvement. Although much can be said and done about the service-providers side this paper focuses on the users’ side and especially on their digital inequality. The lack of studies in the area of digital inequality and online government services adoption and use is the main motivation for this research. The research uses the data provided by Slovenian annual survey Use of Information and Communication Technology in Households and by Individuals of the last four years. The analysis of this data, presented in the paper, exhibits that changes for the better are detected in Slovenian society, but the situation in public-sector services is not optima. The results demonstrate the existence of digital inequality considering the income level of households and education level of individual users. The synthesis of the data demonstrates that the Slovenian government and its ministries should consider adding tangible actions to the already set strategies if the country wants to catch up with the leading countries of the EU and achieve goals, set by the DAE.

Using clinical Natural Language Processing for health outcomes research: Overview and actionable suggestions for future advances.

The importance of incorporating Natural Language Processing (NLP) methods in clinical informatics research has been increasingly recognized over the past years, and has led to transformative advances.Typically, clinical NLP systems are developed and evaluated on word, sentence, or document level annotations that model specific attributes and features, such as document content (e.g., patient status, or report type), document section types (e.g., current medications, past medical history, or discharge summary), named entities and concepts (e.g., diagnoses, symptoms, or treatments) or semantic attributes (e.g., negation, severity, or temporality).From a clinical perspective, on the other hand, research studies are typically modelled and evaluated on a patient- or population-level, such as predicting how a patient group might respond to specific treatments or patient monitoring over time. While some NLP tasks consider predictions at the individual or group user level, these tasks still constitute a minority. Owing to the discrepancy between scientific objectives of each field, and because of differences in methodological evaluation priorities, there is no clear alignment between these evaluation approaches.Here we provide a broad summary and outline of the challenging issues involved in defining appropriate intrinsic and extrinsic evaluation methods for NLP research that is to be used for clinical outcomes research, and vice versa. A particular focus is placed on mental health research, an area still relatively understudied by the clinical NLP research community, but where NLP methods are of notable relevance. Recent advances in clinical NLP method development have been significant, but we propose more emphasis needs to be placed on rigorous evaluation for the field to advance further. To enable this, we provide actionable suggestions, including a minimal protocol that could be used when reporting clinical NLP method development and its evaluation.

Recalibrating the integration agenda: the position of citizens and communities in integrated care

Introduction: In this conceptual paper, we reflect on the emergence of citizens as active participants to care integration within Western, highly professionalized care systems. We explore how this development challenges established ways of conceptualizing and practicing integrated care. Ranging from professionals’ alignment with lay caregivers to citizens taking up formal ownership of services, citizen participation is often presented as a new frontier for care integration. Still, scholarly insight into the organizational implication of integration with and by citizens (instead of ‘merely’ for citizens) remains limited. Theory/Methods: First, we select and review key publications in the field of integrated care, analyzing how citizens and communities are positioned within the process of integration. Second, we draw on literature on citizen involvement to analyze the tension between the logics by which professional services are organized and the rationale(s) for involving citizens. We draw on our own empirical studies and examples from the literature to illustrate the areas in which such tensions surface. Findings: First, we discuss three reasons why citizens’ role in integrating services deserves more attention within the field of integrated care. These include (1) citizens’ life-world perspective, enabling them to contribute to the normative frameworks that guide service integration by prioritizing which issues ‘matter’ at the local level or for particular user groups; (2) citizens’ ability to identify whether the efforts of multiple organizations and professionals give rise to barriers to service access and quality at the individual user level; and (3) citizens’ prominent role as ‘lay’ providers of care, who are at risk of being ignored or marginalized when integration is approached as a predominantly professional or managerial endeavor. Second, we explore how these three incentives for involving citizens can be at odds with professional or managerial principles that often dominate how services are organized and integrated. We discuss five key areas of competing principles or perspectives—each potentially legitimate when considered in isolation—that become increasingly salient and require careful consideration when citizens assume a more prominent role in processes of integration: Competing ‘democratic’ and ‘instrumental’ rationales for involvement Competing claims of who represents ‘the community’ Different ways of valuing and utilizing professional knowledge and lay knowledge Trying to be ‘in control’ of work processes while flexibly aligning these with and to citizens Disparate perspectives on professional care organizations’ raison d’etre Discussion/Conclusion/Lessons Learned: We discuss how these five areas of tension force us to reconsider established assumptions that often guide efforts at care integration. While highlighting the potential value of citizen involvement, we also debunk the myth of citizens as the panacea for all challenges to service integration; particularly remaining critical of opportunistic, tokenistic or instrumental attempts at fostering their involvement. Limitations/Future Research: Our paper outlines a broad agenda to recalibrate the position of citizens and communities in integrated care. Future research needs to elaborate each of these five areas in more depth, developing our insights as well as practical tools for supporting constructive citizen involvement.

Exploring Systemic Problems in IS Adoption Using Critical Systems Heuristics

Most of the traditional technology acceptance models revolve around information systems (IS)/information technology (IT) adoption at individual user level. Organizations are complex social systems in which stakeholders interact and play different roles in IS/IT adoption and use. This study provides an organizational perspective through multiple stakeholder viewpoints to explore ‘systemic problems’ in IS adoption. This paper contributes to IS literature by applying boundary critique mechanism of Critical Systems Heuristics (CSH) through an interpretive study of a web portal implementation project in a West Australian University. This perspective considers systemic problems as a ‘system of conflicts’ comprising key factors and organization-wide stakeholder interactions. Moreover, it adds to CSH theory as to how systemic problems are identified by using boundary judgments and evaluated using a hermeneutic approach.

Burden of diverticular disease: an observational analysis based on Italian real-world data.

Diverticular disease (DD) represent a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis which can lead to hospitalization and surgery with various types of consequences. The main aim of this study was to evaluate, from both cross-sectional and longitudinal perspective, the economic burden of diverticulitis in the real practice. A deterministic linkage was performed at individual user level between the different administrative sources of the Marche Region through anonymised ID number for a period of analysis between 1 January 2008 and 31 December 2014. We enrolled all patients with at least one hospitalization for "diverticulitis of the colon without mention of haemorrhage" (ICD-9-CM code 562.11) or "diverticulitis of the colon with haemorrhage" (ICD-9-CM code 562.13) as primary or secondary diagnosis. Cost and outcome were analysed considering transversally (for contemporaneous) and longitudinal (for cohort) perspective. Hospital mortality at one year after discharge was evaluated by mortality rates and Kaplan-Meier curve considering the surgery performed (or not performed) during the index hospitalization. Considering the cross-sectional perspective, 427 patients per year were estimated (about 35 patients per 100,000 adult residents) with an average number of hospitalization equal to 1.14. The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008-2014 amounted to approximately € 11.4 million (€ 1.6 million a year), of which € 10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and € 270,000 (2.4%) for specialist outpatient services. The cohort analysis estimates an intra-hospital mortality rate equal to 5.9 per 100 patients' year (5.5 for non-surgery patients and 8.9 for surgery patients - P<0.05). Kaplan-Meier curve demonstrate that there were no differences between intra-hospital mortality due to surgery during index hospitalization. Our study is the first analysis in Italy to use real-world data to measure the burden of DD with a cross-sectional and longitudinal perspective. This study could be useful for decision maker that could quantify the economic and epidemiological burden of DD in hospital.

Using Smartphones for Research Outside Clinical Settings: How Operating Systems, App Developers, and Users Determine Geolocation Data Quality in mHealth Studies.

Smartphones that collect user geolocation provid opportunities for mobile Health (mHealth). Although granularity of geolocation data may be high, data completeness depends on the device's operating system, application developer decisions, and user actions. We investigate completeness of geolocation data collected via smartphones of 5601 people that self-reported daily chronic pain symptoms on 349,293 days. On 17% of these days, hourly geolocation data is reported, but days with 0 (16%), 1 (14%) and 2 (13%) geolocations are common. Android phones collect geolocation more often than iPhones (median 17 versus 2 times a day). Factors on operating system level and individual user level influence completeness of geolocation data collected with smartphones. mHealth researchers should be aware of these factors when designing their studies. The mHealth research community should devise standards for reporting geolocation data quality, analysing systematic differences in data quality between participant groups, and methods for data imputation.

Economic burden of diverticular disease: An observational analysis based on real world data from an Italian region

IntroductionDiverticular disease (DD), a herniation of the colonic mucosa through the muscle layer, covers a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis, which can lead to hospitalization and surgery with various types of consequences. The main aim of this study is to evaluate the economic burden of hospitalizations arising from acute episodes of diverticulitis using data from the administrative databases used in the Marche region in Italy and, as a secondary objective of this real-world data analysis, to study patient outcome variables following initial hospitalization for diverticulitis. MethodA deterministic linkage was performed at individual user level between the different administrative sources of the Marche region through anonymous ID number for a period of analysis between 1 January, 2008 and 31 December, 2014. We enrolled all patients with at least one hospitalization for “diverticulitis of the colon without mention of haemorrhage” (ICD-9-CM code 562.11) or “diverticulitis of the colon with haemorrhage” (ICD-9-CM code 562.13) as primary or secondary diagnosis. For each patient we assessed the cost of hospitalization, of medicines and of specialist services considering a time-scale of one year or cohort analysis 365days after first admission. ResultsThe total number of residents in the Marche region who had at least one hospitalization for diverticulitis in the period 2008–2014 was 2987 (427 patients a year, corresponding to about 35 patients per 100,000 adult residents); the total number of admissions was 3453 (just over 490 a year). The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008–2014 amounted to approximately €11.4 million (€1.6 million a year), of which €10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and €270,000 (2.4%) for specialist outpatient services. The average annual cost per patient was €3826, of which €3653 was for hospitalization, while pharmaceutical expenditure and specialist services accounted for €83 and €90, respectively. The cohort of patients undergoing a first admission for diverticulitis between 2010 and 2013 was made up of 1729 people (54.4% women, mean age 68.9 years), of whom 1500 (86.8%) did not undergo surgery while in hospital. Hospital mortality, recorded only for the over-65 age class, averaged 1.2%; for patients not receiving surgery during the initial hospitalization it was 0.5%, reaching 5.2% in patients undergoing surgery. The percentage of patients with one or more readmissions for diverticulitis within a year of the first was on average 7.8% and in 48% of cases this resulted in surgery. ConclusionsOur study is the first analysis in Italy to use real-world data to measure the financial impact of diverticular disease. Assuming that the diagnostic and therapeutic behaviour identified in the Marche region could be representative of the situation nationwide, the estimated annual number of hospitalizations in Italy for acute episodes of diverticulitis is 19,000. The total amount of economic resources needed to treat patients suffering from acute episodes of diverticulitis is estimated at €63.5 million a year.

The Enlightenment of Nolan Model to the Information Management of Educational Administration in Colleges and Universities

In view of the current problems in the educational management of colleges and universities, such as the construction phase and development path is not clear, resulting in the development of hardware and software is not coordinated; lack of effective integration between the business segmentation, resulting in the lack of effective sharing of information; lack of deep value-added services, this paper focuses on the Nolan model and technology acceptance model, from the perspective of organizational level and individual user level of the information life cycle of different stages of information technology organization learning, and analyzes the technology diffusion and technical acceptance of the mechanism, to promote and regulate the management of information and the regularity of the revelation.

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

BackgroundIt is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach.MethodsThirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied.ResultsAll groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions.ConclusionAs Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.