Use Of eHealth Services Research Articles

Improving access to healthcare for paediatric sickle cell disease patients: a qualitative study on healthcare professionals\u2019 views

BackgroundIn well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families.MethodsHealthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as “transportation”, or “telecommunication”). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data.ResultsIn 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient’s home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users’ health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings.ConclusionThis qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child.

Johtajien käsitykset e-palveluiden yleistymisen vaikutuksista hoidon tarpeen arviointitoimintaan – laadullinen tutkimus erikoissairaanhoidon yhteispäivystyksestä

Sähköisten terveydenhuoltopalveluiden (e-palvelut) yleistyminen muuttaa hoidon tarpeen arviointitoimintaa erikoissairaanhoidon yhteispäivystyksessä. Päivystyksellisellä hoidon tarpeen arvioinnilla tarkoitetaan ammattilaisen suorittamaa arviota potilaan tarvitsemasta päivystyshoidosta. E-palveluiden yleistyessä ihmiset arvioivat yhä useammin itse omaa hoidon tarvettaan sähköisillä työkaluilla ennen päivystykseen saapumista ja ilman kontaktia terveydenhuollon ammattilaiseen. E-palveluiden käyttöönotto on haasteellista ilman ymmärrystä teknologian, ihmisten ja toimintaympäristön välisistä suhteista. Tämän tutkimuksen tarkoituksena on kuvata johtajien käsityksiä 1) päivystyksen hoidon tarpeen arviointitoiminnasta, 2) e-palveluiden yleistymisen vaikutuksista hoidon tarpeen arviointitoimintaan, 3) e-palveluiden yleistymisestä aiheutuvaan toiminnan muutokseen varautumisesta ja 4) toiminnan muutoksen onnistumiseen vaikuttavista tekijöistä.
 Tutkimusaineisto kerättiin syksyllä 2019 teemahaastattelulla viiden yliopistosairaanhoitopiirin yhteispäivystyksen operatiivisesta johtamisesta vastaavilta hoitotyön johtajilta ja lääkärijohtajilta (n=10). Aineisto analysoitiin sisällönanalyysillä.
 Tulosten mukaan e-palveluiden yleistymisen vaikutukset kohdistuvat yhteispäivystyksessä ihmisiin ja toimintaan. Ammattilaisten työ, asiakkaiden toimintamallit sekä hoidon tarpeen arviointitoiminta muuttuvat ja päivystystoiminta kehittyy. Johtajat ymmärtävät e-palveluiden yleistymisen vaikutukset sosioteknisen lähestymistavan mukaisena, koko yhteispäivystystä koskevana toiminnan muutoksena. E-palveluiden yleistymisestä aiheutuvaan toiminnan muutokseen on varauduttu, mutta siinä on myös haasteita. Varautumista pyritään edistämään ja siihen tarvitaan tukea. Yhteispäivystyksessä toiminnan muutoksen onnistumiseen vaikuttavat esimerkiksi asenne, hyötyjen osoittaminen, toimintaympäristö ja resurssit.
 Edellytykset e-palveluiden käyttöönoton onnistumiselle yhteispäivystyksen hoidon tarpeen arviointitoiminnassa ovat optimistiset. Toiminnan muutokseen on tärkeää varautua ja huomioida muutoksen onnistumista edesauttavat ja estävät tekijät. Ilman riittävää taloudellista varautumista toiminnan muutoksen onnistuminen voi olla vaikeaa. Tuloksia voidaan hyödyntää e-palveluiden käyttöönotossa ja kehittämisessä yhteispäivystyksen hoidon tarpeen arviointitoimintaa tukeviksi sekä toiminnan muutosten ennakoinnissa ja johtamisen tehostamisessa.

Public health policy-making for hearing loss: stakeholders\u2019 evaluation of a novel eHealth tool

BackgroundHearing loss (HL) affects 466 million people of all ages worldwide, with a rapidly increasing prevalence, and therefore requires appropriate public health policies. Multi-disciplinary approaches that make use of eHealth services can build the evidence to influence public policy. The European Union-funded project EVOTION developed a platform that is fed with real-time data from hearing aids, a smartphone, and additional clinical data and makes public health policy recommendations based on hypothetical public health policy-making models, a big data engine and decision support system. The present study aimed to evaluate this platform as a new tool to support policy-making for HL.MethodsA total of 23 key stakeholders in the United Kingdom, Croatia, Bulgaria and Poland evaluated the platform according to the Strengths, Weaknesses, Opportunities and Threats methodology.ResultsThere was consensus that the platform, with its advanced technology as well as the amount and variety of data that it can collect, has huge potential to inform commissioning decisions, public health regulations and affect healthcare as a whole. To achieve this, several limitations and external risks need to be addressed and mitigated. Differences between countries highlighted that the EVOTION tool should be used and managed according to local constraints to maximise success.ConclusionOverall, the EVOTION platform can equip HL policy-makers with a novel data-driven tool that can support public health policy-making for HL in the future.

Ethical issues related to eHealth: An integrative review.

Identifying and safeguarding ethics in eHealth services from the service users' perspective in social care and healthcare is important. The use of eHealth services should not prejudice the quality of services or the social interaction required in care. There is a lack of studies about the ethics of eHealth services from the service users' perspective. The aim of this study is to identify and analyse ethical issues related to eHealth in social care and healthcare from the service users' perspective. An integrative literature review. The review followed good scientific conduct. A systematic literature search was performed using CINAHL, Scopus, PubMed/MEDLINE, Web of Science, Cochrane Library and Academic Search Premier to find relevant empirical studies published in English from their earliest up to 30 November 2018. In addition, reference lists from the identified research papers were searched. A quality appraisal of each paper included in the review was conducted before thematic analysis. In total, 26 studies were included in the review, and from these four ethical themes were identified: (1) privacy in eHealth, (2) beneficence and nonmaleficence in eHealth, (3) justice in eHealth and (4) trust in eHealth. The ethical issues within these themes were related to information sharing; ownership; access to information and data protection; informed consent; defence of rights; and equity, equality and proportionality of response. eHealth inequality occurs in social care and healthcare. eHealth service designers and social care and healthcare professionals need to act to maintain and improve user access and data accuracy and provide different levels of security in eHealth services, relative to the information stored. There is a need for further research about ethical issues of eHealth from the user's perspective, including the customer-oriented availability and usability of eHealth services which avoid discrimination.

E-Health in Norway Before and During the Initial Phase of the Covid-19 Pandemic.

The use of e-health services has for many years gradually increased in Norway as in most European countries. Searching for information about health and illness has previously by far been the most popular service. In this study, we review the literature with the aim of examining any changes in e-health use during the Covid-19 pandemic. We find that there has been a marked change in Norway, with an extreme increase in video consultations, especially in primary care and in the mental health field. The government has also released an app for tracking the illness, which so far has been downloaded by approximately 1/4 of the population. These changes are likely to impact the use of e-health also after the pandemic.

Electronic Health Use in a Representative Sample of 18,497 Respondents in Norway (The Seventh Tromsø Study - Part 1): Population-Based Questionnaire Study.

BackgroundElectronic health (eHealth) services may help people obtain information and manage their health, and they are gaining attention as technology improves, and as traditional health services are placed under increasing strain. We present findings from the first representative, large-scale, population-based study of eHealth use in Norway.ObjectiveThe objectives of this study were to examine the use of eHealth in a population above 40 years of age, the predictors of eHealth use, and the predictors of taking action following the use of these eHealth services.MethodsData were collected through a questionnaire given to participants in the seventh survey of the Tromsø Study (Tromsø 7). The study involved a representative sample of the Norwegian population aged above 40 years old. A subset of the more extensive questionnaire was explicitly related to eHealth use. Data were analyzed using logistic regression analyses.ResultsApproximately half (52.7%; 9752/18,497) of the respondents had used some form of eHealth services during the last year. About 58% (5624/9698) of the participants who had responded to a question about taking some type of action based on information gained from using eHealth services had done so. The variables of being a woman (OR 1.58; 95% CI 1.47-1.68), of younger age (40-49 year age group: OR 4.28, 95% CI 3.63-5.04), with a higher education (tertiary/long: OR 3.77, 95% CI 3.40-4.19), and a higher income (>1 million kr [US $100,000]: OR 2.19, 95% CI 1.77-2.70) all positively predicted the use of eHealth services. Not living with a spouse (OR 1.14, 95% CI 1.04-1.25), having seen a general practitioner (GP) in the last year (OR 1.66, 95% CI 1.53-1.80), and having had some disease (such as heart disease, cancer, asthma, etc; OR 1.29, 95% CI 1.18-1.41) also positively predicted eHealth use. Self-rated health status did not significantly influence eHealth use. Taking some action following eHealth use was predicted with the variables of being a woman (OR 1.16, 95% CI 1.07-1.27), being younger (40-49 year age group: OR 1.72, 95% CI 1.34-2.22), having a higher education (tertiary/long: OR 1.65, 95% CI 1.42-1.92), having seen a GP in the last year (OR 1.58, 95% CI 1.41-1.77), and having ever had a disease (such as heart disease, cancer or asthma; OR 1.26, 95% CI 1.14-1.39).ConclusionseHealth appears to be an essential supplement to traditional health services for those aged above 40 years old, and especially so for the more resourceful. Being a woman, being younger, having higher education, having had a disease, and having seen a GP in the last year all positively predicted using the internet to get health information and taking some action based on this information.

The Association Between Health Information Seeking on the Internet and Physician Visits (The Seventh Tromsø Study - Part 4): Population-Based Questionnaire Study.

BackgroundThe internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services.ObjectiveWe examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician.MethodsWe used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Tromsø Study (Tromsø 7). The participants were aged ≥40 years and living in Tromsø, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants.ResultsThe use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95% CI 1.94-2.02) and 1.07 (95% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95% CI 2.03-4.46), video search engines (OR 1.43, 95% CI 1.21-1.70), and health apps (OR 1.26, 95% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95% CI 1.92-4.18), video search engines (OR 1.27, 95% CI 1.07-1.51), social media (OR 1.28, 95% CI 1.10-1.49), and health apps (OR 1.20, 95% CI 1.07-1.35).ConclusionsHealth information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement.

Antecedents of use of e-health services in Central Eastern Europe: a qualitative comparative analysis

BackgroundThe objective of this paper is to identify the key conditions that positively affect the use of e-health services in Central Eastern Europe (CEE) countries. CEE countries after the political and economic transformation in 1989/90 implemented slightly different national health care models. The research question of the study is: how do the various institutional conditions at the national level affect the use of e-health services in CEE countries?MethodsThe e-health description was derived from papers indexed in Web of Science and Scopus. The data for computation were collected from the 2015 global survey by the WHO Global Observatory for eHealth. We used a narrative literature review in order to identify key terms associated to e-health and conditions for the implementation of e-health services. The search terms were “e-health” and “*” where * was particular thematic section of e-health according to WHO GOeH. The inclusion criterion was relevance of the paper to e-health and searched phase. Eligibility criteria for countries for being described as CEE countries: Estonia, Lithuania, Latvia, Poland, Hungary, Romania, Bulgaria, Czech Republic, Slovenia, and Croatia (we omitted Slovakia from the analysis because this country was not covered by the WHO Survey). We applied qualitative comparative analysis (QCA) to analyse the necessary order of conditions. The dependent variable of the study is the national rate of use of e-health services.ResultsQCA shows that legal medical jurisdiction, teleprogramme and electronic health records supplemented by adequate training constitute critical conditions to achieve success in e-health implementation.ConclusionsWe conclude that the more formalised a framework for e-health service delivery is, the more likely it will be used. Therefore formalisation fosters the diffusion, dissemination and implementation of e-health solutions in this area. Formalisation must be accompanied by tailored training for health care professionals and patients. Our analyses are related only to the paths of e-health implementation in CEE countries thus consequently the findings and conclusions cannot be directly applied to other countries. The limitations of this study are related the absence of a broader context of e-health development, including the development of ICT infrastructure and ICT literacy.

Factors influencing health managers’ acceptance of eHealth services in Saudi Arabia

Introduction: The World Health Organization (WHO) refers to the term of Electronic Health (eHealth) as “the use of Information and Communication Technology (ICT) for health”. In the Kingdom of Saudi Arabia (KSA) where difficult geographical terrain makes the delivery of healthcare services challenging, eHealth offers innovative solutions for improving the access and management of healthcare delivery. Health managers are professionals with responsibility for services, resources and partnership in healthcare including eHealth. They are drawn from a range of backgrounds, many are clinicians employed in health management roles. For the purpose of gaining a deeper and broader understanding of the questions under investigation, this doctoral study has been planned to be carried out in three sequential phases in which findings from each phase informs the next one. A systematic review (SR) of the status of eHealth in Saudi Arabia from the perspectives of multiple professionals was the first phase. It was conducted in 2017. Findings showed that despite the growth of eHealth services in KSA, research publications related to the end-users’ acceptance/intention to use services remains scarce. Thirty-nine influencing factors to the acceptance and use of eHealth services were identified and similarities and differences between these outcomes and what had been found from other studies such as were highlighted.

Encouraging the Use of eHealth Services: A Survey of Patients' Experiences.

To promote eHealth services effectively, it is important to understand what motivates people to use these services and how they can be further supported. Our aim was to explore user experiences with eHealth services from the viewpoint of patients with chronic illnesses. The survey data included responses from 397 patients actively using eHealth services in Finland. Most of them had positive experiences using the services. We found that these positive experiences and the perceived benefits of eHealth services encouraged patients to continue using the services. In order to bolster the use of eHealth services, patients and other potential users must be informed about the new services and how to access them. Healthcare personnel play a key role in introducing eHealth services to patients and instructing them on their use.

Immigrants’ Use of eHealth Services in the United States, National Health Interview Survey, 2011-2015

Little is known about the use of electronic health (eHealth) services supported by information technology in the United States among immigrants, a group that faces barriers in accessing care and, consequently, disparities in health outcomes. We examined differences in the use of eHealth services in the United States by immigration status in a nationally representative sample. We used data from the 2011-2015 National Health Interview Survey to assess use of eHealth services among US natives, naturalized citizens, and noncitizens. Our outcome variable of interest was respondent-reported use of eHealth services, defined as making medical appointments online, refilling prescriptions online, or communicating with health care professionals through email, during the past 12 months. We analyzed use of eHealth services, demographic characteristics, socioeconomic status, and health status among all 3 groups. We used multivariate logistic regression models to examine the association between immigration status and the likelihood of using eHealth services, adjusting for individual demographic, socioeconomic, and health characteristics. Among 126 893 US natives, 18 763 (16.1%) reported using any eHealth services in the past 12 months, compared with 1738 of 15 102 (13.0%) naturalized citizens and 1020 of 14 340 (7.8%) noncitizens. Adjusting for socioeconomic factors reduced initial gaps: naturalized citizens (adjusted odds ratio [aOR] = 0.81; 95% confidence interval [CI], 0.75-0.87) and noncitizens (aOR = 0.81; 95% CI, 0.72-0.90) had approximately 20% lower odds of using eHealth services than did US natives. However, the differences varied by type of eHealth service. Immigrants with higher English-language proficiency were more likely to use eHealth services than were immigrants with lower English-language proficiency. Targeted interventions that reduce socioeconomic barriers in accessing technology and promote multilingual electronic portals could help mitigate disparities in use of eHealth services.

The importance of ethical aspects when implementing eHealth services in healthcare: A discussion paper.

The aim of this paper was to discuss the importance of ethical aspects when implementing eHealth services in health care. Challenges in healthcare today include a growing older population and, as a consequence, an increased need for healthcare services. One possible solution is the use of eHealth services. Discussion paper. Research literature published from 2000-2017 in CINAHL, PubMed and Scopus. Implementing eHealth services in health care involves ethical challenges where different technologies can solve different problems in different ways. eHealth services should therefore be developed and implemented based on the patient's specific needs and conditions for use and in accordance with the healthcare professionals' presumption to provide high-quality care. To preserve patients' integrity, dignity and autonomy, healthcare professionals must include ethical aspects when implementing and using eHealth services in health care. Healthcare professionals have to take responsibility for the eHealth services introduced, explaining why and how they are implemented based on a person-centred approach. More knowledge is needed about ethical aspects when implementing eHealth services to improve the quality of care.

EHealth literacy, Internet and eHealth service usage: a survey among cancer patients and their relatives.

The aim of our study was to investigate Internet and eHealth usage, with respect to eHealth literacy, by cancer patients and their relatives. Using a standardized questionnaire we asked patients who attended lectures on complementary medicine in 2016. We received 142 questionnaires. The frequency of general Internet usage was directly associated with younger age and better Internet connection. Younger participants were not only more confident in allocating health-related Internet information into reliable or unreliable facts, but also more confident and capable of gaining medical knowledge through eHealth services. A regular use of eHealth services facilitated the decision-making process. Reading ability was associated with a better understanding regarding eHealth offers. In a modern health care system, emphasis should be on skills contributing to eHealth literacy among patients to improve their ability to profit from eHealth offers and improve health care.

P125 Use of digital sexual health services by under-16s and an evaluation of safeguarding procedures

IntroductionDigital health is an increasingly popular way for young people to access health services. There is paucity of research exploring the use of e-health services by under-16s. As an online doctor service offering sexual health services to adults, we reviewed under-16s trying to access services and evaluated safeguarding procedures.MethodsA retrospective audit of under-16s trying to access e-sexual health services between January-December 2015.Results66 patients were identified, 71.2% female, mostly distributed in urban areas (13-fold increase from 2008-2013).The most frequently accessed services were emergency contraception (27.3%) and routine contraception (43.9%). 22.7% (n15) entered an incorrect date-of-birth. Along with answering a questionnaire online, of the remaining patients, 52.9% (n27) completed a safeguarding assessment with a doctor via telephone, 5.9% (n3) via online messaging, both guided by ‘Spotting- the-Signs’, 41.2% (n21) did not respond to requests for further information and could not be contacted. Safeguarding concerns were identified in 37.3% (n19) and referred to social services. All were directed to appropriate face-to-face services and advised GP follow-up.DiscussionOur data shows increasing access by under-16s to esexual health services. A significant proportion were identified as being at-risk of sexual exploitation. A telephone safeguarding assessment together with our online evaluation was effective for identifying safeguarding concerns. Alongside IT systems to prevent those trying to bypass checks online, many of our services (including contraception and emergency contraception) require attendance to pharmacy. This provides an additional opportunity to verify identity and screen for safeguarding concerns supporting the ongoing safety of young people.

Older People Using e-Health Services—Exploring Frequency of Use and Associations with Perceived Benefits for Spouse Caregivers

ICT, information- and communication technologies, and e-health services are essential for meeting future care demands. Greater knowledge regarding the implementation of e-health services in long-term care for older people is needed. The purpose of the study was to explore older people’s use of e-health services and associations between frequency of use and perceived benefits. In the longitudinal comparative intervention study (n = 65), intervention group participants (n = 42) used an e-health service for 1.5 years. A control group (n = 23) used similar services provided in a traditional manner. Data was collected through questionnaires and analyzed using linear and logistic regressions. Although general use of the Internet was similar in both groups, the e-health group perceived significantly higher benefits. The component information- and education programs, developed specifically for the e-health service, had the highest association with benefits. Conclusion: e-health services targeted at supporting older people who care for a spouse at home can provide benefits which most likely will not be obtained without participation in an organized e-service. Care professionals play an essential role in encouraging spouse caregivers to become e-service users.

Investigating factors influencing the adoption of e-Health in developing countries: A patient’s perspective

ABSTRACTPurpose: The aim of the study was to investigate factors that influence the adoption and use of e-Health applications in Bangladesh from citizens’ (patients’) perspectives by extending the technology acceptance model (TAM) to include privacy and trust. Methods: A structured questionnaire survey was used to collect data from more than 350 participants in various private and public hospitals in Dhaka, the capital city of Bangladesh. The data were analyzed using the partial least-squares (PLS) method, a statistical analysis technique based on structural equation modeling (SEM). Results: The study determined that perceived ease of use and perceived usefulness and trust (p < 0.05) were significant factors influencing the intention to adopt e-Health. Privacy (p > 0.05) was identified as a less significant factor in the context of e-Health in Bangladesh. The findings also revealed that gender was strongly associated with the adoption and use of e-Health services. Conclusions: The findings of the present study contribute to the development of strategies and policies to enhance e-Health services in Bangladesh. Furthermore, as a result of the generic approach used in this study, the acceptance model developed can be easily modified to investigate the adoption of e-Health in other developing countries.

Managing Everyday Life: A Qualitative Study of Patients' Experiences of a Web-Based Ulcer Record for Home-Based Treatment.

Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited research on patients’ use of e-health services for home-based ulcer treatment. This article reports an exploratory qualitative study of the first Norwegian web-based counselling service for home-based ulcer treatment, established in 2011 by the University Hospital of North Norway (UNN). Community nurses, general practitioners (GPs) and patients are offered access to a web-based record system to optimize ulcer care. The web-based ulcer record enables the exchange and storage of digital photos and clinical information, by the use of which, an ulcer team at UNN, consisting of specialized nurses and dermatologists, is accessible within 24 h. This article explores patients’ experiences of using the web-based record for their home-based ulcer treatment without assistance from community nurses. Semi-structured interviews were conducted with a total of four patients who had used the record. The main outcomes identified were: autonomy and flexibility; safety and trust; involvement and control; and motivation and hope. These aspects improved the patients’ everyday life during long-term ulcer care and can be understood as stimulating patient empowerment.

Technology and its ethics in nursing and caring journals: An integrative literature review.

Over the past 20 years, the impact of technology has increased significantly in health care. The diversity of technology is growing and its knowledge scattered. The concept of technology is ambiguous in caring and nursing sciences and its ethics remains unidentified. To find evidence on how the concept of technology and its ethics are defined in caring and nursing sciences and practice. The purpose of this study is to describe and summarize the concept of technology and its ethics in the past nursing and caring literature. The integrative literature review of the past nursing and caring literature. The data were collected from caring and nursing journal articles from 2000 to 2013 focusing on technology and its ethics.The results were summarized and themed. Technology as a concept has three implications. First, technology is devices and products, including ICT and advanced, simple and assistive technology. Second, technology refers to a process consisting of methods for helping people. Third, technology as a service indicates the production of care by technology. The ethics of technology has not been established as a guiding principle. Some studies excluded ethical reflection completely. Many studies discussed the ethics of technology as benefits such as improved communication and symptoms management, and the simple use of e-health services whilst others remained critical presenting ethical problems such as unwillingness and the inability to use technology, or conflicts with human aspects or questions of inequality. In conclusion, this study indicates that technology as a concept is described diversely. The relation between technology and ethics is not a truism. Despite some evidence, more is needed to promote ethical care when using technology.

Trends in U.S. Consumers’ Use of E-Health Services: Fine-Grained Results from a Longitudinal, Demographic Survey

Although growth in U.S. consumers’ overall use of e-health is strong, it is being driven by only a portion of the e-health services that are offered through online health portals. Fine-grained, longitudinal analysis of three representative e-health services shows that, while online communication with medical personnel has grown consistently between 2003 and 2012, the purchase of health supplies online plateaued by 2007, and participation in online support groups has been flat since 2003. Socio-economic factors of income and education level continue to have an impact on consumers’ use of e-health; however, differences based on age, sex, and race/ethnicity are trending lower during this period. The findings caution against the common practice of studying e-health adoption principally at the level of online health portals, which can mask substantial variation in adoption trends among the underlying e-health services, and suggest that it is important to update trend studies on a regular basis to maintain currency.

Using a screening tool to evaluate potential use of e-health services for older people with and without cognitive impairment

Objectives: E-health services are increasingly offered to provide clients with information and a link to healthcare services. The aim of this study is to investigate the perceived access to and the potential to use technologies important for e-health services among older adults with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD) and controls.Method: The perceived access to and perception of difficulty in the use of everyday technology (such as cell phones, coffee machines, computers) was investigated in a sample of older adults (n = 118) comprising three subsamples: adults with MCI (n = 37), with mild AD (n = 37), and controls (n = 44) using the Everyday Technology Use Questionnaire (ETUQ). The use of seven technologies important for e-health services was specifically examined for each subsample and compared between the subsamples.Results: The findings demonstrated that the older adults in all subsamples perceive access to e-health technologies and potentially would use them competently in several e-health services. However, among persons with AD a lower proportion of perceived access to the technology was described, as well as for persons with MCI.Conclusion: To make the benefits of e-health services available and used by all clients, it is important to consider access to the technology required in e-health services and also to support the clients’ capabilities to understand and use the technologies. Also, the potential use of the ETUQ to explore the perceived access to and competence in using e-health technologies is a vital issue in the use of e-health services.