Patients' compliance behavior in a personalized mobile patient education system (PMPES) setting: Rational, social, or personal choices?

OBJECTIVE: With the advancement of mobile technologies, patients can access medical and patient educational information anytime and anywhere. Computer-aided patient education has been advocated as a key means of interventions for improving patient knowledge and compliance (i.e., adherence). However, evidence of the efficacy of computer-aided patient education remains relatively limited. For example, little is known about how the latest mobile technologies influence patients' compliance intention and their actual compliance behavior. The objective of this study is to investigate patients' compliance intention and behavior using a personalized mobile patient education system (PMPES) as a novel technological intervention for patients based on rational choice theory (RCT) and the theory of planned behavior (TPB). MATERIALS AND METHODS: We conducted a field survey with 125 actual patients in U.S. who obtained their patient education through PMPES while seeking medical treatment advice from their doctors. We used partial least squares (PLS) regression path modeling to test our model. RESULTS: We found that, based on RCT, the benefits of compliance and cost/threat of noncompliance positively influenced intention toward treatment compliance; in contrast, costs of compliance negatively influenced intention toward treatment compliance. However, the benefits of noncompliance had no effect on intention toward treatment compliance. The results also indicated that intention toward treatment compliance, response efficacy, and self-efficacy related to TPB jointly influenced the degree of actual compliance behaviors. Social influence factors including subjective norms and descriptive norms had no influence on patients' actual treatment compliance behavior. CONCLUSION: Overall, the research model explains 69.2 % of the variance in patients' actual compliance behavior. We find our model robust in using RCT as a key theoretical lens for the assessment of patients' compliance intention to follow medical recommendations enabled by the PMPES and delivered to mobile devices. The factors associated with RCT and TPB jointly influence patients' actual compliance behavior. Future mobile patient education programs should consider patients' age groups, mixed-gender groups, different medical settings, and cross-cultural contexts.

Electronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements.

OBJECTIVE: Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS: University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS: We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION: While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION: This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.

Older Adults' Live Demonstration of Electronic Personal Health Record Use: Factors Mediating Initial Proficiency.

Adoption of electronic personal health records by older adults offers multiple advantages to healthcare and is being encouraged by federal agencies and health associations. However, obstacles have limited older adults' rates of adoption to approximately 10%. This study examined the initial proficiency of older adults at entering 21 standard health elements into an electronic personal health record. Entry completeness, accuracy, elapsed time, and help requests were measured. A combination of standard technology adoption model and older adult characteristics accounted for 52% of variability in proficiency at entering electronic personal health record data. Automatic linear modeling identified three variables as primarily related to proficiency with electronic personal health record use: age, computer competency, and mental status. Interventions to increase electronic personal health record adoption and proficiency of use will require the consideration of variables specific to older adults, and may best focus on younger seniors with good mental status and computer competency. Efforts for older seniors with decreased mental status might better center on delegation to a primary caregiver.