A Mixed-Methods Study of Users' Journey Mapping Experience and Acceptance of Telehealthcare Technology in Taiwan.

Background: The integration of telehealthcare technologies into geriatric care has clear advantages, but poses challenges for key stakeholders, including the telehealthcare service industry, smart device developers, marketers and, of course, users. The purpose of this study was to gain insight into user experience and acceptance of telehealthcare technology in Taiwan. Materials and Methods: Taking an integrated mixed-methods approach, 51 participants-33 women (64.71%) and 18 men (35.29%) (mean age: 52.1 years)-were examined before, during, and after using a telehealthcare device. A questionnaire was used to assess users' acceptance of the technology. Interviews were conducted to gather feedback. Results: The quantitative analysis revealed that (1) effort expectancy and relatives significantly influenced users' behavior intentions, (2) error and memorability significantly affected users' satisfaction, and (3) intention and satisfaction significantly affected users' behavior. The qualitative analysis revealed two key implications. First, participants generally were not satisfied with the telehealthcare device. Second, participants suggested the redesign of the telehealthcare device to reduce operating errors and time consumption to meet users' needs. Conclusions: Contemporary telehealthcare devices do not meet users' needs. Participants were made to adapt to the equipment rather than the equipment tailored to meet their needs. Although there were key benefits from home telehealthcare, the systems require enhanced technology, improved usability, and an expanded scale of services backed by government before widespread implementation can successfully proceed.

From ships to robots: The social relations of sensing the world ocean.

The dominant practices of physical oceanography have recently shifted from being based on ship-based ocean sampling and sensing to being based on remote and robotic sensing using satellites, drifting floats and remotely operated and autonomous underwater vehicles. What are the implications of this change for the social relations of oceanographic science? This paper contributes to efforts to address this question, pursuing a situated view of ocean sensing technologies so as to contextualize and analyze new representations of the sea, and interactions between individual scientists, technologies and the ocean. By taking a broad view on oceanography through a 50-year shift from ship-based to remote and robotic sensing, I show the ways in which new technologies may provide an opportunity to fight what Oreskes has called 'ideologies of scientific heroism'. In particular, new sensing relations may emphasize the contributions of women and scientists from less well-funded institutions, as well as the ways in which oceanographic knowledge is always partial and dependent on interactions between nonhuman animals, technologies, and different humans. Thus, I argue that remote and robotic sensing technologies do not simply create more abstracted relations between scientists and the sea, but also may provide opportunities for more equitable scientific practice and refigured sensing relations.

Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up.

BACKGROUND: Health-related quality of life (HRQoL) improves shortly after pacemaker (PM) implantation. No studies have investigated the HRQoL trend for elderly patients with a remote device monitoring follow-up system. METHODS: Using EuroQol-5D Questionnaire and the PM-specific Assessment of Quality of Life and Related Events Questionnaire, HRQoL was measured at baseline and then repeatedly during the 6 months following PM implantation in a cohort of 42 consecutive patients. Twenty-five patients were followed-up with standard outpatient visits, while 17 used a remote monitoring system. RESULTS: Aquarel scores were significantly higher in patients with remote device monitoring system regarding chest discomfort and arrhythmia subscales the first month after PM implant and remained stable until 6 months. Remote monitoring affected the rate of HRQoL improvement in the first 3 months after pacemaker implantation more than ambulatory follow-up. CONCLUSIONS: Remote device monitoring has a significant impact on HRQoL in pacemaker patients, increasing its levels up to 6 months after implant.

Predicting adherence to use of remote health monitoring systems in a cohort of patients with chronic heart failure.

BACKGROUND: It is unclear whether subgroups of patients may benefit from remote monitoring systems (RMS) and what user characteristics and contextual factors determine effective use of RMS in patients with heart failure (HF). OBJECTIVE: The study was conducted to determine whether certain user characteristics (i.e. personal and clinical variables) predict use of RMS using advanced machine learning software algorithms in patients with HF. METHODS: This pilot study was a single-arm experimental study with a pre- (baseline) and post- (3 months) design; data from the baseline measures were used for the current data analyses. Sixteen patients provided consent; only 7 patients (mean age 65.8 ± 6.1, range 58-83) accessed the RMS and transmitted daily data (e.g. weight, blood pressure) as instructed during the 12 week study duration. RESULTS: Baseline demographic and clinical characteristics of users and non-users were comparable for a majority of factors. However, users were more likely to have no HF specialty based care or an automatic internal cardioverter defibrillator. The precision accuracy of decision tree, multilayer perceptron (MLP) and k-Nearest Neighbor (k-NN) classifiers for predicting access to RMS was 87.5%, 90.3%, and 94.5% respectively. CONCLUSION: Our preliminary data show that a small set of baseline attributes is sufficient to predict subgroups of patients who had a higher likelihood of using RMS. While our findings shed light on potential end-users more likely to benefit from RMS-based interventions, additional research in a larger sample is warranted to explicate the impact of user characteristics on actual use of these technologies.

Examining Korean and Korean American older adults' perceived acceptability of home-based monitoring technologies in the context of culture.

OBJECTIVE: Despite the increasing use of home-based monitoring technologies by older adults, few studies have examined older adults' acceptance of these technologies, especially among people from diverse cultural groups. The purpose of this study was to explore Korean and Korean American older adults' attitudes toward and perceptions of home-based monitoring technologies in a cultural context. METHODS: A qualitative analysis of focus groups and individual interviews using inductive coding methods and a constant comparative approach for emerging themes was conducted. RESULTS: Several cultural factors that determine the acceptability of home-based monitoring technologies were identified. Most notably, the necessity of living alone due to loosened filial tradition and immigration was a main motivator for adopting these technologies for both Korean and Korean Americans. The level of satisfaction with the health care system or therapeutic interaction affected participants' perceived need for technologies. Compared with the Korean American group, Korean older adults regarded the government's role as more important in increasing adoption and use of new technologies. CONCLUSIONS: Contextual factors need to be considered when explaining perceptions of home-based monitoring technologies among older adults from various ethnic groups and developing diffusion strategies according to end users' attitudes, experiences, and cultural backgrounds.

How older adults make decisions regarding smart technology: an ethnographic approach.

Comparatively little research has been conducted regarding the smart technology needs of the older adult population despite the proliferation of smart technology prototypes. The purpose of this study was to explore the perceived smart technology needs of older adults with mobility impairments while using an ethnographic research approach to construct a preliminary decision tree model of how these smart technology decisions are made. In-depth individual interviews with 11 older adults aged 65 and older with mobility impairments provided insight into how older adults perceived smart technology. Audio-taped interviews were transcribed verbatim, then analyzed for key phrases that represented participant decision criteria. Decision criteria concepts were combined to construct an older adult smart technology decision tree model. The model consisted of a preliminary decision stage that participants engaged in to make the decision of whether a change was needed in their current pattern of behavior; followed by an evaluation stage that included five potential barriers (i.e., not easy to use/learn) and seven potential facilitators (i.e., decreasing imposition on family/friends) to the smart technology need decision process. Future designers could use this decision model to create appropriately matched technological devices to promote independence of aging baby boomers with mobility impairments.

[Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease]. / Akzeptanz einer telemedizinischen Intervention bei Patienten mit chronisch-obstruktiver Lungenerkrankung.

OBJECTIVE: The aim of this trial was to assess the acceptance of a telemonitoring device (Health Buddy®) by patients with chronic obstructive pulmonary disease (COPD). The device makes it possible to monitor vital parameters and to ask questions about symptoms, behavior and disease-specific knowledge. METHOD: A single-arm non-randomized clinical study was performed for three months in 43 patients with severe/very severe COPD. The primary intent was to determine the patients' compliance with the device. In addition the patients were questioned about their general acceptance of the telemonitoring intervention, their quality of life and the overall use of resources. RESULTS: 36 patients (25 men, 11 women, mean age 67,9 ± 6,9; range 54 - 81 years) completed the protocol. All 43 patients were using the device (Health Buddy®) on two thirds of all possible working days (this had been predefined as full compliance). Especially the questions on technical functioning of the device, trust in the technique and data security, as well as the confidentiality of communication with the physician via telemedicine were very positively answered. Health-related quality of life did not change and no rise of autonomy was noted. However, the objective of early detecting of acute exacerbations by daily measurements of vital parameters and assessment of symptoms was difficult to achieve because of inadequate definition of the parameters. CONCLUSION: This cohort of patients with advanced COPD was highly compliant in the use of the telemonitoring device. But clinical efficacy and economic effectiveness remain to be investigated.

Patient perceptions of remote monitoring for nocturnal home hemodialysis.

Adoption of nocturnal home hemodialysis (NHHD) has been slow, due in part to patient-perceived barriers, such as anxiety and lack of self-efficacy. This study investigates patient perception of remote monitoring in addressing these barriers. Perceptions of remote patient monitoring (RPM) were studied through a quantitative survey and qualitative interviews. The NHHD and conventional hemodialysis (CHD) were included in the survey (209 in total). Twenty semistructured interviews were conducted as well as a focus group that included NHHD patients and family caregivers. The CHD patients had greater interest in adopting NHHD with RPM than without (1.90±1.37 vs. 1.71±1.28, P<0.002), with the negative intensity ratio declining from 10.50 to 5.56. Interest in RPM was correlated with interest in NHHD (r=0.768, P<0.001). Other significant factors correlated with interest in NHHD include the belief that remote monitoring will ease the performing of NHHD (r=0.452, P=0.001) and the belief that RPM should be mandatory (r=0.541, P=0.000). Qualitative findings supported three themes: (1) There is an expectation for the use of RPM, (2) RPM should be used at a minimum transitionally, and (3) RPM acts as a surrogate support of family-caregivers. The RPM may lower perceived barriers to the adoption of NHHD, in part through its surrogate support of family caregivers. However, RPM alone is likely insufficient to alter patients' attitudes to undergo NHHD. RPM is a common expectation of CHD patients considering the therapy, at a minimum during the transitional phase.