RESUMO
BACKGROUND: COVID-19 has had a significant impact on the public's health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public's well-being; however, the public's safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public's well-being. OBJECTIVE: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. METHODS: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. RESULTS: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public's health and safety was indicated by 78% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87% (20/23) of participants. Our qualitative results further showed details of the public's health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. CONCLUSIONS: Despite the critique of Sweden's lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public's safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public's safety, supporting the public's well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted.
RESUMO
BACKGROUND: Third-party cloud-based data analysis applications are proliferating in electronic health (eHealth) because of the expertise offered and their monetary advantage. However, privacy and security are critical concerns when handling sensitive medical data in the cloud. Technical advances based on "crypto magic" in privacy-preserving machine learning (ML) enable data analysis in encrypted form for maintaining confidentiality. Such privacy-enhancing technologies (PETs) could be counterintuitive to relevant stakeholders in eHealth, which could in turn hinder adoption; thus, more attention is needed on human factors for establishing trust and transparency. OBJECTIVE: The aim of this study was to analyze eHealth expert stakeholders' perspectives and the perceived tradeoffs in regard to data analysis on encrypted medical data in the cloud, and to derive user requirements for development of a privacy-preserving data analysis tool. METHODS: We used semistructured interviews and report on 14 interviews with individuals having medical, technical, or research expertise in eHealth. We used thematic analysis for analyzing interview data. In addition, we conducted a workshop for eliciting requirements. RESULTS: Our results show differences in the understanding of and in trusting the technology; caution is advised by technical experts, whereas patient safety assurances are required by medical experts. Themes were identified with general perspectives on data privacy and practices (eg, acceptance of using external services), as well as themes highlighting specific perspectives (eg, data protection drawbacks and concerns of the data analysis on encrypted data). The latter themes result in requiring assurances and conformance testing for trusting tools such as the proposed ML-based tool. Communicating privacy, and utility benefits and tradeoffs with stakeholders is essential for trust. Furthermore, stakeholders and their organizations share accountability of patient data. Finally, stakeholders stressed the importance of informing patients about the privacy of their data. CONCLUSIONS: Understanding the benefits and risks of using eHealth PETs is crucial, and collaboration among diverse stakeholders is essential. Assurances of the tool's privacy, accuracy, and patient safety should be in place for establishing trust of ML-based PETs, especially if used in the cloud.
RESUMO
BACKGROUND: Patients' privacy is regarded as essential for the patient-doctor relationship. One example of a privacy-enhancing technology for user-controlled data minimization on content level is a redactable signature. It enables users to redact personal information from signed documents while preserving the validity of the signature, and thus the authenticity of the document. In this study, we present end users' evaluations of a Cloud-based selective authentic electronic health record (EHR) exchange service (SAE-service) in an electronic health use case. In the use case scenario, patients were given control to redact specified information fields in their EHR, which were signed by their doctors with a redactable signature and transferred to them into a Cloud platform. They can then selectively disclose the remaining information in the EHR, which still bears the valid digital signature, to third parties of their choice. OBJECTIVE: This study aimed to explore the perceptions, attitudes, and mental models concerning the SAE-service of 2 user roles: signers (medical professionals) and redactors (patients with different technical knowledge) in Germany and Sweden. Another objective was to elicit usability requirements for this service based on the analysis of our investigation. METHODS: We chose empirical qualitative methods to address our research objective. Designs of mock-ups for the service were used as part of our user-centered design approach in our studies with test participants from Germany and Sweden. A total of 13 individual walk-throughs or interviews were conducted with medical staff to investigate the EHR signers' perspectives. Moreover, 5 group walk-throughs in focus groups sessions with (N=32) prospective patients with different technical knowledge to investigate redactor's perspective of EHR data redaction control were used. RESULTS: We found that our study participants had correct mental models with regard to the redaction process. Users with some technical models lacked trust in the validity of the doctor's signature on the redacted documents. Main results to be considered are the requirements concerning the accountability of the patients' redactions and the design of redaction templates for guidance and control. CONCLUSIONS: For the SAE-service to be means for enhancing patient control and privacy, the diverse usability and trust factors of different user groups should be considered.
