Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study.

BACKGROUND: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. OBJECTIVE: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. METHODS: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. RESULTS: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients' internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system's barriers were largely privacy, confidentiality, and legal review concerns. CONCLUSIONS: These findings echo similar studies in other health systems, surrounding providers' lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients' internet access to fully use mHealth in their delivery of care.

Needs assessment survey for enhancing United States child agricultural injury prevention capacity: Brief report.

The dissemination of childhood agricultural safety and health information and resources through organizations that farmers trust enhances implementation and the Socio-Ecological Model can help identify these organizations. However, to become effective partners in improving agricultural health and safety, organizations need to build capacity in child agricultural safety and health, thus, more information is needed about these organizations' current practices, needs, and capacity for leadership, policy makers, and knowledge mobilization. An online survey was administered to organization leaders with an interest in child agricultural injury prevention, chosen through agricultural health and safety organization membership lists. Invitations to participate in the online survey were mailed to 95 organization leaders with three weekly reminders, resulting in participation from 50 organization leaders (53% response rate). Respondents indicated a high level of awareness of child agricultural injuries, yet few were actively engaged in injury prevention. When asked about "needs" for building capacity in injury prevention, over half (56%) identified a need for more promotion and dissemination of safety resources and strategies, including ATV safety, no extra riders on equipment, and keeping young children out of the worksite. The only topic that more than half of the organizations (54%) identified as "needing more information" was childhood agricultural injury surveillance. This assessment yielded valuable details for identifying opportunities, priorities, and topics for future collaborations and capacity building. Findings help inform national and international planning committees' work, such as the next iteration of a US National Action Plan for Childhood Agricultural Injury Prevention, scheduled for release in 2024.

Agricultural youth injuries: An updated review of cases from U.S. news media reports, 2016-2021.

Introduction: Fatal and non-fatal youth (ages 0-17) injuries in U.S. agriculture continue to be a significant public health concern. Despite sustained work and attention from federally supported research programming, we continue to observe an unacceptably high number of life-altering and life-ending traumatic injuries to youth in agricultural environments. Likewise, there is still a gap in stringent systematic agricultural injury and/or illness surveillance at the federal level. This paper will provide an updated review of child agricultural injuries from U.S. news media reports, expanding upon this author team's initial 2018 report. Methods: Data collection from 2016 to 2021 occurred as part of the AgInjuryNews initiative, and data were coded according to the Farm and Agricultural Injury Classification (FAIC) system and the Occupational Injury and Illness Classification System (OIICS). The AgInjuryNews system primarily contains news media reports. Categorical variables were analyzed and compared using a chi-square test. In addition, the Jonckheere-Terpstra test for trend was used to test the yearly change in the number of youth injuries. Results: We observed a general decrease in agricultural injuries compared to the original 2015-2017 dataset. Younger children (<5 years-old) and males were more often injured and more fatally injured than older children and females, respectively. Males and older victims were more likely to suffer an occupational-related injury compared to females and younger victims, respectively. Vehicles remained a major source of injuries, with tractors comprising 28%, and ATVs/UTVs comprising 26% of all injuries. Roadway incidents involving tractors and UTVs were less often fatal compared to non-roadway incidents, while ATVs were more fatal on roadways. Discussion: This updated review shows childhood agricultural injuries and fatalities continue to be a major public health concern within the US. It is unclear if the trend downward in injuries is due to reporting, data capture methods, or a true decrease in injuries. These data continue to be of interest to stakeholders in academia, public health, government, and private industry-user groups who regularly and consistently seek this type of information, often from multiple data sources, including as registered users on AgInjuryNews.org. These data identify emerging issues within the industry and further inform national and international planning committees' work.

What about the Rest of Them? Fatal Injuries Related to Production Agriculture Not Captured by the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI).

Surveillance of injuries in production agriculture is necessary to inform stakeholders about workplace hazards and risks in order to improve and advance injury prevention policies and practices for this dangerous industry. The most comprehensive fatal injury surveillance effort currently in the United States is the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), which covers occupational fatalities in all U.S. industries, including production agriculture. However, this surveillance does not include many categories of fatalities that occur during agricultural work or on production agriculture worksites. To better capture the human cost of production agriculture, the authors of this paper call for the collection of additional data with a broader scope that supplements, not replaces, the current CFOI. This paper describes challenges in surveillance, highlights key procedural gaps, and offers recommendations for advancing national surveillance of fatal traumatic injuries associated with production agriculture.

Rural Telehealth Use during the COVID-19 Pandemic: How Long-term Infrastructure Commitment May Support Rural Health Care Systems Resilience.

Amid concerns of inadequate medical supplies and staffing anticipated from a surge in COVID-19 cases, many health care systems across the United States (U.S.) began shutting down non-essential patient services in March 2020. These sudden shifts bring up questions about the long-term effects of COVID-19 on already fragile rural health care systems and the ability of rural populations, including farmers and farm workers, to meet their health care needs. To provide alternative and safe access to health care, the Federal government relaxed telehealth regulations, which effectively removed some of the largest regulatory barriers that had limited the adoption of telehealth in the U.S. In this commentary, we draw on the example of the Marshfield Clinic Health System (MCHS), a large rural health care system in Wisconsin and provide an early assessment of how it adjusted its telehealth services during the early months of COVID-19. While the long-term effects of the pandemic on rural health care systems will not be known for some time, the example of MCHS points to the importance of on-going and sustained investments to support the resilience of health care systems and their ability to weather crises. With early evidence that MCHS patients and practitioners are interested in continuing to use telehealth post-COVID-19, we conclude our commentary by offering three recommendations to remove hurdles and improve quality of telehealth care.

Finding the Edges of Problems: Social Media as an Exploratory Research Tool.

Social media use in public health and other health related research applications has seen a rapid increase in recent years. However, there has been very limited utilization of this growing digital sector in agricultural injury research. Social media offers immense potential in gathering informal data, both text and images, converting them into knowledge, which can open up avenues for research, policy, and practice. There are a number of ways social media data can be utilized in agricultural injury research. This paper touches on the adoption of these data sources in health research and discusses the use of social media as an exploratory research tool that can peer into and identify the edges of potential health and safety problems.