Bakgrund   Utvecklingen av den digitala tekniken i samhället har bidragit till en alltmer digitaliserad hälso- och sjukvård. I takt med digitaliseringen har hjälpmedel så som mobila applikationer utvecklats. Ett område där mobila applikationer har ökat är inom diabetesvården. Diabetes ökar i snabb takt i världen och mobila applikationer kan ses som ett hjälpmedel i patientens egenvård. En av sjuksköterskans kärnkompetenser är informatik och innebär bland annat att sjuksköterskan skall stärka patienter i sin egenvård med hjälp av digitala verktyg.  Syfte  Syftet var att beskriva patienter med diabetes och deras upplevelser och erfarenheter av att använda mobila diabetesapplikationer.     Metod En litteraturöversikt genomfördes och databassökningar utfördes i PubMed och CINAHL. Femton vetenskapliga artiklar, publicerade de senaste fem åren, av kvalitativ och kvantitativ design inkluderades. Vidare kvalitetsgranskades artiklarna enligt Sophiahemmet högskolas bedömningsunderlag och analyserades i tre steg som resulterade i en beskrivande sammanställning innehållande teman och subteman. Resultat  Resultatet sammanställdes i tre övergripande teman som undersökt patienter med diabetes och deras upplevelser och erfarenheter av att använda mobila applikationer: betydelsen av användarvänlighet, behov av stöd samt personliga egenskapers inverkan på upplevelsen.Teknologi, design, tidsåtgång och mätning av hälsodata var viktiga faktorer relaterat till applikationernas användarvänlighet. Kommunikation med vården, utbildning och motivation var andra faktorer som påverkade deltagarnas upplevelse. Resultatet tog även upp upplevda hinder hos användarna.   Slutsats Majoriteten av patienter med diabetes var positiva till att använda mobila applikationer som hjälpmedel i sin egenvård. Det fanns skillnader i patienternas upplevelser och erfarenheter av att använda applikationer. Skillnader kan härledas till patientens egenförmåga, personliga faktorer och tillgången till adekvat stöd. Vidare var användarvänligheten och tekniken avgörande faktorer för om mobila applikationer upplevdes värda att använda. För att erhålla mer evidensbaserad kunskap om patienters upplevelser av att använda mobila applikationer i egenvården bör fler longitudinella studier där patienter använt en och samma applikation under längre tid studeras. / Background  The development of technology has led to an increasingly digitalised healthcare system. Over this period of technological advancement, mobile applications were developed. In the treatment of diabetes care, the use of mobile applications has seen significant growth. The prevalence of diabetes has increased and mobile applications can be used as a tool for patients to administer self-care. A core competency of a nurse is informatics and, within this field, a nurse should direct and assist the patient in the use of digital tools to aid in the patients ability to administer self-care.    Aim  The objective was to describe the experience of patients with diabetes when using diabetes related mobile applications   Method  A literature review was conducted and database searches were performed in PubMed and CINAHL. Fifteen scientific articles, published in the last five years, of qualitative and quantitative design were included. Furthermore, the articles were quality-reviewed according to Sophiahemmet University's assessment data and analyzed in three steps, which resulted in a descriptive compilation containing themes and sub-themes.  Results  The results were compiled into three overarching themes that examined patients with diabetes and their experiences of using mobile applications: the importance of user-friendliness,the need for supportand the impact of personal characteristics on the experience.Technology, design, time consumption and measurement of health data were important factors related to the user-friendliness of the applications. Communication with health-care providers, education and motivation were other factors that influenced the participants' experience. The result also addressed perceived barriers among users.  Conclusions  The majority of patients with diabetes were positive about using mobile applications as aids in their self-care. There were differences in patients' experiences when using applications. Differences can be attributed to the patient's self-esteem, personal factors, and the availability of adequate support. Furthermore, the user-friendliness and technology were decisive factors for whether mobile applications were perceived as worth using. In order to obtain more evidence-based knowledge about patients' experiences of using mobile applications in self-care, more longitudinal studies where patients have used one and the same application for a longer period of time should be studied.

Bakgrund: Den ökade medellivslängden leder till att fler äldre individer söker vård relaterat till geriatriska sjukdomar. Det moderna samhällets digitalisering har implementerats inom vården och anses skapa ökad tillgänglighet och delaktighet för patienter. För att säkerställa en jämlik vård som är tillgänglig för alla, är det viktigt att undersöka äldre patienters upplevelser av digital rådgivning inom primärvården. På så sätt kan e-hälsa utformas utifrån individens behov och en mer personcentrerad vård kan bidra till ökad användning av e-hälsa och bättre hälsa för individen. Syfte: Att belysa äldre patienters upplevelser av digital rådgivning inom primärvården. Metod: En litteraturstudie bestående av 12 vetenskapliga artiklar med kvalitativ ansats där datan analyserades genom kvalitativ innehållsanalys. Resultat: Tre kategorier och sju underkategorier identifierades. Kategorierna var: Blandade känslor kring vårdens digitalisering, Utmaningar med digitala verktyg och Tryggheten med fysiska möten. Underkategorierna var: Telefonrådgivning, Tillgänglighet, Integritetsintrång, Svårigheter kring användningen, Behov av hjälp, Hjälpverktyg och layout och Relationen mellan patient och vårdpersonal. Konklusion: Äldre patienter upplevde blandade känslor kring vårdens digitalisering. Det förekom varierande svårigheter och utmaningar. Dessutom fanns det en preferens för det fysiska vårdmötet framför ett digitalt. Slutligen fanns det ett ökat behov av kunskap och information om e-hälsa och dess fördelar, för att underlätta användningen för den äldre. / Background: The increased life expectancy leads to more elderly individuals seeking care related to geriatric diseases. The digitalization of modern society has been implemented in healthcare and is considered to create increased accessibility and participation for patients. To ensure equal care that is accessible to all, it is important to investigate elderly patients´ experiences of digital counseling in primary health care. In this way, eHealth can be designed based on the individual's needs and a more person-centred care can contribute to increased use of e-health and better health for the individual. Aim: To highlight elderly patients' experiences of digital counseling in primary health care. Method: A literature review consisting of 12 scientific articles with a qualitative approach where the data was analyzed through qualitative content analysis. Results: Three categories and seven subcategories were identified. The categories were: Mixed feelings about the digitalization of healthcare, Challenges with digital tools and The security of physical meetings. The subcategories were: Telephone counseling, Accessibility, Invasion of privacy, Difficulties with use, Need for help, Assistance tools and layout and The relationship between patient and healthcare professional. Conclusion: Elderly patients’ experienced mixed feelings about the digitalization of healthcare. There were varying degrees of difficulty and challenge. In addition, there was a preference for the physical care meeting over a digital one. Finally, there was an increased need for knowledge and information about eHealth and its benefits, in order to facilitate its use for the elderly.

It is widely believed that eHealth will play a vital role in the development and shaping of healthcare systems in the twenty first century. However, despite all documented reports and benefits of eHealth technologies, many attempts to extend successful pilot projects have not sufficiently met promised results and to a large extent failed. The purpose of this study is to investigate the Centre for Rheumatology’s current implementation process of eHealth services in order to identify success factors and improvement areas. To reach the purpose, the research was delimitated to solely focus on the eHealth service Patient Self-Test and the implementation of it at the care unit.The research was conducted as a case study with a qualitative approach based on the notion of induction. The research process consisted of three major areas: pre-study, literature review and qualitative interviews. The pre-study was based on interviews with different actors within the health care industry in Sweden to provide an academic, political and business perspective of the research area. The literature review focused on the areas eHealth and change management and empirical data was gathered through qualitative interviews. Moreover, to have a tool for analysis, a research framework named 4 Seasons Model was developed.The results of the thesis indicate on a gap between how the literature advocates the implementation of transitional changes, and how it is currently done at Centre for Rheumatology’s. Based on an analysis from a 4 Seasons Model perspective, three success factors and seven improvement areas have been identified in Centre for Rhematology’s current implementation process of the Patient Self-Test.

Finding health information online continues to help patients understand new symptoms. However, incomplete information or advice that errs on the site of caution can cause distress or anxiety and prompt visits to a doctor. Cyberchondria, a new phenomenon, is defined as excessive compulsive searching for health information online that leads to distress and increase utilization of healthcare services. Grounded theory guided the conception of a mixed method study to investigate cyberchondria and symptom appraisal within Emergency Departments. A questionnaire and interviews were used to collect data from patients visiting a local Emergency Room. Results showed 63.3% of respondents looked up their symptoms online before their visit, and exhibited higher levels of cyberchondria and health anxiety than those who did not (p .001, p .004), and that health information consulted online can impact the decision to seek out immediate care. Strategies are needed to improve and promote quality online sources to benefit both seekers and services.

BACKGROUND: Faculty members in higher education participate in a diversity of scholarly activities. Feedback performance and data on these academic contributions must be tracked for multiple formative and summative purposes including faculty development, promotions, and annual reporting requirements. However, this data are frequently not captured, primarily because most teaching institutions have not implemented a system to effectively collect and report this data. PURPOSE: This thesis designed prototypes for an online performance analytics dashboard for Health Sciences faculty members, including researchers, teachers, administrators, leaders, and clinical educators. This project incorporated UCD (user-centered design) to focus on the end-users and seek to understand their needs and wants. METHOD: McMaster University was used as a case study for this Design-Based Research study. Dashboard preferences were gathered from literature reviews, stakeholder interviews, document analysis, focus groups and interviews. These findings informed the build of a dashboard prototype. Multiple iterations of end-user evaluation and prototype revisions were conducted to refine the design. A constructivist grounded theory approach was utilized to analyze qualitative data from focus group and interviews to generate theory. RESULTS: 25 key resources from the literature review were listed in an annotated bibliography. 10 stakeholders were interviewed. Several McMaster policies and forms were reviewed. 18 faculty members reviewed the dashboard and provided feedback. Qualitative data from focus groups and interviews revealed 4 main themes pertaining to dashboard needs. CONCLUSION: By designing prototypes, this study revealed several requirements and considerations for the construction of a faculty performance dashboard. The dashboard must be customizable, dynamic, organized by user groups, and include specific requirements for the relevant faculty roles. The quality, governance and weighting of data in the dashboard must be considered. Notably, the implementation of this solution would enhance faculty learning and assessment, data reporting and faculty development in the Health Sciences. / Thesis / Master of Science (MSc)

<p>This thesis reports on the development of a Two Way Interactive Video eConsult System (TWIVES), a telemedicine application for the continuity of care in rural communities, remote areas, and in developing countries. In developed countries like Canada, there has been much development of complex telemedicine solutions that may not be suitable for rural communities in developing countries. TWIVES can be a useful alternative when mobility is limited, the patient is disabled, or commuting is not an option for the patient. This system is both easy and inexpensive to use, and operates well in the low bandwidth Internet connections available in these areas.</p> <p>TWIVES aims to facilitate an environment where users can securely request medical consultations from healthcare providers at distant locations, thereby saving time, money, and providing patients access to medical expertise that would otherwise not be available. TWIVES also introduces the concept of web-based submission of requests, replacing the existing traditional method of telephoning to arrange personal face-to-face appointments.</p> <p>TWIVES is a proof of concept (POC) designed and built with the Drupal framework, with particular attention paid to access control and user management, content management, custom search, private messaging and file sharing, request management, and real time video consultation. This thesis explain the purpose and features of TWIVES, its interfaces, what it can do, the constraints under which it must operate, and how it will react to external stimuli.</p> / Master of Science (MSc)

<p>Early trials of Electronic Personal Health Records (ePHRs) show they provide two strong benefits: better healthcare outcomes and lower taxpayer costs. However, consumers are concerned about the possible loss or misuse of personal health data. For people to adopt ePHRs, they must trust both the system and the operating organization. The model presented here studies consumers’ likelihood of adopting ePHRs, combining trust, distrust, risk, motivation, and ease of use; as well as their perceptions of government, software vendors, and physicians as providers of ePHRs. Based on the Technology Acceptance Model, and incorporating elements of trust-distrust dualism and perceived risk, the model was tested empirically using survey data from 366 Canadian adults. The model explains 52 percent of the variance in the intention to use an ePHR, with strong negative effects from perceived risk and distrust, and strong positive effects from trust and perceived usefulness. Other findings include further evidence that trust and distrust are different constructs, not ends of a spectrum; that Canadians’ relationship with their healthcare system is complex; and that the risks in using an online system can be overcome by the perceived benefits. Open-ended responses show that people generally trust their doctors, but are sceptical that a doctor could provide a secure ePHR. Responses indicated that participants liked the consolidation of data and ease of access, but feared loss of privacy.</p> / Doctor of Philosophy (PhD)

This study is the first report of Saudi patients in the literature on electronic personal health records (ePHRs). It investigates patients’ attitudes and expectations regarding ePHRs in Saudi Arabia. It also gives insights about addressing the gap between the interest and the utilization of ePHRs by presenting information about patients’ preferences for ePHR features and activities. The findings show higher interest rates in ePHR use compared to other studies with similar sample frame in developed countries. They also indicate high levels of perceived usefulness of ePHRs on patients’ health and healthcare. More research is needed to explore the ePHR privacy concerns of patients and the key factors in improving the use of ePHRs among specific populations such as the elderly and those patients with chronic disease. / Thesis / Master of Science (MSc) / This study is the first report of Saudi patients in the literature on electronic personal health records (ePHRs). It investigates patients’ attitudes and expectations regarding ePHRs in Saudi Arabia. It also gives insights about addressing the gap between the interest and the utilization of ePHRs by presenting information about patients’ preferences for ePHR features and activities. More research is needed to explore the ePHR privacy concerns of patients and the key factors in improving the use of ePHRs among specific populations.

Adolescent and young Canadians are a group with the highest rates of symptoms of anxiety and depression. Such conditions, when unaddressed, negatively impact the development of a person, restricting their chances of attaining a fulfilling future and career. Even when deciding to reach out to access care, the process can be a challenging one with many barriers along the way. Online therapies in the form of online Cognitive Behavioural Therapies, have shown to be a promising format for some, but have faced some shortcomings with low uptake and variable results. Adding guidance and support to such therapies has been shown to help address these barriers. The objective of this research is to explore how support is currently provided for online cognitive behaviour therapies for anxiety and depression, targeting adolescents and young adults. To achieve this objective a scoping review methodology was utilized to identify relevant articles. The approach taken in a scoping review methodology allows for identification of a wide range of articles, which was necessary in this case because research isolating support features from other interventions is very limited. The scoping review identified fifty articles to be reviewed, and they were analyzed using a framework created for this review. The framework covered human, delivery, and design factors. Consultations with five key informants was also used to identify more findings related to the themes identified in the framework and to complement the findings from the articles in the scoping review. The resulting picture identified the field of support for online CBT for anxiety and depression in adolescents and young adults, covering a field with a great diversity ranging from virtual guides to face-to-face support from therapists. The features were organized into groups of ‘toolkits’ that can be considered by CBT developers for different situations and needs. / Thesis / Master of Science (MSc)

“Exploring the Impact and Roles that Strategic Government Leadership Plays in the Adoption and Use of eHealth in Low Resource Countries: A Quantitative and Descriptive Study of the Medical and Dental Council of Nigeria as a Health Regulatory Agency”. MSc eHealth Defense Candidate: Victor Gbenro Governments of low resource countries (LRCs) have embraced and leveraged the potential benefits Information Computer Technology (ICT) brings to the healthcare sector, taking various steps to adopt and use eHealth to improve healthcare delivery despite recognized challenges. LRCs have been identified as most challenged with the implementation of policies that can drive the development of critical sectors. Despite the development of policies and frameworks in these countries, many still struggle to deliver on their health goals. It is yet to be fully understood to what extent professional health regulatory agencies (PHRAs) understand their roles in effective regulation, as it would relate to medical education, professional conduct and registration of practitioners. The Healthcare workforce is one of the core building blocks of any health system and the regulation of the workforce is central to the provision of quality healthcare services. PHRAs provide strategic leadership through existing legislation, policies, and frameworks and are themselves adopting the use of ICT in a range of applications. These include the registration and licensure process of practitioners, and training and retraining of practitioners through continuing professional development activities. In 2016, the Nigerian government approved the implementation of it National ICT Strategic Framework for health and empowered its agency, the National Information Technology Development Agency (NITDA) which is an agency in the ministry of communication to provide the required leadership, governance, and stewardship in coordinating and improve upon the use of ICT in all key sectors of the country. This study was undertaken to understand the role PHRAs like the Medical and Dental Council of Nigeria (MDCN) a regulatory body for the professions of medicine and dentistry in Nigeria provides Strategic Government Leadership (SGL) in the adoption and use of eHealth tools through policies and legislation in the health sector. The study also assessed the knowledge and perception of employees of the (MDCN) on existing eHealth policies and legislation and of their relevancy or adequacies in providing effective regulation. The study answers the research questions i) does a relationship exist between SGL and capacity for eHealth innovation and technological/ infrastructural development? ii) What are the measures taken and the importance of the security and privacy of practitioner records to PHRA? and iii) Does SGL, as demonstrated through policy development, affect the adoption and use of eHealth by employees of the PHRA? A systematic literature review was performed, and a structured questionnaire was administered to MDCN professional staff. The results were subjected to statistical analysis to investigate relationships between the dependent variable (SGL) and 14 independent variables representing the 15 constructs from the questionnaire. A regression model found four significant predictors of the value of the dependent variable. A study of other related PHRAs is recommended to improve the suitability of the framework proposed, considering the limitations of this study. / Thesis / Master of Science (MSc)