Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2006. / "A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Description based on contents viewed Nov. 13, 2007; title from "catalog record" of the print edition. Includes bibliographical references (leaves 103-119). Online version of the print edition.

Zoonotic diseases are diseases that are transmitted from animals or vectors to humans and vice versa. The public together with veterinarian authorities should readily access disease information as it is vital in rapidly controlling resultant zoonotic outbreak threats through improved awareness. Currently, the reporting of disease information in South Africa is predominantly limited to traditional methods of Information Communication Technologies (ICTs) like faxes, monthly newspaper reports, radios, phones and televisions. Although these are effective ways of communication, their disadvantage is that the information that most of them offer can only be accessed at specific times during a crisis. New technologies like the internet have become the most efficient way of distributing information in near-real-time. Many developed countries have used web-based reporting platforms to deliver timely information through temporal and geographic visualisation techniques. There has been an attempt in the use of web-based reporting in South Africa but most of these sites are characterised by heavy text which makes them time consuming to use or maintain. As a result most sites have not been updated or have ceased to exist because of the work load involved. The success of web reporting mechanisms in developed countries offers evidence that web-based reporting systems when appropriately visualised can improve the easy understanding of information and efficiency in the analysis of that data. In this thesis, a web-based reporting prototype was proposed after gathering information from different sources: literature related to disease reporting and the visualisation of infectious diseases; the exploration of the currently deployed web systems; and the investigation of user requirements from relevant parties. The proposed prototype system was then developed using Adobe Flash tools, Java and MySQL languages. A focus group then reviewed the developed system to ascertain that the relevant requirements had been incorporated and to obtain additional ideas about the system. This led to the proposal of a new prototype system that can be used by the authorities concerned as a plan to develop a fully functional disease reporting system for South Africa.

Utilization of airway protective rehabilitation among individuals with neurodegenerative disease is astoundingly low. Yet, due to progressive decline in airway protective function and resulting health consequences such as aspiration pneumonia, the need for rehabilitation is clear. Moreover, a growing literature supports the benefit of airway protective rehabilitation in neurodegenerative populations. Therefore, it is a healthcare priority to increase treatment utilization in order to improve health and quality of life for individuals with neurodegenerative disease. Improving treatment accessibility and relevance are two approaches that have the potential to improve utilization. Despite the need to increase treatment accessibility and the growing evidence base to support the use of telehealth to increase access, a significant gap remains in our understanding of the feasibility and acceptability of telehealth to manage dysphagia in neurodegenerative disease. Moreover, little is known about patient perspectives which are critical to refine person-centered models of care that are relevant to patient’s needs. To address this important clinical research gap, this dissertation includes a series of three research studies aimed at improving accessible and relevant rehabilitation for airway protective dysfunction in neurodegenerative disease. Chapter 1 will provide an overview of the current literature as it relates to airway protective dysfunction in neurodegenerative disease, existing rehabilitation approaches, telehealth to manage dysphagia, and the need for personalized care. Chapter 2 will examine the feasibility of rehabilitating airway protection via telehealth in individuals with neurodegenerative movement disorders. Chapter 3 will then explore speech language pathologists’ (SLPs) perspectives and experiences using telehealth to manage dysphagia. Chapter 4 will characterize patient perspectives on airway protective dysfunction and treatment experience following cough skill training (CST). I will conclude (Chapter 5) by synthesizing the findings from chapters 2-4 and suggesting directions for future research.

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic & Business Sciences, November 2016 / Community Health Workers or “CHWs” are often the only link to healthcare for millions of people in the developing world. They are the first point of contact with the formal care system, and represent the most immediate and cost effective way to save lives and improve healthcare outcomes in low-resource contexts. Mobile-health or ‘mHealth’ technologies may have potential to support CHWs at the point-of-care and enhance their performance. Yet, there is a gap in substantive empirical evidence on whether the use of mHealth tools enhances CHW performance, and how their use contributes to enhanced healthcare service delivery, especially in low-resource communities. This is a problem because a lack of such evidence would pose an obstacle to the effective large-scale implementation of mHealth-enabled CHW projects in low-resource settings. This thesis was motivated to address this problem in the Kenyan community health worker context. First, it compared the performance of CHWs using mHealth tools to those using traditional paper-based systems. Second, it developed and tested a replicable Technology-to-Performance Chain (TPC) model linking a set of CHW task and mHealth tool characteristics, to use and user performance outcomes, through four perspectives of Task-Technology Fit (TTF), namely Matching, Moderation, Mediation, and Covariation. A quasi-experimental post-test only research design was adopted to compare performance of CHWs using an mHealth tool to those using traditional paper-based systems. A primary structured questionnaire survey instrument was used to collect data from CHWs operating in the counties of Siaya, Nandi, and Kilifi, who were using an mHealth tool to perform their tasks (n = 257), and from CHWs operating in the counties of Nairobi and Nakuru using traditional paper-based systems to perform their tasks (n = 353). Results showed that CHWs using mHealth tools outperform their counterparts using paper-based systems, as they were observed to spend much less time completing their monitoring, prevention, and referral reports weekly, and report higher percentages of both timeous and complete monthly cases. In addition, mHealth tool users were found to have more positive perceptions of the effects of the technology on their performance, compared to those using traditional paper-based systems. An explanatory, predictive, research design was adopted to empirically assess the effects of a ‘fit’ between the CHW task and mHealth technology (TTF) on use of the mHealth technology and on CHW user performance. TTF was tested from the Matching, Moderation, Mediation, and Covariation ‘fit’ perspectives using the cross-sectional survey data collected from the mHealth tool users (n = 257). Results revealed that there are various unique ways in which a ‘fit’ between the task and technology can have significant impacts on use and user performance. Specifically, results showed that the paired-match of time criticality task and technology characteristics impacts use, while that of time criticality and information dependency task and technology characteristics impacts user performance. Results also showed that the cross-product interaction of mobility task and interdependence technology characteristics impacts use, and that of mobility task and interdependence and information dependency technology characteristics, impacts user performance. Similarly, the cross-product interaction of information dependency task and time criticality technology characteristics impacts user performance. Moreover, results showed that a perceived ‘fit’ between CHW task and mHealth technology characteristics partially and fully mediates the effects of user needs and tool functions on use and user performance, whereas ‘fit’ as an observed pattern of holistic configuration among these task and technology characteristics impacts use and user performance. It was also found that the perfect ‘fit’ between CHW task and mHealth tool technology characteristics leads to the highest levels of use and user performance, while a misfit leads to a decline in use and user performance. Notably, an over-fit of mHealth technology support to the CHW task leads to declining use levels, while an under-fit leads to diminishing user performance. Of the four ‘fit’ perspectives tested, the matching and cross-product interaction of task and technology characteristics offer the most dynamic insights into use and user performance impacts, whereas user-perception and holistic configuration, were also shown to be significant, thus further reinforcing these effects. Tests of a full TPC model revealed that greater mHealth tool use had a positive effect on the effectiveness, efficiency, and quality of CHW performance in the delivery of patient care. Moreover, it was found that ‘facilitating conditions’ and ‘affect toward use’ had positive effects on mHealth tool use. Furthermore, a perceptual TTF was found to have positive effects on mHealth tool use and CHW performance. Of note, this perceived TTF construct was found to be simultaneously a stronger predictor of mHealth tool use than ‘facilitating conditions’ and ‘affect toward use’, and a stronger predictor of CHW performance than mHealth tool use. Consequently, TTF was confirmed as the central construct of the TPC. The findings constitute significant empirical insights into the use of mHealth tools amongst CHWs in low resource settings and the extent to which mHealth contributes to the enhancement of their overall performance in the capture, storage, transmission, and retrieval, of health data as part of their typical workflows. This study has provided much needed evidence of the importance of a ‘fit’ between CHW task and mHealth technology characteristics for enabling mHealth impacts on CHW performance. The study also shows how these inter-linkages could improve the use of mHealth tools and the performance of CHWs in their delivery of healthcare services in low-resource settings, within the Kenyan context. Findings can inform the design of mHealth tools to render more adequate support functions for the most critical CHW user task needs in a developing world context. This study has contributed to the empowerment of CHWs at the point-of-care using mHealth technology-enabled service delivery in low-resource settings, and contributes to the proper and successful ‘scaling-up’ of implemented mHealth projects in the developing world. / MT 2018

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This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.

The COVID pandemic led to a sudden expansion of telehealth in the delivery of nursing services. At the same time, nursing education was forced to extend clinical learning to online approaches. However, telehealth clinical experiences are limited in the nursing curricula of entry-level programs. Nursing simulation is an educational activity that prepares students for clinical practice by supporting the learning of fundamental clinical competencies. This study was designed to explore prebriefing methods for simulation to prepare entry-level nursing students for telehealth patient care visits. Standardized patient (SP) methodology was used to simulate a telehealth video conferencing call for an infectious disease case interview. Simulations were conducted remotely using Zoom technology with breakout rooms adhering to Healthcare Simulation Standards of Best PracticeTM, and informed by NLN Jeffries Simulation Theory and Experiential Learning Theory. The experiment compared two different methods for prebriefing: traditional prebriefing with a narrated script and structured prebriefing with a narration script plus learners viewed a role modeling video and participated in guided reflection. Participants from one private university in the Northeast (N =126) were randomized and simulations took place over one semester. In conclusion, the standardized patient simulations were an effective teaching strategy for developing fundamental telehealth skills of therapeutic communication and confidence with patient safety. Learners in the structured prebriefing group had significantly higher scores for confidence in quality and safety, faculty assessed therapeutic communication, and simulation effectiveness. There were significant improvements of therapeutic communication scores over time for both groups, but there were no differences between groups. Future research might extend the explanations of how to best prepare learners for telehealth experiences; it is important to further explore telehealth clinical competencies with entry-level nursing students.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2012. / This research is an attempt to investigate the utilisation of Information Communication Technology (ICT) in Healthcare to support the flow of HIV/AIDS patient’s general information in public and private sector. Furthermore, the research examines the detail flow of database information for healthcare service delivery to patients, in particular HIV/AIDS patients, in Khayelitsha Township. Finally, the research will detail the types of technologies currently being utilised to transfer this information, technology utilised for capturing or data collection profile of the patient. The research study data collecting was done in 2009 in mostly private and public healthcare centre in Khayelitsha township. First, the study will concentrate on general utilisation of ICT in healthcare service delivery and flow of information for public and private sector healthcare centres. Additionally, the research also looks at NGOs such as HIV/AIDS Unit in Cape Peninsula University of Technology (CPUT) and Treament Action Campaign (TAC) to find out what ICT equipment is being utilised to transfer this information to adult people to inform and make them to be aware of HIV/AIDS and improve healthcare service delivery to patients and particularly to HIV/AIDS patients. Taking NGO’s such as TAC and CPUT HIV/AIDS Unit that are well informed about HIV/AIDS, nationally and internationally will make our research results to be more precise. The research will also look at the utilisation of ICT in flow of information at healthcare centre such as communication between healthcare providers such as receptionist/clerk, nurses, doctors and medical researchers since they are the first people who deal with HIV/AIDS patient cases when they come for healthcare provision.

eHealth is commonly defined as health services and information provided through the Internet and related technologies. Health educators have taken advantage of Internet and social media venues to disseminate health information essential to health risk management, disease prevention, and disease management and did not have a validated theoretical model to explain their experiences. The goal of this study was to create and test an integrated model of eHealth communication specific to 18-30 year old college students based on five research questions that identified and confirmed the factors most highly correlated with the presentation of health information on Internet or social media venues that improve eHealth literacy and provoke eHealth behavioral intention among college students. A sample of over 1400 18-30 year old college students was surveyed about their general and health information related use of the Internet and social media. As a result of exploratory factor analysis and subsequent structural equation modeling, the proposed theoretical model was revised and tested for statistical power. Two revised integrative models of eHealth communication, one for Internet and one for social media, were developed and validated. The model for social media shows statistically significant paths throughout the model; however, the model for the Internet reveals that the path between two constructs and Online Health Behavior are not statistically significant and is worthy of further examination. This study has important practical implications for eHealth educators, organizations dedicated to informing the public about specific diseases or health promotion techniques, health practitioners seeking improved strategies for effective eHealth message design, and to health information professionals.

Background. Mothers of children with Autism Spectrum Disorder (ASD) report high levels of stress, depression, and poor well-being, with little sense of social support due to the high demands of their child’s care. The Incredible Years® for Autism and Language Delays (IY-ASLD) program offers a unique model in that there is a dual focus on both child and parent outcomes. However, there is a dearth of literature on whether IY-ASLD can improve parental mental health outcomes. While there is some evidence to suggest that in-vivo therapist-to-parent supportive statements reduce parental resistance to treatment, there remains a gap in the literature regarding whether these behaviors directly impact parental mental health outcomes. Therefore, the present study investigated the degree to which exposure to the IY-ASLD telehealth curriculum (total minutes in attendance across sessions) along with in-vivo therapist-parent group verbal support was related to parental mental health outcomes and parental verbal approval statements of the child at post-treatment after controlling for baseline mental health and verbal approval. Methods. Participants were seventeen mother-child dyads, with children ages 2-years-8-months to 5-years-old recruited from a preschool utilizing an Applied Behavior Analysis (ABA) approach to schooling. All or virtually all children referred to this school by their school district are at-risk for or have been diagnosed with ASD. All of the children had an IEP or IFSP with mandated speech services, 71% of the children met criteria for ASD (N = 12) on the Childhood Autism Rating Scale- 2-SF, and 2/3 of the sample had adaptive behavior composites below a standard score of 70 on the Vineland Adaptive Behavior Scales- Third Edition Comprehensive Teacher Form (Sparrow et al., 2016). Participants were assigned to one of four treatment groups based on language level of the child and convenience of the group meeting time. Groups met for 12-weekly IY-ASLD sessions via telehealth. Data were collected at the beginning, mid-point, and end of treatment in the form of a parent questionnaire covering demographics, parental well-being (World Health Organization- Five Well-Being Index; WHO, 1998), depressive symptoms (Patient Health Questionnaire; Kroenke et al., 2001), and parenting stress (Parenting Stress Index-Fourth Edition, Short Form; Abidin, 2012). At post-treatment, parents reported satisfaction with the IY-ASLD-T program (IY-ASLD Parent Program Satisfaction Questionnaire). Data were also collected throughout treatment by recording IY-ASLD parent sessions. From the recorded parent sessions, two primary variables were developed. The first was treatment dosage, calculated as the total minutes each parent attended over the course of the 12-week intervention. The second was exposure to supportive therapist verbalizations during the first 10-minutes of each session, which was coded using the Therapy Process Code (TPC) to measure therapist supportive verbalizations during therapist-parent interaction (Chamberlain et al., 1986). Additionally, data were collected via a virtual parent-child play session (PCI) at the beginning, mid-point, and end of treatment, and later coded using the Verbal Behavior Developmental Language Coding System (VBDT) to measure parental verbal approval to child (Greer & Ross, 2008). Results. Mothers in this study had low levels of depression (PHQ-9; M = 4.59, SD = 4.69), average parenting stress (PSI-4-SF; M = 78.12, SD = 23.78), and low levels of well-being (WHO-5; M = 12.82, SD = 4.47). There were no statistically significant changes in parental depression, parental stress, or observed verbal approval from pre- to post-treatment and the effect sizes were small based on the partial eta squared and Kendall’s W values as per Cohen’s (1988, 1994) guidelines (small = .20-.49, medium = .50-.79, large > .80). However, there was a statistically significant change in caregiver well-being from baseline, mid-treatment, to post-treatment and a small effect size based on Kendall’s W (W = .31). A Friedman test indicated that caregivers demonstrated significant improvements in well-being from baseline to mid-treatment, and the improvement remained at post-treatment, χ2 (2) = 10.04, p < .01. There was no significant relationship between treatment dosage or supportive verbalizations and change in caregiver well-being. There was a significant negative correlation between treatment dosage and well-being at mid-treatment (r = -.493, p = .044), trending in the same direction at post-treatment (r = -.369, p = .146), possibly suggesting that parents with lower well-being, and therefore in greater need of support, attended IY-ASLD more frequently. An additional unexpected finding indicated that parents who were exposed to more supportive verbalizations had statistically significantly lower well-being at post-treatment. One explanation proposed by the authors is that parents who had lower well-being, and attended IY-ASLD sessions more frequently, received more supportive therapist verbalizations, possibly because they pulled for supportive verbalizations from the therapist. Results from the Incredible Years satisfaction questionnaire indicated there was high satisfaction with the program and the group leaders. High ratings of satisfaction with the group leaders and the program overall indicated that group leaders in the program may have successfully accomplished providing a “good enough” sense of support and reinforcement to parents over the course of the intervention. Therefore, it’s possible that specific therapist-to-parent supportive verbalizations were less related to improvements in parental well-being, and rather, the overall sense of support from the therapist to the parents in the group, along with support between the parents in the group, were sufficient to result in improvements in maternal well-being over the course of the intervention. Conclusions. Over the course of the IY-ASLD-T intervention, mothers demonstrated significant improvements in their overall well-being. While exposure to treatment and to supportive verbalizations from therapist to parents were not related to residualized change in well-being, these seem to be important factors in understanding the needs of parents with young children with ASD (e.g., parents with low well-being had higher attendance and received more supportive verbalizations). Taken together, the results suggest maternal well-being is an important and promising target for evidence-based behavioral parenting interventions such as IY-ASLD.