Telehealth has great potential for providing timely and comprehensive care to community-dwelling older adults while reducing their barriers to healthcare access. The purpose of this study is to understand how older adults with chronic diseases access healthcare services in their community and evaluate the impact of telehealth on access to care from a self-reported survey conducted in British Columbia. About a quarter of older adult participants reported barriers to healthcare access in their community. Participants frequently reported financial barriers to healthcare access regardless of telehealth use. In addition, telehealth users more frequently reported a lack of necessary healthcare services in their community and physical barriers to access to care. Although the findings did not demonstrate a significant difference in access to care between telehealth users and nonusers, telehealth was identified as a meaningful care delivery tool for older adults with barriers to healthcare access. Further efforts are needed to implement a valid tool for ongoing evaluation and optimization of telehealth and integrate telehealth into clinical and community programs to reduce physical and financial barriers to healthcare access for community-dwelling older adults with chronic illnesses. / Graduate

Abstract Telehealth adoption is a complex and challenging process that often ends in failure. In Finland, telehealth in the form of videoconferencing is used relatively little in patient care, despite the relatively long geographical distances. The aim of this study was to describe telehealth adoption within one Finnish telehealth project. The aim was also to investigate why some telehealth applications remained in permanent use after the experimental phase while others did not. This was a qualitative study in which the material was gathered using theme interviews. Document material was also used to complement the interview data. Employees working in health care centres and specialised health care (n=41) took part in the study in 2007–2009. Some of the staff members were interviewed twice, which is why the material comprised a total of 55 interviews. The material was analysed using inductive, deductive and theory-driven content analysis. Successful adoption of telehealth applications is influenced by a variety of factors. The key factor is telehealth compatibility, which must be looked at from the perspectives of individuals (staff and patients), processes and the organisation. In terms of adoption success, factors associated with the organisation and how the project was organised were particularly emphasised, such as the need for adoption and arrangement of teleconsultations as regular processes with permanent staff and due attention to technology access and functionality. As a whole, health care staff were positive towards telehealth adoption; however, a negative attitude is not a definite obstacle to adoption. Health care staff perceived telehealth as having a number of benefits for patients, employees and society as a whole. Telehealth must be suited for patients and employees, clinical healthcare processes and the organisation. Suitability can be impacted by organisation and technology. The study has generated information about the adoption of telehealth in the Finnish health care system. This information can be made use of when planning new telehealth projects. / Tiivistelmä Etäterveydenhuollon käyttöönotto on monimutkainen ja haasteellinen prosessi, jossa epäonnistutaan usein. Suomessa videoneuvottelutekniikan avulla toteutettua etäterveydenhuoltoa käytetään potilastyössä melko vähän, vaikka meillä maantieteelliset välimatkat ovat pitkiä. Tämän tutkimuksen tarkoituksena oli kuvata etäterveydenhuollon käyttöönottoa yhdessä suomalaisessa etäterveydenhuoltohankkeessa. Tarkoituksena oli myös selvittää, miksi osa etäterveydenhuollon sovelluksista jäi pysyvään käyttöön ja osa loppui kokeiluvaiheen jälkeen. Tutkimusmetodina oli laadullinen tutkimus, jossa aineisto kerättiin teemahaastatteluilla. Lisäksi dokumenttiaineistoa käytettiin täydentämään haastatteluaineistoa. Haastatteluihin osallistui terveyskeskusten ja erikoissairaanhoidon työntekijöitä (n =  41) vuosina 2007–09. Osa työntekijöistä haastateltiin kahteen kertaan, joten kokonaisuutena tutkimusaineisto käsitti 55 haastattelua. Tutkimusaineisto analysoitiin aineistolähtöisellä, teorialähtöisellä ja teoriaohjaavalla sisällönanalyysillä. Etäterveydenhuollon sovellusten käyttöönoton onnistumiseen vaikuttavat monet eri tekijät. Keskeisin tekijä on etäterveydenhuollon soveltuvuus, jota pitää tarkastella yksilön (työntekijöiden ja potilaiden), prosessien ja organisaation näkökulmista. Käyttöönoton onnistumisessa painottuvat etenkin organisaatioon ja hankkeen organisoimiseen liittyvät tekijät, kuten tarve käyttöönotolle ja etäkonsultaatioiden järjestäminen säännöllisiksi prosesseiksi, joissa on pysyvät työntekijät ja joissa teknologian saatavuudesta sekä toimivuudesta on huolehdittu. Terveyskeskustyöntekijät suhtautuvat pääasiassa myönteisesti etäterveydenhuollon käyttöönottoon, eikä kielteinen asenne ole ehdoton este käyttöönotolle. Terveyskeskustyöntekijät kokevat etäterveydenhuollosta olevan monenlaista hyötyä potilaille, työntekijöille ja yhteiskunnalle. Etäterveydenhuollon täytyy soveltua potilaille ja työntekijöille, terveydenhuollon kliinisiin prosesseihin ja organisaatiolle. Organisoinnilla ja teknologialla voidaan vaikuttaa soveltuvuuteen. Tutkimus on tuottanut tietoa etäterveydenhuollon käyttöönotosta suomalaisessa terveydenhuoltojärjestelmässä. Tätä tietoa voidaan hyödyntää suunniteltaessa uusia etäterveydenhuoltohankkeita.

Les questions centrales de la recherche et de sa problématique, nous ont semblé exiger non pas une approche limitée au seul contexte local – ici, brésilien –, mais bien de jeter un regard investigateur qui tiendrait également compte des implications du contexte international sur le pays en question. Il nous fallait comprendre comment les différents acteurs impliqués dans la définition de politiques pour l’adoption des technologies de l’information et de la communication dans les domaine de la santé se communiquaient, aux différents niveaux d’action politique, mondial, régional ou local. Parmi ces « acteurs », citons l’engagement d’organisations internationales faisant partie des Nations unies, telles l’Organisation Mondiale de la Santé, l’Union Internationale des Télécommunications et celles qui travaillent dans le cadre de l’Amérique Latine, région géopolitique où le Brésil se situe. En soulignant le rôle de ces organisations dans la diffusion de modèles ou recettes politiques dans le monde, notre recherche a pris en considération aussi bien le phénomène de la mondialisation que la question délicate de la régulation internationale. À partir des constatations préliminaires, nous avons établi que la recherche devait se concentrer sur l’étude de la caractérisation normative du programme de télésanté brésilien - programme Telessaúde Brasil Redes -, face aux recommandations d’organisations internationales sur la question, et notamment des organisations faisant partie des Nations unies travaillant à l’échelle mondiale ou régionale, à savoir le continent latino-américain dans le cas qui nous intéresse plus particulièrement. La comparaison (ou confrontation) entre ces deux pôles nous a semblé la meilleure solution pour vérifier les retombées du global et du régional sobre le local. Compte tenu du contexte réformiste et d’autres questions relatives à la santé publique au Brésil et après avoir vérifié les bases normatives du programme Telessaúde Brasil Redes, on peut considérer que « sa création a été la conséquence de l’observance des recommandations internationales » ou au contraire, que « sa création se soit réglée sur les éléments locaux caractéristiques de la santé publique brésilienne et autres facteurs de politique interne ». Pour parvenir à prendre position face à cette dichotomie, nous avons défini nos deux hypothèses et nos méthodes et matériels de recherche. Il a fallu démontrer que les organisations internationales s’appuient sur des structures de sensibilisation qui visent à favoriser l’engagement des États membres pour qu’ils adoptent des modèles ou des recettes de politiques détaillés dans leurs recommandations. La démonstration de la présence des structures de sensibilisation a exigé la définition d’une méthode d’analyse. Pour ce faire, nous avons eu recours aux outils de l’analyse du discours (AD) et de l’analyse du contenu (AC) pour mettre en évidence dans les documents les éléments observables pertinents et pour les associer ensuite aux trois structures de sensibilisation identifiées: légitimité, efficacité et coercibilité. Nous avons associé ces trois structures de sensibilisation à un « processus d’acceptabilité ». Après avoir défini la base épistémologique et le corpus d’analyse, avoir séparé et analysé deux grands groupes de documents, nous avons demontré et interpreté le niveau de corrélation entre les observables associés au cadre normatif du programme Telessaúde Brasil Redes et celui des recommandations internationales sur la télésanté. / The central issues of the research and its problem, we seemed to require non-not an approach limited to the only local context - here, Brazilian-, but to take an investigative look that also consider implications of the international context on the country in question. We needed to understand how the different actors involved in the definition of policies for the adoption of information and communication technologies in the field of health is communicated at all levels of political, global, regional or local action. These "actors", include the commitment of international organizations forming part of the United Nations, such as the world Organization of health, the International Telecommunication Union and those working in the context of Latin America, geopolitical region where the Brazil is located. Stressing the role of those organizations in the dissemination of models or « political recipes » in the world, our research took into account both the phenomenon of globalisation than the delicate question of international regulation. From the preliminary findings, we determined that research should focus on the study of normative characterization of the Brazilian Telehealth Program - Program Telessaúde Brasil Redes - facing the recommendations of international organizations on the issue, including organizations part of the UN working on a global or regional level, namely the Latin American continent in the case that interests us more particularly. The comparison (or confrontation) between these two poles seemed the best solution to check the global and the regional facing the local. Taking into account the reform context and other matters relating to public health in the Brazil and after checking the normative bases of the « Telessaude Brasil Redes program », we can consider that "its creation has been the consequence of compliance of international recommendations" or on the contrary, that "its creation is set to local features of public health Brazilian and other factors of internal policy. Getting to take a stand against this dichotomy, we have defined our two assumptions and our methods and research materials. It was necessary to demonstrate that international organizations rely on awareness-raising structures that are designed to promote the engagement of the Member States that they adopt models policies detailed in their recommendations. The demonstration of the presence of the structures of awareness demanded the definition of a method of analysis. To do this, we resorted to the analysis tools of discourse (AD) and the content analysis (AC) to highlight the relevant observable elements in documents and then associate them with the three structures of awareness identified: « legitimacy, efficiency and coercion. We've combined these three structures of awareness to a "process of acceptability." After defining the epistemological basis and the analysis corpus, have separated and analyzed two groups of documents, we have shown and interpreted the level of correlation between the observable associated with the normative framework of Telessaúde Brasil Redes program and the international recommendations on telehealth.

The purpose of this dissertation is to explore the contemporary area of information technologies employed in health care (eHealth). Focusing on the systems already employed in the Czech Republic, it aims to analyse them, to quantify expenditures of their introduction and maximum benefits derived from these, as well as to evaluate their real current profit. Out of the three existing national systems, this dissertation concentrates on the two only (eRecept, ePACS), as it became impossible to evaluate the third -- IZIP system due to scarcity of the relevant information available. In the field of expenditures not only generally published numbers are taken into consideration, but this dissertation also evaluates the expenditures of other subjects involved (IT systems producers, health care providers, etc.). As the first dissertation in the Czech Republic it quantifies benefits derived from the existing eHealth systems and unlike foreign theses it greatly emphasizes just the expenditures of other subjects involved. Included in this dissertation is also the evaluation of achievements of the eHealth systems in the Czech Republic complete with supposed grounds for this situation. This dissertation also recommends courses of action for contractors of these systems to ensure future basis for more economical and successful eHealth systems. These recommendations are mainly based on analysis of development of the existing national eHealth systems. For the complex evaluation of the costs, maximum of possible and real benefit of the individual eHealth systems the research approach adopted in this dissertation includes descriptive method and SWOT analysis, extrapolation and abstraction, comparative and factor analysis.

Autism Spectrum Disorder (ASD) is a developmental disorder characterized primarily by social skills deficits that can impair the individual’s ability to develop and maintain meaningful relationships. Research has shown that social skills training provides lasting improvement in social interactions. However, many factors can hinder the availability of intervention groups outside of major metropolitan areas. Individual online social skills interventions have been shown to translate to increases in everyday social skills, and while further investigation is required, current literature suggests that there is great potential for live, interactive online social skills groups to provide similar benefits to in-person intervention groups. Thus, online groups may be one solution to the barriers to accessing available resources. This study sought to explore the feasibility of conducting a live, interactive online social skills group by comparing two groups using the same curriculum; one in-person group that met in a lab on a local college campus, and one piloted online group that met through Zoom, a video conference platform, each for 14 weeks. Each group also participated in person in social activities on campus to gather preliminary generalization data. The online intervention was acceptable to therapists and participants, and a group of therapists who implemented both delivery models reported some advantages and disadvantages of an online format for social skills, expressing a preference for in-person delivery model when possible, but acceptability of online delivery where in-person groups are not available. The online model showed somewhat lower levels of participation, but slightly higher attendance rates than the in-person model. Understanding both the advantages and disadvantages to online social skills, clinicians can utilize the method the best fits their needs.

The purpose of this study was to gain a deeper understanding of the patient’s perspective regarding social interactions in video healthcare meetings. Social presence theory was used in the context of how video calls can result in vital aspects of social interactions disappearing and how that can affect the outcome of a doctor consultation in contrast to physical meetings. A qualitative method with semi-structured interviews was applied to this study. This study included 7 participants with similar age range from 26-36 years old including both genders. This study resulted in many different views and perspectives whereas some participants found it harder to communicate virtually whereas others did not think that social interactions was not even an important factor. The conclusion that could be made from this study is that virtual healthcare meetings are good depending on which context they are used for. Furthermore, the doctor cannot always get the full picture because the camera creates a psychological distance which makes it harder for the doctor to observe as much as he/she can in a physical setting which can lead to many signals and cues missing out.

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. Methods: A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.

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Digital tools are being implemented in every area of society. Digital healthcare, or E-health, is an area that is increasing in popularity with various mobile applications and online services available. Entergate, a company based in Halmstad, has developed a service called EnterMedic. It is a cloud service that collects data from patients through online questionnaires. Once submitted, the service can directly forward data from these questionnaires to patient journals. EnterMedic also helps researchers with data to develop effective work methods in healthcare. The service was however limited to the web. This thesis consists of developing a mobile version of the service as it is more convenient to use compared to a web-based one and research contributing to what E-health applications can be used for. Interactivity is a desired feature for applications. EnterMedic will provide the users with feedback after questionnaire submissions, to help them track their state of health. / Digitala verktyg blir implementerade i alla områden av samhället. Digital hälsovård, eller E-hälsa, är ett område som ökar i populäritet med olika mobiltelefon applikationer och on-line tjänster tillgängliga. Entergate, ett företag baserat i Halmstad, har utvecklat en tjänst som heter EnterMedic. Det ar en moln-tjänst som samlar data från patienter genom online formulär. När dessa skickas in kan tjänsten direkt vidarebefodra datan från formulären till patient journaler. EnterMedic hjälper även forskare med data för att utveckla mer effektiva arbetsmetoder inom hälsovården. Tjänsten är dock begränsad till webben. Det här examensarbetet består av att utveckla en mobil version av tjänsten då det är mer bekvämt att använda jämfört med en webb-baserad tjänst och forskning som bidrar till vad E-hälsa applikationer kan användas för. Interaktivitet är en önskad funktion för applikationer. EnterMedic kommer förse användare med återkoppling efter att ett formulär har skickats in, som i sin tur hjälper dem följa sitt hälsotillstånd.