Background: International agencies such as the World Health Organisation have highlighted the potential of digital information and communications technologies to strengthen health systems, which are underpinned by the 'building blocks' of information, human resources, finances, commodities, leadership and governance, and service delivery. In high income countries, evidence of the positive impacts of 'eHealth' innovations on the cost-effectiveness of healthcare is growing and many governments are now providing incentives for their adoption. In contrast, the use of eHealth in developing countries has remained low and efforts to introduce these new approaches have experienced high failure rates. There is even scepticism regarding the feasibility of eHealth in low-resource settings, which may be hindered by high costs, indeterminate returns on investment, technical problems and socio-organisational barriers. More research is needed to document both the value of eHealth for strengthening resource-limited health systems and the challenges involved in their implementation and adoption, so that insights from such research may be used to inform future initiatives. While many studies of eHealth for patient care in low- and middle-income countries (LMIC) are taking place, evidence of its role in improving administrative processes such as financial management is lacking, despite the importance of 'good governance' (transparency and accountability) for ensuring strong and resilient health systems. The overall objective of this PhD was to elucidate the enablers, inhibitors and outcomes characterising the implementation and adoption of a modular eHealth system in a group of healthcare facilities in rural Malawi. The system included both clinical and billing modules. The specific objectives were (i) to understand the socio-technical, organisational and change management factors facilitating or hindering the implementation and adoption of the eHealth system, (ii) to assess the quality of data captured by the eHealth system compared with conventional paper-based records, and (iii) to understand how information within the eHealth system was used for service delivery, reporting and financial management. A further aim was to contribute to the corpus of mixed-methods case studies exploring eHealth system implementation processes and outcomes (including data quality) in LMIC. As described in the following chapters, the research also gave rise to unanticipated and serendipitous findings, which led to new lines of enquiry and influenced the theoretical perspectives from which the analysis drew.

Background: Recent empirical research and theoretical models acknowledge that impulsive processes, can often undermine peoples’ attempts to lose weight despite currently available and effective support (Chapter 2). Aim: To develop, deliver, and evaluate an impulse management intervention to support weight loss in adults. Methods: A systematic review was conducted to identify available impulse management techniques for influencing eating behaviour (Chapter 3). Intervention Mapping was used to develop the intervention (Chapter 4) which drew on various sources including the findings from the systematic review, stakeholder consultations, existing guidance, and qualitative interviews. A two-arm randomised controlled feasibility trial (Chapter 5), with nested mixed-methods process evaluation and two cycles of intervention delivery and data collection (Chapter 6), was conducted. This assessed the feasibility and acceptability of, and informed refinements to, both the intervention and trial procedures in preparation for a full-scale effectiveness evaluation. Weight was measured as the proposed primary outcome for a full-scale trial at baseline, one-month, and three-months of follow-up, app usage data were collected at both follow-up time points, and semi-structured interviews were conducted at one-month with a subsample of intervention group participants only. Results: The systematic review critically appraised and synthesised evidence on 17 identified techniques which were categorised as Impulse-focused or Reflective techniques. Promising changes in eating behaviour and craving were found for the techniques of visuospatial loading, physical activity, and implementation intentions. Intervention Mapping resulted in development of a novel smartphone app-based intervention (ImpulsePal) aimed to reduce unhealthy snacking, overeating, and alcoholic and sugary drink consumption using impulse management techniques identified in the systematic review. Eighty-eight adults with a Body Mass Index of ≥25kg/m2 and wishing to lose weight, were recruited and randomised in a 2:1 ratio to use ImpulsePal (n=58) or to a waiting list control (n=30) group. Data were available for 74 participants (84%) at one-month and 67 (76%) at three months. Exploratory analyses suggest that the ImpulsePal group (n=43) lost 1.03kg (95% CI 0.33 to 1.74) more than controls (n=26) at one-month, and 1.01kg (95% CI -0.45 to 2.47) more at three months. Participants reported high satisfaction with the intervention and trial procedures. The process evaluation suggests that ImpulsePal and the impulse management techniques are feasible to deliver and acceptable to users. Interviews with twenty-two participants suggest that they valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to resist temptations. Conclusions: This work has developed a novel, theory- and evidence-informed, person-centred app which showed potential to improve impulse management, promote healthier eating, and support weight loss. ImpulsePal is acceptable to overweight and obese adults who want to lose weight and is now ready for evaluation in a full-scale trial. The thesis discusses theoretical, methodological, and practical implications for the future development, evaluation, and implementation of digital behaviour change interventions.

Nowadays, Information and Communication Technologies and Internet play an important role supporting everyday objectives. The speed of tasks performance, the easy access to all kind of information and the possibility of having a synchronous and asynchronous communication at any time and place, are some of the advantages that technologies provide us in everyday activities. In fact, these days, it¿s almost unthinkable for a company or institution not making to use these technologies, because they are increasingly present, allowing a fast performance of administrative tasks, product or service promotion in WEB, eLearning or blended-learning, etc. However, it still exist some resistance to technology. Health is a field where technology is constantly used when referring to equipment (hardware) to assist medical exams, such as ultrasounds, electrocardiograms, electroencephalograms, magnetic resonance imaging, and others. Yet, regarding the use of software and systems applied to therapies, this is one of the sectors that use less technology, especially when referring the mental health sector. Given the several advantages that technology provides, it¿s important to find out the technology potential users¿ reactions, as well as the factors that affect their behavior and the reasons that slow down the technology expansion, in mental health field. The work presented in this thesis is about the introduction of multimedia tools in schizophrenic patient¿s therapy, having as the main goal the exploratory study of technology acceptance in a therapy context of schizophrenic cognitive rehabilitation. In order to achieve the main goal and to know the context of this work, it was made a theoretical study about mental health, particularly about schizophrenia, technology use, where it is referred the Human-Computer Interaction, health technologies and technology acceptance and adoption. The theoretical study has allowed the empirical work development, resulting in the design and development of a multimedia system for cognitive rehabilitation of schizophrenic patients ¿ eSchi System ¿ and in two different micro-studies that aimed to complement information: (1) Case study of technology acceptance (eSchi system) by schizophrenic patients; (2) a survey applied to acceptance technology experts, related to the relevance of creating a general technology model applied to therapies. The results of the theoretical study suggest the need of organization and generalization health technology concepts, given the variety of existing concepts without clear and universal definition. About the empirical study it¿s important to focus: the patient¿s good receptivity to eSchi system, although it was noticed some difficulty in generalizing activities to different types of schizophrenia; the difficulties to access real clinical contexts; and the significance to create an eTherapy model that could be applied to different scenarios. Given the exploratory nature of this work, many questions have been raised leading to new research proposals, such as the technology acceptance study applied to different users, or the study of the factors that cause resistance to the implementation os technology in health sector. / En la actualidad, las Tecnologías de la Información y la Comunicación e Internet juegan un importante rol en la cosecución de los objetivos cotidianos. La velocidad con la cual se pueden realizar las tareas, el fácil acceso a todo tipo de información y la posibilidad de mantener comunicaciones síncronas o asíncronas en cualquier lugar y momento, son algunas de las ventajas que las tecnologías nos aportan en las actividades diarias. De hecho, hoy es impensable para una compañía o institución no usar estas tecnologías, porque están cada vez más presentes, aportan rápidas soluciones a las tareas administrativas, a la promoción de productos y servicios en la WEB, a la formación a distancia o híbrida, etc. A pesar de ello todavía existe resistencia a la tecnología. La salud es un campo en el que se aplican intensivamente tecnologías para el equipamiento (hardware) de asistencia a los exámenes médicos, como son los ultrasonidos, electrocardiogramas, electroencefalogramas, resonancia magnética, radiografías, y otros. Pero todavía la sanidad, en lo que hace referencia al software y los sistemas aplicados a las terapias, es uno de los sectores en el que se emplean menos tecnologías, y en especial el sector de la salud mental. Dadas las numerosas ventajas que aporta la tecnología es importante descubrir las potenciales reacciones de los usuarios a la tecnología, así cómo afecta a su comportamiento y las razones por las cuales se ralentiza su expansión en el campo de la salud mental. El trabajo presentado en mi tesis trata de la introducción de las herramientas multimedia en la terapia de los pacientes de esquizofrenia, teniendo como objetivo principal el estudio exploratorio de la aceptación en el contexto de la terapia para la rehabilitación cognitiva. Para conseguir el objetivo principal y conocer el contexto de este trabajo se realizó un estudio teórico sobre la salud mental, y en particular sobre la esquizofrenia, sobre el uso tecnológico referido a la Interacción Hombre-Ordenador, sobre las tecnologías médicas y sobre la aceptación y adopción de la tecnología. El estudio teórico hizo possible el desarrollo del trabajo empírico y dió como resultado el diseño y desarrollo de un sistema multimedia para la rehabilitación cognitiva de los pacientes esquizofrénicos – sistema eSchi – y dos diferentes micro investigaciones con el objeto de complementar la información: (1) Caso de estudio sobre la aceptación de la tecnología (Sistema eSchi) por los pacientes de esquizofrenia; (2) Estudio aplicado a la aceptación de la tecnología por los expertos, relacionado con la relevancia de la creación de un modelo general para la aplicación de la tecnología en las terapias. Los resultados del estudio teórico sugieren la necesidad de organizar y generalizar los conceptos de la tecnología para la salud, dada la variedad de conceptos existentes sin una definición clara y universal. Sobre el estudio empírico es importante destacar: la buena recepción del sistema eSchi por parate de los pacientes, aunque se notificaron incidencias en la generalización de las actividades en los diferentes tipos de esquizofrenia; las dificultades para acceder al contexto clínico real, y la relevancia de crear un modelo de eTherapia que pueda ser aplicado en diferentes escenarios. Dada la naturaleza exploratoria de este trabajo, han surgido muchas preguntas que orientan nuevas propuestas de investigación, tales como el estudio de la aceptación de la tecnología, aplicado a diferentes usuarios, o el estudio de las causas que provocan resistencia en la introducción de las tecnologias en el sector de la salud. / Nos dias de hoje as Tecnologias da Informação e Comunicação e a Internet desempenham um papel fundamental no apoio às tarefas do dia-a-dia. A rapidez na execução de tarefas, o fácil acesso a todo o tipo de informação e a possibilidade de comunicação síncrona e assíncrona, tudo a qualquer hora e a partir de qualquer local, são algumas das vantagens que as tecnologias proporcionam e que auxiliam a realização das diversas actividades do quotidiano. De facto, nos dias que correm é quase impensável uma empresa ou instituição não fazer uso das tecnologias, uma vez que estas estão cada vez mais presentes, permitindo uma rápida execução de trabalhos administrativos, a divulgação de produtos ou serviços na WEB, a aprendizagem à distância ou semi-presencial, etc. Todavia, ainda existe alguma resistência às tecnologias. A área da saúde é uma das áreas que utiliza bastante tecnologia, designadamente no que se refere à utilização de equipamento (hardware) para a realização de exames, tais como ecografias, electrocardiogramas, electroencefalogramas, ressonâncias magnéticas, entre outras. No entanto, no que se refere a utilização de programas ou sistemas de apoio às terapias, é uma das áreas que menos utiliza a tecnologia, sobretudo no que diz respeito à área da saúde mental. Tendo em conta as inúmeras vantagens que as tecnologias podem proporcionar, é importante saber as reacções dos potenciais utilizadores de tecnologia no contexto de saúde mental, saber quais os factores que afectam o seu comportamento e quais os motivos que abrandam a expansão da tecnologia no campo da saúde mental. O trabalho apresentado nesta tese relaciona-se com a introdução de ferramentas multimédia num contexto de terapia de pacientes esquizofrénicos, tendo como principal objectivo o estudo exploratório da aceitação da tecnologia num ambiente de terapia para a reabilitação cognitiva destes pacientes. De forma a atingir o objectivo e a conhecer o contexto deste trabalho, foi realizado um estudo teórico relativo a: saúde mental, em particular à esquizofrenia; utilização das tecnologias, designadamente à Interacção Humano-Computador; tecnologias na área da saúde; e aceitação e adopção de tecnologia. O estudo teórico permitiu o desenvolvimento do trabalho empírico, que resultou no desenho e desenvolvimento de um sistema multimédia para a reabilitação cognitiva de pacientes esquizofrénicos – sistema eSchi – e em duas micro-investigações distintas que visam complementar a informação: (1) estudo de caso da aceitação da tecnologia (sistema eSchi) por parte de pacientes esquizofrénicos; (2) inquérito a autores da literatura científica em aceitação da tecnologia, referente à pertinência de criação de um modelo geral de aceitação da tecnologia aplicado às terapias. Os resultados do estudo teórico sugerem a necessidade de organização e generalização de conceitos relacionados com as tecnologias na saúde, tendo em conta a diversidade de conceitos existente, sem que existam definições precisas e universais. Do estudo empírico é importante destacar: a boa receptividade dos pacientes relativamente ao sistema eSchi, ainda que se tenha notado alguma dificuldade na generalização das actividades às diferentes tipologias de esquizofrenia; a dificuldade de acesso a contextos clínicos reais; e a importância de se criar um modelo de eTerapia que possa ser aplicado a diferentes cenários. Tendo em conta o carácter exploratório do trabalho apresentado nesta tese, muitas questões se levantaram, dando lugar a novas propostas de investigação, tais como o estudo da aceitação da tecnologia aplicado a diferentes utilizadores, ou o estudo das causas que provocam resistência à implementação das tecnologias no sector da saúde.

Thesis (Ph. D. in Biomedical Informatics)--Vanderbilt University, Dec. 2009. / Title from title screen. Includes bibliographical references.

Health communications providers strive to increase the health literacy of patients and care takers. Basic health literacy is a measure of a person’s ability to understand and act according to appropriate health information. The rise in the number of people attaining basic health literacy increases the amount of positive health behavior in the aggregate. Therefore, health communication providers can create a direct impact on tangible health results in a given population. The introduction of new technology has led to new ways of distributing health information, specifically through online media. Along with a new method of communication comes a need for a new way of evaluating it. As new media emerge and proliferate in the marketplace, different populations’ levels of health literacy become shaped in previously unpredictable ways. Current research suggests that significant differences in wealth and pervasive cultural features account for why distinct populations respond to these developments differently. Thus, the task of determining health communications’ success overall just got harder. It is now necessary to reassess health communications providers’ efficiency and effectiveness with regard to particular minority populations such as Hispanic/Latino adults. Throughout this paper, I refer to the Hispanic/Latino population’s unique characteristics as a case study for the derivation and application of universal health communication values. Thus, the purpose of this report is, based on current findings, to expose the primary values that describe and prescribe the efficacy of online health communication geared towards minorities such as Hispanic/Latino adults residing in the United States. This report concludes that the effectiveness of health information online is a function of three elements: access, quality, and communication strategy. Access represents the extent to which the intended user can search online for the sought-after health information, employ techniques to locate the intended information, and benefit from the search and comprehend the content. The quality prong of the health related Web content represents the useful indicia of accuracy and completeness of the information provided. The first two factors are a sine qua non for a robust health communication campaign. The communication strategy determines the audience reach and the relevance of the health message; both of which ultimately are the driving force for achieving lasting health behavior modification. Health information providers must periodically assess their services along the model’s benchmarks in order to achieve the highest possible levels of health literacy in their target populations and overall. Providers may engage in self-evaluation in order to gauge their own effectiveness, make improvements wherever necessary, and thereby ensure continued conformity to the aforementioned values. If/when these market players are unable or unwilling to adhere to this rubric, the public sphere may need to enforce it as a last resort. This paper does not investigate the merits of either public or private systems of governance; no matter how compliance is achieved, the modern promotion of optimal health literacy in minority communities (and hence, overall) requires that all three elements comprise a new, uniform model for online health communication initiatives. / text

In this study, a user-centred design approach was used to develop a mobile health application designed to support adult T1DM patients with their self-management routine. In the requirements gathering phase, an observational study of a diabetes clinic and patient interviews were conducted. An analysis of the data collected from this phase helped identify the functional design requirements used to guide the design. Using a rapid prototyping approach, data visualizations, game-based elements, carb-counting and social networking features were explored. The final prototype developed in this research was evaluated for its ease of use and perceived usefulness. The design was found to be generally easy to use. With respect to data visualizations, participants preferred the scatter plot view of their blood glucose readings to a bar chart. In addition, it was found that all participants wanted a way to track their HbA1c on a regular basis.

Objective The use of telehealth to provide health service delivery to rural and remote First Nations populations Canada-wide has greatly increased in recent years. Telehealth provides a mechanism for these disadvantaged and underserved communities to access timely healthcare services that would otherwise be expensive, delayed or unavailable due to geographic and resource limitations. There are numerous benefits, challenges and cultural issues that must be understood from a healthcare professional perspective when providing telehealth care to First Nations communities. Once educated with respect to these issues and experienced in providing care, healthcare professionals are well poised to provide feedback with respect to improving telehealth mediated health care delivery. This thesis examines these issues in the context of using telehealth for patient care, specifically cancer care. Methods This thesis is divided into two phases. Phase one is a literature review assessing the use of telehealth, specifically in rural and remote First Nations communities in Canada. Phase 2 is a study using a survey to assess healthcare professionals who provide telelehealth mediated patient care (in particular cancer care) to Northern BC First Nations communities. The participants were contacted through the use of an online survey tool to assess their perceptions of benefits, challenges, and cultural awareness when providing patient care. The survey population consisted of onsite health professionals and urban health professionals providing patient care to Northern BC First Nations communities via telehealth. Specific participant groups of interest were (1) onsite cancer care professionals, (2) onsite other (non-cancer) care professionals, (3) urban cancer care professionals, and (4) urban other (non-cancer) care professionals. Results The participant population of 45 was too limited a sample size for inferential statistics to be conducted. Therefore our survey data was interpreted by comparing the mean composite scores of the participants groups within each category. Our survey data implied that onsite cancer care providers found fewer benefits and more challenges with respect to telehealth than the other participant groups. We did not see any differences between the participant groups with respect to cultural awareness. Conclusion Based on the literature we reviewed telehealth can reduce costs and extend health care services in a timely manner while at the same time complement conventional care to build stronger health care community relationships. Despite these positive benefits found in literature, our survey found onsite cancer care professionals did perceive fewer benefits and more challenges regarding telehealth use. Specific issues raised by our survey participants that need to be addressed are the physical disconnect associated with telehealth and the perception that telehealth is a replacement for conventional care. / Graduate

In this study, a user-centred design approach was used to develop a mobile health application designed to support adult T1DM patients with their self-management routine. In the requirements gathering phase, an observational study of a diabetes clinic and patient interviews were conducted. An analysis of the data collected from this phase helped identify the functional design requirements used to guide the design. Using a rapid prototyping approach, data visualizations, game-based elements, carb-counting and social networking features were explored. The final prototype developed in this research was evaluated for its ease of use and perceived usefulness. The design was found to be generally easy to use. With respect to data visualizations, participants preferred the scatter plot view of their blood glucose readings to a bar chart. In addition, it was found that all participants wanted a way to track their HbA1c on a regular basis.

This degree project is a part of information and communication technology supported self-care system for the diabetes, mainly in diabetes data collection and visualization. The report is organized in four main sections: investigation and internet search, literature review, application design and implementation, system test and evaluation. Existed applications and research studies has been compared and, a responsive web application is developed aiming at providing relevant functionalities and services regarding diabetes self-management.

This thesis is dealing with problems of eHealth specified on particular conditions on the territory of the Czech Republic in context of national economy. Positive and negative aspects of implementation of eHealth solution into health services is evaluated in theoretic part of thesis as well as dominative problems which faces development of eHealth in the Czech Republic. Fundamental plans of support eHealth in the European Union and Czech Republic are described as well. Practical part of thesis is concerned with particular projects of eHealth in the Czech republic. Evaluation of project IZIP is performed due to questionnaire inquiry among the doctors. The example of contribution of implementation eHealth solution into health services is shown on Oblastní nemocnice Mladá Boleslav, a.s.