Despite rapid advances in technology, there is currently a complex, and somewhat disjointed approach to the way health information is collected, stored, and organized for both healthcare consumers and professionals. Incompatible electronic medical records from various healthcare providers add to the complexity of a system tasked with delivering a patient’s relevant medical information in a timely manner to the appropriate point of care. Personal health records (PHR) grew out of the efforts to produce an integrated electronic record to manage the multifaceted aspects of healthcare required by both healthcare consumers and professionals. PHRs are a transformative technology with the potential to alter patient-provider relationships in a way that produces a more efficient and cost effective healthcare system as a result of better patient outcomes. PHRs can potentially include a wide variety of users ranging from the lay public to clinical professionals. As such, it is important to identify potential user groups and their corresponding health information needs in order to design PHRs that maximize accessibility, usability, and clinical relevance. This study focused on laypeople who represented a wide age-range of individuals, evenly split in gender, with an above average level of computer literacy. Most of the participants had not used an electronic PHR prior to this study. However, after a hands-on session with PHR software, most participants found it to be easy to use, accompanied with the functionality they expected from such a system. Most participants were satisfied that an electronic PHR would meet their health information needs and would recommend the use of PHRs to family and friends. Anyone in the general public is a potential PHR user. However, this study found that individuals with chronic conditions and those with complex health needs had the most to gain from using a PHR as an integral part of their healthcare routine. This study also demonstrated that an individual’s health condition has a stronger influence on their perceptions about the usefulness of PHRs than does their demographic background (age, education, computer literacy). Finally, this study established that PHRs are considered by participants of the study to be useful tools in meeting their health information needs. / Graduate / 0723 / 0769 / 0984 / dguarin@uvic.ca

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<p>In spite of numerous benefits that are suggested for consumers’ utilizing integrated personal health record (PHR) systems, research has shown that these systems are not yet popular or well known to consumers. Therefore, research is needed to understand what would rise adoption rates for these systems. Hence, the main objective of this dissertation is to develop and empirically validate a theoretical model for explaining consumers’ intention to use integrated PHR systems.</p> <p>In developing the theoretical model of this dissertation, theories of information systems adoption were integrated with Self-Determination Theory (SDT), which is a well established theory from the Psychology literature that explains the mechanism through which individuals become more self-determined, i.e., motivated to take more active (rather than passive) roles in undertaking different behaviours. Taking such an active role by consumers, in the context of personal health management, is suggested to be necessary for realizing the full benefits of integrated PHR systems.</p> <p>The proposed theoretical model was validated using the PLS approach to structural equation modeling, on data collected from a cross-sectional survey involving 159 participants with no prior experience in using PHR systems. A stratified random sampling was employed to draw a representative sample of the Canadian population. The results show that consumers with higher levels of self-determination in managing their health are more likely to adopt integrated PHR systems since they have more positive perceptions regarding the use of such systems. Further, such self-determination is fueled by autonomy support from consumers’ physicians as well as consumers’ personality trait of autonomy orientation.</p> <p>This study advances the theoretical understanding of integrated PHR system adoption, and it contributes to practice by providing insightful implications for designing, promotion, and facilitating the use of integrated PHR systems among consumers.</p> / Doctor of Philosophy (PhD)

Health information technology (HIT) aims to improve healthcare services by means of technological tools. Patient centered technologies such as personal health records are relatively new HIT tools that enable individuals to get involved in their health management activities. These tools enable the transformation of health consumer behavior from one of passive health information consumers to that of active managers of their health information. This new role is more interactive and engaged, and with such tools, patients can better navigate their lives, and exercise more control over their treatments, hence potentially also leading to improvement in the quality of health services. Despite the benefits of using personal health record systems for health consumers, the adoption rate of these systems remains low. Many free and paid services have not received the uptake that had been anticipated when these services were first introduced. This study investigates some factors that affect the adoption of these systems, and may shed light on some potential reasons for low adoption rates. In developing the theoretical model of this study, social cognitive theory (SCT) and technology acceptance model (TAM) were utilized. The theoretical model was validated through a quantitative survey-based methodology, and the results were derived using structural equation modeling techniques. The key findings of this study highlight the role of individual and environmental factors as determinants of end-user behavior in the adoption of personal health records. The results show that in addition to perceptions of usefulness and ease of use, factors such as social norms and technology awareness are also significantly associated with various factors that directly and indirectly affect intention to use PHRs Based on the results obtained in this study, recommendations are offered for technology providers, and possible directions are proposed for academic researchers.

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Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-19T16:23:48Z No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) / Made available in DSpace on 2017-04-19T16:23:48Z (GMT). No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) Previous issue date: 2017-02-21 / Nenhuma / O crescimento constante da expectativa de vida no Brasil trouxe à tona um desafio para a rede de atendimento de saúde. A maior longevidade da população resulta diretamente no aumento do registro de doenças crônicas, elevando a procura por atendimento médico. A superação desse desafio passa pela mudança no modelo de atendimento de saúde, cujo objetivo é inserir o paciente como membro ativo no cuidado ao próprio bem-estar. Esse novo modelo gerou demanda por novas soluções de tecnologia de informação e comunicação capazes de atender satisfatoriamente ao paciente, como soluções em computação móvel e ubíqua. Assim, o presente trabalho propõe o modelo chamado AllHealthcare, consistindo em uma solução de registro de saúde pessoal (PHR), em que o próprio paciente é capaz de construir um Perfil de Acompanhamento Dinâmico (PAD) para seus cuidados de saúde, de acordo com suas necessidades, e alterá-lo conforme novas demandas ou focos venham a ser considerados. Tal dinamismo na construção de um perfil personalizado é alcançado devido ao modelo proposto se basear em arquétipos do padrão OpenEHR, o que também atribui a característica de interoperabilidade semântica à presente proposta. Em revisão de pesquisas com foco em PHR, grande parte das soluções encontradas são concebidas e focadas para tratamento de determinada doença, ou seus modelos não atendem a um conjunto de requisitos operacionais importantes e atuais, como a mobilidade do cuidado de saúde e a interoperabilidade semântica das informações de saúde. Do modelo proposto, foi implementado um protótipo funcional, o qual passou por três etapas de avaliação. Nas três etapas de avaliação os resultados foram positivos e e os participantes apontaram um conjunto de possíveis melhorias, mesmo assim, aplicando-se o modelo de aceitação de tecnologia (TAM) a 22 usuários do protótipo, obteve uma aceitação média de 86,6%. / The constant growth of life expectancy in Brazil brought to the focus a challenge for the healthcare systems. The increased longevity of the population directly results in increased registration of chronic diseases, increasing the demand for healthcare. Overcoming this challenge is to change the health care model, whose goal is to insert the patient as an active member in the care of own welness. This new model has generated demand for new information and communication technologies solutions able to satisfactorily meet the patient, as solutions in mobile and ubiquitous computing. Thus, this paper proposes the model called AllHealthcare, consisting of a personal health record (PHR) solution that the patient is able to build a Dynamic Accompanying Profile (PAD) for their health care, according to their needs, and change it as new demands or focus may be considered. This dynamism in building a custom profile is achieved due to the proposed model is based on openEHR standard archetypes, which also provides the feature of semantic interoperability to this proposal. In a review research focusing on PHR, most of the solutions founded are designed and focused for treatment of a particular disease or their models do not fulfill a number of important and current operational requirements, such as healthcare mobility and semantic interoperability of health information. From the proposed model, a functional prototype was implemented, underwent through three stages of evaluation. In the three evaluation stages, the results were positive and the participants pointed out a set of possible improvements, even though applying the technology acceptance model (TAM) to 22 prototype users, obtained an average acceptance of 86.6%.