No description available.

Telehealth and telemedicine have revolutionized the healthcare system in terms of access to information and remote medical treatment. While there is a great deal of literature on current perceptions of telehealth care systems, relatively little is known about perceived user needs and acceptance of future telehealth systems. One way to assess future attitudes is to evaluate anticipated usage of telehealth devices through perceived advantages and disadvantages. Additionally, this study seeks to assess the reliability of a new measure of technology acceptance that capitalizes on human motivation using self-determination theory. An online survey consisted of an original 40-item measure of motivation to use telehealth technology, the Psychosocial Impact of Assistive Devices Scale (PIADS; Jutai & Day, 1996), questions adapted from Edwards et al. (2014) about perceived advantages and disadvantages of telehealth devices, and open-ended questions about advantages, disadvantages, and concerns of interacting with telehealth devices in the future. The open-ended questions were coded for themes. Results also indicated that there was a high reliability between the MUTT and the PIADS, however the MUTT was slightly more reliable. Significant correlations were found between the overall MUTT and subscales of autonomy, competence, relatedness, and goals, as well as moderate correlations between the subscales of the PIADS (i.e., competence, adaptability, self-esteem) and the MUTT. The results of this research will be discussed further.

Background: Patient experience is a crucial measure of patient-centeredness and quality care delivery. Digital health may contribute to patient experience by offering tailored and accessible avenues of care. Purpose: I explored how access to digital health, including telehealth, electronic health records, and online booking, may be associated with improved primary care experience for Ontario adults. Methods: This cross-sectional study included Ontario adults (16 years or older) who responded to waves 27 to 29 of the Health Care Experience Survey (HCES) between May 2019 and February 2020. Adults who did not see their primary care provider within the past 12 months or did not have a primary care provider were excluded. Outcomes included a summed patient experience score derived from five HCES experience-related questions and time to appointment for a health concern. Associations between outcomes and digital health interventions were tested through chi-square tests and logistic regression while adjusting for confounders and stratifying by health care utilization. Results: 3,700 participants met the inclusion criteria, where 2204 remotely communicated with their primary care provider (59.6%), 98 digitally accessed health records (2.6%), and 120 booked an appointment online (3.2%). We observed no significant associations between digital health tools and patient experience or time to appointments through chi-square tests. Participants with over three primary care visits in the past year who accessed online booking were 84% less likely to report poorer experience scores than participants without online booking access [Adjusted OR 0.16, 95% CI 0.02 – 0.56, p < 0.05]. Participants with three or fewer primary care encounters who accessed online booking, compared to the same reference group, were 72% less likely to report having a same or next day appointment with their primary care provider [Adjusted OR 0.25, 95% CI 0.08 – 0.64, p < 0.01]. Significant associations were observed between other sociodemographic factors and patient experience and access to care outcomes. Interpretation: The associations between digital health access and patient experience and access to care were inconsistent across different analyses. Despite experimental studies observing the benefits of digital health adoption in primary care, the effect is unclear in the real-world context. Furthermore, drawing conclusions on the relationship between digital health and quality care outcomes was limited due to the lack of adoption of digital health before the COVID-19 pandemic. As digital health adoption grows, future research should utilize the availability of further data to evaluate the effectiveness of digital health in Ontario primary care. / Thesis / Master of Science (MSc) / Patient outcomes such as experience and timeliness of care are frequently viewed as aims of quality health care. Although past studies indicate digital health supports quality care, the real-world effectiveness of digital health is underexplored in Ontario. This thesis aimed to explore relationships between real-world use of digital health in Ontario and primary care experience and access using survey data. This study found very few survey respondents used digital health before the COVID-19 pandemic. The primary care experience and access to care of adults who did use digital health did not differ very much from adults who did not use the technology. Some outcomes differed in adults who booked their primary care appointment online compared to those who did not; however, the study could not conclude on the relationship. Other personal factors such as age and residence area impacted the quality of primary care. This study was limited due to the lack of digital health users. Future studies should explore digital health's impact on patient outcomes beyond the pandemic.

A demanda crescente de usuários de implante coclear (IC) e a distribuição irregular de profissionais especializados no país, tornam necessário o deslocamento de pacientes por longas distâncias para os atendimentos, com consequente aumento dos custos diretos e indiretos do tratamento. A teleconsulta pode ser vista como uma alternativa em potencial para o acesso desta população a estes serviços. O presente ensaio clínico, randomizado, controlado, avaliou a eficácia da teleconsulta síncrona na programação dos sistemas de IC em usuários acompanhados em um Programa de Implante Coclear credenciado pelo Sistema Único de Saúde. Participaram do estudo 79 indivíduos com idades entre nove e 68 anos (média de 21,6), 41 do sexo masculino e 38 do sexo feminino, usuários de IC por um período de 0,58 a 24,75 anos. Estes indivíduos foram divididos em dois grupos, de acordo com o modo de programação do IC: controle (n=40), que realizou o procedimento face a face e experimental (n=39) que realizou a teleconsulta síncrona. Treze fonoaudiólogos sem experiência na programação do dispositivo atuaram como facilitadores das teleconsultas. Os procedimentos de programação do IC englobaram a telemetria de impedância, definição dos níveis de estimulação elétrica, varredura e balanceamento dos eletrodos e ajuste fino da programação. Como medidas de avaliação de resultados foram utilizados o tempo dispendido na consulta, a audiometria em campo livre, o percentual de reconhecimento de sentenças no silêncio e no ruído, o limiar de reconhecimento de sentenças no silêncio e ruído (HINT-Brasil), a avaliação da satisfação com a consulta (escala MISS-21) e de aspectos pertinentes à teleconsulta. Os facilitadores responderam as questões abertas referentes à suas impressões dos atendimentos. Os dados foram analisados por meio de estatística inferencial (testes t de Student, Wilcoxon, Mann-Whitney e correlação de Spearman). Os resultados mostraram que após a programação do IC, em média, os participantes apresentaram limiares audiométricos abaixo de 30 dB NA. O reconhecimento da fala pós atendimento, respectivamente para os grupos experimental e controle, foram de 81,3% e 83,8% (silêncio) e 57,9% e 58,1% (ruído). No HINT-Brasil os resultados foram, respectivamente, para os grupos experimental e controle 61,4 dB NA e 61,8 dB NA (silêncio) e relação S/R de 9,5 dB NA e 10,4 dB NA (ruído). Os participantes estiveram satisfeitos com a consulta. Não houve diferença estatisticamente significativa entre os grupos em nenhuma das medidas de resultado. Todos os participantes relataram que teleconsulta pode ser vista como uma alternativa viável ao atendimento face a face e sua aplicação clínica facilitaria a rotina de pacientes usuários de IC. Os facilitadores destacaram a sua importância para o aprendizado e como ferramenta de formação continuada. A teleconsulta síncrona foi eficaz na programação dos sistemas de IC e amplamente aceita pelos usuários e profissionais. / The growing number of cochlear implant (CI) users and the uneven distribution of specialized professionals in the country makes necessary patients traveling over long distances to receive care, with consequent increase in direct and indirect costs of treatment. The telehealth can be viewed as an alternative for this population to access such services. This clinical randomized, controlled clinical trial evaluated the efficacy of synchronous teleconsultation in the programming of CI systems in a Cochlear Implant Program accredited by the National Health System in Brazil. Participate in this study 79 subjects aged between nine and 68 years (average 21.6), 41 males and 38 females, CI users for a period from 0.58 to 24.75 years. The participants were divided into two groups, according to the nature of consultation: control group (n = 40), who performed the CI programming face-to-face and experimental group (n = 39) who performed the CI programming through the synchronous teleconsultation. Thirteen audiologists without experience in CI programming acted as facilitators of teleconsultation. The CI programming procedures encompassed the impedance telemetry, setting of electrical stimulation levels, sweeping and balancing of the electrodes and programming evaluation in live speech mode. The outcome measures were the time spent in consultation, free field audiometry, the percentage of sentence recognition in quiet and in noise, the sentence recognition threshold in silence and noise (HINT-Brazil), satisfaction with the consultation (MISS-21 scale) and aspects related to teleconsultation. The facilitators responded open questions regarding their impressions of the teleconsultations. Data were analyzed using inferential statistics (Student t test, Wilcoxon, Mann-Whitney and Spearman correlation). The results showed that after CI programming, on average, the participants had audiometric thresholds below 30 dB HL. The speech perception for the experimental and control groups post CI programming were respectively, 81.3% and 83.8% (in silence) and 57.9% and 58.1% (in noise). In HINT-Brazil the results were, respectively, for the experimental and control groups 61.4 and 61.8 dB (silence) and S/N ratio of 9.5 dB and 10.4 dB (in noise). Participants were satisfied with the teleconsultation. There were no statistically significant difference between the groups in any of the outcome measures. All participants reported that teleconsultation could be a viable alternative to facilitate CI users follow up routine. Facilitators emphasized the importance of teleconsultation for learning and for continuing education. The teleconsultation was effective in programming the CI systems and accepted by users and professionals.

Para alcançar diferentes círculos sociais aumentando a qualidade e os resultados na educação em saúde, é preciso identificar os arquétipos culturais para adequar as evidências científicas que comporão o núcleo central do conteúdo educacional. Essa pesquisa de doutorado desenvolveu um modelo e a produção de uma série audiovisual mesclando conteúdos científicos e estórias de ficção para produzir vídeos flexíveis que possibilitou entretenimento com educação formal, promoção de saúde e redução de riscos e agravos para adolescentes sobre Sexualidade, Doenças Sexualmente Transmissíveis, Saúde Oral e Saúde Nutricional. Os conteúdos científicos foram integrados a roteiros de ficção e dramaturgia baseados em situações reais (aprendizado vivencial), documentários interativos (debates com diferentes olhares), depoimentos de especialistas (consolidação do conhecimento), e unidades de conhecimento (computação gráfica 3D do corpo humano com narração). Os vídeos foram transmitidos por canal de televisão e utilizados integralmente em plataforma educacional para realização de curso de difusão à distância em nível nacional para promoção de saúde nas escolas com realização de 2 edições consecutivas / To reach different social circles keeping the raise of quality and results in health education, it is necessary to identify cultural archetypes to adequate the communication of scientific evidences, which will represent the central core of educational content. The present PhD research has developed a video based model, and produced a TV Show integrating scientific guidelines and fiction screenplays to produce flexible entertainment videos, resulting in entertainment with formal education, health promotion, and reduction of hazards and risks among teenagers about sexuality, sexual transmitted infections, oral health, and nutritional health. The scientific contents were integrated to fiction screenplays inspired in real life facts (experimental learning process), interactive documentaries (debates with different points of view), specialists\' statements (knowledge consolidation), and knowledge units (3D computer graphics of the human body). The video units were broadcast in national television, and fully applied in an educational platform as a distancelearning course with national range to promote education in health in schools for two consecutive years

Os conhecimentos, percepções e práticas dos professores pedagogos e médicos pediatras em relação às alterações de linguagem na criança, revelaram grande variação de conceitos, atitudes e condutas, demonstrando um conhecimento insatisfatório quanto ao desenvolvimento da linguagem infantil. Dado preocupante, visto que esses profissionais trabalham diretamente com a criança em desenvolvimento, sendo cruciais no acompanhamento dos conteúdos linguísticos, devendo estar atentos para os sinais de alerta e fatores de risco para alterações no desenvolvimento da linguagem, podendo facilitar o diagnóstico e a intervenção precoce. O objetivo deste estudo foi o de verificar e comparar o conhecimento adquirido entre os profissionais pedagogos e pediatras, sobre a aquisição e o desenvolvimento de linguagem infantil típica e suas possíveis alterações, como também, verificar a qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. A metodologia foi composta por 54 profissionais das áreas de Pediatria e Pedagogia, sendo estes divididos em dois grupos, GM médicos Pediatras (N=27) e GP Pedagogos (N=27). Ambos os grupos foram convidados a visitar o ambiente virtual de aprendizagem desenvolvido por Martins (2012) e modificado por Marson (2014) e disponibilizado na web no link: http://fonopediatria.com. Devido ao contato acessível às escolas, para o GP o convite e a participação foram feitas de forma presencial em 03 escolas públicas de um município do interior de São Paulo. No propósito de romper barreiras, como a distância e a falta de tempo, o GM participou somente à distância, sendo o convite por meio do envio de email, redes sociais, e sociedades relacionadas. O GP respondeu a dois questionários, sendo o primeiro referente à avaliação do conhecimento específico sobre aquisição e o desenvolvimento de linguagem infantil pré e pós-leitura do conteúdo do ambiente virtual de aprendizagem e o segundo quanto à qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. O GM respondeu ao questionário de avaliação sobre aquisição e desenvolvimento de linguagem infantil pós-leitura do material do ambiente virtual e também, ao questionário quanto à qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. Resultados: Quanto ao questionário de desenvolvimento de linguagem, ambos os grupos adquiriram conhecimento, porém os resultados revelaram que o GP apresentou melhor desempenho no pós-análise do ambiente virtual de aprendizagem quando comparado com o GM. Em relação à avaliação geral da qualidade e dos recursos tecnológicos do material proposto, para ambos os grupos as escalas de conteúdo, precisão, autoria, atualizações, público, navegação, links externos e estruturas foram classificada em nível de excelência. Conclusão: Os profissionais adquiriram conhecimento quanto à aquisição e o desenvolvimento da linguagem infantil, como também, sobre os fatores de risco para alterações de linguagem. Além disso, consideraram o ambiente virtual de aprendizagem como sendo excelente para todos os aspectos avaliados. / The knowledge, perceptions and practices of pedagogues teachers and medical pediatricians in relation to language disorders in children, revealed wide range of concepts, attitudes and conducts, demonstrating an unsatisfactory knowledge about the development of children\'s language. Worrying statistic, as these professionals work directly with children in development, being crucial in monitoring the linguistic content and must be alert to the warning signs and risk factors for changes in language development and can facilitate diagnosis and early intervention. The objective of this study was to verify and compare the knowledge acquired among professionals pedagogue and pediatricians of typical acquisition and development of children\'s language and its possible alterations, but also check the quality of the content presented and technological resource used by means of the use of interactive distance learning. The methodology consisted of 54 professionals in the areas of Pediatrics and Pedagogy, which are divided into two groups, GM Pediatricians (N = 27) and GP Pedagogues (N = 27). Both groups were invited to visit the Virtual Learning Environment developed by Martins (2012) and modified by Marson (2014) and available on the web at link: http://fonopediatria.com . Due to the flexible access to schools, to the GP the invitation and participation were made in person in 03 public schools a city in the interior of São Paulo. In order to break down barriers such as distance and lack of time currently experiencing medical professionals, the invitation and participation for GM was the distance and the call through sending e-mail, social networking, and related societies. The GP answered two questionnaires, the first relating to the specific knowledge of acquisition and development of children\'s language pre and post reading the virtual learning environment content and the second on the quality of the content presented and the technological resources used. The GM only answered the questionnaire on acquisition and development of children\'s language after reading the virtual learning environment, as well as the questionnaire on the quality of the content presented and the technological resources used. Results: As to the questionnaire of language development, the results revealed that the GP showed better performance in the post virtual learning environment analysis when compared to the GM. Referring to the general evaluation of the quality and technological features of virtual learning environment, for both groups the content scales, accuracy, authorship, updates, public, navigation, external links and structures were classified in level of excellence.. Conclusion: The professionals acquired knowledge on the acquisition and development of children\'s language, but also about the risk factors for language disorders. Moreover, they considered the virtual learning environment as excellent for all aspects evaluated.

Os conhecimentos, percepções e práticas dos professores pedagogos e médicos pediatras em relação às alterações de linguagem na criança, revelaram grande variação de conceitos, atitudes e condutas, demonstrando um conhecimento insatisfatório quanto ao desenvolvimento da linguagem infantil. Dado preocupante, visto que esses profissionais trabalham diretamente com a criança em desenvolvimento, sendo cruciais no acompanhamento dos conteúdos linguísticos, devendo estar atentos para os sinais de alerta e fatores de risco para alterações no desenvolvimento da linguagem, podendo facilitar o diagnóstico e a intervenção precoce. O objetivo deste estudo foi o de verificar e comparar o conhecimento adquirido entre os profissionais pedagogos e pediatras, sobre a aquisição e o desenvolvimento de linguagem infantil típica e suas possíveis alterações, como também, verificar a qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. A metodologia foi composta por 54 profissionais das áreas de Pediatria e Pedagogia, sendo estes divididos em dois grupos, GM médicos Pediatras (N=27) e GP Pedagogos (N=27). Ambos os grupos foram convidados a visitar o ambiente virtual de aprendizagem desenvolvido por Martins (2012) e modificado por Marson (2014) e disponibilizado na web no link: http://fonopediatria.com. Devido ao contato acessível às escolas, para o GP o convite e a participação foram feitas de forma presencial em 03 escolas públicas de um município do interior de São Paulo. No propósito de romper barreiras, como a distância e a falta de tempo, o GM participou somente à distância, sendo o convite por meio do envio de email, redes sociais, e sociedades relacionadas. O GP respondeu a dois questionários, sendo o primeiro referente à avaliação do conhecimento específico sobre aquisição e o desenvolvimento de linguagem infantil pré e pós-leitura do conteúdo do ambiente virtual de aprendizagem e o segundo quanto à qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. O GM respondeu ao questionário de avaliação sobre aquisição e desenvolvimento de linguagem infantil pós-leitura do material do ambiente virtual e também, ao questionário quanto à qualidade do conteúdo apresentado e dos recursos tecnológicos utilizados. Resultados: Quanto ao questionário de desenvolvimento de linguagem, ambos os grupos adquiriram conhecimento, porém os resultados revelaram que o GP apresentou melhor desempenho no pós-análise do ambiente virtual de aprendizagem quando comparado com o GM. Em relação à avaliação geral da qualidade e dos recursos tecnológicos do material proposto, para ambos os grupos as escalas de conteúdo, precisão, autoria, atualizações, público, navegação, links externos e estruturas foram classificada em nível de excelência. Conclusão: Os profissionais adquiriram conhecimento quanto à aquisição e o desenvolvimento da linguagem infantil, como também, sobre os fatores de risco para alterações de linguagem. Além disso, consideraram o ambiente virtual de aprendizagem como sendo excelente para todos os aspectos avaliados. / The knowledge, perceptions and practices of pedagogues teachers and medical pediatricians in relation to language disorders in children, revealed wide range of concepts, attitudes and conducts, demonstrating an unsatisfactory knowledge about the development of children\'s language. Worrying statistic, as these professionals work directly with children in development, being crucial in monitoring the linguistic content and must be alert to the warning signs and risk factors for changes in language development and can facilitate diagnosis and early intervention. The objective of this study was to verify and compare the knowledge acquired among professionals pedagogue and pediatricians of typical acquisition and development of children\'s language and its possible alterations, but also check the quality of the content presented and technological resource used by means of the use of interactive distance learning. The methodology consisted of 54 professionals in the areas of Pediatrics and Pedagogy, which are divided into two groups, GM Pediatricians (N = 27) and GP Pedagogues (N = 27). Both groups were invited to visit the Virtual Learning Environment developed by Martins (2012) and modified by Marson (2014) and available on the web at link: http://fonopediatria.com . Due to the flexible access to schools, to the GP the invitation and participation were made in person in 03 public schools a city in the interior of São Paulo. In order to break down barriers such as distance and lack of time currently experiencing medical professionals, the invitation and participation for GM was the distance and the call through sending e-mail, social networking, and related societies. The GP answered two questionnaires, the first relating to the specific knowledge of acquisition and development of children\'s language pre and post reading the virtual learning environment content and the second on the quality of the content presented and the technological resources used. The GM only answered the questionnaire on acquisition and development of children\'s language after reading the virtual learning environment, as well as the questionnaire on the quality of the content presented and the technological resources used. Results: As to the questionnaire of language development, the results revealed that the GP showed better performance in the post virtual learning environment analysis when compared to the GM. Referring to the general evaluation of the quality and technological features of virtual learning environment, for both groups the content scales, accuracy, authorship, updates, public, navigation, external links and structures were classified in level of excellence.. Conclusion: The professionals acquired knowledge on the acquisition and development of children\'s language, but also about the risk factors for language disorders. Moreover, they considered the virtual learning environment as excellent for all aspects evaluated.

Para alcançar diferentes círculos sociais aumentando a qualidade e os resultados na educação em saúde, é preciso identificar os arquétipos culturais para adequar as evidências científicas que comporão o núcleo central do conteúdo educacional. Essa pesquisa de doutorado desenvolveu um modelo e a produção de uma série audiovisual mesclando conteúdos científicos e estórias de ficção para produzir vídeos flexíveis que possibilitou entretenimento com educação formal, promoção de saúde e redução de riscos e agravos para adolescentes sobre Sexualidade, Doenças Sexualmente Transmissíveis, Saúde Oral e Saúde Nutricional. Os conteúdos científicos foram integrados a roteiros de ficção e dramaturgia baseados em situações reais (aprendizado vivencial), documentários interativos (debates com diferentes olhares), depoimentos de especialistas (consolidação do conhecimento), e unidades de conhecimento (computação gráfica 3D do corpo humano com narração). Os vídeos foram transmitidos por canal de televisão e utilizados integralmente em plataforma educacional para realização de curso de difusão à distância em nível nacional para promoção de saúde nas escolas com realização de 2 edições consecutivas / To reach different social circles keeping the raise of quality and results in health education, it is necessary to identify cultural archetypes to adequate the communication of scientific evidences, which will represent the central core of educational content. The present PhD research has developed a video based model, and produced a TV Show integrating scientific guidelines and fiction screenplays to produce flexible entertainment videos, resulting in entertainment with formal education, health promotion, and reduction of hazards and risks among teenagers about sexuality, sexual transmitted infections, oral health, and nutritional health. The scientific contents were integrated to fiction screenplays inspired in real life facts (experimental learning process), interactive documentaries (debates with different points of view), specialists\' statements (knowledge consolidation), and knowledge units (3D computer graphics of the human body). The video units were broadcast in national television, and fully applied in an educational platform as a distancelearning course with national range to promote education in health in schools for two consecutive years

No description available.

<p>The present thesis explores the potential role and implications of technology in elderly care from the users’ perspective. This exploration is undertaken in terms of five empirical studies of a telehealth project and a meta-analysis of their contributions. An important insight emerging from this work is the need to rethink the human subject as a body, rather than as a mere mind using technology. The thesis draws on phenomenology to reconceptualize the user of technology, and on this basis, to theorize about the potential role and implications of technology in care. It concludes that, in combination with humans that integrate technology with their other sensory and emotional capacities, technology can produce affect. The findings indicate that technology can contribute to senior citizens feeling safe, cared for and thereby less isolated. The findings further demonstrate that, because of the perceptual capacity gained from technology, the care workers become aware of new health problems that urgently call for their sensory and emotional responsiveness.</p><p>On this ground, the thesis challenges the determinist view that technology threatens the essentially ‘human’ aspect; rather, it concludes that feeling and other bodily resources are fundamental in the use of technology. Indeed, technology activates such ‘human’ capabilities.</p><p>Hence, technology plays a role as a complement for rather than as a replacement of care workers. It increases their work burden by informing them about new needs. This may improve care quality but at an increased cost, which is relevant from a practical perspective. At a more general level, the thesis challenges the dualist legacies in mainstream management research that have sought to divorce mind form body, nature from culture and reason from emotion. It can therefore contribute to broader theoretical developments and fuel existing debates beyond the care setting.</p>