Investigating the digital health acceptance of Korean baby boomers: Comparative study of telemedicine and wearable healthcare devices

ObjectiveIn the COVID-19 era, the importance of and need for digital health services, such as telemedicine and wearable healthcare devices, are increasing. Although these services are treasured by older adults, their acceptance rates remain low. Thus, we attempted to find ways to enhance the acceptance rates of these services by investigating factors that influence the digital health acceptance of baby boomers. Based on the behavioral model of health service use and a multi-dimensional value perspective, we developed a research model to compare the factors influencing telemedicine and wearable healthcare device acceptance.MethodsTo examine the research model, we conducted face-to-face surveys with 300 baby boomers. The survey consisted of two sections: telemedicine and wearable healthcare devices. We used measurement instruments that had been validated in previous studies.ResultsEach research model's measurement model and structural model were evaluated. The reliability and validity of the measurement items of each model were satisfactory. The structural model test illustrates that three beliefs (usefulness, information, and cost saving) are important for the acceptance of telemedicine and wearable healthcare devices. Reassurance and convenience only significantly influence telemedicine and wearable healthcare devices, respectively. Among need and enabling factors, subjective health and income affect the intention to accept telemedicine and wearable healthcare devices. Conclusions: This study has theoretical implications in that it applied multidisciplinary theories by reflecting on the convergence characteristics of digital health, which are health and digital. In addition, it provides managerial implications to promote baby boomers' acceptance of digital health services.     

Technology and medical practice

Abstract One of the most significant developments in healthcare over the past 25 years has been the widespread deployment of information and communication technologies. These technologies have had a wide‐ranging impact on the organisation of healthcare, on professional practice and on patients’ experience of illness and its management. In this paper we discuss the ways in which Sociology of Health and illness has provided a forum for the analysis of these new technologies in healthcare. We review a range of relevant research published in the Journal; papers that address such issues as dehumanisation and emotional labour, professional practice and identity, and the social and institutional shaping of technology. Despite these important initiatives, we suggest that information and communication technologies in healthcare remain relatively under‐explored within the Journal and, more generally, by the sociology of health and illness and point to developments in cognate areas which may have some bearing upon the analysis of technology in action.     

Telemedicine,COVID-19, and disparities: Policy implications

While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.     

Telemedicine is an important aspect of healthcare services amid COVID‐19 outbreak: Its barriers in Bangladesh and strategies to overcome

The current pandemic of coronavirus disease 19 (COVID‐19) has been a global concern since early 2020, where the number of COVID‐19 cases is also on a rapid surge in Bangladesh with the report of a total of 276,549 cases after the detection of the first three cases in this country on 8 March 2020. The COVID‐19 pandemic has made a seismic shift in the healthcare delivery system, where physician offices have accelerated digital health solutions at record speed, putting telemedicine (i.e., telehealth) at centre stage. Amid the severely contagious COVID‐19, telemedicine has moved from being an optional service to an essential one. As the developing country, there are some barriers to get evenly distributed advantages of this approach due to the digital divides and disparities. In this commentary, we have described the importance of telemedicine service amid the outbreak of COVID‐19 in Bangladesh, the barriers and challenges that the country is facing to implement this approach and the strategies to overcome these barriers in this developing country.     

Human factors considerations in implementing telemedicine systems to accommodate older adults

The number of older adults is increasing, and telemedicine has the potential to improve their access to health care. Telemedicine systems have been shown to benefit older adults by increasing peer support interactions, providing health-care access to older adults in rural communities, reducing the cost of health care, increasing exercise, reducing pain and depression, and, perhaps most important, improving functional independence. However, older adults may have different needs from other users when interacting with telemedicine systems, because of age-related changes in perceptual, motor and cognitive abilities. The design of telemedicine technologies should, therefore, capitalize on older adults' strengths while minimizing their weaknesses. The field of human factors has much to offer in optimizing interactions between older adults and telemedicine technologies. Future research should take advantage of human factors methodologies to best design telemedicine technologies for an older population.     

Telemedicine in the future

Telemedicine can provide a compelling alternative to conventional acute, chronic and preventive care, and can improve clinical outcomes. In the industrialized world, it is likely that telemedicine will continue to move healthcare delivery from the hospital or clinic into the home. In the developing world or in regions with limited infrastructure, telemedicine will mainly be used in applications that link providers based at health centres, referral hospitals and tertiary centres. The future of telemedicine will depend on: (1) human factors, (2) economics and (3) technology. Behaviours related to technology affect change at the individual, organizational and societal level. Personnel shortages and decreasing third-party reimbursement are significant drivers of technology-enabled health care in the industrialized world, particularly in the areas of home care and self-care. We can safely assume that developments in mobile communications, sensor devices and nanotechnology will alter the way that health care is delivered in the future. The growth and integration of information and communication technologies into health-care delivery holds great potential for patients, providers and payers in health systems of the future. Perhaps the most difficult question to answer, however, is 'When will telemedicine become part of the standard of care?'     

Experiences from the frontline: An exploration of personal advisers’ practice with claimants who have health‐related needs within UK welfare‐to‐work provision

Recent UK welfare reforms have been less successful than expected by the Government in supporting unemployed people with long‐term illness into work. Frontline workers remain a core element of the new welfare‐to‐work machinery, but operate within a changed organisational and policy landscape. These changes raise important questions regarding whether and how claimants’ health‐related barriers to work are considered. This paper examines the UK welfare‐to‐work frontline worker's role with claimants who have long‐term illness. Fieldwork observations in three not‐for‐profit employment support services and semi‐structured interviews with 29 participants (claimants, frontline workers, healthcare professionals and managers) were conducted between 2011 and 2012. Participant observation of the wider welfare‐to‐work arena was initiated in 2009 and continued until 2013. A qualitative methodology drawing on ethnographic principles was adopted. Thematic analysis of the data was carried out. The findings show that the frontline worker plays a key role in assessing and addressing claimants’ health‐related barriers to work. Two important health‐related role dimensions were identified: a health promoter role which involved giving health promotional advice to claimants about their general health; and a health monitor role which involved observing and questioning claimants about their general health. Frontline workers’ practice approaches were shaped by organisational and individual factors. Integration between the National Health Service and employment support services was limited, and the findings suggested improvements were required to ensure an adequate response to claimants’ health‐related needs to support their journey into work.     

Digital technologies in primary care: Implications for patient care and future research

Digital health is the convergence of digital technologies with health, healthcare, living, and society. Contrasting with the slow trend during the last decades, in the last few years, we have observed an expansion and widespread adoption and implementation. In this paper, we revisit the potential that digital health presents for the delivery of higher quality, safer and more equitable care. Focussing on three examples – patient access to health records, big data analytics, and virtual care – we discuss the emerging opportunities and challenges of digital health, and how they can change primary care. We also reflect on the implications for research to evaluate digital interventions: the need to evaluate clear outcomes in light of the six dimensions of quality of care (patient-centredness, efficiency, effectiveness, safety, timeliness, and equity); to define clear populations to understand what works and for which patients; and to involve different stakeholders in the formulation and evaluation of the research questions. Finally, we share five wishes for the future of digital care in General Practice: the involvement of primary healthcare professionals and patients in the design and maintenance of digital solutions; improving infrastructure, support, and training; development of clear regulations and best practice standards; ensuring patient safety and privacy; and working towards more equitable digital solutions, that leave no one behind.     

Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio‐material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long‐standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time‐lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision‐making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.     

Stand, Möglichkeiten und Grenzen der Telemedizin in Deutschland

In Germany there are many successful special applications of telemedicine. However, these projects are generally not extendable to the whole nation because of the highly complex German health care system, limited funding, heterogeneous IT standards in ambulatory and hospital care, insufficient official electronic health card use, the different data protection and privacy regulations of the federal and state governments, doubts of physicians and patients as well as unequal costs and benefits for the various persons involved in telemedicine. These problems can be overcome by better legal regulations for a seamless interaction of ambulatory and hospital care, improved IT standards and support of the interoperability of telemedical and other health care IT, adaption of the health care organization, work flow and reimbursement of telemedicine services, better information and education of all persons involved about the necessity and limits of telemedicine. There are no doubts about the benefits of telemedicine but to achieve these advantages for the whole healthcare system in Germany requires much work, time and good will.     

Bringing critical realism to nursing practice: Roy Bhaskar's contribution

In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complexities of the social world. In recent evidence from healthcare literature, there has been a surge in research using realist methodology (realist evaluation and realist synthesis), which is underpinned by the philosophy of critical realism and which offers a different perspective to understanding nursing and healthcare problems through the realist lens. However, we suggest that sufficient attention is not always paid to the philosophical roots of this methodology. In this paper, we provide insight into Bhaskar's work and demonstrate how research positioned within critical realism and realist methodology can advance nursing and healthcare‐related knowledge. Through shining a light on Bhaskar, we illustrate how critical realism philosophy is a natural fit with human and health science enquiry, including nursing.     

A research impact model for work and health

Research organizations, governments and funding agencies are increasingly interested in the impact of research beyond academia. While a growing literature describes research impacts in healthcare and health services, little has focused on occupational health and safety research. This article describes a research impact model that has been in use for over a decade. The model was developed to track and describe the impact of research conducted by a mid‐sized institute that focuses on work and health. Model development was informed by existing models, with the goal of contextualizing the institute's case studies describing three types of research impact: evidence of the diffusion of research; evidence of research informing decision‐making; and evidence of societal impact. A logic model describes research actions and outcomes, as well as key audiences and knowledge transfer approaches. A unique element is its indication of the level of difficulty in determining types of impact. The model compares well with current research impact models developed or used in healthcare and health services research, and it has been useful in guiding a mid‐sized research organization's process for tracking and describing the impact of its research. It may be useful to other small and mid‐sized research organizations that focus on workplace health and safety.     

‘You're just a locum’: professional identity and temporary workers in the medical profession

Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi‐structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory‐driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety.     

5G技术助力“互联网＋医疗”健康管理模式发展

文章介绍了5G技术在医疗行业的应用和实践,包括远程医疗探视与护理、远程医疗会诊、远程医疗诊断、5G急救通道、远程机器人手术等,并结合5G技术的应用特点和智慧医疗发展要求,指出了5G医疗产业统筹化、智能化、个性化的发展趋势,以及远程医学研究、体征监测管理研究、精准医学研究、高精度测量研究、公众健康管理研究的主要研究方向,为5G技术在“互联网+医疗”中的深度融合应用和推进智慧医疗建设提供参考     

Treading Water: The No-Growth Investment in Health Services Research

There is a “perfect storm” brewing in the American healthcare system. Healthcare spending has grown faster than our economy for many years and is projected to double in as little as 10 years. In spite of what we spend on healthcare, research tells us that we only receive appropriate care half the time. We are simply not getting what we are paying for. Health services research provides the data and the evidence needed to make better decisions, design healthcare benefits, and develop effective policies to optimize healthcare financing, facilitate access to healthcare services, and improve healthcare outcomes. Despite what we know and what we can learn from health services research, federal funding for this important field continues to erode. This article provides a primer on the federal budget process and summarizes findings from the Federal Funding for Health Services Research 2007.Health services research (HSR) explores healthcare costs, quality, and access and seeks ways to improve healthcare delivery, safety, availability, and affordability. HSR has been defined as a “multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of healthcare, and ultimately our health and well-being.”1 In particular, HSR identifies what treatments work best when, for whom, and at what sites of service; it evaluates how best to finance healthcare and control spending; it helps inform healthcare benefit design; it translates the innovations from basic bench science into medical practice, allowing providers, health plans, and patients to make more informed health choices. HSR is the link between research and patient care.Since 2003, the Coalition for Health Services Research (coalition) has been tracking the federal government''s investment in HSR by collecting budgetary data from federal agencies that principally fund HSR. The coalition has been collecting annual budgetary data from the federal agencies that fund HSR. In the past 5 years, we have found that despite what we can learn from HSR, there has been an erosion of federal funding for this field, in part because of competing federal priorities, a constrained fiscal climate, and polarizing partisan politics. These trends have likely hindered the ability of the researchers to examine the healthcare system and identify innovative and effective solutions. If left unchecked, the declining investment in HSR may have further implications for the study of health and patient care in the future.This article provides a primer on the federal budget process and summarizes findings from Federal Funding for Health Services Research 2007, the fifth annual report of HSR expenditures.2Federal agencies have not developed or adopted a uniform definition for HSR or standard categories for collecting and reporting data about reimbursement and funding methodologies, health disparities, patient safety, and chronic disease management. Therefore, questions remain about the breadth and scope of activities included in the funding totals presented in this article. Investments in what any one agency has self-reported as “health services research” may not be equivalent to what is reported by another agency. For example, budget numbers can reflect entire agency budgets, including overhead costs or a rough estimate of dollars spent on HSR. Nevertheless, our data offer the best available estimate on the federal government''s investment in this area.     

Telemedicine and mobile health with integrative medicine in developing countries

African Home-based Care (AHC) and African Traditional Medicine (ATM) provide a number of self-sustainable primary health care workers in a rural region with the appreciation of ancestral knowledge and its contextual management. Even though most urban residents are able to afford and use conventional medicine to large extent, the implementations of modern medicine in rural areas and in poor peri-urban areas are limited. Our proposal is on how telemedicine solutions could enhance AHC and ATM practices and facilitate simultaneous delivery of both modern and traditional healthcare with evident added value to the recipients. This is indeed a fresh angle, as information and communication technologies (ICTs) could play an important role in developing countries in the management of patients and enhance quality care for patients in particular and healthcare (both traditional and modern heath systems) in general. This delivers comprehensive insights concerning the implementation on telemedicine where integrative medicine and African traditional medicine is in the back seat.     

Telemedicine in daily practice: Addressing legal challenges while waiting for an EU regulatory framework

Telemedicine is revolutionising conventional healthcare thanks to countless technological devices that allow patients to remotely access a huge range of care services. In the coming years, the spread of telemedicine will arguably redesign the geography of EU healthcare, with main repercussions on the organisation of the Member States’ health systems and the extent of health protection in the EU. Given the current lack of an EU regulatory framework for telemedicine, this analysis aims to explore the most relevant acts issued in the field of (conventional) healthcare in order to assess their suitability for telemedicine services. In the conclusion, the need for an adequate regulatory framework of telemedicine in the EU will be discussed, in order to sustain its spread in daily practice and to guide patients and healthcare professionals towards a safe use of these innovative services.     

“It’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender‐affirming care from transgender and gender diverse adolescents in the United States

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents’ experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender‐related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi‐structured interviews with 12 TGD‐identified adolescents aged 14–17, living in Minnesota, USA in 2017–2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers’ concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth.     

The technical and interpersonal aspects of telemedicine: effects on doctor-patient communication

The influence of telemedicine on the nature and content of doctor-patient communication stems from both its technical and its interpersonal aspects. While the technical aspects are concerned with the communication technologies used and the clinical processes enabled by those technologies, the interpersonal aspects are concerned with relationships between system personnel, providers and patients, and the way in which those relationships are organized. On the one hand, this paper posits that the influence of the technical environment stems from depersonalization of the doctor-patient relationship, participatory enhancements and impediments, and sensory and non-verbal limitations. On the other hand, it posits that the influence of the interpersonal environment stems from third-party participation, social and professional distancing, and underdeveloped norms and standards. A combined positivist and interpretivist evaluation strategy would enable researchers to make better-informed connections between telemedicine, medical encounter behaviour and health outcomes.     

Patient data work: filtering and sensing patient-reported outcomes

With digital patient-reported outcome (PRO) tools in clinical practice, patients are given new tasks of providing data that aim at supporting and individualising care, simultaneously reducing unnecessary clinical visits. While the innovative potential of mobilising PRO data for care is increasingly explored, little attention is given to the efforts that the provision of PRO data rests on – that of the patients. Based on ethnographic fieldwork carried out among cancer patients receiving PRO-based follow-up care, we argue that with the increased reliance on patient-generated health data, we need to consider patients’ data work. Drawing on emerging literature on healthcare professionals’ data work and the rich work in sociology and Science and Technology Studies (STS) on patients’ active engagement in shaping and managing care, we conceptualise PRO patient data work as two simultaneous processes: the process of data filtering – patients filter information to fit the envisaged recipient and purpose; and the process of data sensing – patients evaluate their embodied experiences. By doing so, we show that patients’ data work has implications beyond simply providing data that represent their experiences.