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Health Informatics Journal Sep 2019Given the increasingly widespread use of mobile phones in the developing world, the application of this technology for healthcare (also referred to as m-health) has...
Given the increasingly widespread use of mobile phones in the developing world, the application of this technology for healthcare (also referred to as m-health) has tremendous potential. However, there is a need for more research on factors that influence the sustainable and scalable adoption of m-health in developing countries. To fill this gap, in this study, drawing on the theory of diffusion of innovation, we conducted in-depth interviews with 29 health professionals in Sri Lanka to understand their views on the benefits and barriers to adopting m-health. Participants had mixed views on the adoption of this technology. Reasons for m-health adoption included efficiency and usefulness in emergency situations. Barriers to adoption included risks for miscommunication/misinterpretation and lack of systems/policies for implementing m-health technology. With regard to the innovation-decision process, most participants appear to be in the stages of "persuasion" and "decision"; with regard to degree of innovativeness, interviewees comprise a mix of "early adopters" and "laggards." Assuming mobile health apps afford improvements in health outcomes for developing countries, contextual factors in each national setting should inform design and implementation of m-health interventions.
Topics: Adult; Female; Health Personnel; Humans; Interviews as Topic; Male; Middle Aged; Perception; Qualitative Research; Sri Lanka; Telemedicine
PubMed: 28825329
DOI: 10.1177/1460458217725903 -
BMC Medical Informatics and Decision... Jul 2018Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized...
BACKGROUND
Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures.
METHODS
A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis.
RESULTS
Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05).
CONCLUSIONS
Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.
Topics: Adult; Aged; Aged, 80 and over; Facilities and Services Utilization; Female; Hospitalization; Humans; Inpatients; Male; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Patient Portals; Patient Satisfaction; Retrospective Studies
PubMed: 30053809
DOI: 10.1186/s12911-018-0644-4 -
JMIR MHealth and UHealth Mar 2018Although mobile technologies such as smartphone apps are promising means for motivating people to adopt a healthier lifestyle (mHealth apps), previous studies have shown...
BACKGROUND
Although mobile technologies such as smartphone apps are promising means for motivating people to adopt a healthier lifestyle (mHealth apps), previous studies have shown low adoption and continued use rates. Developing the means to address this issue requires further understanding of mHealth app nonusers and adoption processes. This study utilized a stage model approach based on the Precaution Adoption Process Model (PAPM), which proposes that people pass through qualitatively different motivational stages when adopting a behavior.
OBJECTIVE
To establish a better understanding of between-stage transitions during app adoption, this study aimed to investigate the adoption process of nutrition and fitness app usage, and the sociodemographic and behavioral characteristics and decision-making style preferences of people at different adoption stages.
METHODS
Participants (N=1236) were recruited onsite within the cohort study Konstanz Life Study. Use of mobile devices and nutrition and fitness apps, 5 behavior adoption stages of using nutrition and fitness apps, preference for intuition and deliberation in eating decision-making (E-PID), healthy eating style, sociodemographic variables, and body mass index (BMI) were assessed.
RESULTS
Analysis of the 5 behavior adoption stages showed that stage 1 ("unengaged") was the most prevalent motivational stage for both nutrition and fitness app use, with half of the participants stating that they had never thought about using a nutrition app (52.41%, 533/1017), whereas less than one-third stated they had never thought about using a fitness app (29.25%, 301/1029). "Unengaged" nonusers (stage 1) showed a higher preference for an intuitive decision-making style when making eating decisions, whereas those who were already "acting" (stage 4) showed a greater preference for a deliberative decision-making style (F=21.83, P<.001). Furthermore, participants differed widely in their readiness to adopt nutrition and fitness apps, ranging from having "decided to" but not yet begun to act (stage 2; nutrition: 6.88%, 70/1017; fitness: 9.23%, 95/1029) to being "disengaged" following previous adoption (stage 5; nutrition: 13.77%, 140/1017; fitness: 15.06%, 155/1029).
CONCLUSIONS
Using a behavior stage model approach to describe the process of adopting nutrition and fitness apps revealed motivational stage differences between nonusers (being "unengaged," having "decided not to act," having "decided to act," and being "disengaged"), which might contribute to a better understanding of the process of adopting mHealth apps and thus inform the future development of digital interventions. This study highlights that new user groups might be better reached by apps designed to address a more intuitive decision-making style.
PubMed: 29535078
DOI: 10.2196/mhealth.8261 -
The Early Growth and Development Study: A Dual-Family Adoption Study from Birth Through Adolescence.Twin Research and Human Genetics : the... Dec 2019The Early Growth and Development Study (EGDS) is a prospective adoption study of birth parents, adoptive parents and adopted children (n = 561 adoptees). The original...
The Early Growth and Development Study (EGDS) is a prospective adoption study of birth parents, adoptive parents and adopted children (n = 561 adoptees). The original sample has been expanded to include siblings of the EGDS adoptees who were reared by the birth mother and assessed beginning at age 7 years (n = 217 biological children), and additional siblings in both the birth and adoptive family homes, recruited when the adoptees were 8-15 years old (n = 823). The overall study aims are to examine how family, peer and contextual processes affect child and adolescent adjustment, and to examine their interplay (mediation, moderation) with genetic influences. Adoptive and birth parents were originally recruited through adoption agencies located throughout the USA following the birth of a child. Assessments are ongoing and occurred in 9 month's intervals until the adoptees turned 3 years of age, and in 1 to 2 year intervals thereafter through age 15. Data collection includes the following primary constructs: child temperament, behavior problems, mental health, peer relations, executive functioning, school performance and health; birth and adoptive parent personality characteristics, mental health, health, context, substance use, parenting and marital relations; and the prenatal environment. Findings highlight the power of the adoption design to detect environmental influences on child development and provide evidence of complex interactions and correlations between genetic, prenatal environmental and postnatal environmental influences on a range of child outcomes. The study sample, procedures and an overview of findings are summarized and ongoing assessment activities are described.
Topics: Adolescent; Adolescent Development; Adoption; Child; Child Development; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Twins
PubMed: 31526412
DOI: 10.1017/thg.2019.66 -
PloS One 2019This study aimed to evaluate the attitudes of male and female members of the public toward uterus transplantation (UTx), surrogacy, and adoption in Japan via a web-based...
This study aimed to evaluate the attitudes of male and female members of the public toward uterus transplantation (UTx), surrogacy, and adoption in Japan via a web-based survey. One thousand six hundred participants were recruited with equal segregation of age (20s, 30s, 40s, and 50s) and gender. We assessed the association between ethical view and gender, age, infertility, and the knowledge level of UTx, using a questionnaire. The findings were as follows. First, 36.5% and 31.0% of respondents agreed that UTx and gestational surrogacy should be approved, respectively. Second, the respondents would potentially choose to receive UTx (34.4%), gestational surrogacy (31.9%), and adoption (40.3%), if they or their partners experienced absolute uterine factor infertility. Third, 10.1%, 5.8%, and 14.3% of the respondents chose UTx, gestational surrogacy, and adoption as the most favorable option, respectively. Fourth, if their daughters suffered from absolute uterine factor infertility, 32.3% of female respondents might want to be donors, and 36.7% of male respondents might ask their wives to be donors. These data were affected by age, gender, infertility, or the knowledge level of UTx. UTx was a more acceptable option than gestational surrogacy and adoption. The effects of gender, age, infertility, and the level of knowledge of UTx are important in understanding the attitude toward UTx. On the other hand, there were concerns about the safety of UTx for recipients, donors, and babies. It is important to continue to understand public attitudes to inform the development and safety of UTx, which will enhance the discussion on the ethical consensus on UTx.
Topics: Adoption; Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Japan; Male; Middle Aged; Organ Transplantation; Public Opinion; Surrogate Mothers; Surveys and Questionnaires; Uterus; Young Adult
PubMed: 31665149
DOI: 10.1371/journal.pone.0223571 -
PloS One 2021Women who start using contraception ("adopters") are a key population for family planning goals, but little is known about characteristics that predict the adoption of...
BACKGROUND
Women who start using contraception ("adopters") are a key population for family planning goals, but little is known about characteristics that predict the adoption of contraception as opposed to current use. We used prospective data from women and facilities for five countries, (Democratic Republic of Congo, India, Kenya, Nigeria, and Burkina Faso) and identified baseline characteristics that predicted adoption of modern contraception in the short term.
METHODS
We used data from the Performance Monitoring for Action (PMA) Agile Project. PMA Agile administered service delivery point (SDP) client exit interview (CEI) surveys in urban sites of these five countries. Female clients responding to the CEI were asked for phone numbers that were used for a phone follow-up survey approximately four months later. For our analysis, we used data from the SDP and CEI baseline surveys, and the phone follow up to compare women who start using contraception during this period with those who remain non-users. We used characteristics of the facility and the woman at baseline to predict her contraception adoption in the future.
RESULTS
Discussing FP with a partner at baseline was associated with greater odds of adoption in DRC (OR 2.34; 95% CI 0.97-5.66), India (OR 2.27; 95% CI 1.05-4.93), and Kenya (OR 1.65; 95% CI 1.16-2.35). Women who discussed family planning with any staff member at the health facility had 1.72 greater odds (95% CI 1.13-2.67) of becoming an adopter in Nigeria. The odds of adoption were lower in Nigerian facilities that had a stockout (OR 0.66 95% CI 0.44-1.00) at baseline. Other characteristics associated with contraception adoption across settings were education, age, wealth, parity, and marital status.
CONCLUSIONS
Characteristics of both the woman and the health facility were associated with adoption of modern contraception in the future. Some characteristics, like discussing family planning with a spouse, education, and parity, were associated with contraceptive adoption across settings. Other characteristics that predict contraceptive use, such as health facility measures, varied across countries.
Topics: Burkina Faso; Congo; Contraceptive Agents; Female; Follow-Up Studies; Humans; India; Interviews as Topic; Kenya; Logistic Models; Longitudinal Studies; Nigeria
PubMed: 34403428
DOI: 10.1371/journal.pone.0254775 -
Scientific Reports Sep 2020The urban-rural divide is increasing in modern societies calling for geographical extensions of social influence modelling. Improved understanding of innovation...
The urban-rural divide is increasing in modern societies calling for geographical extensions of social influence modelling. Improved understanding of innovation diffusion across locations and through social connections can provide us with new insights into the spread of information, technological progress and economic development. In this work, we analyze the spatial adoption dynamics of iWiW, an Online Social Network (OSN) in Hungary and uncover empirical features about the spatial adoption in social networks. During its entire life cycle from 2002 to 2012, iWiW reached up to 300 million friendship ties of 3 million users. We find that the number of adopters as a function of town population follows a scaling law that reveals a strongly concentrated early adoption in large towns and a less concentrated late adoption. We also discover a strengthening distance decay of spread over the life-cycle indicating high fraction of distant diffusion in early stages but the dominance of local diffusion in late stages. The spreading process is modelled within the Bass diffusion framework that enables us to compare the differential equation version with an agent-based version of the model run on the empirical network. Although both model versions can capture the macro trend of adoption, they have limited capacity to describe the observed trends of urban scaling and distance decay. We find, however that incorporating adoption thresholds, defined by the fraction of social connections that adopt a technology before the individual adopts, improves the network model fit to the urban scaling of early adopters. Controlling for the threshold distribution enables us to eliminate the bias induced by local network structure on predicting local adoption peaks. Finally, we show that geographical features such as distance from the innovation origin and town size influence prediction of adoption peak at local scales in all model specifications.
PubMed: 32934332
DOI: 10.1038/s41598-020-72137-w -
Frontiers in Nutrition 2022The adoption of a vegetarian diet might have public health and environmental benefits. However, little is known about urban and rural Generation Z tourists' attitudes...
The adoption of a vegetarian diet might have public health and environmental benefits. However, little is known about urban and rural Generation Z tourists' attitudes toward vegetarianism or vegetarian consumption within the Chinese urban and rural settings. Hence, to address this gap, the present study adopted a sequential and mixed research approach based on a survey ( = 212) and laddering interviews ( = 20) to validate post-millennial tourists' motives for adopting a vegetarian diet. The results identified the top four motives as environmental protection and resource conservation, ethical consideration, personal taste and choice, and personal healthcare issues. The top four barriers to vegetarianism were unavailability and limited choice, peer pressure, traditional prejudice/habit, and the inability to change. The results also demonstrated that both rural and urban tourists adopt vegetarianism mainly for environmental protection and ethical consideration, a subtle difference between them is that urban vegetarians emphasized ethical considerations more but rural ones emphasized food and variety. Urban consumers considered unavailability and limited choice as the topmost barriers to being vegetarian, while rural vegetarians found traditional prejudice to be restricting. Due to traditional dietary habits and peer influence, rural tourists face many more challenges when adopting a vegetarian diet. Understanding the perceived benefits and barriers to being vegetarian in different regions will not only enrich the theory of food nutrition but also expand Generation Z tourists' consumption behavior and practices.
PubMed: 36570159
DOI: 10.3389/fnut.2022.996158 -
Changes in Attachment Disorder symptoms in children internationally adopted and in residential care.Child Abuse & Neglect Aug 2022A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and...
BACKGROUND
A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity.
OBJECTIVE
The present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity.
PARTICIPANTS AND SETTING
The participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children.
METHODS
The Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4-8 years old (Wave 1). At this stage, the assessment of the community comparison group was added.
RESULTS
Adopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1.
CONCLUSIONS
Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.
Topics: Adoption; Child; Child Abuse; Child, Institutionalized; Child, Preschool; Humans; Institutionalization; Internationality; Object Attachment; Problem Behavior; Psychology, Child; Reactive Attachment Disorder; Residential Facilities; Retrospective Studies; Social Participation; Spain
PubMed: 34544592
DOI: 10.1016/j.chiabu.2021.105308 -
Medical Care Feb 2020There is a concern that the Oncology Care Model (OCM), a voluntary bundled payment program, may incentivize mergers and acquisitions among physician practices leading to...
BACKGROUND
There is a concern that the Oncology Care Model (OCM), a voluntary bundled payment program, may incentivize mergers and acquisitions among physician practices leading to reduced competition and price increases. These concerns are heightened if OCM is preferentially adopted in competitive health care markets because it could result in reduced competition, but little is known about the characteristics of markets where OCM is adopted.
OBJECTIVE
To measure the association between regional market competition among medical oncologists with the initial adoption of OCM.
RESEARCH DESIGN
The Herfindahl-Hirschman Index (HHI), a measure of competition, was calculated for hospital referral regions (HRRs) using secondary data from the Centers for Medicare and Medicaid Services. The relationship between HHI and OCM adoption was assessed using a 2-part regression model adjusting for the market-level number of practices, physician density, average practice size, sociodemographic characteristics, and medical resources. A count model on all HRRs was also estimated to assess an overall effect.
SUBJECTS
A total of 10,788 physicians in 3,537 practices who billed Medicare for oncology services in 2015.
RESULTS
OCM was adopted in 114 (37%) of the 306 HRRs. We found that practices in competitive health care markets were more likely to adopt OCM than in noncompetitive markets. Two-part regression analysis indicated a nonlinear relationship between HHI and OCM adoption. Average practice size, number of practices in an HRR, and the hospital bed rate were positively associated with adoption, whereas the rate of full-time equivalent hospital employees to 1000 residents was negatively associated with adoption.
CONCLUSIONS
OCM adoption was higher in HRRs with greater competition. Careful monitoring of market-level changes among OCM adopters should be undertaken to ensure that the benefits of the OCM outweigh the negative consequences of possible changes in competition.
Topics: Economic Competition; Health Resources; Health Workforce; Medical Oncology; Medicare; Patient Care Bundles; Physicians; Regression Analysis; United States
PubMed: 31688568
DOI: 10.1097/MLR.0000000000001243