Finnish Journal of eHealth and eWelfare

Announcements and conferences

Pia Liljamo — 2023-09-29

Towards digital counselling in primary care management of symptomatic knee osteoarthritis: a qualitative descriptive study in Finnish primary care

Miia Jansson — 2023-09-29

Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study.

Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence).

According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account.

Digital tools to support the implementation of self-care among people with problematic substance use: An integrative literature review

Tuija Karsimus — 2023-09-29

Problematic substance use causes significant harm to individuals, communities and society as a whole. Nowadays solutions to bring substance abuse under control and provide help are being sought from digital tools. This literature review scrutinizes digital applications and internet-based self-care programs from the perspective of providing services. The purpose is to ascertain how the preconditions for the implementation of self-care are understood in studies addressing digital tools for the substance abuse sector. The question posed concerns what features in digital applications supporting control of substance abuse, their users and operating environment influence the implementation of self-care. The research method is an integrative literature review. The data consist of peer-reviewed scientific publications from the period 2012–2022. Data were gathered from two databases (ProQuest Central, PubMed). The final corpus comprises 18 research articles. The analytical frame of reference is the definition by El-Osta and others of four main dimensions of self-care. The findings suggest that factors pertaining to applications in the implementation of self-care are the technical usability of the service, the option for anonymity, variation in content, active reminders and application feedback, gamification and ability to identify with the user. Factors pertaining to the users, in addition to age and gender, are mode of substance abuse, duration of using history, severity of the problem, readiness for change, possible concurrent diagnoses, ability to process own feelings, social relations and digital literacy. Factors pertaining to the operating environment are legislation governing substance abuse, national intoxicant culture, stigma attached to substance abuse treatment, availability of support outside the application and the pandemic situation restricting face-to-face interaction. The diverse nature of the group of individuals with problematic substance use will in the future increase the need for user profiling and more individualized tailoring of application content in keeping with their life situations and stages of recovery.

Older adults’ experiences of ehealth in health and social care

Jukka Mielonen — 2023-09-29

Using the Unified Theory of Technology Acceptance (UTAUT) model as a framework for this study, the aim was to describe how older adults assess digital services in terms of ease of use and quality in health and social care and how often those services are offered. Further, the aim was to describe how older adults receive support for service use, focusing on people aged 65 and over. A structured web-based questionnaire was used for data collection. The data (N=978) was analysed by quantitative statistical analysis. Most of the respondents found the digital services of health and social care easy to use. The function of the services was considered understandable. Respondents also felt that they could find the necessary information about the services. For the most part, they received service use help from their children or grandchildren. However, the role of health and social services professionals was less important. According to our findings, older adults received minimal support from health and social care professionals or employees in third sector organizations. Although, most respondents (70 %) needed support when using digital services.

In the future, health and social care service providers should invest in increased digital services. In conclusion, we found that older citizens know how to use digital services in the health and social care context and they receive adequate help from their relatives in using them.

Digital primary care visits designed for different patient segments in the pre-pandemic era: A scoping review

Sanna Lakoma — 2023-09-29

Digital healthcare services have been implemented increasingly during and after the COVID-19 pandemic. They have been expected to improve access, reduce inefficiencies, improve the quality of care, lower the cost of healthcare, and provide more personalised care.

This study focuses on digital visits: digital health care services that replace a general practitioner (GP) appointment in primary care. The aim of this review is to assess the perspectives used in studying digital visits, and to describe the services studied in terms of modalities used and patient segments targeted. We aim to find how digital visits were studied prior to their becoming a necessity during the COVID-19 pandemic.

This is a scoping review of English language papers published between 1.1.2010-31.5.2020. The papers were eligible for the review if they focused on a digital primary care visit which replaced a face-to-face appointment with a GP. In total, 36 papers were included.

Ten of the studies described services tailored to the needs of a patient segment. The rest of the studies (26/36) did not differentiate between patient segments. The most often-used perspective was that of the clinician (16/36 studies). Fifteen studies were descriptive. The costs and outcomes were rarely utilised as a perspective: the costs were used in only one study and outcomes in six. Patient experience was the perspective chosen in 11 studies. Among all the interventions, the most common modality was by phone call (20), and the second most common was asynchronous messaging and video consultation (10 each).

Prior to the COVID-19 pandemic, digital visits had mostly been developed for the entire population instead of a particular segment of patients. We argue that developing them to fit the needs of a patient segment would help make them more acceptable and suitable for patients. More studies from the patient perspective are needed to develop these services to better fit the needs of patients. The situation is likely to have changed during the pandemic, as a large number of studies has been published since May 2020.

Short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in arthroplasty: a pragmatic randomized controlled trial

Miia Jansson — 2023-09-29

Mobile health solutions for patient support have been proposed as promising and safe alternatives to usual care in adults undergoing primary total hip and knee arthroplasty. Studies of such applications, however, have produced conflicting results and only moderate- to low-quality evidence.

This study aims to evaluate the short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in patients undergoing total hip and knee arthroplasty using a pragmatic randomized controlled trial design. Randomly allocated patients in the control arm (n = 35, 64 ± 9 years) received usual care, while patients in the intervention arm (n = 34, 62 ± 11 years) received the digital patient journey solution in addition to usual care.

The primary outcome was health-related quality of life as measured by the EuroQol EQ-5D-5L scale. Secondary outcomes included functional recovery, pain, self-efficacy, patient experience, adherence to fast-track protocol, and health care utilization. Participants were followed from a preoperative surgical visit until a postoperative follow-up visit at 6–12 weeks.

The health-related quality of life, functional recovery, pain, patient experience, adherence to the fast-track protocol, and health care utilization did not differ between the arms. During the study, however, the self-efficacy to use digital health services (p=0.027) increased in the intervention arm.

The use of the digital patient journey solution was not superior to usual care in terms of patient-reported outcomes and health care utilization. However, the solution improved the self-efficacy of patients to use digital health services, which may lead to greater demand for similar digital offerings as patient become more familiar with mobile health solutions.

Introducing technology to support older people living at home – a qualitative study of ethics from the perspective of care professionals

Nina Keskitalo — 2023-09-29

Today’s demographic shift towards an aging population is increasing health challenges, and technologies need to be developed to support older people. The national policy in Finland is that older people have the right to live in their own homes for as long as this is safe and meets their needs. However, introducing technology comes with ethical challenges and requires new skills of care personnel. The ethical aspects of technology need to be discussed in more depth.

This study aimed to explore the ethical competence of care professionals who work with older people concerning the introduction of technology that supports living at home and to reveal the issues in this area that need development. The study was based on an electronic survey of 14 care professionals working in home care and used a descriptive qualitative study design. Inductive content analysis revealed four main categories: professional ethics, decision-making, change brought about by technology, and factors affecting the introduction of technology.

This study shows that care professionals, regardless of their level or field of education, recognize professional ethics as a factor that guides their everyday work. However, it seems that ethics are not always realized in practice. To meet older peoples’ needs and wishes decision-making and individual assessment play an important role when introducing technology.

The introduction of technology to support living at home among older people has a strong ethical dimension and requires strong professional ethics. The present study suggests that care personnel have insights into these ethical aspects, but that training, guidelines and operative models are needed to support care professionals’ ethical thinking and decision-making. The results of this study can help health care organizations identify care personnel's training needs and requirements for a clear, uniform process to introduce technology.

Privacy protection, data security and protection in technology utilization in home care services for the older people: A survey study of managers

Suvi Kuha — 2023-09-29

The purpose of this study was to describe managers' perceptions of privacy protection, data security and protection in technology utilization, related challenges, and solutions, and factors related not acquiring technological solutions in home care services for the older people.

This cross-sectional survey study was conducted by electronic survey in Autumn 2022. The data was collected from the managers of home care services (n=68) from five public social and healthcare joint municipal authorities and fifteen municipalities or cities located in different parts of Finland. The questionnaire included four structured and two open questions. The data was analyzed using descriptive statistical methods and the principles of inductive content analysis.

According to results, the issues raised by the Digi-HTA evaluations regarding data security and protection are mainly adequately considered when implementing technological solutions, but areas for development were also identified. According to managers' evaluations, factors related to data protection are adequately considered in the technology acquisition processes, and criteria related to data security have been created for the processes. Not acquiring technological solutions was estimated to be especially influenced by the fact that the solutions did not meet the clients’ needs or were not seen to make operations more efficient. The managers' perceptions of the challenges of privacy protection and data security and protection in technology utilization, were related to the operating environment, digital solutions, procedures, competence, and the organization's practices in the prevention of challenges. The solutions to these challenges were seen as communication and interaction, defining processes of privacy protection, data security and protection, changing procedures, and developing competence.

Taking account of factors related to privacy protection, data security and protection is mainly adequately implemented in home care services, though the challenges associated with them are perceived as diversified. The research identified a clear need for comprehensive training of all personnel, concrete evidence-based recommendations, and clear instructions of procedures. Particularly, attention should be paid to realizing the older people's right to self-determination and ensuring informed consent.

“I get to do what I want to do, now I just do it remotely” – perceptions of workers and managers

Sini Eloranta — 2023-09-29

The study describes the adoption of remote home care as a part of the home care service. The data was collected with online interviews in the remote home care units of two large cities in the spring 2022. Altogether, nine members of workers and three managers (n=12) were interviewed. One researcher pair interviewed the manager of one of the cities with individual interviews and the employees with pair interviews, and the other researcher pair interviewed the other city’s managers with pair interviews and the employees with a group interview. The data was analysed with content analysis. The data of the workers and managers were combined at the analysis stage.

According to the results, the factors which supported adopting and implementing remote home care as a part of the service supply of home care were: a centralized organizing method, shared methods, increasing awareness of the service, an experience on the usefulness of the service and employees’ competence.

As a conclusion it can be stated that in home care, adopting remote home care was mainly considered positive and beneficial for the customer’s situation as experienced by the employees and managers.

Head nurses' experiences of the information and support they received and needed to lead operational change in the implementation of Health Village’s digital care pathways

Hanna Mikkonen — 2023-09-29

Digitalisation enables the reform of healthcare. The implementation of digital services requires changes in the internal structures and work processes within the organisation. Leaders have a key role in supporting the implementation of digital services and in making new operational models part of everyday practice. Digitalisation also changes leadership and the behaviour of leaders. Leaders need competence related to the utilisation of digitalisation. In addition, they need support and education on the implementation of digital services.

The purpose of this qualitative study was to describe head nurses’ experiences of the information and support they have received on leading operational change and the factors affecting the management of operational change in connection with the implementation of Health Village’s digital care pathways. Digital care pathways are a web-based service that can be used to replace or complement traditional healthcare visits. The data were gathered through a thematic interview with the head nurses of one university hospital (n = 6). The data were analysed using content analysis.

The head nurses felt they had received support and information from their networks about the implementation of the digital care pathway and operational change as well as concrete support for development. On the other hand, there were perceived shortcomings and challenges in the knowledge and support received during the development process. Management of the operational change was promoted by realisation of resourcing and funding, a positive attitude towards development and knowledge accrual, a goal-oriented development process, inclusion and co-development, as well as support received from networks and active deployment of digital services. Factors that challenged the management of the operational change included resourcing and scheduling, resistance to change, operational change, shortcomings in support and digital competence, and technical issues of the information system.

Head nurses receive knowledge and support to manage the operational change, but the information should be directed at supervisors. Higher management support is needed, especially for setting goals and concretising the benefits of the digital care pathway. For successful operational change, the implementation of the digital care pathways requires sufficient time and human resources.

The information obtained in the study can be utilised in the development and implementation of digital care pathways and other e-services and in leading the operational change in social and health care, and in planning education and training aimed at superiors.

Body like an idol: K-pop fitspiration on Tumblr – an analysis of texts and images

Linda Achilles — 2023-09-29

Eating disorders are a major health issue in societies today which oftentimes remain untreated. In social media, such as Tumblr, people build communities to exchange information and connect to each other using specific hashtags. Some of these trends which emerge around these hashtags, are related to eating disorders. This study in information science addresses how inspiration for fitness (Fitspiration) inspired by music fandom (in particular K-pop) can be characterized on Tumblr by automatically analyzing text and images of posts. Images are evaluated based on their colorfulness and emotional measures, texts undergo a sentiment and readability analysis, as well as an evaluation of their psycho-linguistic features. Furthermore, a qualitative content analysis of K-pop Fitspiration posts (n=119) is performed and they are compared to the K-pop Thinspiration posts, regular Thinspiration and control group posts. Results reveal, that K-pop Fitspiration posts are oftentimes more similar to posts from the control group than to Thinspiration posts, but that they also share psycho-linguistic features with posts of eating disordered users.

Stress and coping connected to higher education study structures: combined views from teachers and students

Eija-Liisa Heikka — 2023-09-29

Experienced stress by students and teachers in higher education has attracted increasing interest, but the two groups are rarely studied together. We combine their perspectives by considering the stress and coping among students and teachers concerning the development of study structures in a business school context. The findings indicate a strong connection between stress experienced by students and teachers, reflecting their interactive nature in this context. We categorize factors causing stress to those for which effective coping mechanisms exist, those causing tensions and requiring active management, and stressors that are difficult to remove because a coping mechanism for one group increases the stress of the other. Our findings add to existing knowledge on stress and coping mechanisms in higher education by combining the perspectives of students and teachers concerning study structures in business education.

Digitaalisia palveluja kehittäessä, arvioitaessa ja käyttöönotettaessa on huomioitava asiakastarve, kyvykkyys ja käyttäjäkokemus

Pia Liljamo — 2023-09-29