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Systematic review

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Auteurs Chesser A , Burke A , Reyes J , Rohrberg T
Tijdschrift Informatics for health & social care
Year 2016
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eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

Systematic review

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Tijdschrift Health & social care in the community
Year 2014
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As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta-study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.

Systematic review

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Auteurs Cameron MP , Ray R , Sabesan S
Tijdschrift Journal of telemedicine and telecare
Year 2014
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We conducted a systematic review of the perceptions of physicians about clinical supervision and educational support via videoconferencing. A search of literature databases, reference lists and specific journals was performed for relevant articles published between 1990 and 2013. A total of 1288 studies were identified, of which 13 fulfilled the inclusion criteria for review. Six studies concerned education, six concerned clinical practice and one concerned supervision. The studies employed a wide variety of methodologies, including quantitative and qualitative techniques, so a meta-analysis was not practicable. Overall satisfaction and acceptance rates were reported in nine studies, mainly using Likert scales. Several positive aspects of videoconferencing were reported, including increased education and clinical practice support, and autonomy for rural areas. The main negative aspects related to the technology itself, poorer interaction and decreased rapport building when using videoconferencing. There is a paucity of literature regarding the perceptions of videoconferencing-based supervision of junior doctors in rural areas. No studies have considered measures of cost effectiveness. More rigorous study design in future research is recommended.

Systematic review

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Tijdschrift BMC palliative care
Year 2013
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Background: Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods. A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results: There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion: Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology. © 2013 Bradford et al; licensee BioMed Central Ltd.

Systematic review

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Auteurs Jennings L , Gagliardi L
Tijdschrift International journal for equity in health
Year 2013
INTRODUCTIE: Onderzoek heeft aangetoond dat mHealth initiatieven, of gezondheidsprogramma's verbeterd door de mobiele telefoon technologie, empowerment van vrouwen kunnen bevorderen. Toch is er een groeiende bezorgdheid dat de mobiele-gebaseerde programma's gericht op vrouwen genderongelijkheid kan verergeren. Methode: Een systematische literatuurstudie werd uitgevoerd om de empirisch bewijs van de veranderingen bij mannen en interacties van de vrouw als gevolg van mHealth interventies te onderzoeken. Om in aanmerking te komen, moest studies zijn gepubliceerd in het Engels 2002-2012, uitgevoerd in een ontwikkelingsland, een evaluatie van een mobiele gezondheids-interventie, en presenteerde de bevindingen op resulterende dynamiek tussen vrouwen en mannen. De zoekstrategie bestaat uit vier elektronische bibliografische databases naast een handmatige controle van de literatuurlijsten van relevante artikelen en een overzicht van de organisatorische websites en tijdschriften met recente publicaties mHealth. De methodologische strengheid van geselecteerde studies werd beoordeeld door twee onafhankelijke beoordelaars die ook geabstraheerd gegevens over de kenmerken van de studie. Iteratieve thematische analyses werden gebruikt om de bevindingen met betrekking tot gender transformatieve en niet-transformatieve ervaringen synthetiseren. RESULTATEN: Uit de 173 artikelen opgehaald voor herziening, zeven artikelen voldeden aan de inclusiecriteria en werden opgenomen in de uiteindelijke analyses. Meest mHealth interventies SMS-gebaseerde en uitgevoerd in sub-Sahara Afrika over onderwerpen met betrekking tot HIV / AIDS, seksuele en reproductieve gezondheid, gezondheidskundige micro, en niet-overdraagbare ziekten. Verschillende methodologische beperkingen werden vastgesteld tussen de subsidiabele kwantitatief en kwalitatief onderzoek. De huidige literatuur suggereert dat de mobiele telefoon programma's genderverhoudingen op zinvolle wijze een positieve manier kan beïnvloeden door het aanbieden van nieuwe modi voor paar gezondheid communicatie en samenwerking en doordat een grotere participatie van mannen in de gezondheidszorg gebieden meestal gericht op vrouwen. MHealth initiatieven verhoogden ook vrouwen besluitvorming, sociale status, en toegang tot gezondheidszorg middelen. Echter, programmatische ervaringen door het ontwerp onbedoeld versterken van de digitale kloof, en bestendigen bestaande gendergerelateerd machtsongelijkheid. Binnenlandse geschillen en het ontbreken van echtelijk goedkeuring bovendien bemoeilijkt de deelname van vrouwen. CONCLUSIE: De inspanningen om opschaling gezondheidsinterventies verbeterd door mobiele technologieën moeten overwegen de uitvoering en evaluatie noodzakelijk ervoor te zorgen dat mHealth programma transformeren plaats genderongelijkheid versterken. De wetenschappelijke gegevens over het effect van mHealth interventies op genderverhoudingen is zwak, en rigoureus onderzoek is dringend nodig.

Systematic review

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Tijdschrift BMC health services research
Year 2013
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ACHTERGROND: Een vergrijzende bevolking wordt gezien als een bedreiging voor de kwaliteit van het leven en de gezondheid op het platteland, en wordt vaak aangenomen dat e-gezondheidszorg kan dit probleem aan te pakken. Als succesvolle e-Health implementatie in organisaties is moeilijk gebleken, deze systematische literatuurstudie wordt nagegaan of dit zo is voor plattelandsgemeenschappen. Deze beoordeling identificeert de kritische factoren en implementatie, na de wijziging model van Pettigrew en Whipp, classificeert deze in termen van "context", "proces", en "inhoud". Door middel van deze lens, analyseren we de empirische bevindingen uit de literatuur om de vraag in te gaan: Hoe context, proces en inhoud factoren van e-gezondheidszorg implementatie beïnvloeden de goedkeuring ervan in landelijke gemeenschappen? METHODEN: We voerden een systematisch literatuuronderzoek. Deze beoordeling opgenomen documenten dat zes in-en exclusiecriteria voldaan en had voldoende methodologische kwaliteit. Bevindingen werden ingedeeld in een classificatie matrix op de bevordering van en het fixeren van de uitvoering factoren te identificeren en te onderzoeken of er wisselwerkingen tussen context, proces en inhoud adoptie beïnvloeden. Resultaten Van de 5.896 abstracts in eerste instantie geïdentificeerd, slechts 51 papieren voldeed aan al onze criteria en werden opgenomen in de review. We hebben vijf verschillende perspectieven onderscheiden op het platteland e-gezondheidszorg implementatie in deze papieren. Verder hebben we een lijst van de context, proces en inhoud implementatie factoren gebleken dat het aan bevorderen of landelijke e-gezondheidszorg adoptie te beperken. Veel implementatie factoren lijken herhaaldelijk, maar er zijn ook een aantal tegenstrijdige resultaten. Op basis van een nadere analyse van de papieren bevindingen, stellen we dat interactie-effecten tussen context, proces en inhoud van veranderingen, kunnen deze tegenstrijdige resultaten te verklaren. Meer specifiek, drie thema's die cruciaal worden weergegeven in e-gezondheidszorg implementatie in landelijke gemeenschappen opgedoken: de dubbele effecten van geografische isolatie, de targeting van kansarme groepen, en de veranderingen in de eigendomsverhoudingen die nodig zijn voor een duurzame e-gezondheidszorg adoptie. CONCLUSIES: Landelijk e-Health implementatie is een opkomende, zich snel ontwikkelende, veld. Maar al te vaak, e-gezondheidszorg adoptie mislukt als gevolg van onderschatting van de uitvoering factoren en hun interacties. We stellen dat het platteland e-gezondheidszorg implementatie leidt alleen maar tot een duurzame adoptie (dat wil zeggen het "stokken") wanneer de uitvoering beschouwt zorgvuldig en lijnt de e-gezondheidszorg-inhoud (de "klikt"), de reeds bestaande structuren in de context (de " stenen "), en de interventies in het implementatieproces (de" trucs ").

Systematic review

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Tijdschrift Qualitative health research
Year 2013
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Women live within complex and differing social, economic, and environmental circumstances that influence options to seek health care. In this article we report on a metasynthesis of qualitative research concerning access disparities for women in the Canadian province of Ontario, where there is a publicly funded health care system. We took a metastudy approach to analysis of results from 35 relevant qualitative articles to understand the conditions and conceptualizations of women's inequitable access to health care. The articles' authors attributed access disparities to myriad barriers. We focused our analysis on these barriers to understand the contributing social and political forces. We found that four major, sometimes countervailing, forces shaped access to health care: (a) contextual conditions, (b) constraints, (c) barriers, and (d) deterrents. Complex convergences of these forces acted to push, pull, obstruct, and/or repel women as they sought health care, resulting in different patterns of inequitable access.

Systematic review

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Tijdschrift Genetics in medicine : official journal of the American College of Medical Genetics
Year 2012
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PURPOSE: Telemedicine is being increasingly used in many areas of health care, particularly to reduce the barriers that rural populations face in accessing health-care services. Telemedicine may also be effectively utilized in clinical genetics services-an application that has been termed "telegenetics." METHODS: A systematic review of the literature was conducted to identify studies of genetic consultations carried out through videoconferencing so as to determine whether conclusions can be drawn about the value of telegenetics. A total of 14 articles reporting data from 12 separate studies met the inclusion criteria. RESULTS: In a majority of these studies, patients received their telegenetics consultation at a local clinic or outreach center, from where they communicated via a synchronous video link with a genetics practitioner. All the studies reported high levels of patient satisfaction with telegenetics, and patients were generally more receptive to telegenetics than the genetics practitioners were. The studies had limitations of small sample sizes and lack of statistical analyses. CONCLUSIONS: This review suggests that telegenetics may be a useful tool for providing routine counseling and has the potential to evaluate pediatric patients with suspected genetic conditions. Prospective, fully powered studies of telegenetics that explore the accuracy of diagnoses and patient outcomes are needed to allow informed decisions to be made about the appropriate use of telemedicine in genetics service delivery.

Systematic review

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Tijdschrift Genetics in medicine : official journal of the American College of Medical Genetics
Year 2012
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PURPOSE: Telemedicine is being increasingly used in many areas of health care, particularly to reduce the barriers that rural populations face in accessing health-care services. Telemedicine may also be effectively utilized in clinical genetics services—an application that has been termed “telegenetics.” METHODS: A systematic review of the literature was conducted to identify studies of genetic consultations carried out through video conferencing so as to determine whether conclusions can be drawn about the value of telegenetics. A total of 14 articles reporting data from 12 separate studies met the inclusion criteria. RESULTS: In a majority of these studies, patients received their telegenetics consultation at a local clinic or outreach center, from where they communicated via a synchronous video link with a genetic spractitioner. All the studies reported high levels of patient satisfaction with telegenetics,and patients were generally more receptive to telegenetics than the genetics practitioners were. The studies had limitations of small sample sizes and lack of statistical analyses. CONCLUSIONS: This review suggests that telegenetics may be a useful tool for providing routine counseling and has the potential to evaluate pediatric patients with suspected genetic conditions. Prospective,fully powered studies of telegenetics that explore the accuracy of diagnoses and patient outcomes are needed to allow informed decisions to be made about the appropriate use of telemedicine in genetics service delivery.

Systematic review

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Tijdschrift Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Year 2011