Technology that supports older adults can have a positive effect on their psychological and physical well-being in a way that they may live independently for longer periods of time. This study is conducted to identify relevant factors that influence the use of smart home and telecare technologies in order to develop a measurement tool for telecare acceptance. In this study we revise the original Technology Acceptance Model (TAM) to explain the use of smart home and telecare technology by older adults. The model will be tested in the field by researching the use of telecare technology (with multiple functionalities, such as personal alarms, screen-to-screen communication, and teleservices) by approx. 100 Dutch households. The research will provide guidelines for design, implementation and functionality of smart home and telecare technology for older adults. It will provide insight into what features contribute to effective use of technology for older adults who live at home independently.
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Keywords: technology adoption; telecare systems; user acceptance; quality of experience
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The effectiveness of smart home technology in home care situations depends on the acceptance and use of the technology by both users and end-users. In the Netherlands many projects have started to introduce smart home technology and telecare in the homes of elderly people, but only some have been successful. In this paper, features for success and failure in the deployment of new (ICT) technology in home care are used to revise the technology acceptance model (TAM) into a model that explains the use of smart home and telecare technology by older adults. In the revised model we make the variable 'usefulness' more specific, by describing the benefits of the technology that are expected to positively affect technology usage. Additionally, we state that several moderator variables - that are expected to influence this effect - should be added to the model in order to explain why people eventually do (not) use smart home technology, despite the benefits and the intention to use. We categorize these variables, that represent the problems found in previous studies, in 'accessibility', 'facilitating conditions' and 'personal variables'.
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BACKGROUND: Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19.METHODS: A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment.RESULTS: This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups' exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results.CONCLUSION: Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.
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1e alinea column: Hoofdpijn of een wondermiddel? Huidige zorg efficiënter. Over weinig onderwerpen in de zorg is meer geschreven dan over hoe internet, mobiele data en sociale media de zorg goedkoper, beter en leuker zouden kunnen maken. Heel veel zaken zijn al beschreven de laatste 15 jaar en zitten in de pijplijn. Het inzicht is er. Het wachten is op de implementatie.
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Technology in general, and assistive technology in particular, is considered to be a promising opportunity to address the challenges of an aging population. Nevertheless, in health care, technology is not as widely used as could be expected. In this chapter, an overview is given of theories and models that help to understand this phenomenon. First, the design of (assistive) technologies will be addressed and the importance of human-centered design in the development of new assistive devices will be discussed. Also theories and models are addressed about technology acceptance in general. Specific attention will be given to technology acceptance in healthcare professionals, and the implementation of technology within healthcare organizations. The chapter will be based on the state of the art of scientific literature and will be illustrated with examples from our research in daily practice considering the different perspectives of involved stakeholders.
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Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Expectations are high with regards to smart home technology. In particular, smart home technology is expected to support or enable independent living by older adults. This raises the question: can smart home technology contribute to independent living, according to older adults themselves? This chapter aims to answer this question by reviewing and discussing older adults’ perspectives on independence and their views on smart home technology. Firstly, older adults’ opinions on independence and aging in place are discussed. Secondly, this chapter will review to what extent smart home technology can support older adults’ independence. Thirdly, it will be explained how community-dwelling older adults’ concept of independence entails three distinct types or modes, and how these modes are related to their perceptions and acceptance of technology. In the last section of this chapter, an overview of key points is presented, and recommendations for technology designers, policy makers, and care providers are postulated.
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Background: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. Method: In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Results: Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Discussion/Conclusion: Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at easewhen they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.
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At the present time, nearly all Dutch nursing schools are searching for suitable ways to implement technology-based healthcare in their curriculum. Some Universities chose elective education, others a mandatory solution. Several studies were executed to determine competencies needed by nurses in order to work with technology-based healthcare. In 2016 a nationwide new curriculum for nurses has been published. Providing technology-based healthcare is included under the core competencies of this new curriculum. All baccalaureate nursing educational institutes must implement this new curriculum at the start of 2016 which will have a huge impact on the implementation of technology-based healthcare in the education programs. In the future, technology centers from Universities will collaborate and specialize, partner with technology companies and crossovers between information and communication technology and healthcare education will be expanded.
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