Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study

Background: Prevention and management of chronic conditions is a priority for many healthcare systems. Personal health records have been suggested to facilitate implementation of chronic care programs. However, patients’ attitude towards personal health records (PHRs) can significantly affect the ad...

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Autores:
Khaneghah, Peyman Azad
Cruz, Antonio Miguel
Bentley, Pamela
Liu, Lili
Stroulia, Eleni
Ferguson-Pell, Martin
Tipo de recurso:
Article of investigation
Fecha de publicación:
2016
Institución:
Escuela Colombiana de Ingeniería Julio Garavito
Repositorio:
Repositorio Institucional ECI
Idioma:
eng
OAI Identifier:
oai:repositorio.escuelaing.edu.co:001/1580
Acceso en línea:
https://repositorio.escuelaing.edu.co/handle/001/1580
Palabra clave:
Enfermedades - Enfermedad crónica
Historias clínicas - Comunicación en medicina
Diabetes
Accesibilidad a los servicios de salud
Registros de salud personal
Diabéticos
Health services accessibility
Personal health records
Diabetics
Chronic disease
Diabetes mellitus
Personal health records.
Enfermedad crónica
Diabetes mellitus
Historia clínica personal.
Rights
openAccess
License
http://purl.org/coar/access_right/c_abf2
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network_acronym_str ESCUELAIG2
network_name_str Repositorio Institucional ECI
repository_id_str
dc.title.spa.fl_str_mv Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
title Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
spellingShingle Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
Enfermedades - Enfermedad crónica
Historias clínicas - Comunicación en medicina
Diabetes
Accesibilidad a los servicios de salud
Registros de salud personal
Diabéticos
Health services accessibility
Personal health records
Diabetics
Chronic disease
Diabetes mellitus
Personal health records.
Enfermedad crónica
Diabetes mellitus
Historia clínica personal.
title_short Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
title_full Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
title_fullStr Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
title_full_unstemmed Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
title_sort Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot Study
dc.creator.fl_str_mv Khaneghah, Peyman Azad
Cruz, Antonio Miguel
Bentley, Pamela
Liu, Lili
Stroulia, Eleni
Ferguson-Pell, Martin
dc.contributor.author.none.fl_str_mv Khaneghah, Peyman Azad
Cruz, Antonio Miguel
Bentley, Pamela
Liu, Lili
Stroulia, Eleni
Ferguson-Pell, Martin
dc.contributor.researchgroup.spa.fl_str_mv GiBiome
dc.subject.armarc.none.fl_str_mv Enfermedades - Enfermedad crónica
Historias clínicas - Comunicación en medicina
Diabetes
topic Enfermedades - Enfermedad crónica
Historias clínicas - Comunicación en medicina
Diabetes
Accesibilidad a los servicios de salud
Registros de salud personal
Diabéticos
Health services accessibility
Personal health records
Diabetics
Chronic disease
Diabetes mellitus
Personal health records.
Enfermedad crónica
Diabetes mellitus
Historia clínica personal.
dc.subject.armarc.spa.fl_str_mv Accesibilidad a los servicios de salud
Registros de salud personal
Diabéticos
dc.subject.armarc.eng.fl_str_mv Health services accessibility
Personal health records
Diabetics
dc.subject.proposal.eng.fl_str_mv Chronic disease
Diabetes mellitus
Personal health records.
dc.subject.proposal.spa.fl_str_mv Enfermedad crónica
Diabetes mellitus
Historia clínica personal.
description Background: Prevention and management of chronic conditions is a priority for many healthcare systems. Personal health records have been suggested to facilitate implementation of chronic care programs. However, patients’ attitude towards personal health records (PHRs) can significantly affect the adoption rates and use of PHRs. Objectives: to evaluate the attitude of patients with Type II diabetes towards using a PHR to manage their condition. Methods: We used a cross-sectional exploratory pilot study. Fifty-four (54) patients used a PHR to monitor and record their blood glucose levels, diet, and activities for 30 days, and to communicate with their clinicians. At the end of the study, patients responded to a survey based on three constructs borrowed from different technology acceptance frameworks: relative advantage, job fit, and perceived usefulness. A multivariate predictive model was formed using partial least squaring technique (PLS) and the effect of each construct on the patients’ attitude towards system use was evaluated. Patients also participated in a semi-structured interview. Results: We found a significant positive correlation between job fit and attitude (JF → ATT = +0.318, p<0.01). There was no statistical evidence of any moderating or mediating effect of other main constructs or any of the confounding factors (i.e., age, gender, time after diagnosed) on attitude. Conclusion: The attitude of patients towards using PHR in management of their diabetes was positive. Their attitude was mainly influenced by the extent to which the system helped them better perform activities and self-manage their condition.
publishDate 2016
dc.date.issued.none.fl_str_mv 2016
dc.date.accessioned.none.fl_str_mv 2021-06-17T18:11:23Z
2021-10-01T17:16:49Z
dc.date.available.none.fl_str_mv 2021-06-17T18:11:23Z
2021-10-01T17:16:49Z
dc.type.spa.fl_str_mv Artículo de revista
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dc.relation.indexed.spa.fl_str_mv N/A
dc.relation.ispartofjournal.eng.fl_str_mv Applied Clinical Informatics
dc.relation.references.eng.fl_str_mv Ant Ozok A, Wu H, Garrido M, Pronovost PJ, Gurses AP. Usability and perceived usefulness of Personal Health Records for preventive health care: a case study focusing on patients’ and primary care providers’ perspectives. Appl Ergon 2014; 45(3): 613-628.
Markle Foundation. Connecting Americans to their Health Care Final Report. 2004.
Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association: JAMIA 2006; 13(2): 121-126.
Logue MD, Effken JA. An exploratory study of the personal health records adoption model in the older adult with chronic illness. Informatics in primary care 2012; 20(3): 151-169
Kahn JS, Aulakh V, Bosworth A. What it takes: characteristics of the ideal personal health record. Health affairs (Project Hope) 2009; 28(2): 369-376
Canadian Diabetes Association. The cost of diabetes in Alberta. 2009 [cited 2015 July,07]; Available from: http://www.diabetes.ca/documents/get-involved/diabetes-in-alberta.pdf.
Logue MD, Effken JA. Modeling factors that influence personal health records adoption. Computers, informatics, nursing: CIN 2012; 30(7): 354-362.
Angst CM, Agarwal R. Adoption of electronic health records in the presence of privacy concerns: the elaboration likelihood model and individual persuasion. MIS Quarterly 2009; 33(2): 339-370.
Andrews L, Gajanayake R, Sahama T. The Australian general public’s perceptions of having a personally controlled electronic health record (PCEHR). Int J Med Inform 2014; 83(12): 889–900
Butler JM, Carter M, Hayden C, Gibson B, Weir C, Snow L, Morales J, Smith A, Bateman K, Gundlapalli AV, Samore M. Understanding adoption of a personal health record in rural health care clinics: revealing barriers and facilitators of adoption including attributions about potential patient portal users and self-reported characteristics of early adopting users. AMIA Annu Symp Proc 2013; 16: 152-161
Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior: An Introductionto Theory and Research. MA: Addison-Wesle; 1975.
Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Quarterly 1989; 13(3): 319-340.
Venkatesh V, Morris GM, Davis GB, Davis DF. User Acceptance of Information Technology: Toward a Unified View. MIS Quarterly 2003; 27(3): 425-478.
Thompson RL, Higgins CA, Howell JM. Personal Computing: Toward a Conceptual Model of Utilization. MIS Quarterly 1991; 15(1): 125-143.
Teddlie C, Yu F. Mixed Methods Sampling: A Typology with Examples. Journal of Mixed Methods Research 2007; 1(1): 77–100.
Standards of Medical Care in Diabetes – 2012. Diabetes Care 2012; 35(Suppl. 1): S11-S63.
. Chin W. The partial least squares approach to structural equation. In: GA M, editor. Modern methods for business research. Mahwah (NJ): Taylor & Francis; 1998; 295–336.
. Ringle CM, Wende, Sven, & Becker, Jan-Michael. Smartpls 3. Hamburg: SmartPLS; 2014 [cited 2015 July 07]; Available from: http://www.smartpls.com.
Hair FJ HM, Ringle MCh, Sarstedt M. A primer on partial least sqares structural equation modeling (PLSSEM). Thousand Oaks (CA): SAGE; 2014.
. Miles MB, Huberman AM, Saldaña J. Qualitative data analysis : a methods sourcebook: Thousand Oaks, Califorinia : SAGE Publications, Inc., Edition 3.; 2014.
. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to practice. Second ed. New Jersy Prince Hall 2000.
Logue MD, Effken JA. Validating the personal health records adoption model using a modified e-Delphi. Journal of advanced nursing 2013; 69(3): 685-696.
Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. Journal of the American Medical Informatics Association: JAMIA 2011; 18(4): 515-522.
Bickmore TW, Caruso L, Clough-Gorr K. Acceptance and usability of a relational agent interface by urban older adults. CHI ’05 Extended Abstracts on Human Factors in Computing Systems; Portland, OR, USA. 1056879: ACM; 2005; 1212-1215.
Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes 1991; 50(2): 179–211.
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dc.publisher.eng.fl_str_mv Georg Thieme Verlag
dc.publisher.place.spa.fl_str_mv Brasil
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institution Escuela Colombiana de Ingeniería Julio Garavito
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spelling Khaneghah, Peyman Azada6e50249d10b87a51ab51fc5795722bc600Cruz, Antonio Miguel60f912e3d0e1a88c51207ae38b105011600Bentley, Pamela45a2392264254bf1f7687e4d9b793751600Liu, Lili4cbfe7450765f6f2ac895b375e7def11600Stroulia, Eleni9391924e7d29a500d3d1d79108ed9af6600Ferguson-Pell, Martin8a70bead16bfeac352bf03a6a8243fac600GiBiome2021-06-17T18:11:23Z2021-10-01T17:16:49Z2021-06-17T18:11:23Z2021-10-01T17:16:49Z20161869-0327https://repositorio.escuelaing.edu.co/handle/001/1580Background: Prevention and management of chronic conditions is a priority for many healthcare systems. Personal health records have been suggested to facilitate implementation of chronic care programs. However, patients’ attitude towards personal health records (PHRs) can significantly affect the adoption rates and use of PHRs. Objectives: to evaluate the attitude of patients with Type II diabetes towards using a PHR to manage their condition. Methods: We used a cross-sectional exploratory pilot study. Fifty-four (54) patients used a PHR to monitor and record their blood glucose levels, diet, and activities for 30 days, and to communicate with their clinicians. At the end of the study, patients responded to a survey based on three constructs borrowed from different technology acceptance frameworks: relative advantage, job fit, and perceived usefulness. A multivariate predictive model was formed using partial least squaring technique (PLS) and the effect of each construct on the patients’ attitude towards system use was evaluated. Patients also participated in a semi-structured interview. Results: We found a significant positive correlation between job fit and attitude (JF → ATT = +0.318, p<0.01). There was no statistical evidence of any moderating or mediating effect of other main constructs or any of the confounding factors (i.e., age, gender, time after diagnosed) on attitude. Conclusion: The attitude of patients towards using PHR in management of their diabetes was positive. Their attitude was mainly influenced by the extent to which the system helped them better perform activities and self-manage their condition..Antecedentes: la prevención y el manejo de las enfermedades crónicas es una prioridad para muchos profesionales de la salud. sistemas Se han sugerido registros personales de salud para facilitar la implementación de la atención crónica. programas Sin embargo, la actitud de los pacientes hacia los registros personales de salud (PHR, por sus siglas en inglés) puede afectar significativamente las tasas de adopción y el uso de los PHR. Objetivos: evaluar la actitud de los pacientes con diabetes tipo II hacia el uso de un PHR para el manejo de su condición. Métodos: Utilizamos un estudio piloto exploratorio transversal. Cincuenta y cuatro (54) pacientes usaron un PHR para monitorear y registrar sus niveles de glucosa en sangre, dieta y actividades durante 30 días, y comunicarse con sus médicos. Al final del estudio, los pacientes respondieron a una encuesta basada en tres constructos tomados de diferentes marcos de aceptación de tecnología: ventaja relativa, adecuación al trabajo y utilidad percibida. Se formó un modelo predictivo multivariado utilizando la técnica de mínimos cuadrados parciales (PLS) y se determinó el efecto de cada constructo en la actitud de los pacientes hacia el uso del sistema. evaluado. Los pacientes también participaron en una entrevista semiestructurada. Resultados: Encontramos una correlación positiva significativa entre el ajuste al trabajo y la actitud (JF → ATT = +0,318, p<0,01). No hubo evidencia estadística de ningún efecto moderador o mediador de otros constructos principales o cualquiera de los factores de confusión (es decir, edad, género, tiempo después del diagnóstico) sobre la actitud. Conclusión: La actitud de los pacientes hacia el uso de PHR en el manejo de su diabetes fue positiva. Su actitud estuvo influenciada principalmente por la medida en que el sistema los ayudó a mejorar realizar actividades y autogestionar su condición.14 páginasapplication/pdfengGeorg Thieme VerlagBrasilhttps://pubmed.ncbi.nlm.nih.gov/27437062/Users' Attitudes Towards Personal Health Records: A Cross-Sectional Pilot StudyArtículo de revistainfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a8558625737N/AApplied Clinical InformaticsAnt Ozok A, Wu H, Garrido M, Pronovost PJ, Gurses AP. Usability and perceived usefulness of Personal Health Records for preventive health care: a case study focusing on patients’ and primary care providers’ perspectives. Appl Ergon 2014; 45(3): 613-628.Markle Foundation. Connecting Americans to their Health Care Final Report. 2004.Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association: JAMIA 2006; 13(2): 121-126.Logue MD, Effken JA. An exploratory study of the personal health records adoption model in the older adult with chronic illness. Informatics in primary care 2012; 20(3): 151-169Kahn JS, Aulakh V, Bosworth A. What it takes: characteristics of the ideal personal health record. Health affairs (Project Hope) 2009; 28(2): 369-376Canadian Diabetes Association. The cost of diabetes in Alberta. 2009 [cited 2015 July,07]; Available from: http://www.diabetes.ca/documents/get-involved/diabetes-in-alberta.pdf.Logue MD, Effken JA. Modeling factors that influence personal health records adoption. Computers, informatics, nursing: CIN 2012; 30(7): 354-362.Angst CM, Agarwal R. Adoption of electronic health records in the presence of privacy concerns: the elaboration likelihood model and individual persuasion. MIS Quarterly 2009; 33(2): 339-370.Andrews L, Gajanayake R, Sahama T. The Australian general public’s perceptions of having a personally controlled electronic health record (PCEHR). Int J Med Inform 2014; 83(12): 889–900Butler JM, Carter M, Hayden C, Gibson B, Weir C, Snow L, Morales J, Smith A, Bateman K, Gundlapalli AV, Samore M. Understanding adoption of a personal health record in rural health care clinics: revealing barriers and facilitators of adoption including attributions about potential patient portal users and self-reported characteristics of early adopting users. AMIA Annu Symp Proc 2013; 16: 152-161Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior: An Introductionto Theory and Research. MA: Addison-Wesle; 1975.Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Quarterly 1989; 13(3): 319-340.Venkatesh V, Morris GM, Davis GB, Davis DF. User Acceptance of Information Technology: Toward a Unified View. MIS Quarterly 2003; 27(3): 425-478.Thompson RL, Higgins CA, Howell JM. Personal Computing: Toward a Conceptual Model of Utilization. MIS Quarterly 1991; 15(1): 125-143.Teddlie C, Yu F. Mixed Methods Sampling: A Typology with Examples. Journal of Mixed Methods Research 2007; 1(1): 77–100.Standards of Medical Care in Diabetes – 2012. Diabetes Care 2012; 35(Suppl. 1): S11-S63.. Chin W. The partial least squares approach to structural equation. In: GA M, editor. Modern methods for business research. Mahwah (NJ): Taylor & Francis; 1998; 295–336.. Ringle CM, Wende, Sven, & Becker, Jan-Michael. Smartpls 3. Hamburg: SmartPLS; 2014 [cited 2015 July 07]; Available from: http://www.smartpls.com.Hair FJ HM, Ringle MCh, Sarstedt M. A primer on partial least sqares structural equation modeling (PLSSEM). Thousand Oaks (CA): SAGE; 2014.. Miles MB, Huberman AM, Saldaña J. Qualitative data analysis : a methods sourcebook: Thousand Oaks, Califorinia : SAGE Publications, Inc., Edition 3.; 2014.. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to practice. Second ed. New Jersy Prince Hall 2000.Logue MD, Effken JA. Validating the personal health records adoption model using a modified e-Delphi. Journal of advanced nursing 2013; 69(3): 685-696.Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. Journal of the American Medical Informatics Association: JAMIA 2011; 18(4): 515-522.Bickmore TW, Caruso L, Clough-Gorr K. Acceptance and usability of a relational agent interface by urban older adults. CHI ’05 Extended Abstracts on Human Factors in Computing Systems; Portland, OR, USA. 1056879: ACM; 2005; 1212-1215.Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes 1991; 50(2): 179–211.info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Enfermedades - Enfermedad crónicaHistorias clínicas - Comunicación en medicinaDiabetesAccesibilidad a los servicios de saludRegistros de salud personalDiabéticosHealth services accessibilityPersonal health recordsDiabeticsChronic diseaseDiabetes mellitusPersonal health records.Enfermedad crónicaDiabetes mellitusHistoria clínica personal.TEXTUsers’ attitudes towards personal.pdf.txtUsers’ attitudes towards personal.pdf.txtExtracted texttext/plain45723https://repositorio.escuelaing.edu.co/bitstream/001/1580/3/Users%e2%80%99%20attitudes%20towards%20personal.pdf.txtba97b2c6ed994ea33b1cacf9b70fbd8dMD53open accessTHUMBNAILUsers’ attitudes towards personal.pdf.jpgUsers’ attitudes towards personal.pdf.jpgGenerated Thumbnailimage/jpeg11509https://repositorio.escuelaing.edu.co/bitstream/001/1580/4/Users%e2%80%99%20attitudes%20towards%20personal.pdf.jpgb5670f35ca4c396d99530bc8a520094fMD54open accessLICENSElicense.txttext/plain1881https://repositorio.escuelaing.edu.co/bitstream/001/1580/1/license.txt5a7ca94c2e5326ee169f979d71d0f06eMD51open accessORIGINALUsers’ attitudes towards personal.pdfapplication/pdf267200https://repositorio.escuelaing.edu.co/bitstream/001/1580/2/Users%e2%80%99%20attitudes%20towards%20personal.pdfa4361b074a337b4e24129565b10cfc2aMD52metadata only access001/1580oai:repositorio.escuelaing.edu.co:001/15802022-09-28 17:59:30.222metadata only accessRepositorio Escuela Colombiana de Ingeniería Julio Garavitorepositorio.eci@escuelaing.edu.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