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Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach.

ABSTRACT: OBJECTIVES:To investigate mobile health product use in Australia and societal and clinician perceptions towards smartphone based visual acuity (VA) assessment tools. DESIGN:Quantitative analysis of a cross-sectional survey delivered to the general public and thematic analysis of in-depth interviews of eye health clinicians. SETTING:Online survey within Australia and face-to-face in-depth interviews of clinicians. PARTICIPANTS:1016 adults were recruited via Survey Monkey Audience, social media (Facebook and Twitter), Rotary Australia and Lions Clubs Australia. Six clinicians were recruited from private and public settings in Melbourne, Australia. PRIMARY AND SECONDARY OUTCOME MEASURES:The study assessed socio-demographic characteristics, history of mobile health product use and perceived advantages and potential drawbacks of smartphone based VA assessment tools. RESULTS:A total of 14.4% of the study population had previously used a mobile-based health product. After adjusting for covariates, younger age (p=0.001), male gender (p=0.01) and higher income (>$45 000) were associated with increased likelihood of having used a mobile health product (p=0.005). Seventy-two per cent of participants would use an automated smartphone based VA assessment tool, provided that the accuracy was on par to that of human assessors. Convenience (37.3%) and cost-savings (15.5%) were ranked as the greatest perceived advantages. While test accuracy (50.6%), a lack of personal contact with healthcare providers (18.3%) and data security (11.9%) were the greatest concerns. Themes to emerge from clinician qualitative data included the potential benefits for identifying refractive error in patients, as well as the ability to self-monitor vision. Concerns were raised over the potential misuse of self-testing vision apps and the inability to detect pathology. CONCLUSION:Our findings suggest that a substantial proportion of the Australian population do not use mobile health products. Furthermore, there remains notable concerns, including test accuracy and data privacy, with smartphone-based VA assessment tools by both clinicians and the public.

SUBMITTER: Keel S

PROVIDER: S-EPMC6475225 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach.

Keel Stuart S Scheetz Jane J Holloway Edith E Han Xiaotong X Yan William W Mueller Andreas A He Mingguang M

BMJ open 20190323 3

<h4>Objectives</h4>To investigate mobile health product use in Australia and societal and clinician perceptions towards smartphone based visual acuity (VA) assessment tools.<h4>Design</h4>Quantitative analysis of a cross-sectional survey delivered to the general public and thematic analysis of in-depth interviews of eye health clinicians.<h4>Setting</h4>Online survey within Australia and face-to-face in-depth interviews of clinicians.<h4>Participants</h4>1016 adults were recruited via Survey Mon ...[more]

PMID: 30904849

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Project description:China is engaged in promoting community health services (CHS) nationwide. This study examines the public's views towards CHS and their utilisation of community-based and hospital-based outpatient services.A mixed methods study using qualitative interviews and a cross-sectional survey.The study was conducted among the public between September 2014 and September 2015 in Zhejiang province, China. Six focus groups and 13 individuals were interviewed. The questionnaire was completed by 1248 respondents (response rate: 83%).Utilisation of community-based and hospital-based outpatient services.Functions of CHS perceived by the public included provision of minor illness management, coordination, drug dispensing, follow-up care and patient education. However, many also showed a distrust in primary care providers' (PCPs) competence for confirming the initial diagnosis and management plan. As coordinators, PCPs' integrity was challenged, and PCPs were thought to be potential 'tuo er' (cunning agents who tried to lead patients to some notorious hospitals to make money). Survey results showed that 800 (64.1%) respondents visited hospital-based clinics and 688 (55.1%) visited CHS at least once in the past year. Compared with the uninsured group, those covered by Urban Resident Medical Insurance (adjusted OR (AOR)=1.95, 95%?CI 1.24 to 3.07) and Urban Employee Medical Insurance (AOR=2.59, 95%?CI 1.59 to 4.24) were more likely to use hospital-based services. Respondents who had a chronic condition were more likely than their counterparts to use both hospital-based services (AOR=1.72, 95%?CI 1.18 to 2.49) and CHS (AOR=1.66, 95%?CI 1.19 to 2.32). Income levels were positively associated with the likelihood of visiting hospital-based clinics (AOR=1.67, 95%?CI 1.15 to 2.42) but negatively associated with the likelihood of using CHS (AOR=0.68, 95%?CI 0.48 to 0.96).Demand of hospital-based outpatient services is much higher than the community-based outpatient services. Policy reformers need to take further actions to address the public distrust in PCPs to facilitate their gatekeeping role.

Project description:BackgroundViscoelastic tests enable a time-efficient analysis of coagulation properties. An important limitation of viscoelastic tests is the complicated presentation of their results in the form of abstract graphs with a multitude of numbers. We developed Visual Clot to simplify the interpretation of presented clotting information. This visualization technology applies user-centered design principles to create an animated model of a blood clot during the hemostatic cascade. In a previous simulation study, we found Visual Clot to double diagnostic accuracy, reduce time to decision making and perceived workload, and improve care providers' confidence.ObjectiveThis study aimed to investigate the opinions of physicians on Visual Clot technology. It further aimed to assess its strengths, limitations, and clinical applicability as a support tool for coagulation management.MethodsThis was a researcher-initiated, international, double-center, mixed qualitative-quantitative study that included the anesthesiologists and intensive care physicians who participated in the previous Visual Clot study. After the participants solved six coagulation scenarios using Visual Clot, we questioned them about the perceived pros and cons of this new tool. Employing qualitative research methods, we identified recurring answer patterns, and derived major topics and subthemes through inductive coding. Based on them, we defined six statements. The study participants later rated their agreement to these statements on five-point Likert scales in an online survey, which represented the quantitative part of this study.ResultsA total of 60 physicians participated in the primary Visual Clot study. Among these, 36 gave an interview and 42 completed the online survey. In total, eight different major topics were derived from the interview field note responses. The three most common topics were "positive design features" (29/36, 81%), "facilitates decision making" (17/36, 47%), and "quantification not made" (17/36, 47%). In the online survey, 93% (39/42) agreed to the statement that Visual Clot is intuitive and easy to learn. Moreover, 90% (38/42) of the participants agreed that they would like the standard result and Visual Clot displayed on the screen side by side. Furthermore, 86% (36/42) indicated that Visual Clot allows them to deal with complex coagulation situations more quickly.ConclusionsA group of anesthesia and intensive care physicians from two university hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision making in situations of active bleeding. From the responses of these possible future users, Visual Clot appears to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test-based coagulation management.

Project description:BackgroundEndotracheal intubation by direct laryngoscopy is a mainstay of advanced airway management performed both in the prehospital environment and in the Emergency Department. Many factors may affect the quality of view during direct laryngoscopy, one of them being the visual acuity (VA) of the intubator under these demanding conditions. While some individual variation in VA is to be expected in younger populations, VA naturally deteriorates in older populations particularly beyond the age of 40 years. This study aimed to describe VA in a younger (n=19) and an older (≥40 years of age, n=20) cohort of intubators at baseline and during simulated adult laryngoscopy, and to compare VA between these two age cohorts.MethodsA baseline near VA test was done using a Sloan Early Treatment Diabetic Retinopathy Study (EDTRS) near vision chart at 40 cm under ambient indoor light. Participants in both age cohorts were then requested to perform laryngoscopy using an airway simulator at 40 cm viewing distance and again at a viewing distance of their choice. Both binocular and monocular VA were tested using a near VA chart placed anterior to the vocal cords of the airway trainer. VA was quantified using the logarithm of the minimum angle of resolution (logMAR). Differences in VA between age cohorts were assessed using independent samples t-tests and differences within age cohorts were assessed using paired samples t-tests.ResultsBinocular and monocular near VA was significantly reduced in the older cohort compared to the younger cohort at baseline (both eyes -0.129 logMAR; p = 0.04, right eye -0.147 logMAR; p = 0.005, left eye -0.197 logMAR; p = 0.002). Within each age cohort VA was significantly reduced during laryngoscopy at a fixed viewing distance (younger; both eyes -0.111 logMAR; p < 0.001, right eye -0.095 logMAR; p < 0.001, left eye -0.105 logMAR; p < 0.001; older; both eyes -0,08 logMAR; p < 0.001, right eye -0.110 logMAR; p < 0.001, left eye -0.065 logMAR; p = 0.01) but this was improved by reducing viewing distance.ConclusionIncreased age was associated with a significant reduction in VA at baseline and during laryngoscopy, which can be partially compensated for by adjusting viewing distance. Although it is currently unknown to what extent this age-related reduction of VA might negatively affect time to place an endotracheal tube or success of placement under direct vision, older intubators should be aware of this effect and consider specialized corrective eyewear in order to maintain an adequate level of VA.

Project description:BackgroundIn Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake.MethodsA convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians' perspective on standardised care packages. RESULTS: Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered 'Strongly agree' or 'Agree' in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as 'problematic' as more than 20% of clinicians disagreed or strongly disagreed: 'Socio-political context', 'Goals' and 'Innovation'. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor's role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes).ConclusionIn general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor's role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility.

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Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach.

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Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach.

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