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      Clinical utility and acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): A prospective e-survey of parents and health professionals

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          Abstract

          Background

          Paediatric early warning systems (PEWS) are a means of tracking physiological state and alerting healthcare professionals about signs of deterioration, triggering a clinical review and/or escalation of care of children. A proactive end-to-end deterioration solution (the DETECT surveillance system) with an embedded e-PEWS that included sepsis screening was introduced across a tertiary children’s hospital. One component of the implementation programme was a sub-study to determine an understanding of the DETECT e-PEWS in terms of its clinical utility and its acceptability.

          Aim

          This study aimed to examine how parents and health professionals view and engage with the DETECT e-PEWS apps, with a particular focus on its clinical utility and its acceptability.

          Method

          A prospective, closed (tick box or sliding scale) and open (text based) question, e-survey of parents (n = 137) and health professionals (n = 151) with experience of DETECT e-PEWS. Data were collected between February 2020 and February 2021.

          Results

          Quantitative data were analysed using descriptive and inferential statistics and qualitative data with generic thematic analysis. Overall, both clinical utility and acceptability (across seven constructs) were high across both stakeholder groups although some challenges to utility (e.g., sensitivity of triggers within specific patient populations) and acceptability (e.g., burden related to having to carry extra technology) were identified.

          Conclusion

          Despite the multifaceted nature of the intervention and the complexity of implementation across a hospital, the system demonstrated clinical utility and acceptability across two key groups of stakeholders: parents and health professionals.

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          Most cited references53

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          Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies

          Background Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Objective Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. Methods The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. Results The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. Conclusions Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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            A Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

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              Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement

              Background Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user’s journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches. Objective This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance. Methods We searched the PubMed database for publications indexed under the Medical Subject Headings terms “Patient Acceptance of Health Care” and “Mobile Applications.” We included publications that (1) contained at least one of the terms “acceptability,” “acceptance,” “adoption,” “accept,” or “adopt”; and (2) defined the term. The final corpus included 68 relevant studies. Results Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools. Conclusions Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 September 2022
                2022
                : 17
                : 9
                : e0273666
                Affiliations
                [1 ] Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
                [2 ] Department of Social Sciences, University of West of England, Bristol, United Kingdom
                [3 ] Department of General Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [4 ] High Dependency Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [5 ] Faculty of Health, Public Health Institute, Liverpool John Moores University, United Kingdom
                [6 ] Oncology Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [7 ] Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [8 ] Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
                [9 ] Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [10 ] Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
                [11 ] NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                [12 ] Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
                [13 ] Paediatric Intensive Care Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
                PLOS ONE, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ GS and EDC were the Co-Chief Investigators.

                Author information
                https://orcid.org/0000-0001-5226-9878
                https://orcid.org/0000-0001-7563-3409
                https://orcid.org/0000-0001-6584-1642
                Article
                PONE-D-21-34519
                10.1371/journal.pone.0273666
                9477367
                c4dbb6b3-eff7-42cb-884b-e9ec4ef4d723
                © 2022 Carter et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 October 2021
                : 11 August 2022
                Page count
                Figures: 3, Tables: 5, Pages: 24
                Funding
                Funded by: NIHR Invention for Innovation i4i Programme
                Award ID: II-LA-0216-20002
                Award Recipient :
                NIHR Invention for Innovation i4i Programme. https://fundingawards.nihr.ac.uk/award/II-LA-0216-20002 Initials of authors:EDC, GS, BC, MP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Medicine and Health Sciences
                Pediatrics
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Pediatric Surgery
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Sepsis
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Custom metadata
                The North-West, Liverpool East Research Ethics Committee placed ethical restrictions on sharing the data publicly. The anonymised datasets used and/or analysed during the survey are available from the corresponding author on reasonable request. Additionally the data underlying the results presented in the study are available from Prof Chris Littlewood (external to research team) Chris.Littlewood@ 123456edgehill.ac.uk .

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