Background: The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development.Methods: In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services.Results: We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external–internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders).Conclusions: Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context.

Background: Digital health literacy is the use of information and communication technology to support health and health care. Digital health literacy is becoming increasingly important as individuals continue to seek medical advice from various web-based sources, especially social media, during the pandemics such as COVID-19. Objective: The study aimed to assess health professionals’ digital health literacy level and associated factors in Southwest Ethiopia in 2021. Methods: An institution-based cross-sectional study was conducted from January to April 2021 in Ethiopia. Simple random sampling technique was used to select 423 study participants among health professionals. SPSS (version 20) software was used for data entry and analysis. A pretested self-administered questionnaire was used to collect the required data. Multivariable logistic regression was used to examine the association between the digital health literacy skill and associated factors. Significance value was obtained at 95% CI and P<.05. Results: In total, 401 study subjects participated in the study. Overall, 43.6% (n=176) of respondents had high digital health literacy skills. High computer literacy (adjusted odds ratio [AOR] 4.43, 95% CI 2.34-5.67; P=.01); master’s degree and above (AOR 3.42, 95% CI 2.31-4.90; P=.02); internet use (AOR 4.00, 95% CI 1.78-4.02; P=.03); perceived ease of use (AOR 2.65, 95% CI 1.35-4.65; P=.04); monthly income of >15,000 Ethiopian birr (>US $283.68; AOR 7.55, 95% CI 6.43-9.44; P<.001); good knowledge of eHealth (AOR 2.22, 95% CI 1.32-4.03; P=.04); favorable attitudes (AOR 3.11, 95% CI 2.11-4.32; P=.04); and perceived usefulness (AOR 3.43, 95% CI 2.43-5.44; P=.02) were variables associated with eHealth literacy level. Conclusions: In general, less than half of the study participants had a high digital health literacy level. High computer literacy, master’s degree and above, frequent internet use, perceived ease to use, income of >15,000 Ethiopian birr (>US $283.68), good knowledge of digital health literacy, favorable attitude, and perceived usefulness were the most determinant factors in the study. Having high computer literacy, frequent use of internet, perceived ease of use, perceived usefulness, favorable attitude, and a high level of education will help to promote a high level of digital health literacy.

Background: In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in healthcare. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM.Methods: The TM elements were developed through a comprehensive participatory process, resulting in the decision to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients.Results: The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed.Conclusions: Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare.

Background: As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective: The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods: This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results: Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions: Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available.

Background: Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists’ services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system. Methods: Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software. Results: Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service. Conclusions: This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians’ ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians’ competence through long-term and short-term trainings are recommended to improve the referral consultation practice.

Aim To explore next of kin's experiences and attitudes regarding information surrounding the introduction and use of technology to monitor residential home residents with dementia. Background As our population ages, conditions increase health care and societal challenges. Digitalisation and welfare technology are important for developing health services for the ageing population; adapting information-sharing and communication about these pics with those involved, such as next of kin, will become increasingly important for developing appropriate services. Design This qualitative study has an exploratory and interpretative approach, using in-depth interviews based on a hermeneutical–phenomenological perspective. Methods During the process of implementing a variety of residential care monitoring technologies, data were collected primarily via semi-structured, in-depth interviews with care providers and next of kin. In addition to the individual interviews, one focus group interview was carried out with care providers. Results Next of kin are a heterogeneous group who need differing types of information – and different styles of communication – to convey information about their relatives in residential care. General attitudes among the next of kin towards welfare technology were positive. Three analytic themes that illustrate the next of kin concerns emerged: (1) concern for safety, autonomy and ethics; (2) resistance and optimism towards technology; (3) information about the use of monitoring technology. Conclusion Digital monitoring technology is increasingly being implemented in residential care. Next of kin are salient in this context. Accordingly, best practices for informing and communicating in a collaborative process must be developed. While some next of kin have resources and are able to be highly engaged, others are unable or unwilling to be active participants in their family members’ lives. It is critical that care providers are aware that next of kin are a heterogeneous group. Our proposed profiles may prove helpful for giving the right information and attention to next of kin, and this may improve residential care services. Relevance to clinical practice These findings may aid in the tailoring of information and communication systems to individual next of kin's needs and in improving residential care services.