Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The growing demand for elderly care due to aging populations and healthcare workforce shortages requires innovative solutions. Socially assistive robots (SARs) are increasingly explored for their potential to reduce workload by handling routine tasks. Yet, adoption can be hindered by various healthcare workers’ concerns. Objective: This study examined the perceptions of healthcare workers toward SARs before and after a pilot use in a clinical nursing care setting. The study focused on SAR usability, emotional appropriateness, and readiness for adoption. Methods: A mixed-methods pilot study was conducted at the East Tallinn Central Hospital’s Nursing Care Clinic in collaboration with Tallinn University of Technology. The TEMI v3 robot was used for two weeks for visitor guidance, goods delivery, and patrolling tasks. Healthcare workers filled in pre- and post-intervention questionnaires with Likert-scale items and a broad open-ended question. Quantitative data were analyzed for changes in perceived safety, trust, and usability. Qualitative data underwent thematic analysis to understand participants’ opinions. Results: Out of 45 involved healthcare workers, 20 completed the pre-test questionnaire, and 5 completed the post-test questionnaire (a 75% attrition). Pre-test results show that 17 of 20 participants (85%) had limited previous exposure to SARs and mixed perceptions of their role, with 9 (45%) viewing SARs as machines and 6 (30%) as somewhat human-like. Although 60% believed SARs could become mainstream within 5-10 years, there were concerns about the robot’s emotional adequacy and job displacement. Post-test findings showed increased confidence in SARs, with all respondents perceiving them as safe tools. Qualitative results indicate improved trust and readiness to integrate SARs into daily routines, with 4 out 5 (80%) being willing to advocate for SAR use. Still, participants noted limited impact on facilitating their jobs. Conclusions: The study indicates that short-term collaboration with SARs can enhance healthcare workers’ confidence and their readiness for adoption. However, actual use would need proper emotional adequacy from the robot and aligning its functionalities with specific care needs. The future studies need to examine long-term impacts on care quality and job satisfaction, and also strategies to address generational differences and technophobia among healthcare staff. Transparent communication and proper training are required for ensuring acceptance.

This article uses social practice theory to examine the role of information-seeking in the maintenance of existing lifestyle and illness-related adjustments in the context of chronic illnesses. The research findings are derived from a thematic analysis of 16 semi-structured in-depth interviews with Estonian Parkinson’s disease patients. The coding scheme bases on the four practice elements outlined by Schatzki (practical understandings, rules, teleological structures and general understandings) and other categories related to chronic illness self-management skills, bodily movements, daily routines and information-seeking practices. The findings reveal that people with chronic illness value maintaining their existing lifestyles as long as possible and the willingness to seek out illness-related information is related to the severity and duration of the disease. These findings suggest that effective illness-related communication that supports self-management should provide patients with possibilities to adjust and switch between practices in a time and a pace that is natural and acceptable to them.

Breast cancer is the most common cancer in women. Despite the availability of effective breast cancer screening programmes, there are only six countries in the European Union reaching the recommended target rate of 70% screened. In addition to the individual reasons for refraining from breast cancer screening, this research aims to follow earlier suggestions to use a practice theoretical approach. The study sites were Estonia and Latvia, where 9 and 12 semi-structured interviews were conducted, respectively. Convenience and snowball sampling methods were used. The research was approved by ethics committees in both countries. The interviews passed textual analysis and coding. The findings revealed that there are three major types of reasons - habitual, practical, and emotional - that influence the formation of the final decision to participate in breast cancer screening. The implementation of an individualistic approach is not sufficient to bring along desired health behaviour. All groups of reasons, individual and societal context are involved in the decision formation. Thus, structurally provided approaches and messages should be re-conceptualised and re-designed accordingly. Future screening related campaigns and public health education should address the concerns derived from different types of reasons for refraining from screening.

Efficiency-oriented healthcare reforms have led to the closure of obstetric units in several European countries, particularly affecting rural areas that are experiencing depopulation and a decreased birthrate. Using Bourdieu's field theory, this qualitative study aimed to explore how women's economic, cultural, and social capital affects their coping at different stages of maternity. The study was based on 20 semi-structured interviews with women in rural Estonian areas where obstetric units have been closed or face imminent closure because of the low number of deliveries. The findings suggest that the utilisation and interplay of these types of capital are shaped by the geographical context, digital opportunities, and the framework of biomedicalization. From pregnancy through childbirth to the postpartum stage, the importance of economic capital increased because the women were obliged to plan their travel to doctors and hospitals more carefully. The women's cultural and social capital, in the form of information retrieved from the Internet and the availability of family support, was closely associated with their travel decisions. Structural limitations and poor collaboration between healthcare providers and social services hindered capital interplay across fields, especially during the postpartum period. This focus on rural women's lived experiences of coping with maternity care complements previous quantitative studies that have highlighted the health risks associated with the closure of obstetric units in rural hospitals. Our findings suggest that the effect is not overwhelmingly negative, although we observed greater risk for some individuals and varying capabilities in coping with maternity care challenges.

While healthcare systems struggle to manage the COVID-19 pandemic, community pharmacies have changed the way in which they serve society by ensuring the availability of primary-level medical care. This study aims to examine the rearrangement of service provision at community pharmacies through the prism of social practice theory. Qualitative in-depth semi-structured interviews. In total, 21 community pharmacists, 3 hospital pharmacists and 10 experts in Estonia were interviewed. For data analysis, two-dimensional thematic textual analysis was performed according to four types of practices proposed in social practice theory and based on temporal distinction. The findings of this study reveal that, in order to maintain and improve community pharmacy service provision during the pandemic, there have been changes to all aspects of practice elements, including practical understandings, rules and teleological structures. The majority of challenges were experienced because of necessary changes to the habitual ways of providing pharmacy services, indicating resistance to these changes and reinforcing the need to continue existing ‘practice-bundles’. Limited access to healthcare services during the COVID-19 pandemic has resulted in community pharmacists becoming the primary (and only) accessible healthcare contact; thus, leading to a shift in awareness about the role of pharmacists. Although large-scale changes may result in the dissolvement of practice-bundles and require readiness to adjust current methods of service provision, dissolution is a gradual process. There is an urgent need to support pharmacists in managing the challenges of rearranging service provision, such as immediate organisational changes, lack of information and changing resources.

Background: The objective of the study was to investigate frontline healthcare professionals’ experiences and attitudes in relation to the COVID-19 pandemic’s ethical and psychosocial aspects in Estonia. There were two research foci: first, ethical decision-making related to treating patients in the context of potential medical resource scarcity, and second, other psychosocial factors for healthcare professionals pertaining to coping, role conflicts, and the availability of institutional support. Methods: An online survey was conducted in the fall of 2020 amongst the frontline healthcare professionals working in the three most impacted hospitals; respondents were also drawn from two ambulance services. The focus of the survey was on the first wave of COVID-19 (spring 2020). A total of 215 respondents completed the quantitative survey and qualitative data were gathered from open comments. Results: Over half of the surveyed healthcare professionals in Estonia expressed confidence in their roles during the pandemic. More than half cited the complex ethical aspects related to their decisions as their main source of doubt and uncertainty. In response to this uncertainty, Estonian healthcare professionals drew on their previous training and experience, the policies and guidelines of their institution, and support from their colleagues, to aid their decision-making during the pandemic. Conclusions: Although frontline healthcare professionals faced difficult decisions during the first wave of the pandemic, overall, most agreed that experiencing the pandemic reconfirmed that their work mattered greatly.