Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students

The use of eHealth is a common phenomenon in healthcare practices across the globe (van Zelst et al., 2021). eHealth provides the means to facilitate communication among care providers and between care providers and their patients to exchange information and facilitate self-monitoring among patients (Reiners, Sturm, Bouw, & Wouters, 2019). eHealth involves the use of digital technologies and telecommunications, such as electronic patient records, telephone follow-ups, telehealth, SMS text messaging and remote consultations, to facilitate health improvements and healthcare service delivery in both clinical and home care settings (Peate, 2013, RCN, 2012). eHealth technologies are used across a varied range of healthcare professionals and patient groups, including community dwelling older adults with complex chronic diseases and disabilities (Gray, Miller, Kuluski, & Cott, 2014), adolescents (Badawy et al., 2018), persons with multiple sclerosis (Marrie et al., 2019), persons living with chronic diseases (Reiners et al., 2019) and older adults (Wong et al., 2021, Kwan et al., 2020). This is an indication of their increasing popularity in the healthcare field.

While some studies have highlighted the challenges associated with eHealth usage, including an increased workload (Klocek, Smahelova, Knapova, & Elavsky, 2019; Waizinger et al., 2022) and technology-related issues such as installation and troubleshooting (Gulzar, Khoja, & Sajwani, 2013), the use of eHealth by nurses and other healthcare professionals has been shown to promote, empower and facilitate the health and wellbeing of patients (Peate, 2013). The Royal College of Nursing (RCN) of the United Kingdom has reported that the use of eHealth improves the monitoring of conditions and self-management, while reducing traveling time; and facilitates quicker clinical discussions, diagnoses and treatment (RCN, 2012). Interventions employing the use of eHealth have also been reported to improve health management and the quality of life of cancer patients (Triberti, Savioni, Sebri, & Pravettoni, 2019) and their caregivers (Li et al., 2022, Slev et al., 2016), older adults (Gustafson et al., 2022, Wong et al., 2022), persons with chronic pain (Licciardone & Pandya, 2020) and persons with chronic illnesses (Wong et al., 2022). In addition, a recent systematic review and meta-analysis has reported that cardiac rehabilitation programs incorporating eHealth were effective at engaging patients in leading an active lifestyle, improving their quality of life and reducing re-hospitalizations (Lee, Wong, Hung, Yan, & Yang, 2022). Existing studies have also highlighted the finding that healthcare providers find eHealth beneficial for their professional development and feel that it saves them time and offers them learning opportunities (van Grootven et al., 2023, Nilsson et al., 2010).

As the largest group of healthcare professionals, nurses play critical roles in the development, implementation and evaluation of eHealth technologies (Bartosiewicz, Burzyńska, & Januszewicz, 2021). In fact, nurses have historically led the way in the clinical, managerial and educational use of digital technologies (Honey et al., 2017) and several eHealth applications strongly rely on their involvement in the delivery of the service (Yoo & Lee, 2022). With the assistance of eHealth systems, the roles of nurses in the provision of health and social care services may span from supporting patients enrolled in telemonitoring by assisting them during teleconsultation services with specialists, to case management in advanced and comprehensive e-health systems focusing on long-term care. In many e-health initiatives, nurses play a critical role in training patients and their families to navigate through the eHealth platform (Duplaga andrychiewicz, & Danda, 2013). Considering the roles played by nurses in the development, implementation and evaluation of eHealth, it is imperative that nurses possess the required competency, knowledge and skills to promote its use among patients and their families (Duplaga et al., 2013). However, current evidence suggested that there is still shortage of undergraduate and postgraduate eHealth courses in nursing curriculum in both China (Sun et al., 2022) and international (Arends et al., 2021, Cassiday et al., 2021; Taylor & Fuller, 2021). For those nursing curriculums that included eHealth, they were focusing more on eHealth communication between nurse and patient and ethical issues of using eHealth technology (Kazawa et al., 2022). There were much less emphasized on eHealth usage, knowledge and application skills (Arends et al., 2021).

In a study examining the information technology competence of 2,844 Canadian nurses, it was observed that the nurses' self-perceived informatics competency was slightly above the cut-off point for competent (Kleib & Nagle, 2018). Perceptions of competency were highest on basic computer literacy skills and lowest on information and knowledge management. The researchers further discovered that the mean scores for overall informatics competency varied significantly in relation to age, educational qualifications, years of experience and work setting (Kleib & Nagle, 2018). A similar study of Korean nurses also reported below-average informatics competency among more than two-thirds of the sample; while most scored highest on security and confidentiality and lowest on the use of telehealth applications (Hwang & Park, 2011). These notable challenges are likely to affect the operation/use of eHealth services even if eHealth technologies are available and affirm the need for ongoing education, particularly in the pandemic and post-pandemic eras (Cunningham et al., 2021).

Further to the above, existing studies have highlighted other factors associated with eHealth usage. Using the Consolidated Framework for Implementation Research (CFIR), Ross, Stevenson, Lau and Murray (2016) reported that the factors associated with eHealth usage include innovation characteristics (the adaptability, complexity and cost of the eHealth system), the outer setting (external policies and incentives), the inner setting (the climate surrounding the implementation of the eHealth system) and the individual characteristics of the practitioners (their knowledge and beliefs and computer literacy). Although demographic characteristics such as age, gender and nationality, may influence the attitudes of healthcare professionals towards eHealth systems (Goldstein et al., 2014), other studies have concluded that no clear relationships between these characteristics could be established (Ross et al., 2016, Waneka and Spetz, 2010). From the perspectives of end users, perceived ease of use, perceived usefulness and trust have been identified as significant factors influencing their intention to adopt eHealth (Hoque et al., 2017, Hossain et al., 2019).

Beyond competency, it is imperative that nurses possess the right perceptions of eHealth applications. Whereas physicians have been reported to perceive eHealth to be useful and to indicate that they would be very likely to promote its use (Ruiz Morilla et al., 2017, Wernhart et al., 2019), the findings on how nurses perceive eHealth have been limited. While one study reported that nurses believed eHealth improved safety and patient care (Dhaliwal et al., 2022), another study reported just the opposite – that nurses perceived that eHealth led to a decrease in the quality of care (Waizinger et al., 2022). One study also highlighted skepticism among Polish nurses regarding the development and implementation of eHealth services (Duplaga et al., 2013). There is also the fact that the concept of perceptions of eHealth is a broad construct that includes perceived risks to data privacy, acceptance, readiness, knowledge, attitude and the potential promise and challenges of its use (Kwan et al., 2022). Existing studies have therefore only captured one aspect of the perception of eHealth among practicing nurses (Kwan et al., 2022). In addition, nursing students have often been excluded from such studies, which creates another knowledge gap. Examining this broad concept in a study can inform actions and policies to improve the use of eHealth.

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