Journal Digest: Understanding Factors Influencing the Adoption of mHealth in Elderly

For the requirement of this course, we were tasked to digest an academic journal relating to the adoption or use of an any telehealth system.  I chose this article from the 2017 International Journal of Medical Informatics published by Rakibul Hoque  and Golam Sorwar, “Understanding factors influencing the adoption of mHealth by the elderly: An Extension of the UTAUT model”.

You can access the abstract of the article here.

Unified Theory of Adaption and Utilization of Technology (UTAUT) was first described by Venkatesh et al in 2002 to explain user intentions to use a technology and subsequent use of the technology [1]. UTAUT suggest that there are four main constructs that determines user’s intent to use, and use behavior: Performance Expectancy (PE), Effort Expectancy, (EE) Social Influence (SI), and Facilitating Conditions (FC). PE, EE, SI are direct determinants of behavioral Intention(BI) where BI determines Use Behavior, while facilitating condition is a direct determinant of Use Behavior (Figure 1) [1].

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Further, there are four factors that moderates the determinants of the four constructs: Gender, Age, Experience, Voluntariness of Use.

In the paper of Hoque and Sorwar, they explored further the applicability of the model to the elderly population, and hypothesized two new factors that might affect behavior intent: Technology Anxiety and Resistance to Change.

They were testing the following hypothesis.

H1. PE has positive impact on the elderly’s intention to use mHealth
H2. EE has a positive impact on the elderly’s intention to use mHealth.
H3. SI has a positive impact on the elderly’s intention to use mHealth.
H4. FC has a positive impact on the elderly’s inention to use mhealth.
H5. FC has a positive impact on the elderly’s actual use of mHealth.
H6. BI has positive impact on the actual use of mHealth.
H7. (New) TA has negative impact on the elderly’s intention to use mHealth.
H8. (New) RC has a negative impact on the elderly’s intention to use mHealth.

The eight (8) hypothesis can be summarize by the figure below.

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The study found out that performance expectancy, effort expectancy, social influence, technology anxiety, and resistance to change had significant impact on the user’s behavioral intention to adopt mHealth services. The facilitating condition, however, showed no significant relation to behavioral intention to adopt mhealth Services. 

This study is significant in the Philippine setting as the mobile penetration rate of the country as of 2016 is at 87%[3]. Also, hospitals in Geographically Isolated Areas and other Rural Health Units are now gearing towards improvisation of health systems by implementing telehealth services such as electronic medical records, telemedicine, etc. This initiatives are supported by private institutions, NGOs, and government offices (DOH, DOST, PhilHealth etc.). some projects are even lead by these government offices themselves. However, although the the intentions of implementing these initiatives are good, there are very few studies conducted in the Philippines on how these technologies be easily adopted by the end users, and thus sustainable also. Adding to the fact, that majority of the implementers of these technologies, especially in Rural Health Units, are tenured individuals and therefore (most but not all) belong to an older age bracket. This recent study emphasizes special consideration to the elderly and adds new factors to test and consider to improve behavioral intent, and use behavior.

References:

1. V. Venkatesh, M.G. Morris, G.B. Davis, F.D. Davis, User acceptance ofinformation technology: toward a unified view, MIS Q. 27 (3) (2003).

2. R. Hoque, G. Sorwar, Understanding factors influencing the adoption of mHealth by the elderly: An extension of the UTAUT model

3. http://wearesocial.com/uk/special-reports/digital-in-2016

The Night We Met

by Lord Huron
The Night We Met
I am not the only traveler
Who has not repaid his debt
I’ve been searching for a trail to follow again
Take me back to the night we met
And then I can tell myself
What the hell I’m supposed to do
And then I can tell myself
Not to ride along with you
I had all and then most of you
Some and now none of you
Take me back to the night we met
I don’t know what I’m supposed to do
Haunted by the ghost of you
Oh, take me back to the night we met
When the night was full of terrors
And your eyes were filled with tears
When you had not touched me yet
Oh, take me back to the night we met
I had all and then most of you
Some and now none of you
Take me back to the night we met
I don’t know what I’m supposed to do
Haunted by the ghost of you
Take me back to the night we met

Off the Grid

I (was and) will be off the grid indefinitely to physically, mentally, and emotionally prepare for July onwards. 

Beginning and the entire month of May took a toll on me that the dark cloud almost got me. I was slipping to wilderness, I almost lose control. I almost did something irreversible.

These coming days, things will be different. I’m not sure if it will be better or it will be more difficult. But for whatever the universe gives me, I have to be emotionally, physically, and mentally ready. 

I have to be grounded, focused, and balanced.

Breathe, let go, and let life happen.

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I hope (and I know) that someday you will find someone who will love you more than I have loved you; and who will not hurt you the way that you hurt me.

Reasons Why You should (or shouldn’t) Watch It

If you’re only interested to know what is my take on the controversial series, “Thirteen Reasons Why”you can skip the lengthy post and just read the quoted text.

“13 Reasons Why” is obviously not a series intended for all audiences. And by groups of audience I don’t only mean according to age, but according their state of mental health. 13 reasons Why has a lot of sensitive scenes that for someone who is depressed, or had experienced the same fate as Hanah Baker could trigger or suggest a wrong method of handling their mental health problem. But for advocates, family, friends and support groups the story of Hanah Baker is a wake up call that we should do something. It is a good case study that shows (some but not all) the different factors that could contribute to one taking his/her life. And while you’re in it, try thinking of your friends, of your family, or colleagues and  acquiantances. Try to look for Hanah Baker in your own circle; listen, understand, and be there for her.

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13 Reasons Why revolves around the story of Hanah Baker, a high school girl, and the reasons why she took her own life. Before she died of suicide, she recorded 13 tapes intended to 13 different people she thought contributed to her death.

The series gathered a lot of controversies from the public as it showed sensitive scenes that could trigger someone to die of suicide or justify suicide as a means to end the suffering. The show had also shown detailed scenes of how the lead actress, Hanah Baker, slit her wrist and ended her life.

“13 Reasons Why” is obviously not a series intended for all audiences. It has target audiences and anyone who would want to watch it should watch with caution and should be open-minded about the film.

By target audience, I don’t only mean according to age, gender or social classification but according to their state of mental health. If by chance you are aware that you are depressed, or had experienced what Hannah Baker had experience then, by all means, I ask you to NOT watch the series. Even if you think that you are currently okay and that you are now emotionally and mentally stable, DO NOT watch the show as it will haunt you and feed you wrong messages. If you are unsure about the state of your well-being, then choose the safe side and do not watch the show. If you watched the show and you’re starting to see yourself in Hannah Baker’s shoes, you have to stop.

13 reasons Why has a lot of sensitive scenes that for someone who is depressed, or had experienced the same fate as Hanah Baker could trigger or suggest a wrong method of handling their mental health problem. (Spoiler) Especially on the last episode where Hanah Baker already sought the help of a health professional, but still failed and still decided to take her own life, it might give (or is giving) a wrong message that it becomes justifiable already that she took her own life because she did everything and that everything failed her. Suicidal is a difficult state to be in and a sensitive topic, and the series should have been cautious to not lead the story to dying of suicide as it might be mimic by someone watching the show. It should have given hope and second chances so that people who were feeling like Hanah Baker would hold on and continue to live.

If you are experiencing emotional crisis and in need of immediate assistance, please call the HOPELINE at (02) 804-4673 or 0917 558 4673, or you may visit a psych facility or clinic nearest you. Here is the database of the nearest psych clinic in the Philippines: bit.ly/MHPHServiceDatabase.

Suicide should never be portrayed as the solution and should not be justified as the only way out. The series somehow delivered the wrong message, and will somehow make you feel that it was okay for Hanah Baker to take her life because she was bullied, she was raped, she wasn’t heared of, her friends failed her, her guidance counselor failed her, society failed her– her life was difficult and that taking her life away is a justifiable choice, and you can just blame anybody and somebody about it.

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It was also insensitive for the show to repeatedly describe victims of suicide as selfish, fame-whores, over reacting, and individuals looking for attention. Notions that were never resolved or corrected at the end of the show. 

“Suicide isn’t selfish. It’s sad, yes, but not selfish. It’s selfish of those left behind to try to make light of the deceased’s situation. Suicide is not a selfish act. It’s not for attention. It’s for relief. As sad as that sounds, it is. Someone who commits suicide, who goes> all in> for an act that takes it all away, is looking for a way to feel better. At the point when someone is suicidal, they aren’t thinking about other people, but they aren’t thinking about themselves either. (Which, by definition, rules out their SELFishness.) They are lost, confused, and consumed by a dark feeling that takes away their ability to truly think about the world around them. They get swept up in a bad place and, sometimes, unfortunately, can’t find their way out” (Sarah Laughon, 2014)

What’s missing in the series also is that it failed to emphasize that Hanah Baker may actually be suffering from depression and post-traumatic stress disorder. The series could have used it as a medium to raise awareness on this topic and help people understand it better.

But for advocates, family, friends and support groups the story of Hanah Baker is a wake up call for us to be sensitive, vigilant, and kind to people around us. It is a good case study that showed (only some, not all) factors that could contribute to one taking his/her life.

The series slaps you in the face of the existing and still unresolved problem in the society: the culture of bullying in schools (not limited to high school), lack of/insufficient policy and system in schools to protect the kids, the lack of support systems from the family or friends, and the stigmas attached to mental health.

These gaps in the society could be, for advocates and experts, be looked into and targetted to save a Hanah Baker. A lot has been done, but still, a lot is left for us to do.

Since the release of “13 Reasons Why” it caused a lot of discussion in schools, news, and social media about mental health. It was a timely topic to portray in an international TV series to raise awareness about mental health and suicide, but it could’ve been done better and more sensitive. I do not want to call the series a piece of trash as, for me, it somehow invalidates and denies thefact that somehow there are Hanah Bakers in this world who needs help, but a work in progress. And no, I do not want it to be taken down (as many people already have watched it), rather I’d that Netflix should release a more sensitive version of it and a follow-up story to correct the stigma and misconceptions in the first season, and put a better closure and hope to those who were affected by it.

And if this post made you curious and decide to watch “13 Reasons Why”, my only advice is for you to watch it with caution and an open mind. And while you’re on it, try thinking of your friends, of your family, or colleagues and acquaintances. Try to look for Hanah Baker in your own circle; listen, understand, and let them know you’ll be there for her. 
Because after all, we do not want to end up listening to tapes and being told we’re too late.

Bonus thought: My colleagues in the medical field had been wondering why the series showed Hanah Baker slitting her arms longitudinally and wondered if that could actually caused her to die. My theory is that the producers intentionally showed is it in that way so that in case there will be someone who would mimic the act, they would least likely die of hemorrhage and will just pass out. Just a theory though.

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I’ve been talking cryptics to my friends to protect something classified and still being able to express what I feel and find comfort.

But then things happened and all it takes now is one brilliant friend to put all the pieces together and discover what I’ve been protecting for so long.

I just wish that the news will die down quickly and people will forget and lose all the obvious pieces.

And so for now, I have to maintain my balance and be conscious of what I’m feeling because I have to bottle up everything again, at least for now.

This is how I value you. And yet, again and again, never will I get thanked for this. 

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So just in case you’re asking
Where am I in the so-called phases of moving on

I’m in the part where I started following you again
Not censoring the fact that you exist, that we both co-exist.

Getting hurt every time
But slowly accepting the fact that

It is what it is.