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Most Influential Qualities in Creating Satisfaction Among the Users of Health Information Systems: A Study in Seven EU Countries
Blekinge Institute of Technology, Faculty of Engineering, Department of Health.ORCID iD: 0000-0002-0316-548x
Blekinge Institute of Technology, Faculty of Engineering, Department of Health.ORCID iD: 0000-0003-4312-2246
Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering. (Product Development Research Lab)ORCID iD: 0000-0002-9662-4576
Blekinge Institute of Technology, Faculty of Computing, Department of Technology and Aesthetics.
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2018 (English)In: JMIR Medical Informatics, Vol. 6, no 4, p. 3-21Article in journal (Refereed) Published
Abstract [en]

Background:

Several models suggest how the qualities of a product or service influence user satisfaction. Models, such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success (D&M IS), demonstrate those relations and have been used in the context of health information systems.

Objective:

We want to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and if this makes user satisfaction a proxy indicator of those qualities.

Methods:

The Unified eValuation using ONtology (UVON) method was utilised to construct an ontology of the required qualities for seven e-health applications being developed in the FI-STAR project, a European Union (EU) project in e-health. The e-health applications were deployed across seven EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. Two similar questionnaires, for 87 patient users and 31 health professional users, were elicited from the ontology. In the questionnaires, user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analysed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, two Partial Least Squares Structural Equation Modelling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

Results:

Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures which reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

Conclusions:

For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, while professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfilment of expectations, but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple, fast way to infer if the system has improved the abovementioned qualities in treatment and care.

Place, publisher, year, edition, pages
JMIR Publications , 2018. Vol. 6, no 4, p. 3-21
Keywords [en]
Health Information Systems, Telemedicine, Evaluation Studies as Topic, Consumer Behavior, Treatment Outcome, Safety, Efficiency, Health Care Costs, Ontology Engineering, Equation Models
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:bth-16998DOI: 10.2196/11252ISI: 000454162600001OAI: oai:DiVA.org:bth-16998DiVA, id: diva2:1247712
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Open access

Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2019-10-29Bibliographically approved
In thesis
1. Evaluating Success Factors of Health Information Systems
Open this publication in new window or tab >>Evaluating Success Factors of Health Information Systems
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Health information systems are our technological response to the growing demand for health care. However, their success in their mission can be challenging due to the complexity of evaluating technological interventions in health care. In the series of studies compiled in this dissertation, we looked at the evaluation of these systems. We focused on the evaluation of factors that lead to success, where success is indicated by user satisfaction and can be induced by both intervention-specific and individual-specific factors.

Study 1 developed a method, called UVON, to elicit and organise the user-demanded qualities in the outcomes of the health information system intervention. Through the application of the UVON method in the FI-STAR project, an EU project which developed and deployed seven e-health applications in seven member countries, ten categories of quality and their subcategories were identified. These qualities formed two questionnaires, specific to the patient and health professional users. Through the questionnaires, the patients and health-professionals users evaluated and graded both the occurrence of those demanded qualities in the project outcomes and their general satisfaction.

Study 2 analysed the survey results to find out which of those ten qualities have the highest impact on satisfaction or can predict it better. Two partial least squares structural equation modelling (PLS-SEM) models were constructed, for the patient and health professionals, based on the Unified eValuation using ONtology (UVON) and survey outputs. The models showed that effectiveness is an important quality in creating satisfaction for both user groups. Besides, affordability for the health professionals and efficiency plus safety for the patients were the most influential. A satisfaction index is also introduced for simple and fast inferring of the changes in the outcome qualities.

Study 5 recruited outputs and learnings from studies 1 and 2 to design a system that partially automates the process of evaluating success factors in health information systems, making it continuous and real-time, and replacing hard-to-run surveys with automatically captured indicators and analytics.

Study 3 focused on individual-specific factors in using health information systems, particularly the technophilia personality trait. A short six-items instrument, called TechPH, was designed to measure technophilia in users, tuned for older users. The study recruited empirical data from the Swedish National Study on Aging and Care (SNAC) project. Two factors, labelled techAnxiety and techEnthusiams, are identified by the factor analysis method. A TechPH score was introduced as a scalar measurement of technophilia.

Study 4 elicited and discussed the ethical challenges of evaluating and researching health information systems. Both a scoping review and a novel systematic postulation approach were recruited to identify twenty ethical challenges. The identified ethical challenges were discussed and mapped into a three-dimensional space of evaluation stages, demanded qualities, and major involving entities (stakeholder and artefacts), which fosters further postulation of ethical challenges.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2019. p. 340
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 14
National Category
Other Electrical Engineering, Electronic Engineering, Information Engineering
Identifiers
urn:nbn:se:bth-18799 (URN)978-91-7295-387-1 (ISBN)
Supervisors
Available from: 2019-10-29 Created: 2019-10-29 Last updated: 2019-11-08Bibliographically approved

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Eivazzadeh, ShahryarSanmartin Berglund, JohanLarsson, TobiasFiedler, MarkusAnderberg, Peter

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