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Write a report on Perceptions and barriers of elderly adults and health professionals towards of information and communication technologies.

The Significance of the Systematic Literature Review

The rapid demographic change of ageing population is increasing in the world wide.  This shift has become a trend specially in developed countries (Barbosa, & Amaro, 2012), although by 2050 the number of people over 65 years will reach to 22% of the global entire population (Chen, &Schulz, 2016). In Australia, older people has almost doubled from 8% in 1964 (948.100 people over 65 years old at that time) to 15% in 2014 (3.4 million over 65 years) and is expecting to continue increasing (Australian Institute of Health and Welfare (AIHW), 2017).  Consequently, more individuals and families will need the services provided by the healthcare system especially in the age care settings which are addressed to the management of adults who have complex conditions or disabilities (McVey, McKenzie, & White, 2013). With the emerging field of ICT in the health sector, there is an innovation in the promotion of care which facilitates the decision making, allows the communication and exchanging of information, and integrates people’s preferences (Abaidoo, & Teye, 2014). These applications may assist older adults and healthcare professionals.

The use of ICT in healthcare has become an essential factor in the quality and delivery of health services. Jones and Groom (2012) claim due to the increasing of ageing population it is necessary the adoption of technologies to minimise costs and to provide efficient and effective health services, allowing the improvement of medical outcomes, and enhancing the safety and experience of patients. Likewise, technological devices may be useful to minimise the feeling of social isolation, to maintain the cognitive skills, to improve health status and the proper use of leisure time through the activities offered by different apps (Czaja, 2016; Mosthagel, 2016; Heinz et al, 2013). ICT is useful to improve the efficiency and effective delivery of services and has some specific benefits for older adults.  

There are many source of technologies that may be used by elderly adults and healthcare providers. For instance, computers and mobile phones are the most popular technologies which connect people from anywhere, allowing the introduction of telehealth services and the management of chronic conditions (Free, Phillips, Watson, Galli, Felix, …& Haines, 2013). Wearable sensors are considered as other alternative to monitor physiological functions, to ongoing treatments and to prevent falls (Patel, Park, Bonato, Chan &Rodgers, 2012). Another example is the implementation of robots which is considered as an option for providing care assistance especially in the places where is a shortage of health workforce, to assist people to perform some basic activities, to improve the patients’ safety or to reduce the level of loneliness (Wu, Cristancho, Fassert, Faucounau, Rotrou, & Rigaud, 2014). However, there are positive and negative attitudes for using technologies in healthcare.  This document will review the main perceptions of elderly adults and health care providers towards ICT in healthcare.

Scope

The experience of elderly people to live in aged care facilities have had an important impact on their lives. For instance, Walker (2016) claim that one of the greatest changes that elderly adults have is losing contact with relatives and friends, leading to some degree of isolation and loss of purpose of life. However, the lack of social interaction may be associated to other factors such as death of friends or family members and the relocation of the place of living (McMurtrey, Downey, Zeltmann, & McGaughey, 2012). This aspect is fundamental because social interactions have been linked to a reduction of mortality rates and better health conditions (Thomas, O’Connell, & Gaskin, 2013). With the introduction of ICT social isolation can be minimised.

The research of ICT has been addressed mainly to the spatial science, telecommunications, business, and humanities (Curtin University, 2016). Likewise, some studies developed in the health sector have mentioned the advantages of implementing ICT to improve the efficiency and effectiveness of services, to monitor patients and follow up ongoing treatments and to improve patients’ safety (Jones, & Groom, 2012, Patel, et al 2012). The adoption of ICT by older adults has also important benefits in different spheres of their lives such as social, physical, and for entertainment (Czaja, 2016; Mosthagel, 2016; Heinz et al, 2013; Thomas, O’Connell, & Gaskin, 2013). However, limited research has been done to explore the perceptions and barriers of older adults and health professionals towards the use of ICT (Vadillo, Rojo, Garces & Checton, 2016). This literature review will identify some common perceptions and barriers that may be useful to make improvements in the design of applications and devices to facilitates a greater acceptance of ICT by older adults and health professionals.

This literature review is limited to identify the perceptions and barriers of older adults and healthcare professionals towards the implementation of ICT in the aged care settings which include hospitals, aged care facilities and private homes. The investigation does not include the perceptions or barriers identified by care givers or personnel from the administrative area of hospitals and aged care facilities. This research will contribute with valuable aspects that motivate or hinders the use of ICT and which may facilitate a greater acceptance for both parties. Also, the investigation will provide with useful information in order to make improvements of the current technologies and applications.

This literature review aims to address the following questions:

  1. What are the main factors that restrict the adoption of technology by older adults and healthcare professionals in the aged care settings?
  2. What considerations may influence the adoption of technologies by older adults and health professionals in the aged care settings?
  1. Determine the barriers that older adults and health professionals have about the adoption of ICT in aged care settings.
  2. Identify the common perceptions that motivate older adults and healthcare professionals in the adoption of ICT in aged care settings.

Research Questions

This document is a systematic review of the literature. Liamputtong (2013) states that a systematic review involves the understanding and synthetising of the available information in a specific field. One of the greatest advantages of a systematic review is that it allows to researchers to quickly identify important information, summarising the findings and providing reliable data that is relevant in the clinical decision-making. The systematic review includes some specific criteria to minimise the biases in the selection of the information. Liamputtong (2013) provides the steps to guide the review: Set the questions for the review, select the strategy for evidence, define the inclusion and exclusion criteria, assess the quality, extract data and summarise the findings. Following the criteria mentioned, the purpose of this literature review was addressed to identify the positive perceptions and barriers that elderly people and health professionals have towards technologies.

  • Search strategy: The research was conducted only in English and the main data bases consulted were NCBI PubMed, Elsevier, ProQuest Central, Emerald and Google Cochrane. However, due to the costs of the articles was necessary the use of Griffith Library database because there is a free access to the articles published. The terms included for researching the articles were perceptions, attitudes, elderly adults, health professionals, and ICT. Also, the articles included were from 2010 until now because technologyadvances rapidly and the perceptions or barriers of users may shift faster over the time.

To keep focus on the research was necessary to understand the meaning of the key terms included in the review. For instance, perception is defined as a belief or opinion and attitude is the feeling or opinion of someone about something (Oxford Dictionary, 2015). Barrier is considered as an obstacle that that prevents the achievement of something (Collins Dictionary, 2016). Moreover, elderly adults in most of the developed nations is defined as individuals with an age of 65 years or over and who are retired (World Health Organisation (WHO), 2017). Health professionals involves a varied workforce such as practitioners, nurses, allied professionals, etc. who provide essential health services, promote health and prevent illness for individuals and communities (WHO, 2017). Finally, ICT includes different devices such as computers, mobile phones, networks, communication satellites, as well as the gathering and storing of data which are used to improve the quality of care, enhance safety and reduce costs (Gagnon, et al 2012).

  • Inclusion and Exclusion Criteria: The research included journal peer review articles published only in English, while publications from conferences, newspapers, and magazines were excluded from the review of the literature. Also, articles that are addressed to asses only the perceptions of implementing electronic health records were also excluded because just evaluates one specific aspect and extended research have done to evaluate this area, reason for what this review is addressed to analyse the general use of ICT in healthcare and the perceptions of the users.
  • Assessment of the Quality:This is an important part of the literature review and helps to identify the strengths and limitations of the studies in order to reduce bias (Liamputtong, 2013). The evaluation of the quality of the information consulted includes the Mixed Method Appraisal Tool (MMAT) which is a checklist that assess qualitative, quantitative and mixed method studies (McGill, 2011). The checklist is divided in five parts and each one has specific questions with a yes/no answer, can’t tell and comments from the authors. 
  • Extraction of Data: A careful reading of the abstracts and the results was performed to ensure that the articles matched to the criteria describe above. Also, the review involved various types of studies such as qualitative, quantitative and mixed methods. The articles selected reported the perceptions and/or barriers that elderly people and health professionals have towards the introduction of technologies, aspects that were summarised in some tables provided to facilitates the analysis of both groups.

Likewise, due to the increasing number of studies published in various databases is essential to establish a process of research. Hoogendam, Robbé and Overbeke (2012) claim that there is a high volume of resources available in the databases and therefore it is necessary key strategies to ensure the efficient searching of material. One approach that helps to search relevant information is the PICO framework which defines four components of the research: Population, Intervention, Comparison or control and Outcomes (Hoogendam et al, 2012). This is a recommended method to improve the research of evidence in the medical field.

For this literature research the PICO framework will be structured by the following components:

Population

Older adults and health professionals

Intervention

The term used to filter the published studies in accordance to the scope of this systematic literature review is information and communication technologies. This term involves different sort of technologies used in health such as mobile phones, computers, tablets, telehealth and robots.

Comparison or Control

Aspects that influence and hinders the use of ICT by older adults and health professionals in the aged care setting.

Outcomes

Barriers and facilitators that enhance or hinders the adoption of ICT. This information might be useful for vendors and ICT designers to improve the accessibility to technologies

Methodology

Maintaining social interactions is an essential aspect of elderly adults who have a positive attitude in the adoption of ICT because of their remarkable advantages. Most of the authors that were consulted agree that the use of ICT help to keep the bond with relatives and friends and may alleviate the feeling of loneliness, improving motivation and self-esteem. The most common method used by elderly people for the maintenance of social interactions is the mobile phone (Walsh, 2011, McMurtrey, et al, 2012) although there are other different alternatives of communication especially over long distances such as emails, social networks and text messages. This review shows the importance of social support to older adults.  

Likewise, elderly adults have a positive perception towards the use of ICT for the aim of improving cognitive skills and health conditions, as well as a source of entertainment. Conversely, the use of internet motivates seniors to maintain mental skills and improve self-esteem (Heart, & Kalderon, 2013). Moreover, a study reveals that participants recognised that cognitive games are useful to stimulate the mind, to improve memory, to compete with others or just as a source of entertainment (Heinz, Martin, Margrett, Yearns, & Franke, 2013).

Another advantage perceived by elderly adults is related to the safety and the management of diseases. A study developed in four European countries with a sample of 250 seniors who live in private homes reported that they are aware about the importance of using technological devices to monitor symptoms, to avoid falls or to locate people with dementia (Williams, McCrindle, & Victor, 2010). In addition, Czaja (2016) and Walsh (2010) agree that there are applications that facilitate the management of illnesses and the enhancement of safety to avoid injuries in limbs, hips, or head resulting of falls by using smartphones, interactive television, tablets and telehealth. These approaches benefits the older section of the society from the social and safety view.

The use of robots in healthcare may be perceived as a positive benefit for elderly adults. Wu et al (2014) identify in their investigation that some participants have positive perceptions about using robots in the stimulation of cognitive skills or to assist them to find lost objects. However, other adults consider that robots may not have a valuable use, they may be potentially dangerous and its use may reduce the human contact. This study also shows that some participants are willing to use robots in the future if they have any impairment, while very few people of the sample reported that they do not have any idea about this sort of technology. The results from this investigation shows certain ambiguity of the participants to implement robots in healthcare or to assist them in the performance of some activities.

Key Terms

Another example of technology used by some elderly adults is e-healthcare services. This sort of healthcare can be provided to people with chronic conditions, individuals who live in rural areas or patients who want to be treated at home. Most of the participants of these studies have good attitudes in the adoption of e-health services, and they are aware of the benefits provided. However, some participants prefer face to face consultations because they consider physical examination to be more important than telemedicine (Bradford et al, 2015). Another aspect identified in the review is the issues faced during the use of applications and also the technical support that adults may need (Acharya and Rai, 2017; Cimperman et al, 2013). This is an innovation that is currently changing the model and delivery of services.

The literature review also points out various factors that influence negatively the perceptions of older people towards adopting technology. Firstly, the age, level of education and health conditions may restrict the use of ICT. For instance, a study developed in United States and Israel shows that 68% of the participants associated the adoption of technology with the level of education (Heart & Kalderon, 2013), while another study conducted in Scotland reveals that adults from rural areas have less computer skills compared with the adults in cities (Philip et al, 2014). Also, the decline of cognitive and motor abilities hinders the use of ICT because of the gradual weakening of senses, as also the difficulties that some older people may experience in the execution of fine movements which are essential for the use of  small buttons of mobile phones and tablets.

However, the most common barrier that is faced in the association of ICT in older age group is the lack of feeling of using technologies (Vroman, Arthanat & Lysack, 2015). They do not have the mentality of associating themselves with new technologies or innovations (Garvey, 2014). This barrier can be overcome by highlighting the benefits and the possibilities involved in ICT. It is believed that once this group of older people learns about the possibilities of ICT they will start using them in their day-to-day activities (Bloom, Garicano, Sadun & Van Reenen, 2014).

Fear of privacy and safety also plays an important role in developing hindrances of using ICT. Older age people think that that social media is not safe and therefore lacks the capability of protecting their privacy (Bilbao-Osorio, Dutta & Lanvin, 2013). In addition, there are some others who think that their activities will be affected by viruses. It is learned from different studies that most of these people do not have any prior experience of using ICT (Shahbaz, Rehman, Sbia, & Hamdi, 2016).  

Another barrier identified is related to the privacy and confidentiality of older people. This can be a critical problem for older people who use devices to access to e-healthcare or to send medical information to health professionals (Williams et al, 2010). Other authors agree that privacy and confidentiality in the management of information is still an issue for older people despite of the improvements made to tackle this issue (Czaja, 2016; Heart & Kalderon, 2013). Therefore, it is indispensable that vendors explain their achievement while fighting these issues.

Older people with physical or mental difficulties cannot use ICT. Use of ICT is very much problematic for people who are visually impaired (Button, Harrington & Belan, 2014; Zaidi, Fernando & Ammar, 2015). Another barrier associated here is the increase in the use of unofficial languages, which may prove problematic for some people in the older age group (Vaishnavi & Kuechler, 2015). 

Lack of training as well as lack of technical support was identified as an obstacle by older people for the adoption of ICT. Some elderly people consider that poor knowledge and skills of using technologies may generate anxiety and frustration (Hearth & Kalderon, 2013; Walsh & Callan, 2011). However, they think that these problems can be mitigated with training and technical support to sophisticate the use of different communication technologies such as internet, computers, mobile phones and e-healthcare services (Heinz et al, 2013; Walsh & Callan, 2011; Cimperman, Brencic, Trkman, & Stanonik, 2013), although participants in one study recognised that the learning process may prove difficult for some elderly adults (Gonzales, Ramirez, & Viadel, 2015).

The use of ICT by elderly people has increased dramatically in the recent years because of the benefits associated with it, but also health professionals are adopting new sorts of technology for executing daily tasks. ICT has various tools that are very much useful for the collection, storage and exchange of information, which will impact the integration of services and also the improvement of productivity and patients’ care (Davis, Morgans, & Burgess, 2016; Mutula, 2015; Gagnon, Desmartis, Labrecque, Car, Pagliari, Pluye, … & Legare, 2012).  However, despite of the benefits of using technology in the workplace there are some hindrances in using it that are faced by health professionals and both these aspects will be discussed in this document.

Healthcare providers have a positive perception in the introduction of ICT in aged care. For instance, a literature review conducted in Sweden shows that ICT is useful in the improvement of  services (Mostaghel, 2016) and similarly another review derived from 31 journal articles state that emerging technologies have increased the use of ICT in different fields of healthcare industry while sophisticating the accessibility and quality of services (Sezgin & Yildirim, 2014). These attitudes are also confirmed in a qualitative study that includes a survey and whose results show that many registered nurses of various institutions in Netherlands claim that the uses of different technologies have positive outcomes at different levels of the organisation (Veer, Fleuren, Bekkema, & Francke, 2011).

Likewise, many participants from different countries agree that technology has become an essential tool to collect data, avoids repetitive tasks, saves time, facilitates the accreditation process and enhance the delivery of services (Vadillo, Rojo, Garces & Checton, 2016; Gund, Lindecrantz, Schaufelberger, & Sjöqvist, 2012; McDonalds, & Russell, 2012; Gagnon et al, 2012).  However, few employees with low computer skills consider that technology has a negative impact in workloads (Mutula, 2015; McDonalds, & Russell, 2012), but the overall perception of health professionals towards technology is favourable.

Similarly, health professionals recognised that training related to ICT is crucial to facilitate the introduction of ICT and to improve the attitudes toward technology. On the other hand, some employees perceive the lack of training as a barrier to adopt the use of technologies in health organisations, causing frustration and delays during the implementation process (Vadillo et al, 2016; Mutual, 2015; Gagnon et al, 2012; Veer, 2011). Training and coaching are important to foster the acceptance of ICT and to replace the negative attitudes of employees with positive attitudes.

Also, some health professionals agrees to the fact that ICT allows collecting accurate data and exchange of information between health professionals and institutions (Mutula, 2015; Vanneste et al, 2013; Gagnon et al, 2012). Moreover, some nurses claim that in particular cases the collection of information is incomplete or inaccurate, especially when patients are transferred from hospitals to aged care facilities and the reason is problem in communication which hinders the continuity of care and may put the patient’s safety at risk (Olsen, Ostnor, Enmarker, & Hellzen, 2013; Vanneste et al, 2013).

Another positive perception towards the use of ICT identified by healthcare providers is in relation with the improvement of accessibility in the services, especially in rural areas or with patients who can be treated at their home. This is possible through the e-healthcare services which involves computation and mobile applications supporting medical decisions in places where there are no specialists or in the management of chronic conditions (Free, Phillips, Watson, Galli, Felix, …& Haines, 2013). Most health professionals have a positive attitude towards the use of e-healthcare services because they understand the advantages of using this sort of technology for the aim of providing care, for reducing the expenses of transportation and to enhance the accessibility to health services of patients living in rural areas (Guise, & Wiig, 2017; Acharya, & Rai, 2017; Ayatollahi, Sarabi, & Langarizad, 2015; Fortino, DiMartino, Entrikin, Muliner, Hanson, & Kath, 2012). However, few participants of a study report that they do not have knowledge of e-healthcare services and dentists do not consider this sort of care as valuable as compared with the opinions given by other health professionals (Ayatollahi et al, 2017). Also, health professionals concern about the privacy and confidentiality of patients’ data (Ayatollahi et al, 2015; Fortino et al, 2012). There are other specific opinions which differ among the studies.

The use of technology by healthcare professionals is also perceived as a threat by some professionals. For instance, some nurses who reported are concerned that technology may replace the human workforce, which will have a  negative impact on the human resources of any organisation (Vanneste et al, 2013; McDonalds, & Russell, 2012). Other unfavourable conditions are also present which are having a direct relation with the level of workload and emotional reactions, which may arise because of the difficulties faced in completing a task using ICT (Vanneste et al, 2013). However, these problems can be reduced with strong leadership, good managerial strategies, support and a change in management plan addressed to enhance employees’ participation and the acceptance of introduction of new technologies (Vanneste et al, 2013; McDonalds & Russell, 2012)

Other barriers identified by professionals from the health field are associated with the age, gender, computer skills and training. Some authors consider that younger employees are more familiar with computers and they consider that the use of ICT is influenced by the educational background and age, recognising that older women face more difficulties in the acceptance and use of new technologies (Vadillo et al, 2016; Adeleke, Lawal, Adio, & Abdullateef, 2014; Vanneste et al, 2013; Gagnon et al, 2012).

Furthermore, some authors agree that low research been conducted to determine perceptions and attitudes of health professionals towards the acceptance and use of ICT in their workplace (Vadillo et al, 2016; McDonalds & Russell, 2012). On the other hand, the participation of healthcare providers in the designing of technologies and applications is not sufficient and they suggest that vendors should obtain more contributions from them.

The dominant topics can be categorised in two areas: On the one hand, the perceptions and barriers of older adults towards ICT and on the other hand, the perceptions and barriers of health professionals about using ICT in the aged care setting. Initially, the literature review was addressed to identify the perceptions and barriers from healthcare providers and older adults in the field of age care. However, minimum research has been done in this industry on the use of ICT, reason for what was necessary to broad the research including hospitals, private homes, and nursing homes or aged care facilities.

The articles selected in the initial research before applying the exclusion criteria were 47 and from this selection 9 of them were duplicated. Once it was applied the exclusion criteria, the number of articles removed were 14 and the remain documents selected for eligibility included 32 studies. However, the final documents that meet the quality criteria were 24 investigations that were analysed and included in this systematic literature review. This information has been summarised using the PRISMA flow chart that is a guideline introduced in 2009 and which provides important steps to reduce bias in the research, allowing a critical selection of information (Akhigbe, Zolnouriana, & Bultersb, 2017). The PRISMA flow chart for this literature review may be found in the figure 1.

  • Study Characteristics:The number of studies selected to identify the perceptions and barriers of older adults towards ICT were 10 and included 1 article from 2017, 2 articles from 2015, 2 articles from 2014, 3 articles from 2013, one article from 2011 and one more from 2010. The articles for this group were classified by continent and included 6 studies conducted in Europe, 2 investigations developed in Asia, 2 searches conducted in North America and 1 study from Oceania.

To identify the perceptions and barriers that health professionals have about using ICT was necessary to consult 14 documents: 2 from 2017, 1 article from 2016, 3 studies from 2015, 1 investigation from 2014, 2 searches from 2013, 3 documents from 2012 and 2 studies from 2011. These investigations also were classified by continent and included 5 documents from Europe, 3 investigations developed in Asia, 3 articles from Africa, 2 investigations conducted in North America, and 1 from Oceania.

  • Research Design Characteristics:The type of research used to identify the perceptions and barriers of older adults towards ICT included 8 qualitative studies and 2 mixed methods, while for evaluating the same aspects in healthcare professionals involved 12 qualitative studies, 1 mixed method research and 1 quantitative research.
  • Participants Characteristics:The evaluation of the perceptions and barriers of older adults involved adults over 65 years old, while the age of healthcare professionals was not essential in the studies although full time and part-time employees who only work in the healthcare area and included clinicians, nurses, allied staff, psychiatrists, and social workers. The studies did not include dentists. 

The perceptions and barriers towards the adoption of ICT by older adults and health professionals were analysed separately and the information was categorised in hospitals, home care, aged care facilities and community care for each group. In the category of older adults, the number of studies developed in hospitals were 2; 5 investigations evaluated the use of technology by older people in their homes (home care) and 3 of these articles sought to compare the perceptions and barriers of the participants who lived in urban and rural areas; only 2 studies were addressed to evaluate these aspects in aged care facilities and 1 study was developed in a computer training program provided in an aged care community. On the other hand, the perceptions and barriers from health professionals were analysed in the same categories that for older adults, where 10 of the articles included participants who work in hospitals; 2 investigations were developed using telehealth in home care; 2 studies were conducted in an aged care facility and 1 article did not mention the area of healthcare where was developed. This information has been summarised in the Graph 1.

The analysis of perceptions and barriers towards the use of technology was done using the same two categories: Older adults and health professionals. However, it is important to mention that most of the articles reviewed sought to identify some perceptions and barriers towards ICT from healthcare providers. The results show that healthcare professionals and older adults have positive attitudes towards the use of technology and most of them are aware about the benefits that ICT provide, but at the same time some of the participants have reported a few barriers that hinders the adoption of different technologies in the healthcare setting. This information has been summarised in each group in the following tables.

Theme

Number of studies

Article

Perception

Reduction of social isolation

4 articles

2,4,8,9

· + to keep in contact with family and friends even over long distances.

· + to reduce depression.

Enjoyment of free time

3 articles

4,7,8,

· + to remind exercises.

· + to gaming and playing videogames.

Unnecessary transportation

3 articles

1,3,6

· + to reduce costs.

· + to schedule appointments.

· + to improve accessibility to healthcare services.

Improvement of mental skills

3 articles

5,7, 8

· + to stimulate mind with puzzles.

Monitoring physiological systems

2 articles

4,10

· + to check blood pressure, glucose levels, oxygen saturation and temperature.

Table 1: Perceptions of older adults towards the use of ICT in aged care settings

From the above result, it is inferred that in order to implement and adopt the ICT, the older people needs to keep contact with the family and friends irrespective of the distance in order to avoid being isolated from society they also needs to reduce depression, to remind exercises, and to get into playing games and video games in order to enjoy free time. Moreover they need to reduce costs, to schedule appointments, to improve accessibility to healthcare services one must stop unnecessary transportation. The older people need to stimulate mind with puzzles in order to improve mental skills. They also need to check blood pressure, glucose levels, oxygen saturation and temperature.

Theme

Number of studies

Article

Perception

Accessibility and delivery of care

8 studies

11, 12, 13, 14, 15, 16, 17, 21, 22

· + impact in the delivery of services and in the diagnose of illnesses.

· + effects in patients’ outcomes.

· Technology has become an essential tool in health.

· + to provide services in remote areas.

Reduction of repetitive tasks

6 studies

16, 18, 20, 21, 23, 24

· + perception of ICT to save time.

· + to follow patients.

· + to improve productivity and performance.

· +  perception in the improvement of job satisfaction.

· + attitude in the decision making and workload.

Communication

2 studies

17, 18

· + to improve the communication among professionals.

· + to allow the exchanging of information between institutions.

Unnecessary transportation

2 studies

11, 14

· Reduction of costs and unnecessary transportation.

Gathering data

1 study

20

· + outcomes to collect patients’ data.

Table 2: Perceptions of health professionals towards the use of ICT in aged care settings

The above outcomes reveal the perceptions of health professionals towards the use of ICT. They need to put an impact in the delivery of services and in the diagnosis of illness, effects in patients’ outcomes to provide services in remote areas in order to access delivery of care.

In order to get a perception of ICT to save time to follow patients to improve productivity and performance, perception in the job satisfaction, attitude in the decision making and workload, they should reduce repetitive tasks. To improve the communication among professionals, to allow the exchanging of information between institutions they should communicate. In order to reduce costs they should avoid unnecessary transportation.

Table 3: Barriers of older adults towards the use of ICT in aged care settings

Theme

Number of studies

Article

Barrier

Distance

5 studies

1, 2, 3, 5, 7

· - due to the lack of physical examination.

· - for few adults, due to the poor satisfaction with the treatment provided.

· - for some people who may loss the physical contact with family and friends.

Ergonomic challenges

2 studies

4, 10

· - for some older adults, due to the difficulties to type, using a mouse or a touch screen.

· - for patients with vision or hearing issues.

Lack of training

2 studies

8, 9

· - for some adults who may experiment anxiety.

· - for some adults who consider that poor knowledge affect the use of ICT.

In reference to the above data the barriers of older towards the use of ICT has been discussed.

Due to the lack of physical examination poor satisfaction with the treatment provided some people may lose contact with their relatives. For some older adults, due to the difficulties to type, using a mouse or a touch screen for patients with vision or hearing issues leads to ergonomic challenges. For some adults who may experiment anxiety or some adults who consider that poor knowledge affect the use of ICT are not trained properly.

Table 4: Barriers of health professionals towards the use of ICT in aged care settings

Theme

Number of studies

Article

Barrier

Lack of training and technical issues

6 studies

11, 12, 14, 16, 20, 24

· Some professionals in Africa have poor computer skills.

· Poor computer abilities lead to discomfort and anxiety.  

Age

4 studies

11, 13, 17, 18

· Some professionals associate the age and educational background to the use of technology.

· One study report that older professionals are more frustrated than men in using technology.

· Negative feelings such as anxiety and frustration may arise using ICT.

Privacy

4 studies

14, 16, 18, 22

· Some professionals are concern about the patients’ data resulting in some resistance to accept ICT.

· Few professionals consider that ICT will reduce the issues about patients’ privacy.

Costs

15, 16

· Costs for maintenance may restrict the use of technology

· Some technologies are not available for professionals in Africa.

· Lack of technology’s infrastructure will increase costs (Africa).

Communication barriers

19

· Communications problems between hospitals and aged care facilities.

In context of the above outcomes, there are challenges regarding lack of technical skills and training like people living in Africa have a low level of computer skills and because of these type of lacking different type of anxieties and discomfort may arise. Privacy is also a factor that plays an important role in the acceptance of ICT; there are some professionals who believe that these types of issues can be reduced by highlighting the benefits of ICT. The cost of using ICT can also prove to be pressurising in day to day use of ICT for older age groups as well as health professionals because the cost of maintenance may sometime restrict its uses. This cost of using ICT on a daily basis increases because of lack in the infrastructure of the technology.

The aim of this literature review was to identify the main perceptions and barriers of older people and health professionals towards ICT in the aged care settings which include hospitals, nursing homes and private residences and which results show that the evaluation of these characteristics have very low research. Most of the studies reviewed are from 2015, 2013 and 2014. This may reflect the lack of research conducted in the last two years to explore the perceptions and barriers of older adults and healthcare providers in the aged care settings, as well as the lack of involvement of these people in the improvement and design of technologies addressed to the health field.

This review also points out that most of the investigations were developed in Europe and Asia for both groups. However, Africa shows some research to identify the perceptions and barriers of health professionals about using ICT, although there are some issues to determine their level of acceptance of technology and drawbacks related to its use due to the lack of infrastructure and the costs associated to its implementation and maintenance.  Also, there are some popular technologies such as fax, scans, or computers that are available for many health professionals in other countries, but in Africa still being unaffordable due to the limited health budget and the prioritisation that government gives to other issues.

This literature review shows that most of the older adults and health professionals have positive perceptions of introducing ICT in the aged care settings, although many investigations have been addressed only to the clinical field involving different health professionals. It is important to mention that ageing population is increasing dramatically especially in developed countries and it is probably that more older adults will need the use of technology to support their independence, maintain their social life, preserve their cognitive skills, etc. However, the use of technology for some older adults has become difficult due to the decline of the sensory-motor abilities.

Likewise, most of the studies were addressed to evaluate the perceptions and barriers that hinders the introduction of ICT by professionals who work especially in hospitals, leaving out other areas of the aged care setting that have equal importance. Also, the results show a very important issue in the communication between aged care facilities and transfers which affect the continuity of the care and may affect patients’ safety.  Further investigations may provide other perceptions and barriers in using technology to make improvements in the current issues and to ensure that the technologies implemented meet the expectations and needs of healthcare providers and older adults.

The literature review also highlights that most of the healthcare providers and older adults have a positive view about using telehealth or telemedicine because it improves the accessibility to healthcare services and reduces travel expenses or unnecessary transportation especially for people with chronic conditions or who have mobility problems. However, there are important barriers that make difficult the adoption of this service because the results show that people from rural areas have less technology skills compared with individuals who live in cities. This aspect can be unfavourable to manage because the use of technology for the population who live in remote areas may be not necessary in their daily lives. Also, there is a wrong misconception of health professionals who belief that telemedicine may lead in increasing wrong practices.

Many studies suggest that various factors play an important role in the association of ICT in older age group. These factors are Age, Level of income, Educational background. Though from the above studies, it is found that association of ICT can be used as a tool to remove social isolation that many older people face. They can use ICT to maintain contact with their families and friends even if they are great distance away from them. Not only this, but older age people can enjoy their leisure time with the use of ICT and this will help them to cope with isolated depression. ICT also helps in the monitoring of physiological system of older people with the help of innovative technologies. According to the study conducted by Haert & Kalderon (2013), it is inferred that use of ICT helps in improving and maintaining mental skills and self esteem, which will further help in the development of a more positive attitude towards ICT. Similarly, many studies which were addressed above suggest that use of ICT by health professionals can be of great help to them because through the use of innovative technologies many symptoms can be identified and monitored beforehand. Also, people who are having dementia can be monitored. The use of ICT also aids to the management of illness and enhancing safety to avoid injuries in different parts of the body.  According to the results of the study, a major portion of the older age group (41.6 percent) does not know how to use computers while another significant part of this group rarely uses computer or technologies (39.6). Also there are some other variables associated in it and these variables are level of experience and obviously cognitive skills. These variables differ from individual to individual in the population of a country. The results of this study shows that there is still a need to improve the practice of ICT among older people but there are many hindrances that are faced in this improvement or association process, like some older people merely does not feel the use of technologies because they think that technologies and innovations will complicate their activities or it may prove inaccessible. This study therefore shows the positive sides of using ICT among the older age group of people in the society. It shows that though there are many different types of barriers present in the introduction and association of ICT, but all these barriers can be removed if proper and appropriate steps are taken.

This also expects cooperation from the older age group because their cooperation will act as a catalyst in the introduction and association process, which will obviously enhance and polish the quality of learning of these older people.

Conclusion: 

The increase of ageing people in Australia and around the world has required the modification of the model and delivery of care, where the adoption of ICT has become an essential tool for health institutions to improve the performance, to facilitate the decision-making process, to strength the communication among different services and users and to assist staff members in the execution of some tasks. Also, ICT plays and important role for the ageing community because it increases independence, reduces social isolation, and improves their safety not only in aged care facilities but also its implementation has many advantages for elderly adults’ private homes. Consequently, ICT has impacted positively in the quality and delivery of care, as well in the independent living of the ageing people.

Likewise, introducing various wearables and technologies addressed to elderly adults and healthcare providers is influenced by individualand organisational factors that have been identified in different studies. This review shows that both groups are aware about the benefits that ICT has in different contexts and situations. Firstly, the common technology used by elderly adults is mobile phones, although the literature mentions other sort of technologies that have a number of benefits for improving different spheres of their lives in the social, leisure and cognitive areas, aspects that are fundamental for maintaining the wellbeing of people in the physical and psychological level, improving self-esteem, motivation and longevity.

Also, some elderly people are not prepared for the complete adoption of ICT due to the lack of training and technical support, poor computer skills and / or difficulties to execute fine movements as a result of the age or an illness, aspects that can be considered as barriers. These factors may be related to the educational background, although some authors agree that elderly adults who lived in rural areas have more negative perceptions to use ICT. Few studies mention that elderly adults suggest more involvement in the design of applications and technologies addressed to them to ensure that these wearables and devices meet their expectations and needs according to their sensor-motor skills and cognitive abilities.

On the other hand, most of the health professionals have positive attitudes and perceptions to use ICT because of the outcomes achieved at different levels of the organisation, excepting dentists who do not perceive the use of technology as favourable for treating patients. Also, the use of ICT has helped to avoid repetitive tasks and has facilitated the accessibility of people to health services especially in rural areas through the use of telehealth, improving productivity and the efficiency of health services. However, there are few health professionals who are not informed about the advantages of telehealth and others consider that ICT increase workload. Moreover, some professionals have mentioned difficulties to receive data from patients transferred from hospitals to nursing homes, because in some cases the information is incomplete and may be associated to the lack of compatibility between programs.  

ICT has a great positive impact on the field of healthcare and on the society as well. society mainly to the senior citizens who are getting advanced by the ways they are being introduced to in order to be up to dated and lead a better and easy life.ICT has empowered patients to take care of their own health and quality of life they lead in.The use of health technologies allows a two way advantage to the patient as well to the medical professionals in the treatment procedures.

The better use of ICT in healthcare services is for the development and to build a better future in health care services and technologies.

ICT has a great contribution to the elder people. The use of ICT has led to better living conditions of the people of the society. Researchers also indicate that social isolation has an adverse effect on the wellbeing of the older people. Research shows that effectiveness of the technologies has evaluated social isolation

Health professionals and elderly people agree that some of the main factors that hinders the adoption of ICT are related to the age and training. Both groups perceive that young generations have more interaction and are more familiarise with technology compared with the older adults and professionals. Also, they consider that these aspects are crucial in the use of different wearables technologies and applications. Likewise, few healthcare providers and elderlies perceive that privacy and confidentiality of the information still an issue despite of the improvements made in this matter to maintain patients’ data safely stored.

It is recommended further research to obtain a better understanding about the perceptions and attitudes of the elderly population and health professionals towards the implementation of ICT because it has been ignored by researchers and vendors.  The results may be useful to make improvements in the technologies and applications implemented, as well as to determine factors that hinders the adoption of ICT by those groups in order to deploy strategies that allow an easier access and management of them. Also, it is necessary a greater involvement of older adults and health professionals in the development of technologies because there are some factors that were identified and need to be improved.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

1. Acharya & Rai (2016)

India

Qualitative Study

(Cross sectional study)

71 people who are registered in Apollo Hospital Telemedicine

· Telemedicine

· Computers

· Mobile phones

· 63 of the participants report that they are satisfied with the services provided by telehealth and with the schedule of the appointments.

· They state that the treatments provide suit their needs.

· 38 patients claim that they do not have issues with the use of telemedicine.

· 17 people report technical problems using telehealth.

· 6 older adults said that they do not feel comfortable with the consultation because of the lack of physical contact with the doctor.

2. Gonzales, Ramirez, & Viadel (2015)

Spain

Qualitative

(Exploratory Study)

191 older adults.

Training program

· Computers

·  Internet

· 177 participants express positive attitudes towards the use of computers for socialising and online surfer.

· The confidence and negative attitudes from some participants to use computers increase with the training provided.

· 74 people have some level of difficulty to use the computer.

· The experience and skills influence the use of computers.

· The learning process to use new technologies can be complicated for some adults.

3. Bradford, Caffery, & Smith (2015)

Australia

Qualitative Study

(Phenomenological study with Semi-structured interviews)

47 patients in rural areas of Darling Downs.

· Telemedicine

· 28 of the participants identify the benefits of telehealth services because it reduces the travel expenses and improve the accessibility to healthcare, reducing inequity.  

· 19 participants are not aware about the benefits of using telehealth.

· 3 participants consider that they will not use telehealth services because they prefer face to face consultations.

· 2 participants see as a disadvantage the use of this service because of the lack of physical examination.

· 4 participants believe that older generations may be difficult to engage with this sort of service.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

4. Philip, Roberts, Currie, & Alasdair, (2014)

Scotland

Mixed Study

168 participants who live in urban and rural areas.

Private homes of elderly adults

· Mobile phones

· Computers

· Blood pressure monitor

· Glucose monitor

· Sensors for falls

· Telehealth

· 151 adults think that telehealth is an option to receive health services and it is perceived as positive.

· 132 participants use mobile phones for keeping in contact with professionals and family. They perceive the use of technology beneficial to reduce loneliness and depression.

· The most used technologies are mobile phones and computers.

· Also, technology is used for pain management and adults believe that this option is good to remind the exercises.  

· 17 people from rural areas are less likely to use telehealth because of the lack of equipment or knowledge.

· who live in urban areas have more computer skills than people from rural areas.

· 67older adults express difficulties to use internet.

· Patients from rural areas expressed no experience with eHealth.

·  Older people face ergonomic challenges in using ICT devices (typing, using a mouse, or touch the screen of mobile or tablet).

· Impairing vision or hearing difficult the use of devices.

5. Wu, Cristancho, Fassert, Faucounau, Rotrou, & Rigaud (2014)

France

Qualitative Study

(Focus group and semi-structured interview)

20 adults from Broca Hospital in Paris.

· Robots

· Some participants have good perceptions about using robots to assist them to cognitive stimulation and to obtain help to find objects.

· 7 people think that they consider the use of a robot if they have some impairment.

· Few people did not have any idea about robots.

· Some adults perceive robots as potentially dangerous and their use is not valuable.

· Some participants reported the need of human contact and the relationships that are not provided by the robots.

· Most of the participants perceived that robots are suitable for providing care.

6. Cimperman, Brencic, Trkman, Stanonik (2013)

Slovenia

Qualitative Study

(Focus Group)

87 participants living in their homes in rural and urban areas between 55 and 75 years old.

· Telemedicine

· Monitors

· Most of participants believe that telehealth services are useful and they are willing to pay for additional services are home.

· Elderly adults consider that family members are the primary source to obtain help in the access to Ehealth.

· Elderly adults think that only their own doctor should access to their medical information.

· They concern about the technical support to use systems if they have problems in using them.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

7. Heinz, Martin, Margrett, Yearns, & Franke (2013)

United States

(Group Focus)

Qualitative research

(Focus Group)

30 Participants:

Living in private homes in urban and community areas.

· Computers

· All participants included in the study were aware about using different technologies.  

· People enjoy gaming and puzzles because they stimulate their mind and is a good source for entertainment.

· The study focus in the needs and challenges of adopting technology.

· Sometimes older adults are not aware about the benefits of using technology.

· Concerns about privacy.

· Lack of training and support in the use of applications.

· The use of technology improve communication but also hinders the physical contact with family and friends.

8. Hearth & Kalderon (2013)

United States and Israel

Qualitative Study

(Survey)

123 respondents: 63 from United States and 60 from Israel.

Private homes and aged care facilities.

· Mobile phones.

· Computers

· 98 participants use different sort of technologies and recognise the benefits that they provide.

· Minimising social isolation by using different technologies.

· Different applications are useful to maintain cognitive skills, foster mental stimulation and improve memory.

· Improving self-esteem.

· Most of the activities done by elderly people are sending and receiving emails followed by videogames.

· 26 older believe that the use of computer is too difficult.

· Declining of sensory and cognitive skills, makes more difficult the use of technology.

· Difficulties in obtaining technical support.

· Many older adults have a negative attitude for using technology due to the lack of knowledge or the anxiety that may arise.

· The adoption of technology is associated to the education.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

9. Walsh & Callan (2011)

Ireland

Mix method

60 participants.

Rural and urban community-care sites.

· Mobile phones.

· Computers.

· Telehealth.

· 53 older adults recognise that technology has many benefits especially for social connection.

· Mobile phone is the more used device to keep in touch with family and friends.

· The use of technology addressed to prevent falls has remarkable benefits to avoid potential risks to people.

· Another benefit of technology is that devices are useful to reduce social isolation.

· Few people (3) have negative attitudes towards the use of devices due to the limited knowledge for their use.

· Lack of resources, limited budget to invest in ICT and prioritisation of other activities hinders the adoption of technology in long term facilities.

· Training and education are crucial factors to enhance the use of technology.

· The wrong implementation of technology could be a problem to integrate systems with the current model of care, affecting the quality and delivery of the services.

10. Williams, McCrindle, & Victor (2010)

United Kingdom, Greece, Czech Republic, and Belgium.

Qualitative Study

(Exploratory)

158 participants from private homes.

· Mobile phones.

· Computers.

· Internet.

· 146 older adults use technological devices in their homes.

· Some technologies are used to monitoring blood pressure, pulse, temperature and oxygen saturation.

· Detects falls and help staff to locate people specially with dementia.

· 38 people report difficulties to manipulate small buttons and buttons from mobile phones.  

· Concerns about privacy and confidentiality.

· The use of internet is associated to the educational level and the geographical location.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

11. Guise & Wiig (2017)

Norway

Qualitative Study

(Focus group)

26 participants working in home care services.

· Telemedicine

· They recognised that telehealth have many advantages for delivery health and to reduce transport expenses, but the use video technology will improve the results.

· Most of the participants consider that training is needed to conduct proper virtual home visits.

· Several participants report poor training experiences.

· Participants identify that older professionals have difficulties to cope with this sort of technology.

12. Acharya & Rai (2016)

India

Qualitative Study

(Cross sectional study)

116 professionals who are working in Apollo Hospital

· Telemedicine

· All professionals have used telehealth services and perceive that this sort of technology is useful to improve the accessibility to services.

· 109 health professionals are satisfied with the diagnose and results obtained.

· 66 of the professionals recommend the use of telehealth services.

· 4 specialists report technical issues with the hardware.

·  17 professionals encounter problems with the speed of the service.

· 14 professionals mention constraints in the delay of information scheduling appoinments.

13. Vadillo, Rojo, Garces & Checton (2016)

United States

Mix Method

85 full time and part time employees who work in a small hospital.

· Computer

· Electronic health records

· 72 employees agree that using computers is beneficial to improve patient care. Also, they perceive that technology is becoming an essential tool.

· The investigation highlights the importance of training in the use of computers or new systems.

· 2 participants report the need for training in the use of computers.

· 4 participants state that other barriers are related to reasons such as workforce generation, age, anxiety to use technologies.

· The professionals in health consider that “acquiring, integrating and analysing patient data” (p. 354) cause frustration because of the programs’ incompatibility and the lack of standards.

· Limited research has been conducted to determine the perceptions of technology.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

14. Ayatollahi, Sarabi, & Langarizadeh (2015)

Iran

Qualitative Study

(Semi-structured survey)

206 clinicians.

Three public and private hospitals located in northern of Iran.

· Telemedicine

· 198 clinicians perceive that the use of telemedicine has many advantages. One is addressed to the reduction of unnecessary transportation and its costs.

· 154 clinicians agree that the use of telemedicine will be beneficial to provide services in remote areas.

· 96.1% of clinicians report low knowledge in telemedicine.

· It is essential to provide training to improve the knowledge of telemedicine.

· 65 participants believe that the use of telemedicine may lead to the increase of wrong practices.

· Dentists perceive that the use of telemedicine has less benefits compared with the opinions given by physicians, nurses, and specialists.

· Most of the participants report concerns about the privacy and confidentiality of patients’ data.

15. Olok, Yagos, Ovuga (2015)

Uganda

Qualitative Study

(Cross sectional Study)

68 doctors.

Three public hospitals and four private hospitals.

· Mobile phones

· Internet

· Computers

· E-health

· 40 participants have moderate attitudes towards ICT and they perceive an improvement of the medical practices.

· The technologies more used by doctors in Uganda are computers and mobile phones.

· The level of skills influence the used of ICT and is a predictor of their use in the workplace.

· Doctors believe that the use of E-health positively impact in the delivery of services.

· Doctors over 50 years old have more access to computer and internet facilities that professionals between 41 and 50 years old.

· 24 participants report that in some hospitals is limited due to the high cost for its maintenance and problems with the electricity. The improvements of these aspects may impact positively the delivery of services.

· Some technologies may not be available to all health professionals such as fax machines, scans or computerised sensors.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

16. Mutula (2015)

South Africa

Qualitative Study

(Cross sectional descriptive study)

226 registered nurses, nurse assistants and enrolled nurses.

16 hospitals of KwaZulu-Natal

· Computers

· Internet

· 151 professionals consider that the use of computers will improve the storage of medical data and the delivery of care, facilitating the performance of tasks, increasing productivity and saving time.

· Some professionals consider that introducing technology will increase the cost of car and workload, as well as will affect the attention to patients.

· They concern about the confidentiality and privacy of patients’ data.

· Some challenges that nurses concern is the lack of enough computers, poor computer skills and training and lack of technical support.

· Internet and intranet is not available in some hospitals due to the lack of infrastructure.

· Some professionals express the frustration of using computers

17. Adeleke, Lawal, Adio, & Abdullateef (2014)

Nigeria

Qualitative

(Cross sectional study)

374 health information management professionals

· Computers

· Electronic health records

· Integration systems

· 364 participants acknowledge the importance of ICT in healthcare, especially in the delivery of services and in the management of patients’ records.

· 366 health professionals perceive that ICT improve the communication between health professionals.

· 258 participants report need for training especially in statistical analysis of patient data.

· The age and educational background is associated to the use of ICT.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

18. Vanneste, Vermeulen& Declercq (2013)

Belgium

Qualitative Study

(Structured Questionnaire)

282 qualified professionals including: nurses, allied professionals, dieticians, social workers, physicians, etc.

Home care, nursing care and acute hospital care.

· Information    and Communication Technologies

· The results highlight the need of training, computer skills and a good software. The training should be long enough to obtain familiarisation with the new software or equipment.

· The use of technology improves job performance.

· The acceptance of technology by nurses is influenced by facilitators such as leadership, good managerial strategies, support and collaboration.

· Information technologies allows the exchanging of accurate information between institutions.

· The use of technology cause concerns on human resources, confidentiality and an increase of workload.

· The experience towards technology is influenced by the age and gender. Older women may be frustrated using technology.

· Some employees may experiment anxiety or emotional reactions because of the difficulties to complete a task.

· The lack of communication may lead to clinical errors or adverse events.

19. Olsen, Ostnor, Enmarker, & Hellzen (2013)

Norway

Qualitative

(Descriptive exploratory study)

14 registered nurses with minimum 5 years of experience from an aged care facility.

· Computers

· Email

· The study does not report any positive aspect towards the use of technology. Just focus on the issues.

· 12 nurses report that around one-third of the patients (34/102 patients) transferred from hospital to the geriatric home do not send the documentation immediately or is incomplete.  

· Other barriers are the lack of a standard method to gather data and the lack of knowledge to send information outside the institution in both parties.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

20. McDonalds & Russell (2012)

Australia

Qualitative Study

(Semi-structured survey)

250 health professionals including registered nurses, assistant nurses and allied staff. Only 112 professionals answered the survey.

Aged care facility.

· Computers

· Electronic health records

· 90 participants report that they feel comfortable using computers and 155 respondents have confidence and knowledge using their programs.

· Managers and health professionals have positive perceptions about ICT because it avoids repetitive tasks and saves time.

· New technologies in aged care involved “training and individual coaching” (p. 88) to improve employees’ attitudes.

· The introduction of technologies requires change management and leadership to obtain the acceptance.  

· Participants consider that technology has positive outcomes in gathering data and in the accreditation.

· Only 30 participants do not feel comfortable using computers.

· Low research has been conducted to determine the professionals’ view of using technologies in the daily work.

· Some nurses are concern that technology may replace them.

· Employees with low computer skills have some discomfort in using it at the workplace.

21. Gund, Lindecrantz Schaufelberger &Sjöqvist (2012)

Sweden

Qualitative

(Survey)

139 healthcare professionals working chronic heart failure (CHF) of 85 hospital departments.

· Computers

· ICT

· 93 participants recognise the importance of using computers at work and they state that they use this tool for largest part of the day.

· 89 participants report that ICT save time.

· 97 respondents believe that technology is useful to monitor patients and follow up patients from home.

· Just 3 participants consider that technology does not have any benefit to monitor patients in long distances. This can be related to the lack of experience to monitor patients at home.

22. Fortino, DiMartino, Entrikin, Muliner, Hanson & Kahn (2012)

United States

Qualitative Study

(Cross sectional study)

179 nurses who work in three hospitals

· Telemedicine

· Despite that the sample was 179, only 93 professionals decided the participation in the study.

· 50 nurses belief that telehealth has positive effects on patients’ outcomes who live in remote areas or have mobility issues.

· 84 nurses consider that telehealth services will not reduce medical errors.

· 25 nurses consider that this service may affect patients’ privacy.

Author(s)

Country(s)

Type of Study

Sample

Technology

Positive Perceptions

Barriers

23. Veer, Fleuren, Bekkema, & Francke (2011)

Netherlands

Qualitative Study

(Survey)

685 registered nurses and assistants who work in hospitals, psychiatry, care for disable people, home care, nursing homes for elderly people.

· Sensors

· Electronic monitoring

· Telecare

· Electronic health records

· The study took a sample of 685 registered nurses and only 459 responded a survey to evaluate the aspects that influence or failure the implementation of technologies introduced the past three years.

· 280 health professionals claim that the use of technology has positive outcomes in the professional and financial level, as well as job satisfaction and saving time.

· 203 employees recognised that the most well-known technology in healthcare is electronic health records. These participants usually work at hospitals or aged care facilities.

· 110 nurses believe that they do not have sufficient involvement in the development of new sorts of technology and they recommend to vendors more participation of health professionals.

· Some employees perceive as disadvantages the lack of technical support and training.

· The study stress in the need of developing clinical guidelines before adopting and implementing technologies.

· If employees consider the use of a new technology difficult to use it is perceived as a barrier.

24. Al-Harbi (2011)

South Arabia

Hospital

Quantitative Research

623 healthcare providers including physicians, nurses and other clinical personnel in a hospital.

· Health records

· Computerised physician order entry

· All respondents perceive that technologies have valuable benefits

· 311 respondents have participated in the introduction of a new technology.

· Only 112 participants think that some technologies are easy to use.

· 87 participants perceived a significant relationship between training and good use of technologies.

· There are not differences in the perceptions of technologies between males and females.

· Nurses have higher positive perceptions in the use of technology especially for preparing reports, decision making and workload.

· Some barriers perceived by 220 participants are related to the lack of training, lack of technical support and lack of management support.

· There are important differences between employees who attend to training and those one who did not attend it.

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