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  1. Article: Preliminary Evidence of the Use of Generative AI in Health Care Clinical Services: Systematic Narrative Review.

    Yim, Dobin / Khuntia, Jiban / Parameswaran, Vijaya / Meyers, Arlen

    JMIR medical informatics

    2024  Volume 12, Page(s) e52073

    Abstract: Background: Generative artificial intelligence tools and applications (GenAI) are being increasingly used in health care. Physicians, specialists, and other providers have started primarily using GenAI as an aid or tool to gather knowledge, provide ... ...

    Abstract Background: Generative artificial intelligence tools and applications (GenAI) are being increasingly used in health care. Physicians, specialists, and other providers have started primarily using GenAI as an aid or tool to gather knowledge, provide information, train, or generate suggestive dialogue between physicians and patients or between physicians and patients' families or friends. However, unless the use of GenAI is oriented to be helpful in clinical service encounters that can improve the accuracy of diagnosis, treatment, and patient outcomes, the expected potential will not be achieved. As adoption continues, it is essential to validate the effectiveness of the infusion of GenAI as an intelligent technology in service encounters to understand the gap in actual clinical service use of GenAI.
    Objective: This study synthesizes preliminary evidence on how GenAI assists, guides, and automates clinical service rendering and encounters in health care The review scope was limited to articles published in peer-reviewed medical journals.
    Methods: We screened and selected 0.38% (161/42,459) of articles published between January 1, 2020, and May 31, 2023, identified from PubMed. We followed the protocols outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to select highly relevant studies with at least 1 element on clinical use, evaluation, and validation to provide evidence of GenAI use in clinical services. The articles were classified based on their relevance to clinical service functions or activities using the descriptive and analytical information presented in the articles.
    Results: Of 161 articles, 141 (87.6%) reported using GenAI to assist services through knowledge access, collation, and filtering. GenAI was used for disease detection (19/161, 11.8%), diagnosis (14/161, 8.7%), and screening processes (12/161, 7.5%) in the areas of radiology (17/161, 10.6%), cardiology (12/161, 7.5%), gastrointestinal medicine (4/161, 2.5%), and diabetes (6/161, 3.7%). The literature synthesis in this study suggests that GenAI is mainly used for diagnostic processes, improvement of diagnosis accuracy, and screening and diagnostic purposes using knowledge access. Although this solves the problem of knowledge access and may improve diagnostic accuracy, it is oriented toward higher value creation in health care.
    Conclusions: GenAI informs rather than assisting or automating clinical service functions in health care. There is potential in clinical service, but it has yet to be actualized for GenAI. More clinical service-level evidence that GenAI is used to streamline some functions or provides more automated help than only information retrieval is needed. To transform health care as purported, more studies related to GenAI applications must automate and guide human-performed services and keep up with the optimism that forward-thinking health care organizations will take advantage of GenAI.
    Language English
    Publishing date 2024-03-20
    Publishing country Canada
    Document type Journal Article ; Review
    ZDB-ID 2798261-0
    ISSN 2291-9694
    ISSN 2291-9694
    DOI 10.2196/52073
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Expert Credibility and Sentiment in Infodemiology of Hydroxychloroquine's Efficacy on Cable News Programs: Empirical Analysis.

    Yim, Dobin / Khuntia, Jiban / King, Elliot / Treskon, Matthew / Galiatsatos, Panagis

    JMIR infodemiology

    2023  Volume 3, Page(s) e45392

    Abstract: Background: Infodemic exacerbates public health concerns by disseminating unreliable and false scientific facts to a population. During the COVID-19 pandemic, the efficacy of hydroxychloroquine as a therapeutic solution emerged as a challenge to public ... ...

    Abstract Background: Infodemic exacerbates public health concerns by disseminating unreliable and false scientific facts to a population. During the COVID-19 pandemic, the efficacy of hydroxychloroquine as a therapeutic solution emerged as a challenge to public health communication. Internet and social media spread information about hydroxychloroquine, whereas cable television was a vital source. To exemplify, experts discussed in cable television broadcasts about hydroxychloroquine for treating COVID-19. However, how the experts' comments influenced airtime allocation on cable television to help in public health communication, either during COVID-10 or at other times, is not understood.
    Objective: This study aimed to examine how 3 factors, that is, the credibility of experts as doctors (DOCTOREXPERT), the credibility of government representatives (GOVTEXPERT), and the sentiments (SENTIMENT) expressed in discussions and comments, influence the allocation of airtime (AIRTIME) in cable television broadcasts. SENTIMENT pertains to the information credibility conveyed through the tone and language of experts' comments during cable television broadcasts, in contrast to the individual credibility of the doctor or government representatives because of the degree or affiliations.
    Methods: We collected transcriptions of relevant hydroxychloroquine-related broadcasts on cable television between March 2020 and October 2020. We coded the experts as DOCTOREXPERT or GOVTEXPERT using publicly available data. To determine the sentiments expressed in the broadcasts, we used a machine learning algorithm to code them as POSITIVE, NEGATIVE, NEUTRAL, or MIXED sentiments.
    Results: The analysis revealed a counterintuitive association between the expertise of doctors (DOCTOREXPERT) and the allocation of airtime, with doctor experts receiving less airtime (P<.001) than the nonexperts in a base model. A more nuanced interaction model suggested that government experts with a doctorate degree received even less airtime (P=.03) compared with nonexperts. Sentiments expressed during the broadcasts played a significant role in airtime allocation, particularly for their direct effects on airtime allocation, more so for NEGATIVE (P<.001), NEUTRAL (P<.001), and MIXED (P=.03) sentiments. Only government experts expressing POSITIVE sentiments during the broadcast received a more extended airtime (P<.001) than nonexperts. Furthermore, NEGATIVE sentiments in the broadcasts were associated with less airtime both for DOCTOREXPERT (P<.001) and GOVTEXPERT (P<.001).
    Conclusions: Source credibility plays a crucial role in infodemics by ensuring the accuracy and trustworthiness of the information communicated to audiences. However, cable television media may prioritize likeability over credibility, potentially hindering this goal. Surprisingly, the findings of our study suggest that doctors did not get good airtime on hydroxychloroquine-related discussions on cable television. In contrast, government experts as sources received more airtime on hydroxychloroquine-related discussions. Doctors presenting facts with negative sentiments may not help them gain airtime. Conversely, government experts expressing positive sentiments during broadcasts may have better airtime than nonexperts. These findings have implications on the role of source credibility in public health communications.
    Language English
    Publishing date 2023-06-27
    Publishing country Canada
    Document type Journal Article
    ISSN 2564-1891
    ISSN (online) 2564-1891
    DOI 10.2196/45392
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis.

    Khuntia, Jiban / Ning, Xue / Cascio, Wayne / Stacey, Rulon

    JMIR formative research

    2022  Volume 6, Issue 5, Page(s) e34808

    Abstract: Background: The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares ... ...

    Abstract Background: The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders.
    Objective: The primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D&I practices and benefits, (2) examine the associations between D&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE).
    Methods: During February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits.
    Results: Health system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system.
    Conclusions: Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.
    Language English
    Publishing date 2022-05-06
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/34808
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Competition and Integration of US Health Systems in the Post-COVID-19 New Normal: Cross-sectional Survey.

    Khuntia, Jiban / Ning, Xue / Stacey, Rulon

    JMIR formative research

    2022  Volume 6, Issue 3, Page(s) e32477

    Abstract: Background: How do health systems in the United States view the concept of merger and acquisition (M&A) in a post-COVID 19 "new normal"? How do new entrants to the market and incumbents influence horizontal and vertical integration of health systems? ... ...

    Abstract Background: How do health systems in the United States view the concept of merger and acquisition (M&A) in a post-COVID 19 "new normal"? How do new entrants to the market and incumbents influence horizontal and vertical integration of health systems? Traditionally, it has been argued that M&A activity is designed to reduce inequities in the market, shift toward value-based care, or enhance the number and quality of health care offerings in a given market. However, the recent history of M&A activity has yielded fewer noble results. As might be expected, the smaller the geographical region in which M&A activity is pursued, the higher the likelihood that monopolistic tendencies will result.
    Objective: We focused on three types of competition perceptions, external environment uncertainty-related competition, technology disruption-driven competition, and customer service-driven competition, and two integration plans, vertical integration and horizontal integration. We examined (1) how health system characteristics help discern competition perceptions and integration decisions, and (2) how environment-, technology-, and service-driven competition aspects influence vertical and horizontal integration among US health systems in the post-COVID-19 new normal.
    Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (21.6%) responded to our survey. We considered competition and integration aspects from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set for 124 health systems. We used inferential statistical comparisons to assess differences across health systems regarding competition and integration, and we used ordered logit estimations to relate competition and integration.
    Results: Health systems generally have a high level of the four types of competition perceptions, with the greatest concern being technology disruption-driven competition rather than environment uncertainty-related competition and customer service-driven competition. The first set of estimation results showed that size, teaching status, revenue, and uncompensated care burden are the main contingent factors influencing the three competition perceptions. The second set of estimation results revealed the relationships between different competition perceptions and integration plans. For vertical integration, environment uncertainty-related competition had a significant positive influence (P<.001), while the influence of technology disruption-driven competition was significant but negative (P<.001). The influence of customer service-driven competition on vertical integration was not evident. For horizontal integration, the results were similar for environment uncertainty-related competition and technology disruption-driven competition; however, the significance of technology disruption-driven competition was weak (P=.05). The influence of customer service-driven competition in the combined model was significant and negative (P<.001).
    Conclusions: Competition-driven integration has subtle influences across health systems. Environment uncertainty-related competition is a significant factor, with underlying contingent factors such as revenue concerns and leadership as the leading causes of integration plans. However, technology disruption may hinder integrations. Undoubtedly, small- and low-revenue health systems facing a high level of competition are likely to merge to navigate the health care business successfully. This trend should be a focus of policy to avoid monopolistic markets.
    Language English
    Publishing date 2022-03-24
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/32477
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Impact of Remote and Virtual Care Models on the Sustainability of Small Health Care Businesses: Perceptual Analysis of Small Clinics, Physician Offices, and Pharmacies in Colorado.

    Parthasarathy, Madhavan / Khuntia, Jiban / Stacey, Rulon

    Journal of medical Internet research

    2021  Volume 23, Issue 2, Page(s) e23658

    Abstract: Background: Lockdowns and shelter-in-place orders during COVID-19 have accelerated the adoption of remote and virtual care (RVC) models, potentially including telehealth, telemedicine, and internet-based electronic physician visits (e-visits) for remote ...

    Abstract Background: Lockdowns and shelter-in-place orders during COVID-19 have accelerated the adoption of remote and virtual care (RVC) models, potentially including telehealth, telemedicine, and internet-based electronic physician visits (e-visits) for remote consultation, diagnosis, and care, deterring small health care businesses including clinics, physician offices, and pharmacies from aligning resources and operations to new RVC realities. Current perceptions of small health care businesses toward remote care, particularly perceptions of whether RVC adoption will synergistically improve business sustainability, would highlight the pros and cons of rapidly adopting RVC technology among policy makers.
    Objective: This study aimed to assess the perceptions of small health care businesses regarding the impact of RVC on their business sustainability during COVID-19, gauge their perceptions of their current levels of adoption of and satisfaction with RVC models and analyze how well that aligns with their perceptions of the current business scenario (SCBS), and determine whether these perceptions influence their view of their midterm sustainability (SUST).
    Methods: We randomly sampled small clinics, physician offices, and pharmacies across Colorado and sought assistance from a consulting firm to collect survey data in July 2020. Focal estimated study effects were compared across the three groups of small businesses to draw several insights.
    Results: In total, 270 respondents, including 82 clinics, 99 small physician offices, and 89 pharmacies, across Colorado were included. SRVC and SCBS had direct, significant, and positive effects on SUST. However, we investigated the effect of the interaction between SRVC and SCBS to determine whether RVC adoption aligns with their perceptions of the current business scenario and whether this interaction impacts their perception of business sustainability. Effects differed among the three groups. The interaction term SRVC×SCBS was significant and positive for clinics (P=.02), significant and negative for physician offices (P=.05), and not significant for pharmacies (P=.76). These variations indicate that while clinics positively perceived RVC alignment with the current business scenario, the opposite held true for small physician offices.
    Conclusions: As COVID-19 continues to spread worldwide and RVC adoption progresses rapidly, it is critical to understand the impact of RVC on small health care businesses and their perceptions of long-term survival. Small physician practices cannot harness RVC developments and, in contrast with clinics, consider it incompatible with business survival during and after COVID-19. If small health care firms cannot compete with RVC (or synergistically integrate RVC platforms into their current business practices) and eventually become nonoperational, the resulting damage to traditional health care services may be severe, particularly for critical care delivery and other important services that RVC cannot effectively replace. Our results have implications for public policy decisions such as incentive-aligned models, policy-initiated incentives, and payer-based strategies for improved alignment between RVC and existing models.
    MeSH term(s) Adult ; COVID-19/epidemiology ; Colorado/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Pharmacies/economics ; Physicians' Offices/economics ; Referral and Consultation ; SARS-CoV-2/isolation & purification ; Small Business/economics ; Surveys and Questionnaires ; Telemedicine/methods
    Language English
    Publishing date 2021-02-25
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/23658
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Digital Orientation of Health Systems in the Post-COVID-19 "New Normal" in the United States: Cross-sectional Survey.

    Khuntia, Jiban / Ning, Xue / Stacey, Rulon

    Journal of medical Internet research

    2021  Volume 23, Issue 8, Page(s) e30453

    Abstract: Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries ... ...

    Abstract Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems' abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies.
    Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post-COVID-19 "new normal" in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation-oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems' digital orientation, whereas the latter two will prepare for future disruptions.
    Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption.
    Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations.
    Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern.
    MeSH term(s) COVID-19 ; Cross-Sectional Studies ; Delivery of Health Care ; Humans ; Pandemics ; SARS-CoV-2 ; Telemedicine ; United States
    Language English
    Publishing date 2021-08-16
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/30453
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis.

    Al-Hasan, Abrar / Khuntia, Jiban / Yim, Dobin

    Frontiers in public health

    2021  Volume 9, Page(s) 715931

    Abstract: Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in ... ...

    Abstract Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in vaccination intentions will be influenced by beliefs around vaccines to influence health. Often perceptions of what others are doing and the information available guide individuals' behaviors for vaccination. This is more so in the digital age with the influence of the internet and media. This study aims to determine the factors that impact willingness to vaccinate for COVID-19. We examined factors associated with acceptance of vaccine based on (1) constructs of the Health Belief Model (HBM), (2) sources of information, (3) social media usage, (4) knowledge of COVID-19 treatment, and (5) perception of government's efforts for mitigation. Randomly sampled online survey data was collected by a global firm between December 2020 and January 2021 from 372 citizens (with a response rate of 96.6%) from multiple regions, including North America, the Middle East, Europe, and Asia. Ordered probit regression suggests that the health belief model constructs hold. Perceived severity of COVID-19 (
    MeSH term(s) COVID-19 Vaccines ; Cross-Sectional Studies ; Humans ; Immunity, Herd ; Reproducibility of Results ; SARS-CoV-2 ; Social Media ; Vaccination ; Vaccines ; COVID-19 Drug Treatment
    Chemical Substances COVID-19 Vaccines ; Vaccines
    Language English
    Publishing date 2021-11-02
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2021.715931
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Citizens' Adherence to COVID-19 Mitigation Recommendations by the Government: A 3-Country Comparative Evaluation Using Web-Based Cross-Sectional Survey Data.

    Al-Hasan, Abrar / Yim, Dobin / Khuntia, Jiban

    Journal of medical Internet research

    2020  Volume 22, Issue 8, Page(s) e20634

    Abstract: Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. ... ...

    Abstract Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens' adherence actions will be influenced by their perceptions about government's plans and the information available to guide their behaviors-more so in the digital age in the realm of mass influence of social media on citizens. Insights into the underlying factors and dynamics involved with citizens' adherence process will inform the policy makers to follow appropriate communication and messaging approaches to influence citizens' willingness to adhere to the recommendations.
    Objective: The aim of this study is a comparative evaluation of citizens' adherence process to COVID-19-relevant recommendations by the government. The focus is on how three different countries' (United States, Kuwait, and South Korea) citizens, randomly sampled, respond to governments' pandemic guidance efforts. We draw insights into two categories of perceived government roles in managing the pandemic: (1) citizens' perceptions of government's role in responding to the pandemic and (2) citizens' perceptions of government's business reopening efforts. Undoubtedly, the internet and social media have burgeoned, with differing effects on shaping individuals' views and assessments of the COVID-19 situation; we argue and test for the effects of information sources, social media use, and knowledge on the adherence actions.
    Methods: We randomly sampled web-based survey data collected by a global firm in May 2020 from citizens of the United States, Kuwait, and South Korea. A nonlinear ordered probit regression, controlling for several counterfactuals, was used for analysis. The focal estimated effects of the study were compared across countries using the weighted distance between the parameter estimates.
    Results: The total sample size was 482 respondents, of which 207 (43%) lived in the United States, 181 (38%) lived in Kuwait, and 94 (20%) lived in South Korea. The ordered probit estimation results suggest that overall, perception of government response efforts positively influenced self-adherence (P<.001) and others' adherence (P<.001) to social distancing and sheltering. Perception of government business reopening efforts positively influenced others' adherence (P<.001). A higher intensity of general health information source for COVID-19 had a positive effect on self-adherence (P=.003). A higher intensity of social media source use for COVID-19 positively influenced others' adherence (P=.002). A higher intensity of knowledge on COVID-19 positively influenced self-adherence (P=.008) and negatively influenced others' adherence (P<.001). There were country-level variations-broadly, the United States and Kuwait had better effects than South Korea.
    Conclusions: As the COVID-19 global pandemic continues to grow and governmental restrictions are ongoing, it is critical to understand people's frustration to reduce panic and promote social distancing to facilitate the control of the pandemic. This study finds that the government plays a central role in terms of adherence to restrictions. Governments need to enhance their efforts on publicizing information on the pandemic, as well as employ strategies for improved communication management to citizens through social media as well as mainstream information sources.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Communication ; Coronavirus Infections ; Cross-Sectional Studies ; Government ; Humans ; Kuwait ; Pandemics ; Pneumonia, Viral ; Republic of Korea ; SARS-CoV-2 ; Social Media ; Surveys and Questionnaires ; United States
    Keywords covid19
    Language English
    Publishing date 2020-08-11
    Publishing country Canada
    Document type Comparative Study ; Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/20634
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey.

    Al-Hasan, Abrar / Khuntia, Jiban / Yim, Dobin

    Journal of medical Internet research

    2020  Volume 22, Issue 11, Page(s) e23019

    Abstract: Background: Social distancing is an effective preventative policy for COVID-19 that is enforced by governments worldwide. However, significant variations are observed in adherence to social distancing across individuals and countries. Due to the lack of ...

    Abstract Background: Social distancing is an effective preventative policy for COVID-19 that is enforced by governments worldwide. However, significant variations are observed in adherence to social distancing across individuals and countries. Due to the lack of treatment, rapid spread, and prevalence of COVID-19, panic and fear associated with the disease causes great stress. Subsequent effects will be a variation around the coping and mitigation strategies for different individuals following different paths to manage the situation.
    Objective: This study aims to explore how threat and coping appraisal processes work as mechanisms between information and citizens' adherence to COVID-19-related recommendations (ie, how the information sources and social media influence threat and coping appraisal processes with COVID-19 and how the threat and coping appraisal processes influence adherence to policy guidelines). In addition, this study aims to explore how citizens in three different countries (the United States, Kuwait, and South Korea), randomly sampled, are effectively using the mechanisms.
    Methods: Randomly sampled online survey data collected by a global firm in May 2020 from 162 citizens of the United States, 185 of Kuwait, and 71 of South Korea were analyzed, resulting in a total sample size of 418. A seemingly unrelated regression model, controlling for several counterfactuals, was used for analysis. The study's focal estimated effects were compared across the three countries using the weighted distance between the parameter estimates.
    Results: The seemingly unrelated regression model estimation results suggested that, overall, the intensity of information source use for the COVID-19 pandemic positively influenced the threat appraisal for the disease (P<.001). Furthermore, the intensity of social media use for the COVID-19 pandemic positively influenced the coping appraisal for the disease (P<.001). Higher COVID-19 threat appraisal had a positive effect on social distancing adherence (P<.001). Higher COVID-19 coping appraisal had a positive effect on social distancing adherence (P<.001). Higher intensity of COVID-19 knowledge positively influenced social distancing adherence (P<.001). There were country-level variations. Broadly, we found that the United States had better results than South Korea and Kuwait in leveraging the information to threat and coping appraisal to the adherence process, indicating that individuals in countries like the United States and South Korea may be more pragmatic to appraise the situation before making any decisions.
    Conclusions: This study's findings suggest that the mediation of threat and coping strategies are essential, in varying effects, to shape the information and social media strategies for adherence outcomes. Accordingly, coordinating public service announcements along with information source outlets such as mainstream media (eg, TV and newspaper) as well as social media (eg, Facebook and Twitter) to inform citizens and, at the same time, deliver balanced messages about the threat and coping appraisal is critical in implementing a staggered social distancing and sheltering strategy.
    MeSH term(s) Adaptation, Psychological ; Adult ; COVID-19/epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Internet ; Male ; Middle Aged ; Physical Distancing ; Surveys and Questionnaires ; Telemedicine/methods
    Keywords covid19
    Language English
    Publishing date 2020-11-18
    Publishing country Canada
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/23019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Integration vs Collaborative Redesign Strategies of Health Systems' Supply Chains in the Post-COVID-19 New Normal: Cross-sectional Survey Across the United States.

    Khuntia, Jiban / Mejia, Frances J / Ning, Xue / Helton, Jeff / Stacey, Rulon

    JMIR formative research

    2022  Volume 6, Issue 6, Page(s) e35317

    Abstract: Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health ... ...

    Abstract Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health systems' supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies.
    Objective: This study focuses on teasing out the nuance of supply chain integration versus collaborative redesign strategies for health systems in the post-COVID-19 new normal. We focus on 2 research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems' supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes.
    Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 health system CEOs contacted, 135 (21.6%) responded to our survey. We considered supply chain-relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set from the 124 health systems. Next, we used ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices.
    Results: Health systems with higher disruptions would choose integration (positive, P<.001) over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes (P<.01), while collaborations are perceived to lead to greater growth opportunities (P<.05); however, the role of integration in growth is not entirely ruled out (combined model, P<.001). Plausibly, some health systems would choose integration and collaborative redesign models, which have a significant relationship with both services (combined model, P<.01) and growth, establishing the importance of mixed strategies for health systems.
    Conclusions: The cost of health care continues to rise, and supply-related costs constitute a large portion of a hospital's expenditure. Understanding supply chain strategic choices are essential for a health system's success. Although collaboration is an option, focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems.
    Language English
    Publishing date 2022-06-15
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/35317
    Database MEDical Literature Analysis and Retrieval System OnLINE

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