Top

BMC Geriatrics

Published in:

Open Access 01-12-2021 | Care | Research

Barriers to accessing internet-based home Care for Older Patients: a qualitative study

Authors: Baosheng Zhao, Xiaoman Zhang, Rendong Huang, Mo Yi, Xiaofei Dong, Zhenxiang Li

Published in: BMC Geriatrics | Issue 1/2021

Abstract

Background

Due to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care.

Objective

The goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients.

Methods

Based on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis.

Results

We identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety.

Conclusions

Internet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks.

Available only for authorised users

XINHUA. Internet-plus nursing program offers convenience to patients [EB/OL]. [2021.4.10]. http://en.nhc.gov.cn/2019-03/22/c_74874.htm.

CN C C. Healthcare plan launches in six pilot areas [EB/OL]. [2020.4.10]. http://en.nhc.gov.cn/2019-02/14/c_74241.htm.

Johnson S, Bacsu J, Abeykoon H, et al. No place like home: a systematic review of home Care for Older Adults in Canada [J]. Can J Aging. 2018;37(4):400–19. https://doi.org/10.1017/S0714980818000375.CrossRefPubMed

Leff B, Weston CM, Garrigues S, et al. Home-based primary care practices in the United States: current state and quality improvement approaches [J]. J Am Geriatr Soc. 2015;63(5):963–9. https://doi.org/10.1111/jgs.13382.CrossRefPubMed

Genet N, Boerma WG, Kringos DS, et al. Home care in Europe: a systematic literature review [J]. BMC Health Serv Res. 2011;11(1):207. https://doi.org/10.1186/1472-6963-11-207.CrossRefPubMedPubMedCentral

Morioka N, Okubo S, Yumoto Y, et al. Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis [J]. BMC Health Serv Res. 2019;19(1):398. https://doi.org/10.1186/s12913-019-4225-8.CrossRefPubMedPubMedCentral

Zhu H, Lu J, Zhang Y, et al. Responses to population ageing in the new era: a national condition report from China [J]. China Popul Dev Stud. 2019;2(3):272–83. https://doi.org/10.1007/s42379-018-0017-9.CrossRef

Chow SK, Wong FK, Chan TM, et al. Community nursing services for postdischarge chronically ill patients [J]. J Clin Nurs. 2008;17(7B):260–71. https://doi.org/10.1111/j.1365-2702.2007.02231.x.CrossRefPubMed

Markman GD, Lieberman M, Leiblein M, et al. The Distinctive Domain of the Sharing Economy: Definitions, Value Creation, and Implications for Research [J]. J Manag Stud. 2021.

10.

Sheng Z, Wang J, Sun K, et al. Nurses' attitudes toward internet-based home care: a survey study [J]. Comput Inform Nurs. 2020;39(2):97–104. https://doi.org/10.1097/CIN.0000000000000670.CrossRefPubMed

11.

Huang R, Xu M, Li X, et al. Internet-based sharing nurse program and Nurses' perceptions in China: cross-sectional survey [J]. J Med Internet Res. 2020;22(7):e16644. https://doi.org/10.2196/16644.CrossRefPubMedPubMedCentral

12.

Berger T, Bur O, Krieger T. [Internet-based psychotherapeutic interventions][J]. Psychother Psychosom Med Psychol. 2019;69(9–10):413–26. https://doi.org/10.1055/a-0963-9055.CrossRefPubMed

13.

Wang Q, Lee R, Hunter S, et al. The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: an integrative review [J]. Int J Nurs Stud. 2021;115:103845. https://doi.org/10.1016/j.ijnurstu.2020.103845.CrossRefPubMed

14.

Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews [J]. Int J Med Inform. 2010;79(11):736–71. https://doi.org/10.1016/j.ijmedinf.2010.08.006.CrossRefPubMed

15.

Elliott B. A day in the life of a home care nurse in Hawaii [J]. Home Healthc Nurse. 2014;32(8):503–4. https://doi.org/10.1097/NHH.0000000000000119.CrossRefPubMed

16.

Liebel DV, Powers BA, Hauenstein EJ. Home health care nurse interactions with homebound geriatric patients with depression and disability [J]. Res Gerontol Nurs. 2015;8(3):130–9. https://doi.org/10.3928/19404921-20150105-01.CrossRefPubMed

17.

Daugherty JD, Eiring H, Blake S, et al. Disaster preparedness in home health and personal-care agencies: are they ready?[J]. Gerontology. 2012;58(4):322–30. https://doi.org/10.1159/000336032.CrossRefPubMed

18.

Franzosa E, Tsui EK. Professional, friend or family?: how home care companies sell emotional care [J]. J Women Aging. 2020;32(4):440–61. https://doi.org/10.1080/08952841.2020.1763894.CrossRefPubMed

19.

Oh EG, Lee HJ, Kim Y, et al. [current status of home visit programs: activities and barriers of home care nursing services][J]. J Korean Acad Nurs. 2015;45(5):742–51. https://doi.org/10.4040/jkan.2015.45.5.742.CrossRefPubMed

20.

Tourangeau A, Patterson E, Rowe A, et al. Factors influencing home care nurse intention to remain employed [J]. J Nurs Manag. 2014;22(8):1015–26. https://doi.org/10.1111/jonm.12104.CrossRefPubMed

21.

Bayer B. A day in the life of a New Orleans home care nurse [J]. Home Healthc Now. 2018;36(4):265–6. https://doi.org/10.1097/NHH.0000000000000700.CrossRefPubMed

22.

Heydari H, Shahsavari H, Hazini A, et al. Exploring the barriers of home Care Services in Iran: a qualitative study [J]. Scientifica (Cairo). 2016;2016:2056470–6. https://doi.org/10.1155/2016/2056470.CrossRef

23.

de Graaff FM, Francke AL. Home care for terminally ill Turks and Moroccans and their families in the Netherlands: carers’ experiences and factors influencing ease of access and use of services [J]. Int J Nurs Stud. 2003;40(8):797–805. https://doi.org/10.1016/S0020-7489(03)00078-6.CrossRefPubMed

24.

Levesque J F, Harris M F, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations [J]. Int J Equity Health, 2013,12: 18, 1, DOI: https://doi.org/10.1186/1475-9276-12-18.

25.

Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data [J]. BMJ. 2000;320(7227):114–6. https://doi.org/10.1136/bmj.320.7227.114.CrossRefPubMedPubMedCentral

26.

Kelly M. The role of theory in qualitative health research [J]. Fam Pract. 2010;27(3):285–90. https://doi.org/10.1093/fampra/cmp077.CrossRefPubMed

27.

Elo S, Kyngäs H. The qualitative content analysis process [J]. J Adv Nurs. 2008;62(1):107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x.CrossRefPubMed

28.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis [J]. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687.CrossRefPubMed

29.

Bujnowska-Fedak MM, Mastalerz-Migas A. Usage of medical internet and e-health services by the elderly [J]. Adv Exp Med Biol. 2015;834:75–80. https://doi.org/10.1007/5584_2014_74.CrossRefPubMed

30.

Quittschalle J, Stein J, Luppa M, et al. Internet use in old age: results of a German population-representative survey [J]. J Med Internet Res. 2020;22(11):e15543. https://doi.org/10.2196/15543.CrossRefPubMedPubMedCentral

31.

Chen MC, Kao CW, Chiu YL, et al. Effects of home-based long-term care services on caregiver health according to age [J]. Health Qual Life Outcomes. 2017;15(1):208.CrossRefPubMedPubMedCentral

32.

Jawahir S, Tan EH, Tan YR, et al. The impacts of caregiving intensity on informal caregivers in Malaysia: findings from a national survey [J]. BMC Health Serv Res. 2021;21(1):391. https://doi.org/10.1186/s12913-021-06412-5.CrossRefPubMedPubMedCentral

33.

Van DT, Macq J, Jeanmart C, et al. Tools for measuring the impact of informal caregiving of the elderly: a literature review [J]. Int J Nurs Stud. 2012;49(4):490–504. https://doi.org/10.1016/j.ijnurstu.2011.10.011.CrossRef

34.

Bom J, Bakx P, Schut F, et al. The impact of informal caregiving for older adults on the health of various types of caregivers: a systematic review [J]. Gerontologist. 2019;59(5):e629–42. https://doi.org/10.1093/geront/gny137.CrossRefPubMed

35.

Walker J, Crotty BH, O'Brien J, et al. Addressing the challenges of aging: how elders and their care partners seek information [J]. Gerontologist. 2017;57(5):955–62. https://doi.org/10.1093/geront/gnw060.CrossRefPubMed

36.

Fischer SH, David D, Crotty BH, et al. Acceptance and use of health information technology by community-dwelling elders [J]. Int J Med Inform. 2014;83(9):624–35. https://doi.org/10.1016/j.ijmedinf.2014.06.005.CrossRefPubMedPubMedCentral

37.

Crotty BH, Walker J, Dierks M, et al. Information sharing preferences of older patients and their families [J]. JAMA Intern Med. 2015;175(9):1492–7. https://doi.org/10.1001/jamainternmed.2015.2903.CrossRefPubMed

38.

Taylor JO, Hartzler AL, Osterhage KP, et al. Monitoring for change: the role of family and friends in helping older adults manage personal health information [J]. J Am Med Inform Assoc. 2018;25(8):989–99. https://doi.org/10.1093/jamia/ocy037.CrossRefPubMedPubMedCentral

39.

Geraedts M, Heller GV, Harrington CA. Germany's long-term-care insurance: putting a social insurance model into practice [J]. Milbank Q. 2000;78(3):375–401, 340. https://doi.org/10.1111/1468-0009.00178.CrossRefPubMedPubMedCentral

40.

Olivares-Tirado P, Tamiya N, Kashiwagi M. Effect of in-home and community-based services on the functional status of elderly in the long-term care insurance system in Japan [J]. BMC Health Serv Res. 2012;12(1):239. https://doi.org/10.1186/1472-6963-12-239.CrossRefPubMedPubMedCentral

41.

Hirth V, Baskins J, Dever-Bumba M. Program of all-inclusive care (PACE): past, present, and future [J]. J Am Med Dir Assoc. 2009;10(3):155–60. https://doi.org/10.1016/j.jamda.2008.12.002.CrossRefPubMed

42.

Walters K, Frost R, Kharicha K, et al. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT [J]. Health Technol Assess. 2017;21(73):1–128. https://doi.org/10.3310/hta21730.CrossRefPubMedPubMedCentral

43.

Swihart D. Finding common ground: Interprofessional collaborative practice competencies in patient-centered medical homes [J]. Nurs Adm Q. 2016;40(2):103–8. https://doi.org/10.1097/NAQ.0000000000000149.CrossRefPubMed

44.

Alkhatib S, Waycott J, Buchanan G, et al. Privacy and the internet of things (IoT) monitoring solutions for older adults: a review [J]. Stud Health Technol Inform. 2018;252:8–14.PubMed

45.

Dostálová V, Bártová A, Bláhová H, et al. The needs of older people receiving home care: a scoping review [J]. Aging Clin Exp Res. 2021;33(3):495–504. https://doi.org/10.1007/s40520-020-01505-3.CrossRefPubMed

46.

Åkerlind C, Martin L, Gustafsson C. eHomecare and safety: the experiences of older patients and their relatives [J]. Geriatr Nurs. 2018;39(2):178–85. https://doi.org/10.1016/j.gerinurse.2017.08.004.CrossRefPubMed

47.

Romagnoli KM, Handler SM, Hochheiser H. Home care: more than just a visiting nurse [J]. BMJ Qual Saf. 2013;22(12):972–4. https://doi.org/10.1136/bmjqs-2013-002339.CrossRefPubMedPubMedCentral

48.

Craven C, Byrne K, Sims-Gould J, et al. Types and patterns of safety concerns in home care: staff perspectives [J]. Int J Qual Health Care. 2012;24(5):525–31. https://doi.org/10.1093/intqhc/mzs047.CrossRefPubMed

49.

Johannessen T, Ree E, Aase I, et al. Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development [J]. BMC Health Serv Res. 2020;20(1):277. https://doi.org/10.1186/s12913-020-05149-x.CrossRefPubMedPubMedCentral

Title: Barriers to accessing internet-based home Care for Older Patients: a qualitative study
Authors: Baosheng Zhao
Xiaoman Zhang
Rendong Huang
Mo Yi
Xiaofei Dong
Zhenxiang Li
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02474-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Barriers to accessing internet-based home Care for Older Patients: a qualitative study

Abstract

Background

Objective

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

The prognostic role of functional dependency in older inpatients with COVID-19

Molecular investigation of a RSV outbreak in a geriatric hospital

Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system

Smell, taste and trigeminal disorders in a 65‐year‐old population

Correction to: Evaluation of FindMyApps: protocol for a randomized controlled trial of the effectiveness and cost-effectiveness of a tablet-based intervention to improve self-management and social participation of community-dwelling people with mild dementia, compared to usual tablet use

Lifestyle exercise attenuates immunosenescence; flow cytometry analysis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page