Rohan Jayasuriya

A review of the construct of computer experience

This paper reviews and evaluates current definitions and methods used to assess computer experience. The authors argue that most studies reported in the literature have adopted measures that assess what they term objective computer experience, rather than subjective computer experience. A bi-dimensional view of computer experience is proposed, with emphasis placed on the development of a measure of subjective computer experience.

Determinants of microcomputer technology use: implications for education and training of health staff

In hospitals and other Healthcare settings, increasingly, hands-on computer use is becoming an important behaviour for effective job performance. The literature has identified differences that relate to computer use between occupational categories in health services. The objectives of this study were to identify factors that determine computer acceptance among occupational groups in Community Health and to predict the factors that relate to computer use. A survey was administered to all Community Health staff in one health service area. Health administrators were found to have a significantly higher training in computers, a higher frequency of use and a higher level of skill for both applications (word processing (WP) and database (DB)) than nurses. The results of a regression analysis shows that about 55% of the variation in the use of WP is explained by computer skills, perceived usefulness (PU) and designation. In the case of DB use, PU was the only significant predictor explaining 53% of the variation. Both level of education and prior training were not significant predictors. The implication for health informatics education (and service training) of these findings is that, in the workplace, health professionals would use computers when they perceive it to be useful for performance in their jobs.

The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus

BackgroundOngoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences.MethodsA qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services) and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons.ResultsThree themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each others roles and professional identity. The level of trust related to the acceptance of each others roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level of trust and mistrust.ConclusionsCollaboration across organisational boundaries remains challenging. Power dynamics and trust affect the strategic choices made by each health professional about whether to collaborate, with whom, and to what level. These decisions directly influenced patient experiences. Unlike the difficulties in shifting the balance of power in interprofessional relationships, trust and respect can be fostered through a mix of interventions aimed at building personal relationships and establishing agreed rules that govern collaborative care and that are perceived as fair.

Listening to the rural health workers in Papua New Guinea – The social factors that influence their motivation to work

Despite rural health services being situated and integrated within communities in which people work and live, the complex interaction of the social environment on health worker motivation and performance in Low Middle Income Countries has been neglected in research. In this article we investigate how social factors impact on health worker motivation and performance in rural health services in Papua New Guinea (PNG). Face-to-face in-depth interviews were conducted with 33 health workers from three provinces (Central, Madang, and Milne Bay) in PNG between August and November 2009. They included health extension officers, community health workers and nursing officers, some of whom were in charge of the health centres. The health centres were a selection across church based, government and private enterprise health facilities. Qualitative analysis identified the key social factors impacting on health worker motivation and performance to be the local community context, gender roles and family related issues, safety and security and health beliefs and attitudes of patients and community members. Our study identified the importance of strong supportive communities on health worker motivation. These findings have implications for developing sustainable strategies for motivation and performance enhancement of rural health workers in resource poor settings.

Fatigue and psychological disorders in chronic hepatitis C.

Background and Aim Most patients with chronic hepatitis C report that they suffer from fatigue. The aim of this study was to determine if the symptom of fatigue can be a guide to indicate disease activity in chronic hepatitis C, or if it is related to psychological factors.

Exploring the role of goal theory in understanding training motivation

A model to test conceptions from goal theory within an existing framework of training motivation was developed and tested with employees participating in training in a non-profit organization. It was hypothesized that goal orientation (distal factors) along with self-efficacy, expectancy and valence (proximal factors) would predict goal intentions as well as training outcomes such as affective responses to training, perceptions of training utility and intention to transfer or use the training provided. Results revealed that goal orientation predicted a significant proportion of variance in the proximal antecedents (valence (33 per cent), expectancy (39 per cent) and self-efficacy (31 per cent)) whereas the proximal antecedents explained 43 per cent of the variance in goal intentions. In turn, goal intentions were related to training outcomes (affect (b=0.7), utility (b=0.6) and transfer intention (b=0.5)). Goal intentions mediated the relationship between proximal antecedents and training outcomes, providing evidence that goal intentions play a pivotal role in the causal path from proximal factors to training outcomes. Valence alone was found to be a significant mediator of the relationship between goal orientation and goal intentions.

Managing information systems for health services in a developing country: a case study using a contextualist framework

Investments in information technology (IT) have been escalating in the health sector in both developed and developing countries. However, the failure rate of applications is of concern especially for countries with scarce resources. There is insufficient understanding of factors that lead to such failures in developing countries. A case study of implementing a computerised information system (IS) for health services in the Philippines is analysed using a contextualist framework. Factors that led to the failure included ambiguity in the organisation and in responsibility for the project, lack of capacity to undertake large information systems development projects and inability to retain appropriate staff. However, when the historical and contextual issues were revealed and the interplay between the content, process and context of the change was analysed it was revealed that the content of the IS was not responsive to the changes in the wider health system. The case study confirms the need to analyse and understand organisational, environmental and cultural issues in adopting models and procedures used elsewhere when managing information systems in developing countries.

Rural health workers and their work environment: the role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea

BackgroundJob satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors that relate to rural nurses are different. This study examined inter-personal, intra-personal and extra-personal factors that influence job satisfaction among rural primary care nurses in a Low and Middle Income country (LMIC), Papua New Guinea.MethodsData was collected using self administered questionnaire from rural nurses attending a training program from 15 of the 20 provinces. Results of a total of 344 nurses were available for analysis. A measure of overall job satisfaction and measures for facets of job satisfaction was developed in the study based on literature and a qualitative study. Multi-variate analysis was used to test prediction models.ResultsThere was significant difference in the level of job satisfaction by age and years in the profession. Higher levels of overall job satisfaction and intrinsic satisfaction were seen in nurses employed by Church facilities compared to government facilities (P <0.01). Ownership of facility, work climate, supervisory support and community support predicted 35% (R2 =0.35) of the variation in job satisfaction. The factors contributing most were work climate (17%) and supervisory support (10%). None of these factors were predictive of an intention to leave.ConclusionsThis study provides empirical evidence that inter-personal relationships: work climate and supportive supervision are the most important influences of job satisfaction for rural nurses in a LMIC. These findings highlight that the provision of a conducive environment requires attention to human relations aspects. For PNG this is very important as this critical cadre provide the frontline of primary health care for more than 70% of the population of the country. Many LMIC are focusing on rural health, with most of the attention given to aspects of workforce numbers and distribution. Much less attention is given to improving the aspects of the working environment that enhances intrinsic satisfaction and work climate for rural health workers who are currently in place if they are to be satisfied in their job and productive.

Collaboration across private and public sector primary health care services: benefits, costs and policy implications

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

Stages of growth in end-user computing: applications in the health sector of developing countries in Asia-Pacific

Information technology is being adopted in the health sector of developing countries at a rapid rate to enhance management of health services. Lessons from the experiences of the business sector of developed countries are useful if adapted to the situation. End-User Computing (EUC) has been recognized to have potentially the greatest impact on productivity and on the efficient use of resources in developed countries. The experience of developing countries in introducing IT is reviewed. Based on the stage hypothesis model of growth in computing, a framework to analyse and predict EUC growth in the health sector of developing countries is described. Using the structure, people and technology parameters of the framework, benchmarks applicable to the health sector in developing countries for each stage are applied to case studies from the Asia-Pacific region. The utility of the framework in identifying key issues that need to be addressed in planning information systems in developing countries is presented.