Acceptance of Telemedical Consultations in Nursing Homes: First

Insights & Outlook

Julia Offermann-van Heek

, Anne Kathrin Schaar

, Jörg Christian Brokmann

and

Martina Ziefle

Human-Computer Interaction Center, RWTH Aachen University, Campus-Boulevard 57, 52074 Aachen, Germany

Emergency Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

Keywords: Telemedicine, Telemedical Consultations, Acceptance, Nursing Homes, Geriatric Patients.

Abstract: Rising numbers of older people and people in need of care pose tremendous challenges for care institutions.

Due to a lack of medical personnel, residents of nursing homes (geriatric patients) are frequently hospitalized

although it is not medically necessary and causes a deterioration of health in many cases. Telemedical

consultations in nursing homes represent one approach to relief and support care personnel in emergency and

medically uncertain situations aiming at a reduction of unnecessary hospitalizations of geriatric patients. For

a successful implementation of these consultations and related innovative processes, the patients’ and as well

as other stakeholders’ (caregivers, doctors, relatives) perspectives and acceptance are important. Thus, a

systematic investigation and adjustment of the requirements is of immense importance. This paper introduces

the Optimal@NRW approach for a cross-sectoral care structure that aims at an avoidance of unnecessary

hospital admissions by implementing telemedical infrastructure in nursing homes. A first scenario-based

acceptance evaluation of telemedical consultations provides insights into the people’s attitudes and allows to

outline an acceptance research agenda as well as next steps within the project.

1 INTRODUCTION

In Europe and worldwide, national health systems are

under pressure. Even before Covid-19 many countries

were confronted with shortages of medical personnel

and limited financial resources as well as an

increasing number of old people entering the care

system as a result of demographic change (Schmidt et

al., 2013; Abbing et al., 2016). The increasing number

of people with need for professional care burdens the

health system and calls for new innovative solutions.

One critical aspect that is of particular importance

refers to acute medical emergency situations of

people in nursing homes. These situations often cause

hospitalization as a result of a rescue service,

especially during the weekend and outside the

consulting hours of physicians (Ouslander &

Berenson, 2011). In this context, it is important to

point out that hospitalization of older people supports

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an increase of a delirium or secondary diseases

(Marcantonio, 2017). This fact has a double negative

impact: On the one hand, unnecessary hospital stays

are an immense financial burden for the health

system. On the other hand, immobilization and a high

mortality rate come along with the necessity to

discuss social implications and questions about a

dignified end of life. In sum, the necessity for

innovative approaches including all relevant

stakeholders to foster resilient, sustainable, and

accepted approaches is without controversy. Digital

measure such as telemedicine could offer relief.

However, a success of telemedicine is no self-starter

at all. How telemedicine can be implemented in

nursing homes, how old structures can be

reorganized, and how acceptance of all stakeholders

involved can be fostered need special attention,

research, and implementation work.

This paper steams from the research project

“Optimal@NRW” that proposes an approach for a

Offermann-van Heek, J., Schaar, A., Brokmann, J. and Zieﬂe, M.

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook.

DOI: 10.5220/0010444000360045

In Proceedings of the 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2021), pages 36-45

ISBN: 978-989-758-506-7

systematic implementation of a telemedical

infrastructure in German nursing homes that is

accompanied by a fundamental reorganization of

intersectoral emergency care.

The focus of this paper is put on the acceptance of

telemedical consultations in nursing homes with

special attention to nursing home residents and their

relatives. In this respect, the paper is structured as

follows: Section 1 starts with a short state of the art of

telemedical applications (section 1.1) in general and

leads over to a presentation of technology acceptance

research (section 1.2) with focus on health-related

technologies and telemedical applications (section

1.3). Following that, section 2 presents the research

project and its aim to illustrate the research context of

the presented study. Afterwards, section 3 presents

first insights from a scenario-based questionnaire

study with focus on future users’ and their relatives’

attitude towards telemedical consultations in nursing

homes. Section 4 contains the discussion and presents

a roadmap for future research on the acceptance of

telemedical consultations in nursing homes. The

paper closes with a short conclusion (see section 5).

1.1 Telemedicine and eHealth

Digital measures offer possible solutions to address

the main challenges in the healthcare sector, such as

shortages of medical personnel and lack of financial

resources. The ubiquitous presence of the Internet in

combination with modern sensor technology, for

example, open up innovative monitoring concepts for

the private space or nursing facilities. Since 2005

eHealth is a central element within the work of the

World Health Organization (WHO) (Al-Shorbaji,

2013). From that moment on, there was a clear

endorsement to the value of information and

communication technologies (ICT) for health and

their socioeconomic benefits in healthcare.

Moreover, since that time there has been immense

progress and innovation in the field of eHealth (and

thus also telemedicine). For the professional medical

sector, we can see two different levels of telemedical

advantages: One the one hand, within the field of

doctor-patient communication and, on the other hand,

in the context of communication between medical

professionals, e.g., in the field of tele-intensive care

(Amkreutz, et al. 2020) or tele-emergency care

(Felzen et al., 2019; Czaplik, et al 2014).

Telemedicine and eHealth concepts are currently

being developed and tested in numerous national and

international research projects. National and

international research funding systematically

supports the development and research of eHealth and

networked. A few of them are mentioned here to

illustrate the broad range of approaches and research

activities: The PAAL project, an EU project, for

example aims at a development of different video-

sensor-, and speech-based systems supporting older

and frail people in their everyday life (Flórez-

Revuelta et al., 2018). Other projects, such as the

BMBF project AIDA, focus on the medical care of

residents in nursing homes. In this context, the aim is

to use telemedicine to ensure adequate care for

elderly people in nursing homes, despite the

increasing lack of resources. At the same time, it is to

be examined whether telemedical measures are

suitable for reducing unnecessary hospital admissions

(Ohligs et al 2020). However, even though research

projects such as the ones described here are promising

it is still difficult to make the move from the project

phase into the standard care of the national health

insurance funds. In addition to these financial aspects,

the acceptance of the involved stakeholders (nurses,

patients, physicians) is an important aspect, which,

just like ethical and legal aspects, is necessary for the

successful and sustainable introduction of concepts

(see section 1.3).

1.2 Technology Acceptance

Due to the fundamental digitalization technology

acceptance and use is a crucial topic in these days.

Since the 1980ies technology acceptance is part the

research agenda in different disciplines (e.g., business

economics, psychology, social sciences).

With focus on different acceptance subjects,

objects and contexts technology acceptance research

is focused on the willingness to use technology as

well as using conditions and human factors as a

potential influencing factor on acceptance. The most

successful acceptance models like TAM (Davis,

1989) and UTAUT (Venkatesh et al., 2003) steam

from the late 1980ies and are focused on the adoption

ICT in the working context. In the context of these

models, factors like the perceived ease of use or

perceived usefulness were identified to be good

predictors for the behavioral intention to use a special

technology. Up to today these models emboss

acceptance research and were transferred to other

technical domains (e.g., medical technology, or

energy) and innovative approaches from the field of

ICT. Acceptance research is often challenged to

research the status quo at the beginning of these

phases, when no interaction with technical artefacts

has yet happened and only theoretical deliberations

were made. In these cases, adequate methodological

approaches are needed to gain resilient information.

Scenario-based approaches (see section 3) are one

suitable measure. Derived from the computer

sciences, which uses scenario-based methods to

integrate the perspective of future users into the

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook

software design process, scenario-based surveys are

today also used in other fields of research, such as

technology acceptance research. The next section

focuses on the acceptance of (tele)medical

applications as one sensitive area in acceptance

research.

1.3 Acceptance of eHealth and

Telemedical Technologies

Within the field of technology acceptance research

medical or health-related technology (such as

telemedical technologies) are playing a special role.

The sensitive circumstances of their application

require a review of existing models and acceptance

factors. Most studies on the acceptance of

telemedicine or other eHealth applications focus on

the acceptance of medical professionals. In this

context, it could be revealed that the classical

technology acceptance models like TAM and

UTAUT (see section 1.2) also have a prediction for

the medical use context (Holden & Karsh, 2010).

Nevertheless, there is a lack of adequate

standardization of acceptance factors and testing of

their robustness. According to Holden and Kars

(2010), it must be assumed that factors such as social

influence have other reference points (e.g., patients or

relatives) than in the area of ICT in the work context.

From several research projects and studies, we know

different factors that have been proven to be relevant

for the acceptance of medical technologies (human

factors, system related factors, and context factors):

Human factors: Age (e.g., Ziefle & Wilkowska,

2010), gender, expertise with (medical) technologies

(Ziefle & Wilkowska, 2010), perceived locus of

control over technology (Burde & Blankerts, 2002),

but also health status (Calero Valdez & Ziefle, 2015)

and care experience (Offermann-van Heek & Ziefle,

2018) were revealed to be relevant factors in the field

of human factors.

System related factors: As relevant system

factors, the perceived ease of use and usefulness (e.g.,

Brauner, 2016) as well as perceived costs as classical

technology acceptance factors are of importance. In

addition to that, perceived system security as well as

privacy and data security (Wilkowska, 2015) were

revealed be play an important role in the context of

the acceptance of medical technologies. In the case of

telemedical technologies, teleconsultation

presentations types (e.g., display size) can also have

an important influence on the evaluation by patients

(Beul et al., 2011). When examining such

technologies, it is therefore of particular importance

to make mutually influencing aspects measurable in a

differentiated manner in order to examine which

factors are ultimately decisive for acceptance.

Context factors: The relevant contextual factors

arise directly from the framework conditions of

technology use. In the case of medical technology or

telemedicine, this can be the living environment, the

clinical context, or further social conditions, for

example acceptance or rejection of family or doctors

(e.g., Brauner, 2016).

2 RESEARCH AIM & PROJECT

As described above, a specific challenge of

demographic change is the provision of adequate

geriatric care in nursing homes or home environments

of geriatric patients. Telemedicine is a promising

approach to tackle the existing challenges, but so far

there are no solutions that have been rolled out on a

large scale. A widespread use would require the

implementation and standardization of technical

means, the proof of medical evidence, cost coverage

by the health insurance companies as well as the

acceptance of the involved stakeholders. This is

precisely where the Innovation Fund project

Optimal@NRW comes in. The Optimal@NRW

project represents a new intersectoral approach to

provide acute care and support for geriatric persons in

need of care by means of an implementation of an

early warning system and the integration of

telemedical consultation systems in 25 nursing homes

and outpatient care within the region of Aachen in

Germany. To realize this goal the project is focused

on restructuring the emergency care infrastructure for

nursing homes as well as improving the collaboration

between the involved stakeholders (emergency

service, emergency department, general practitioners,

care personnel, etc.). According to this goal, a central

emergency number provided by the Association of

Statutory Health Insurance should act as a virtual hub

for the care of geriatric patients. The concrete

approach of the project involves that the participating

nursing homes first contact the doctor's call center

(116 117) when a medical problem arises. Then, the

call center is responsible for an initial medical

assessment and decides whether the respective

general practitioner can be involved or if a

teleconsultation with the “virtual digital desk” (which

means the medical experts from the emergency

department at the University Hospital RWTH

Aachen) should be conducted. In addition, mobile

care assistants are introduced within the project, who

can also support the care personnel and provide

services that can be delegated by doctors – especially

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

if the general practitioner is not available at that time.

Applying these processes, the central project goals

refer to the avoidance of inadequate hospital

admissions in outpatient-sensitive hospital cases and

improved medical care at the nursing homes and in

outpatient care.

During the project, an evaluation of the efficacy

of the implemented structure and processes will be

carried out in a cluster-randomized study. Besides

this health economic evaluation and concrete medical

questions, one central focus of the project relates to

user-related acceptance, perceptions, requirements,

and wishes. Thereby, all relevant stakeholders (i.e.,

residents of nursing homes, relatives of residents, care

personnel, general practitioners, emergency

department, emergency services etc.) have to be

considered in order to identify and evaluate the user

requirements and acceptance with regard to the usage

of telemedical consultations in nursing homes

holistically. The study (see section 3) in this paper

represents the first (scenario-based) step of the user-

related acceptance evaluation.

3 FIRST STUDY INSIGHTS

Within this paper, we like to present first insights

from the previously described project. For this

purpose, the applied online survey, the acquired

sample as well as exemplary results are presented in

the following.

3.1 Online Survey

In the initial phase of the project – in which the

technology is still being configured, requirements

must be identified, and processes coordinated, a first

scenario-based study was conducted to initially

evaluate the use of telemedical technology in nursing

homes from the perspective of younger and older

adults being predominantly not affected by care

themselves. For this purpose, an online survey was

conceptualized focusing on two different self-

developed scenarios: the participants were asked to

put themselves in situations that 1) the telemedical

consultations are used for a family member who lives

in a nursing home, and 2) that they will live

themselves in a nursing home in a few years and the

telemedical technology is used for them.

In the first part of the online survey, the

participants indicated demographic information (i.e.,

age, gender, educational level, living situation).

Afterwards, the participants stated if they suffer from

a chronic disease and if they are in need of support

and care. In addition, the participants were also asked

if they had previous professional or private

experience in care (each as yes/no answer options).

Subsequently, the participants were informed in

detail about the projects’ idea, concept, and

functionality of integrating telemedical consultations

in nursing homes. Thereby, an exemplary situation

was described. In this context, it was explained in

which way telemedical technology can be used and

be beneficial for both, residents and personnel in

nursing homes, by preventing unnecessary hospital

admissions and the associated, frequently occurring

deterioration in the health status of geriatric patients

(e.g., delirium).

Following this explanation, the participants were

asked to empathize with the first scenario – imaging

that telemedical consultations are integrated in a

nursing home a family member is living in. Thus, the

participants should evaluate the usage of telemedical

consultations from a perspective of a relative of a

nursing home resident. Overall, 13 items were used

for the evaluation of the telemedical consultations

(see Figure 1). In more detail, the general attitude

towards the technology (3 items), the behavioral

intention to use the technology (3 items), and the

perception of potential advantages (4 items) as well

as potential barriers (3 items) of using telemedical

consultations in nursing homes were assessed.

In a second step, the participants were asked to

imagine that some years have passed and they

themselves live in a nursing home. Hence, they

should therefore evaluate the use of telemedical

consultations for themselves. Here, the participants

evaluated the same statements again from their “own”

perspective (being a resident in a nursing home).

Aiming for a comparison of both scenarios, all

participants evaluated both scenarios, while

participants who evaluated only one scenario and

filled out the onine survey incompletely were

excluded from statistical analyses.

At the end of the online survey, the participants

were asked to evaluate (yes/no answer options) two

final statements (“Telemedicine enriches care in

nursing homes” and “Telemedicine replaces human

attention in nursing homes”) from both introduced

perspectives (i.e., relative vs. resident),

3.2 Participants

Overall, N = 118 participants filled out the online

survey in November and December 2020 in

Germany. The mean age of the participants was 36.58

years (SD = 15.12; min = 21; max = 79) and the

sample consisted of a higher proportion of female

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook

(70.3%, n = 83) compared to male participants

(29.7%; n = 35). Overall, the sample’s educational

level was comparably high as the majority (60.2%, n

= 71) indicated to hold a university degree, 22.9% (n

= 27) a university entrance certificate, and 8.5% (n =

10) a PhD. In contrast, only 8.5% (n = 10) of the

participants indicated lower education levels, i.e.

diverse secondary school certificates.

Asked about their current living situation, the

majorities of the participants reported to live together

with another person (49.2%, n = 53) or together with

several people (32.2%, n = 38), while only a small

proportion (18.6%, n = 22) lived alone.

Referring to health-related characteristics, the

participants assessed their health status as very good

(26.3%, n = 31), good (47.5%, n = 56), and rather

good (22.3%, n = 24), while only (5.9%, n = 7)

indicated lower assessments. In addition, 25.4% (n =

30) of the participants reported to suffer from a

chronic disease (e.g., hypertension), and only 1.7% (n

= 2) indicated to be in need of care.

As last person-related characteristics, the

participants were asked for their previous experience

in care. Thereby, 15.3% (n = 18) reported to be

professionally experienced in care, whereas 27.1% of

the participants indicated private passive experience

in the sense that a person in their close environment

is in need of care. Beyond that, 21.2% (n = 25) of the

participants reported to have active experience in

care, as they have already been the caregiver for a

person needing care in their close environment.

3.3 Results

In a first step and apart from descriptive statistics,

repeated measure ANOVAs were calculated in order

to investigate the influence of the different

perspectives (a relative of a resident in a nursing

home vs. a resident in a nursing home) – on the

evaluations of telemedical consultations in nursing

homes. In a second step, (multivariate) analyses of

variance were applied to examine whether the

evaluations were influenced by individual

characteristics of the sample. Finally, it was

investigated to what extent the evaluations of

telemedical consultations relate with each other. For

this purpose, bivariate correlation analyses were

calculated. In the following, means (M) and standard

deviations (SD) are reported for descriptive analyses.

For the omnibus significance of analyses of variance,

the F-Tests were taken from the Pillai values,

Pearson’s coefficient are reported for correlations,

and the level of statistical significance (p) was set at

a conventional level of 5% (* = p < .05; ** = p < .01).

3.3.1 Two Perspectives on the Evaluation of

Telemedical Consultations in Nursing

Homes?

The results regarding the evaluations of telemedical

consultations in nursing home differing both

described perspectives are presented in Figure 1.

Thereby, means above the mean of the scale (3.5)

indicate the agreement, while means below 3.5

rejection of an item.

Starting with the overall acceptance, telemedical

consultations in nursing homes were evaluated to be

equally useful (n.s.), and the usage of innovative

technologies in nursing homes was desired

independent from both investigated perspectives

(n.s.). Compared to that, the item “I find the system

meaningful” was confirmed significantly more from

the perspective of a relative (M = 4.74, SD = 0.92)

compared to the perspective of a resident (M = 4.54,

SD = 1.05; F(1,115)=6.211, p < .05).

Beyond the general acceptance, the participants

also evaluated a more concrete facet of acceptance in

terms of an intention to use telemedical consultations

in nursing homes. Thereby, both perspectives equally

rejected to “do not want to use the system” (n.s.) and

agreed with the statement that they “can imagine

using the system in the future” (n.s.). Instead, the

most concrete statement “I would like to use it” was

evaluated more affirmative from the perspective of a

relative (M = 4.46, SD = 1.06) compared to the

perspective of a resident (M = 4.23, SD = 1.20;

F(1,116)=4.993, p < .05).

Among potential barriers of using telemedical

consultations, the item “I would prefer personal

contact” was confirmed most from both perspectives

(n.s.) and, thus, revealed the most relevant aspect.

Further, both perspectives (n.s.) confirmed to “would

not have any concerns that data is transmitted

securely”. As a last barrier, both perspectives (n.s.)

showed rejections with regard to the statement “I feel

that the technology is not mature”.

Moving to perceived benefits and motives to use

telemedical consultations, the results show the

descriptive tendency that all four items were

evaluated more affirmatively from the resident’s than

from the relative’s perspective. In particular, the item

“[My relative / I] would feel safe” was even evaluated

significantly more positive from the perspective of a

resident (M = 4.26, SD = 0.90) compared to the

perspective of a relative (M = 3.99, SD = 0.98;

F(1,114)=6.972, p < .01).

In addition to the evaluations, the participants

assessed two final statements also from both

perspectives. In accordance with the non-varying

evaluations of the barriers, the statement

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Figure 1: Evaluation of telemedical consultations in nursing homes from two different perspectives.

“Telemedicine replaces human attention in

nursing homes” was evaluated almost the same

(F(1,115)=.498; n.s.) from both perspectives –

relative: yes 12.8% (n = 15), no 87.2% (n = 102);

resident: yes 13.0% (n = 12), no 87.0% (n = 104). In

line with the tendency of a higher evaluations from

the relative perspective (e.g., meaningfulness), the

statement “Telemedicine enriches care in nursing

homes” was also evaluated more confirmatively

(F(1,114)=7.799; p < .01) from the relative’s (yes

94.8% (n = 109), no 5.2% (n = 6)) compared to the

resident’s perspective (yes 86.2% (n = 100), no

13.8% (n = 16)).

3.3.2 Influence of Individual Factors on the

Evaluation of Telemedical

Consultations

For both scenario perspectives, MANOVA analyses

did not reveal significant omnibus effects for the

included demographic characteristics, i.e., age,

gender, and educational level. Further, also the living

situation and health-related characteristics of the

participants did not influence the evaluations of

telemedical consultations in nursing homes in

general. The same appeared for both facets of private

experience in care.

In contrast, professional experience in care

influenced the evaluations of telemedical

consultations in nursing homes significantly within

the relative’s scenario perspective (F(13,98)=2.218;

p<.05): in particular, professionally experienced

participants (M = 4.41, SD = 1.18) showed higher

agreements to the statement “My relative would feel

safe” (F(1,111)=4.114; p < .05) compared to

inexperienced participants (M = 3.89, SD = 0.93).

Further, they (M = 3.71, SD = 1.61) showed lower

confirmations of the statement “I would prefer

personal contact for my relative” (F(1,111)=4.228)

compared to inexperienced participants (M = 4.33,

SD = 1.05). Interestingly, these effects were not

apparent for the own perspective of a resident in a

nursing home.

3.3.3 Relevant Relationships

In order to analyze die extent of relationships within

the evaluations of telemedical consultations,

correlation analyses were conducted. Therefore,

overall scores for the participants’ general

acceptance, their intention to use telemedical

consultations as well as their evaluations of perceived

benefits and barriers were created for the relative’s

and the resident’s perspectives. The results are

presented in Figure 2.

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook

Figure 2: Relationships regarding the evaluation of

telemedical consultations from two perspectives.

Starting with the relative’s perspective on using

telemedical consultations in nursing homes, strong

relationships showed up between the participant’s

general acceptance and intention to use (r = .782; p <

.01). Further, also the perceived benefits correlated

strongly with the general acceptance (r = .735; p <

.01) and the intention to use telemedical consultations

(r = .771; p < .01).

Considering the perceived barriers, comparably

lower, moderate (negative) relationships appeared

with regard to perceived benefits (r = -.419; p < .01),

general acceptance (r = -.450; p < .01), and the

intention to use (r = -.490; p < .01).

Moving to the resident’s perspective, even

stronger relationships were apparent. General

acceptance and the intention to use correlated

strongly (r = .810; p < .01) and also the perceived

benefits showed strong relationships with general

acceptance (r = .755; p < .01) and the intention to use

telemedical consultations in nursing homes (r = .819;

p < .01). However, the differences are most noticeable

in terms of perceived barriers: in comparison, the

perceived barriers correlated (more) strongly

negatively with the perceived benefits (r = -.583 p <

.01), general acceptance (r = -.492 p < .01), and the

participants’ intention to use (r = -.556 p < .01).

4 DISCUSSION

Overall, this paper aimed at an introduction of a

current research project focusing on the integration of

telemedicine in nursing homes in order to relief

caregivers, and to reduce the probability of

inadequate hospital admissions. Focusing on the

communication science perspective the results of a

first scenario-based study were presented. In the

following, the findings of this study are discussed,

allowing to outline a research roadmap which

indicates relevant further steps within the project for

the technology acceptance part.

4.1 Key Insights & Limitations of a

First Study

Inquiry of the Involved Stakeholders: In general,

the study revealed rather similar evaluations with

regard to using telemedicine in nursing homes from

both perspectives – the perspective of a relative of a

nursing home resident and being the nursing home

resident him- or herself. These similar evaluations

could be caused by the scenario-based approach. In

this regard, the gap between (reported) attitudes and

the actual behavior of people is well known (Ajzen &

Fishbein, 1980). Therefore, affected stakeholders

(i.e., in particular nursing home residents, their

relatives and caregivers) should be directly addressed

in future studies.

Considering Diverse Stakeholders: Despite the

overall rather similar evaluations, single significant

differences with regard to the different perspectives

were apparent: on the one hand, perceived

meaningfulness and a concrete intention to use

telemedicine in nursing homes were higher from a

relative’s perspective than from a nursing home

resident’s perspective; on the other hand, the

perceived benefit in terms of higher felt safety was

more acknowledged from the nursing home resident’s

than the relative’s perspective. These (within a

scenario-based study gained) differences indicate the

importance of considering diverse stakeholders in

future research on the acceptance of integrating

telemedicine in nursing homes. This procedure

addresses different aspects: On the one hand, the

results obtained here are to be tested for their

resilience. On the other hand, other perspectives (e.g.,

those of the nursing staff) and any interactions

between the stakeholders are to be brought into focus.

Contrasting Professional and Non-professional

Stakeholders: With regard to the impact of

individual factors on the evaluations of telemedicine

in nursing homes the study did not reveal any effects

of demographic characteristics, such as age, gender,

or educational level. Here, it should be considered

that the study’s sample was comparably small,

reached rather young participants, contained a higher

proportion of female than male participants, and

reached predominantly participants being less

experienced in care. Changes in the evaluation

patterns can be expected when the opinions of older

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

participants (e.g., Wilkowska, 2015; Brauner, 2016)

and also care-experienced participants are

investigated. Therefore, future studies should aim at

reaching broader and more balanced samples in order

to integrate all relevant stakeholders equally and

adequately. In line with previous research on the

acceptance of assisting technologies in care (e.g.,

Offermann-van Heek & Ziefle, 2018), effects of

professional experience on the evaluations of using

telemedicine in nursing homes were identified in the

present study. Here, professionally experienced

participants saw a greater advantage in increased

safety by using telemedicine in nursing homes and

showed lower concerns of a loss of personal contact.

These effects were only apparent within the scenario

including the perspective of a relative of a nursing

home resident, which makes sense as this perspective

is close to a professional caregiver’s perspective.

These insights confirm the relevance of integrating all

affected stakeholders within research on the

acceptance of using telemedicine in nursing homes

since perceived (dis)advantages may differ

depending on the respective stakeholders’

perspectives.

Investigating Interrelations between

Acceptance, Requirements, and Perceived

(dis)Advantages: In line with previous research on

the acceptance of assisting technologies in older age

(e.g., Peek et al., 2014, Offermann-van Heek et al.,

2019) the results showed that the acceptance and

intention to use telemedicine in nursing homes are

connected with the perception of potential

technology-related advantages and disadvantages.

Beyond that, the relationships were even stronger for

the perspective of a nursing home resident compared

to the perspective of a relative of a nursing home

resident. Hence, future research should also

investigate the interrelations between acceptance,

requirements, and perceived (dis)advantages

depending on the perspective of all affected

stakeholders.

Holistic Evaluation of User Requirements:

Another aspect refers to the fact that only few aspects

were part of this first study, and, therefore, this study

has certainly not included all relevant aspects

holistically. As mentioned above, future studies

should address all relevant stakeholders in order to

identify relevant requirements as well as perceived

(dis)advantages of using telemedicine in nursing

homes. Only this way, it can be ensured that all

“user”-relevant requirements and wishes are

considered within the adaption and integration of

telemedicine in nursing homes.

4.2 Investigating Acceptance of

Telemedicine in Nursing Homes in

the Future

Based on the identified insights of a first scenario-

based study focused on potential users’ attitude

towards telemedicine in nursing homes within the

Optimal@NRW project, concrete strategies for

further steps of the user-centered investigations can

be derived:

From the user-centered communication science

perspective, a major focus must be put on

acceptance research and respective assessments of

“real” interactions with telemedical systems in

addition to a usage of scenario-based analyses.

Analyzing direct interactions within telemedical

consultations enables to identify appearing problems,

(initial) reactions, and relevant process flows between

the different involved stakeholders (i.e., care

personnel, doctors, emergency services, patients) and

also in the field of human-technology interaction. In

addition, scenario-based approaches support the

understanding and identify existing opinions and

mental models regarding care in nursing homes,

process flows, or general attitudes before

telemedicine is integrated in the involved nursing

homes.

A further major, user-centered task refers to the

integration of all relevant stakeholders in all phases

of the project (before telemedicine is implemented,

during the different interaction phases, and at the end

of the project). As the results of the present study

suggest significant differences in the acceptance of

telemedicine depending on different user

perspectives, it is necessary to talk to the "real"

stakeholders and to systematically survey the real

perspectives within all steps of the project. This way,

all relevant user requirements can be identified and

validated for the diverse stakeholders.

To realize acceptance research within the project

successfully, a combination of qualitative and

quantitative methodological approaches is

necessary. Thereby, interviews will be conducted in

particular at the beginning of the project to identify

the status quo regarding relevant process flows,

communication requirements as well as wishes,

attitudes, and needs of all involved stakeholders. Only

on the basis of these qualitative studies and analyses

a holistic quantification of the results using (online)

surveys is usefully realizable considering the

different stakeholders and their specific

characteristics.

Finally, the mix of summative and comparative

acceptance analyses enables to identify changing

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook

acceptance parameters over time as well as to

determine influencing characteristics of the

stakeholders (e.g., age, gender, experience), which

may also vary over the different project phases.

5 CONCLUSIONS

This paper presented a first scenario-based

acceptance study with focus on future users’ attitude

towards the use of telemedicine in nursing homes. on

the attitude of potential users Focusing on a user-

centered and technology acceptance related

perspective is one focus addressed within research

project “Optimal@NRW”. Overall, the project aims

at a sustainable implementation of telemedicine in

nursing homes and outpatient care in order to avoid

inadequate hospital admissions of geriatric patients.

The results of this particular presented study highlight

the importance of integrating all involved

stakeholders into all further project phases in order to

do justice to user-specific requirements. Beyond that,

the study’s insights enable to outline research tasks

within a research roadmap, that will be pursued in the

acceptance research part of the project.

ACKNOWLEDGEMENTS

The authors thank all participants for their openness

to share opinions on telemedical consultations and

processes. Furthermore, the authors want to thank

Vanessa Petring for research assistance. This work

was funded by the German joint federal committee

“Innovationsfond” (grant number: 01NVF19015).

Regarding the acceptance-related issues, this work

based on the project “Privacy Aware and Acceptable

Lifelogging services for older and frail people”

(16SV7955).

REFERENCES

Abbing, H. R., 2016. Health, healthcare and ageing

populations in Europe, a human rights challenge for

European health systems. European Journal of Health

Law, 23(5), 435-452.

Ajzen I, Fishbein M., 1980. Understanding Attitudes and

Predicting Social Behavior, Englewood Cliffs, NJ:

Prentice-Hall.

Al-Shorbaji, N., 2013. The World Health Assembly

resolutions on eHealth: eHealth in support of universal

health coverage. Methods of Information in Medicine,

52(06), 463-466.

Amkreutz, J., Lenssen, R., Marx, G., Deisz, R., & Eisert,

A., 2020. Medication safety in a German telemedicine

centre: Implementation of a telepharmaceutical expert

consultation in addition to existing tele-intensive care

unit services. Journal of Telemedicine and Telecare,

26(1-2), 105-112.

Beul, S., Ziefle, M., & Jakobs, E. M. (2011, May). Users'

preferences for telemedical consultations: Comparing

users' attitude towards different media in technology-

mediated doctor-patient-communication. In 2011 5th

International Conference on Pervasive Computing

Technologies for Healthcare (PervasiveHealth) and

Workshops (pp. 614-620). IEEE.

Brauner, P. M., 2016. Serious Games for Healthcare in

Ambient Assisted Living Environments: A Technology

Acceptance Perspective. Apprimus Verlag.

Burde, W., & Blankertz, B., 2006. Is the locus of control of

reinforcement a predictor of brain-computer interface

performance? TU Berlin. http://doc.ml.tu-

berlin.de/publications/publications/BurBla06.pdf.

Calero-Valdez, A., & Ziefle, M., 2015. Older Users’

Rejection of Mobile Health Apps a Case for a Stand-

Alone Device? In International Conference on Human

Aspects of IT for the Aged Population, pp. 38-49.

Springer, Cham.

Czaplik, M., Bergrath, S., Rossaint, R., Thelen, S.,

Brodziak, T., Valentin, B., Hirsch, F., Beckers, S.K., &

Brokmann, J. C., 2014. Employment of telemedicine in

emergency medicine. Methods of Information in

Medicine, 53(02), 99-107.

Davis, F. D., 1989. Perceived usefulness, perceived ease of

use, and user acceptance of information technology.

MIS Quarterly, 319-340.

Felzen, M., Beckers, S. K., Kork, F., Hirsch, F., Bergrath,

S., Sommer, A., Brokmann, J.C., Czaplik, M., &

Rossaint, R. (2019). Utilization, Safety, and Technical

Performance of a Telemedicine System for Prehospital

Emergency Care: Observational Study. Journal of

Medical Internet Research, 21(10), e14907.

Flórez-Revuelta, F., Mihailidis, A., Ziefle, M., Colonna, L.,

& Spinsante, S. (2018, September). Privacy-Aware and

Acceptable Lifelogging services for older and frail

people: The PAAL project. In 8th International

Conference on Consumer Electronics-Berlin (ICCE-

Berlin) (pp. 1-4). IEEE.

Holden, R. J., & Karsh, B. T., 2010. The technology

acceptance model: its past and its future in health care.

Journal of Biomedical Informatics, 43(1), 159-172.

Marcantonio, E. R., 2017. Delirium in hospitalized older

adults. New England Journal of Medicine, 377(15),

1456-1466.

Offermann-van Heek, J., & Ziefle, M., 2018. They Don’t

Care About Us! Care Personnel’s Perspectives on

Ambient Assisted Living Technology Usage: Scenario-

Based Survey Study. JMIR Rehabilitation and Assistive

Technologies, 5(2), e10424.

Offermann-van Heek, J., Wilkowska, W., Brauner, P., &

Ziefle, M. (2019). Guidelines for Integrating Social and

Ethical User Requirements in Lifelogging Technology

Development. In: 4th International Conference on

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Information and Communication Technologies for

Ageing Well and e-Health (ICT4AWE 2018).

SCITEPRESS.

Ohligs, M., Stocklassa, S., Rossaint, R., Czaplik, M., &

Follmann, A., 2020. Employment of Telemedicine in

Nursing Homes: Clinical Requirement Analysis,

System Development and First Test Results. Clinical

Interventions in Aging, 15, 1427.

Ouslander, J. G., & Berenson, R. A., 2011. Reducing

unnecessary hospitalizations of nursing home residents.

New England Journal of Medicine, 365(13), 1165.

Peek, S. T., Wouters, E. J., Van Hoof, J., Luijkx, K. G.,

Boeije, H. R., & Vrijhoef, H. J., 2014. Factors

influencing acceptance of technology for aging in

place: a systematic review. International Journal of

Medical Informatics, 83(4), 235-248.

Schmidt, S., Hendricks, V., Griebenow, R., & Riedel, R.

2013. Demographic change and its impact on the

health-care budget for heart failure inpatients in

Germany during 1995–2025. Herz, 38(8), 862-867.

Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D.,

2003). User acceptance of information technology:

Toward a unified view. MIS Quarterly, 425-478.

Wilkowska, W., 2015. Acceptance of eHealth technology

in home environments: Advanced studies on user

diversity in ambient assisted living. Apprimus Verlag.

Ziefle, M., & Wilkowska, W., 2010. Technology

acceptability for medical assistance. In 2010 4th

International Conference on Pervasive Computing

Technologies for Healthcare (pp. 1-9). IEEE.

Acceptance of Telemedical Consultations in Nursing Homes: First Insights Outlook