The development of Information Systems for the support of health care research in clinical environments is a major enterprise. Based on this fact the Laboratory of Health Informatics, University of Athens, Greece developed a paradigm application for the Health Surveillance and the Epidemiologic Study of the farming population, based on the routinely collected wellness informations and agricultural wellness and safety paramount information.
Scope: The current survey purposes to measure the theoretical perceptual experience of possible Information System users in footings of system serviceability as it is related to clinical pattern and epidemiologic research on husbandmans ‘ wellness. In add-on, the survey is acute to measure the perceptual experience in footings of the system acceptance by possible users, the system usefulness in a existent clinical environment, its part to the typical activities of a Primary Healthcare Center and to the planning of wellness publicity schemes turn toing husbandmans.
Material and Methods: The rating was performed with the usage of a questionnaire which included inquiries on the system serviceability, the computing machine experience and the possible part in epidemiologic research, wellness publicity policies and clinical pattern. The sample consists of 58 Medical, Nursing and Dentistry pupils, which were identified as possible users.
Consequences: Multiple arrested development analysis was used to prove possible correlativities, harmonizing to the bow mentioned research hypotheses. Based on the consequences, the deciding factors of the users ‘ perceptual experience sing the support in clinical pattern are the system usage and the system information quality. The system pertinence has besides been found to be positively correlated with the system use. Finally the screen show appears to be correlated statistically important with both the perceptual experience that the system is a utile epidemiological research tool and the perceptual experience that it can lend to the planning and execution of wellness publicity schemes turn toing husbandmans ‘ wellness.
Harmonizing to the literature, husbandmans are at hazard of developing a series of inauspicious wellness effects, which are chiefly caused by exposure to pesticides, allergenic agents, bad position and weight lifting. The exposure to pesticides can do malignant diseases [ 1 ] , [ 2 ] , whereas allergenic dusts are associated with the development of respiratory symptoms [ 3 ] , [ 4 ] . In add-on, inappropriate organic structure position, quivers and heavy weight raising may do assorted musculoskeletal jobs. Furthermore, accidents consist of an of import jeopardy for the safety of husbandmans [ 5 ] , [ 6 ] .
Data collected in Primary Healthcare Centers in rural countries is non easy utilizable for the efficient surveillance of the patients ‘ wellness. An efficaciously organized wellness record could expeditiously be used for the betterment of the surveillance of husbandmans ‘ wellness. The execution of Electronic Health Records for Primary Healthcare Centers is important [ 7 ] . Until now, there have been few efforts towards the usage of new engineerings to back up the epidemiological surveillance of the population at big [ 8 ] , [ 9 ] . These attempts have been achieved either by integrating surveillance systems into bing information systems, or by the extraction of wellness informations from Electronic Health Records for farther processing to do sound medical determinations [ 10 ] , [ 11 ] . Rather really few wellness Information Systems focal point on husbandmans ‘ wellness in specific. In order to back up the epidemiologic surveillance of husbandmans the system should non merely be based on the routinely collected wellness informations, but besides on informations related to the exposure to harmful agents, to the extent of usage of Personal Protective Equipment ( PPE ) and to the type of farming activities.
Primary Healthcare Information System undertaking for the Health Surveillance and the Epidemiologic Study of husbandmans
Based on the above informations, the Laboratory of Health Informatics has undertaken the enterprise to develop a paradigm Primary Healthcare Information System for the Health Surveillance and the Epidemiologic Study of farming population. The construction of the Information System, is based on literature research sing husbandmans ‘ wellness, wonts and factors related to assorted risky exposures.
The Information System is composed of two faculties. A web application has been developed for the storage, redacting and retrieval of wellness and occupational wellness and safety informations. The faculty can be accessed from Primary Healthcare Settings, viz. Primary Healthcare Centers, Remote Rural Health Centers and Primary Homecare Services. The information collected through the web application are stored into a Central Database Server which synchronizes the 2nd faculty of the Information System, viz. the Local Application for the “ Health Surveillance and Epidemiologic Research of Farmers ” . The 2nd faculty can be installed in Hospitals, Health Surveillance Sectors ( i.e. Ministry of Health ) and University Institutes. The Local Application can be utilized for the production of general descriptive and inference statistical information every bit good as for the appraisal of epidemiologic indexs and clip series charts on husbandmans ‘ wellness. The Local Information System is comprised of six distinguishable subdivisions viz. “ Descriptive Statistics ” , “ Graphs and Charts ” , “ Inference Statistics ” , “ Prevalence Map ” , “ Time Series ” and “ Epidemiologic Indicators ” [ 12 ] . The visual image of both spacial and temporal dimensions is hence expected to heighten the ability to set about environmental wellness research utilizing clip referenced geospatial informations [ 13 ] . In add-on, the information system uses the information stored into the chief waiter from the Primary Healthcare Settings for the computation of a series of executable farmer-specific indexs, based on the consequences of the European undertaking [ 14 ] , [ 15 ] , [ 16 ] . Table 1 shows the chief classs of research hypotheses that can be tested with the usage of the Information System. The Information System has been presented in item by Diomidus et al [ 17 ] .
Table 1: Research hypotheses supported by the Information System
Epidemiologic Research on husbandmans
Surveillance of husbandmans ‘ wellness and agricultural work
There is a possible correlativity between the demographics with the development of specific diseases
The surveillance of the wellness position of farming population may lend to the strategic policy execution on Primary Healthcare Level
There is a possible correlativity between the demographics with the extent of usage of Personal Protective Equipment
Personal features and information on agricultural work may lend to the probe of husbandmans profile
There is a possible correlativity between the degree of usage of PPE with the development of certain diseases
The extent of PPE usage may lend to the designation of deficient protective steps so far adopted and in a 2nd measure towards the execution of targeted intercessions
There is a possible correlativity between the type of farming production and the exposure to risky agents with the development of specific diseases
The designation of clip related alterations in the wellness position of population and other parametric quantities may lend to expeditiously organized wellness publicity schemes turn toing husbandmans
Evaluation of Information Systems
The rating of Information Systems in footings of system serviceability is important due to the fact that system serviceability may positively act upon the system acceptance. Harmonizing to Nielsen [ 18 ] the usability constituents refer to the easiness of usage perceptual experience, the familiarisation with the system, the system effectivity every bit good as the subjective perceptual experience of users. System usefulness refers to the system value -allowing the user to pull off the occupation undertakings expeditiously. A hard to pull off and utilize computing machine system is expected to hold limited acceptance by the possible users, therefore taking to restricted usage. The quality of information besides seems to be a major factor, in relation to the system credence. Consequently, to heighten system acceptance, parametric quantities such as the quality of information should be taken into history by the development squad.
2. Scope of the Evaluation
The range of the rating procedure is to measure the theoretical perceptual experience of possible users of the Information System in footings of serviceability every bit good as the perceptual experience in footings of
the system acceptance by possible users
the system usefulness in a existent clinical environment
part to the typical activities of a Primary Healthcare Center
possible part towards the planning of wellness publicity schemes turn toing husbandmans
possible system support for the Epidemiologic Studies of husbandmans
The survey aims to prove the being of possible correlativity between demographic features of possible users and their perceptual experience in footings of serviceability and utility for the epidemiologic survey of husbandmans. Another alternate hypothesis describes a possible correlativity between the sensed serviceability and the perceptual experience of the part to the epidemiological research and the clinical pattern.
Overall, the survey aims to look into the undermentioned hypotheses:
Is the Information System efficient in footings of serviceability?
Is the Information System sufficient to lend to future epidemiological research and current clinical pattern?
Is the experience in computing machine use a factor that has a major impact in the system serviceability?
Is there a correlativity between the sensed serviceability and the perceptual experience of the part to the epidemiological research and the clinical pattern?
3. Material and Methods
The system usability rating has been performed with the usage of a questionnaire based on two good known system serviceability tools as a mention base, viz. the PSSUQ ( Post Study System Usability Questionnaire ) tool [ 19 ] and QUIS questionnaire ( Quality of User Interaction Satisfaction ) [ 20 ] . Nineteen inquiries from PSSUQ have been incorporated into the questionnaire, every bit good as a selected set of parametric quantities based on the QUIS tool. In add-on, some inquiries on demographic informations every bit good as a set of consistent inquiries mentioning to the perceptual experience of the users in respects to the possible part of the system have been included. The latter purposes to place the possible utility of the Information System in relation to the strategic aims of the application ( Table 7 ) . Finally the questionnaire includes a subdivision with inquiries on the bing experience in computing machine usage and on the degree of cognition in statistics and epidemiology.
Fifty eight Medical, Nursing and Dentistry pupils, were identified as possible users and attended a 20 infinitesimal presentation of the Information System. They were so requested to finish a scenario with typical operations and fill-in the questionnaire. The cardinal indexs of the PSSUQ and QUIS inquiries, every bit good as the parametric quantities sing the System Contribution related to Research and Health Surveillance were calculated afterwards.
The selected sample that evaluated the Information System has an average age of 26.8 old ages ( st.dev=4.69 ) . 27.6 % ( N=16 ) of the sample were male and 72.4 % ( I?=42 ) , female ( Table 2 ) . Male participants have an mean age of 28.93 old ages ( st.dev=3.24 ) and female participants have an mean age of 26.02 old ages ( st.dev=4.92 ) .
Table 2: The sample age by gender
In relation to the sample ‘s type of profession, 28.1 % ( I?=16 ) are Nurses, 19.3 % ( I?=11 ) Dentists and 8.8 % ( I?=5 ) are Medical Doctors. Meanwhile, 36.8 % ( I?=21 ) of the sample are undergraduate pupils, which have no working experience in the clinical sector. To the inquiry sing the working position in the wellness field, 46.4 % ( I?=26 ) responded positively and 53.6 % ( I?=30 ) responded negatively ( Table 3 ) .
Table 3: Working position in the wellness field, by gender
62,5 % ( I?=10 )
37,5 % ( I?=6 )
40 % ( I?=16 )
60 % ( I?=24 )
46,4 % ( I?=26 )
53,6 % ( I?=30 )
Experience of Computer Use
In order to cipher the experience of computing machine usage, six 5-scale inquiries have been used, mentioning to the ability to utilize a word processor, utilize copy-paste options, create a simple spreadsheet papers, shop the worldwide web, develop an application and make a simple database. These variables have been used for the computation of a cardinal computing machine experience index, viz. “ PC_OVERALL ” . Besides, two extra inquiries have been used, which refer to the clip continuance and frequence of computing machine usage.
Sing the figure of old ages of computing machine usage, 6.9 % ( I?=4 ) has been utilizing computing machines less than one twelvemonth. 12.1 % ( I?=7 ) and 19 % ( I?=11 ) has been utilizing computing machines 1-3 old ages and 3-5 old ages, severally. Finally, the bulk of the participants 62.1 % ( N=36 ) has been utilizing computing machines for at least 5 old ages.
Equally far as the frequence of computing machine usage is concerned, 43.1 % ( I?=25 ) of the sample uses computing machines all the clip, 43.1 % ( I?=25 ) uses computing machines often and 12.1 % ( I?=7 ) uses computing machines on occasion. This determination is expected, due to the fact that the judges are university pupils, and the computing machine is an indispensible tool for their surveies.
Sing thr ability of finishing typical computing machine assignments, the overall index “ PC_OVERALL ” was found to be equal to 4.02 ( st.dev=0.89 ) in the 5-grade graduated table ( 1-no accomplishments, 5-perfect accomplishments ) . The variables of the cardinal index are described in Table 4.
Table 4: Ability to finish typical computing machine assignments
usage of a word processor
usage of copy-paste options
make a simple database
browse the worldwide web
make a simple spreadsheet papers
System usability rating
The parametric quantities included in the PSSUQ and QUIS subdivisions of the questionaaire have been used in order to cipher cardinal indicators.The cogency of the produced indexs was examined with Cronbach A trial. Alpha was really high ( & gt ; 0.8 ) for all instances ( Table 5 ) .
Table 5: Trial of Validity for the Central Indicators of the Usability Evaluation subdivisions of the questionnaire
Cronbach ‘s Alpha
N of points
Cardinal Usability Indicator
Overall System Use
Quality of Information
Quality of Interaction
Overall System Percept
Screen end product
Quality of Information
Sing the PSSUQ questionnaire subdivision, the Central Usability Indicator ( PSSUQ_OVERALL ) has been calculated to be 4.95 in the 7-grade graduated table. The Overall System Use ( PSSUQ_SYSUSE ) index was found to be equal to 4.71 and the Quality of Information ( PSSUQ_INFOQUAL ) index proved to be 5.03. Finally, the Quality of Interaction ( PSSUQ_INTERQUAL ) calculator has been calculated to be 5.28, in the 7-grade graduated table.
Equally far as the QUIS subdivision is concerned, the Overall System Perception ( QUIS_OVERALL ) was found to be equal to 6.18, in the 9-grade graduated table this clip. In add-on, the Screen Output Indicator ( QUIS_SCREEN ) and the Quality of Information Indicator ( QUIS_INFO ) proved to be 6.79 and 6.76 severally. The Learning Curve index was found to be equal to 6.39, in the 9-grade graduated table. Finally, the System Power index has been calculated to be 6.79.
Percept for the System Contribution in research and clinical pattern
The Information System has been evaluated in footings of research part, part in Primary Healthcare, part in publicity policies turn toing husbandmans and to the system pertinence in clinical environment. Sing the participants ‘ perceptual experience of the system part in the epidemiological research the mean mark was found to be equal to 7.599 ( st.dev=1.380 ) . in the 9-grade graduated table. I?I»I?I?I±I?I± . The index that has been used for the appraisal of the system part in clinical pattern was equal to 7.425 ( st.dev=1.554 ) . The possible part of the application to heath publicity policies was calculated to be 7.491 ( st.dev=1.644 ) . Finally in footings of System pertinence, the average value was found to be equal to 6.316 ( st.dev=1.698 ) in the 9-grade graduated table ( Table 6 ) .
Table 6: Questionnaire subdivision on the application ‘s possible part to the epidemiologic research, clinical pattern and wellness publicity policies
Contribution to the research on the husbandmans wellness
Contribution to research
Use of the information System as a tool for epidemiological research surveies
Possibilities for research project offered by the system
Utility of the application for the mundane activities
Contribution to Primary Healthcare
Indispensable tool for Primary Healthcare Centers
Possibilities of the application to be used by Primary Healthcare Professionals
Indispensable tool for wellness policy planning
Contribution to heath publicity policies
Contribution to execution of wellness publicity schemes
Contribution to the followup of husbandmans ‘ wellness indexs.
System pertinence in a clinical environment
System acceptance by possible users
Potential involvement by healthcare professional
In order to prove the hypothesis whether the serviceability variables affect the perceptual experience sing the part of the application to the Health Surveillance and Epidemiologic research, multiple arrested development statistical analysis was used. The normalcy trial for the cardinal indexs, showed that all but the “ CONTRIB_PRIMARY_HEALTHCARE ” calculators are usually distributed ( Table 8 ) .
Table 8: Trial of Normality for the produced cardinal indexs
Kolmogorov Smirnov Z
Asymp. Sig. ( 2-tailed )
Usability testing of the system and perceptual experiences on the part to epidemiological research and clinical pattern
It has been presumed that certain correlativity between the system serviceability and the part to epidemiological research and clinical pattern, exist ( Figure 1 ) .
System usability perceptual experiences
Contribution to epidemiological research and clinical pattern
May lead to
Figure 1: trial hypotheses for possible correlativity between the system serviceability and part to epidemiological research and clinical pattern
After proving each “ Contribution ” variable with each “ Usability ” variable individually utilizing individual additive arrested development, the non-significant variables were excluded from the multiple arrested development theoretical account. Backwards Elimination arrested development theoretical account has been used. Harmonizing to the consequences, the variable QUIS_SCREEN ( Screen end product ) man-made variable is a deciding factor for the perceptual experience of possible part of the application to research ( B=0.726, p=0.000 ) . For each 1 point rise of the 9-grade graduated table QUIS_SCREEN ( Screen end product ) variable, there appears to be a rise of 0.726 points of the CONTRIB_RESEARCH ( Contribution to research ) index. It appears that the system screen visual aspect ( layout, work flow, colour pallet, founts etc ) may act upon the perceptual experience for the possible part of the Information System to epidemiological research and clinical pattern. In add-on, the QUIS_SCREEN ( Screen end product ) cardinal index appears to be a forecaster of the possible part to the planning and execution of wellness publicity policies turn toing husbandmans ( B=0.675, p=0.000 ) .
By proving the CONTRIB_PRIMARY_HEALTHCARE index as a dependant variable, utilizing the multiple arrested development theoretical account, both the QUIS_INFO ( System Information ) and the QUIS_POWER ( System Power ) man-made values are found to be determiners of the part to primary health care ( B=0.74, p=0.01 and B=0.66, p=0.04 severally ) .
Finally, it has been found that the system usage ( PSSUQ_SYSUSE ) and the quality of information ( QUIS_INFO ) may impact the possible users ‘ perceptual experience on the system pertinence in a existent clinical environment ( B=1.661. p=0.002 and B=0.752, p=0.005 severally ) ( Table 9 ) .
Table 9: Predictive serviceability factors for the possible system part to epidemiological research and clinical pattern
P ( Sig )
Dependent variable: CONTRIB_RESEARCH, R2 = 0.526, F=52.233, P=0.000 ( ANOVA )
Dependent variable: CONTRIB_PROMOTION_POLICIES, R2 = 0.325, F=22.192, P=0.000 ( ANOVA )
Dependent variable: CONTRIB_PRIMARY_HEALTHCARE, R2 = 0.545, F=10.291, P=0.000 ( ANOVA )
Dependent variable: CONTRIB_APPLICABILITY, R2 = 0.424, F=11.047, P=0.000 ( ANOVA )
The serviceability of an information system is related to the utility of the system in a existent environment, harmonizing to the literature [ 18 ] . This paper aims to place the serviceability factors that may act upon the part of the Information System in a Primary Healthcare environment. The information system that has been developed has some alone features. The system is non merely intended to be used for the support of mundane clinical pattern, but it has been designed with the chief intent to back up the wellness surveillance and the epidemiological research. The system addresses a specific rather big occupational group of the Grecian population, viz. husbandmans. In this sense, some of the serviceability constituents which have been evaluated may turn out positive the first research hypotheses of the survey.
It seems that a good prepared application of such an Information System is able to carry a possible user for its part both to research and wellness publicity of the agrarian population. It has been noted besides a statistically important relationship between the perceptual experience that the information and the nomenclature used by the system, are positively correlated to the part of the system in a Primary Healthcare environment. The latter means that the four mentioned parametric quantities turn out to be of import determiners to ameliorated health care services provided in a Primary Healthcare Centre. It besides seems that, harmonizing to the consequences of the multivariate analysis, the perceptual experiences on the system use based on the “ System Use ” index, are positively correlated with the overall activities of a Primary Healthcare Setting. Finally the perceptual experience of the “ System Use ” seems to be a major determiner for the possible users, sing the system pertinence in a existent environment. It should be noted that the underpinned correlativity between the variables under survey does non necessary connote a causal relationship between them, but may enable to gauge possible determiners of the application possible part in footings of back uping the epidemiologic research and the clinical pattern.