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Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands ( N  = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives’ actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Aim The threats of novel coronavirus disease 2019 (COVID‐19) have caused fears worldwide. The Fear of COVID‐19 Scale (FCV‐19S) was recently developed to assess the fear of COVID‐19. Although many studies found that the FCV‐19S is psychometrically sound, it is unclear whether the FCV‐19S is invariant across countries. The present study aimed to examine the measurement invariance of the FCV‐19S across eleven countries. Design Cross‐sectional study. Methods Using data collected from prior research on Bangladesh (N = 8,550), United Kingdom (N = 344), Brazil (N = 1,843), Taiwan (N = 539), Italy (N = 249), New Zealand (N = 317), Iran (N = 717), Cuba (N = 772), Pakistan (N = 937), Japan (N = 1,079) and France (N = 316), comprising a total 15,663 participants, the present study used the multigroup confirmatory factor analysis (CFA) and Rasch differential item functioning (DIF) to examine the measurement invariance of the FCV‐19S across country, gender and age (children aged below 18 years, young to middle‐aged adults aged between 18 and 60 years, and older people aged above 60 years). Results The unidimensional structure of the FCV‐19S was confirmed. Multigroup CFA showed that FCV‐19S was partially invariant across country and fully invariant across gender and age. DIF findings were consistent with the findings from multigroup CFA. Many DIF items were displayed for country, few DIF items were displayed for age, and no DIF items were displayed for gender. Conclusion Based on the results of the present study, the FCV‐19S is a good psychometric instrument to assess fear of COVID‐19 during the pandemic period. Moreover, the use of FCV‐19S is supported in at least ten countries with satisfactory psychometric properties.

A vast digital ecosystem of entrepreneurship and exchange has sprung up with Bitcoin’s digital infrastructure at its core. We explore the worldwide spread of infrastructure necessary to maintain and grow Bitcoin as a system (Bitcoin nodes) and infrastructure enabling the use of bitcoins for everyday economic transactions (Bitcoin merchants). Specifically, we investigate the role of legal, criminal, financial, and social determinants of the adoption of Bitcoin infrastructure. We offer some support for the view that the adoption of cryptocurrency infrastructure is driven by perceived failings of traditional financial systems, in that the spread of Bitcoin infrastructure is associated with low trust in banks and the financial system among inhabitants of a region, and with the occurrence of country-level inflation crises. On the other hand, our findings also suggest that active support for Bitcoin is higher in locations with well-developed banking services. Finally, we find support for the view that bitcoin adoption is also partly driven by cryptocurrencies’ usefulness in engaging in illicit trade.

This study examined the 1) psychometric properties of an independently translated Swedish version of the gaming disorder test (GDT) among Swedish adolescents based on two psychometric theories, 2) measurement invariance across age (i.e., 15 vs 16–17), gender (i.e., males vs females), and gaming time (i.e., < 2 h vs ≥ 2 h), and 3) factors that predict gaming disorder. The findings will help researchers understand and ascertain the use of the GDT among Swedish adolescents. A total of 5320 Swedish adolescents were recruited and responded to measures including gaming disorder, gaming duration, sleep duration, physical activity, mental well-being, and self-esteem. Statistical analyses were conducted using confirmatory factor analysis, regression analysis, latent class analysis, classical test theory, and Rasch analysis. Satisfactory and unidimensional psychometric properties for the independently translated Swedish version of the GDT were found. Specifically, the factor structure, internal consistencies, separation reliability and separation index were supported, but not the person separation reliability and index. Also, the GDT was invariant across ages but only partially so across gender and gaming time. The GDT can classify adolescents as having a high or low risk of gaming disorder. Lastly, factors that predicted gaming disorder were poorer mental well-being and longer gaming time among males and low physical activity and longer gaming time among females. Due to its conciseness, researchers may use the independently translated Swedish version of the GDT for screening people for gaming issues even in busy settings like schools. Moreover, attention must be paid to males, those with poorer mental well-being, those who are physically inactive, and those with a longer gaming time to help curb gaming disorder. Future research may focus on examining the test-retest reliability and clinical validity of the GDT among adolescents. •The GDT had satisfactory and unidimensional psychometric properties.•The GDT was invariant across ages but only partially across gender and gaming time.•The GDT can classify adolescents as having a high or low risk of gaming disorder.•Being male, with poorer mental well-being, and a longer gaming time were associated with an elevated risk of gaming disorder.

Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression. The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD. A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire-9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale-self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models. Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=-2.34 [95% CI -3.58 to -1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression. Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time. ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.

To use theory to design and evaluate an intervention to promote sleep hygiene and health among adolescents. The Theory of Planned Behavior (TPB) and the Health Action Process Approach (HAPA) were used to develop an intervention, which was then evaluated in a cluster randomized trial. Participants were high school students (N = 2,841, M age = 15.12, SD = 1.50). Adolescents in the intervention group received four face-to-face sessions providing behavior change techniques targeting the theoretical determinants of sleep hygiene. Adolescents in the control group only received educational material at the end of the study. The primary outcome was sleep hygiene measured at 1 and 6 months postintervention. A number of secondary outcomes were also measured, including beliefs about sleep, self-regulatory processes, and outcomes related to health and wellbeing. Sleep hygiene was improved in the intervention group when compared with the control group at both follow-up points (coefficients = 0.16 and 0.19, 95% CIs = 0.12-0.20 and 0.15-0.23 at 1 and 6 months, respectively, for scores on the Adolescent Sleep Hygiene Scale), as were psychosocial and general aspects of health. Mediation analyses suggested that beliefs about sleep hygiene as specified by the TPB, along with self-regulatory processes from HAPA, both mediated the effect of the intervention on outcomes. In turn, the effects of the intervention on sleep hygiene mediated its impact on general health. Healthcare practitioners might consider intervention programs based on the TPB and the HAPA to improve sleep among adolescents. Clinicaltrials.gov (NCT02551913) https://clinicaltrials.gov/ct2/show/NCT02551913.

An increased use of the internet and digital health care for patients with long-term conditions implies a need for assuring digital health literacy skills. Patients with restless legs syndrome (RLS) represent a group where digital sources of information are highly valued. This is due to a difficult diagnosis and complex treatment situation that contributes to patients seeking out digital resources themselves to handle the perceived shortcomings in their care. To benefit from these resources, patients need to have the digital skills to explore information to optimize their understanding of the disease and its treatments. The eHealth Literacy Scale (eHEALS), which has been used in both general populations and patients with long-term conditions, could, if proven valid, be used by researchers and clinicians to assess digital health literacy among patients with RLS to inform the development of patient-centered digital health care information and interventions. The aim of the study is to investigate the psychometric properties of eHEALS in patients with RLS to determine its adequacy and potential utility. A cross-sectional design including patients with RLS from the Swedish national RLS patient organization was used. Data were collected via a mail-based survey comprising back-and-forth translated Swedish versions of the following instruments: eHEALS, Restless Legs Syndrome-6 Scale (RLS symptoms), Pittsburgh Sleep Quality Inventory (sleep quality), Epworth Sleepiness Scale (daytime sleepiness), Patient Health Questionnaire-9 (depressive symptoms), and CollaboRATE (shared decision-making). Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the eHEALS. Measurement invariance, unidimensionality, and differential item functioning across age, gender, medication use, sleep quality, level of depressive symptoms, and participation in care decisions were assessed. A total of 788 patients with a mean age of 70.8 (SD 11.3) years participated. Among them, 64.7% (n=510) were women, 73.8% (n=582) were married or living together, and 43.5% (n=343) had attained a university education. A median eHEALS score of 28 (IQR 22-33) was reported. The unidimensionality of the eHEALS was supported by the confirmatory factor analysis and the Rasch model. The reliability of the eHEALS was confirmed using composite reliability and Cronbach α. No differential item functioning was identified for age, gender, medication use, shared decision-making condition, depressive symptoms, or sleep quality, meaning that these groups do not have different probabilities of endorsing a given item after controlling for the overall score. The eHEALS showed good validity and reliability and operated equivalently for men and women of different ages with various clinical and treatment conditions related to RLS. Accordingly, health care professionals can use eHEALS as a psychometrically sound tool to explore the digital health literacy level among patients with RLS.

Air pollution is one of the major contributors to the global burden of disease, with particulate matter (PM) as one of its central concerns. Thus, there is a great need for exposure and risk assessments associated with PM pollution. However, current standard measurement techniques bring no knowledge of particle composition or shape, which have been identified among the crucial parameters for toxicology of inhaled particles. We present a method for collecting aerosols via impaction directly onto Transmission Electron Microscopy (TEM) grids, and based on the measured impactor collection efficiency and observed impact patterns we establish a reproducible imaging routine for automated Scanning Electron Microscopy (SEM) analysis. The method is validated by comparison to scanning mobility particle sizer (SMPS) measurements, where a good agreement is found between the particle size distributions (PSD), ensuring a representative description of the sampled aerosol. We furthermore determine sampling conditions for achieving optimal particle coverage on the TEM grids, allowing for a statistical analysis. In summary, the presented method can provide not only a representative PSD, but also detailed statistics on individual particle geometries. If coupled with Energy-dispersive X-ray spectroscopy (EDS) analysis elemental compositions can be assessed as well. This makes it possible to categorize particles both according to size and shape e.g. round and fibres, or agglomerates, as well as classify them based on their elemental composition e.g. salt, soot, or metals. Combined this method brings crucial knowledge for improving the foundation for PM risk assessments on workplaces and in ambient conditions with complex aerosol pollution.

One of the most efficient methods to control the high infection rate of the coronavirus disease 2019 (COVID-19) is to have a high coverage of COVID-19 vaccination worldwide. Therefore, it is important to understand individuals’ intention to get COVID-19 vaccinated. The present study applied the Theory of Planned Behavior (TPB) to explain the intention to get COVID-19 vaccinated among a representative sample in Qazvin, Iran. The TPB uses psychological constructs of attitude, subjective norm, and perceived behavioral control to explain an individual’s intention to perform a behavior. Fear and perceived infectability were additionally incorporated into the TPB to explain the intention to get COVID-19 vaccinated. Utilizing multistage stratified cluster sampling, 10,843 participants (4092 males; 37.7%) with a mean age of 35.54 years (SD = 12.00) completed a survey. The survey assessed TPB constructs (including attitude, subjective norm, perceived behavioral control, and intention related to COVID-19 vaccination) together with fear of COVID-19 and perceived COVID-19 infectability. Structural equation modeling (SEM) was performed to examine whether fear of COVID-19, perceived infectability, and the TPB constructs explained individuals’ intention to get COVID-19 vaccinated. The SEM demonstrated satisfactory fit (comparative fit index = 0.970; Tucker-Lewis index = 0.962; root mean square error of approximation = 0.040; standardized root mean square residual = 0.050). Moreover, perceived behavioral control, subjective norm, attitude, and perceived COVID-19 infectability significantly explained individuals’ intention to get COVID-19 vaccinated. Perceived COVID-19 infectability and TPB constructs were all significant mediators in the relationship between fear of COVID-19 and intention to get COVID-19 vaccinated. Incorporating fear of COVID-19 and perceived COVID-19 infectability effectively into the TPB explained Iranians’ intention to get COVID-19 vaccinated. Therefore, Iranians who have a strong belief in Muslim religion may improve their intention to get COVID-19 vaccinated via these constructs.