Public knowledge and perceptions of connected health

Public knowledge and perceptions of connected healthPaul J. Barr MSc PhD,1* Shauna C. Brady MPharm,2 Carmel M. Hughes BSc PhD MRPharmS MPSNI3

and James C. McElnay BSc PhD FPSNI FRPharmS FACCP FBPharmacolS3

1Research Fellow, 2Undergraduate Pharmacy Student, 3Professor, School of Pharmacy, Queen’s University Belfast, UK

Keywords

health care surveys, health knowledgeattitudes, practice, telemedicine

Correspondence

Professor James C. McElnayClinical and Practice Research GroupSchool of PharmacyQueen’s University BelfastBelfast, Northern Ireland BT9 7BLUKE-mail: [email protected]

* Present address: The Dartmouth Center,Hinman Box 7256, 37 Dewey Field Road,4th Floor, Hanover, NH 03755, USA.

Accepted for publication: 6 February 2014

doi:10.1111/jep.12118

AbstractRationale, aims and objectives This study aims to examine the public’s knowledge andperceptions of connected health (CH).Methods A structured questionnaire was administered by face-to-face interview toan opportunistic sample of 1003 members of the public in 11 shopping centres acrossNorthern Ireland (NI). Topics included public knowledge of CH, opinions aboutwho should provide CH and views about the use of computers in health care. Multivar-iable analyses were conducted to assess respondents’ willingness to use CH in thefuture.Results Sixty-seven per cent of respondents were female, 31% were less than 30 years oldand 22% were over 60 years. Most respondents had never heard of CH (92%). Followinga standard definition, the majority felt CH was a good idea (≈90%) and that generalpractitioners were in the best position to provide CH; however, respondents were equivocalabout reductions in health care professionals’ workload and had some concerns about theease of device use. Factors positively influencing willingness to use CH in the futureincluded knowledge of someone who has a chronic disease, residence in NI since birth andless concern about the use of information technology (IT) in health care. Those over 60years old or who felt threatened by the use of IT to store personal health information wereless willing to use CH in the future.Conclusion Increased public awareness and education about CH is required to alleviateconcerns and increase the acceptability of this type of care.

IntroductionThe population of the world is ageing, which has been associatedwith the increased prevalence of chronic conditions such as car-diovascular disease and diabetes [1,2]. Coupled with improved lifeexpectancy and projected shortages in health care staff, a signifi-cant strain will be placed on health care resources in the future[1,3–7]. The new challenges come at a time when worldwidehealth care costs are soaring and initiatives to reduce spending arebeing implemented [8,9]. Connected health (CH), a form oftelemedicine, has been proposed as a way of partially alleviatingthese pressures. In CH, patients with chronic medical conditionsare remotely monitored through the use of home medical devices,working in partnership with health professionals promoting self-management/self-care of disease [10]. For example, patients withhypertension can use a home blood pressure monitor, the results ofwhich can be automatically forwarded on to a health professionalvia the Internet.

Public awareness of, and opinion on, CH are unclear. Previouspublic surveys in the United States and Canada have highlighted alack of awareness of telemedicine as only a minority (8.9–18.2%)of those surveyed were familiar with telemedicine [11–13]. Yetonce explained, approximately 50% of those surveyed indicatedthat they would be willing to use telemedicine services as theycould improve access to health services and quality of care, whilepotentially reducing health care expenditure [12]. Gagnon et al.also reported that those most willing to use telemedicine hadknowledge of its applications, recognized its benefits, perceivedfewer barriers associated with telemedicine and were more likelyto be female [12]. Katz and Rice investigated the views of thepublic towards mobile health care technology, such as monitoringblood pressure through radio frequency identification devices [11].They found that people who had strong interpersonal socialsupport, higher levels of trust, higher levels of concern aroundprivacy and those from a non-white ethnicity were more interestedin using these services.

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However, the public are less likely to request or accept CH ifthey are unaware of its availability and health care providers areunaware of the public’s views and expectations regarding CH [14].Furthermore, there have been few studies that have investigated therole of the pharmacist in CH provision, despite their widespreaddistribution in the community [10]. It has been argued thatthe community pharmacist could act as the ‘hub’ for CH pro-vision [15].

AimThe main aim of the study was to gain a better understanding of theknowledge and perceptions of CH within the general public, inNorthern Ireland (NI); as such, a survey was deemed the mostappropriate research method. This is pertinent given the introduc-tion of CH in NI for approximately 20 000 patients at the time thestudy was undertaken [16]. The objectives of the study were four-fold: (1) to assess the public’s knowledge about, and perceptionsof, CH; (2) to identify the public’s preferred provider of CH and inparticular to explore their views on the role of the pharmacist inCH provision; (3) to assess views of members of the public on theperceived benefits and concerns related to CH; and (4) to explorefactors related to willingness to use connected health technology.

Methods

Participants

The study population chosen for the survey was an opportunisticsample of the general public in NI. Data were collected in shop-ping centres across NI via a face-to-face, interviewer-administered, structured questionnaire. People aged 18 years orolder and who had lived in NI for 2 years or more were includedin the study. A total sample size of 1000 participants was targeted,which provided a 95% probability of estimating the true publicopinion to within ±3% (a confidence interval width of 6%).

The survey was conducted in 11 shopping centres in provincialtowns and cities across the region from January to August 2011.Shopping centre managers were contacted prior to the commence-ment of the study in order to gain their approval. Four interviewerswere trained in the administration of the survey, with a maximumof two interviewers attending a particular shopping centre at anyone time. Each centre was visited on at least two occasions and aminimum of 40 surveys was administered per centre. Ethicalapproval for the survey was granted from the Ethics Committee,School of Pharmacy, Queen’s University Belfast (QUB).

Questionnaire

The questionnaire was developed by the research team takingaccount of previous surveys investigating public knowledge andviews of telemedicine [11,12,14] and surveys previously con-ducted on health care-related issues in NI [17,18]. Colleagueswithin the School of Pharmacy reviewed the questionnaire for facevalidity. The survey instrument was piloted with students and stafffrom QUB (n = 20), after which the survey instrument was furtherrefined to produce the final version, with a total of 27 items. Thesurvey took approximately 15 minutes to complete and consistedof seven main sections:

1 prior knowledge of CH or related terms;2 views on the potential providers and recipients of CH;3 perceived benefits and concerns related to CH;4 individual views of the use of computers in health care to storepersonal information;5 the potential role of the community pharmacist in CH provision;6 respondents’ medical history, demographics and experience ofmedical and information technology (IT) devices; and7 willingness to use or recommend CH servicesThe majority of responses were binary, yes or no, or on a Likertscale.

Data collection

Members of the general public were approached in the shoppingcentres and, if they met the inclusion criteria, were asked whetherthey would like to take part in a survey about health care. Theywere asked if they had heard of CH or related terms (whichincluded telehealth, telemedicine, telemonitoring and telecare).Following this, to help ensure consistency in understanding acrossthe survey population, each participant was given the definition ofCH (Fig. 1); their views of CH were assessed throughout theremainder of the survey. No reference was made to the School ofPharmacy during the interviews to reduce the possibility ofresponse bias. Participation was voluntary and all participantswere informed that information would be dealt with anonymously,remain confidential and be used for research purposes only.Consent was implied if the member of the public agreed to par-ticipate in the interview; this approach was viewed as beingacceptable in previous studies carried out by members of theresearch team [17].

Data analysis

Descriptive analyses were conducted for all key variables, whichincluded demographic information, prior experience with healthcare technology and current views of the use of computers inhealth care (Tables 1 & 2). Parametric and non-parametric testing,as appropriate, were also conducted between the main outcome ofinterest (participant’s willingness to use CH if he or she currentlysuffer, or in the future suffered, from a long-term health condition)and the key variables. Multiple logistic regression analyses wereconducted to identify factors associated with the main outcome.The response was categorized as 0, ‘no/not sure’, or 1, ‘yes’.A further analysis was conducted with the outcome ‘would yoube happy for community pharmacists to be involved in the provi-sion of a CH service’. Robust standard errors for estimates wereused to account for clustering of respondents’ characteristicswithin the different recruitment sites [19]. All analyses wereconducted using the STATA 11.2® statistical package [20] andsignificance was set a priori at P < 0.05.

ResultsA total of 1003 people were interviewed; however, incompletesurveys were recorded for 12 of these respondents, who, due tolack of time, did not complete the interview.

Approximately 33% of those interviewed were male (n = 326),30.5% of participants were aged 18–30 years old (n = 304),

P.J. Barr et al. Public views on connected health

© 2014 John Wiley & Sons, Ltd. 247

whereas 22.1% were over 60 years old (n = 221), with the remain-der evenly distributed across the other age categories (Table 1).The majority of respondents (85.3%) knew, or had known well,someone who suffered from a chronic medical condition and overhalf of the respondents themselves suffered from a medical con-dition that required the use of medication. The majority of thesample reported having access to computers (83.7%), the Internet(79.4%) and mobile phones (87.8%), of which 39% were definedas smart phones (Table 2). Fewer respondents over 60 years of agehad Internet access (49.8%) in comparison to those less than 30years of age (95.1%) and 30–60 years of age (83.9%).

The majority of respondents had never heard of CH (n = 924,92.1%), or any of the related terms, prior to the survey. However,following the provision of a definition of CH (Fig. 1), 89.1% ofrespondents’ felt that it was a ‘very good idea’ or ‘good idea’ tomonitor health ‘from information sent by a patient from theirhome’. In addition, 91.9% of those surveyed felt it was a very goodor good idea to alert patients about potential health problems.

Provision of CH

Participants believed that CH could be very helpful or helpful forpeople with diabetes (95.3%), heart disease (94.8%) and asthma(88.4%). However, participants were equivocal as to whether thisservice would be helpful for patients with dementia or Alzheimer’sdisease (52.6%); a number of participants suggested that the latterwould only be appropriate if a carer was available to assist. Otherconditions suggested by respondents for which CH could possiblybe used included cancer, cystic fibrosis, mental illness, epilepsy,renal disease, multiple sclerosis, stroke, thyroid conditions andblindness. In addition, some people mentioned the potential use ofCH during pregnancy.

The majority of participants (n = 808; 80.6%) felt that within aCH service, if a concern about the patient’s condition was raised,for example, via home monitoring, the health professional couldsend an alert to the patient about their condition via the Internet ormobile phone (or both). The remaining respondents (n = 194;19.4%) preferred a mix of landline calls, face-to-face visits ormailing feedback to patients. Of those respondents who reportedhaving a medical condition themselves, 25% would prefer a meansof contact other than the Internet or mobile phone, compared toonly 15% of respondents without a current medical condition(P < 0.001).

Table 1 Characteristics of respondents*

Item N N%

DemographicsSex

Male 326 32.7%Female 672 67.3%

Age (years)18–30 304 30.5%31–40 140 14.0%41–50 168 16.8%51–60 165 16.5%>60 221 22.1%

EducationPrimary/Secondary 573 57.8%Tertiary (University) 418 42.2%

National Statistics Socio-Economic Classifications†

Managerial/professional 56 7.1%Intermediate occupations 305 38.7%Routine and manual occupations 209 26.5%Unemployed 77 9.8%Student 96 12.2%Retired 215 21.4%

Live alone?Yes 185 18.5%No 813 81.5%

Lived in NI entire life?Yes 890 89.4%No 106 10.6%

Do you suffer from a medical condition?Yes 466 46.9%No 528 53.1%

Have you ever used a home medical deviceYes 319 32.0%No 677 68.0%

If yes: type of home medical device (n = 319)BP 208 65.2%Glucose monitor 92 28.8%

Do you know someone who suffers froma medical condition?

Yes 849 85.3%No 146 14.7%

*Some cells do not match total due to uncompleted survey items.†National Statistics Socio-Economic Classifications.BP, blood pressure; NI, Northern Ireland.

Table 2 Characteristics of respondents*

Use of home technology N N%Do you use any of the following technology at home?

Computer 840 83.7%Internet 796 79.4%Mobile phone 881 87.8%Games console 334 33.3%

Use of computers in health carThe storage of personal information on computers

of health care professionals is a threat topersonal privacy

Agree 262 26.3%Neither agree or disagree 126 12.6%Disagree 610 61.1%

Health care providers ask for too much personalinformation


People should have more control over the personalinformation held on computer health records


*Some cells do not match total due to uncompleted survey items.

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© 2014 John Wiley & Sons, Ltd.248

In terms of who would be in the best position to provide a CHservice, participants were asked to rank health professionals from1 (best position), to 5 (worst position). General practitioners wereconsidered to be in the best position to provide the service, with amean rank of 1.6 [standard deviation (SD) 0.9] (ranked first 627times), followed by nurses, 2.7 (SD 1.2) (ranked first 115 times),hospital doctors, 3.0 (SD 1.2) (ranked first 83 times), communitypharmacists, 3.25 (SD 1.3) (ranked first 83 times), and hospitalpharmacists, 4.32 (SD 0.91) (ranked first 11 times).

When asked why they felt their chosen health professional wasin the best position, several themes emerged, the most common ofwhich were as follows: familiar with the patient history (40%),health professional was appropriately educated/trained (11.9%),better access to the chosen health professional (9.9%), they wouldhave more time to deliver the CH service (8.6%) and arecommunity-based (7.4%).

Benefits of and concerns about CH

The interviewees were provided with a number of statements andasked to indicate their opinion about the potential benefits andconcerns that could arise with CH. Overall, respondents agreedwith the range of possible advantages of CH (Fig. 2), althoughrespondents were more equivocal regarding the potential of CH toreduce health care professionals’ workload (59.2% stronglyagreed/agreed).

In terms of perceived concerns, the responses were more vari-able. The respondents appeared to be most concerned aboutdevices being difficult to use (Fig. 3). Interestingly, older respond-ents (over 60 years) seemed less concerned regarding difficulty ofdevice use (5% very concerned) compared to other age groups, forexample, less than 30 years (11.2%) and 30–60 years (11.3%),

P < 0.001. Respondents who reported suffering from a medicalcondition compared to those who did not, and those who hadreceived only primary or secondary education versus tertiary edu-cation, were also less likely to be ‘very concerned’ regardingdifficulty of device use (6.7% versus 12.1%, P < 0.001; 6.5%versus 13.7%, P = 0.003, respectively). Overall, the respondentswere much less concerned with the potential reduction in face-to-face contact between patients and health providers and the possibleinconvenience to patients of using a remote monitoring device(Fig. 3). In addition, most respondents did not feel that storage ofpersonal information on the computers of health care professionalsthreatened their privacy (61.1%) and did not feel that health pro-fessionals asked for too much personal information (73.4%)(Table 2).

The pharmacist

Approximately 55% of those who responded visited the commu-nity pharmacist on a weekly or monthly basis. Respondents wereasked about the potential role of the community pharmacist in theprovision of CH. A high percentage of respondents stronglyagreed/agreed that it would be beneficial if the community phar-macist could check whether patients had taken their medication(86.5%) and remind patients (e.g. text message) to take the medi-cation (88%), via the use of a CH service. However, only 53.4% ofrespondents strongly agreed/agreed with the pharmacist making anadjustment to patient medication in response to information sent.In general, however, respondents believed that the communitypharmacists could help with the provision of a CH service (94.6%)and were happy for them to do so (93.4%).

A multiple logistic regression analysis was conducted, whereeach variable was analysed while controlling for the effect of all

Connected health can be described as a way of connecting a person with a long term-illness,

for example, high blood pressure, diabetes or asthma, from their own home to the health

professional (doctor, pharmacist or nurse) looking after them. This involves people regularly

monitoring their illness (e.g., daily) from their own home using a medical device, for example,

a blood pressure or blood sugar monitor. This information is then sent to their health

professional automatically, for example, through the Internet or via the mobile phone network.

If the person’s condition begins to get worse, the health professional can be automatically

sent an alert and they can then contact the patient to recommend a course of action, for

example, a change in medication.

Just to repeat – a person uses a device in their own home to monitor control of their illness,

the results go directly to a health care professional’s computer, via the Internet or mobile

phone network. The healthcare professional can offer advice as required. In other words, the

patient is connected in to the health care system – hence the term Connected Health.

Figure 1 Definition of connected health as used during the face-to-face interview.



other variables. Female respondents, compared to male respond-ents [odds ratio (OR) 2.30; 95% confidence interval (CI) 1.44–3.65; P < 0.01], respondents who disagreed with the statement thathealth professionals ask for too much personal information, com-pared to those who did not (OR 2.53; 95% CI 1.57–4.08; P < 0.01)and those who received primary or secondary education, comparedto those who had a tertiary education (OR 2.15; 95% CI 1.22–3.82;P = 0.01) were all more than twice as likely to be ‘happy’ for thecommunity pharmacists involvement in the provision of CH.

Who would use CH?

Upon survey completion, 91.8% strongly agreed or agreed that CHwas a ‘good idea’, 87.2% indicated that they would be willing to

use CH services if they currently suffered from or developed along-term health condition and 86.1% would recommend CH to afamily member or friend with a long-term health condition(Table 3).

Logistic regression analyses were conducted to identify the keycharacteristics of respondents who expressed a willingness to useCH, if they had, or were to develop, a long-term health condition(Table 4). Following an unadjusted analysis, an analysis was con-ducted to identify the independent relationship of each variablewith willingness to use CH in the future, adjusted for all othervariables in Table 4. The respondents who expressed most willing-ness to use CH in the future were those resident in NI their entirelives (OR 2.40; 95% CI 1.45–4.00; P < 0.01); those with family orfriends who had a chronic disease (OR 2.25; 95% CI 1.48–3.41;

Figure 2 Perceived benefits regarding con-nected health.

Figure 3 Perceived concerns regarding con-nected health.



P < 0.01), respondents who disagreed that the storage of personalinformation on the computers of health professionals was a threatto personal privacy (OR 1.92; 95% CI 1.65–4.93; P < 0.01), dis-agreed that health professionals asked for too much personal infor-mation (OR 2.85; 95% CI 1.65–4.93; P < 0.01) and who agreedthat patients should be allowed more control over medical records(OR 2.01; 95% CI 1.07–3.76; P = 0.03). In comparison, peopleaged over 60 years (OR 0.51; 95% CI 0.29–0.90; P = 0.02) andthose who agreed that IT in health care was a threat to personalprivacy (OR 0.50; 95% CI 0.30–0.85; P = 0.01) were less willingto support the CH approach.

DiscussionThe majority of the public had never heard of CH, similar tosurvey findings in North America [11,12]. However, most respond-ents provided positive views of CH following an explanation of theapproach. The actual proportion supporting the concept of CH wasmuch larger in NI, that is, almost 90% indicated that they would beprepared to use CH, when compared with approximately 50% ofthose surveyed regarding telemedicine in Quebec, Canada [12].Lack of awareness has been identified as a barrier to implementa-tion of telemedicine [14].

The higher levels of acceptance of CH in NI may be a temporaleffect, as the survey in Quebec was conducted almost a decadeago. IT is much more integrated in today’s society, for instance,the proportion of people in the UK with access to the Internet hassteadily increased from 61% in 2007 to 77% in 2011, similar to thelevels reported in the current project, 79.4% [21].

Respondents felt that GPs were in the best position to provideCH. Given the GP’s role as the main gatekeeper to hospital ser-vices in the UK, this is not surprising. The primary reason behindthe choice was the GP’s familiarity with the patient and theircondition, lending support to the belief that trust and a goodrapport with a health professional can facilitate the uptake ofCH [22].

The greatest perceived benefit of CH was its potential to makepatients feel more secure at home, a finding common across otherstudies, particularly when the monitoring is conducted by a trustedhealth care professional [22,23]. It had been suggested that patientconcern regarding reduced face-to-face contact with a health care

provider could be a major barrier to the implementation of remotemonitoring technologies [24]. However, this was not a major causeof concern among the current respondents.

Respondents were less certain about the potential of CH toreduce the workload on health professionals. In a recent systematicreview of barriers and facilitators to telemedicine implementation,11 studies identified telemedicine as time saving compared to 30studies where it was perceived as time consuming or as increasingthe workload for the health professional [25]. Particular concernshave been raised about the loss of treatment time due to the initialimplementation and learning phases of new IT and telemedicineprogrammes in health care [25–28]. The review also highlightedease of use as a major barrier to the introduction of telemedicineand IT technologies in health, that is, similar to the currentstudy [25].

Privacy and confidentiality of information were also commonconcerns. However, they have been viewed as both facilitators andbarriers to CH implementation [25]. Some consider remote patientmonitoring as a protector of privacy by allowing people to bemonitored from home, therefore offering patients more independ-ence, while others argue that it impinges upon individual privacyand are opposed to providing personal information over theInternet [11,22].

CH and the pharmacist

Community pharmacists are the most frequently contacted healthprofessionals in the UK and the results of the current surveyindicated public support for their involvement in CH provision[29]. Some contend that the community pharmacist could act asthe ‘hub’ for a CH service [15]. Such integration of servicesprovided by different health professionals could help with thesuccessful implementation of CH [23]. Interestingly, females(compared to males) and respondents with primary or secondaryeducation (compared to tertiary) were happier for the pharmacistto be involved in the provision of CH, and upon further analysis, itwas shown that both groups visited the pharmacist more often thantheir comparators. This reinforces the importance of patient famili-arity with the health professional providing CH services [22].

Willingness to use CH

In comparison to younger age groups, those aged over 60 yearsexpressed less willingness to use CH in the future. Respondentsover 60 years were also less likely to have Internet access (49.8%);however, access among respondents was higher than officialfigures of those aged 65 or older in the UK (40%) and the UnitedStates (41.5%) [30,31]. Previous studies have suggested that olderpeople may find the use of IT-related technology both complicatedand confusing, leading to low self-efficacy in terms of utilizing anew technology [32,33]. However, Irizarry et al. believed that thisis simply a ‘transitional issue’ as IT has become integrated in thehome, work place and educational settings in recent years [34].Lack of training of older adults in the use of IT has been identifiedas a key barrier to the implementation of IT devices and it istherefore important that CH devices are user-friendly, particularlyfor older patients who may have less experience with IT [35,36].

Knowing someone with a chronic disease was associated withan increased willingness to use CH in the future. This observation

Table 3 Views of connected health

Would you use connected health in the futureif you developed a chronic disease?

Yes 865 87.2%No 48 4.8%Don’t know 79 8.0%

Would you recommend connected health to familyor friends if they developed a chronic disease?

Yes 858 86.1%No 28 2.8%Don’t know 110 11.0%

Do you think connected health is a good idea?Yes 913 91.8%No 28 2.8%Don’t know 54 5.4%



may be due to differences in illness perception; family members ofthose with disease can perceive illness, for example, diabetes, asmuch more serious than those who actually have the illness [37].As a result, respondents who know someone with an illness maybe more in favour of an intervention. Furthermore, caregivers have

been found to hold positive views of IT in providing health careand access to patient monitoring data can improve their feelings ofcompetence and reduce caregiver burden [35].

Those domiciled in NI for their entire lives indicated morewillingness to try CH. They were generally less concerned about

Table 4 Factors influencing the willingness to use connected health in the future*

Variable Unadjusted odds ratio (95% CI) P-value Adjusted odds ratio (95% CI) P-value

DemographicMale (%) Gender (Reference: Male)Female 0.91 (0.64–1.29) 0.58 0.86 (0.60–1.24) 0.43

Age (Reference: <30 years)30–60 years 1.06 (0.66–1.72) 0.81 0.89 (0.43–1.84) 0.76>60 years 1.03 (0.68–1.56) 0.88 0.51 (0.29–0.90) 0.02

Education (Reference: Primary/secondary)Tertiary 0.85 (0.55–1.30) 0.44 0.81 (0.47–1.41) 0.46

Socio-economic classification (Reference: Intermediate)Professional/managerial 0.80 (0.44–1.44) 0.45 0.70 (0.34–1.44) 0.34Routine/manual 0.67 (0.46–0.95) 0.03 0.83 (0.59–1.17) 0.28Student 1.68 (0.77–3.67) 0.19 1.35 (0.49–3.70) 0.56Unemployed (not including retired) 3.77 (0.54–26.3) 0.18 3.40 (0.41–28.0) 0.25Retired 1.40 (0.80–2.44) 0.24 2.33 (0.86–6.31) 0.10

Live alone (Reference: No)Yes 0.73 (0.52–1.03) 0.08 0.73 (0.52–1.02) 0.06

Live in NI entire life (Reference: No)Yes 2.25 (1.4–3.38) <0.01 2.40 (1.45–4.00) <0.01

Medical condition (Reference: No)Yes 1.42 (1.07–1.89) 0.01 1.20 (0.86–1.67) 0.29

Friend/family with medical condition (Reference: No)Yes 2.12 (1.5–3.00) <0.01 2.25 (1.48–3.41) <0.01

Home technology

Familiar with connected health or related terms (Reference: No)Yes 1.31 (0.66–2.61) 0.44 1.25 (0.48–3.25) 0.64

Ever used a home medical device (Reference: No)Yes 1.16 (0.73–1.84) 0.53 0.89 (0.57–1.40) 0.61

Internet (Reference: No)Yes 1.33 (0.80–2.22) 0.26 1.31 (0.79–2.18) 0.30

Mobile phone (Reference: No)Yes 1.23 (0.73–2.06) 0.43 1.09 (0.70–1.70) 0.69

Games console (Reference: No)Yes 1.01 (0.75–1.38) 0.92 1.14 (0.84–1.56) 0.40

Current health care provision

The storage of personal information on computers of health care professionals is a threat to personal privacy (Reference: Neither agree ordisagree)

Agree 0.60 (0.39–0.92) 0.02 0.50 (0.30–0.85) 0.01Disagree 2.55 (1.84–3.53) <0.01 1.92 (1.24–3.00) <0.01

Health professionals ask for too much personal information (Reference: Neither agree or disagree)Agree 0.99 (0.56–1.76) 0.98 1.04 (0.47–2.30) 0.92Disagree 4.23 (2.77–6.48) <0.01 2.85 (1.65–4.93) <0.01

Patient’s should have more control over their personal information held on computer health records (Reference: Neither agree or disagree)Agree 1.31 (0.80–2.16) 0.29 2.01 (1.07–3.76) 0.03Disagree 2.05 (1.28–3.29) <0.01 1.19 (0.74–1.92) 0.48

*Adjusted for clustering by shopping centre.CI, confidence interval



CH implementation and were also more positive about the poten-tial benefits. In addition, respondents resident in NI all of theirlives are likely to be more familiar with the health care systemin NI and may have stronger social networks; the latter hasbeen associated with willingness to try telemedicine in previousstudies [11].

Finally, respondents who felt that privacy was not threatened bythe digital storage of personal information by health care profes-sionals or did not feel that they required more control over theirmedical records, were more willing to try CH in the future. Asmentioned previously, the role of privacy can be viewed as both afacilitator and a barrier to CH uptake [25].

Limitations

The current study is not without limitations. The survey onlyprovided a snapshot of the population’s views of CH. In addition,there were some differences in the characteristics of participants inthe current study and the NI population as recorded by the 2001Census in NI [38,39]. There were more females (67% versus 52%in the Census), more people who had a tertiary level education(44.2% versus 16.5% in the Census), more people with self-reported long-term medical conditions (46.9% versus 25% in theCensus) and there was a lower proportion of respondents whoreported having routine/manual occupations (26.5% versus 40.5%in the Census); all P-values < 0.0001. However, respondent char-acteristics were similar to that of a previous study based in shop-ping centres in NI [17].

The rate of non-response was not estimated as it was difficult toidentify the number of potential participants who did not want tobe interviewed, that is, avoided researchers with a clipboard. Thesurvey consisted largely of closed questions, which prohibitedmore in-depth probing of respondents’ responses, and given thestudy environment (shopping centres), respondents had littleopportunity to think deeply about CH. Although no time limit wasplaced on the survey and respondents could take as much time asthey liked in providing a response, it was clear that some partici-pants had self-imposed time pressures.

ConclusionsAlthough there was a lack of familiarity with the concept of CH,the general view of the service among the public was positive.Overall, the results suggest that prior to further implementation ofCH, a public awareness programme may be required to help facili-tate its introduction. Such a programme should focus upon thereliability and ease of use of CH devices and should target groupswho may be less willing to use the service.

Conflict of interestThe authors declare no conflict of interest.

AcknowledgementsWe would like to thank Rachel Moohan, Úna McMenamin andMichael O’Rourke for their assistance with recruitment and thestaff of the shopping centres for their assistance in conducting this

piece of research. This research received no specific grant fromany funding agency in the public, commercial or not-for-profitsectors.

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Public knowledge and perceptions of connected health