FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024User Needs and Factors Associated With the
Acceptability of Audiovisual Feedback Devices for Chest
Compression Monitoring in
Cardiopulmonary Resuscitation
Desale Tewelde Kahsay, MSc, Sanna Salanterä, PhD, Miretta Tommila, MD, PhD, Tanja Liukas, MSc, Riitta Rosio, MSc,
Abigail Kusi-Amponsah Diji, PhD, Laura-Maria Peltonen, PhDAu
ve
Tu
of
Un
ici
sit
Th
in
Co
In
Th
(C
th
Co
DO
VoThe use of audiovisual feedback devices to guide the quality
of chest compressions during cardiopulmonary resuscita-
tion has increased in recent years. Audiovisual feedback de-
vices can be classified as integrated (eg, Zoll AED Plus defi-
brillator) or standalone (eg, CPRmeter). This study aimed to
explore users' needs and factors affecting the acceptability
of audiovisual feedback devices. Semistructured interviews
were conducted with healthcare professionals involved in
lifesaving activities. The Unified Theory of Acceptance and
Use of Technology was used as a theoretical framework for
the study. TheUnified Theory of Acceptance andUseof Tech-
nology model has four constructs: performance expectancy,
effort expectancy, social influence, and facilitating factors.
Ten themes were identified under the four constructs. The
performance expectancy constructs include three themes:
perceived usefulness, outcome expectation, and applicabil-
ity in diverse situations. The effort expectancy construct en-
compasses two themes: user-friendliness and complexity.
The social influence construct has two themes: social and
organizational factors. Lastly, the facilitating factors con-
struct includes three themes: staff competence, perceived
cost, and compatibility of devices. Exploring the needs and
factors influencing the acceptability of audiovisual feedback
devices used during cardiopulmonary resuscitation will in-
form healthcare providers, managers, manufacturers, and
procurers on how to improve the efficiency and use of these
devices.thor Affiliations:Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Uni-
rsity of Turku (Mr Kahsay); Department of Nursing Science, Faculty of Medicine, University of
rku and Turku University Hospital, Turku, Finland (Drs Salanterä and Peltonen), and Department
Perioperative Services, Intensive Care Medicine and Pain Management (Dr Tommila), Turku
iversity Hospital and University of Turku; and Department of Nursing Science, Faculty of Med-
ne, University of Turku (Ms Liukas), Finland; Department of Nursing, Kwame Nkrumah, Univer-
y of Science and Technology, Ghana (Dr Diji).
e authors have disclosed that they have no significant relationships with, or financial interest
, any commercial companies pertaining to this article.
rresponding Author: Desale Tewelde Kahsay, MSc, Department of Anaesthesiology and
tensive Care, Faculty of Medicine, University of Turku, Turku, Finland (desale.t.kahsay@utu.fi)
is is an open access article distributed under the Creative Commons Attribution License 4.0
CBY), which permits unrestricted use, distribution, and reproduction in any medium, provided
e original work is properly cited.
pyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.
I: 10.1097/CIN.0000000000001126
lume 42 | Number 8KEY WORDS: Audiovisual feedback, Cardiopulmonary
resuscitation, Medical devices, Technology adoption
C ardiac arrest is a challenging event and remains one ofthe public health burdens across the world.1,2 Factorsinfluencing survival after cardiac arrest are well under-
stood, but there is still considerable variation in incidence and
outcome.3 Survival after a cardiac arrest depends on several
factors, such as the cause of the cardiac arrest, response time,
the place where the cardiac arrest occurred, the initiation of
bystander cardiopulmonary resuscitation (CPR), the availabil-
ity of a defibrillator, the quality of CPR, the age of the victim,
and the quality of postresuscitation care.1–3 Based on data
from 2008 to 2017, the rate of in-hospital cardiac arrest in
the United States ranged from 9 to 10 per 1000 admissions,
and survival to hospital discharge ranges from 0% to 42%.4
In Europe, annual in-hospital cardiac arrest rates ranged from
1.5 to 2.8 per 1000 hospital admissions, with survival rates of
15% to 34%.3 The incidence of out-of-hospital cardiac arrest
per 100 000 inhabitants is 67 to 170 in Europe3 and 51 to 107
in Australia and New Zealand, with an average survival rate
of 8% and 12%, respectively.5
Cardiopulmonary resuscitation is a lifesaving procedure
performed on cardiac arrest patients. Cardiopulmonary re-
suscitation aims to provide artificial blood flow to the vital or-
gans until the natural circulation is returned.4 High-quality
chest compressions are an essential part of successful resuscitation.6
However, there have been instances when even experienced
healthcare professionals have failed to perform chest com-
pressions as recommended by CPR guidelines.7 For example,
a study evaluating the impact of CPR quality and adherence
to CPR guidelines on patient outcomes found that only 37%
and 63.9% of compressions were within the recommended
range for rate and depth, respectively.8
Several medical devices have been developed to provide
real-time audiovisual feedback (AVF) to inform rescuers
about the quality of chest compressions during CPR.9 These
devices can be broadly divided into integrated and standaloneCIN: Computers, Informatics, Nursing 583
FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024AVF devices. Integrated AVF devices are integral to complex
multifunctional medical devices such as defibrillators or simu-
lation manikins.10 Despite their advanced features, integrated
AVF devices are more expensive, relatively complex, and in-
accessible to community-based rescuers. Standalone AVF de-
vices are freestanding and typically placed between the
rescuer's hand and the patient's chest.10 Unlike integrated
AVF devices, standalone AVF devices often have fewer fea-
tures. They are less expensive and portable, potentially helpful
in guiding inexperienced healthcare professionals and layper-
sons in hospital and community settings.10,11
Technological innovations can transform our lives and
bring new values and practices to society.12 However, as
technological innovations continue to evolve, it is difficult
to predict how influential they will be. Adoption of new tech-
nologies is unpredictable and prone to failure, as the success
of an innovation depends on end-user acceptance of a partic-
ular technology.12 The features of technology play a crucial
role in whether the people involved in an activity will accept
and use it.13 Therefore, exploring the needs and understand-
ing users' perceptions of acceptability may help further pro-
mote the adoption of new technologies. 12,13
Previous studies have explored participants' perceptions
of the acceptability of various health-related medical tech-
nologies, including digital health technology,14 electronic
medical records,15 and wearable health devices for different
purposes.16 Despite this reality, medical devices that provide
feedback on the quality of chest compressions have not been
studied from a user perspective. Therefore, this study aimed
to explore the needs and factors that influence the accept-
ability of AVF devices that monitor chest compression qual-
ity during CPR from the users' perspective.
METHODOLOGY
Theoretical Framework
The Unified Theory of Acceptance and Use of Technology
(UTAUT) guided the study. We chose the UTAUT model
for its comprehensiveness because it is derived through anal-
ysis and consolidation of eight commonly used Technology
Acceptance Models, including the Theory of Reasoned Ac-
tion, Technology Acceptance Model (TAM 1), Technology
Acceptance Model (TAM2), Diffusion of Innovation The-
ory, Theory of Planned Behavior, Model of Personal Com-
puter Use, Social Cognitive Theory, a Combined Theory
of Planned Behavior/Technology Acceptance Model, and
the motivational model.17 This work aimed to develop a uni-
fied acceptance model that predicts better technology accep-
tance variance.17 The UTAUT model has been successfully
applied to understand the adoption of various health-related
technologies, including digital health technology,14 elec-
tronic medical records,15,18 and wearable devices for differ-
ent purposes.16,19 The UTAUT model evolved with four584 CIN: Computers, Informatics, Nursingfundamental constructs that determine the acceptance of be-
havior: performance expectancy, effort expectancy, social in-
fluence, and facilitating conditions.17 This model was used in
developing the interview guide and data analysis. The cod-
ing matrix used in the data analysis is shown in Table 1.
Design
This study adopted a qualitative descriptive approach, using
focus group discussions and individual interviews to gather
more detailed information to explore the needs and under-
stand the factors associated with AVF devices' acceptability
during CPR.
Setting and Participants
The sample was drawn from active members of departments
involved in lifesaving activities, including the Ghana Red
Cross Society—Ashanti Branch, Komfo Anokye Teaching
Hospital, Ghana, Southwest Finland Emergency Services,
and the Emergency and Intensive Care Departments of
Turku University Hospitals.
The Ghana Red Cross Society is the country's largest vol-
unteer humanitarian relief organization, serving the
region.20 There is a first aid department in all 10 regions to
strengthen first aid training activities for individuals, organi-
zations, institutions, and communities.20 Volunteers trained
in Basic Life Support by the Ghana Red Cross Society pro-
vide first aid services for patients with various injuries.20 The
Komfo Anokye Teaching Hospital is a large tertiary health-
care facility in Kumasi, Ghana. The hospital is vital in pro-
viding medical education and training to healthcare profes-
sionals and acts as a referral and teaching hospital. It is affiliated
with the Kwame Nkrumah University of Science and Tech-
nology and is responsible for training medical students and
other healthcare professionals.
The Southwest Finland Emergency Services is part of
Finland's national rescue service system, which aims to ensure
the safety and welfare of citizens by responding to emergen-
cies and promoting fire safety. Turku University Hospital,
on the other hand, offers extensive specialized healthcare ser-
vices to the residents of Southwest Finland. Turku University
Hospital is also responsible for the university hospital–level
services in Satakunta and Vaasa, which have a total popula-
tion of 869 786 inhabitants. In Finland, professionals handling
resuscitation cases are typically physician anesthesiologists and
nurses with extensive paramedic training.
Nursing education in Finland is unique. The comprehen-
sive paramedic degree program aims to equip students with
the necessary knowledge and skills to become both para-
medics (known as “ensihoitaja” in Finnish) and RNs (known
as “sairaanhoitaja” in Finnish). The program consists of 240
ECTS (European Credit Transfer and Accumulation Sys-
tem) credits and is designed to be completed in 4 years.August 2024
Table 1. Coding Matrix Used for Categorizing the Data
UTAUT Model
Constructs Definition From UTAUT17 Adapted Definition Relevant to AVF Devices
Performance
expectancy
The degree to which an individual believes that using
the system will help him or her to attain gains in job
performance
The degree to which an individual believes that using the
audiovisual feedback devices will help him or her attain gains
in terms of CPR performance
Effort expectancy The degree of ease associated with the use of the
system
The degree of ease associated with the use of the audiovisual
feedback devices for the purposes of CPR performance
Social influence The degree to which an individual perceives that
important others believe he or she should use the
new system
The degree to which an individual perceives that important
others can influence him or her on the use of the audiovisual
feedback devices during CPR
Facilitating and
impeding conditions
The degree to which an individual believes that an
organizational and technical infrastructure exists
to support use of the system
The degree to which an individual believes that an
organizational and technical infrastructure exists to support
use of the audiovisual feedback devices during CPR
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024Upon graduation, students receive two-degree titles: a nurse
and a paramedic. Their job titles, therefore, depend on the
specific work they perform, such as paramedics (who work
in ambulances), emergency nurses (who work in emergency
rooms), and intensive care nurses (who work in ICUs). In ad-
dition, general nurses with qualifications in the competence
area of Basic Life Support may be involved. The general
nursing program is a degree program that lasts approxi-
mately 3.5 years and comprises 210 ECTS credits.
We included participants from Finland and Ghana to obtain
data from the perspectives of developed and developing coun-
tries. The inclusion criteria were health professionals (1)
who have participated in basic and/or advanced cardiac life
support, (2) who had at least Basic Life Support training,
and (3) who had at least 1 year of experience in actual
patient resuscitation.
Data Collection
Purposive sampling was used to explore the issue from differ-
ent experiences and locations. We used maximum variation
sampling to cover a broader range of perspectives and cap-
ture a wide range of information and experiences.21 In the
qualitative research approach, researchers select participants
purposefully rather than randomly, allowing them to focus
on the most relevant and appropriate informants who can
provide rich data and insights on the phenomenon of
interest.22 In this research approach, the research question
can usually be answered more effectively by people with rel-
evant experience or expertise.22 It is essential to include par-
ticipants with varying viewpoints and a range of perspectives
to prevent a single group's viewpoint from being overrepre-
sented in a situation.22,23 The selection of participants who
represent various roles, perspectives, experience levels, and
demographics allows a comprehensive understanding of
the phenomenon being studied.24 To enhance the rigor of
the study, we carefully selected participants based on theo-
retical perspectives, research questions, and the existingVolume 42 | Number 8evidence.24 Therefore, one of the strengths of this study lies
in the inclusion of ideas, opinions, and experiences from in-
dividuals with different geographical locations, training
backgrounds, and working environments.
The primary analysis was started after a few interviews, as
Elo and Kyngäs25 recommended, to ensure data saturation
was achieved.21 Sampling was stopped when a thorough un-
derstanding of the phenomenon under study was reached, an
endpoint often referred to as saturation.21 Researchers consider
sample saturation when interviewing more participants does
not generate new concepts, categories, or themes.21,25
Two authors conducted the interview sessions. Healthcare
professionals in departments that deal with emergency pa-
tients typically have a very tight schedule. Organizing a time
that worked for everyone was a challenging task that resulted
in conducting seven interviews with two participants each,
commonly called dyadic interviews. 26–28 In addition to the
dyadic interviews, we conducted two focus group discussions
with three participants and two individual interviews. All the
interviews, including the dyadic, focus group, and individual
interviews, were performed using the same questions.
The interviews were conducted via Zoom. The virtual inter-
view had advantages over the face-to-face interviews, such as
safety due to the COVID-19 pandemic, access to diverse loca-
tions, and greater flexibility of schedules. The semistructured
questions and probes were based on the four UTAUT con-
structs: performance expectancy, effort expectancy, social influ-
ence, and facilitating conditions (Table 2). Each interview ses-
sion lasted between 36 and 75 minutes (average, 57 minutes).
The interviews were audio recorded and stored on a secure
platform, that is, Sea file at the University of Turku. The audio
records were transcribed verbatim into text.
Ethical Consideration
Ethical approval was received from the Human Research,
Publications and Ethics Committee, Ghana, and the Ethics
Committee for Human Science Research at the UniversityCIN: Computers, Informatics, Nursing 585
Table 2. Interview Questions Guided by UTAUT Model
UTAUT Domain Question Probes
Performance
expectancy
Can you share your experience in using devices that help you evaluate
chest compression performance during CPR training and actual
patient resuscitation
What are these devices' key strengths?
What are the specific issues, concerns, or
problems that you have faced when using this
product?
What are the most common issues that need to be
addressed?
If you had the opportunity to choose the best device that provides
real-time feedback on the quality of chest compression during CPR,
what features would you like to include to use it effectively?
What features of the device do you think need to be
addressed for better performance and outcome?
Effort expectancy Can you tell how easy or difficult it is to learn or operate the available
medical devices that guide you on the quality of chest compression
during CPR?
In your opinion, which features of the devicesmake
the available devices easy or difficult to use?
If you think they are difficult to use, what do you
think the solution is?
Social influence What influence do others have on the use of medical devices that
provide feedback on the quality of chest compressions during CPR?
What is the influence of your organization, senior
managers, and colleagues?
How much do their opinions or suggestions matter
to you in using the AVF devices?
Facilitating
factors
In your setting, what organizational and technical infrastructure would
facilitate the implementation/acceptance and use of medical devices
that provide guidance on the quality of chest compression during CPR?
Can you tell any support that would facilitate the
implementation of the devices?
Can you tell possible barriers that may hinder
implementation of the devices?
FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024of Turku, Finland. Permission to conduct the study was also
obtained from all involved institutions. The organizations
distributed the study information sheet and consent form, af-
ter which participants announced their interest. The partici-
pants' autonomy was guaranteed by allowing them to decide
voluntarily about their participation, including the right to
withdraw at any time. The principal investigator collected
the signed consent forms from the institutions before the
interview sessions.
Data Analysis
Data were analyzed using qualitative thematic content analy-
sis. We began the analysis with several readings of the tran-
scribed text to familiarize ourselves with the data, as described
by Braun and Clarke.29 We developed a structured categori-
zation matrix based on the UTAUT model for deductive
analysis. 25 The developedmatrix was used as a lens to catego-
rize codes that represent similar meanings. Our deductive
coding was composed to reflect the four UTAUTmodel con-
structs: performance expectancy, effort expectancy, social in-
fluence, and facilitating conditions. Reviewed contents and
meanings corresponding to the matrix were coded and trans-
ferred to the respective construct. The first author (D.T.K.)
primarily performed the analysis but in constant consultation
with the coauthors to ensure trustworthiness.25
RESULTS
We interviewed 22 participants, 18 from Finland and four
from Ghana (Table 3). The demographic characteristics of586 CIN: Computers, Informatics, Nursingparticipants are shown in Table 3. Fifty percent (50%) of the
participants were paramedics, 13.7% were emergency nurses,
13.7% were intensive care nurses, 9% were anesthesiologists,
and 13.7% were Red Cross–trained first aiders. There were
more males (63.6%) than females. They had a wide range of
work experience: Eight participants had less than 10 years of
experience, nine had 10 to 20 years of work experience, and
five had more than 20 years of work experience.
Despite the significant differences in their backgrounds,
all participants agreed that real-time AVF devices were ben-
eficial in delivering quality chest compressions during CPR
training and actual patient resuscitation. We have identified
10 themes that fall under the four UTAUTmodel constructs
(performance expectancy, effort expectancy, social influence,
and facilitating factors) that define the needs and acceptability
of AVF devices. The performance expectancy construct in-
cludes three themes: perceived usefulness, outcome expecta-
tion, and applicability in diverse situations. On the other hand,
the effort expectancy construct consists of two themes: user-
friendliness and complexity. The social influence construct
has two themes: social and organizational factors. Lastly, the fa-
cilitating factors construct includes three themes: staff compe-
tence, perceived cost, and compatibility of devices (Figure 1).
Performance Expectancy
In the performance expectation construct, study participants
often focused on discussing how the AVF devices help them
make a gain in terms of CPR training and actual patient resus-
citation. Three themes were identified under this construct:August 2024
Table 3. Participants Characteristics
Participants Characteristics n (%)
Country
Finland 18 (81.8)
Ghana 4 (18.2)
Setting
Southwest Finland Rescue Department 11 (50)
Turku University Hospital 7 (31.8)
Ghana Red cross 3 (13.7)
Komfo Anokye Hospital 1 (4.5)
Work experience, y
<10 8 (36.4)
10-20 9 (40.9)
>20 5 (22.7)
Sex
Female 8 (36.4)
Male 14 (63.6)
Profession
Paramedics 11 (50)
Intensive care nurses 3 (13.7)
Emergency nurses 3 (13.7)
Anesthesiologist 2 (9)
First aid–trained Red Cross personnel 3 (13.7)
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024perceived usefulness, outcome expectation, and applicability of
the device in diverse situations (Figure 1).
Perceived Usefulness
Perceived usefulness was often cited as the main factor in
accepting AVF devices. All participants emphasized the
need for convincing evidence of the device's usefulness in
providing real-time guidance for their CPR performance.
Participants said that AVF devices that monitor chestFIGURE 1. Constructs, themes, and subthemes identified through qu
devices used in CPR.
Volume 42 | Number 8compression performance should offer efficient and reliable
feedback and eliminate any uncertainty for better accep-
tance and higher user rates. In addition, some participants
linked the AVF device acceptance rate with the option of
possible access to stored data.
We should have the option to extract or print data from the devices.
When we go through the situation after the task, we can see how
we performed, which would undoubtedly increase the resuscitation
quality. Also, we should be able to extract the recorded feedback data
from the device easily for other purposes. (Participant from Finland)
Outcome Expectation
Participants preferred AVF devices to traditional CPR be-
cause they felt the AVF device improved the quality of chest
compressions and could potentially improve patient out-
comes after cardiac arrest. Participants felt that a feedback
device could help them achieve their goals more effectively.
Goals could range from maintaining high levels of compres-
sion to improving patient survival. Participants described
how the AVF device helped them increase the effectiveness
of chest compressions by increasing their alertness and focus.
Even for an experienced person, it's incredibly good help. When you
are sure your strength will start to fade, and your pace will get con-
fused, it's nice when the machine tells you to concentrate and pay at-
tention. (Participant from Finland)
Applicability in Diverse Situations
Participants stated that AVF devices should come in differ-
ent sizes and shapes to fit in the hands of all rescuers (health
professionals and laypersons) and on the chest of all victims.
They mentioned that current AVF devices are primarily for
adults, and they would like to have a device that can be usedalitative analysis to define the needs and acceptability of AVF
CIN: Computers, Informatics, Nursing 587
FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024to resuscitate children as well. According to the participants,
wearable AVF devices should be designed to be used by both
left- and right-handed individuals. Moreover, they wanted de-
vices that were suitable for both professionals and laypersons.
The devices intended for a layperson and professional use should be such
that if, for example, a layperson cardiac monitor was placed on a patient
in a shopping center, it would not require any action from us (the profes-
sionals).When the layperson is changed, the device should not require any
action for the feedback device itself. (Participant from Finland)
In addition, participants mentioned that AVF devices that
do not malfunction when wet due to rain or extremely high
temperatures may have a high adoption rate. According to
participants from Finland, some devices fail in freezing
weather conditions, which could affect their acceptance. Par-
ticipants also stressed the need to use these devices in health-
care facilities without reliable power supplies. In the case of
Ghana, power sources appear to be a particular concern,
as power outages are common in healthcare facilities. A par-
ticipant fromGhana expressed this with the following quote:
Here in Ghana, we have our problem. When it comes to power in the
city, we have a proven problem. So, if you come out with any device
that uses much power or electricity, we will face a problem. So, it
should not consume much power and can be rechargeable. It would
be great if we could get a solar aspect on it. (Participant from Ghana)
Effort Expectancy
We identified two themes from the group discussion and in-
dividual interview content that were captured by the effort
expectancy: user-friendliness and complexity (Figure 1).
User-Friendliness
Participants expressed that devices that are easy to learn and
use are preferable for CPR training and actual patient resus-
citation. If the devices are difficult to understand and oper-
ate, they can pose a significant challenge, especially to people
who are unfamiliar with them. In addition, they indicated
that it would be easier to achieve their mission if the AVF de-
vices were small and lightweight.
Well, we carry a lot of stuff to the floors or wherever we go. Of course,
carrying a kilo bundle is more fun than a 50-kilo bundle. Therefore,
the feedback devices should be small and lightweight, and every feature
should be in one place. Making the devices as light and small as possible
makes our work much more manageable. (Participant from Finland)
Complexity
Participants sometimes felt constrained by the complexity of
the feedback provided by the devices. According to the par-
ticipants, the level of complexity depends not only on the de-
vice itself but also on the situation in which it is used. Although
they prefer visual feedback to audio feedback, devices that dis-
play feedback on a small screen were also difficult to read.588 CIN: Computers, Informatics, NursingWell… if there is audio feedback, “press harder,” for ex-
ample, then the person presses deeper on the chest, and then
suddenly, there is the feedback that you are pushing too
hard. You know! …The resuscitator gets discouraged by
the feedback he/she gets because he/she does not precisely
know what he/she is doing. If a layperson is doing it, there
will be a sense of failure and discouragement, and then the
person will stop resuscitation because he/she feels he/she
cannot do it properly. (Participant from Finland)
Social Influence
In the social influence construct, some participants men-
tioned how others influenced them to use AVF devices. So-
cial factors and organizational influence were the themes
identified from this construct (Figure 1).
Social Factors
The experiences of respected colleagues and supervisors in-
fluenced the use of an AVF device. They were affected when
they saw their colleagues properly using a new device. In ad-
dition, the participants would trust the competence of their
supervisors and use the devices as recommended by their su-
pervisors. One participant put it this way:
If someone recommends a device, it means the person might have had
an experience. Therefore, I will go for the brand that a colleague rec-
ommends, but I will still ask for some instruction or a video to observe.
I should also assume that my seniors might have experience in the use
of the device. So, whether they are well trained in using it or not, I can
trust the experience and use it the same way after seeing my managers
using it. (Participant from Ghana)
Organizational Factors
Participants addressed the influence of organizational deci-
sions and recommendations on acceptance and intent to
use AVF devices. They agreed that they were happy to ac-
cept any device introduced by the organization as it helped
them perform high-quality chest compressions. Their expe-
rience shows that the organization directs them to use the de-
vices because they have no other options. They agreed that
there was not a single time they had a say in purchasing a
new device.
Decisions are usually made without the workers being informed. They
do not discuss them at all with the persons who use them. It happens
that we now have a new device. Yesterday, however, we did not know
that something like that was coming. So, I would be ready to use what
my organization wants because I could not do much about it. (Par-
ticipant from Finland)
Facilitating Factors
Participants mentioned conditions that facilitate the adoption
and use of AVF devices during CPR. Three themes wereAugust 2024
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024identified under the facilitating factors construct, including staff
competence, perceived cost, and compatibility of the devices (Figure 1).
Staff Competence
Participants emphasized that the provision of regular training
on the presented devices improves the knowledge and compe-
tence of the users and thus promotes the acceptance and use
of the AVF devices. However, users had different experiences
with the availability of training at their facilities. Many men-
tioned that regular training is provided, and professionals
have sufficient knowledge and skills to adapt and use newly in-
troduced AVF devices. Some said the training was inade-
quate. Interestingly, participants from Ghana were reluctant
to accept a device without access to qualified technicians
and reliable spare parts to service it. In their opinion, the
availability of spare parts and a skilled technical professional
are essential for maintaining the newly launched device.
We must know the brand of the device we are going to adopt or use. A
technical framework should assure us that if we buy this device, we
have these replacement parts. Also, technical arrangements and how
to maintain these devices must be in place so that we can maintain
these machines for the next 5 years or more. (Participant from Ghana)
Perceived Cost
Participants believed high costs could be a barrier to
adopting and using an AVF device. They felt that the cost
of an AVF device could be a barrier to adoption and use,
but the organization's financial performance would influence
this. Most participants from Finland felt that only unjustifi-
ably high costs could be a barrier to adopting and using these
devices. In contrast, participants fromGhana saw cost as the
main barrier to adopting these AVF devices.
Because of the cost element, we are where we are now, and we have
much distance. If they are very high quality, and they have a price that
people or organizations cannot easily afford. Then, yes, it will be
good, but just a few will have the advantage of it in their life, although
any life is precious. (Participant from Ghana)
Compatibility of the Devices
Participants discussed AVF device compatibility in terms of
functional and physical compatibility. Regarding physical
compatibility, few participants wanted an AVF device to
be an integral part of other multifunction devices such as de-
fibrillators. Regarding functional compatibility, participants
agreed that the AVF device should be functionally compati-
ble with devices from different manufacturers and in various
departments. Participants explained that devices that work
the same way in hospitals or places such as shopping malls
would be adopted quickly.
Feedback devices used in public areas such as the shopping center
should be compatible with those in emergency units and assess theVolume 42 | Number 8same thing in the same way. When the emergency team arrives at
the site, they should be able to connect it to their own and continue
working with it. (Participant from Finland)
DISCUSSION
This study aimed to explore user needs and factors associated
with the acceptability of AVF devices for monitoring chest
compressions during CPR. Our finding indicated that the
four UTAUT constructs (performance expectancy, effort ex-
pectancy, social influence, and facilitating factors) could ex-
plain health professionals' decision to accept and use AVF de-
vices. Ten themes were identified under the four UTAUT
constructs defining the needs and acceptability of AVF devices,
including perceived usefulness, outcome expectation, applica-
bility in diverse situations, user-friendliness and perceived com-
plexity, social and organizational factors, staff competence, per-
ceived cost, and compatibility of devices. Most themes had a
positive association with the intended use of AVF devices,
whereas increased cost and device complexity had a negative
association. The participants' experiences, perceptions, and ex-
pectations of the AVF devices varied slightly, reflecting the dif-
ferent backgrounds of the participants.
Performance Expectancy
Overall, the perceived usefulness of AVF devices by health-
care professionals was the key driver behind the adoption
of AVF devices. Participants agreed that AVF devices that
guide CPR performance should be reliable and accurate,
allowing users to store and extract data for various purposes.
Because chest compressions are one of the lifesaving tech-
niques in cardiac arrest,11 devices that monitor the quality
of chest compressions should not provide unnecessary infor-
mation that could affect the quality of CPR. Our findings
from the qualitative analysis are well supported by previous
studies that have described technology usefulness as a critical
factor in predicting health device adoption.30–32
Participants preferred AVF devices over traditional tech-
niques because they helped them achieve a better patient
outcome after cardiac arrest. Like our findings, participants
in previous studies had positive attitudes toward using AVF
devices because they believed that AVF devices made their
job easier and improved patient outcomes.10,33 According
to the participants, in addition to the corrective feedback
they receive, individuals performing chest compressions with
AVF devices do not need to count while performing chest
compressions, which can help them conserve energy and fo-
cus on monitoring signs of patient recovery.
There is evidence that considering the user characteristics
and the context in which health technologies are used is cru-
cial for the smooth acceptance of modern technologies.34
Likewise, the participants in this study were particularly inter-
ested in innovative AVF devices applicable in diverseCIN: Computers, Informatics, Nursing 589
FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024situations. Applicability in diverse situations has been described
in terms of usability by all people, reliable power supply during
power outages, and tolerance to extreme conditions. Partici-
pants indicated that when the intended task and the design of
the AVF device match, institutions may not need to invest in
multiple devices unnecessarily, which could motivate institu-
tions and healthcare professionals to adopt the device.
Although previous research has shown that engineers gener-
ally understand comfort and usability metrics, it can be chal-
lenging to tailor all specifications well to a target user popula-
tion in themedical context.35 Therefore, involving stakeholders
in a medical device's prototyping, designing, and development
process can help designers and developers better understand
the usability requirements of amedical device. Design processes
that encourage early and frequent stakeholder engagement can
increase the impact of medical devices by improving the accep-
tance and sustainable use of such devices.36
Participants from Ghana admitted that the country's lack
of reliable power supply could hamper the acceptance of
new devices. Studies conducted in Nigeria and Uganda also
identified energy supply as one of the main barriers to
adopting new technologies.14,37 Therefore, new technology
innovators targeting African countries should consider the
energy source to improvemedical device acceptance. Audio-
visual feedback designers must also figure out how best to re-
spond to the different environments in which these devices
will be used so that they can meet the humidity, rain, and
temperature requirements of a given environment.
Effort Expectancy
Various studies have yielded inconsistent results regarding
the acceptability and usability of medical devices, depending
on the type of service and user experience. Generally, med-
ical technologies that are easy to learn and operate tend to
encourage users to adopt and use them..16,30 In contrast,
technologies that are difficult to use because of their com-
plexity have been unfavorable to users.19,31 In this study,
participants preferred to adopt small and lightweight devices
with all functions in one place. Devices that gave audible and
excessive feedback were also distracting and discouraging.
This finding is well supported by previous studies in which
participants chose wearable heart technologies that are easy
to use, small, lightweight, and easily accessible.38 In this
study, a device that seems easy to learn and use during
CPR training may suddenly prove complex when resuscitat-
ing actual patients, as rescuers are careful not to cause fur-
ther harm to the patient.39 Participants noted that integrated
devices provide experienced healthcare professionals with
various options that are usually incomprehensible to laypeo-
ple. It was, therefore, difficult for inexperienced rescuers to
know where to place the different parts and which button
to press in a stressful situation. This description suggests that590 CIN: Computers, Informatics, NursingAVF devices designed for actual patient resuscitation should
be even easier to use than those used for training. In addi-
tion, the finding indicates that standalone AVF devices that
monitor chest compression quality without complex features
appear to be preferred by inexperienced rescuers.
Social Influence
Many studies identified social influence as one of the critical
factors for accepting and adopting new technology.14,17,37
Organizational culture and individuals' willingness to use
and adopt new technologies are linked to each other.16 Sim-
ilarly, in this study, participants agreed that the recommen-
dations of respected colleagues and senior managers were
likely to impact the adoption and use of new AVF devices.
Participants would consider using AVF technology if they
saw people around them using it safely and effectively. Con-
sistent with our findings, most studies reported a positive ef-
fect of social influence on technology adoption.16,17
Furthermore, our results suggest that users are strongly in-
fluenced by organizational decisions and recommendations
to accept and use a newly introduced AVF device. Partici-
pants emphasized that user opinion is not considered when
new equipment is purchased. Therefore, participants would
immediately adopt a new AVF device recommended by the
organization. Similarly, Venkatesh et al17 concluded that so-
cial influence becomes important in binding contexts when
individuals have no say in adopting modern technologies.
Facilitating Factors
Facilitating conditions that influence the adoption of AVF
devices include staff competence, perceived cost, and com-
putability. The availability of regular training on existing
and newly introduced AVF devices would increase staff atti-
tude, knowledge, and competence in the safe and appropri-
ate use of the AVF device. Therefore, user training would be
crucial when adopting new technologies, as noted by
Namatovu et al.37 The experienced users reported that they
had a significantly higher level of knowledge and skill in
using the AVF device than the inexperienced users. It is,
therefore, essential to provide tailored training and support
to users with different backgrounds and experiences to increase
their knowledge and confidence in using the technology.40
According to participants from Ghana, the availability of
spare parts and technically qualified personnel could posi-
tively influence the acceptance of a newly introduced AVF
device. This finding is consistent with a previous study, which
reported a lack of knowledge and technical support as signifi-
cant barriers to adopting modern technologies.37
The cost of AVF devices and the financial capability of orga-
nizations have also been identified as important factors
influencing the adoption and use of AVF technologies. Price
has a positive effect on the intention to use when the benefitsAugust 2024
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024of the technology are perceived to be greater than the mone-
tary cost.41 The balance between price and quality depends
on the type of construct, but quality criteria are more relevant
in highly specialized healthcare settings. Similarly, in this study,
participants from Finland appeared to be more concerned
about the quality of the device. In contrast, participants from
Ghana saw cost as the main barrier to adopting new technolo-
gies, as reflected in previous African studies.14,37 This indicates
that users' price expectations vary depending on the financial
capacity of a given institution. Therefore,manufacturers should
consider the financial situation of different countries and institu-
tions to improve the uptake of new technologies.
Another concept that was discussed as a facilitating factor
for the acceptance of AVF devices was compatibility. Yang
et al42 defined compatibility as the degree to which a new
technology integrates with other existing technologies with-
out significantly affecting their functionality. A high degree
of compatibility of new technologies with existing technology
is positively related to the intention to continue using them.43
In our study, the compatibility of AVF devices with existing
technology and other aspects of life shaped the intent of
healthcare professionals to continue using them. These find-
ings are consistent with the scientific literature, which found
that perceived compatibility is significantly associated with
customers' positive attitudes toward technologies.14,17,42
The design and development of AVF devices are not the
sole responsibility of engineers. Instead, a multidisciplinary
approach is required, involving experts from different educa-
tional backgrounds, such as engineering, technology, design,
and healthcare professionals. The integrated training of peo-
ple with varying experiences in the design and development
of medical devices can help to synthesize and harmonize the
connections between the disciplines into a coordinated and
coherent whole. According to the current EuropeanResusci-
tation Council Guidelines for Resuscitation, all communi-
ties, including school-age children, should learn and partici-
pate in CPR.44 Therefore, feature research should consider
the perception of laypersons' intent to use AVF devices dur-
ing CPR training and actual patient resuscitation.
LIMITATIONS
This study had some limitations. Although the discussions
and interviews were conducted with individuals experienced
in basic and/or advanced CPR, their exposure to AVF de-
vice technologies varied widely. This meant some partici-
pants could not provide detailed feedback on their experiences
with AVF devices. Yet, including participants from diverse
backgrounds helped us explore the barriers and enablers of
technology adoption in different contexts. Another limita-
tion was the small number of participants in each group.
The recommended number of participants per focus group
interview should ideally be more than three.45 Therefore,Volume 42 | Number 8the participation of only two people in each group interview
was low in the traditional sense. Nonetheless, the small num-
ber of participants in each interview created an interactive
atmosphere to explore participants' views, experiences, and
future expectations of AVF technologies.
However, the study used a theoretical model to provide
conceptual support for the study results, thereby increasing
the credibility of the study. In addition, information on par-
ticipants' characteristics was disclosed to allow an assessment
of the transferability of the results to other settings.
CONCLUSION
Healthcare professionals from different backgrounds felt that
developing AVF devices with different features would im-
prove the delivery of quality chest compressions during
CPR. Although very similar, participants' experiences and
expectations of the AVF devices varied based on partici-
pants' backgrounds. This result showed that considering
the characteristics of the users and including them in the de-
sign and development process of AVF technologies are cru-
cial for the smooth and successful adoption of these technol-
ogies. The current study defined the needs and identified the
factors that influence the acceptability of these devices.
Therefore, manufacturers and procurers should consider
users' needs and factors affecting the AVF devices' accept-
ability. The UTAUT theory and identified questions can
serve as useful tools for those interested in qualitative re-
search projects exploring the acceptance and use of other
similar devices. Including participants from Finland and
Ghana helped us understand whether this innovation could
be useful from both developed and developing countries'
perspectives, and further studies may provide a deeper un-
derstanding of AVF device requirements in various settings.
References
1. Davida Paratz E, Rowsell L, Zentner D, et al. Cardiac arrest and sudden
cardiac death registries: a systematic review of global coverage. Heart.
2020;7: 1195. doi:10.1136/openhrt-2019-001195.
2. Gräsner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac
arrest in Europe—results of the EuReCa TWO study. Resuscitation. 2020;
148: 218–226. doi:10.1016/j.resuscitation.2019.12.042.
3. Gräsner JT, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council
Guidelines 2021: epidemiology of cardiac arrest in Europe. Resuscitation.
2021;161: 61–79. doi:10.1016/J.RESUSCITATION.2021.02.007.
4. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital
cardiac arrest: a review. Journal of the American Medical Association. 2019;
321(12): 1200–1210. doi:10.1001/JAMA.2019.1696.
5. Beck B, Bray J, Cameron P, et al. Regional variation in the characteristics,
incidence and outcomes of out-of-hospital cardiac arrest in Australia and New
Zealand: results from the Aus-ROC Epistry. Resuscitation. 2018;126: 49–57.
doi:10.1016/J.RESUSCITATION.2018.02.029.
6. Sugerman NT, Edelson DP, Leary M, et al. Rescuer fatigue during actual
in-hospital cardiopulmonary resuscitation with audiovisual feedback: a
prospective multicenter study. Resuscitation. 2009;80(9): 981–984. doi:10.
1016/J.RESUSCITATION.2009.06.002.
7. Ballesteros-Peña S, Vallejo-De La Hoz G, Fernández-Aedo I, Etayo-Sancho A,
Berasaluze-Sanz L, Domínguez-García J. Accuracy of healthcare providers'CIN: Computers, Informatics, Nursing 591
FEATURE ARTICLE
D
ow
nloaded from
 http://journals.lww.com/cinjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
wCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 08/07/2024perception of chest compression depth and chest recoil. Signa Vitae. 2020;
16(1): 159–162. doi:10.22514/sv.2020.16.0021.
8. Kaplow R, Cosper P, Snider R, et al. Impact of CPR quality and adherence to
advanced cardiac life support guidelines on patient outcomes in in-hospital
cardiac arrest. AACN Advanced Critical Care. 2020;31(4): 401–409. doi:10.
4037/AACNACC2020297.
9. Gugelmin-Almeida D, Tobase L, Polastri TF, Peres HHC, Timerman S. Do
automated real-time feedback devices improve CPR quality? A systematic
review of literature. Resuscitation Plus. 2021;6: 100108. doi:10.1016/J.
RESPLU.2021.100108.
10. Miller AC, Scissum K, McConnell L, et al. Real-time audio-visual feedback
with handheld nonautomated external defibrillator devices during
cardiopulmonary resuscitation for in-hospital cardiac arrest: a meta-analysis.
International Journal of Critical Illness and Injury Science. 2020;10(3):
109–122. doi:10.4103/IJCIIS.IJCIIS_155_20.
11. Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation
Council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:
98–114. doi:10.1016/J.RESUSCITATION.2021.02.009.
12. KimHC. Acceptability engineering: the study of user acceptance of innovative
technologies. Journal of Applied Research and Technology. 2015;13(2):
230–237. doi:10.1016/J.JART.2015.06.001.
13. Taherdoost H. A review of technology acceptance and adoption models and
theories. Procedia Manufacturing. 2018;22: 960–967. doi:10.1016/J.
PROMFG.2018.03.137.
14. Akinnuwesi BA, Uzoka FME, Fashoto SG, et al. A modified UTAUT model for
the acceptance and use of digital technology for tackling COVID-19.
Sustainable Operations and Computers. 2022;3: 118–135. doi:10.1016/J.
SUSOC.2021.12.001.
15. Faida EW, Supriyanto S, Haksama S, Markam H, Ali A. The acceptance and
use of electronic medical records in developing countries within the Unified
Theory of Acceptance and Use of Technology framework. Open Access
Macedonian Journal of Medical Sciences. 2022;10(E): 326–336. doi:10.
3889/OAMJMS.2022.8409.
16. Yin Z, Yan J, Fang S, Wang D, Han D. User acceptance of wearable intelligent
medical devices through a modified Unified Theory of Acceptance and Use of
Technology. Annals of Translational Medicine. 2022;10(11): 629. doi:10.
21037/ATM-21-5510.
17. Venkatesh C, Morris MG, Davis GB, Davis FD. User acceptance of information
technology: toward a unified view. MIS Quarterly. 2003;27(3): 425–478.
18. Ahmed MH, Bogale AD, Tilahun B, et al. Intention to use electronic medical
record and its predictors among health care providers at referral hospitals,
North-West Ethiopia, 2019: using Unified Theory of Acceptance and Use
Technology 2 (UTAUT2) model. BMC Medical Informatics and Decision
Making. 2020;20(1): 207. doi:10.1186/S12911-020-01222-X.
19. Chen J, Wang T, Fang Z, Wang H. Research on elderly users' intentions to accept
wearable devices based on the improvedUTAUTmodel. Frontiers in Public Health.
2023;10: 5237. doi:10.3389/FPUBH.2022.1035398/BIBTEX.
20. Ghana 2023 IFRC Network Country Plan (MAAGH002)—Ghana | ReliefWeb. https://
reliefweb.int/report/ghana/ghana-2023-ifrc-network-country-plan-maagh002
21. Kuper A, Lingard L, Levinson W. Critically appraising qualitative research.
BMJ. 2008;337(7671): 687–689. doi:10.1136/BMJ.A1035.
22. Johnson JL, Adkins D, Chauvin S. A review of the quality indicators of rigor in
qualitative research. American Journal of Pharmaceutical Education. 2020;
84(1): 7120. doi:10.5688/ajpe7120.
23. Mays N, Pope C. Qualitative research in health care. Assessing quality in
qualitative research. BMJ. 2000;320(7226): 50–52. doi:10.1136/BMJ.
320.7226.50.
24. Sargeant J. Qualitative research part II: participants, analysis, and quality
assurance. Journal of Graduate Medical Education. 2012;4(1): 1–3. doi:10.
4300/JGME-D-11-00307.1.
25. Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced
Nursing. 2008;62(1): 107–115. doi:10.1111/J.1365-2648.2007.04569.X.
26. Morgan DL, Ataie J, Carder P, Hoffman K. Introducing dyadic interviews as a
method for collecting qualitative data. Qualitative Health Research. 2013;23
(9): 1276–1284. doi:10.1177/1049732313501889.592 CIN: Computers, Informatics, Nursing27. Morgan DL, Hoffman K. A system for coding the interaction in focus groups
and dyadic interviews. The Qualitative Report. 2018;23(3): 519–531. doi:
10.46743/2160-3715/2018.2733.
28. Szulc JM, King N. The practice of dyadic interviewing: strengths, limitations
and key decisions. Forum Qualitative Sozialforschung/Forum: Qualitative
Social Research. 2022;23(2). doi:10.17169/FQS-22.2.3776.
29. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research
in Psychology. 2006;3(2): 77–101. doi:10.1191/1478088706QP063OA.
30. Yang Q, Al Mamun A, Hayat N, Salleh MFM, Jingzu G, Zainol NR. Modelling
the mass adoption potential of wearable medical devices. PLoS One. 2022;
17(6): e0269256. doi:10.1371/JOURNAL.PONE.0269256.
31. Asadi S, Abdullah R, Safaei M, Nazir S. An integrated SEM-neural network
approach for predicting determinants of adoption of wearable healthcare devices.
Mobile Information Systems. 2019;2019: 1–9. doi:10.1155/2019/8026042.
32. Tak SH, Choi H, Lee D, Song YA, Park J. Nurses' perceptions about smart
beds in hospitals. CIN: Computers, Informatics, Nursing. 2023;41(6):
394–401. doi:10.1097/CIN.0000000000000949.
33. Goharani R, Vahedian-Azimi A, Farzanegan B, et al. Real-time compression
feedback for patients with in-hospital cardiac arrest: a multi-center
randomized controlled clinical trial. Journal of Intensive Care. 2019;7: 5. doi:
10.1186/S40560-019-0357-5/TABLES/7.
34. Money AG, Barnett J, Kuljis J, Craven MP, Martin JL, Young T. The role of the
user within the medical device design and development process: medical
device manufacturers' perspectives. BMC Medical Informatics and Decision
Making. 2011;11(1): 1–12. doi:10.1186/1472-6947-11-15/FIGURES/2.
35. Hagedorn TJ, Krishnamurty S, Grosse IR. An information model to support
user-centered design of medical devices. Journal of Biomedical Informatics.
2016;62: 181–194. doi:10.1016/J.JBI.2016.07.010.
36. Coulentianos MJ, Rodriguez-Calero I, Daly SR, Sienko KH. Global health
front-end medical device design: the use of prototypes to engage
stakeholders. Development Engineering. 2020;5: 100055. doi:10.1016/J.
DEVENG.2020.100055.
37. Namatovu HK, Oyana TJ, Sol HG. Barriers to eHealth adoption in routine
antenatal care practices: perspectives of expectant mothers in Uganda—a
qualitative study using the Unified Theory of Acceptance and Use of
Technology model. Digital Health. 2021;7: 20552076211064406. doi:10.
1177/20552076211064406.
38. Ferguson C, Inglis SC, Breen PP, et al. Clinician perspectives on the design
and application of wearable cardiac technologies for older adults: qualitative
study. JMIR Aging. 2020;3(1): e17299. doi:10.2196/17299.
39. Hansen CM, Rosenkranz SM, Folke F, et al. Lay bystanders' perspectives on
what facilitates cardiopulmonary resuscitation and use of automated external
defibrillators in real cardiac arrests. Journal of the American Heart Association.
2017;6(3): e004572. doi:10.1161/JAHA.116.004572/FORMAT/EPUB.
40. Kuek A, Hakkennes S. Healthcare staff digital literacy levels and their
attitudes towards information systems. Health Informatics Journal. 2020;
26(1): 592–612. doi:10.1177/1460458219839613/ASSET/IMAGES/10.
1177_1460458219839613-IMG3.PNG.
41. Venkatesh V, Thong JYL, Xu X. Consumer acceptance and use of information
technology: extending the Unified Theory of Acceptance and Use of
Technology.MIS Quarterly. 2012;36(1): 157–178. doi:10.2307/41410412.
42. Yang H, Yu J, Zo H, Choi M. User acceptance of wearable devices: an
extended perspective of perceived value. Telematics and Informatics. 2016;
33(2): 256–269. doi:10.1016/J.TELE.2015.08.007.
43. Ahmad A, Rasul T, Yousaf A, Zaman U. Understanding factors influencing
elderly diabetic patients' continuance intention to use digital health
wearables: extending the Technology Acceptance Model (TAM). Journal of
Open Innovation: Technology, Market, and Complexity. 2020;6: 81. doi:10.
3390/JOITMC6030081.
44. Perkins GD, Gräsner JT, Semeraro F, et al. European Resuscitation Council
Guidelines 2021: executive summary. Resuscitation. 2021;161: 1–60. doi:
10.1016/j.resuscitation.2021.02.003.
45. Gill P, Baillie J. Interviews and focus groups in qualitative research: an update
for the digital age [published online October 5, 2018]. British Dental Journal.
2018. doi:10.1038/sj.bdj.2018.815.August 2024