Document Type : Original Article
Authors
Abstract
INTRODUCTION: It is less than a decade in Iran that integrated health kiosks have been limitedly
provided to public by private sector. Considering the significant benefits of them, this study aimed
to identify the barriers and facilitators for deploying kiosks in Iran’s formal health system in three
phases, “design and construct, implement, and use.”
MATERIALS AND METHODS: This was a qualitative study in Iran, and the data were collected
through 20 semi‑structured interviews with experts in 2019. Participants were selected by purposeful
method with the most diversity in terms of background and work experience; the interview texts were
coded in MAXQDA10 software and analyzed through framework analysis. Participants’ viewpoint
was used to verify the data and observers’ review to confirm them.
RESULTS: The barriers for designing and constructing kiosks were identified in the form of two main
themes: the overall structure of the country and the structure of the health system; the obstacles for
implementing were categorized in one main theme, lack of sources; and the barriers to use were also
fall into four themes related to people, policymakers, service providers, and designers of kiosks. The
facilitators at construction and implementation phases included the overall structure of the country
and the structure of health system. At the use stage, the facilitators related to people, health and
insurance policymakers, and owners and constructers were identified.
CONCLUSION: It is possible to deploy health kiosks in the Iranian formal health system, although
there are some time‑consuming and costly barriers which can be overcome by the strengths and
opportunities of the system.
Keywords
1. Williams P, Nicholas D, Huntington P. Non use of health
information kiosks examined in an information needs context.
Health Info Libr J 2003;20:95‑103.
2. Best R, Michael L, Kumar R. Sustainability failures of rural
telecenters: Challenges from the sustainable access in rural
India (sari) project. ITID 2008;4:31‑45.
3. Multi‑Functional Kiosks. UK; 2018. Available from: http://www.
healthkiosk.us/cms.php?id_cms. [Last cited on 2018 Jan 18].
4. Zwicker M, Seitz J, Wickramasinghe N. Adaptations for e‑kiosk
systems in Germany to develop barrier‑free terminals for
handicapped persons. In critical issues for the development
of sustainable e‑health solutions. Boston, MA: Springer; 2012.
p. 99‑112.
5. Tony RA, Sarah T, Dhinagaran D, Ugargo AP. Design,
development and implementation of a touch‑screen health
information kiosk for patients at the outpatient waiting area
in a large tertiary care hospital in India: An evaluation of user
satisfaction. J Health Inform Dev Ctries 2013;7:8‑19.
6. Takyi H, Watzlaf V, Matthews JT, Zhou L, Dealmeida D. Privacy
and security in multi‑user health kiosks. Int J Telerehabil
2017;9:3‑14.
7. Kaplan B, Brennan PF. Consumer informatics supporting patients
as co‑producers of quality. J Am Med Inform Assoc 2001;8:309‑16.
8. Bluth C, Bluth J. Inventors; Computerized Screening Inc, Assignee.
Health Care Information System. United States Patent US
6,692,436; 2004.
9. Dirocco DN, Day SC. Obtaining patient feedback at point of
service using electronic kiosks. Am J Manag Care 2011;17:e270‑6.
10. Wunker S. A New Age for Healthcare Kiosks, Five Ways
Next Generation Kiosks Disrupt Medicine and Healthcare
Marketing. Available from: https://www.forbes.com/sites/
stephenwunker/2013/07/16/a‑new‑age‑for‑healthcare‑kiosks‑
five‑ways‑next‑generation‑kiosks‑disrupt‑medicine‑and‑health
care‑marketing/#132d578140dc. [Last updated on 2013 Jul 16;
Last cited on 2018 Feb 05].
11. Shahmoradi L, Hossein‑Ravandi M, Aslani N, Shahidzade M.
The role of health kiosks in public health. Health Inf Manage
2015;12: 379‑89.
12. Jones R. The role of health kiosks in 2009: Literature and informant
review. Int J Environ Res Public Health 2009;6:1818‑55.
13. Strecher VJ, Greenwood T, Wang C, Dumont D. Interactive
multimedia and risk communication. J Natl Cancer Inst Monogr
1999;25:134‑9.
14. Matthews PH, Darbisi C, Sandmann L, Galen R, Rubin D.
Disseminating health information and diabetes care for Latinos
via electronic information kiosks. J Immigr Minor Health
2009;11:520‑6.
15. Sun BC, Knapp H, Shamouelian A, Golden J, Goetz MB, Asch SM.
Effect of an education kiosk on patient knowledge about rapid
HIV screening. J Telemed Telecare 2010;16:158‑61.
16. Saifu HN, Shamouelian A, Davis LG, Santana‑Rios E, Goetz MB,
Asch SM, et al. Impact of a kiosk educational module on HIV
screening rates and patient knowledge. J Telemed Telecare
2011;17:446‑50.
17. Yvonne Chan YF, Nagurka R, Bentley S, Ordonez E, Sproule W.
Medical utilization of kiosks in the delivery of patient education:
A systematic review. Health Promot Perspect 2014;4:1‑8.
18. Yang HD, Lee J, Park C, Lee K. The adoption of mobile self‑service
technologies: Effects of availability in alternative media and trust
on the relative importance of perceived usefulness and ease of
use. IJSH 2014;8:165‑78.
19. Nicholas D, Huntington P, Williams P, Vickery P. Health
information: An evaluation of the use of touch screen kiosks in
two hospitals. Health Info Libr J 2001;18:213‑9.
20. Lesselroth BJ, Felder RS, Adams SM, Cauthers PD, Dorr DA,
Wong GJ, et al. Design and implementation of a medication
reconciliation kiosk: The Automated Patient History Intake
Device (APHID). J Am Med Inform Assoc 2009;16:300‑4.
21. Sara L, Ackerman A, Kathleen‑Tebb A, John C, Stein A,
Bradley W, et al. Benefit or burden? A sociotechnical analysis of
diagnostic computer kiosks in four California hospital emergency
departments. Soc Sci Med 2012;75:2378‑85.
22. Nicholas D, Huntington P, Williams CA. Digital Consumer Health
Information and Advisory Services in the UK: A User Evaluation
and Sourcebook; City University Centre for Information
Behaviour and the Evaluation of Research; 2004. Available from:
http://www.homepages.ucl.ac.uk/~uczciro/kioskSummary%20
Report%20260404.pdf. [Last cited on 2019 May 08].
23. Hsieh YH, Gauvey‑Kern M, Peterson S, Woodfield A,
Deruggiero K, Gaydos CA, et al. An emergency department
registration kiosk can increase HIV screening in high risk patients.
J Telemed Telecare 2014;20:454‑9.
24. Courtney KL, Lingler JH, Mecca LP, Garlock LA, Schulz R,
Dick AW, et al. Older adults’ and case managers’ initial
impressions of community‑based telehealth kiosks. Res Gerontol
Nurs 2010;3:235‑9.
25. Tse J, Nansel TR, Weaver NL, Williams J, Botello‑Harbaum M.
Implementation of a tailored kiosk‑based injury prevention
program in pediatric primary care. Health Promot Pract
2014;15:243‑51.
26. Chung CF, Munson SA, Thompson MJ, Baldwin LM, Kaplan J,
Cline R, et al. Implementation of a New Kiosk Technology for
Blood Pressure Management in a Family Medicine Clinic: From
the WWAMI Region Practice and Research Network. J Am Board
Fam Med 2016;29:620‑9.
27. Ng G, Tan N, Bahadin J, Shum E, Tan SW. Development
of an automated healthcare kiosk for the management of
chronic disease patients in the primary care setting. J Med Syst
2016;40:169.
28. Kizza JM. Guide to computer network security, Security
threats to computer. Vol. 8. London: Springer, Networks; 2013.
p. 63‑88.
29. Metlay JP, Camargo CA Jr., Bos K, Gonzales R. Assessing the
suitability of intervention sites for quality improvement studies
in emergency departments. Acad Emerg Med 2005;12:667‑70.
30. Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G,
Chilcott M. Computerised cognitive behavioural therapy for
depression and anxiety. BJPsych 2008;193:181‑4.
31. Green B, Chia‑Fang C, Baldwin LM, Thompson MJ, Munson SA.
Implementing patient self‑measurement of blood pressure using
a kiosk in a clinic waiting room. JASH 2016;10:25.
32. Nicholas D, Huntington P, Williams P, Chahal P. Determinants
of health kiosk use and usefulness: Case study of a kiosk which
serves a multi‑cultural population. Libri 2001;51:102‑13.
33. Nicholas D, Huntington P, Williams P. Delivering consumer
health information digitally: A comparison between the web and
touchscreen kiosk. J Med Syst 2003;27:13‑34.
34. Maunder RG, HunterJJ. An Internet resource for self‑assessment
of mental health and health behavior: Development and
implementation of the self‑assessment kiosk. JMIR Ment Health
2018;5:e39.
35. Fintor L. The Michigan health kiosk: Cancer info on the go. J Natl
Cancer Inst 1998;90:809‑10.
36. Wrenn G, Kasiah F, Syed I. Using a self‑service kiosk to identify
behavioural health needs in a primary care clinic serving an urban,
underserved population. J Innov Health Inform 2015;22:323‑8.
37. Press A, DeStio C, McCullagh L, Kapoor S, Morley J, SBIRT
NY‑II Team, et al. Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records. JMIR
Hum Factors 2016;3:e18.
38. Glasgow RE, Emmons KM. How can we increase translation
of research into practice? Types of evidence needed. Annu Rev
Public Health 2007;28:413‑33.
39. LyuY, Vincent CJ, ChenY, ShiY, TangY, WangW, et al. Designing
and optimizing a healthcare kiosk for the community. Appl Ergon
2015;47:157‑69.
information kiosks examined in an information needs context.
Health Info Libr J 2003;20:95‑103.
2. Best R, Michael L, Kumar R. Sustainability failures of rural
telecenters: Challenges from the sustainable access in rural
India (sari) project. ITID 2008;4:31‑45.
3. Multi‑Functional Kiosks. UK; 2018. Available from: http://www.
healthkiosk.us/cms.php?id_cms. [Last cited on 2018 Jan 18].
4. Zwicker M, Seitz J, Wickramasinghe N. Adaptations for e‑kiosk
systems in Germany to develop barrier‑free terminals for
handicapped persons. In critical issues for the development
of sustainable e‑health solutions. Boston, MA: Springer; 2012.
p. 99‑112.
5. Tony RA, Sarah T, Dhinagaran D, Ugargo AP. Design,
development and implementation of a touch‑screen health
information kiosk for patients at the outpatient waiting area
in a large tertiary care hospital in India: An evaluation of user
satisfaction. J Health Inform Dev Ctries 2013;7:8‑19.
6. Takyi H, Watzlaf V, Matthews JT, Zhou L, Dealmeida D. Privacy
and security in multi‑user health kiosks. Int J Telerehabil
2017;9:3‑14.
7. Kaplan B, Brennan PF. Consumer informatics supporting patients
as co‑producers of quality. J Am Med Inform Assoc 2001;8:309‑16.
8. Bluth C, Bluth J. Inventors; Computerized Screening Inc, Assignee.
Health Care Information System. United States Patent US
6,692,436; 2004.
9. Dirocco DN, Day SC. Obtaining patient feedback at point of
service using electronic kiosks. Am J Manag Care 2011;17:e270‑6.
10. Wunker S. A New Age for Healthcare Kiosks, Five Ways
Next Generation Kiosks Disrupt Medicine and Healthcare
Marketing. Available from: https://www.forbes.com/sites/
stephenwunker/2013/07/16/a‑new‑age‑for‑healthcare‑kiosks‑
five‑ways‑next‑generation‑kiosks‑disrupt‑medicine‑and‑health
care‑marketing/#132d578140dc. [Last updated on 2013 Jul 16;
Last cited on 2018 Feb 05].
11. Shahmoradi L, Hossein‑Ravandi M, Aslani N, Shahidzade M.
The role of health kiosks in public health. Health Inf Manage
2015;12: 379‑89.
12. Jones R. The role of health kiosks in 2009: Literature and informant
review. Int J Environ Res Public Health 2009;6:1818‑55.
13. Strecher VJ, Greenwood T, Wang C, Dumont D. Interactive
multimedia and risk communication. J Natl Cancer Inst Monogr
1999;25:134‑9.
14. Matthews PH, Darbisi C, Sandmann L, Galen R, Rubin D.
Disseminating health information and diabetes care for Latinos
via electronic information kiosks. J Immigr Minor Health
2009;11:520‑6.
15. Sun BC, Knapp H, Shamouelian A, Golden J, Goetz MB, Asch SM.
Effect of an education kiosk on patient knowledge about rapid
HIV screening. J Telemed Telecare 2010;16:158‑61.
16. Saifu HN, Shamouelian A, Davis LG, Santana‑Rios E, Goetz MB,
Asch SM, et al. Impact of a kiosk educational module on HIV
screening rates and patient knowledge. J Telemed Telecare
2011;17:446‑50.
17. Yvonne Chan YF, Nagurka R, Bentley S, Ordonez E, Sproule W.
Medical utilization of kiosks in the delivery of patient education:
A systematic review. Health Promot Perspect 2014;4:1‑8.
18. Yang HD, Lee J, Park C, Lee K. The adoption of mobile self‑service
technologies: Effects of availability in alternative media and trust
on the relative importance of perceived usefulness and ease of
use. IJSH 2014;8:165‑78.
19. Nicholas D, Huntington P, Williams P, Vickery P. Health
information: An evaluation of the use of touch screen kiosks in
two hospitals. Health Info Libr J 2001;18:213‑9.
20. Lesselroth BJ, Felder RS, Adams SM, Cauthers PD, Dorr DA,
Wong GJ, et al. Design and implementation of a medication
reconciliation kiosk: The Automated Patient History Intake
Device (APHID). J Am Med Inform Assoc 2009;16:300‑4.
21. Sara L, Ackerman A, Kathleen‑Tebb A, John C, Stein A,
Bradley W, et al. Benefit or burden? A sociotechnical analysis of
diagnostic computer kiosks in four California hospital emergency
departments. Soc Sci Med 2012;75:2378‑85.
22. Nicholas D, Huntington P, Williams CA. Digital Consumer Health
Information and Advisory Services in the UK: A User Evaluation
and Sourcebook; City University Centre for Information
Behaviour and the Evaluation of Research; 2004. Available from:
http://www.homepages.ucl.ac.uk/~uczciro/kioskSummary%20
Report%20260404.pdf. [Last cited on 2019 May 08].
23. Hsieh YH, Gauvey‑Kern M, Peterson S, Woodfield A,
Deruggiero K, Gaydos CA, et al. An emergency department
registration kiosk can increase HIV screening in high risk patients.
J Telemed Telecare 2014;20:454‑9.
24. Courtney KL, Lingler JH, Mecca LP, Garlock LA, Schulz R,
Dick AW, et al. Older adults’ and case managers’ initial
impressions of community‑based telehealth kiosks. Res Gerontol
Nurs 2010;3:235‑9.
25. Tse J, Nansel TR, Weaver NL, Williams J, Botello‑Harbaum M.
Implementation of a tailored kiosk‑based injury prevention
program in pediatric primary care. Health Promot Pract
2014;15:243‑51.
26. Chung CF, Munson SA, Thompson MJ, Baldwin LM, Kaplan J,
Cline R, et al. Implementation of a New Kiosk Technology for
Blood Pressure Management in a Family Medicine Clinic: From
the WWAMI Region Practice and Research Network. J Am Board
Fam Med 2016;29:620‑9.
27. Ng G, Tan N, Bahadin J, Shum E, Tan SW. Development
of an automated healthcare kiosk for the management of
chronic disease patients in the primary care setting. J Med Syst
2016;40:169.
28. Kizza JM. Guide to computer network security, Security
threats to computer. Vol. 8. London: Springer, Networks; 2013.
p. 63‑88.
29. Metlay JP, Camargo CA Jr., Bos K, Gonzales R. Assessing the
suitability of intervention sites for quality improvement studies
in emergency departments. Acad Emerg Med 2005;12:667‑70.
30. Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G,
Chilcott M. Computerised cognitive behavioural therapy for
depression and anxiety. BJPsych 2008;193:181‑4.
31. Green B, Chia‑Fang C, Baldwin LM, Thompson MJ, Munson SA.
Implementing patient self‑measurement of blood pressure using
a kiosk in a clinic waiting room. JASH 2016;10:25.
32. Nicholas D, Huntington P, Williams P, Chahal P. Determinants
of health kiosk use and usefulness: Case study of a kiosk which
serves a multi‑cultural population. Libri 2001;51:102‑13.
33. Nicholas D, Huntington P, Williams P. Delivering consumer
health information digitally: A comparison between the web and
touchscreen kiosk. J Med Syst 2003;27:13‑34.
34. Maunder RG, HunterJJ. An Internet resource for self‑assessment
of mental health and health behavior: Development and
implementation of the self‑assessment kiosk. JMIR Ment Health
2018;5:e39.
35. Fintor L. The Michigan health kiosk: Cancer info on the go. J Natl
Cancer Inst 1998;90:809‑10.
36. Wrenn G, Kasiah F, Syed I. Using a self‑service kiosk to identify
behavioural health needs in a primary care clinic serving an urban,
underserved population. J Innov Health Inform 2015;22:323‑8.
37. Press A, DeStio C, McCullagh L, Kapoor S, Morley J, SBIRT
NY‑II Team, et al. Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records. JMIR
Hum Factors 2016;3:e18.
38. Glasgow RE, Emmons KM. How can we increase translation
of research into practice? Types of evidence needed. Annu Rev
Public Health 2007;28:413‑33.
39. LyuY, Vincent CJ, ChenY, ShiY, TangY, WangW, et al. Designing
and optimizing a healthcare kiosk for the community. Appl Ergon
2015;47:157‑69.
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