BackgroundSelf-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors.ObjectiveThe aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels.MethodsA telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not.ResultsThere was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant.ConclusionsTelehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.

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Because of the influence of globalization and updated information technologies (IT), firms in China face an urgent need to adopt e-procurement systems (EP) to deal with their daily procurement activities. However, implementing EP in China encounters various uncertainties from internal and external business environments. To address this issue, this research aims to examine the fit between business and the IT environment and to study its impact on system performance. The literature review allows the proposal of two internal business environmental uncertainties and two external business environmental uncertainties covering the perspectives of process, knowledge, partnership and environment. Based on a multiple-case study performed in four Chinese firms that supply various personal computer components to a Taiwanese original equipment manufacturer via an EP, it was found that the firms' external and internal uncertainty factors affected the performance of EP. In addition, an EP with a low level of integration -the EP type used most frequently in China -can only achieve great performance when the adopting firms faced a low uncertainty of environment, partnership and process, and had low levels of IT knowledge. It was also observed that lack of fit between the business environment and EP produced extra burdens and costs in the buyer-supplier relationship. This significantly reduced the system performance of the Chinese firms. Hence, the contribution of this research can be twofold. First, practitioners in China can use this framework to diagnose their environmental conditions and then choose the appropriate type of EP to implement. Second, researchers can build upon this model to further examine the impact of fit on EP performance and generalize the results.

This study explores the readiness of enterprises for developing emerging e-business technology. A three-staged e-business technology roadmap is proposed, from pre-e-business, to transactional e-business, and then to on-demand e-business. We use the diffusion of innovation theory to identify a series of enterprises' internal capabilities and environmental drivers that can explain enterprises' e-business adoption along our proposed roadmap. The model is validated in a survey of 175 businesses from the Taiwanese PC industry. The results show that enterprises' internal capabilities are more influential than the environmental drivers when the enterprises move from the pre-e-business stage to the transactional e-business stage. As enterprises start to migrate to on-demand e-business, environmental factors play a critical role in determining the adoption. The implications of this study are multifold. Enterprises can use this model to evaluate their current readiness for the adoption of emerging e-business technology. By locating their current status in the roadmap, they can also understand the steps they should take to improve their readiness.

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