The use of a digital post-ICU diary through intensive care survivors’ relatives: The Technology Acceptance Model applied

Nanda Tummers, Madelon van Hooff, Margo van Mol

In this multicentre, cross-sectional online survey study, a mediation analysis was used to examine the relationship between technophobia and intention to use a digital Post-ICU diary among intensive care survivors’ relatives and whether this relationship is mediated by two user perceptions ‘Perceived Ease of Use’ (PEOU) and ‘Perceived Usefulness’ (PU). In total 63 relatives participated in the study, of which 57.1% women and an average age of 51 years was found. The results showed a positive relationship between the PU and the intention to use the Post-ICU diary. However, the relationship between technophobia and intention to use was not mediated by PEOU and PU. This means, the digital diary seems a valuable alternative to the paper version whereby technophobia no hindering factor is in the applicability of the Post-ICU diary. In addition, the participants perceived the digital diary as a positive intervention, which could support the social interaction between the relative and their own network as well as the interaction with the ICU team. This could reduce the emotional impact in ICU survivors’ relatives in the long run.

748 Weergaven
Log in
Het gebruik van een dagboek is een bewezen effectieve interventie om de emotionele impact van een opname op de intensive care (IC) te verminderen voor zowel patiënten als naasten. De noodzaak om een digitale versie, het ‘Post-’ dagboek, te implementeren werd tijdens de Covid-19 pandemie urgent vanwege de bezoekbeperkende maatregelen. Inzicht in waargenomen gebruiksgemak en bruikbaarheid, alsmede de rol van angst voor digitale technologie van het Post-IC dagboek bij naasten, is relevant voor nationale implementatie.

Het post-intensive care syndroom

De aandacht voor een opname op een IC-afdeling, en het herstel na een kritieke ziekte, verschuift steeds meer van korte termijn overleven naar de gezondheidsbeperkingen op de lange termijn (Turnbull et al., 2016; White, Connolly, & Rowland, 2021). De fysieke, cognitieve en psychische klachten na ontslag van de IC-afdeling worden sinds 2012 internationaal gedefinieerd als het post-intensive care syndroom (PICS; Davidson et al., 2013; Inoue et al., 2019; Needham et al., 2012). Ook naasten kunnen door de impact van een IC-ervaring psychische klachten ontwikkelen, deze zijn beschreven als PICS-Familie (PICS-F; Davidson, Jones, & Bienvenu, 2012).

Jaarlijks worden gemiddeld 75.000 volwassenen opgenomen op IC-afdelingen in Nederland, waarbij het in 54% van de gevallen ongeplande niet-chirurgische opnames betreft (NICE). Een recente Nederlandse studie toonde aan dat de helft van deze ongeplande IC-patiënten in het eerste jaar na ontslag uit


  1. Aitken, L.M., Castillo, M.I., Ullman, A., Engström, Å., Cunningham, K. & Rattray, J. (2016). What is the relationship between elements of ICU treatment and memories after discharge in adult ICU survivors? Australian Critical Care, 29 (1), 5-14.
  2. Azoulay, E., & Kentish-Barnes, N. (2020). A 5-point strategy for improved connection with relatives of critically ill patients with COVID-19. The Lancet. Respiratory Medicine, 8 (6).
  3. Barreto, B.B., Luz, M., de Oliveira Rios, M.N., Lopes, A.A., & Gusmao-Flores, D. (2019). The impact of intensive care unit diaries on patients’ and relatives’ outcomes: a systematic review and meta-analysis. Critical Care, 23 (1), 411.
  4. Barreto, B.B., Luz, M., do Amaral Lopes, S.A.V., Rosa, R.G. & Gusmao-Flores, D. (2021). Exploring family members’ and health care professionals’ perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Medicine, 47 (7), 737-749.
  5. Chow, M., Herold, D.K., Choo, T.-M. & Chan, K. (2012). Extending the technology acceptance model to explore the intention to use Second Life for enhancing healthcare education. Computers & Education, 59 (4), 1136-1144.
  6. Davidson, J.E., Harvey, M.A., Schuller, J. & Black, G. (2013). Post-intensive care syndrome: What it is and how to help prevent it. American Nurse Today, 8 (5), 32-38.
  7. Davidson, J.E., Jones, C. & Bienvenu, O.J. (2012). Family response to critical illness: Postintensive care syndrome–family. Critical Care Medicine, 40 (2), 618-624. Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly, 319-340.
  8. Davydow, D.S., Desai, S.V., Needham, D.M. & Bienvenu, O.J. (2008). Psychiatric morbidity in survivors of the acute respiratory distress syndrome: A systematic review. Psychosomatic Medicine, 70 (4), 512-519.
  9. Fathema, N., Shannon, D. & Ross, M. (2015). Expanding the Technology Acceptance Model (TAM) to examine faculty use of Learning Management Systems (LMSs) in higher education institutions. Journal of Online Learning & Teaching, 11 (2).
  10. Fishbein, M. & Ajzen, I. (1977). Belief, attitude, intention, and behavior: An introduction to theory and research. Philosophy and Rhetoric, 10 (2). Fishbein, M. & Ajzen, I. (2011). Predicting and changing behavior: The reasoned action approach. New York: Psychology press.
  11. Fritz, M.S. & MacKinnon, D.P. (2007). Required sample size to detect the mediated e§ect. Psychological Science, 18 (3), 233-239.
  12. Garrouste-Orgeas, M., Périer, A., Mouricou, P., Grégoire, C., Bruel, C., Brochon, S., . . . Misset, B. (2014). Writing In and Reading ICU Diaries: Qualitative Study of Families’ Experience in the ICU. PloS one, 9 (10), e110146.
  13. Geense, W.W., van den Boogaard, M., van der Hoeven, J.G., Vermeulen, H., Hannink, G. & Zegers, M. (2019). Nonpharmacologic interventions to prevent or mitigate adverse long-term outcomes among ICU survivors: a systematic review and meta-analysis. Critical care medicine, 47 (11), 1607-1618.
  14. Geense, W. W., Zegers, M., Peters, M.A., Ewalds, E., Simons, K.S., Vermeulen, H., . . . van den Boogaard, M. (2021). New Physical, Mental, and Cognitive Problems 1-year Post-ICU: A Prospective Multicenter Study. American Journal of Respiratory and Critical Care Medicine 203 (12), 1512-1521.
  15. Hart, J.L., Turnbull, A.E., Oppenheim, I.M. & Courtright, K.R. (2020). Family- Centered Care During the COVID-19 Era. Journal of pain and symptom management, 60, (2), e93-e97.
  16. Harvey, M.A., & Davidson, J.E. (2016). Postintensive care syndrome: right care, right now… and later. Critical Care Medicine, 44 (2), 381-385. Hayes, A.F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford publications.
  17. Hogan, M. (2008). Age Di§erences in Technophobia: An Irish Study. Information Systems Development, 117-130. Doi: 10.1007/978-0-387-68772-8_10 Holden, R.J. & Karsh, B.-T. (2010). The technology acceptance model: its past and its future in health care. Journal of biomedical informatics, 43 (1), 159-172.
  18. Inoue, S., Hatakeyama, J., Kondo, Y., Hifumi, T., Sakuramoto, H., Kawasaki, T., . . Kawai, Y. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Medicine & Surgery, 6 (3), 233-246.
  19. Khasawneh, O.Y. (2018). Technophobia: Examining its hidden factors and defining it. Technology in Society, 54 (1), 93-100.
  20. Liang, H., Xue, Y. & Byrd, T.A. (2003). PDA usage in healthcare professionals: testing an extended technology acceptance model. International Journal of Mobile Communications, 1 (4), 372-389.
  21. Liaw, S.-S., & Huang, H.-M. (2013). Perceived satisfaction, perceived usefulness and interactive learning environments as predictors to self-regulation in e-learning environments. Computers & Education, 60 (1), 14-24.
  22. McIlroy, P.A., King, R.S., Garrouste-Orgeas, M., Tabah, A. & Ramanan, M. (2019). The e§ect of ICU diaries on psychological outcomes and quality of life of survivors of critical illness and their relatives: a systematic review and metaanalysis. Critical Care Mdicine, 47 (2), 273-279.
  23. Melas, C.D., Zampetakis, L.A., Dimopoulou, A. & Moustakis, V. (2011). Modeling the acceptance of clinical information systems among hospital medical sta§: an extended TAM model. Journal of biomedical informatics, 44 (4), 553-564.
  24. Mickelson, R.S., Piras, S.E., Brown, L., Carlile, C., Drumright, K.S. & Boehm, L. (2020). The use and usefulness of ICU diaries to support family members of critically ill patients. Journal of Critical Care, 61, 168-176.
  25. Murthy, S., Gomersall, C.D. & Fowler, R.A. (2020). Care for critically ill patients with COVID-19. JAMA, 323 (15), 1499-1500. Needham, D.M., Davidson, J., Cohen, H., Hopkins, R.O., Weinert, C., Wunsch, H., . . . Bienvenu, O.J. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical Care Medicine, 40 (2), 502-509.
  26. NICE. (2020). Basic data ICUs in the Netherlands. Retrieved from https://www. Nielsen, A.H. & Angel, S. (2016). How diaries written for critically ill influence the relatives: a systematic review of the literature. Nursing in Critical Care, 21 (2), 88-96.
  27. Nydahl, P., Egerod, I., Hosey, M.M., Needham, D.M., Jones, C. & Bienvenu, O.J. (2020). Report on the third International intensive care unit diary conference. Critical Care Nurse, 40 (5), e18-e25.
  28. Osiceanu, M.-E. (2015). Psychological implications of modern technologies:“technofobia” versus “technophilia”. Procedia-Social and Behavioral Sciences, 180, 1137-1144. Post-IC. (2021). Over Post-IC. Geraadpleegd van:
  29. Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Annals of intensive care, 10 (1), 1-9.
  30. Saadé, R.G. & Kira, D. (2006). The emotional state of technology acceptance. Issues in Informing Science & Information Technology, 3. Schofield, R., Dibb, B., Coles-Gale, R. & Jones, C.J. (2021). The experience of relatives using intensive care diaries: A systematic review and qualitative synthesis. International Journal of Nursing Studies, 119 (103927).
  31. Scruth, E.A., Oveisi, N. & Liu, V. (2017). Innovation and technology: electronic intensive care unit diaries. AACN Advanced Critical Care, 28 (2), 191-199.
  32. Sun, X., Huang, D., Zeng, F., Ye, Q., Xiao, H., Lv, D., . . . Cui, X. (2021). Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta-analysis. Journal of Advanced Nursing, 77 (7), 2929-2941.
  33. Turnbull, A.E., Rabiee, A., Davis, W.E., Nasser, M.F., Venna, V. R., Lolitha, R., . . . Needham, D.M. (2016). Outcome measurement in ICU survivorship research from 1970-2013: a scoping review of 425 publications. Critical Care Medicine, 44 (7), 1267.
  34. van Beusekom, I., Bakhshi-Raiez, F., de Keizer, N.F., Dongelmans, D.A. & van der Schaaf, M. (2015). Reported burden on informal caregivers of ICU survivors: a literature review. Critical Care, 20 (1), 1-8.
  35. White, C., Connolly, B. & Rowland, M.J. (2021). Rehabilitation after critical illness. British Medical Journal Publishing Group, 2021 (373).