OBJECTIVE: The Tailored Interventions for management of DEpressive Symptoms (TIDES) program was designed based on social cognitive theory to provide tailored, computer-based education on key elements and self-care strategies for depressive symptoms in persons living with HIV/AIDS (PLWHAs). DESIGN AND MEASUREMENT: Based on an extension of the Technology Acceptance Model (TAM), a cross-sectional design was used to assess the acceptance of the HIV TIDES prototype and explore the relationships among system acceptance factors proposed in the conceptual model. RESULTS: Thirty-two PLWHAs were recruited from HIV/AIDS clinics. The majority were African American (68.8%), male (65.6%), with high school or lower education (68.7%), and in their 40s (62.5%). PARTICIPANTS spent an average of 10.4 minutes (SD = 5.6) using HIV TIDES. The PLWHAs rated the system as easy to use (Mean = 9.61, SD = 0.76) and useful (Mean = 9.50, SD = 1.16). The high ratings of behavior intention to use (Mean = 9.47, SD = 1.24) suggest that HIV TIDES has the potential to be accepted and used by PLWHAs. Four factors were positively correlated with behavioral intention to use: perceived usefulness (r = 0.61), perceived ease of use (r = 0.61), internal control (r = 0.59), and external control (r = 0.46). Computer anxiety (r = -0.80), tailoring path (r = 0-.35) and depressive symptoms (r = -0.49) were negatively correlated with behavioral intention to use. CONCLUSION: The results of this study provide evidence of the acceptability of HIV TIDES by PLWHAs. Individuals are expected to be empowered through participating in the interactive process to generate their self-care plan. HIV TIDES enables information sharing about depression prevention and health promotion and has the potential to reframe the traditional patient-provider relationship.

The utility of broad-band interactive two-way visual telecommunication has been assessed in a wide variety of healthcare delivery settings in seven exploratory projects funded by the Bureau of Health Services Research, Department of Health, Education, and Welfare. These projects are briefly summarized and communication events are classified into five exhaustive but not matually exclusive categories: consultation, supervision, direct patient care (telemedicine), administration and management, and education and training. Technical and human factors to be considered in the design of a visual telecommunication system are identified. Tradeoffs available among them are discussed, such as resolution for remote controls and frame rate. The impact of visual telecommunication on the often competitive performance goals of the health-care system is discussed, e.g., random video consultations may simultaneously decrease physician productivity and patient inconvenience. The paper concludes by suggesting directions for future research and by noting that broad-band video is but one among many technological, organizational, manpower, and other options available to those who seek solutions to the problems of health-care delivery.

This paper discusses some of the changes that might take place in this nation's health care system with the advent of national health insurance. These changes include structural reforms, planning and regulation, and the introduction of quality assurance mechanisms. The paper argues that a health care system will evolve that is both aggregated and regulated; and it foresees that computer and communication technologies will play significant roles in this evolution. The paper concludes by discussing some potentially harmful social consequences of these developments.