Disseminating Health Information and Diabetes Care for Latinos Via Electronic Information Kiosks

The Role of Health Kiosks: A Scoping Review (Preprint)

Background

Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self–check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow.

Objective

We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks.

Methods

We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables.

Results

A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified.

Conclusions

Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods.

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review

Background

As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions.

Objective

Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics.

Methods

A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics.

Results

We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention.

Conclusions

This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.

Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol

Background

Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population.

Methods/Design

Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management.

Discussion

The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings.

Trial registration

ClinicalTrials.gov Registration Number: NCT02069015. Registered February 19, 2014.

The role of health information kiosks in diverse settings: a systematic review

BACKGROUND

Public access computing through computer kiosks placed in clinical and community settings may help bridge the digital health information divide.

OBJECTIVE

The objective was to examine the current utilisation of computer based health information kiosks in diverse settings. Further, the objective was to examine the locations for health kiosks, kiosk features, application of theoretical framework in the design and development of health kiosks and the outcomes assessed.

METHODS

A search was conducted using Pubmed and CINAHL with articles published from January 2005 to January 2012. The articles that focused on the use of computer based health information kiosks in community and clinical settings.

RESULTS

The majority of the 31 articles included in this study were conducted in urban settings (90%; n = 28), clinical settings (58%; n = 18) and focused on child safety (19%; n = 6). Computer-based tailoring was utilised in majority of the studies (77%; n = 24). However, limited studies described the theoretical frameworks to facilitate this tailoring (42%; n = 13).

CONCLUSIONS

The results suggest that health information kiosks are a feasible medium to disseminate health information among various users in clinical and community settings, with high acceptance and satisfaction by users. Theoretical driven interventions are needed to examine long term impacts of health information kiosks especially in rural and underserved populations.

The use of a kiosk-model bilingual self-triage system in the pediatric emergency department

BACKGROUND

Streamlining the triage process is the key in improving emergency department (ED) workflow. Our objective was to determine if parents of pediatric ED patients in, low-literacy, inner-city hospital, who used the audio-assisted bilingual (English/Spanish) self-triage kiosk, were able to enter their child's medical history data using a touch screen panel with greater speed and accuracy than routine nurse-initiated triage.

METHODS

Parent/child dyads visiting the pediatric ED for nonurgent conditions (February to April 2012) were randomized prospectively to self-triage kiosk group (n = 200) and standard nurse triage group (n = 200). Both groups underwent routine nurse-initiated triage that included verbal elicitation of basic medical history and manual entry into patients' electronic medical records.

RESULTS

The kiosk user was a parent in 88.5% of the cases, a patient (range, 11-17 years) in 9.5% of the cases, and a proxy user (sibling or friend) in 2% of the cases. Language choice for kiosk use was equally distributed (English vs Spanish, 50.5% vs 49.5%). The mean (SD) time to enter medical history data by the kiosk group was significantly shorter than the standard nurse triage group (94.38 [38.61] vs 126.72 [62.61] seconds; P < 0.001). Significant inverse relationship was observed between parent education level and kiosk usage time (r = -0.26; P < 0.001). The mean inaccuracies were significantly lower for kiosk group (P < 0.05) in areas of medical, medication and immunization histories, and total discrepancy score.

CONCLUSIONS

Kiosk triage enabled users to enter basic medical triage history data quickly and accurately in an ED setting with future potential for its wider use in improving ED workflow efficiency.

Examining cultural factors that influence treatment decisions: a pilot study of Latino men with cancer

The objective of this study was to explore beliefs and treatment decisions of foreign-born Latino men from Cuba, Mexico, Colombia, and Venezuela, who have been diagnosed with cancer and who live in Central Florida, USA. Experiences related to knowledge of diagnosis, treatment decisions, communication with health providers, family involvement, and advance care planning (ACP) discussions following the diagnosis of cancer are central to this study. This study used qualitative in-depth semi-structured interviews and thematic analysis. The interviews were conducted with 15 Latino men who have been diagnosed with cancer within the past 5 years and who reside in the community. The interviews were conducted and transcribed in Spanish and then translated into English. The median age was 55.4 years. Nine Latino men had prostate cancer, two had brain cancer, two had colorectal cancer, and two had lung cancer. Emerging themes involved the suddenness of the diagnosis, fear of dying, expectations of diagnosis-related communication, reliance on physicians for treatment decisions, limited information pertaining to ACP, family support, and role changes. Latino men's limited knowledge of cancer diagnosis and treatment options coupled with their fear led them to immediately believe that they were going to die. Knowledge gaps regarding diagnosis-related communication, treatment decisions, and ACP varied among the men. The forthright diagnosis communication and the expectation to engage in decision making are contrary to Latinos men's beliefs of reliance on health providers decisions. The findings contribute to understanding Latino men's beliefs about a cancer diagnosis and treatment decisions.

What is the effect of peer support on diabetes outcomes in adults? A systematic review

AIM

There is increasing interest in the role that peers may play to support positive health behaviours in diabetes, but there is limited evidence to inform policy and practice. The aim of this study was to systematically review evidence of the impact and effectiveness of peer support in adults living with diabetes.

METHODS

We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and CINHAL for the period 1966-2011, together with reference lists of articles for eligible studies. Data were synthesized in a narrative review.

RESULTS

Twenty-five studies, including fourteen randomized, controlled or comparative trials, met the inclusion criteria. There was considerable heterogeneity in the design, setting, outcomes and measurement tools. Peer support was associated with statistically significant improvements in glycaemic control (three out of 14 trials), blood pressure (one out of four trials), cholesterol (one out of six trials), BMI/weight (two out of seven trials), physical activity (two out of five trials), self-efficacy (two out of three trials), depression (four out of six trials) and perceived social support (two out of two trials). No consistent pattern of effect related to any model of peer support emerged.

CONCLUSIONS

Peer support appears to benefit some adults living with diabetes, but the evidence is too limited and inconsistent to support firm recommendations. There remains a need for further well-designed evaluations of its effectiveness and impact. Key questions remain over its suitability to the needs of particular individuals, populations and settings, how best to implement its specific components and the sustainability of its effects.

Nutrition education via a touchscreen: a randomized controlled trial in Latino immigrant parents of infants and toddlers

OBJECTIVE

To investigate whether educational modules presented on a touchscreen computer increase immediate nutrition and feeding knowledge in low-income, Spanish-speaking Latino immigrant parents.

METHODS

This was a randomized controlled trial conducted in an urban pediatric clinic with a sample of low-income, Spanish-speaking Latino parents of children <3 years randomly assigned to the intervention (n = 80) and control groups (n = 80). Intervention group members viewed 5 modules on nutrition and feeding presented on an interactive platform using a touchscreen computer. Modules contained text, pictures, and audio. Content was drawn from Bright Futures Guidelines. The primary outcome was a parental total summed knowledge score based on correct responses to 19 questions related to module content. Domain-specific scores were also analyzed.

RESULTS

Intervention and control groups did not differ on demographic characteristics. Participants were of varied Latino origins, mean age was 27.5 years, 41% reported a <7th grade education, and 65% reported that they rarely/never use a computer. Compared with the control group, the intervention group had a superior mean total summed knowledge score (72.3% vs 90.8%, P < .001). Mean domain-specific summed knowledge scores were also greater in the intervention arm compared with the control for all 5 domains. These results did not differ on the basis of participant education level. 71% (n = 57) of intervention arm participants planned to change something based on what they learned from the computer program, and 80% reported that they will (n = 49) or may (n = 15) talk to their child's doctor about what they learned in the modules.

CONCLUSIONS

Results of this pilot study add to the growing literature on the use of this technology for health education in low-income Latino immigrants. Despite low education levels and computer experience, findings suggest that immediate parental knowledge was enhanced supporting the need for a more rigorous evaluation of this technology and its impact on health behaviors.

Older adults' acceptance of a community-based telehealth wellness system

The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.

Consumer empowerment in health care amid the internet and social media

OBJECTIVES

Consumer empowerment in health and rapid change in health information and communication technologies have their roots in broader social trends. This article reviews the activities at the intersection of consumer empowerment and technology.

DATA SOURCES

Technical reports, white papers, books, journal articles, and Web sites.

CONCLUSION

Social trends are visible in the integration of information and communication technologies into health care, in both searching for and sharing information on the Internet, in the use of social media to create new types of interactions with family, providers, and peers, and in the e-patient, who integrates these new roles and new technologies.

IMPLICATIONS FOR NURSING PRACTICE

Changes in both patients and technology will impact oncology nursing practice as new, patient-centered, interactions emerge.

Current Perspectives on Latino Men’s Health

Health concerns for Latinos, the largest ethnic minority in the United States, merit attention by policy makers. Given the importance of the Latino population to the economic well-being of the United States, ensuring good health for this group is crucial. Lack of access to health care is the most obvious barrier to maintaining good health for Latinos, but it is not the only important factor. Sociocultural factors, including acculturation, culturally competent health professionals, immigration status, income, and education are also influential to health concerns. Recommendations to decrease health disparities among Latino men include theoretically based health interventions, better integration of research findings, working with local communities, and incorporating Latino masculine values into both health care and health education. Given the importance of the sociocultural factors, the discussion that follows emphasizes these and the interaction of these factors with Latino cultural values.

When promotoras and technology meet: a qualitative analysis of promotoras' use of small media to increase cancer screening among South Texas Latinos

Computer-based multimedia technologies can be used to tailor health messages, but promotoras (Spanish-speaking community health workers) rarely use these tools. Promotoras delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a "low-tech" format (flipchart and video) and a "high-tech" format consisting of a tailored, interactive computer program delivered on a tablet computer. Using qualitative methods, the authors observed promotora training and intervention delivery and conducted interviews with five promotoras to compare and contrast program implementation of both formats. The authors discuss the ways each format aided or challenged promotoras' intervention delivery. Findings reveal that some aspects of both formats enhanced intervention delivery by tapping into Latino health communication preferences and facilitating interpersonal communication, whereas other aspects hindered intervention delivery. This study contributes to our understanding of how community health workers use low- and high-tech small media formats when delivering health messages to Latinos.