Interactive multimedia and risk communication

Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial

BACKGROUND

Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them.

PURPOSE

Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care.

METHODS

Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects.

RESULTS

Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone.

CONCLUSIONS

Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.

Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial

INTRODUCTION

Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low.

STUDY DESIGN/PURPOSE

This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients.

METHODS

African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses.

RESULTS

Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening.

CONCLUSION

This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.

Robustness of individual and marginal model-based estimates: A sensitivity analysis of flexible parametric models

BACKGROUND

Flexible parametric survival models (FPMs) are commonly used in epidemiology. These are preferred as a wide range of hazard shapes can be captured using splines to model the log-cumulative hazard function and can include time-dependent effects for more flexibility. An important issue is the number of knots used for splines. The reliability of estimates are assessed using English data for 10 cancer types and the use of online interactive graphs to enable a more comprehensive sensitivity analysis at the control of the user is demonstrated.

METHODS

Sixty FPMs were fitted to each cancer type with varying degrees of freedom to model the baseline excess hazard and the main and time-dependent effect of age. For each model, we obtained age-specific, age-group and internally age-standardised relative survival estimates. The Akaike Information Criterion and Bayesian Information Criterion were also calculated and comparative estimates were obtained using the Ederer II and Pohar Perme methods. Web-based interactive graphs were developed to present results.

RESULTS

Age-standardised estimates were very insensitive to the exact number of knots for the splines. Age-group survival is also stable with negligible differences between models. Age-specific estimates are less stable especially for the youngest and oldest patients, of whom there are very few, but for most scenarios perform well.

CONCLUSION

Although estimates do not depend heavily on the number of knots, too few knots should be avoided, as they can result in a poor fit. Interactive graphs engage researchers in assessing model sensitivity to a wide range of scenarios and their use is highly encouraged.

InterPreT cancer survival: A dynamic web interactive prediction cancer survival tool for health-care professionals and cancer epidemiologists

BACKGROUND

There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics.

METHODS

"InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (http://interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites; Breast, Colon, Rectum, Stomach, Melanoma and Lung.

RESULTS

Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, individualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of individual risk and differences between various measures.

CONCLUSIONS

"InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.

Why hospitals adopt patient engagement functionalities at different speeds? A moderated trend analysis

OBJECTIVE

To investigate acute care hospitals' adoption speed of patient engagement health information technology (HIT) functionalities from 2008 to 2013 and how this speed is contingent on environmental factors and hospital characteristics.

METHODS

Data on non-government acute care hospitals located in the United States was obtained from merging three databases: the American Hospital Association's (AHA) annual survey information technology supplement, AHA annual survey, and the Area Health Resource File (AHRF). The variables obtained from these datasets were the amount of annually adopted patient engagement HIT functionalities and environmental and organizational characteristics. Environmental factors included were uncertainty, munificence, and complexity. Hospital characteristics included size, system membership, ownership, and teaching status.

RESULTS

A regression analysis of 4176 hospital-year observations revealed a positive trend in the adoption of HIT functionalities for patient engagement (β= 1.109, p < 0.05). Moreover, the study showed that large, system-affiliated, not-for-profit, teaching hospitals adopt patient engagement HIT functionalities at a faster speed than their counterparts. Environmental munificence and uncertainty were also associated with an accelerating speed of adoption. Environmental complexity however did not show a significant impact on the speed of adoption.

DISCUSSION

From 2008 to 2013, there was a significant acceleration in the speed of adopting patient engagement HIT functionalities. Further efforts should be made to ensure proper adoption and consistent use by patients in order to reap the benefits of these IT investments.

CONCLUSION

Hospitals adopted at least one HIT functionality for patient engagement per year. The adoption speed varied across hospitals, depending on both environmental and organizational factors.

Prescriptive scientific narratives for communicating usable science

In this paper I describe how a narrative approach to science communication may help audiences to more fully understand how science is relevant to their own lives and behaviors. The use of prescriptive scientific narrative can help to overcome challenges specific to scientific concepts, especially the need to reconsider long-held beliefs in the face of new empirical findings. Narrative can captivate the audience, driving anticipation for plot resolution, thus becoming a self-motivating vehicle for information delivery. This quality gives narrative considerable power to explain complex phenomena and causal processes, and to create and reinforce memory traces for better recall and application over time. Because of the inherent properties of narrative communication, their creators have a special responsibility to ensure even-handedness in selection and presentation of the scientific evidence. The recent transformation in communication and information technology has brought about new platforms for delivering content, particularly through interactivity, which can use structured self-tailoring to help individuals most efficiently get exactly the content that they need. As with all educational efforts, prescriptive scientific narratives must be evaluated systematically to determine whether they have the desired effects in improving understanding and changing behavior.

Implementation of a couple-based HIV prevention program: a cluster randomized trial comparing manual versus Web-based approaches

Background

Despite great need, the number of HIV prevention implementation studies remains limited. The challenge for researchers, in this time of limited HIV services agency resources, is to conceptualize and test how to disseminate efficacious, practical, and sustainable prevention programs more rapidly, and to understand how to do so in the absence of additional agency resources. We tested whether training and technical assistance (TA) in a couple-based HIV prevention program using a Web-based modality would yield greater program adoption of the program compared to training and TA in the same program in a manual-based modality among facilitators who delivered the interventions at 80 agencies in New York State.

Methods

This study used a cluster randomized controlled design. Participants were HIV services agencies (N = 80) and up to 6 staff members at each agency (N = 253). Agencies were recruited, matched on key variables, and randomly assigned to two conditions. Staff members participated in a four-day, face-to-face training session, followed by TA calls at two and four months, and follow-up assessments at 6, 12, and 18 months post- training and TA. The primary outcomes examined number of couples with whom staff implemented the program, mean number of sessions implemented, whether staff implemented at least one session or whether staff implemented a complete intervention (all six sessions) of the program. Outcomes were measured at both the agency and participant level.

Results

Over 18 months following training and TA, at least one participant from 13 (33%) Web-based assigned agencies and 19 (48%) traditional agencies reported program use. Longitudinal multilevel analysis found no differences between groups on any outcomes at the agency or participant level with one exception: Web-based agencies implemented the program with 35% fewer couples compared with staff at manual-based agencies (IRR 0.35, CI, 0.13-0.94).

Conclusion

Greater implementation of a Web-based program may require more resources and staff exposure, especially when paired with a couple-based modality. Manual-based and traditional programs may hold some advantage or ease for implementation, particularly at a time of low economic resources.

Trial registration

ClinicalTrials.gov identifier: NCT01863537

Self-management interventions in the digital age: new approaches to support people with rheumatologic conditions

Self-management interventions are considered a key component of rheumatologic care. Access to these programmes, however, is an issue for some patients, especially those working full time or living in rural and remote communities. Recently, there has been an increase in the use of digital media technologies to deliver self-management interventions. Digital media (e.g., websites, mobile applications, social networking tools, online games and animation) provide tremendous flexibility for delivering health information and resources at a time and place that is chosen by the individual; hence, they are consistent with the patient-centred approach. This review discusses: (1) innovations in self-management interventions for patients with arthritis and (2) research in the use of digital media for delivering self-management interventions.

The era of "e": the use of new technologies in advance care planning

In this article, the authors review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). The article begins with a brief description of ACP and its purpose and then discusses various electronically available resources for ACP in the U.S. Finally the authors provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or "e-planning."

Awareness of diabetes risks is associated with healthy lifestyle behavior in diabetes free American adults: evidence from a nationally representative sample

PURPOSE

The purpose of this study was to examine whether diabetes free healthy non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Mexican-Americans (MA) who are told of their diabetes risk were more likely to adopt healthy lifestyle behavior defined as current weight control, physical activity and reduced fat/calories intake than those who were not told that they were at increased risk.

METHODS

A nationally representative data (n=5073) from the 2007-2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether diabetes free NHW, NHB, and MA who are told of their increased diabetes risk were more likely than those who are not told of their diabetes risk to adopt healthy lifestyle behavior.

RESULTS

Being told of increased diabetes risk was associated with increased adoption of healthy lifestyle behaviors as indicated by odds ratio of 2.38 (95% CI=1.34-4.05) in NHW, 2.46 (95% CI=1.20-5.05) in NHB and 2.27 (95% CI=1.32-3.89) in MA who have no diabetes, after adjusting for age, sex, race/ethnicity, hypertension, education, household income and total cholesterol.

CONCLUSIONS

Awareness of increased risk for diabetes is associated with implementing healthy lifestyle behaviors in diabetes free healthy American adults. Population-based programs designed to assess and communicate diabetes risk may be helpful in preventing or delaying the onset of type 2 diabetes. Programs designed along racial/ethnic line may be needed to reduce racial/ethnic differences in rates of type 2 diabetes.

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.

Visualizing uncertainty about the future

We are all faced with uncertainty about the future, but we can get the measure of some uncertainties in terms of probabilities. Probabilities are notoriously difficult to communicate effectively to lay audiences, and in this review we examine current practice for communicating uncertainties visually, using examples drawn from sport, weather, climate, health, economics, and politics. Despite the burgeoning interest in infographics, there is limited experimental evidence on how different types of visualizations are processed and understood, although the effectiveness of some graphics clearly depends on the relative numeracy of an audience. Fortunately, it is increasingly easy to present data in the form of interactive visualizations and in multiple types of representation that can be adjusted to user needs and capabilities. Nonetheless, communicating deeper uncertainties resulting from incomplete or disputed knowledge--or from essential indeterminacy about the future--remains a challenge.

Promise of and potential for patient-facing technologies to enable meaningful use

Patients are using healthcare technologies for a variety of reasons. Recently, the Meaningful-Use rule was released by the Centers for Medicare and Medicaid Services, providing some initial guidance for patient-facing technologies. There needs to be more of an understanding of patients' needs and how these technologies can be utilized effectively. This article provides a framework for organizing patient-facing technologies into categories of meaningful use, and how these technologies can improve healthcare quality, safety, and population health. Barriers to achieving meaningful use of HIT and unintended consequences of patient-facing technologies are discussed. The success of healthcare reform is predicated on achieving improved health outcomes and reduced costs, which can be accomplished only by activating patients to become more engaged in their own care. Patient-facing technologies are likely to play a critical role in supporting patients to become more informed and activated and may also improve efficiencies. Further research is needed to identify the most useful and effective technologies for patients.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues

OBJECTIVE

To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic.

METHODS

Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses.

RESULTS

Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04).

CONCLUSIONS AND IMPLICATIONS

Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education.

Project ASPIRE: an Interactive, Multimedia Smoking Prevention and Cessation curriculum for culturally diverse high school students

A Smoking Prevention Interactive Experience (ASPIRE) is an innovative, computer-based smoking prevention and cessation intervention delivered to a culturally diverse population of high school students. Founded in the Transtheoretical Model of Change, five main and two "booster" sessions comprise the interactive intervention. Here we describe the intervention and the baseline characteristics from our study sample of 1,574 10th graders from 16 high schools in Houston, Texas. Environmental and behavioral smoking risk factors were assessed, and the two intervention groups were comparable with respect to most measured variables. The intervention program holds considerable promise in its ability to reduce smoking among teens.

Too soon to give up: re-examining the value of advance directives

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning-in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning.

Audiometric testing and hearing protection training through multimedia technology

The purpose of this paper is to present the development process of a computer-based audiometric testing and tailored intervention program, and assess its feasibility by obtaining users' feedback. The program was implemented for 397 operating engineers at their union training center, and its feasibility was evaluated by obtaining quantitative and qualitative feedback from the participants through a survey and focus group. Over 96% of the participants indicated they liked receiving a hearing test by computer; the computer-based test worked smoothly; and the computer-based training was well organized, effective and held their interests. Almost all (more than 99%) said they would recommend this program to other workers. This project is considered as one of the first ones incorporating multimedia computer technology with self-administered audiometric testing and tailored training. Participants' favorable feedback strongly supported the continued utilization of this approach for designing and developing health screening and intervention to promote healthy behaviors.

The role of health kiosks in 2009: literature and informant review

Kiosks can provide patients with access to health systems in public locations, but with increasing home Internet access their usefulness is questioned. A literature and informant review identified kiosks used for taking medical histories, health promotion, self assessment, consumer feedback, patient registration, patient access to records, and remote consultations. Sited correctly with good interfaces, kiosks can be used by all demographics but many ‘projects’ have failed to become routine practice. A role remains for: (a) integrated kiosks as part of patient ‘flow’, (b) opportunistic kiosks to catch people’s attention. Both require clear ‘ownership’ to succeed.

Cancer prevention knowledge of people with profound hearing loss

BACKGROUND

Deaf persons, a documented minority population, have low reading levels and difficulty communicating with physicians. The effect of these on their knowledge of cancer prevention recommendations is unknown.

METHODS

A cross-sectional study of 222 d/Deaf persons in Michigan, age 18 and older, chose one of four ways (voice, video of a certified American Sign Language interpreter, captions, or printed English) to complete a self-administered computer video questionnaire about demographics, hearing loss, language history, health-care utilization, and health-care information sources, as well as family and social variables. Twelve questions tested their knowledge of cancer prevention recommendations. The outcome measures were the percentage of correct answers to the questions and the association of multiple variables with these responses.

RESULTS

Participants averaged 22.9% correct answers with no gender difference. Univariate analysis revealed that smoking history, types of medical problems, last physician visit, and women having previous cancer preventive tests did not affect scores. Improved scores occurred with computer use (p = 0.05), higher education (p < 0.01) and income (p = 0.01), hearing spouses (p < 0.01), speaking English in multiple situations (p < 0.001), and in men with previous prostate cancer testing (p = 0.04). Obtaining health information from books (p = 0.05), physicians (p = 0.008), nurses (p = 0.03) or the internet (p = 0.02), and believing that smoking is bad (p < 0.001) also improved scores. Multivariate analysis revealed that English use (p = 0.01) and believing that smoking was bad (p = 0.05) were associated with improved scores.

CONCLUSION

Persons with profound hearing loss have poor knowledge of recommended cancer prevention interventions. English use in multiple settings was strongly associated with increased knowledge.

Asthma management simulation for children: translating theory, methods, and strategies to effect behavior change

Translating behavioral theories, models, and strategies to guide the development and structure of computer-based health applications is well recognized, although a continued challenge for program developers. A stepped approach to translate behavioral theory in the design of simulations to teach chronic disease management to children is described. This includes the translation steps to: 1) define target behaviors and their determinants, 2) identify theoretical methods to optimize behavioral change, and 3) choose educational strategies to effectively apply these methods and combine these into a cohesive computer-based simulation for health education. Asthma is used to exemplify a chronic health management problem and a computer-based asthma management simulation (Watch, Discover, Think and Act) that has been evaluated and shown to effect asthma self-management in children is used to exemplify the application of theory to practice. Impact and outcome evaluation studies have indicated the effectiveness of these steps in providing increased rigor and accountability, suggesting their utility for educators and developers seeking to apply simulations to enhance self-management behaviors in patients.

Entertainment education for prostate cancer screening: a randomized trial among primary care patients with low health literacy

OBJECTIVE

To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy.

METHODS

Male primary care patients from two clinical sites, one characterized as serving patients with low health literacy (n=149) and the second as serving patients with high health literacy (n=301), were randomized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features. Postintervention and 2-week follow-up assessments were conducted.

RESULTS

Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site. Overall, knowledge improved for all patients. Among patients at the low-literacy site, the entertainment-based aid was associated with lower decisional conflict and greater self-advocacy (i.e., mastering and obtaining information about screening) when compared to patients given the audiobooklet. No differences between the aids were observed for patients at the high-literacy site.

CONCLUSION

Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy.

PRACTICE IMPLICATIONS

As barriers to implementing computer-based patient decision support programs decrease, alternative models for delivering these programs should be explored.

Association of multiple behavioral risk factors with adolescents' willingness to engage in eHealth promotion

OBJECTIVE

This study examines adolescents' willingness to use the internet and other forms of technology for health promotion purposes (i.e., "eHealth promotion" willingness) and determines if a relationship exists between adolescents' behavioral risks and their eHealth promotion willingness.

METHODS

A total of 332 adolescents provided data at a routine medical check-up, including assessments of technology access, eHealth promotion willingness, and multiple behavioral risk factors for child- and adult-onset disease (body mass index, physical activity, smoking, sun protection, depression).

RESULTS

The level of access to technology among the sample was high, with moderate willingness to engage in eHealth promotion. After adjusting for adolescents' access to technology, the presence of multiple behavioral risk factors was positively associated with willingness to use technology for health promotion purposes (beta =.12, p =.03).

CONCLUSIONS

Adolescents with both single and multiple behavioral risk factors are in need of health promotion to prevent the onset of disease later in life. eHealth appears to be an acceptable and promising intervention approach with this population.

Visualizing seismic risk and uncertainty: a review of related research

Government agencies and other authorities often communicate earthquake risks using maps derived from geographic information systems. Yet, little is known about the effects of these maps on risk perceptions. While mental models research and other approaches are available to inform risk communication text design, similar empirically derived guidance is lacking for visual risk communications, such as maps, which are likely to trump text in their impact and appeal. This paper reviews the empirical research that might inform such guidance. Research on graphs, spatial and visual perception, and map design suggests that graphics increase risk avoidance over numerical risk representations, and countable visuals, like dots, can increase the accuracy of perceived risks, but not always. Cartographic design features, such as color, animation, interactivity, and depth cues, are all candidates to represent risk and uncertainty and to influence risk perception. While there are robust known effects of color (e.g., red = danger), with some cultural variability, animation can increase the salience of otherwise obscure features but is not uniformly effective. Depth cues, dimensionality, and the extent to which a representation depicts versus symbolizes a scene will influence the viewer's perspective and perception, depending on the viewer's familiarity with the scene; their effects on risk perception remain unclear. The translation and representation of technical information about risk and uncertainty is critical to risk communication effectiveness. Our review suggests a handful of candidate criteria for evaluating the effects of risk visualizations, short of changes in behavior: accuracy, accessibility, retention, and perceived risk and usefulness.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children

BACKGROUND

Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections.

OBJECTIVE

To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients.

DESIGN

A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention.

SUBJECTS/SETTING

Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic.

INTERVENTION

Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk.

MAIN OUTCOME MEASURES

Change from pre- to postintervention food safety scores.

STATISTICAL ANALYSES PERFORMED

A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance.

RESULTS

Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score.

CONCLUSIONS

The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Patient education on mobile devices: an e-health intervention for low health literate audiences

Providing health information to low health literate audiences remains a challenge. Beyond message design, realistic delivery models are needed for delivering information to a traditionally hard-to-reach audience. This study investigated two e-health interventions to provide health information on mobile devices — one providing diabetes information and one offering childcare information. Both were well-received, and most of the subjects' usability issues related to the translation of these interventions to the mobile device's smaller screen. The diabetes website was effective in providing information to study participants (as measured by pre- and post-tests of knowledge), while the childcare website was not. Continued work in this area could explore improved design strategies for mobile devices — a delivery model that could be used in doctors' offices, for example. Effective delivery of health information to low health literate audiences is an important issue, and this research highlights a critical element by targeting another potential delivery model.

The risk of death by age, sex, and smoking status in the United States: putting health risks in context

BACKGROUND

To make sense of the disease risks they face, people need basic facts about the magnitude of a particular risk and how one risk compares with other risks. Unfortunately, this fundamental information is not readily available to patients or physicians. We created simple one-page charts that present the 10-year chance of dying from various causes according to age, sex, and smoking status.

METHODS

We used the National Center for Health Statistics Multiple Cause of Death Public Use File for 2004 and data from the 2004 US Census to calculate age- and sex-specific death rates for various causes of death. We then combined data on smoking prevalence (from the National Health Interview Survey) and the relative risks of death from various causes for smokers vs never smokers (from the American Cancer Society's Cancer Prevention Study-II) to determine age-, sex-, and smoking-specific death rates. Finally, we accumulated these risks for various starting ages in a series of 10-year life tables. The charts present the 10-year risks of dying from heart disease; stroke; lung, colon, breast, cervical, ovarian, and prostate cancer; pneumonia; influenza; AIDS; chronic obstructive pulmonary disease; accidents; and all causes.

RESULTS

At all ages, the 10-year risk of death from all causes combined is higher for men than women. The effect of smoking on the chance of dying is similar to the effect of adding 5 to 10 years of age: for example, a 55-year-old man who smokes has about the same 10-year risk of death from all causes as a 65-year-old man who never smoked (ie, 178 vs 176 of 1000 men, respectively). For men who never smoked, heart disease death represents the single largest cause of death from age 50 on and the chance of dying from heart disease exceeds the chances of dying from lung, colon, and prostate cancers combined at every age. For men who currently smoke, the chance of dying from lung cancer is of the same order of magnitude as the chance dying from heart disease and after age 50 it is about 10 times greater than the chance of dying from prostate or colon cancer. For women who have never smoked, the magnitudes of the 10-year risks of death from breast cancer and heart disease are similar until age 60; from this age on, heart disease represents the single largest cause of death. For women who currently smoke, the chance of dying from heart disease or lung cancer exceeds the chance of dying from breast cancer from age 40 on (and does so by at least a factor of 5 after age 55).

CONCLUSION

The availability of simple charts with consistent data presentations of important causes of death may facilitate discussion about disease risk between physicians and their patients and help highlight the dangers of smoking.

"Look at your health": outcomes associated with a computer-assisted smoking cessation counseling intervention for community college students

Community college students represent 44% of all students enrolled in U.S. higher education facilities. To our knowledge, no previous smoking cessation intervention has targeted community college students. Previous studies suggest that a motivational smoking cessation intervention could be successful for young adult smokers. Combining motivational interviewing sessions with personalized health feedback is likely to increase participants' motivation to quit and movement through the stages of change. The purpose of this study was to evaluate the impact of a smoking cessation program based on these premises. We designed a computer-assisted, counselor-delivered smoking cessation program that addresses personal health risks and readiness to change smoking behavior among community college students. A group-randomized, controlled trial was used to assess the intervention in a sample of 426 students (58.5% females; mean age, 22.8+/-4.7 years) from 15 pair-matched campuses. At the 10-month follow-up assessment, the cotinine-validated smoking cessation rates were 16.6% in the experimental condition and 10.1% in the standard care condition (p=0.07). Our results indicate that our computer-assisted intervention holds considerable promise in reducing smoking among community college students.

Effects of using online narrative and didactic information on healthcare participation for breast cancer patients

OBJECTIVES

To determine the effects of online narrative and didactic information on breast cancer patients' healthcare participation and the interaction effects of race.

METHODS

SAMPLE

353 breast cancer patients (111 African Americans) using an eHealth program with narratives (audiovisual and text) and didactic information (text only).

MEASURES

healthcare participation scale (0, 4 months), online information use.

ANALYSES

hierarchical regression.

RESULTS

Narrative (beta=0.123, p<0.01) and didactic (beta=0.104, p<0.05) information use had independent and positive effects on healthcare participation. Effects of both were significantly greater for African Americans.

CONCLUSIONS

Findings are consistent with and advance prior research on online learning processes and outcomes for breast cancer patients: (1) benefits accrue with using a variety of online learning tools; (2) African Americans use and benefit more from online narrative and didactic information than do Caucasians.

PRACTICE IMPLICATIONS

eHealth programs should provide both didactic and narrative information-especially for African Americans and might consider making greater use of interactive and audiovisual formats. As patients increasingly use of the web for cancer information, clinicians should provide lists of web high quality resources that provide both narrative and didactic information.

Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.

Evaluation of an interactive computer-tailored nutrition intervention in a real-life setting

BACKGROUND

Studies testing Web-based computer-tailored education in real-life settings are now needed.

PURPOSE

The aim of this study is to examine the effectiveness and applicability of an interactive computer-tailored fat reduction intervention, which was previously tested as efficacious in a controlled setting, delivered to a broader population by local health promotion services. The impact of the computer-tailored intervention is compared with a generic intervention and with a no-intervention control group.

METHODS

A quasi-experimental design was used assigning 6 companies randomly to (a) the computer-tailored intervention condition, (b) the generic intervention condition, and (c) the no-intervention control condition. Participants (N = 337) completed validated baseline and posttest questionnaires and received the personal feedback immediately through the company's intranet. A structured interview with the project coordinators assessed the process that the companies had passed through to disseminate the fat intake intervention.

RESULTS

Six months postbaseline, the results showed that the computer-tailored intervention to reduce fat intake implemented through worksites was more effective in decreasing employees' fat intake compared with a generic intervention, F = 23.5, p < .001, or no intervention, F = 28.1, p < .001. Moreover, the dissemination strategy used is feasible for local health promotion services.

CONCLUSIONS

This study can be regarded as an effective "real-life" trial with an implementation strategy that can be used for large scale dissemination.

Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: a randomized controlled pilot study in physician offices

OBJECTIVE

Screening reduces colorectal cancer (CRC) mortality and is cost-effective, yet uptake is suboptimal. We developed and evaluated a personally tailored interactive multimedia computer program (IMCP) to encourage CRC screening.

METHODS

Randomized controlled pilot trial evaluating the effects of the personally tailored CRC screening IMCP as compared with a non-tailored IMCP ("electronic leaflet") control. The IMCP was tailored to patient preference, self-efficacy, barriers, and readiness and deployed in busy primary care offices before scheduled doctor visits. Main outcomes were: CRC screening knowledge, self-efficacy, benefits and barriers, and stage of readiness.

RESULTS

We enrolled 54 subjects; software glitches occurred in 5, leaving 49 subjects for analysis. In adjusted analyses, compared with control, the experimental group had a significant increase in CRC screening self-efficacy (p=0.049), a significantly greater likelihood of moving to a more advanced stage of readiness for screening (p=0.034), a trend toward fewer perceived barriers to screening (p=0.149), and no difference in perceived benefits or knowledge of screening.

CONCLUSION

Our personally tailored IMCP was significantly more effective than control in bolstering CRC screening readiness and self-efficacy.

PRACTICE IMPLICATIONS

If further streamlined, personally tailored IMCPs might be usefully deployed in busy primary care offices to improve uptake of CRC screening.

People's perceptions of cancer survivability: implications for oncologists

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

A practice-sponsored Web site to help patients pursue healthy behaviors: an ACORN study

PURPOSE

We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.

METHODS

In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction.

RESULTS

During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians.

CONCLUSIONS

Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world's best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.

Science and society: the communications revolution and cancer control

Advances in communications technology, particularly with regards to computer-based media, have opened up exciting possibilities to intervene and influence the trajectory of cancer control, from disease prevention to survivorship, and to reduce the cancer burden. The resulting explosion in cancer information in the mass media and on the Internet, however, also offers challenges in terms of equality in access to information and the ability to act on it, as well as in making sure that it is accurate, readily available and easy to use.

The role of patients in designing health information systems: the case of applying simulation techniques to design an electronic patient record (EPR) interface

One overall objective of Electronic Patient Records (EPRs) is to improve patient education and to enhance the patient experience through the use of information technology (IT) so as to facilitate the sharing of information between providers and their patients. The research project reported on herein took place at University Health Network (UHN) in Toronto (Canada), which is a large academic health science center with multiple hospital sites in the city. As a first step in this process, we examined the literature to investigate the human factors issues related to healthcare as well as other settings. Subsequently, we interviewed a number of interested stakeholders from two groups: the physicians (both family and attending) and the patients themselves. Finally, using a simulation environment, we explored the content that UHN lung-transplant patients would be interested in having within their own EPRs. In this paper, we report on the research, the methodology and the findings pertaining to the both the content and the design of an electronic patient record.

Short-term efficacy of a web-based computer-tailored nutrition intervention: Main Effects and Mediators

BACKGROUND

This study evaluates the short-term efficacy and respondents' evaluations of a Web-based computer-tailored nutrition intervention, aiming to decrease saturated fat intake and increase fruit and vegetable intake. Perceived personal relevance, individualization, and interestingness of the information were tested as mediators of the effects of the tailored intervention.

PURPOSE

The objective was to study the short-term effects of a Web-based computer-tailored nutrition intervention.

METHODS

Respondents (N = 782) were randomly assigned to a tailored intervention group, a generic nutrition information control group, or a no-information control group. Fat, fruit, and vegetable intakes and behavioral determinants were measured at baseline and at 3 weeks postintervention. Posttest group differences were determined by multiple linear regression analyses.

RESULTS

The computer-tailored intervention produced significant effects for the determinants of fat, fruit, and vegetable intake and for vegetable and fruit intake. The tailored information was rated as more personally relevant, individualized, interesting, and new than the generic nutrition information. Perceived personal relevance, individualization, and interestingness were identified as mediators of some of the tailoring effects.

CONCLUSIONS

The findings of this study indicate that Web-based, computer-tailored nutrition information can have a short-term effect on the determinants of fat, fruit, and vegetable intake. The effect of the tailored information may be partly explained by the perceived personal relevance and individualization of the information.

A critical dialogue: communicating with type 2 diabetes patients about cardiovascular risk

Patients with type 2 diabetes mellitus (DM) are at increased risk for cardiovascular disease (CVD), and many patients are inadequately treated for risk factors such as hyperglycemia, hyperlipidemia, hypertension, and smoking. Providing individualized risk information in a clear and engaging manner may serve to encourage both patients and their physicians to intensify risk-reducing behaviors and therapies. This review outlines simple and effective methods for making CVD risk information understandable to persons of all levels of literacy and mathematical ability. To allow the patient to understand what might happen and how, personal risk factors should be clearly communicated and the potential consequences of a CVD event should be presented in a graphic but factual manner. Risk calculation software can provide CVD risk estimates, and the resulting information can be made understandable by assigning risk severity (eg, "high") by comparing clinical parameters with accepted treatment targets and by comparing the individual's risk with that of the "average" person. Patients must also be informed about how they might reduce their CVD risk and be supported in these efforts. Thoughtful risk communication using these techniques can improve access to health information for individuals of low literacy, especially when interactive computer technology is employed. Research is needed to find the best methods for communicating risk in daily clinical practice.

Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial

CONTEXT

As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed.

OBJECTIVE

To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing.

DESIGN

Randomized controlled trial conducted from May 2000 to September 2002.

SETTING AND PARTICIPANTS

Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer.

INTERVENTIONS

Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106).

MAIN OUTCOME MEASURES

Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation.

RESULTS

Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status.

CONCLUSIONS

An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk.

Colon cancer: risk perceptions and risk communication

Members of a health maintenance organization (N=353) interacted with a computer program that provided personalized information about their risk of developing colon cancer in the next 20 years. Prior to computer feedback, most people greatly overestimated their numerical, absolute risk (chances per 1000) and also overestimated their relative risk compared to peers (e.g., "above average"). Their relative risk estimates were correlated with several risk factors, whereas their absolute risk estimates were not, suggesting that assessing individual risk perceptions with numerical, absolute risk scales may provide misleading information about what people believe. Computer feedback improved the accuracy of mean risk estimates, but about half of participants did not accept the personalized feedback as correct. In fact, correlations between actual and perceived risk were no greater among participants who received risk scores than among those who did not. Three possible explanations for resistance to lower-than-expected risk feedback are considered.

Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians

PURPOSE

To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice.

DATA SOURCES

medline, 1966-April 2003, and the google search engine on the Internet. TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use.

DATA EXTRACTION

Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information.

DATA SYNTHESIS

Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited.

CONCLUSIONS

Several easy-to-use tools are available for estimating patients' CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.

Risk communication strategies: state of the art and effectiveness in the context of cancer genetic services

The objective of this paper is first to describe the different strategies used to communicate risks to patients in the field of cancer or genetics, to review their effectiveness, and to summarise the state of the art of this practice in particular, in cancer genetics. The target audience is health care professionals involved in the communication of cancer risks, and genetic risks of breast/ovarian or colorectal cancer in particular. The methods include a review of the literature (Medline, Pascal, PsycInfo, Embase) by a panel of researchers and clinicians (cancer geneticists, epidemiologists, health psychologists, sociologists) in the context of a European Project on risk communication. We highlight practices that have been shown to be effective in the context of health psychology research and those being still under consideration for use in routine practice. In conclusion, this paper adds clinical relevance to the research evidence. We propose specific steps that could be integrated in standard clinical practice based on current evidence for their usefulness/effectiveness.

An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility

As genetic testing for susceptibility to breast cancer becomes more widespread, alternative methods for educating individuals prior to testing will be needed. Our objective was to compare face-to-face education and counseling by a genetic counselor with education by an interactive computer program, assessing the effects of each on knowledge of breast cancer genetics and intent to undergo genetic testing. We used a randomized, controlled trial. Seventy-two self-referred women with a first-degree relative with breast cancer received outpatient education and counseling at the Clinical Center of the National Institutes of Health (NIH). Twenty-nine received individualized counseling from a genetic counselor (counseling group), 29 received education from an interactive computer program followed by individualized counseling (computer group), and 14 were controls. Both pre- and postintervention assessment of knowledge about breast cancer genetics and intent to undergo genetic testing were measured. The control group participants correctly answered 74% of the knowledge questions; the counselor group, 92%; and the computer group, 96% (P <.0001). Unadjusted mean knowledge scores were significantly higher in the computer group than the counselor group (P =.048), but they were equivalent when adjusted for demographic differences (P = 0.34). Intent to undergo genetic testing was influenced by the interventions: preintervention, a majority in all groups (69%) indicated that they were likely (definitely and most likely) to undergo testing; after either intervention coupled with counseling, only 44% indicated that they were likely to do so (P =.0002; odds ratio = 2.8, 95% CI = 1.7-4.9). We concluded that a computer program can successfully educate patients about breast cancer susceptibility, and, along with genetic counseling, can influence patients' intentions to undergo genetic testing.

Education about genetic testing for breast cancer susceptibility: patient preferences for a computer program or genetic counselor

The purpose of this study was to describe and compare patient preferences for a genetic counselor or an interactive computer program for various components of genetic education and counseling for breast cancer susceptibility. As part of a randomized intervention study on genetics education and counseling for breast cancer risk, 29 women at moderate risk were educated by both a genetic counselor and an interactive computer program. After both educational interventions, participants completed Likert-style and open-ended questionnaires about what they liked most and least about each intervention, and whether they preferred the counselor or computer for a variety of tasks. Participants were largely satisfied with both the computer program and the genetic counselor. A majority preferred the genetic counselor for addressing their concerns, discussing options and alternatives, being sensitive to emotional concerns, helping to make a decision, being a good listener, assuring understanding, helping to make a good choice, helping to understand genes and breast cancer, telling them what they needed to know, being respectful, setting a relaxed tone, and putting them at ease. However, a majority of the women either preferred the computer program or were neutral about allowing patients to learn at their own pace, helping to avoid embarrassment, making good use of time, explaining genes and breast cancer, and treating the patient as an adult. Qualitative analysis of open-ended questions affirmed that patients valued the personal interactions with the counselors, and liked having their specific questions answered. They liked that the computer was self-paced, informative and private, and could be used without causing embarrassment. We concluded that a computer literate, mostly white group of women at moderate risk for inherited susceptibility to breast cancer preferred interacting with a genetic counselor for personal, individualized components of the genetic counseling process, but accepted or preferred a computer program for being self-paced, private, and informative. By incorporating such a computer program into the genetic education process, it is possible that genetic counselors would be able to spend more time performing the personal, individualized components of genetic counseling.

The potential of consumer health informatics

OBJECTIVES

To describe the rapidly evolving field of consumer health informatics (CHI), which is empowering the patient and the public.

DATA SOURCES

Published articles, research studies, and government reports pertaining to interactive health communication and CHI.

CONCLUSIONS

Application of CHI can provide information to patients and the public, promote self-care, enable informed decision-making, promote healthy behaviors, and promote peer information exchange and social support. Quality, research methodology, and accessibility must all be increased to ensure that CHI achieves its potential to improve the nation's health.

IMPLICATIONS FOR NURSING PRACTICE

With the advent of the internet, the profusion of consumer health-related web sites, online support groups, and electronic patient-centered communications present new challenges for clinical practice. Health care providers have important roles in helping their patients as well as the public locate, assess, and interpret health information.