eHealth Technology and Internet Resources

A novel questionnaire for evaluating digital tool use (DTUQ-D) among individuals with type 2 diabetes: exploring the digital landscape

Introduction

Effective healthcare currently incorporates a patient-centric system and accessible technology for patient self-management. This study aimed to develop and validate a novel questionnaire titled the Digital Tool Use Questionnaire for Diabetes (DTUQ-D) - a screening tool identifying the type, number, and frequency of digital tools used by Type 2 Diabetes Mellitus (T2DM) patients with within HMOs, online, and via applications.

Methods

The questionnaire was administered to two ethnic groups and both genders. A mixed-methods approach was used. In the qualitative phase, the questionnaire was developed through phone surveys of 29 T2DM patients, two endocrinologists and two technology experts. In the quantitative phase, involving 367 participants, convergent validity, construct validity, and reliability were examined.

Results

Findings indicated that the DTUQ-D is valid and reliable, successfully identifying digital tools utilized by T2DM patients, notwithstanding variations in factor structures between ethnic groups. This questionnaire provides a foundation for future research, offering a standardized approach to evaluating digital tool usage.

Discussion

The study enhances understanding of the role of digital tools in healthcare, especially for T2DM self-management. It also can be easily adapted to assess digital tool use for other illnesses by adjusting instructions and the wording of certain items.

Promoting informed decision making about maternal pertussis vaccination: the systematic development of an online tailored decision aid and a centering-based group antenatal care intervention

Introduction

Maintaining and enhancing vaccine confidence continues to be a challenge. Making an informed decision not only helps to avoid potential future regret but also reduces susceptibility to misinformation. There is an urgent need for interventions that facilitate informed decision-making about vaccines. This paper describes the systematic development of two interventions designed to promote informed decision making and indirectly, acceptance of maternal pertussis vaccination (MPV) in the Netherlands.

Materials and methods

The 6-step Intervention Mapping (IM) protocol was used for the development of an online tailored decision aid and Centering Pregnancy-based Group Antenatal Care (CP) intervention. A needs assessment was done using empirical literature and conducting a survey and focus groups (1), intervention objectives were formulated at the behavior and determinants levels (2), theoretical methods of behavior change were selected and translated into practical applications (3), which were further developed into the two interventions using user-centered design (4). Finally, plans were developed for implementation (5), and evaluation (6) of the interventions.

Results

The needs assessment showed that pregnant women often based their decision about MPV on information sourced online and conversations with their partners, obstetric care providers, and peers. Responding to these findings, we systematically developed two interactive, theory-based interventions. We created an online tailored decision aid, subjecting it to four iterations of testing among pregnant women, including those with low literacy levels. Participants evaluated prototypes of the intervention positively on relevance and usability. In addition, a CP intervention was developed with midwives.

Conclusion

Using IM resulted in the creation of an online decision aid and CP intervention to promote informed decision making regarding MPV. This description of the systematic development of the interventions not only serves to illustrate design rationales, it will also aid the interpretation of the evaluation of the interventions, the development of future interventions promoting informed decision and acceptance of vaccines, and comparisons with other interventions.

Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study

BACKGROUND

Older adults tend to have insufficient health literacy, which includes eHealth literacy-the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy.

OBJECTIVE

The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy.

METHODS

Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy.

RESULTS

eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases).

CONCLUSIONS

Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains.

The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study

BACKGROUND

During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs.

OBJECTIVE

Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center.

METHODS

In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated.

RESULTS

We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or "other" race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of <US $25,000 (P=.01) were associated with lower odds of MyChart activation. Following COVID-19, younger age (P<.001), commercial insurance (P=.03), state insurance (P=.02), and median income of US $50,000-75,000 (P=.01) were associated with significantly higher odds of MyChart use. However, being of Black or African American (P<.001) or "other" race (P=.01), Spanish as a primary language (P=.002), male sex (P=.004), rural residence (P=.005), and having no insurance (P<.001) or Medicaid (P=.008) were associated with lower odds of MyChart use.

CONCLUSIONS

Residence in a rural area, being of minority race/ethnicity, older age, male sex, lower median income, Medicaid, being uninsured, and non-English primary language are associated with lower odds of patient portal activation and use. Future health policy and clinical practice measures should focus on reducing barriers to health technology adoption among these groups.

Innovating under pressure: Adopting digital technologies in social care organizations during the COVID-19 crisis

To provide ongoing support for vulnerable groups during the COVID-19 pandemic, social care organizations had to shift abruptly to e-health solutions. Qualitative data from three cases illustrate that, more than a year into the pandemic, those adoptions of digital technologies developed differently; the current study aims to shed light on the processes that lead to such differences. Notably, the first organization resisted the large-scale use of digital technologies; the second faced intra-organizational disagreement about the role of digital technology for care provision; and the third organization struggled but managed a broader, more successful adoption of digital technology. The multiple case study findings contribute to extant literature, by (1) detailing the digital innovation process, focusing on the crucial adoption process for digital technology; (2) demonstrating that champions and a shared vision can both enable and constrain the adoption of digital technologies in crisis situations; (3) emphasizing the importance of individual members’ professional identities for determining adoption of digital technologies; and (4) reflecting on the conscious use of transformation practices, even in the ad hoc setting of adopting digital technology during a crisis.

Impacts of the Internet on Health Inequality and Healthcare Access: A Cross-Country Study

Access to information and resources through the Internet has become an increasingly critical aspect of contemporary life. Based on the WHO Health Equity Assessment Toolkit (HEAT) and cross-country panel data, this paper investigates the effect of Internet access on health inequality across different income groups. The results indicate that access to the Internet significantly improves the average health condition and alleviates health inequality. In addition, employing cross-country data from the Global Burden of Disease (GBD) database, this paper further examines the social and economic determinants of access to healthcare. Specifically, it is found that Internet access significantly facilitates healthcare access and mitigates the negative impact of income inequality on healthcare access. Considered together, these findings shed light on the importance of the Internet in reducing health inequality and improving healthcare access.

Meaningful use of a digital platform and structured telephone support to facilitate remote person-centred care - a mixed-method study on patient perspectives

Background

Process evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients’ experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients’ experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use.

Methods

Patients (n = 86) were recruited from the RCT PROTECT intervention group. A convergent mixed-method approach was implemented. Data were collected in parallel with the ongoing RCT via a survey, including ratings and written comments on meaningful or non-meaningful use. Also, interviews were performed with twelve purposefully selected participants. Descriptive statistics, logistic regression and content analysis were employed. Data sources were integrated in the results.

Results

Most participants rated the overall intervention as meaningful to use, with the telephone support rated as most meaningful. Interviews and written comments showed that patient ratings on meaningful use were explained by four categories: Not in need, Communication deficiency, Benefits in everyday life and A personal boost. Meaningful use of rating symptoms on the digital platform was predicted by living alone (adjusted odds ratio [aOR] = 2.8 P = .044). A diagnosis of chronic obstructive pulmonary disease (COPD) predicted meaningful use of digital platform direct messaging (aOR = 3.5, P = .045). Moreover, having access to direct-dial telephone contact explained meaningful use among participants with low ratings of technical competence (aOR = 3.6, P = .014).

Conclusions

The combined digital platform and structured telephone support could be helpful in identifying preventive actions to maintain health for people diagnosed with COPD and chronic heart failure but tends to be more meaningful for those diagnosed with COPD. Overall, lower adoption of the digital platform was seen compared to telephone support. Shortcomings were noted in the digital platform’s implementation that negatively influences experiences of meaningful use. When used, the intervention proved to be an easily applicable and valued tool to support preventive actions in a person-centred manner.

An Iterative and Collaborative End-to-End Methodology Applied to Digital Mental Health

Artificial intelligence (AI) algorithms together with advances in data storage have recently made it possible to better characterize, predict, prevent, and treat a range of psychiatric illnesses. Amid the rapidly growing number of biological devices and the exponential accumulation of data in the mental health sector, the upcoming years are facing a need to homogenize research and development processes in academia as well as in the private sector and to centralize data into federalizing platforms. This has become even more important in light of the current global pandemic. Here, we propose an end-to-end methodology that optimizes and homogenizes digital research processes. Each step of the process is elaborated from project conception to knowledge extraction, with a focus on data analysis. The methodology is based on iterative processes, thus allowing an adaptation to the rate at which digital technologies evolve. The methodology also advocates for interdisciplinary (from mathematics to psychology) and intersectoral (from academia to the industry) collaborations to merge the gap between fundamental and applied research. We also pinpoint the ethical challenges and technical and human biases (from data recorded to the end user) associated with digital mental health. In conclusion, our work provides guidelines for upcoming digital mental health studies, which will accompany the translation of fundamental mental health research to digital technologies.

Perspectives fondamentale, clinique et sociétale de l’utilisation des personnages virtuels en santé mentale

Avec l’attrait engendré par les avancées en informatique et en intelligence artificielle, les personnages virtuels (c.-à-d. personnages représentés numériquement d’apparence humaine ou non) sont pressentis comme de futurs prestataires de soins en santé mentale. À ce jour, l’utilisation principale de tels personnages est toutefois marginale et se limite à une aide complémentaire à la pratique des cliniciens. Des préoccupations liées à la sécurité et l’efficacité, ainsi qu’un manque de connaissances et de compétences peuvent expliquer cette discordance entre ce que certains s’imaginent être l’utilisation future (voire futuriste) des personnages virtuels et leur utilisation actuelle. Un aperçu des récentes données probantes contribuerait à réduire cette divergence et à mieux saisir les enjeux associés à leur utilisation plus répandue en santé mentale.

Objectif Cet article vise à informer tous les acteurs impliqués, dont les cliniciens, quant au potentiel des personnages virtuels en santé mentale, et de les sensibiliser aux enjeux associés à leur usage.

Méthode Une recension narrative de la littérature a été réalisée afin de synthétiser les informations obtenues de la recherche fondamentale et clinique, et de discuter des considérations sociétales.

Résultats Plusieurs caractéristiques des personnages virtuels provenant de la recherche fondamentale ont le potentiel d’influencer les interactions entre un patient et un clinicien. Elles peuvent être regroupées en deux grandes catégories : les caractéristiques liées à la perception (p. ex. réalisme) et celles liées à l’attribution spontanée d’une catégorie sociale au personnage virtuel par un observateur (p. ex. genre). Selon la recherche clinique, plusieurs interventions ou évaluations utilisant des personnages virtuels ont montré divers degrés d’efficacité en santé mentale, et certains éléments de la relation thérapeutique (p. ex. alliance et empathie) peuvent d’ailleurs être présents lors d’une relation avec un personnage virtuel. De multiples enjeux socioéconomiques et éthiques doivent aussi être discutés en vue d’un développement et d’une utilisation plus accrue qui soient responsables et éthiques. Bien que l’accessibilité et la disponibilité des personnages virtuels constituent un avantage indéniable pour l’offre de services en santé mentale, certaines iniquités demeurent. L’accumulation de données biométriques (p. ex. rythme cardiaque) a également le potentiel d’enrichir le travail des cliniciens, mais aussi de mener au développement de personnages virtuels autonomes à l’aide de l’intelligence artificielle, ce qui pourrait conduire à certains dérapages (p. ex. erreurs de décision clinique). Quelques pistes de recommandations visant à éviter ces effets indésirables sont présentées.

Conclusion L’emploi des personnages virtuels sera de plus en plus répandu en santé mentale en raison de leurs avantages prometteurs. Ainsi, il est souhaitable que tous les acteurs impliqués s’informent sur leur usage dans ce contexte, se sensibilisent aux enjeux spécifiques, participent activement aux discussions quant à leur développement et adoptent des recommandations uniformes en vue d’un usage sécuritaire et éthique en santé mentale.

Patient Education and Engagement through Social Media

This review addresses the demographics of social media users and their relative health literacy. Means of overcoming health inequities via social media and the role of social media in patient education and engagement are explored. This review discusses forms of appropriate patient engagement, including the pitfalls of social media use.

Attitudes and Perceptions Toward Voice-Operated Smart Speakers Among Low-Income Senior Housing Residents: Comparison of Pre- and Post-Installation Surveys

Smart speakers have the potential to support independent living and wellness among low-income senior housing (LISH) residents. The aim of this study was to examine and compare LISH residents’ attitudes and perceptions toward smart speakers at two time points: before and after technology use (N = 47). A descriptive survey was administered to ask questions about hedonic motivation, perceived ease of use, self-efficacy, perceived usefulness of some potential or existing smart speaker features, cost, and privacy. Participants were initially favorable toward using a smart speaker and its digital agent (e.g., Alexa) as a daily assistant and wellness tool. They especially liked the smart speaker’s potential functionality of detecting harmful events and notifying someone to receive immediate help. The comparison of pre- and post-use responses revealed non-significant declines in most items, with the exception of willingness to use Alexa as a reminder system (p < .01), asking Alexa for help (p < .01), and asking for help in using Alexa (p < .01). This finding may reflect confusion or frustration with the device among participants. We conclude with recommendations for the design of smart speakers specifically tailored to the needs of LISH residents.

Feasibility of Delivering a Tailored Intervention for Advance Care Planning in Primary Care Practice

BACKGROUND/OBJECTIVES

To determine the feasibility of conducting a cluster randomized controlled trial providing individualized feedback reports to increase advance care planning (ACP) engagement in the primary care setting.

DESIGN

Pilot cluster randomized controlled trial.

SETTING

Two primary care practices selected for geographic colocation.

PARTICIPANTS

Adults aged 55 years and older.

INTERVENTION

Brief assessment of readiness to engage in (stage of change for) three ACP behaviors (healthcare agent assignment, communication with agent about quality vs quantity of life, and living will completion) generating an individualized feedback report, plus a stage-matched brochure.

MEASURES

Patient recruitment and retention, intervention delivery, baseline characteristics, and stage of change movement.

RESULTS

Recruitment rates differed by practice. Several baseline sociodemographic characteristics differed between the 38 intervention and 41 control participants, including employment status, education, and communication with healthcare agent. Feedback was successfully delivered to all intervention participants, and over 90% of participants completed a 2-month follow-up. More intervention participants demonstrated progression in readiness than did control participants, without testing for statistical significance.

CONCLUSIONS

This pilot demonstrates opportunities and challenges of performing a clustered randomized controlled trial in primary care practices. Differences in the two practice populations highlight the challenges of matching sites. There was a signal for behavior change in the intervention group. J Am Geriatr Soc 67:1917-1921, 2019.

The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity

Background and Objectives

Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use.

Design and Methods

Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes.

Results

Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health.

Discussion and Implications

Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.

Which eHealth interventions are most effective for smoking cessation? A systematic review

PURPOSE

To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking.

METHODS

Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included "smoking cessation", "eHealth/mHealth" and "electronic technology" to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel-Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560.

RESULTS

The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7-2.03), and RR 1.71 (95% CI 1.35-2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54-2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17-1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11-1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts.

CONCLUSIONS

There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.

eHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity

AIMS AND OBJECTIVES

To explore whether and how eHealth resources targeted to families during the perinatal period effectively reach a diverse population or further oppress marginalised groups.

BACKGROUND

eHealth is often intended to reach a broad population, thus health content must be relatively generalised which limits the ability to tailor health education and interventions to individual needs. Generalisation of health information has historically represented a hegemonic depiction of the health consumer, especially within the perinatal period, often disregarding the diversity that exists in the world and perpetuating heteronormative constructs within healthcare systems as a result.

DESIGN

A critical review of the literature regarding perinatal eHealth resources was conducted using a feminist poststructuralist approach for analysis. Included literature addresses the development, implementation and/or evaluation of perinatal eHealth resources.

DISCUSSION

This approach uncovered hegemonic discourses related to the current state of perinatal eHealth resources. Nurses and midwives have the unique advantage of interacting and understanding diverse populations. Thus, nurses and midwives are integral to the development, implementation and evaluation of eHealth resources to reduce social health inequity.

RELEVANCE TO CLINICAL PRACTICE

This paper acts as an exemplar on how to apply feminist poststructuralism to highlight inequities that exist and identifies strategies for nurses and midwives to become involved in the development of eHealth resources or advocate for greater visibility within current resources.

Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

BACKGROUND

Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts.

METHODS

PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 - 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results.

RESULTS

Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature.

CONCLUSION

This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews CRD42015029846.

Internet use by international graduate students in the USA seeking health information

Purpose

– Considering that the internet is a useful source for health information, especially by foreign-born students, this exploratory study aimed to investigate international graduate students' internet use in the context of seeking health information.

Design/methodology/approach

– Data were collected from 54 Korean graduate students in the USA using a survey questionnaire. Quantitative analysis using SPSS was conducted to describe Korean graduate students' internet use for seeking health information and to identify factors that possibly influence their health-information seeking activities.

Findings

– The survey participants preferred Korean resources because of language problems and the internet was the primary source. They reported difficulties in identifying appropriate health information sources and understanding medical information. They often sought online health information to solve their or their family's current health problems and consequently, personal relevance was regarded as an important evaluation criterion, as was accuracy.

Research limitations/implications

– By looking at an understudied user group, this study leads to a better understanding of the patterns of internet use for seeking health information among a specific ethnic group. The findings of this study demonstrate the needs of health education materials and guidelines that introduce credible health information sources and medical information for Korean graduate students and their families.

Originality/value

– Despite the increasing number of international students in the USA, there is a lack of research on the health information-seeking behavior of international students. The findings of this study will help health education specialists and health information professionals provide international students with necessary health information.

Older adult experience of online diagnosis: results from a scenario-based think-aloud protocol

Background

Searching for online information to interpret symptoms is an increasingly prevalent activity among patients, even among older adults. As older adults typically have complex health care needs, their risk of misinterpreting symptoms via online self-diagnosis may be greater. However, limited research has been conducted with older adults in the areas of symptom interpretation and human-computer interaction.

Objective

The intent of the study was to describe the processes that a sample of older adults may use to diagnose symptoms online as well as the processes that predict accurate diagnosis.

Methods

We conducted a series of “think-aloud” protocols with 79 adults aged 50 years or older. Participants received one of two vignettes that depicted symptoms of illness. Participants talked out loud about their thoughts and actions while attempting to diagnose the symptoms with and without the help of common Internet tools (Google and WebMD’s Symptom Checker). Think-aloud content was categorized using an adapted Q-sort and general inductive approach. We then compared the think-aloud content of participants who were accurate in their diagnosis with those who were not.

Results

Nineteen descriptive codes were identified from the think-aloud content. The codes touched upon Web navigation, attempts to organize and evaluate online health information, and strategies to diagnose symptoms. Participants most frequently relied on a strategy where they reviewed and then rejected the online diagnoses if they contained additional symptoms than those that were depicted in the vignette. Finally, participants who were inaccurate in their diagnosis reported being confused by the diagnosis task, lacking confidence in their diagnosis, and using their past experiences with illness to guide diagnosis more frequently than those participants who accurately diagnosed the symptoms.

Conclusions

Older adult participants tended to rely on matching strategies to interpret symptoms, but many still utilized existing medical knowledge and previous illness experiences as a guide for diagnosis. Many participants also had difficulty navigating the Internet tools, which suggests an increased need for navigation aids in Web design. Furthermore, participants who were inaccurate in their diagnosis had more difficulty with the Internet tools and confusion with the task than those who were accurate. Future work in this area may want to utilize additional study design such as eye-tracking to further understand the coordination between Web navigation, online symptom information processing, and diagnostic strategies.

The views of health-care personnel about video consultation prior to implementation in primary health care in rural areas

Aim

The aim of this study was to describe the views of health-care personnel about video consultation (VC) prior to implementation in primary health care in rural areas.

Background

For people living in rural areas, it is often a long distance to specialist care, and VC could be an opportunity for increased access to care. Therefore, this study was to investigate what views primary health-care personnel had on VC as a working method in the distance between primary and specialist care. The development of technology in society and the introduction of technology in health care mean that the working methods must be adapted to a new approach. It is therefore important that in the initial phase of the introduction of new working methods to capture the personnel views regarding this.

Methods

Focus group (FG) discussions with health-care personnel from five primary health-care centres in northern Sweden. The transcribed FG discussions were analysed with qualitative content analysis.

Findings

The analysis revealed four main categories: a patient-centred VC; the importance of evaluating costs and resources; new technology in daily work; technology gives new possibilities in future health care.

Type 1 diabetes eHealth psychoeducation: youth recruitment, participation, and satisfaction

Background

The Internet and other eHealth technologies offer a platform for improving the dissemination and accessibility of psychoeducational programs for youth with chronic illness. However, little is known about the recruitment process and yield of diverse samples in Internet research with youth who have a chronic illness.

Objective

The purpose of this study was to compare the demographic and clinical characteristics of youth with Type 1 diabetes on recruitment, participation, and satisfaction with 2 eHealth psychoeducational programs.

Methods

Youth with Type 1 diabetes from 4 sites in the United States were invited to participate (N=510) with 320 eligible youth consenting (mean age=12.3, SD 1.1; 55.3% female; 65.2% white; and mean A1C=8.3, SD 1.5). Data for this secondary analysis included demographic information (age, race/ethnicity, and income), depressive symptoms, and recruitment rates, including those who refused at point of contact (22.0%), passive refusers who consented but did not participate (15.3%), and those who enrolled (62.7%). Participation (80% lessons completed) and a satisfaction survey (ie, how helpful, enjoyable) were also analyzed. Chi-square or analysis of variance (ANOVA) analyses were used.

Results

There were significant differences in recruitment rates by income and race/ethnicity such that black, Hispanic, or mixed race/ethnicity and low-income youth were more likely to refuse passively compared to white and higher-income youth who were more likely to enroll (P<.001). Participation in program sessions was high, with 78.1% of youth completing at least 4 of 5 sessions. There were no significant differences in participation by program, age, gender, or race/ethnicity. Low-income youth were less likely to participate (P=.002). Satisfaction in both programs was also high (3.9 of 5). There were significant gender, race/ethnicity, and income differences, in that girls (P=.001), black, Hispanic, or mixed race/ethnicity youth (P=.02), and low-income youth (P=.02) reported higher satisfaction. There were no differences in satisfaction by program or age.

Conclusions

Results indicate that black, Hispanic, or mixed race/ethnicity youth and low-income youth with Type 1 diabetes are less likely to enroll in Internet-based research than white and higher-income youth; thus, creative recruitment approaches are needed. Low-income youth were less likely to participate, possibly due to access. However, once enrolled, youth of diverse race/ethnicity and low-income youth with Type 1 diabetes were as highly satisfied with the eHealth programs as white youth and those with higher income. Results suggest that eHealth programs have the potential to reach diverse youth and be appealing to them.

Costs and difficulties of recruiting patients to provide e-health support: pilot study in one primary care trust

Background

Better use of e-health services by patients could improve outcomes and reduce costs but there are concerns about inequalities of access. Previous research in outpatients suggested that anonymous personal email support may help patients with long term conditions to use e-health, but recruiting earlier in their 'journey' may benefit patients more. This pilot study explored the feasibility and cost of recruiting patients for an e-health intervention in one primary care trust.

Methods

The sample comprised 46 practices with total patient population of 250,000. We approached all practices using various methods, seeking collaboration to recruit patients via methods agreed with each practice. A detailed research diary was kept of time spent recruiting practices and patients. Researcher time was used to estimate costs. Patients who consented to participate were offered email support for their use of the Internet for health.

Results

Eighteen practices agreed to take part; we recruited 27 patients, most (23/27) from five practices. Practices agreed to recruit patients for an e-health intervention via waiting room leaflets (16), posters (16), practice nurses (15), doctors giving patients leaflets (5), a study website link (7), inclusion in planned mailshots (2), and a special mailshot to patients selected from practice computers (1). After low recruitment response we also recruited directly in five practices through research assistants giving leaflets to patients in waiting rooms. Ten practices recruited no patients. Those practices that were more difficult to recruit were less likely to recruit patients. Leaving leaflets for practice staff to distribute and placing posters in the practice were not effective in recruiting patients. Leaflets handed out by practice nurses and website links were more successful. The practice with lowest costs per patient recruited (£70) used a special mailshot to selected patients.

Conclusion

Recruitment via general practice was not successful and was therefore expensive. Direct to consumer methods and recruitment of patients in outpatients to offer email support may be more cost effective. If recruitment in general practice is required, contacting practices by letter and email, not following up non-responding practices, and recruiting patients with selected conditions by special mailshot may be the most cost-effective approach.

Analysis of use of technological support and information content by patients with chronic obstructive pulmonary disease

OBJECTIVE: To identify types of technological support and information content utilized to promote therapeutic regimen management for patients with chronic obstructive pulmonary disease (COPD). METHODS: In this study, which had a quantitative, exploratory, descriptive, and transversal approach, the authors used a questionnaire organized on the basis of a literature review and two models: One of acceptance of the technology and a theoretical one of the determinants for patients' perceived ease of its use. RESULTS: The patients with COPD reported need for more information related to their daily activities and breathing exercises. Patients who had higher literacy and higher technological literacy reported that web-based technologies were more useful. Those who had lower literacy and lower technological literacy reported higher usefulness, intention and ease of use of mobile phone books, and videos in the access to information. CONCLUSION: Information resources may use any technological support, provided information is available according to the literacy and technological literacy of the patients and tailored to their needs.

A framework for characterizing eHealth literacy demands and barriers

BACKGROUND

Consumer eHealth interventions are of a growing importance in the individual management of health and health behaviors. However, a range of access, resources, and skills barriers prevent health care consumers from fully engaging in and benefiting from the spectrum of eHealth interventions. Consumers may engage in a range of eHealth tasks, such as participating in health discussion forums and entering information into a personal health record. eHealth literacy names a set of skills and knowledge that are essential for productive interactions with technology-based health tools, such as proficiency in information retrieval strategies, and communicating health concepts effectively.

OBJECTIVE

We propose a theoretical and methodological framework for characterizing complexity of eHealth tasks, which can be used to diagnose and describe literacy barriers and inform the development of solution strategies.

METHODS

We adapted and integrated two existing theoretical models relevant to the analysis of eHealth literacy into a single framework to systematically categorize and describe task demands and user performance on tasks needed by health care consumers in the information age. The method derived from the framework is applied to (1) code task demands using a cognitive task analysis, and (2) code user performance on tasks. The framework and method are applied to the analysis of a Web-based consumer eHealth task with information-seeking and decision-making demands. We present the results from the in-depth analysis of the task performance of a single user as well as of 20 users on the same task to illustrate both the detailed analysis and the aggregate measures obtained and potential analyses that can be performed using this method.

RESULTS

The analysis shows that the framework can be used to classify task demands as well as the barriers encountered in user performance of the tasks. Our approach can be used to (1) characterize the challenges confronted by participants in performing the tasks, (2) determine the extent to which application of the framework to the cognitive task analysis can predict and explain the problems encountered by participants, and (3) inform revisions to the framework to increase accuracy of predictions.

CONCLUSIONS

The results of this illustrative application suggest that the framework is useful for characterizing task complexity and for diagnosing and explaining barriers encountered in task completion. The framework and analytic approach can be a potentially powerful generative research platform to inform development of rigorous eHealth examination and design instruments, such as to assess eHealth competence, to design and evaluate consumer eHealth tools, and to develop an eHealth curriculum.

Using Campinha-Bacote's process of cultural competence model to examine the relationship between health literacy and cultural competence

AIM

This paper presents a discussion of the relation between health literacy and cultural competence in nursing practice.

BACKGROUND

Cultural competence involves understanding values, beliefs, traditions and customs of diverse groups. Health literacy is the degree to which individuals can obtain, process, and understand health information to make healthcare decisions. Cultural competence and health literacy are directly related to healthcare. Campinha-Bacote's Process of Cultural Competence Model can assist nurses in addressing cultural issues associated with a person's low health literacy. Data sources.  Literature searches were performed using CINAHL, ERIC, Academic Search Premier, Health Source Nursing, MasterFILE Premier and Academic OneFile. All articles reviewed were published in peer reviewed journals in English from the 1990s to the present and were relevant to health literacy and cultural competence in nursing. Books and other supporting scholarly sources were also used. Discussion.  Health literacy and cultural competence are related. Applying Campinha-Bacote's Process of Cultural Competence Model using the mnemonic ASKED (awareness, skills, knowledge, encounters and desire) involves incorporating culturally appropriate assessments and disseminating healthcare information at lower literacy levels and is needed for nurses to provide care for ethnic minorities and diverse populations. Implications for nursing.  Health literacy should be assessed and care should be based on a client's level of understanding and cultural values and norms.

CONCLUSION

Nurses can care for ethnic minorities by using resources that target health literacy deficits and by increasing their own cultural competence.

Professional practice and innovation: Chronic disease, geographic location and socioeconomic disadvantage as obstacles to equitable access to e-health

Despite recent public attention to e-health as a solution to rising healthcare costs and an ageing population, there have been relatively few studies examining the geographical pattern of e-health usage. This paper argues for an equitable approach to e-health and attention to the way in which e-health initiatives can produce locational health inequalities, particularly in socioeconomically disadvantaged areas. In this paper, we use a case study to demonstrate geographical variation in Internet accessibility, Internet status and prevalence of chronic diseases within a small district. There are significant disparities in access to health information within socioeconomically disadvantaged areas. The most vulnerable people in these areas are likely to have limited availability of, or access to Internet healthcare resources. They are also more likely to have complex chronic diseases and, therefore, be in greatest need of these resources. This case study demonstrates the importance of an equitable approach to e-health information technologies and telecommunications infrastructure.

An assessment of American Indian women's mammography experiences

BACKGROUND

Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey.

METHODS AND DESIGN

The three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements.

DISCUSSION

This formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.

Acceptability of the talking touchscreen for health literacy assessment

Self-administration of a multimedia health literacy measure in clinic settings is a novel concept. Demonstrated ease of use and acceptability will help predicate the future value of this strategy. We previously demonstrated the acceptability of a "Talking Touchscreen" for health status assessment. For this study, we adapted the touchscreen for self-administration of a new health literacy measure. Primary care patients (n = 610) in clinics for underserved populations completed health status and health literacy questions on the Talking Touchscreen and participated in an interview. Participants were 51% women, 10% age 60+, 67% African American, 18% without a high school education, and 14% without any prior computer experience. The majority (93%) had no difficulty using the touchscreen, including those who were computer-naive (87%). Most rated the screen design as very good or excellent (72%), including computer-naive patients (71%) and older patients (75%). Acceptability of the touchscreen did not differ by health literacy level. The Talking Touchscreen was easy to use and acceptable for self-administration of a new health literacy measure. Self-administration should reduce staff burden and costs, interview bias, and feelings of embarrassment by those with lower literacy. Tools like the Talking Touchscreen may increase exposure of underserved populations to new technologies.

Disparities in long-term care: building equity into market-based reforms

A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be related to racial and socioeconomic segregation of long-term care facilities as opposed to within-provider discrimination. Market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.

Rural eHealth nutrition education for limited-income families: an iterative and user-centered design approach

Background

Adult women living in rural areas have high rates of obesity. Although rural populations have been deemed hard to reach, Internet-based programming is becoming a viable strategy as rural Internet access increases. However, when people are able to get online, they may not find information designed for them and their needs, especially harder to reach populations. This results in a “content gap” for many users.

Objective

User-centered design is a methodology that can be used to create appropriate online materials. This research was conducted to apply a user-centered approach to the design and development of a health promotion website for low-income mothers living in rural Maryland.

Methods

Three iterative rounds of concept testing were conducted to (1) identify the name and content needs of the site and assess concerns about registering on a health-related website; (2) determine the tone and look of the website and confirm content and functionality; and (3) determine usability and acceptability. The first two rounds involved focus group and small group discussions, and the third round involved usability testing with individual women as they used the prototype system.

Results

The formative research revealed that women with limited incomes were enthusiastic about a website providing nutrition and physical activity information targeted to their incomes and tailored to their personal goals and needs. Other priority content areas identified were budgeting, local resources and information, and content that could be used with their children. Women were able to use the prototype system effectively.

Conclusions

This research demonstrated that user-centered design strategies can help close the “content gap” for at-risk audiences.

Representations of heart failure in Internet patient information

AIM

This paper is a report of a study which examined representations of heart failure in Internet patient information.

BACKGROUND

The Internet is a popular tool for sourcing health information and has been shown to benefit people with chronic conditions. Nurses as users and producers of Internet health information need to be critical of the information they provide and how this information is portrayed, to support patient knowledge development and decision-making.

METHOD

A critical discourse analysis approach was used to examine representations of heart failure in a range of Internet texts. Data were collected from eight websites over 5 days in July 2006.

FINDINGS

The two major discursive representations evident in the heart failure texts were labelled 'living with heart failure' and 'biomedical' discourses. While both discourses were evident in all of the Internet sites, most sites privileged the biomedical discourse. Absences from the Internet information included the visibility and role of nurses along with emotional and spiritual dimensions of heart failure.

CONCLUSION

Nurses should take individual needs into consideration and be able to critique websites before suggesting appropriate sites to patients. Nurses and consumers can enhance the quality of websites by becoming involved in their development to ensure that all factors that affect health are included, such as the emotional and spiritual aspects of living with heart failure and not just topics that are important within a biomedical view of health.

Web-based care for adults with type 2 diabetes

Telediabetes is a form of telemedicine used to provide education and clinical care to persons living with diabetes. Web-based delivery modes using cellular telephones and/or computers are of particular interest as they are becoming increasingly available. A review of current research on the practice of web-based telediabetes to adults with type 2 diabetes was conducted to determine the potential impact of this delivery mode on professional dietetics practice. Nine articles meeting the inclusion criteria were identified, critiqued, and summarized. Studies varied greatly in breadth and scope; consequently, few general conclusions could be drawn about telediabetes programs. Telediabetes programs were discussed in the context of soundness, effectiveness, cost-effectiveness, and practical characteristics. Trends indicated a promising future for telediabetes. Dietitians should view telemedicine as a viable tool for service delivery and increase their knowledge, competency, advocacy, and research efforts in this area.

Hispanics' use of Internet health information: an exploratory study

PURPOSE

The research examined use of the Internet to seek health information among Hispanics in the United States.

METHODS

A secondary analysis used the Impact of the Internet and Advertising on Patients and Physicians, 2000-2001, survey data. Pearson's chi(2) test, multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and independent samples t tests were conducted to test for relationships and differences between facets of Hispanic and non-Hispanic white online health information seeking.

RESULTS

Findings indicated lower Internet health information seeking among Hispanics (28.9%, n=72) than non-Hispanic whites (35.6%, n=883). On a scale of 1 (strongly agree) to 4 (strongly disagree), Hispanics were likely to agree that Internet health information improves understanding of medical conditions and treatments (M=1.65), gives patients confidence to talk to doctors about health concerns (M=1.67), and helps patients get treatment they would not otherwise receive (M=2.23). Hispanics viewed their skills in assessing Internet health information as good. Overall ratings were also positive for items related to sharing Internet health information with a doctor. Conflicting with these findings, Hispanics (M=3.33) and non-Hispanic whites (M=3.46) reported that physician-patient relationships worsened as a result of bringing online health information to a visit (scale 1=a lot better to 5=a lot worse).

CONCLUSION

This study provides further evidence of differences in Internet health information seeking among Hispanics and non-Hispanic whites. Cultural discordance may be a possible explanation for Hispanics' view that the Internet negatively impacts physician-patient relationships. Strategies to increase Hispanics' access to Internet health information will likely help them become empowered and educated consumers, potentially having a favorable impact on health outcomes.

User acceptance of HIV TIDES--Tailored Interventions for Management of Depressive Symptoms in persons living with HIV/AIDS

OBJECTIVE

The Tailored Interventions for management of DEpressive Symptoms (TIDES) program was designed based on social cognitive theory to provide tailored, computer-based education on key elements and self-care strategies for depressive symptoms in persons living with HIV/AIDS (PLWHAs).

DESIGN AND MEASUREMENT

Based on an extension of the Technology Acceptance Model (TAM), a cross-sectional design was used to assess the acceptance of the HIV TIDES prototype and explore the relationships among system acceptance factors proposed in the conceptual model.

RESULTS

Thirty-two PLWHAs were recruited from HIV/AIDS clinics. The majority were African American (68.8%), male (65.6%), with high school or lower education (68.7%), and in their 40s (62.5%). PARTICIPANTS spent an average of 10.4 minutes (SD = 5.6) using HIV TIDES. The PLWHAs rated the system as easy to use (Mean = 9.61, SD = 0.76) and useful (Mean = 9.50, SD = 1.16). The high ratings of behavior intention to use (Mean = 9.47, SD = 1.24) suggest that HIV TIDES has the potential to be accepted and used by PLWHAs. Four factors were positively correlated with behavioral intention to use: perceived usefulness (r = 0.61), perceived ease of use (r = 0.61), internal control (r = 0.59), and external control (r = 0.46). Computer anxiety (r = -0.80), tailoring path (r = 0-.35) and depressive symptoms (r = -0.49) were negatively correlated with behavioral intention to use.

CONCLUSION

The results of this study provide evidence of the acceptability of HIV TIDES by PLWHAs. Individuals are expected to be empowered through participating in the interactive process to generate their self-care plan. HIV TIDES enables information sharing about depression prevention and health promotion and has the potential to reframe the traditional patient-provider relationship.

Use of a Telehealth Device to Deliver a Symptom Management Intervention to Cardiac Surgical Patients

A variety of approaches can provide cardiac patients with needed follow-up care. However, with the explosion of telehealth capabilities, clinicians are more ready to explore other methods to integrate the use of telehealth devices into the delivery of effective nursing interventions. This article summarizes the development of a symptom management intervention for coronary artery bypass graft patients using the Health Buddy to deliver a nursing intervention in the early recovery period after hospital discharge. Considerations used to design the symptom management intervention and selection of this telehealth modality are discussed. This overview can help clinicians and researchers gain perspective on how to evaluate telehealth modalities to aid in the delivery of interventions for cardiac and other clinical populations.

Using Computers to Improve the Psychosocial Care of Implantable Cardioverter Defibrillator Recipients

Person-to-person psychosocial interventions (e.g., psychological, social) enhance the well-being of implantable cardioverter defibrillator (ICD) patients. Computerized care, though, represents an opportunity to further capitalize on techniques that have already been deemed effective. This includes the provision of tailored, effective patient education; reducing device-specific anxiety; and enhancing social support networks. The aim of this paper is to identify the ways in which computerized psychosocial care could potentially enhance the well-being of ICD recipients. For example, computers may be particularly adept at providing patient education due to the ease in which content can be adapted to meet patient needs. Further, evidenced-based treatments for anxiety and depression (e.g., cognitive behavioral therapy) have demonstrated good applicability to computerized formats. Social support can also be provided online in the form of bulletin boards, email list-servs, or structured online support groups. Despite the existence of some limitations, the use of computers in affecting psychosocial outcomes in implantable defibrillator recipients warrants greater attention.

Internet uses for health information seeking: A literature review

BACKGROUND

With the widespread dissemination of the Internet throughout the world of health, it would be relevant to report on current knowledge about health information search on the Internet from the consumers' standpoint.

METHODS

We conducted a bibliographical research over the past five years and distinguished between international and French studies.

RESULTS

For a long time, the (mostly US) studies have been merely descriptive. The studies highlight that the factors associated with health searches on the Internet are similar to the factors underlying the digital divide. Consumer searches are deemed efficient although search skills are comparatively below standard. Attempts are underway to set up tools, circulate them widely, and ensure better quality information on the Internet. However, comprehension and literacy are still issues in some social groups. Regarding the impact on consumer health per se, a (positive) effect of the Internet seems to emerge but research should be continued.

CONCLUSION

Many of the behaviors, uses or limits addressed in this paper pertain to any information search on the Internet but other problems or differences also occur in the specific area of health. Longitudinal investigations are needed, specifically to gain deeper insight into the impacts we have addressed, while rolling out a comprehensive approach to the temporal evolution of user practices and experiences. Specifically, the central issue is still to determine how (and for whom) the Internet alters information search behaviors and, in fine, to what extent this affects health behaviors and the recourse to healthcare.

Reducing disparities in the access and use of Internet health information. a discussion paper

Internet health information is rated highly by users and is used to compensate for gaps in health information provided by health professionals. Greater understanding of health issues and changes to personal health management has been reported as a consequence of Internet use. However, there are significant disparities in the access and use of Internet health information linked to income, education and ethnicity. In this paper a case is presented that on-line health information particularly benefits the already privileged in terms of health care; well-educated people with access to economic resources. Several intervention points are suggested to improve Internet health information accessibility and use for all population groups. Interventions at an institutional level include improving equity of Internet access through the provision of free services at strategic sites and improving the readability and cultural acceptability of health information. Individually focused interventions involve skill development to enable effective navigation of Internet sites, identification of patient and families' information needs and support to develop evaluation skills. The effectiveness of these interventions in reducing disparities is reliant on nurses and other health professionals' expertise in accessing, evaluating and using Internet health information in their clinical practise. On-line health information is a powerful medium for quick and dynamic knowledge distribution. The challenge for nurses and other health professionals is directing that knowledge to the groups most disadvantaged in the current health care systems, with an agenda of reducing inequalities in access to health information.

What is eHealth (6): perspectives on the evolution of eHealth research

BACKGROUND

The field of eHealth holds promise for supporting and enabling health behavior change and the prevention and management of chronic disease.

OBJECTIVE

In order to establish areas of congruence and controversy among contributors to the early development, evaluation, and dissemination of eHealth applications, as well as the desire to inform an evaluation research funding agenda, 38 semistructured, qualitative interviews were conducted among stakeholders in eHealth between May 2002 and September 2003.

METHODS

Participants were asked about their perspectives on the credibility, value, and future potential of information technology for health behavior change and chronic disease management. Interviews were coded and analyzed for emergent themes using qualitative methods.

RESULTS

Consistent themes were identified across stakeholder groups, with slight differences in emphasis. These topics included the following: (1) consensus and standardization-most stakeholders expressed a strong desire for a more coordinated, rigorous effort to define and integrate the field; (2) evaluation methods and challenges-demonstrating outcomes is required to establish eHealth quality and efficacy, but stakeholders were not satisfied with the sensitivity, validity, and reliability of existing outcome measures; (3) quality, value, and future potential-the intersection between eHealth's potential cost-effectiveness, efficiency, and improved clinical status among users generated a high degree of interest; and (4) health disparities-many stakeholders contended that traditionally underserved populations will particularly benefit from eHealth applications, although others argued that the underserved are also disadvantaged in terms of access to technology.

CONCLUSIONS

Recommendations included the need for improvement and formalization of development and evaluation standards across private and public sectors, additional research on the technology needs and preferences of traditionally underserved populations, and long-term epidemiologic studies of the impact of eHealth on outcomes and cost-effectiveness.

A 10-year retrospective of research in new technologies for health communication

The use of new technologies is growing in virtually all areas of health communication, including consumer, patient, and provider education; decision and social support; health promotion; knowledge transfer; and the delivery of services. Many applications have the potential to make major contributions in meeting the needs of an unhealthy and aging population. Key questions confronting health communication research reflect long-standing concerns about effects of new technology on health knowledge, health behavior, health delivery, and health outcomes. A review of the literature provides useful insights about how technology has been used to communicate health messages and their associated outcomes. Focus is placed on effective health communication, lessons learned, and implications for the future. During the next 10 years, the application of new technologies in health communication will be enriched by a tradition that has evolved to reflect a more dynamic connection between health users and providers. Future applications have the potential to provide cost-effective communications tailored to large numbers of individuals and achieve positive health outcomes. Consequently, we should strive to answer research questions about tailoring communication content, the channel used to deliver the message, and evaluation models that are best suited for examining outcomes of multicomponent tailored, technology-based communication.