Assessment of Electronic Health Literacy among Patients in an Urban, Academic Radiation Therapy Department

PURPOSE/OBJECTIVE(S)

The COVID-19 pandemic dramatically affected health outcomes and healthcare access, especially with the abrupt transition to virtual care. Cancer patients in the New York City borough of the Bronx, a potentially marginalized community with high rates of poverty and non-English speakers, may be particularly vulnerable to healthcare disparities, given their advanced age and possible difficulty navigating telemedicine appointments due to decreased electronic health literacy (EHL). We investigated EHL levels using both subjective and objective measures and associated predictors of EHL in patients within an academic, urban radiation oncology department.

MATERIALS/METHODS

We conducted a prospective IRB-approved study of patients aged ≥18 presenting for care in our department. Patients' internet access and established habits were surveyed via Health Information National Trends Survey (HINTS). Subjective EHL, self-reported comfort using the internet for health information, was assessed via the eHealth Literacy Scale (eHEALS), which calculates a score by adding participants' answers for 8 questions (each on a 1 to 5-point Likert scale). Subjective EHL was categorized as low (8-23), moderate (24-31), or good (32-40). Objective EHL was determined by the eHealth Literacy Objective Scale (eHeLiOS), which tests responses to 9 common scenarios on gathering and assessing electronic health information via multiple-choice questions. The numbers of correct answers were totaled and categorized into low (1-4), moderate (5-7), or good (8-9) EHL.

RESULTS

Patients were enrolled between December 2020 and December 2022. 56 patients completed the subjective eHEALS assessment, while 49 completed the eHeLiOS objective test. 52% and 27% of patients identified as Black and Hispanic, respectively; 66% were male, and the median age was 67 (range 28-86). 76% reported accessing the internet regularly, of which 92% reported doing so via broadband network. The prevalence of good EHL was 10% using objective and 29% using subjective surveys. Using a proportional odds logistic model, only age was associated with EHL. For every increased year of age, there was an 11% decrease in objective (OR 0.89, p = 0.02) and 5% decrease in subjective (OR 0.95, p = 0.08) EHL odds, respectively. Gender, race/ethnicity, income, insurance, and employment status were not significantly associated with EHL.

CONCLUSION

Few study patients, who represent an older and potentially marginalized population, showed good EHL levels; more perceived good EHL via subjective testing than we observed using our objective measure. These data suggest implementation of an objective EHL assessment would aid in identifying patients who may benefit from learning activities to improve EHL and support to navigate telehealth visits effectively. Further research is needed to optimize telemedicine strategies for older cancer patients with low EHL.

Ex-ante evaluation of promising soybean innovations for sub-Saharan Africa

This study undertakes an ex-ante evaluation of the effects of alternative technology and policy options on soybean supply and demand in sub-Saharan Africa (SSA) to 2050. Current soybean consumption in SSA is dominated by cooking oil followed by soybean cake used as animal feed. Due to weak processing sectors and low soybean yields, the region is currently importing about 70% of its consumption requirements. Based on the results from a geospatial bio-economic modeling framework, soybean consumption in SSA is projected to more than double by 2050 compared to 2010 due in part to a rising population and rising incomes. On the other hand, supply from domestic production is projected to increase by 80% over the same period. Hence, by 2050, net imports into SSA would be nearly 4 times higher than supply from domestic production. Under a future drier climate, some of the production gains achieved through soybean research and extension would be lost and this would further worsen the soybean demand gap in SSA relative to the baseline. This study shows that relying on conventional breeding alone to increase soybean yields in SSA would not be enough to substantially reduce the future demand gap. A combination of promising innovations affecting the soybean value chain across SSA would be needed to close the soybean demand gap in SSA by 2050 under a drier future climate.

Looking back and moving forward: 50 years of soil and soil fertility management research in sub-Saharan Africa

Low and declining soil fertility has been recognized for a long time as a major impediment to intensifying agriculture in sub-Saharan Africa (SSA). Consequently, from the inception of international agricultural research, centres operating in SSA have had a research programme focusing on soil and soil fertility management, including the International Institute of Tropical Agriculture (IITA). The scope, content, and approaches of soil and soil fertility management research have changed over the past decades in response to lessons learnt and internal and external drivers and this paper uses IITA as a case study to document and analyse the consequences of strategic decisions taken on technology development, validation, and ultimately uptake by smallholder farmers in SSA. After an initial section describing the external environment within which soil and soil fertility management research is operating, various dimensions of this research area are covered: (i) 'strategic research', 'Research for Development', partnerships, and balancing acts, (ii) changing role of characterization due to the expansion in geographical scope and shift from soils to farms and livelihoods, (iii) technology development: changes in vision, content, and scale of intervention, (iv) technology validation and delivery to farming communities, and (v) impact and feedback to the technology development and validation process. Each of the above sections follows a chronological approach, covering the last five decades (from the late 1960s till today). The paper ends with a number of lessons learnt which could be considered for future initiatives aiming at developing and delivering improved soil and soil fertility management practices to smallholder farming communities in SSA.

Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015

Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.

Does a Post-take Ward Round Proforma Lead to Sustainable Improvements in Quality of Documentation for Patients Admitted to the Medical Assessment Unit?

This study assessed the quality of post-take ward round (PTWR) documentation, specifically looking at twelve criteria, in the medical assessment unit (MAU) prior to, 3- months and 2-years after introducing a PTWR proforma. 216 case records were analysed; 40 prior to, 40 three-months and 146 two-years after introducing the PTWR proforma. There was a significant improvement in eight criteria threemonths after introducing the PTWR proforma. These improvements were sustained two-years later and significant improvements made in a further 3 criteria (1 at p < 0.05 and 2 at p ) 0.01).

Developing a network: the PMM process

Since 1988, the Prevention of Maternal Mortality (PMM) Network has developed, implemented and evaluated projects that focus directly on prevention of maternal deaths. The Network, which consists of 11 multidisciplinary teams in West Africa and one at Columbia University, grew from discussions between the Carnegie Corporation of New York and researchers at Columbia School of Public Health. Its goals are: to strengthen capacities in developing countries; to provide program models for preventing maternal deaths; and to inform policymakers about the importance of maternal mortality. This paper describes the development and functioning of the Network. The initial steps included identifying interested partners in Africa and encouraging them to form multidisciplinary teams. Each African team received two grants: one to perform a needs assessment and then another to develop and implement projects based on the results. The Columbia team provided technical assistance in a variety of ways, including site visits, workshops and correspondence. Teams tested program models and reported findings both to local policymakers and in international fora. Collaboration with government and community leaders helped facilitate progress at all stages. At the PMM Network Results Conference in 1996, the teams decided to continue their work by forming the Regional PMM (RPMM) Network, an entirely African entity.

Lessons learned from the PMM Network experience

For eight years, the Prevention of Maternal Mortality (PMM) Network in West Africa designed, implemented and evaluated projects to reduce barriers to care for women with obstetric complications. Many valuable lessons were learned concerning program development and implementation. A multidisciplinary approach enabled the Network to address the various aspects of the problem; collaboration between teams encouraged the sharing of resources and experiences; and collaboration with government and communities enhanced project sustainability. Capacity building through long-term, systematic technical support resulted in a Network of proficient researchers. Existing human and material resources were utilized to enhance the feasibility and sustainability of projects--a strategy that could be adopted in other developing countries. Cost-tracking was used as a management and evaluation tool. The collective experience of the Network offers guidance for program planners and researchers working on maternal mortality in developing countries.

Pneumococcal resistance in southwest Virginia

Resistance patterns of Streptococcus pneumoniae in southwest Virginia were determined for 100 consecutive, hospital-based isolates, mostly from adults. Oxacillin disk screening identified all resistant isolates. Sixteen percent of the isolates were penicillin resistant (10% were highly resistant). E-strip testing revealed the following MICs (in micrograms per milliliter, with percentages of isolates in parentheses): cefotaxime, < or = 0.5 (92%); ceftriaxone, < or = 0.5 (95%); ceftizoxime, < or = 0.5 (85%); erythromycin, < or = 1 (87%); ofloxacin, < or = 2 (80%); vancomycin, < or = 1 (98%).