Envisioning a social-health information exchange as a platform to support a patient-centered medical neighborhood: a feasibility study.

BACKGROUND: Social determinants directly contribute to poorer health, and coordination between healthcare and community-based resources is pivotal to addressing these needs. However, our healthcare system remains poorly equipped to address social determinants of health. The potential of health information technology to bridge this gap across the delivery of healthcare and social services remains unrealized. OBJECTIVE, DESIGN, AND PARTICIPANTS: We conducted in-depth, in-person interviews with 50 healthcare and social service providers to determine the feasibility of a social-health information exchange (S-HIE) in an urban safety-net setting in Dallas County, Texas. After completion of interviews, we conducted a town hall meeting to identify desired functionalities for a S-HIE. APPROACH: We conducted thematic analysis of interview responses using the constant comparative method to explore perceptions about current communication and coordination across sectors, and barriers and enablers to S-HIE implementation. We sought participant confirmation of findings and conducted a forced-rank vote during the town hall to prioritize potential S-HIE functionalities. KEY RESULTS: We found that healthcare and social service providers perceived a need for improved information sharing, communication, and care coordination across sectors and were enthusiastic about the potential of a S-HIE, but shared many technical, legal, and ethical concerns around cross-sector information sharing. Desired technical S-HIE functionalities encompassed fairly simple transactional operations such as the ability to view basic demographic information, visit and referral data, and medical history from both healthcare and social service settings. CONCLUSIONS: A S-HIE is an innovative and feasible approach to enabling better linkages between healthcare and social service providers. However, to develop S-HIEs in communities across the country, policy interventions are needed to standardize regulatory requirements, to foster increased IT capability and uptake among social service agencies, and to align healthcare and social service priorities to enable dissemination and broader adoption of this and similar IT initiatives.

A Nurse's Eye-View on Health Literacy in Older Adults.

Older adults are being asked to play a more active role in the management of their health, however low health literacy is pervasive in this population and is a major impediment to participation in healthcare activities. We sought to identify literacy-related challenges that older adults experience while managing their health. We interviewed 8 nurses who provided direct care to older adult populations. Thematic analysis was conducted exploring barriers, strategies and resources as they relate to health literacy in older adults. Three main themes were identified: literacy barriers, aging process and social resources. Problems associated with health literacy in this population were pervasive. Numeracy, a component of health literacy, was a central factor for a range of medication management problems. However, nurses reported that they were able to fashion solutions that enabled patients to comprehend quantitative information and act on it accordingly, resulting in better health management.

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.

A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries.

Health information technologies (HIT) have great potential to advance health care globally. In particular, HIT can provide innovative approaches and methodologies to overcome the range of access and resource barriers specific to developing countries. However, there is a paucity of models and empirical evidence informing the technology selection process in these settings. We propose a framework for selecting patient-oriented technologies in developing countries. The selection guidance process is structured by a set of filters that impose particular constraints and serve to narrow the space of possible decisions. The framework consists of three levels of factors: (1) situational factors, (2) the technology and its relationship with health interventions and with target patients, and (3) empirical evidence. We demonstrate the utility of the framework in the context of mobile phones for behavioral health interventions to reduce risk factors for cardiovascular disease. This framework can be applied to health interventions across health domains to explore how and whether available technologies can support delivery of the associated types of interventions and with the target populations.

Mobile phones as mediators of health behavior change in cardiovascular disease in developing countries.

The global burden of cardiovascular diseases (CVD) is becoming a growing problem in developing countries. Successful self-management of CVD is dependent on a multitude of factors, including social support, communication with health care providers, careful monitoring, and other determinants. The growing market penetration and the communication properties of mobile phones create opportunities for innovation in promoting CVD self-management through support of lifestyle and behavior modification. Mobile phones support various modes of communication and interaction, have fewer adoption barriers, and are more prevalent than other available technologies in developing countries. However, mobile phone interventions are not without many challenges such as mobile infrastructure, electric infrastructure, access to mobile devices, and appropriate user interfaces for interaction. In this paper, we discuss current evidence as well as research opportunities to explore the role of mobile phones in supporting behavior modification in developing countries.

A taxonomy characterizing complexity of consumer eHealth Literacy.

There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, media literacy, and scientific literacy [1]. We aim to develop an approach to characterize dimensions of complexity and to reveal knowledge and skill-related barriers to eHealth engagement. We use Bloom's Taxonomy to guide development of an eHealth literacy taxonomy that categorizes and describes each type of literacy by complexity level. Illustrative examples demonstrate the utility of the taxonomy in characterizing dimensions of complexity of eHealth skills used and associated with each step in completing an eHealth task.