Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net.

OBJECTIVES: Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP). MATERIALS AND METHODS: The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. RESULTS: Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. CONCLUSIONS: Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

Attitudes Towards and Use of Information and Communication Technologies (ICTs) Among Older Adults in Italy and Sweden: the Influence of Cultural Context, Socio-Demographic Factors, and Time Perspective.

This study examined determinants of attitudes towards and use of information and communication technologies (ICTs) in older adults, including variations in cultural context, socio-demographic factors (age, education, and gender) and the individual's time perspective. Towards this end, 638 older adults in Italy (n = 262, M = 71.7 years) and Sweden (n = 376, M = 69.9 years) completed the Swedish Time Perspective Inventory (S-ZTPI), the Attitude toward Technologies Questionnaire (ATTQ), and questions regarding use of specific digital technologies (e.g. Internet, Skype, Facebook); data were collected in 2013-2014. The results showed more positive attitudes toward ICTs in Swedish compared with Italian elderly as well as more frequent use of technologies. Regardless of nationality, younger age and higher levels of educational attainment was positively associated with attitudes towards ICTs. Male gender was associated with higher ATTQ scores in the Italian, but not in the Swedish, sample. Time perspective accounted for significant variance beyond the foregoing variables. S-ZTPI Past Negative, Future Negative and Present Fatalistic in particular, were (negatively) related to ATTQ scores, with a similar pattern for ICT use. Future Positive and Present Hedonistic were positively associated with ATTQ scores, across the samples. In conclusion, between-person differences in time perspective organization are an important factor to account for variability in attitudes towards and use of ICTs in old age, and appears to exert an influence over and beyond other significant predictors, such as cultural context, age/cohort membership, and educational level.

Improving older people's life satisfaction via social networking site use: Evidence from China.

OBJECTIVE: This study aimed to examine the pathways by which social networking sites (SNSs) can improve older people's life satisfaction. METHODS: We conducted an online survey in China that lasted eight weeks. Respondents were required to report their demographic characteristics and feelings regarding SNS use. Data were analysed using SPSS 20 and Amos 21. RESULTS: We collected 596 valid samples. The empirical results show that SNS use improves older people's life satisfaction by reducing their loneliness and improving their self-efficacy. Social support alleviates the negative effect of loneliness and enhances the positive effect of self-efficacy on life satisfaction. Sex differences and education differences were significant. Men and less educated people had higher levels of life satisfaction. CONCLUSION: Policymakers should offer support to SNSs targeting older people and encourage them to provide more useful services. SNS operators should encourage social support among older users and pay attention to sex differences and education differences.

Patient portals and personal health information online: perception, access, and use by US adults.

BACKGROUND: Access to online patient portals is key to improving care, but we have limited understanding of patient perceptions of online portals and the characteristics of people who use them. METHODS: Using a national survey of 3677 respondents, we describe perceptions and utilization of online personal health information (PHI) portals. RESULTS: Most respondents (92%) considered online PHI access important, yet only 34% were offered access to online PHI by a health care provider, and just 28% accessed online PHI in the past year. While there were no differences across race or ethnicity in importance of access, black and Hispanic respondents were significantly less likely to be offered access ( P = .006 and <.001, respectively) and less likely to access their online PHI ( P = .041 and <.001, respectively) compared to white and non-Hispanic respondents. CONCLUSION: Health care providers are crucial to the adoption and use of online patient portals and should be encouraged to offer consistent access regardless of patient race and ethnicity.

Online Health Information-Seeking Behavior and Confidence in Filling Out Online Forms Among Latinos: A Cross-Sectional Analysis of the California Health Interview Survey, 2011-2012.

BACKGROUND: Health information is increasingly being disseminated online, but there is a knowledge gap between Latinos and non-Hispanic whites, particularly those whose English language proficiency is poor, in terms both of online health information-seeking behavior and computer literacy skills. This knowledge gap may also exist between US- and foreign-born Latinos. OBJECTIVE: The specific aim of this study was to examine Internet use, online health information-seeking behavior, and confidence in filling out online forms among Latinos, particularly as it relates to health-risk behaviors. We then stratified our sample by nativity. METHODS: We used the adult population file of the 2011-2012 California Health Interview Survey, analyzing Internet use, online health information-seeking behavior, and confidence in filling out online forms using binary logistic regression among Latinos and whites (N=27,289), Latinos (n=9506), and Latinos who use the Internet (n=6037). RESULTS: Foreign-born Latinos (OR 0.71, 95% CI 0.58-0.88, P=.002) have lower odds of engaging in online health information-seeking behavior, and higher odds (OR 2.90, 95% CI 2.07-4.06, P<.001) of reporting a lack of confidence in filling out online forms compared to US-born Latinos. Correlates of online health information-seeking behavior and form confidence varied by nativity. CONCLUSIONS: Latinos, particularly foreign-born individuals, are at an increased risk of being left behind as the move to increase online content delivery and care expands. As online health information dissemination and online health portals become more popular, the impact of these sites on Latino gaps in coverage and care should be considered.

The Impact of Nursing Students' Cultural Diversity on the Intention and Attitudes Towards the Use of Information Technology (IT).

This research highlights the challenge for nursing educators in understanding, developing awareness, and preparing strategies to manage the impact of nursing students' cultural diversity on the relationship between the intention to use computer and attitudes, self-efficacy, innovativeness, and threat and challenge.

Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women.

Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group.

Computer Use and Computer Anxiety in Older Korean Americans.

Responding to the limited literature on computer use in ethnic minority older populations, the present study examined predictors of computer use and computer anxiety in older Korean Americans. Separate regression models were estimated for computer use and computer anxiety with the common sets of predictors: (a) demographic variables (age, gender, marital status, and education), (b) physical health indicators (chronic conditions, functional disability, and self-rated health), and (c) sociocultural factors (acculturation and attitudes toward aging). Approximately 60% of the participants were computer-users, and they had significantly lower levels of computer anxiety than non-users. A higher likelihood of computer use and lower levels of computer anxiety were commonly observed among individuals with younger age, male gender, advanced education, more positive ratings of health, and higher levels of acculturation. In addition, positive attitudes toward aging were found to reduce computer anxiety. Findings provide implications for developing computer training and education programs for the target population.

Prevalence and correlates of screen time in youth: an international perspective.

BACKGROUND: Screen time (including TV viewing/computer use) may be adversely associated with metabolic and mental health in children. PURPOSE: To describe the prevalence and sociodemographic correlates of screen time in an international sample of children aged 4-17 years. METHODS: Data from the International Children's Accelerometry Database were collected between 1997-2009 and analyzed in 2013. Participants were 11,434 children (48.9% boys; mean [SD] age at first assessment, 11.7 [3.2] years). Exposures were sex, age, weight status, maternal education, and ethnicity. The outcome was self- or proxy-reported screen time <2 or >2 hours/day. Analyses were conducted initially at study level and then combined using random-effects meta-analysis. RESULTS: Within each contributing study, at least two thirds of participants exceeded 2 hours/day of screen time. In meta-analytic models, overweight or obese children were more likely to exceed 2 hours/day of screen time than those who were non-overweight (OR=1.58, 95% CI=1.33,1.88). Girls (vs boys: 0.65; 0.54, 0.78) and participants with more highly educated mothers (vs

Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya.

BACKGROUND: The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes. METHODS: This cross sectional descriptive study was conducted among staff nurses working at one public hospital (Kenyatta National Hospital, (KNH) and one private hospital (Aga Khan University Hospital (AKUH). A convenience sample of 200 nurses filled the questionnaires. Data was collected using the modified Nurses' Attitudes Towards Computerisation (NATC) questionnaire. RESULTS: Nurses had a favorable attitude towards computerisation. Non-users had a significantly higher attitude score compared to the users (p = 0.0274). Statistically significant associations were observed with age (p = 0.039), level of education (p = 0.025), duration of exposure to computers (p = 0.025) and attitudes towards computerisation. CONCLUSION: Generally, nurses have positive attitudes towards computerisation.This information is important for the planning and implementation of computerisation in the hospital as suggested in other studies.

Chinese older adults' Internet use for health information.

Technological advancement benefits Internet users with the convenience of social connection and information search. This study aimed at investigating the predictors of Internet use to search for online health information among Chinese older adults. The Technology Acceptance Model (TAM) was applied to examine the predictiveness of perceived ease of use, perceived usefulness, and attitudes toward Internet use on behavioral intention to search for health information online. Ninety-eight Chinese older adults were recruited from an academic institute for older people and community centers. Frequency of Internet use and physical and psychological health were also assessed. Results showed that perceived ease of use and attitudes significantly predicted behavioral intention of Internet use. The potential influences of traditional Chinese values and beliefs in health were also discussed.

O tempo da incerteza: elogio ao pudor: em defesa de um certo mistério necessário à simbolização / El tiempo de la inseguridad: elogio al pudor: en defensa de cierto misterio necesario a la simbolización / The time of uncertainty: praise to decency: advocating a certain mystery necessary to symbolization

O autor discorre sobre os novos paradigmas da ciência no século XX, a nova tecnologia informática e seu impacto sobre a cultura contemporânea, criando, do ponto de vista sociológico, fatos geradores de insegurança e precariedade e, do ponto de vista mental, novos fenômenos no terreno da simbolização. Desenvolve a ideia de que em todas as culturas, em todos os tempos, há forças culturais promotoras do crescimento mental e outras da constrição do pensamento. Então, propõe-se a estudar quais seriam os fatores potencialmente prejudiciais aos processos simbólicos em nossa cultura, particularmente no que tange aos adolescentes e o papel da psicanálise em tudo isso...

The author addresses the new paradigms of science in the XX century, new information technology and its impact over contemporary culture, creating from the sociology stand point, factors which generate insecurity and precariousness and, from the mental stand point, new phenomena in the realm of symbolization. He elaborates on the idea that, in every culture, in all times, there are cultural forces which foster mental growth, and others which hinder thought. He therefore intends to study what would be the factors potentially harmful to symbolic processes in our culture, especially in regard to adolescents, and the role of psychoanalysis in all that...

El autor discurre sobre los nuevos paradigmas de la ciencia en el siglo XX, la nueva tecnología informática y su impacto sobre la cultura contemporánea, creando, desde la mirada sociológica, hechos generadores de inseguridad y precariedad y, desde la mirada mental, nuevos fenómenos en el terreno de la simbolización. Desarrolla la idea que en todas las culturas, en todos los tiempos, hay fuerzas culturales promotoras del crecimiento mental y otras de la constricción del pensamiento. Entonces, se propone a estudiar cuáles serían los factores potencialmente perjudiciales a los procesos simbólicos en nuestra cultura, particularmente en lo que se refiere a los adolescentes y el rol del psicoanálisis en todo eso...

The association between acculturation and recreational computer use among Latino adolescents in California.

BACKGROUND: Physical inactivity like recreational computer use is a likely factor in the rising obesity prevalence among Latino adolescents. OBJECTIVES: Using the data from California Health Interview Survey, we test the hypothesis whether acculturation is associated with recreational computer use among Latino adolescents. METHODS: We run linear regressions of the weekly time spent on recreational computer use among Latino adolescents, stratified first by gender and then by age group (12-14 and 15-17 years). Years living in the United States and language at home are used as key variables for acculturation. RESULTS: For all four sub-populations, living in the United States for less than 5 years is significantly associated with fewer hours on recreational computer use, compared with those US-born. Among female adolescents, those who lived in the United States for 10 years or more spent fewer hours on recreational computer use than those US-born. Among adolescents under 15, speaking English only and speaking English plus another language are both significantly associated with more hours on recreational computer use, compared with those who speak a non-English language at home. CONCLUSION: Educators and health professionals should heed the Latino adolescents' possible increase in recreational computer use.

Patient reported barriers to enrolling in a patient portal.

BACKGROUND: Previous studies of patient portals have found low rates of enrollment and significant disparities in enrollment by race and ethnicity. As the reasons for these findings are unclear, we sought to identify patient reported barriers to enrollment in a patient portal. METHODS: We conducted a telephone survey of patients in one urban general internal medicine clinic. Patients were eligible if they did not enroll within 30 days of receiving an electronic order inviting participation. Our primary outcomes were: (a) reasons for not enrolling in the patient portal; (b) reasons for not attempting enrollment; and (c) perceived benefits of the portal. RESULTS: Participants' (N=159) mean age was 51 years, 48% were black, 72% female, and 70% had a college degree or greater. 63% of respondents not enrolling reported never attempting enrollment despite remembering receiving an order. Most of these 63% did not attempt enrollment because of lack of information or motivation. Smaller proportions reported not attempting enrollment because of negative attitudes toward the portal (30%) or computer related obstacles (8%). Overall, respondents favorably viewed most patient portal features, however black respondents were less likely than white respondents to consider features assisting self-management such as getting test results (69% vs 86%; p<0.05) as important. Adjusting for age, gender, education, and chronic disease did not substantially change results. CONCLUSION: Strategies to increase enrollment in patient portals need to ensure patients understand patient portal features and receive follow-up reminders. Interventions to reduce racial disparities in enrollment must address attitudinal barriers and not focus solely on improving access.

Comparison of human anxiety based on different cultural backgrounds.

This work conceptualizes human behavior on the Internet. The study was conducted with 10 university participants representing two different cultural backgrounds, Asian and Western. The participants were asked to visit any Web page on the Internet for 15 minutes, for 30 minutes, and for 1 hour. The results showed that participants displayed no signs of anxiousness during the 15-minute task and very little anxiousness during the 30-minute task. Western participants showed overall more anxiousness than Asian participants. However, all participants showed anxiousness during the 1-hour task. Data on comparative human anxiety were collected on the basis of a literature review of social fun, online belonging, and community on the Internet. Only the limited set of data of the participant is discussed in this article.

Use of information and communication technology to provide health information: what do older migrants know, and what do they need to know?

BACKGROUND: Governments and businesses are increasingly using the internet and mobile telephones to disseminate information about services and products. However, not all population groups have the resources and capabilities to support equality of access to and use of these technologies. While Australia's ageing population receives attention in a wide variety of literatures, the ageing migrant population has received very little attention in relation to understanding their place in the 'digital divide'. It is not known how this group gathers information used in everyday living, or what role the internet or mobile phones plays within this. At a time when the population is ageing and there is an increasing use of the internet to deliver services and information, there is little research on the effects of ethnicity, migration, socio-economic status, education or gender of older people on the use of information and communication technology (ICT). Addressing this should be a priority in Australia, which has an old and ageing population that includes many post-war migrants from non-English speaking European countries. AIMS: To analyse the views of older migrants living in South Australia with respect to their current information sources, their use of ICT and any barriers and enablers to future use of ICT for accessing health information. METHODS: A qualitative study employing eight focus groups involving 43 older Italian and Greek migrants living in the community in metropolitan or regional settings in South Australia. Interviews were held and audio-recorded and the English language components transcribed. Transcriptions were analysed manually using a grounded theory approach. RESULTS: Older migrants do not use ICT to a great extent to access information in their everyday lives, with many expressing no interest in learning how to do so. However, they access the information they need to function in society with a desired quality of life from multiple sources by various means. Sources include electronic and print media from Australia and their home countries, family and acquaintances, government departments or service providers. Many expressed a preference for receiving information as printed material or directly from another person. DISCUSSION: Governments or primary healthcare organisations planning to make health information solely available via ICT should be aware that doing so may lead to an increase in 'information exclusion' and the formation of functional knowledge deficits for older migrants. At the moment at least, our participants do not perceive any functional knowledge deficits as they engage multiple sources to access the information they need for everyday life. We recommend that governments and healthcare organisations evaluate the appropriateness of using ICT to directly provide information to older migrants and consider non-digital means or the engagement of 'information brokers' when communicating with groups identified as low or non-users of ICT.

Self-concept, self-esteem, gender, race, and information technology use.

This research addressed two fundamental questions regarding self-concept, self-esteem, gender, race, and information technology use. First, is technology use related to dimensions of self-concept and/or to self-esteem? Second, are there gender and/or race differences in self-concept, self-esteem, and technology use? Five hundred youth, average age 12 years old, one third African American and two thirds Caucasian American, completed multidimensional measures of self-concept, the Rosenberg Self-Esteem scale, and measures of frequency of Internet use, Internet use for communication (e-mail and instant messaging), video game playing, and cell phone use. Findings indicated that technology use predicted dimensions of self-concept and self-esteem, with video game playing having a negative influence and Internet use having a positive influence on self-concept dimensions. Gender differences were observed on several self-concept dimensions, but contrary to expectations, girls did not score higher than boys in social self-concept. Only one race difference was observed: African Americans had lower behavioral self-concept than did Caucasian Americans. Implications of the benefits and liabilities of youth's current and projected technology use are discussed.

Web usability testing with a Hispanic medically underserved population.

OBJECTIVES: Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS: METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. RESULTS: Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. CONCLUSIONS: User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

Internet health information in the patient-provider dialogue.

A patient discussing Internet health information with a health care provider (referred to as "patient-provider communication about Internet health information") can contribute positively to health outcomes. Although research has found that once Internet access is achieved, there are no ethnic differences in Internet health information seeking, it is unclear if there are ethnic differences in patient-provider communication about Internet health information. To help fill this gap in the literature, the National Cancer Institute's Health Information National Trends Survey 2005 was analyzed with Stata 9. Two sets of logistic regression analyses were conducted, one for a subsample of Internet users (n = 3,244) and one for a subsample of Internet users who are first-generation immigrants (n = 563). The dependent variable was patient-provider communication about Internet health information, which assessed whether survey participants had discussed online health information with a health care provider. The predictor variables included trust of health care provider, trust of online health information, Internet use, health care coverage, frequency of visits to health care provider, health status, and demographics. Among all Internet users, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. Similarly, among Internet users who are immigrants, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. While the digital divide is narrowing in terms of Internet access, racial differences in patient-provider communication about Internet health information may undermine the potential benefits of the information age.

Access to and use of the Internet by South African general practitioners.

INTRODUCTION: In the developed world, doctors use the Internet to support the delivery of health care. Their usage patterns are explained by Rogers' Diffusion of Innovations. There is no knowledge of Internet usage by doctors in the developing world. METHODS: In July 2006, 2600 survey forms were posted in the first national survey of South African (SA) General Practitioners' (GPs) use of the Internet. A sample of non-responders was followed up. The aim was to determine SA GPs' Internet usage patterns, to compare them to world usage, and to examine them in the light of Diffusion of Innovations. RESULTS: A 10% usable response rate was a major weakness, but similar surveys are unlikely to be more representative. 89% of SA GPs have Internet access, home usage is high, and overall usage patterns are equivalent to the usage patterns of international studies. DISCUSSION: In spite of the overall technological under-development in South Africa, as predicted by Diffusion of Innovations, SA GPs have adopted the technology, and use it for health care in much the same way as their international counterparts. Further studies on some of the details will be valuable. CONCLUSION: The indications are that SA GPs will reap the benefits of the Internet as it continues to evolve, and translate these into improved health care delivery in South Africa.