Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review.

BACKGROUND: Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. OBJECTIVE: This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. METHODS: The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. RESULTS: The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. CONCLUSIONS: The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients.

User-Centered Evaluation and Design Recommendations for an Internal Medicine Resident Competency Assessment Dashboard.

OBJECTIVES: Clinical Competency Committee (CCC) members employ varied approaches to the review process. This makes the design of a competency assessment dashboard that fits the needs of all members difficult. This work details a user-centered evaluation of a dashboard currently utilized by the Internal Medicine Clinical Competency Committee (IM CCC) at the University of Cincinnati College of Medicine and generated design recommendations. METHODS: Eleven members of the IM CCC participated in semistructured interviews with the research team. These interviews were recorded and transcribed for analysis. The three design research methods used in this study included process mapping (workflow diagrams), affinity diagramming, and a ranking experiment. RESULTS: Through affinity diagramming, the research team identified and organized opportunities for improvement about the current system expressed by study participants. These areas include a time-consuming preprocessing step, lack of integration of data from multiple sources, and different workflows for each step in the review process. Finally, the research team categorized nine dashboard components based on rankings provided by the participants. CONCLUSION: We successfully conducted user-centered evaluation of an IM CCC dashboard and generated four recommendations. Programs should integrate quantitative and qualitative feedback, create multiple views to display these data based on user roles, work with designers to create a usable, interpretable dashboard, and develop a strong informatics pipeline to manage the system. To our knowledge, this type of user-centered evaluation has rarely been attempted in the medical education domain. Therefore, this study provides best practices for other residency programs to evaluate current competency assessment tools and to develop new ones.

Using Health Forum Data to Assess User Needs for mHealth App Development: A Feasibility Study on Alzheimer's Disease.

Online health forums are used by patients and caregivers as community and information resources, especially for chronic disease management, and could help determine user needs for digital health app design. This study aims to assess the feasibility of using online forum posts on Alzheimer's disease to inform user needs in mobile health application design and whether this process can be automated through text clustering methods. A total of 413 posts were analyzed manually through thematic coding and yielded three themes and nine subthemes for patient and caregiver needs. The external evaluation showed fair to substantial similarity between the automatically and manually derived labels. Four personas were developed to assess the validity of forum-generated needs. These results establish that health forum data can provide sufficient information to understand user needs. However, further refinement of the analysis process and algorithm is necessary to generalize this method to other disease conditions and types of forum data.

User-Centered Evaluation of a Visual Annotation Tool for Rapid Assessment of Pediatric Weight Entry Errors.

Weight entry errors can cause significant patient harm in pediatrics due to pervasive weight-based dosing practices. While computerized algorithms can assist in error detection, they have not achieved high sensitivity and specificity to be further developed as a clinical decision support tool. To train an advanced algorithm, expert-annotated weight errors are essential but difficult to collect. In this study, we developed a visual annotation tool to gather large amounts of expertly annotated pediatric weight charts and conducted a formal user-centered evaluation. Key features of the tool included configurable grid sizes and annotation styles. The user feedback was collected through a structured survey and user clicks on the interface. The results show that the visual annotation tool has high usability (average SUS=86.4). Different combinations of the key features, however, did not significantly improve the annotation efficiency and duration. We have used this tool to collect expert annotations for algorithm development and benchmarking.

Creating a Queer Ontology: The Gender, Sex, and Sexual Orientation (GSSO) Ontology.

Cultural attitudes, linguistic variation, and historical pathology have led to a plethora of terms concerning gender, sex, and sexual orientation that have caused confusion and uneasiness among both lay people and relevant professionals. For members of the LGBTQIA+ community, these negative reactions are compounded by identities which have historically and contemporarily been mistreated by medical professionals. In an effort to provide a reliable resource for patients and clinicians, we have created the Gender, Sex, and Sexual Orientation (GSSO) ontology, which currently includes over 4,000 entities from multiple disciplines. The GSSO is a manually curated resource utilizing related glossaries from biology, medicine, psychology, sociology, and gender studies. With links to over 20 other ontology resources such as SNOMED-CT and MedDRA, the GSSO aims for accessibility and interoperability with existing systems. It is also open-source and features an easy-to-use web interface (https://github.com/Superraptor/GSSO). Future work involves multiple language support efforts and empirical evaluation.