A Description of Personal Health Information Management Work With a Spotlight on the Practices of Older Adults: Qualitative e-Delphi Study With Professional Organizers.

BACKGROUND: Personal health information (PHI) is created on behalf of and by health care consumers to support their care and wellness. Available tools designed to support PHI management (PHIM) remain insufficient. A comprehensive understanding of PHIM work is required, particularly for older adults, to offer more effective PHIM tools and support. OBJECTIVE: The primary objective of this study was to use the Patient Work System model to provide a holistic description of PHIM work from the perspective of professional organizers with experience assisting health care consumers, including older adults, in managing their PHI. A secondary objective was to examine how factors associated with 4 Patient Work System components (person, tasks, tools and technologies, and context) interact to support or compromise PHIM work performance. METHODS: A modified e-Delphi methodology was used to complete 3 web-based rounds of open-ended questions and obtain consensus among a panel of 16 experts in professional organizing. Data were collected between April and December 2017. The Patient Work System model was used as a coding schema and guided the interpretation of findings during the analysis. RESULTS: The PHIM work of adults who sought assistance focused on the tasks of acquiring, organizing, and storing 3 classifications of PHI (medical, financial, and reference) and then processing, reconciling, and storing the medical and financial classifications to tend to their health, health care, and health finances. We also found that the complexities of PHI and PHIM-related work often exceeded the abilities and willingness of those who sought assistance. A total of 6 factors contributed to the complexity of PHIM work. The misalignment of these factors was found to increase the PHIM workload, particularly for older adults. The life changes that often accompanied aging, coupled with obscure and fragmented health care provider- and insurer-generated PHI, created the need for much PHIM work. Acquiring and integrating obscure and fragmented PHI, detecting and reconciling PHI discrepancies, and protecting PHI held by health care consumers were among the most burdensome tasks, especially for older adults. Consequently, personal stakeholders (paid and unpaid) were called upon or voluntarily stepped in to assist with PHIM work. CONCLUSIONS: Streamlining and automating 2 of the most common and burdensome PHIM undertakings could drastically reduce health care consumers' PHIM workload: developing and maintaining accurate current and past health summaries and tracking medical bills and insurance claims to reconcile discrepancies. Other improvements that hold promise are the simplification and standardization of commonly used financial and medical PHI; standardization and automation of commonly used PHI acquisition interfaces; and provision of secure, Health Insurance Portability and Accountability Act (HIPAA)-certified PHI tools and technologies that control multiperson access for PHI stored by health care consumers in electronic and paper formats.

Identifying Enablers of Participant Engagement in Clinical Trials of Consumer Health Technologies: Qualitative Study of Influenza Home Testing.

BACKGROUND: A rise in the recent trend of self-managing health using consumer health technologies highlights the importance of efficient and successful consumer health technology trials. Trials are particularly essential to support large-scale implementations of consumer health technologies, such as smartphone-supported home tests. However, trials are generally fraught with challenges, such as inadequate enrollment, lack of fidelity to interventions, and high dropout rates. Understanding the reasons underlying individuals' participation in trials can inform the design and execution of future trials of smartphone-supported home tests. OBJECTIVE: This study aims to identify the enablers of potential participants' trial engagement for clinical trials of smartphone-supported home tests. We use influenza home testing as our instantiation of a consumer health technology subject to trial to investigate the dispositional and situational enablers that influenced trial engagement. METHODS: We conducted semistructured interviews with 31 trial participants using purposive sampling to facilitate demographic diversity. The interviews included a discussion of participants' personal characteristics and external factors that enabled their trial engagement with a smartphone-supported home test for influenza. We performed both deductive and inductive thematic analyses to analyze the interview transcripts and identify enabler themes. RESULTS: Our thematic analyses revealed a structure of dispositional and situational enablers that enhanced trial engagement. Situationally, clinical affiliation, personal advice, promotional recruitment strategies, financial incentives, and insurance status influenced trial engagement. In addition, digital health literacy, motivation to advance medical research, personal innovativeness, altruism, curiosity, positive attitude, and potential to minimize doctors' visits were identified as the dispositional enablers for trial engagement in our study. CONCLUSIONS: We organized the identified themes for dispositional and situational enablers of trial engagement with a smartphone-supported home test into a research framework that can guide future research as well as the trial design and execution of smartphone-supported home tests. We suggest several trial design and engagement strategies to enhance the financial and scientific viability of these trials that pave the way for advancements in patient care. Furthermore, our study also offers practical strategies to trial organizers to enhance participants' enrollment and engagement in clinical trials of these home tests.

Personal Health Information Management Among Older Adults: Scoping Review.

BACKGROUND: Older adults face growing health care needs and could potentially benefit from personal health information management (PHIM) and PHIM technology. To ensure effective PHIM and to provide supportive tools, it is crucial to investigate the needs, challenges, processes, and tools used by this subpopulation. The literature on PHIM by older adults, however, remains scattered and has not provided a clear picture of what we know about the elements that play a role in older adults' PHIM. OBJECTIVE: The goal of our review was to provide a comprehensive overview of extant knowledge on PHIM by older adults, establish the status quo of research on this topic, and identify research gaps. METHODS: We carried out a scoping review of the literature from 1998 to 2020, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. First, we executed a broad and structured search. We then carried out a qualitative analysis of papers pertinent to the topic taking into consideration the five elements of the patient work system as follows: (1) personal-level factors, (2) PHIM tasks, (3) tools used, (4) physical settings of PHIM activities, and (5) socio-organizational aspects. RESULTS: The review included 22 studies. Consolidated empirical evidence was related to all elements of the patient work system. Multiple personal factors affected PHIM. Various types of personal health information were managed (clinical, patient-generated, and general) and tools were used (electronic, paper-based, and others). Older adults' PHIM was intertwined with their surroundings, and various individuals participated. The largest body of evidence concerned personal factors, while findings regarding the physical environment of PHIM were scarce. Most research has thus far examined older adults as a single group, and scant attention has been paid to age subgroups. CONCLUSIONS: Opportunities for further PHIM studies remain across all elements of the patient work system in terms of empirical, design science, or review work.

Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study.

BACKGROUND: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. OBJECTIVE: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. METHODS: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. RESULTS: Our qualitative analysis identified adolescents' intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. CONCLUSIONS: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management.

What's on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings.

OBJECTIVE: To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. DESIGN: Systematic review METHODS: We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. RESULTS: Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection. CONCLUSIONS: Computer keyboards and peripheral devices are frequently contaminated; however, our findings do not allow us to draw firm conclusions about their relative impact on the transmission of pathogens or nosocomial infection. Additional studies measuring the incidence of healthcare-acquired infections from computer hardware, the relative risk they pose to healthcare and evidence for effective and practical cleaning methods are needed.

Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations.

Doctors are unequally distributed across different regions in virtually all Latin American countries, which results in limited access to consistent health services. Telemedicine may address such challenges. This study profiles current levels of telemedicine use and assesses forces driving that use for nine Latin American countries (Argentina, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panama, Peru, and Uruguay). Specifically, we examined current national policy and legislation, health organization characteristics, and national culture as driving forces in telemedicine expansion. Action by Latin American policy makers, health care leaders, and funders requires the recognition of telemedicine services as an interconnected system to comprehensively address commonly acknowledged domains of telemedicine barriers (regulatory, legal, financial, technological, organizational, and human factors). Although the specific issues within each of these domains may differ across countries, it is very difficult to maximize the potential impact of telemedicine in any country without comprehensive approaches to addressing these interrelated areas of concern.

Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study.

BACKGROUND: The Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians. OBJECTIVE: To conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings. DESIGN: As part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity. PARTICIPANTS/SETTING: Forty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention. ANALYSIS: All focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes. RESULTS: Adolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards. CONCLUSION: Our findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM.

Patient perspectives of telemedicine quality.

BACKGROUND: The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. METHODS: We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. RESULTS: The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. CONCLUSION: Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding.

A qualitative, exploratory study of predominantly female parental perceptions of consumer health technology use by their overweight and/or obese female adolescent participating in a fee-based 4-week weight-management intervention.

Consumer health technologies (CHTs) are a growing part of the continuum of care for self-management of overweight and obesity. Parents positively or negatively influence adolescent weight-management efforts and are especially important throughout continuum of care settings. User-centered design (UCD) applications have been developed to assist primary users, such as adolescents, with their weight management, but less is known about the influence of parents as secondary users across many socio-ecological environments. The purpose of this study was to use the Unified Theory of Acceptance and Use of Technology (UTAUT) to inform the design of a UCD application in a qualitative study that sought to determine parental views on how technology can support previously learned behaviors that require ongoing management and support beyond formal lifestyle interventions. Parents of overweight and obese adolescents (n=14) were interviewed about perceived usefulness and planned user-intent of CHT that was designed for adolescents. UTAUT provided theoretical parental constructs (intention, performance and effort expectancy, and social influence) interactions within several socio-ecological contexts, including the home food environment and restaurant dining experiences. Although generalizations of this qualitative study are limited by a small sample size with predominantly mothers (n=13) of overweight and obese daughters (n=12), the exploratory inquiry using a parent as a secondary consumer user can complement the adoption of applications designed by adolescents.

Challenges and Opportunities with Empowering Baby Boomers for Personal Health Information Management Using Consumer Health Information Technologies: an Ecological Perspective.

"Baby Boomers" (adults born between the years of 1946 and 1964) make up the largest segment of the population in many countries, including the United States (about 78 million Americans) [1]. As Baby Boomers reach retirement age and beyond, many will have increasing medical needs and thus demand more health care resources that will challenge the healthcare system. Baby Boomers will likely accelerate the movement toward patient self-management and prevention efforts. Consumer Health Information Technologies (CHIT) hold promise for empowering health consumers to take an active role in health maintenance and disease management, and thus, have the potential to address Baby Boomers' health needs. Such innovations require changes in health care practice and processes that take into account Baby Boomers' personal health needs, preferences, health culture, and abilities to use these technologies. Without foundational knowledge of barriers and opportunities, Baby Boomers may not realize the potential of these innovations for improving self-management of health and health outcomes. However, research to date has not adequately explored the degree to which Baby Boomers are ready to embrace consumer health information technology and how their unique subcultures affect adoption and diffusion. This position paper describes an ecological conceptual framework for understanding and studying CHIT aimed at satisfying the personal health needs of Baby Boomers. We explore existing literature to provide a detailed depiction of our proposed conceptual framework, which focuses characteristics influencing Baby Boomers and their Personal Health Information Management (PHIM) and potential information problems. Using our ecological framework as a backdrop, we provide insight and implications for future research based on literature and underlying theories represented in our model.