Design and Architecture of an Ontology-driven Dialogue System for HPV Vaccine Counseling

Speech and conversational technologies are increasingly being used by consumers, with the inevitability that one day they will be integrated in health care. Where this technology could be of service is in patient-provider communication, specifically for communicating the risks and benefits of vaccines. Human papillomavirus (HPV) vaccine, in particular, is a vaccine that inoculates individuals from certain HPV viruses responsible for adulthood cancers - cervical, head and neck cancers, etc. My research focuses on the architecture and development of speech-enabled conversational agent that relies on series of consumer-centric health ontologies and the technology that utilizes these ontologies. Ontologies are computable artifacts that encode and structure domain knowledge that can be utilized by machines to provide high level capabilities, such as reasoning and sharing information. I will focus the agent’s impact on the HPV vaccine domain to observe if users would respond favorably towards conversational agents and the possible impact of the agent on their beliefs of the HPV vaccine. The approach of this study involves a multi-tier structure. The first tier is the domain knowledge base, the second is the application interaction design tier, and the third is the feasibility assessment of the participants. The research in this study proposes the following questions: Can ontologies support the system architecture for a spoken conversational agent for HPV vaccine counseling? How would prospective users’ perception towards an agent and towards the HPV vaccine be impacted after using conversational agent for HPV vaccine education? The outcome of this study is a comprehensive assessment of a system architecture of a conversational agent for patient-centric HPV vaccine counseling. Each layer of the agent architecture is regulated through domain and application ontologies, and supported by the various ontology-driven software components that I developed to compose the agent architecture. Also discussed in this work, I present preliminary evidence of high usability of the agent and improvement of the users’ health beliefs toward the HPV vaccine. All in all, I introduce a comprehensive and feasible model for the design and development of an open-sourced, ontology-driven conversational agent for any health consumer domain, and corroborate the viability of a conversational agent as a health intervention tool

The Social and Historical Subject in Sartre and Foucault and Its Implications for Healthcare Ethics

This dissertation explores Jean Paul Sartre’s and Michel Foucault’s view that subjectivity is socially and historically constituted. Additionally, it explores their corresponding ethical thought and how these viewpoints can be applied to ethical issues in the delivery of healthcare. Sartre and Foucault both hold the view that human beings as subjects are not just participants or spectators in social practices, rather, they become subjects with ontological possibilities through their interaction with these practices. In Chapter One, I trace Sartre’s views on subjectivity in his two major works Being and Nothingness and The Critique of Dialectical Reason, Volume 1, showing how he argues that we are constituted as subjects through a dialectical interaction of consciously intended praxis with the reified results of human affairs, or practico-inert. In Chapter Two, I trace Foucault’s views on the subject through all three periods of his career, and show how he argues that we are constituted as subjects through systems of thought, strategies of power, and practices of the self. I specifically differentiate the views of each philosopher from those of the more traditional moral philosophers Immanuel Kant and John Stuart Mill, who view the subject as self-determining and ahistorical. In Chapter Three, I examine each thinker’s later lectures on ethics, and show that each philosopher presents an outline for an ethical mode of being, which I call “ethical subjectivity.” For both philosophers, ethical subjectivity requires critical historical reflection, ethics as an ongoing task, and innovation. In Chapters Four and Five, I use Sartre’s and Foucault’s views on subjectivity and ethics to analyze two contemporary issues in healthcare ethics: conscience-based refusals and mandatory HPV vaccination. Through discussion of these two issues, I show how focusing on the social, historical, material dimensions of how we become who we are introduces a different starting point for analysis and leads to a unique discussion in contrast to the ethical approaches rooted in the thought of Kant or Mill

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Exploring perspectives of people with type-1 diabetes on goalsetting strategies within self-management education and care

Background. Collaborative goal-setting strategies are widely recommended for diabetes self-management support within healthcare systems. Creating self-management plans that fit with peoples’ own goals and priorities has been linked with better diabetic control. Consequently, goal-setting has become a core component of many diabetes selfmanagement programmes such as the ‘Dose Adjustment for Normal Eating (DAFNE) programme’. Within DAFNE, people with Type-1 Diabetes (T1D) develop their own goals along with action-plans to stimulate goal-achievement. While widely implemented, limited research has explored how goal-setting strategies are experienced by people with diabetes.Therefore, this study aims to explore the perspectives of people with T1D on theimplementation and value of goal-setting strategies within DAFNE and follow-up diabetes care. Furthermore, views on barriers and facilitators to goal-attainment are explored.Methods. Semi-structured interviews were conducted with 20 people with T1D who attended a DAFNE-programme. Following a longitudinal qualitative research design, interviews took place 1 week, and 6-8 months after completion of DAFNE. A recurrent cross-sectional approach is applied in which themes will be identified at each time-point using thematic analyses.Expected results. Preliminary identified themes surround the difference in value that participants place on goal-setting strategies, and the lack of support for goal-achievement within diabetes care.Current stage. Data collection complete; data-analysis ongoing.Discussion. Goal-setting strategies are increasingly included in guidelines for diabetes support and have become essential parts of many primary care improvement schemes. Therefore, exploring the perspectives of people with T1D on the value and implementation of goal-setting strategies is vital for their optimal application

The influence of religion and gender on physician and nurse HPV immunization recommendations in Newfoundland and Labrador

Human papillomavirus (HPV) can have serious consequences for all genders. Despite these risks, Newfoundland and Labrador (NL) has failed to include all individuals in the provincially funded HPV vaccination program. The purpose of this instrumental case study was to assess physicians’ and nurses’ intentions to recommend the HPV vaccine for male youth through the lenses gender and religion, and to use that information to strengthen their intentions to recommend. Data were collected using surveys and individual interviews and analyzed using descriptive statistics and thematic coding. Findings were framed using the Theory of Planned Behaviour and revealed that there is an imbalance in HPV recommendations across genders, that sexual health is viewed primarily the responsibility of females, and that trans and non-female identifying individuals are systematically marginalized by the current policy. These findings have implications for policy and can raise the awareness of practitioners about systemic barriers to recommending the vaccine

Evidence Based Medicine

Evidence-based medicine (EBM) was introduced to the best benefit of the patient. It has transformed the pathophysiological approach to the outcome approach of today's treatments. Disease-oriented to patient-oriented medicine. And, for some, daily medical practice from patient oriented to case oriented medicine. Evidence has changed the paternalistic way of medical practice. And gave room to patients, who show a tendency towards partnership. Although EBM has introduced a different way of thinking in the day to day medical practice, there is plenty of space for implementation and improvement. This book is meant to provoke the thinker towards the unlimited borders of caring for the patient

Exploring the Psychosocial Support and Education Needs of People Diagnosed with Head and Neck Cancer, and the Health Professionals Who Care for Them

The aims of the study were to understand the unmet psychosocial education and support needs of people diagnosed with head and neck cancer, and to identify the educational and communication skills needs of their health professionals. Using an exploratory qualitative research design and social constructionist interpretive framework, findings include the vicarious trauma of health professionals, patients' trauma due to altered appearance, communication inhibitors and promoters, and survivors' return to meaningful activities which foster post-traumatic growth