Forming Impressions on Computer-Mediated Healthcare Peer-Support Systems for Informal Caregivers

The rapid evolution of Information technology (IT) has seen its adoption during many aspects of our lives, including healthcare. Healthcare IT provides the public with access to governmental records, electronic health records, healthcare websites, internet-based medical consultation, and more recently, online peer-support portals. These peer-support portals, which are directed not only towards patients but also caregivers, have been found to be a source of informational and emotional support. In addition, for caregivers who cannot leave their loved ones to access in-person support groups, these online support portals are an important substitute. In these online peer-support portals, informal caregivers interact with one another, providing emotional and personal support, leading to a sense of camaraderie and thereby a social relationship. The contributions on these portals are voluntary, with some members contributing more often than others. The first study in this dissertation focuses on understanding the patterns of interaction between these top contributors, referred to here as peer patrons, and other informal caregivers in terms of the information they provide, and the unique characteristics of the top contributors based on these interactions. Several unique interaction patterns related to peer patrons were found along with information about how peer patrons contribute towards the coping mechanism of informal caregivers. Interface design implications based on these outcomes were discussed. With informal caregivers exchanging not only information and emotional content on online peer-support portals but also forming social relations, it is important to understand how these users form impressions of others based on the information they access. The possible consequences of following healthcare and medical advice posted on these portals further emphasize the need to understand how users form impressions of one another on these portals. The second study in this dissertation focuses on impression formation using profiles based on those of the peer patrons who were the focus of the previous study. This exploratory study brought to light the prominence of the comment content and the profile picture in forming impressions on these portals, thereby supporting literature regarding context effects on impression formation. The final chapter is an intervention-based study investigating factors leading to positive impression formation on online healthcare peer-support portals. It supported the findings from the previous study regarding the importance of comment and profile picture and suggested the use of other peer ratings to solidify impressions formed using the former two cues. Additionally, the contribution of this dissertation to the literature and the improvement of online healthcare peer-support portals is discussed

Social information behaviors in the context of chronic kidney disease: Information seeking and disclosure in online support groups

People diagnosed with chronic illnesses are increasingly turning to the Internet to search for information about their health. In some cases, these individuals also disclose personal health information. In fact, these two information behaviors are often linked. This is particularly true in online support groups. However, we do not currently understand how and why people diagnosed with chronic diseases undergo these activities – although they are becoming increasingly common as the Internet becomes more ingrained in everyday life. This dissertation uses constructivist grounded theory to examine health information seeking online, personal health information disclosure, and the relationship between these processes. Constructivist grounded theory is an ideal research method for examining phenomena, behaviors, and processes that have not yet been fully explored, as is the case in this study. In this study, twelve participants diagnosed with chronic kidney disease were recruited in three different online support groups for chronic kidney disease. Chronic kidney disease was chosen as the illness context in this study as it is a non-stigmatized, incurable, life-long condition that requires patients to manage their treatment over time. Two telephone interviews were conducted with each participant and their comments to online support groups were collected. Data were collected and analyzed using inductive analysis, the constant comparative method, memoing, and theoretical sampling strategies. Trustworthiness of the analysis was obtained using multiple methods, including peer de-briefing and member checking. A model of information seeking, personal health information disclosure, and similarity assessment in online support groups was derived from the analysis. The model highlights one of the central contributions that this study makes to our current understanding of information behavior: similarity assessment, or the process of finding people who are similar in online support groups both as human sources of information and as people with whom to disclose. The assessment of similarity changes over time as experience and knowledge evolve. The findings presented in this dissertation add to our theoretical understanding of information behavior; they also intersect with theories from other disciplines, including communications and nursing. They also have practical implications for healthcare providers and designers of information systems.Doctor of Philosoph

Integrating Behavioral Trigger Messages into a mHealth System Design for Chronic Disease Management

Recent changes in health information technology have dramatically altered the face, delivery, and management of healthcare particularly as it relates to mHealth. With increases in smart phone ownership, mHealth potentially has the ability to provide far-reaching transformation of chronic disease management particularly when aligned with behavioral change theories and persuasive technology. MHealth applications have an advantage over computers and various print communications as the consumer can engage with the application at any time and at any location. The Interactive Health Communication Application (IHCA) states that by combining support mechanisms such as behavior change theories into electronic devices as a method to transmit or receive health information can potentially lead to changes in knowledge, motivation and self-efficacy. Adding constructs of the Fogg Behavior Model, Social Cognitive Theory and Persuasive Technology to the IHCA framework can create an engaged persuasive system leading to improvements in self-efficacy, self-management and knowledge. The hypotheses for our study are 1) participants will demonstrate improved scores on self-efficacy, knowledge and self-management following the intervention period, 2) participants will be more engaged in the usage of capABILITY following behavioral triggers, and 3) participants who receive spark triggers involving motivation will engage in the utilization of capABILITY faster than those who receive facilitator triggers. The results of this study provide important findings for 1) mHealth system design utilizing IHCA with new constructs for chronic disease management, 2) design and develop of persuasive spark and facilitator trigger messages, and 3) understanding of user engagement when behavioral (spark and facilitator) trigger messages are utilized. The findings of the study revealed that self-efficacy, self-management, and knowledge did improve post intervention. In addition, the study showed that spark triggers continually cued participants to engage with capABILITY quicker than facilitator triggers

Effect of an Educational Program based on Health Belief Model on Medication Adherence in Elderly Patients with Hypertension

Background: Aging population growth is accompanied by the risk of cardiovascular diseases and hypertension. Medication nonadherence is one of the problems affecting patients, especially elderly individuals with high blood pressure. Aim: The present study aimed to determine the effect of an educational program based on the Health Belief Model (HBM) on medication adherence in older adults suffering from hypertension. Methods: This randomized controlled clinical trial was conducted on 60-year-old elderly people referring to health centers in Mashhad, Iran, during 2017. To this end, the intervention group received education on medication adherence while the control group was only subjected to typical routine services. The data were analyzed in SPSS Software (Version 20) through the independent t-test, Chi-square test, and Fisher’s exact test. Results: The mean ages of the participants in the intervention and control groups were 69.1±8.3 and 63.9±6.7 years, respectively. The post-test mean score of medication adherence obtained by the intervention group was 6.7±0.5 that was significantly higher than that of the control group (3.7±1.0) (P˂0.001). Moreover, the mean score of medication adherence in the intervention group had significantly increased in the post-test phase (P˂0.001) based on the within-group results of the paired t-test. Implications for Practice: The HBM might improve medication adherence in elderly individuals with hypertension by changing their beliefs. Therefore, it was recommended to use this model for teaching self-care to older adults suffering from chronic illnesses and also in other senior healthcare centers

The influence of perceived medical risks and psychosocial concerns on photoprotection behaviours among adults with xeroderma pigmentosum : a qualitative interview study in the UK

BACKGROUND: A high level of photoprotection is required by people with xeroderma pigmentosum (XP), a rare skin disease, to reduce skin cancer and other risks. However poor photoprotection is thought to be widespread. PURPOSE: This study examines the influences on photoprotection behaviours in adults with XP. DESIGN: Inductive qualitative study with semistructured interviews. Analysis employed a framework approach. SETTING: National sample recruited through a specialist XP centre in London. METHODS: Semistructured interviews at patients’ homes. All transcripts were coded and themes charted for each participant. Comparisons within and across cases identified common themes and differing motivations and approaches to photoprotection. Credibility of interpretations assessed through patient/carer input and clinic adherence scores. PARTICIPANTS: 25 adults (17 male, eight female) aged 16–63 years with diagnosed XP attending a specialist centre. 18 lived outside London. RESULTS: Awareness of risks of ultraviolet radiation (UVR) and photoprotection was high. However, photoprotection behaviours varied according to perceived necessity and concerns. Three behavioural responses were identified: (1) ‘dominated’ by planning and routines to achieve a high level of photoprotection with significant activity restrictions and psychosocial impacts. (2) ‘resistant’ to photoprotection with priority given to avoiding an illness identity and enjoying a normal life. (3) Photoprotection’ integrated’ with an individual’s life with little psychosocial impact. These responses were influenced by illness, personal and contextual factors including age, life stage and social support. Only the ‘integrated’ group achieved an equilibrium between perceived ‘necessity’ and ‘concerns’. CONLCUSIONS: The personal balance between perceived risks of UVR and social/psychological ‘concerns’ led to differing behavioural responses and contributes to an understanding of adaptation and normalisation in chronic illness. The study will also inform a series of individualised behavioural interventions to reduce measured UVR exposure among people with XP that are potentially applicable to other conditions with high risks of skin cancer

Preventing overweight and improving parenting skills from birth to age 3 years: preliminary results

Background. Parenting has been associated with child weight status. This study aims to evaluate the effects on parenting skills and BMI-SDS of the BBOFT+ overweight prevention program, compared to care-as-usual (CAU). Method. In a cluster-randomized trial, 2500 parents participated. Parent-reported weight and length were used. Parenting was measured with subscales control and reinforcement of the parenting strategies for eating and activity scale (PEAS) and the warmth subscale from the Child Rearing Questionnaire. Results. The first univariate analyses show that at age 15 months, no statistically significant differences in BMI- SDS, parental control, reinforcement or warmth were found between the BBOFT+ and the CAU group. Further cluster analyses need to be conducted. Results from age 36 months will be presented during the conference, which will include all subscales of the PEAS and an assessment of parenting styles. Conclusion. The intervention does not seem to have an effect on BMI-SDS or parenting

Why Some Women Eat Too Much: A Qualitative Study of Food-Dependent Women

Obesity has become a worldwide epidemic and limiting one\u27s food intake, or dieting, is usually unsuccessful. The purpose of the study was to explore the effect of food addiction (FA) on the current clinical and behavioral epidemic of obesity. FA, synonymous with food-dependency, is tentatively defined as an eating disorder based on substance dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Measurement of FA has been operationalized by the Yale Food Addiction Scale (YFAS) by applying the diagnostic criteria of substance dependence to eating behaviors. This study was based on the biological theory of chemical addiction and the evidence that highly processed, high-fat, and high-sugar foods may be addictive and may contribute to unsuccessful dieting. To explore the difficulty of adhering to healthy food choices, 6 women were identified who satisfied the diagnostic criteria of FA using the YFAS. These women were invited to participate in a qualitative study. The full transcripts, which were coded via interpretative phenomenological analysis, revealed 6 major themes. The most salient master themes were the loss of control over food intake, the need for external control for successful weight loss, and the significant distress caused by food and eating. All the women interviewed agreed that FA is an eating disorder and that (a) best results were obtained from sugar and flour abstinence and (b) success was found in a 12 Step program for FA based on an addiction model. Once identified with the YFAS, FA has a large impact for social change. Those recognized as having a FA can be offered a specific treatment, based on an addiction model, which differs from the usual treatment for obesity and offers a solution for successful weight management

Characterizing the Information Needs of Rural Healthcare Practitioners with Language Agnostic Automated Text Analysis

Objectives – Previous research has characterized urban healthcare providers\u27 information needs, using various qualitative methods. However, little is known about the needs of rural primary care practitioners in Brazil. Communication exchanged during tele-consultations presents a unique data source for the study of these information needs. In this study, I characterize rural healthcare providers\u27 information needs expressed electronically, using automated methods. Methods – I applied automated methods to categorize messages obtained from the telehealth system from two regions in Brazil. A subset of these messages, annotated with top-level categories in the DeCS terminology (the regional equivalent of MeSH), was used to train text categorization models, which were then applied to a larger, unannotated data set. On account of their more granular nature, I focused on answers provided to the queries sent by rural healthcare providers. I studied these answers, as surrogates for the information needs they met. Message representations were generated using methods of distributional semantics, permitting the application of k-Nearest Neighbor classification for category assignment. The resulting category assignments were analyzed to determine differences across regions, and healthcare providers. Results – Analysis of the assigned categories revealed differences in information needs across regions, corresponding to known differences in the distributions of diseases and tele-consultant expertise across these regions. Furthermore, information needs of rural nurses were observed to be different from those documented in qualitative studies of their urban counterparts, and the distribution of expressed information needs categories differed across types of providers (e.g. nurses vs. physicians). Discussion – The automated analysis of large amounts of digitally-captured tele-consultation data suggests that rural healthcare providers\u27 information needs in Brazil are different than those of their urban counterparts in developed countries. The observed disparities in information needs correspond to known differences in the distribution of illness and expertise in these regions, supporting the applicability of my methods in this context. In addition, these methods have the potential to mediate near real-time monitoring of information needs, without imposing a direct burden upon healthcare providers. Potential applications include automated delivery of needed information at the point of care, needs-based deployment of tele-consultation resources and syndromic surveillance. Conclusion – I used automated text categorization methods to assess the information needs expressed at the point of care in rural Brazil. My findings reveal differences in information needs across regions, and across practitioner types, demonstrating the utility of these methods and data as a means to characterize information needs

Lived Experiences Involving Self-Efficacy Among African American Women Receiving Cardiac Peer Support

Cardiovascular disease (CVD) is the leading cause of death among African American (AA) women in the United States. While there have been advances and more widespread use of peer-to-peer (P2P) support strategies to improve self-management skills among CVD patients, these approaches have not affected AA women, who continue to die from heart disease at significantly high rates. The purpose of this study was to examine real-life experiences of AA women with hypertensive heart disease who receive P2P support and the effect of that support on self-efficacy and cardiac health. The health belief model and social cognitive learning theory were the theoretical framework for the study. A qualitative phenomenological approach with semistructured recorded video conference interviews was used to explore lived experiences and perceptions of a purposeful sample of AA women between 20 and 61 with hypertensive heart disease who have participated in online peer support groups. Thematic analysis revealed AA women welcomed and appreciated P2P support groups, felt empowered due to benefits obtained from these groups, perceived a reduction in cardiac episodes and hospital admissions with the addition of P2P support, and received guidance from primary care providers that supplemented benefits from P2P support groups. These findings indicate that P2P support groups for AA women suffering from CVD may help improve their self-care management and lead to positive social change for this population. Recommendations include more P2P support, both in person and online formats, with guidance from primary care and mental health providers to positively affect lives of AA women afflicted with CVD

Designing high fidelity simulation to maximize student registered nursing decision-making ability

The current healthcare environment is a complex system of patients, procedures, and equipment that strives to deliver safe and effective medical care. High fidelity simulation provides healthcare educators with a tool to create safety conscious practitioners utilizing an environment that replicates practice without risk to patients. Using HFS learning opportunities to refine a learner\u27s clinical decision-making skills under time pressure and high stakes outcomes could provide new opportunities for training the healthcare workforce of the future. This design based research project explored how to structure HFS training to facilitate the development of decision-making in second semester Registered Nursing learners. Borrowing from the research base of aviation and the military, a framework of Situation Awareness was used to define decision-making skills. Using a naturalistic decision-making approach, the research sought to understand how the design of the HFS learning event impacted the ability of participants to demonstrate behaviors of Situation Awareness. Findings of this study demonstrated that design based research is a powerful tool to create a rich understanding of the high fidelity simulation learning experience. The results also supported the work of Jeffries (2005) reiterating that HFS simulation design must be created using strong pedagogical principles that support specific learning outcomes. Particular attention should be focused on maintenance of fidelity, understanding complexity and scaffolding learning opportunities through a multi-phased approach that minimally includes debriefing. The research related to this small group suggests that the briefing stage of HFS learning should be further explored for its influence on learning in HFS. The influence of the facilitator/faculty on the HFS was emphasized in this research suggesting that faculty development would be important for use of this new tool. Additional implications of the research suggest that high fidelity simulation has a role in team training and development of communication skills