What is eHealth (6)? Development of a Conceptual Model for eHealth: Qualitative Study with Key Informants

©Tim Shaw, Deborah McGregor, Melissa Brunner, Melanie Keep, Anna Janssen, Stewart Barnet. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.10.2017. BACKGROUND: Despite rapid growth in eHealth research, there remains a lack of consistency in defining and using terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalize eHealth and enable its implementation in health care practice, research, education, and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalization and hypothesis testing.OBJECTIVE: This study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts.METHODS: We conducted semistructured interviews with key informants (N=25) from organizations involved in health care delivery, research, education, practice, governance, and policy to explore their perspectives on and experiences with eHealth. We used purposeful sampling for maximum diversity. Interviews were coded and thematically analyzed for emergent domains.RESULTS: Thematic analyses revealed 3 prominent but overlapping domains of eHealth: (1) health in our hands (using eHealth technologies to monitor, track, and inform health), (2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients), and (3) data enabling health (collecting, managing, and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains.CONCLUSIONS: This model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that are lacking in previous research. On the basis of this model, we suggest that eHealth initiatives that are most impactful would include elements from all 3 domains

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Patients, trust and ethics in information privacy in eHealth

Using Information and Communication Technologies (ICT) in the health sector (eHealth) is a natural progression for the digital agenda, and is seen as being of benefit to organisations providing healthcare, the patients receiving healthcare, and the development of the ICT industry. With the likelihood of a growing demand for healthcare, particularly from an increasingly elderly population, using ICT to streamline processes and support practitioners makes sense. However, the challenges faced when remodelling a sector that has traditionally operated through direct face-to-face human contact are significant. While the processes of information management and information flow may be improved from an organisational perspective, the people at the heart of eHealth, i.e. the patients, may not be convinced that such a move will be of benefit to them, even though the traditional face-to-face aspects may not be lost. In this chapter, we take the example of the United Kingdom and focus on the patient in the eHealth environment. We take the position that patient trust and confidence in ICT is important, not only for patient ‘buy-in’ but also to maintain the ethical values that are fundamental to medical practice

AIDS Behav

National HIV prevention goals call for interventions that address Continuum of HIV Care (CoC) for persons living with HIV. Electronic health (eHealth) can leverage technology to rapidly develop and disseminate such interventions. We conducted a qualitative review to synthesize (a) technology types, (b) CoC outcomes, (c) theoretical frameworks, and (d) behavior change mechanisms. This rapid review of eHealth, HIV-related articles (2007-2017) focused on technology-based interventions that reported CoC-related outcomes. Forty-five studies met inclusion criteria. Mobile texting was the most commonly reported technology (44.4%, k\ua0=\ua020). About 75% (k\ua0=\ua034) of studies showed proven or preliminary efficacy for improving CoC-related outcomes. Most studies (60%, k\ua0=\ua027) focused on medication adherence; 20% (k\ua0=\ua09) measured virologic suppression. Many eHealth interventions with preliminary or proven efficacy relied on mobile technology and integrated knowledge/cognition as behavior change mechanisms. This review identified gaps in development and application of eHealth interventions regarding CoC.CC999999/Intramural CDC HHS/United States2018-01-10T00:00:00Z28983684PMC5760442vault:2581

Using social media and mobile gaming to improve the vegetable intake of young adults

Australian Dietary Guidelines recommend five servings of vegetables daily for prevention of chronic disease, but only 7% of adults achieve this. The initial stages of this thesis involved secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey data. Results showed young adults aged 18-24 years were the poorest consumers of vegetables, with mean intake of 2.7 serves daily. To inform the design of a targeted intervention using new technology the PhD candidate systematically reviewed the literature and found mobile-phone based interventions have positive effects on vegetable consumption (Cohen’s d 0.15,95% CI 0.04–0.28). Notably, engagement was low among young adults and few studies harnessed novel strategies such as social media or gamification for program delivery. Yet 95% of young adults own a smartphone and 91% use their device for game play or social networking. The final stage of this thesis involved the development of a 4-week social media and mobile-gaming intervention underpinned by behavioural theory, to addresses key barriers to, and psychosocial determinants of, vegetable intake. Behaviour change techniques demonstrated to mediate success, such as goal setting and self-monitoring were integrated. Short mobile-phone delivered cooking videos were developed to address the low level of cooking literacy among this age group, with focus group testing confirming their acceptability among the target audience. A factorial study design was used to determine the feasibility of delivering the program. This was the first study to explore the impact of social support using social media in combination with gaming elements in a nutrition intervention for young adults. The research revealed that it is feasible and practical to deliver behaviour change interventions to young adults using these novel communication mediums. The accessibility of these platforms could allow the dissemination of individual behaviour change interventions at scale

Initiatives to integrate primary and acute health care, including ambulatory care services

Most people, at some time in their lives, will require health care services from multiple health care providers, whether it is for short-term unexpected ill health, long-term chronic conditions or co-morbidities that cross disciplines (eg. substance-related conditions and mental health). Integration of health services is particularly important for patients with chronic and complex conditions as they must frequently negotiate a path through different health care sectors, including primary, acute and ambulatory care services, as well as the public and private health jurisdictions. Standardised pathways for the more common chronic conditions may be needed to enable seamless transitions and avoid negative outcomes that may result from delays, duplications and errors in a system that operates as multiple independent organisations

Analysis of the Federal Health Budget and Related Provisions 2015-16

This analysis looks at the health and related provisions in the Australian Government’s 2015-16 Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where possible, by data drawn from Medicare, the Pharmaceutical Benefits Scheme, reports and published papers

Where can teens find health information? A survey of web portals designed for teen health information seekers

The Web is an important source for health information for most teens with access to the Web (Gray et al, 2005a; Kaiser, 2001). While teens are likely to turn to the Web for health information, research has indicated that their skills in locating, evaluating and using health information are weak (Hansen et al, 2003; Skinner et al, 2003, Gray et al, 2005b). This behaviour suggests that the targeted approach to finding health information that is offered by web portals would be useful to teens. A web portal is the entry point for information on the Web. It is the front end, and often the filter, that users must pass through in order to link to actual content. Unlike general search engines such as Google, content that is linked to a portal has usually been pre-selected and even created by the organization that hosts the portal, assuring some level of quality control. The underlying architecture of the portal is structured and thus offers an organized approach to exploring a specific health topic. This paper reports on an environmental scan of the Web, the purpose of which was to identify and describe portals to general health information, in English and French, designed specifically for teens. It answers two key questions. First of all, what portals exist? And secondly, what are their characteristics? The portals were analyzed through the lens of four attributes: Usability, interactivity, reliability and findability. Usability is a term that incorporates concepts of navigation, layout and design, clarity of concept and purpose, underlying architecture, in-site assistance and, for web content with text, readability. Interactivity relates to the type of interactions and level of engagement required by the user to access health information on a portal. Interaction can come in the form of a game, a quiz, a creative experience, or a communication tool such as an instant messaging board, a forum or blog. Reliability reflects the traditional values of accuracy, currency, credibility and bias, and in the web-based world, durabililty. Findability is simply the ease with which a portal can be discovered by a searcher using the search engine that is most commonly associated with the Web by young people - Google - and using terms related to teen health. Findability is an important consideration since the majority of teens begin their search for health information using search engines (CIBER, 2008; Hansen et al, 2003). The content linked to by the portals was not evaluated, nor was the portals’ efficacy as a health intervention. Teens looking for health information on the Web in English have a wide range of choices available but French-language portals are much rarer and harder to find. A majority of the portals found and reviewed originated from hospitals, associations specializing in a particular disease, and governmental agencies, suggesting that portals for teens on health related topics are generally reliable. However, only a handful of the portals reviewed were easy to find, suggesting that valuable resources for teens remain buried in the Web