One Health Informatics

Zoonoses are a class of infectious diseases causing growing concern of health authorities worldwide. Human and economic costs of zoonoses are substantial, especially in low-resource countries. New zoonoses emerge as a consequence of ecological, demographic, cultural, social and behavioral factors. Meanwhile, global antimicrobial resistance increases. This public health threat demands for a new approach to which the concept of ‘One Health’ is emblematical. It emphasizes the interconnectedness of human, animal and environmental health. To protect and improve public health it is imperative that transdisciplinary collaboration and communication takes place between the human and the veterinary domain. This strategy is now widely endorsed by international, regional and national health policy and academic bodies. Nonetheless the contributions of both the social sciences and the new data sciences need more appreciation. Evidence is available that the methods and concepts they provide can budge ‘One Health’

Persuasive system design does matter: a systematic review of adherence to web-based interventions

Background: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods: We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results: We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adher

ePublic Health: Fresh Approachees to Infection Prevention and Control

Prevention and control of infectious diseases suffer from deficient compliance with preventive measures or guidelines of both professionals and general audience. This poses a threat to public health. Current approaches to prevent risk behavior are in need of innovation. Fresh approaches to education, information and communication are needed. In this study five social media tools i.e., (micro-)blogs, social networks, podcasts, mobile applications, RSS feeds, are (re)designed and operated with regard to four areas of infection prevention and control. They are evaluated according to their impact on public and professional adherence, compliance rate and other indices. Here we present outcomes of the first part of the study; a literature review of social media use in public health, specifically in the Netherlands. Empirical studies are scarce. However anecdotic studies, practices and experiences are reported that imply a range of innovative possibilities and potential impact of social media in the field of prevention and control of infectious diseases, as well as in public health at large

Online usability and patients with long-term conditions: A mixed-methods approach

Background To improve the information position of health care consumers and to facilitate decision-making behavior in health the Dutch ministry of Health commissioned the National Institute for Public Health and the Environment to develop, host and manage a public national health and care portal (www.kiesbeter.nl) on the Internet. The portal is used by over 4 million visitors in 2010. Among them, an increasing amount of patients that use the portal for information and decision making on medical issues, healthy living, health care providers and other topics. Objective First objective is to examine what usability aspects of the portal kiesBeter.nl matter for chronic patients and their informal carers with regard to information seeking, self-management, decision making, on line health information and other variables. Second objective is to make evidence-based practical recommendations for usability improvement. Methods An innovative combination of techniques (semi-structured interviews; eHealth Literacy scale; scenario-based study using think-aloud protocol and screen capture software; focus group) is used to study usability and on line information seeking behavior in a non random judgment sample of three groups of patients (N = 21) with long-term medical conditions (arthritis, asthma and diabetes). Results The search strategy mostly used (65%) by the relatively well-educated subjects is ‘orienteering’. Users with long-term conditions and their carers expect tailored support from a national health portal, to help them navigate, search and find the detailed information they need. They encounter serious problems with these usability issues some of which are disease-specific. Patients indicate a need for personalized information. They report low impact on self-management and decision making. Overall judgment of usability is rated 7 on a Likert type 0–10 scale. Based on the outcomes recommendations could be formulated. These have led to major adaptations to improve usability. Limitations A non-representative composition of a small non random judgment sample does not permit generalization to other populations and cognitive bias cannot be quantified. However if mixed methods are applied valid conclusions can be drawn with regard to usability issue

Health technology assessment frameworks for eHealth:A systematic review

Objectives Traditionally, health technology assessment (HTA) focuses on assessing the impact of pharmaceutical technologies on health and care. Resources are scarce and policy makers aim to achieve effective, accessible health care. eHealth innovations are increasingly more integrated in all healthcare domains. However, how eHealth is assessed prior to its implementation in care practices is unclear. To support evidence-informed policy making, this study aimed to identify frameworks and methods for assessing eHealth's impact on health care.Methods The scientific literature in five bibliographical databases was systematically reviewed. Articles were included if the study was conducted in a clinical setting, used an HTA framework and assessed an eHealth service. A systematic qualitative narrative approach was applied for analysis and reporting.Results Twenty-one HTA frameworks were identified in twenty-three articles. All frameworks addressed outcomes related to the technical performance and functionalities of eHealth service under assessment. The majority also addressed costs (n = 19), clinical outcomes (n = 14), organizational (n = 15) and system level aspects (n = 13). Most frameworks can be classified as dimensional (n = 13), followed by staged (n = 3), hybrid (n = 3), and business modeling frameworks (n = 2). Six frameworks specified assessment outcomes and methods.Conclusions HTA frameworks are available for a-priori impact assessment of eHealth services. The frameworks vary in assessment outcomes, methods, and specificity. Demonstrated applicability in practice is limited. Recommendations include standardization of: (i) reporting characteristics of eHealth services, and (ii) specifying assessment outcomes and methods following a stepped-approach tailored to the functional characteristics of eHealth services. Standardization might improve the quality and comparability of eHTA assessments