Consumer Health Information Technology Research Articles

Conceptualizing Sociotechnical System Boundaries in Healthcare Settings

Healthcare systems are complex dynamic sociotechnical systems, in which groups of people (e.g., patients and families, clinicians) interact with different technologies (e.g., clinical decision support system, consumer health information technology) in various physical (e.g., hospital, patient home) and organizational (e.g., teamwork, culture) environments (Carayon et al., 2006; Effken, 2002; Kleiner, 2007). The complex and dynamic nature of healthcare systems results in their boundaries being increasingly fuzzy (Carayon et al., 2011; Plsek & Greenhalgh, 2001). People are no longer constrained to work in single local work systems. Instead, they work in teams across different system boundaries, including organizational, hierarchical, cultural, spatial, temporal, and process boundaries (Carayon, 2006; Karsh & Alper, 2005). New conceptualizations of healthcare system boundaries are needed to take into consideration the characteristics of complex sociotechnical systems (Carayon et al., 2015). We convene this panel to address the general question of how to conceptualize sociotechnical system boundaries in healthcare. Five panelists present examples from their respective research to illustrate the conceptualization of sociotechnical system boundaries in different healthcare domains.

Mechanisms of Communicating Health Information Through Facebook: Implications for Consumer Health Information Technology Design.

BackgroundConsumer health information technology (IT) solutions are designed to support patient health management and have the ability to facilitate patients’ health information communication with their social networks. However, there is a need for consumer health IT solutions to align with patients’ health management preferences for increased adoption of the technology. It may be possible to gain an understanding of patients’ needs for consumer health IT supporting their health information communication with social networks by explicating how they have adopted and adapted social networking sites, such as Facebook, for this purpose.ObjectiveOur aim was to characterize patients’ use of all communication mechanisms within Facebook for health information communication to provide insight into how consumer health IT solutions may be better designed to meet patients’ communication needs and preferences.MethodsThis study analyzed data about Facebook communication mechanisms use from a larger, three-phase, sequential, mixed-methods study. We report here on the results of the study’s first phase: qualitative interviews (N=25). Participants were over 18, used Facebook, were residents or citizens of the United States, spoke English, and had a diagnosis consistent with type 2 diabetes. Participants were recruited through Facebook groups and pages. Participant interviews were conducted via Skype or telephone between July and September 2014. Data analysis was grounded in qualitative content analysis and the initial coding framework was informed by the findings of a previous study.ResultsParticipants’ rationales for the use or disuse of a particular Facebook mechanism to communicate health information reflected six broad themes: (1) characteristics and circumstances of the person, (2) characteristics and circumstances of the relationship, (3) structure and composition of the social network, (4) content of the information, (5) communication purpose, and (6) attributes of the technology.ConclusionsThe results of this study showed that participants consider multiple factors when choosing a Facebook mechanism for health information communication. Factors included what information they intended to share, what they were trying to accomplish, attributes of technology, and attributes and communication practices of their social networks. There is a need for consumer health IT that allows for a range of choices to suit the intersectionality of participants’ rationales. Technology that better meets patients’ needs may lead to better self-management of health conditions, and therefore, improve overall health outcomes.

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review.

BackgroundAs consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions.ObjectiveOur aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics.MethodsA narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics.ResultsWe included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention.ConclusionsThis study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.

The effectiveness of the use of consumer health information technology in patients with heart failure: A meta-analysis and narrative review of randomized controlled trials

Purpose The purpose of this study was to examine whether the use of consumer health information technologies (CHITs) has an impact on outcomes of patients in the self-management of heart failure (HF). Methods A literature search of six electronic databases was conducted to identify relevant reports of randomized controlled trials (RCTs) for the analysis. Mortality, hospitalization and length of hospital stay were meta-analyzed and other patient outcomes were synthesized using a narrative approach. Results The literature search identified 50 studies, representing 43 RCTs, comparing the use of CHITs with usual care for HF patients. The meta-analysis showed that the use of CHITs reduced the risk of HF-caused mortality (relative risk (RR) = 0.70, 95% confidence interval (CI): 0.54–0.91), p = 0.007), lowered the risk of HF-caused hospitalization (RR = 0.80, 95% CI: 0.66–0.96), p = 0.020), and shortened HF-caused length of hospital stay (mean difference = –0.52, 95% CI: –0.77 to –0.27, p < 0.00), but not all-cause mortality, all-cause hospitalization or all-cause length of hospital stay, compared with usual care. The narrative synthesis indicated that only a small proportion of the trials reported positive effects of CHITs over usual care. Conclusions Evidence from RCTs presents mixed results on the impacts of CHITs for HF management. Further studies are required to assess whether and how CHITs would play a role in enhancing health care and patient outcomes and what specific CHIT features and functions are relevant to different HF treatment goals and self-care objectives.

Family Caregivers and Consumer Health Information Technology.

Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.

"You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions.

BackgroundConsumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as “quantified self” advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population.ObjectiveOur aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data?MethodsWe used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached.ResultsInterviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients’ self-tracked data.ConclusionsDevelopers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered “illness work” connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their “illness work” more efficiently and effectively.

The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

BackgroundA critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors.ObjectiveAs part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information.MethodsSemistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved.ResultsA total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients’ perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work: managing transfers of medical information to solve problems was a tremendous amount of work that was largely unrecognized by the medical establishment.ConclusionsWe conclude that personal health information management should be recognized as an additional burden that MCC places upon patients. Effective structural solutions for information sharing, whether institutional ones such as care management or technological ones such as electronic health information exchange, are likely not only to improve the quality of information shared but reduce the burden on patients already weighed down by MCC.

Exploring patients’ health information communication practices with social network members as a foundation for consumer health IT design

BackgroundThere is a need to ensure that the growing number of consumer health information technologies designed to support patient engagement account for the larger social context in which health is managed. Basic research on how patients engage this larger social context is needed as a precursor to the development of patient-centered consumer health information technology (IT) solutions. PurposeThe purpose of this study was to inform the broader design of consumer health IT by characterizing patients’ existing health information communication practices with their social network members. MethodsThis qualitative study took place between 2010 and 2012 in a Midwestern city. Eighteen patients with chronic conditions participated in a semi-structured interview that was analyzed using qualitative content analysis and descriptive statistics. Emphasis was placed on recruiting a sample representing diverse cultural groups and including participants of low socioeconomic status. ResultsParticipants’ social networks included a wide range of individuals, spanning biological relatives, divinities, and second-degree relationships. Participants’ rationales for health information communication reflected seven themes: (1) characteristics and circumstances of the person, (2) characteristics and circumstances of the relationship, (3) structure and composition of the social network, (4) content of the message, (5) orientation of the goal, (6) dimensions of the context, and (7) adaptive practices. ConclusionsThis study demonstrates that patients’ health information communication practices are multidimensional, engaging individuals beyond formal and informal caregivers and driven by characteristics of their personal lives and larger social contexts in addition to their health problem. New models of consumer health IT must be created to better align with the realities of patients’ communication routines.

Using Publicly Available Data to Characterize Consumers Use of Email to Communicate with Healthcare Providers.

The use of patient focused technology has been proclaimed as a means to improve patient satisfaction and improve care outcomes. The Center for Medicaid/Medicare Services, through its EHR Incentive Program, has required eligible hospitals and professionals to send and receive secure messages from patients in order to receive financial incentives and avoid reimbursement penalties. Secure messaging between providers and patients has the potential to improve communication and care outcomes. The purpose of this study was to use National Health Interview Series (NHIS) data to identify the patient characteristics associated with communicating with healthcare providers via email. Individual patient characteristics were analyzed to determine the likelihood of emailing healthcare providers. The use of email for this purpose is associated with educational attainment, having a usual place of receiving healthcare, income, and geography. Publicly available data such as the NHIS may be used to better understand trends in adoption and use of consumer health information technologies.

Beyond traditional advertisements: leveraging Facebook's social structures for research recruitment.

BackgroundObtaining access to a demographically and geographically diverse sample for health-related research can be costly and time consuming. Previous studies have reported mixed results regarding the potential of using social media-based advertisements to overcome these challenges.ObjectiveOur aim was to develop and assess the feasibility, benefits, and challenges of recruiting for research studies related to consumer health information technology (IT) by leveraging the social structures embedded in the social networking platform, Facebook.MethodsTwo recruitment strategies that involved direct communication with existing Facebook groups and pages were developed and implemented in two distinct populations. The first recruitment strategy involved posting a survey link directly to consenting groups and pages and was used to recruit Filipino-Americans to a study assessing the perceptions, use of, and preferences for consumer health IT. This study took place between August and December 2013. The second recruitment strategy targeted individuals with type 2 diabetes and involved creating a study-related Facebook group and asking administrators of other groups and pages to publicize our group to their members. Group members were then directly invited to participate in an online pre-study survey. This portion of a larger study to understand existing health management practices as a foundation for consumer health IT design took place between May and June 2014. In executing both recruitment strategies, efforts were made to establish trust and transparency. Recruitment rate, cost, content of interaction, and characteristics of the sample obtained were used to assess the recruitment methods.ResultsThe two recruitment methods yielded 87 and 79 complete responses, respectively. The first recruitment method yielded a rate of study completion proportionate to that of the rate of posts made, whereas recruitment successes of the second recruitment method seemed to follow directly from the actions of a subset of administrators. Excluding personnel time, the first recruitment method resulted in no direct costs, and the second recruitment method resulted in a total direct cost of US $118.17. Messages, posts, and comments received using both recruitment strategies reflected ten themes, including appreciation, assistance, clarification, concerns, encouragement, health information, interest, promotion, solicitations, and support. Both recruitment methods produced mixed results regarding sample representativeness with respect to characteristics such as gender, race, and ethnicity.ConclusionsThe results of the study demonstrate that leveraging the social structures of Facebook for health-related research was feasible for obtaining small samples appropriate for qualitative research but not for obtaining large samples needed for quantitative research. The content of interactions with members of the target population prompted ethical deliberations concerning suitable target communities and appropriate boundaries between researchers and participants. Widespread replication of this method would benefit from a broad discussion among researchers, social media users, social media companies, and experts in research ethics to address appropriate protocols for such interactions.

The Work and Work Systems of Patients: A New Frontier for Macroergonomics in Health Care

To maintain and improve their health, patients perform many non-paid activities that may be conceptualized as self-care and self-management work. However, within the domain of health care, macroergonomists have almost exclusively focused on analyzing the work and work systems of those employed by the health care system rather than those served by it. This panel will focus on how macroergonomics principles and models originally developed within an institutional context may be adapted for the contexts in which patients are embedded. The discussion will be grounded in specific analyses of patients’ work and work systems within domains such as consumer health information technology design, self-care work performance, transitions of care, and patient safety. During each of these presentations, panelists will focus on lessons related to the conceptual, methodological and practice-related challenges of understanding and affecting patients’ work and work systems that may be applied by other researchers.

Improving the Effectiveness of Consumer Health IT

Many of the most successful health information technology (IT) applications have made it easier for clinicians to provide high-quality care to patients. However, despite the demonstrated effectiveness of consumer health IT applications to improve health outcomes, their uptake lags. Improved design of consumer health IT applications may enable broader acceptance and increase use. Thus, a project supported by the Agency for Healthcare Research and Quality (AHRQ) was conducted to uncover design methods used in other industries that might be extended to the design of consumer health IT applications. This paper summarizes the findings from that project.

The Influence of Computer Experience and Screen Size on Use Performance and Perceptions of a Tablet-Based Chronic Illness Self-Management System for Older Adults

A usability study of a tablet-based chronic illness self-management system was conducted to evaluate the system’s usability and to examine the effects of screen size and computer experience on use performance and perceptions of the system. A two-factor, between-subjects design was implemented, in which 40 older adults aged from 55 to 88 years were equally assigned to two screen size groups and required to perform a set of self-management tasks. The results showed that screen size had no effect on either the use performance or perceptions of the system, and that computer experience had significant effects on the former but no effect on the latter. Older adults without computer experience tended to perceive the large tablet screen system as more useful. This study verified the usability of the tablet-based self-management system with older adults. Its findings suggest the need to determine an optimal screen size for consumer health information technologies, and highlight the importance of computer experience in usability studies. Future studies may address its limitations.

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.

Roadmap for engaging consumers in using health information technology.

As healthcare costs continue to grow, one method proposed to help reduce costs is consumer engagement in prevention, management, and self-care. This results in less costs incurred by providers and the healthcare system overall. Using consumer Health Information Technology (HIT) makes it easier for consumers to be engaged in managing their own health. The purpose of this research is to develop a strategic roadmap for providers to use when engaging consumers in HIT. Interviews and a literature search of journals and other publications were completed to find successful actions related to engagement of consumers. The research used included healthcare entities in addition to strategic planning practices within business administration. The findings were used to create a method for developing a consumer HIT engagement roadmap. A roadmap was also successfully developed, which can be utilized by organizations as a basis for tailoring their own strategic plans.

Artifact Usage, Context, and Privacy Management in Logging and Tracking Personal Health Information in Older Adults

Consumer health information technology (CHIT) applications have the potential to improve overall care quality for older adults. The design and development of CHIT applications requires an understanding of the current and future personal health information management (PHIM) activities occurring in home and community settings. Building a better understanding of critical PHIM activities, such as how older adults track and log health information, is essential in the design of technologies that support these activities. This paper presents findings from a contextual inquiry of how older adults currently use artifacts in logging and tracking personal health information (PHI). Context and privacy management emerged as key themes in data analysis. Design implications for future CHIT applications are discussed.

Consumer health information technology in an adult public health primary care clinic: A heart health education feasibility study

ObjectiveTo explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic. MethodsFifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up. ResultsParticipants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p=.02), and decreased systolic (p=.01) and diastolic BP (p<.001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant. ConclusionUsing a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults. Practice implicationsA kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.

Older Adults' Perceptions of Home Telehealth Services

The success of home telemedicine depends on end-user adoption, which has been slow despite rapid advances in technological development. This study focuses on an examination of significant factors that may predict the successful adoption of home telemedicine services (HTS) among older adults. Based on previous studies in the fields of remote patient monitoring, assisted living technologies, and consumer health information technology acceptance, eight factors were identified as a framework for qualitative testing. Twelve focus groups were conducted with an older population living in both urban and rural environments. The results reveal seven predictors that play an important role in perceptions of HTS: perceived usefulness, effort expectancy, social influence, perceived security, computer anxiety, facilitating conditions, and physicians' opinion. The results provide important insights in the field of older adults' acceptance of HTS, with guidelines for the strategic planning, developing, and marketing of HTS for the graying market.

Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers.

BackgroundMany patients with chronic conditions are supported by out-of-home informal caregivers—family members, friends, and other individuals who provide care and support without pay—who, if armed with effective consumer health information technology, could inexpensively facilitate their care.ObjectiveWe sought to understand caregivers’ use of, interest in, and perceived barriers to health information technology for out-of-home caregiving.MethodsWe conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers’ technology use for caregiving.ResultsAmong 316 out-of-home caregiver respondents, 34.5% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95% CI 1.01-3.50) for low intensity caregivers, 2.39 (95% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95% CI 1.62-8.45) for high intensity caregivers. Over 70% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients’ health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving.ConclusionsHealth information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers’ interest in and use of technology by modifying privacy policies that impede information exchange.

Designing consumer health IT to enhance usability among different racial and ethnic groups within the United States

Racial and ethnic healthcare disparities remain after differences in income, access, and insurance status have been considered, partly because of the healthcare delivery system’s failure to respond to cultural differences. The Institute of Medicine has called for the development and deployment of culturally appropriate healthcare services to mitigate these disparities. This complex problem of determining how to address the cultural components of racial and ethnic healthcare disparities is an example of what Russell Ackoff terms “messes.” Given consumer health information technology (IT)’s increasing role in patients’ self-care and self-management, one potential solution lies in designing consumer health IT that is culturally-informed. Although both the healthcare informatics community and the engineering design community have begun to seriously consider the role of culture in design to enhance usability, much work remains. Unfortunately, creating culturally-informed consumer health IT can seem daunting, limiting designers’ efforts. We propose the Culturally-Informed Design Framework as a guide for designers of consumer health IT. Designers may use this framework to conceptualize four dimensions of a consumer health IT – technology platform, functionality, content, user interface—in which design choices should be informed by a deep understanding of the users’ culture.