Digital Health Information Research Articles

The Digital Relationship: Board Hears Report On Innovation and Technology

The Digital Relationship: Board Hears Report On Innovation and Technology

\u2018We have the internet in our hands\u2019: Bangladeshi college students\u2019 use of ICTs for health information

BackgroundInformation and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.MethodsThis study relies on two surveys: a 2013–2014 General Survey that randomly sampled 854 households drawn from the general population and a 2015 Student Survey that randomly sampled 436 students from two Mirzapur colleges. Select focus group discussions and in-depth interviews were undertaken with students. Icddr,b’s Ethical Review Board granted ethical clearance.ResultsThe data show that Mirzapur’s college students are economically relatively well positioned, more likely to own mobile and smart phones, and more aware of the internet than the general population. They are interested in health information and use phones and computers to access information. Moreover, they use digital technology to share previously-discreet information, adding value to that information and bypassing former gatekeepers. But access to health information is not entirely unfettered, affecting male and female students differently, and powerful gatekeepers, both old and new, can still control sources of information.ConclusionPersonal searches for SRH and the resultant online information shared through discrete, personal face-to-face discussions has some potential to challenge social norms. This is particularly so for women students, as sharing information may enable them to bypass gatekeepers and make decisions about reproduction. This suggests that digital health information seeking may be exercising a disruptive effect within the health sector. However, the extent of this disruption may depend, not on students’ mobile phone usage, but on the degree to which powerful new gatekeepers are able to retain control over and market SRH information through students’ peer-to-peer sharing.

Trust in Health Information Sources: Survey Analysis of Variation by Sociodemographic and Tobacco Use Status in Oklahoma

BackgroundModern technology (ie, websites and social media) has significantly changed social mores in health information access and delivery. Although mass media campaigns for health intervention have proven effective and cost-effective in changing health behavior at a population scale, this is best studied in traditional media sources (ie, radio and television). Digital health interventions are options that use short message service/text messaging, social media, and internet technology. Although exposure to these products is becoming ubiquitous, electronic health information is novel, incompletely disseminated, and frequently inaccurate, which decreases public trust. Previous research has shown that audience trust in health care providers significantly moderates health outcomes, demographics significantly influence audience trust in electronic media, and preexisting health behaviors such as smoking status significantly moderate audience receptivity to traditional mass media. Therefore, modern health educators must assess audience trust in all sources, both media (traditional and digital) and interpersonal, to balance pros and cons before structuring multicomponent community health interventions.ObjectiveWe aimed to explore current trust and moderators of trust in health information sources given recent changes in digital health information access and delivery to inform design of future health interventions in Oklahoma.MethodsWe conducted phone surveys of a cross-sectional sample of 1001 Oklahoma adults (age 18-65 years) in spring 2015 to assess trust in seven media sources: traditional (television and radio), electronic (online and social media), and interpersonal (providers, insurers, and family/friends). We also gathered information on known moderators of trust (sociodemographics and tobacco use status). We modeled log odds of a participant rating a source as “trustworthy” (SAS PROC SURVEYLOGISTIC), with subanalysis for confounders (sociodemographics and tobacco use).ResultsOklahomans showed the highest trust in interpersonal sources: 81% (808/994) reported providers were trustworthy, 55% (550/999) for friends and family, and 48% (485/998) for health insurers. For media sources, 24% of participants (232/989) rated the internet as trustworthy, followed by 21% of participants for television (225/998), 18% for radio (199/988), and only 11% for social media (110/991). Despite this low self-reported trust in social media, 40% (406/991) of participants reported using social media for tobacco-related health information. Trust in health providers did not vary by subpopulation, but sociodemographic variables (gender, income, and education) and tobacco use status significantly moderated trust in other sources. Women were on the whole more trusting than men, trust in media decreased with income, and trust in friends and family decreased with education.ConclusionsHealth education interventions should incorporate digital media, particularly when targeting low-income populations. Utilizing health care providers in social media settings could leverage high-trust and low-cost features of providers and social media, respectively.

"Analysing Digital Information Seeking and Quality Evaluation of Sources about Healthy Lifestyle among Senior Citizens in Iceland "

As a key to senior citizens health and well-being it is important to support their possibilities to be actively involved in health promotional interventions through life-long learning. The study aims at understanding better older people’s digital information seeking, their source preferences and how they evaluate the quality of the information. An improved awareness of the issue may help to increase the efficiency of disseminating information to seniors and enhance their abilities to adopting healthier lifestyles. A random sample was used in the study and data collected in 2012. Participants were categorized into two groups, 60 to 67 years and 68 years or older. Data analysis was performed with ANOVA (one-way). The difference across the age groups was in most cases not significant. Both groups rarely sought digital information and considered the quality of it to be low. The results indicate that the older population can be reached with information about healthy living through professional health websites. Libraries and information professionals have the possibility and the means to take a leadership role and work together with health authorities at improving and stimulating senior’s use of digital health information.

RESPONSIBLE INNOVATION IN HEALTHCARE — THE CASE OF HEALTH INFORMATION TV

The paper explores the application of responsible innovation (RI) principles in the design and implementation of innovation in the context of digitally-enabled healthcare. In particular, we are interested in the scope for bringing in RI considerations at various stages in the innovation process and in the relevant tools and frameworks which might facilitate this. Using the particular example of a detailed longitudinal case of the development and diffusion (with subsequent modification and “re-innovation”) of a digital health information platform, we identify a number of key points at which the innovation concept “pivoted” to reflect new information, some of which resulted from a wider level of inclusion (one of the core RI principles). The paper explores the role played by structured frameworks (such as the “Business Model Canvas”) in the development of other digital healthcare innovations at an early stage.

The relevance of health literacy to mHealth

This chapter examines the importance of health literacy to the design and use of mobile digital health information technology (mHealth) applications. Over the past two decades mHealth has evolved to become a major health communication channel for delivering health care, promoting health, and tracking health behaviors. Yet, there are serious communication challenges that must be addressed concerning the best way to design and utilize mHealth application to achieve key health promotion goals, including assuring the appropriateness and effectiveness of mHealth messaging for audiences with different communication competencies, styles, and health literacy levels, to ensure that mHealth applications are truly effective tools for health promotion. Health literacy is one of the major communication issues relevant to the effective use of mHealth. To be effective, mHealth applications need to match the messages conveyed via these mobile media to the specific health communication needs, orientations, and competencies of intended audience members. Unfortunately, current evidence suggests that many mHealth applications are difficult for audiences to utilize because they provide health information that is not easy for many consumers to understand and apply. Health literacy refers to the ability of participants within the health care system to accurately interpret and utilize relevant health information and resources to achieve their health goals. Evidence suggests that many consumers possess limited levels of health literacy to adequately understand health information, especially when they are feeling ill, since health literacy is both a trait (limited education, language facility, etc.), and a state condition (based on how their current physical and mental states influence their abilities to communicate effectively). Therefore, it is incumbent upon mHealth developers to design and utilize message systems. Strategies for designing and implementing mHealth applications to meet the health literacy levels of different audiences are described in this chapter.

Abstract A14: Digital health information access among Asian Americans

Abstract Background Access to health information is essential to patient-centered healthcare. Healthy People 2020 recommended three key strategies for improving health outcomes and narrowing health disparities. One of the key strategies is to provide equitable access to health information. Digital technology holds great promise in helping to reduce health disparities. In fact, recent studies indicate that the “digital divide” is narrowing between racial/ethnic minorities and the general population. The question remains, however, on whether or not all groups have equal access to digital health information. Asian Americans (AAs) are the fastest growing minority group in the U.S. More than 65% of AAs are foreign-born, and greater than 30% have limited English proficiency. Non-English speaking AAs were not specifically targeted in previous digital technology ownership and usage surveys. However, such information is important to ensure equal access to digital cancer control information and other health information. Objective The purpose of this study was to examine (1) the most common channels that AA immigrants use to obtain health information, and (2) factors predicting the ownership and usage of computers, as well as the use of the Internet to obtain health information. Methods This study used a cross-sectional design and quota sampling. Participants were recruited through seven community-based organizations and from six Asian subgroups (Cambodian, Chinese, Filipinos, Korean, Laotian, South Asians and Vietnamese) . Participants were asked where they usually received helpful health information. They were also asked whether they had a computer at home and knew how to use it, as well as whether they used the Internet to obtain health information. Surveys were conducted in participants' native language. Only data from participants who were foreign-born were used in the statistical analysis. Results 403 participants completed the survey and 395 (98%) were foreign-born. 49% had family income <$20,000/year, 36% had <9 years of education, 45% reported less than average English proficiency. 26% were less than 50 years old (mean age = 56). 27% in the U.S. less than 10 years (mean years = 20). Overall, 78% of participants had a computer at home and 65% knew how to use it. However, only 14% of participants who did not have a computer at home knew how to use a computer. The most common channels to obtain helpful health information were: doctor (61%), family (38%), friends (37%), newspaper (32%), Internet (30%), ethnic television (29%), and community events (25%). However, there were significant differences across AA subgroups. 29% participants whose family income <$20,000/year did not have a computer at home, compared to 5% of participants whose family income >$20,000/year (p <.0005). Nearly half of the participants (47%) whose family income <$20,000 did not know how to use a computer, compared to only 14% participants whose family income >$20,000/year (p < .0005). Participants who did not have a computer at home were less likely to use the Internet for health information (OR = 0.14, 95%CI: .06-.33, p <.0005), so did participants who did not know how to use a computer (OR=.14, 95%CI: .08-.27, p <.0005). Participants who had less than average English proficiency were less likely to use the Internet to obtain health information (OR=.36, 95%CI: .23-.29, p <.0005), so did participant who had less than 12 years of education (OR=24, 95%CI: .11-.54, p =.001). Conclusion Despite a narrowing racial/ethnic “digital divide”, disparities still exist, particularly among Asian immigrants with low social economic status, less years of education and limited English proficiency. New interventions are needed to target underserved AA subpopulations and help them to gain access to digital health information and develop information seeking skills. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Karen Kim. Digital health information access among Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A14.

Security Attacks and Solutions in Electronic Health (E-health) Systems.

For centuries, healthcare has been a basic service provided by many governments to their citizens. Over the past few decades, we have witnessed a significant transformation in the quality of healthcare services provided by healthcare organizations and professionals. Recent advances have led to the emergence of Electronic Health (E-health), largely made possible by the massive deployment and adoption of information and communication technologies (ICTs). However, cybercriminals and attackers are exploiting vulnerabilities associated primarily with ICTs, causing data breaches of patients' confidential digital health information records. Here, we review recent security attacks reported for E-healthcare and discuss the solutions proposed to mitigate them. We also identify security challenges that must be addressed by E-health system designers and implementers in the future, to respond to threats that could arise as E-health systems become integrated with technologies such as cloud computing, the Internet of Things, and smart cities.

Teens, Health and Technology: A National Survey

In the age of digital technology, as teens seem to be constantly connected online, via social media, and through mobile applications, it is no surprise that they increasingly turn to digital media to answer their health questions. This study is the first of its kind to survey a large, nationally-representative sample of teens to investigate how they use the newest digital technologies, including mobile apps, social networking sites, electronic gaming and wearable devices, to explore health topics. The survey covered the types of health topics teens most frequently search for, which technologies they are most likely to use and how they use them, and whether they report having changed their behaviors due to digital health information. In addition, this survey explores how the digital divide continues to impact adolescents. Results of this study indicate that teens are concerned about many health issues, ranging from fitness, sexual activity, drugs, hygiene as well as mental health and stress. As teens virtually always have a digital device at their fingertips, it is clear that public health interventions and informational campaigns must be tailored to reflect the ways that teens currently navigate digital health information and the health challenges that concern them most.

Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.

Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access.

Digital Health and Doctor-Patient Communication in Nepal

This research pursues how digital health information is consumed and be useful for in Nepal and, second, more globally in terms of e-health around the world because I have been so much fascinated by e-health materials, and have been harnessing them for better reading, writing, researching and teaching for a decade with students from Medical and Science Schools. With the sudden explosion of digital media content and access devices in the last generation, there is now more information available to more people from more sources than at any time in human history, but the innovations in care delivery also could exacerbate disparities in access to care across racial/ ethnic or economic groups or between the technologically sophisticated and native. Health care providers are beginning to deliver a range of Internet-based services to patients; however, it is not clear which of this e-health services patient’s need or desire. My research will dig out what kinds of digital resources do the doctors in the Nepalese hospitals use to cater better care, and whether or not telemedicine is the alternative to e-health. Though the research site is in Nepal, my findings can imply to the global contexts.

Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013

With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.

The Persistence of the Pamphlet: On the Continued Relevance of the Health Information Pamphlet in the Digital Age.

Since the early 2000s, web and digital health information and education has progressed in both volume and innovation (Dutta-Bergman 2006; Mano, Computers in Human Behavior 39 404 412, 2014). A growing number of leading Canadian health institutions (e.g., hospitals, community health centers, and health ministries) are migrating much of their vital public health information and education, once restricted to pamphlets and other physically distributed materials, to online platforms. Examples of these platforms are websites and web pages, eLearning modules, eBooks, streamed classrooms, audiobooks, and online health videos. The steady migration of health information to online platforms is raising important questions for fields of patient education, such as cancer education. These questions include, but are not limited to (a) are pamphlets still a useful modality for patient information and education when so much is available on the Internet? (b) If so, what should be the relationship between print-based and online health information and education, and when should one modality take precedence over the other? This article responds to these questions within the Canadian health care context.

Usability Testing of Oral Health Education Applications - Based on a Comparison of Dentify and Toothflix -

Background In recent years, health conditions have become the most commonly searched content for smartphone users. Moreover, digital health information about prevention and self-care will be in great demand in the near future. Although researchers from the domains of education, information technology, and dentistry have examined digital oral health education, their studies have lacked emphasis on user experience. In this study, we aimed to review and examine usability issues of commercially available oral health education apps. Afterward, we presented design guidelines for these applications. Methods First, we reviewed existing smartphone applications for oral health education and selected two accredited apps; Dentify and Toothflix. Second, for usability testing of these two apps, we adopted a heuristic evaluation system: creating usability checklists based on Peter Morville’s User Experience Honeycomb. Then, we conducted usability testing and performed in-depth interviews with dentists and UX design experts. Result We analyzed the results from the usability checklists using radar charts. Then, usability issues were categorized and summarized into oral health contents and four planes based on Jesse Garrett’s elements of user experience: the scope plane, the structure plane, skeleton plane, and surface plane. Conclusion In addition, we’ve suggested revisionary design guidelines in usability for these two apps; first, Dentify and Toothflix need to have a “Search” option. Second, the apps should incorporate multi-information channels, such as, text, images, videos, and audio. Third, these apps should require as little as possible cognitive burdens for users.

Emerging Ethical Issues in Digital Health Information

The problems of poor or biased information and of misleading health and well-being advice on the Internet have been extensively documented. The recent decision by the Internet Corporation for Assigned Names and Numbers to authorize a large number of new generic, top-level domains, including some with a clear connection to health or healthcare, presents an opportunity to bring some order to this chaotic situation. In the case of the most general of these domains, ".health," experts advance a compelling argument in favor of some degree of content oversight and control. On the opposing side, advocates for an unrestricted and open Internet counter that this taken-for-granted principle is too valuable to be compromised, and that, once lost, it may never be recovered. We advance and provide evidence for a proposal to bridge the credibility gap in online health information by providing provenance information for websites in the .health domain.

Guest Editorial : Special Issue on Internet of Things for Smart and Connected Health

The articles in this special section are focused on two major aspects of Internet of things (IoT) technologies for smart and connected health services (SCH): 1) monitoring and assisting individuals by means of smart systems including sensors, devices, and robotics; and 2) creating interoperable digital health information infrastructures to increase medical/health information availability and use. The papers published in this SI provide evidence that SCH tools that rely upon IoT technologiescould significantly improve clinical outcomes and thequality of life of individuals undergoing monitoring.

Why primary care practices should become digital health information hubs for their patients.

BackgroundTwo interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible.DiscussionWe contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive.SummaryWe view the primary care practice as a central component of digital information coordination, especially when considering the current challenges of digital health information fragmentation. Given these fragmentation issues and the emphasis on primary care as central to improving health and lower overall health care costs, we suggest that primary care practices should embrace their evolving role and should seek to become digital health information hubs for their patients.

Recent Trends in Digital Convergence Information System

Welcome to this special issue of the Wireless Personal Communications journal on recent trends in digital convergence information systems. The main goal behind the initiation of this special issue is to create a timely host be the vehicle for publishing selected research papers from academia and practitioners in different industries on this emerging topic. With the advancements in convergence technology, interactive multimedia communications, context awareness, and the proliferation of low cost compact sensing and computing devices, great attention is being paid to the study, development and deployment of digital convergence information systems in various sectors of the society such as healthcare, e-commerce, critical infrastructures, etc.. In healthcare, digital convergence information systems have the potential for lengthening life expectancy and most importantly improving Quality of Life (QoL). For these reasons and also to reduce healthcare costs (e.g., providing smarter healthcare to the elderly at home in an increasingly aging society), many governments worldwide, working with research centers and the industry, are to promoting the development of test projects for onand off-line digital convergence-based health information systems. The industry has acknowledged their great potentials and is heavily investing in the development not only products that are enabling digital convergence information systems but also in the provisioning of digital convergence services for people as a business [1–3]. This special issue covers some of the hottest topics in digital convergence information systems, including: Personal

The role of health information kiosks in diverse settings: a systematic review.

Public access computing through computer kiosks placed in clinical and community settings may help bridge the digital health information divide. The objective was to examine the current utilisation of computer based health information kiosks in diverse settings. Further, the objective was to examine the locations for health kiosks, kiosk features, application of theoretical framework in the design and development of health kiosks and the outcomes assessed. A search was conducted using Pubmed and CINAHL with articles published from January 2005 to January 2012. The articles that focused on the use of computer based health information kiosks in community and clinical settings. The majority of the 31 articles included in this study were conducted in urban settings (90%; n=28), clinical settings (58%; n=18) and focused on child safety (19%; n=6). Computer-based tailoring was utilised in majority of the studies (77%; n=24). However, limited studies described the theoretical frameworks to facilitate this tailoring (42%; n=13). The results suggest that health information kiosks are a feasible medium to disseminate health information among various users in clinical and community settings, with high acceptance and satisfaction by users. Theoretical driven interventions are needed to examine long term impacts of health information kiosks especially in rural and underserved populations.

Students’ trust judgements in online health information seeking

As one of the most active groups of Internet users, students and other young people are active users of digital health information. Yet, research into young people's evaluation of health information is limited, and no previous studies have focused on trust formation. In addition, prior studies on adults' use of digital information do not reach a consensus regarding the key factors in trust formation. This study seeks to address this gap. A questionnaire-based survey was used to collect data from undergraduate students studying a variety of disciplines in one UK university. The Trust in Online Health Information Scale is proposed, and it includes the following dimensions: authority, style, content, usefulness, brand, ease of use, recommendation, credibility, and verification. In addition, inspection of responses to specific items/questions provides further insights into aspects of the information that were of specific importance in influencing trust judgements.