TECHNOLOGY, INNOVATION AND HEALTH COMMUNICATION Why Context Matters and How to Assess Context

Transcription

1 TECHNOLOGY, INNOVATION AND HEALTH COMMUNICATION Why Context Matters and How to Assess Context Ellen Balka, Ph.D. Senior Scholar, Michael Smith Foundation for Health Research Senior Scientist, Centre for Clinical Epidemiology and Evaluation, VCH Professor, Simon Fraser University July 26, 2012

2 Overview of Talk General Interest: Technology as a factor in health communication processes Focus on Two Areas: 1) Due diligence prior to designing interventions; 2) Evaluating technology-enabled interventions. Focus on continuum of communication, and how to assess the context, necessity, and appropriateness of the use of technology in communication strategies.

3 Ellen Balka Uses of Information Technology in Healthcare Patient data (from multiple sources) may be combined via computer in order to assess population health, and to identify the causes and determinants of health problems. Computes are used to analyze data in order to develop interventions, and computers may be used as part of the delivery of the intervention. Administrative data and data about health outcomes will increasingly be used in health policy making. Based on graphic from McDowell, I. & Edwards, N. (1998, April). Population Health Perspectives: Community Health Research Unit Newsletter, vol. 7 #1, p.3, revised by E. Balka with focus on computers.

4 Brief exercise Think of a health communication problem or issue. In one sentence, write down what that problem is; write down how technology might be used to solve that problem.

5 Using information technology as a means of information dissemination The dream: The Field of Dreams mentality build it and they will come. The reality: Many on-line health resources have failed to serve their intended audiences.

6 A few technology enabled health communication scenarios Findings from Action for Health: Varied health information situations Study 1: Online health information seeking at VPL Study 2: Use of BC HealthGuide Online among 3 target populations Ellen Balka Scenario: Provision of on-line information in minority languages

7 Health Information Seeking: Guiding Questions, ACTION for Health Who has access to computer mediated health information in which settings? What general, health and technology literacy issues arise in relation to consumption of health information? What role do human information intermediaries play in the consumption of on-line health information? What role do technological intermediaries play in the consumption of on-line health information?

8 Research Findings, ACTION for Health: High Level Overview Some projects successfully enhanced community capacity building around issues related to knowledge and skills of individuals/groups about health information & health support systems (Rural HIV/AIDS; Macmorran) Individuals encounter barriers in using IT-based systems to locate, use and interact with health-related information (MidMain; Vancouver Public Library; Huron County telephone survey) Key informants, such as natural helpers, embedded in various social networks mediate transmission of health information (Rural HIV/AIDS; BC HealthGuide; Macmorran; Natural Helpers) Low general awareness for government sponsored health information websites at both the federal & provincial levels (Huron County telephone survey; BC HealthGuide) Health information websites tend to be written at very high levels of readability (Content analysis of HI websites)

9 Use of the Internet for Health Information: BC Only 28% of British Columbians believe they know what health resources are available online 38% believe they know where to find health resources online 48% feel they have the skills necessary to evaluate health info online 34% feel they could tell high quality from low quality health resources on the Internet

10 Finings, VPL Study Demographics (VPL and BCHG Studies) BCHG (n=559) VPL (n=14) %women % men Note: BCHG respondents differ from those who use the web site (based on comparison with provincial phone survey)

11 Demographics Age Group BCHG VPL Teens 4% 20s 24% 28% 30s 26% 21% 40s 23% 7% 50s 17% 7% 60s 6% 7% 70+ <1% 14%

12 Demographics Level of Education BCHG VPL < HS graduate 3% HS graduate 10% 28% Some or finished college 27% 21% Some of finished university 51% 50%

13 Demographics Language spoken at home BCHG VPL English 93% 86% Spanish 7% Punjabi 7% VPL: 36% born outside of Canada

14 If yes, who -or where- did you get advice or information from? 43% No response 14% librarian 7% AA 7% rehab physiologist 7% internet 7% instructor 7% psychologists assn. 7% other Information Chain (VPL) Before you began your search about this topic, did you get advice or information about where to look for health information? 57% yes 28% no 14% no answer Before talking with the reference librarian, what other information sources (if any) did you get information from? 50% Internet 21% did not go elsewhere 7% library staff 7% library catalogue 7% friends/ family with medical background 7% rehab physiologist

15 BCHG OnLine BCHGOL Jan May Jan -04 Feb-05 Nov -05 May-06 Awareness Utilization Satisfaction

16 Information Chain / Intermediaries (VPL) First 3 places you went in current search? 21% did not go anywhere first 50% internet 14% library 7% AA 7% school outline BCHG Before today, how often did you come to this web site? 43% first time users 15% frequent users (8+ times in last 6 months)

17 Findings interviews with class participants, health information seeking class offered at VPL -- Barriers Interviewees` ability to access and use online health information was limited by: Internet navigation skills The time it takes to find the information needed Advertising and product sales Difficulties identifying reliable sources and accurate information Technical information targeted at health professionals, not the layperson Self-motivation

18 Observation and Discussion BCHG Focus Groups Google.ca search engine used by all Most expected google-like capacity on other search engines Correction of spelling mistakes, links with brief abstracts People chose information from within the 1 st page of results Generally liked BCHG OnLine, but: Adults did not think information labeled age 4 and older applied to them Lack of google-like functionality noted

19 Design generally OK attractive, professional Language and content Generally clear, easy to understand and informative Comments on BCHG OnLine Readability generally OK to good younger users wanted less text, more bullets Navigability and search features youth and parent groups frustrated by non-google functionality about half thought BCHG OL results not directly relevant about half thought website easy to navigate classification of information somewhat confusing e.g. not immediately obvious that age 4 and older classification contains youth and adult-relevant information youth most dissatisfied with the site

20 ACTION for Health Summary Search optimization strategies could improve return rates for BCHG OnLine content Site evaluated did not resonate well with youth Falling satisfaction could be influenced by BCHG OnLine functionality, accuracy of search results and classification of information

21 Scenario: Provision of Online Health Information in non-dominant languages A technology enabled health communication scenarios Ellen Balka

22 Making sense of it all Sender Message Receiver Sender Information Technology Message Receiver Ellen Balka

23 Capacities e.g.,general literacy, health literacy, computer literacy Constraints e.g., access to computer, time Behaviours & Norms e.g., intergenerational behaviours; work hierarchies; culture Capacities e.g.,general literacy, health literacy, computer literacy Constraints e.g., access to computer, time Behaviours & Norms e.g., intergenerational behaviours; work hierarchies; culture Sender Information Technology Message Receiver Ellen Balka Health status as mediating factor Reasons data / information were created Assumptions about users e.g., who they are what their context is what their capacities are what their behaviours are Health status as mediating factor Need for data / information -- is it compatible with sender's intentions? Actual users e.g.,are they who we thought they would be? is their context as thought? are their capacities as thought? do they behave as expected?

24 Context matters Need to know not just who your target population is also need to know about their capacities, constraints, behaviours and culture. Also need to check your assumptions about what information your target audience wants, as well as how they want to consume it. Ellen Balka

25 Accounting for Context Strategies include: Develop & use a logic model to make your operating assumptions explicit; Doing a due diligence literature review communication, health communication, computer science, medicine & allied health professions as well as general social science. Before designing interventions, summarize what you know (vs. assume) about your target audience, across multiple areas (e.g., capacities, behaviours, norms, culture ) Ellen Balka

26 Accounting for Context After doing your due diligence literature review, summarize what you know (again) and modify planned intervention accordingly. Conduct primary research (interviews, focus groups, observations) to confirm your setting reflects similar conditions to those outlined in literature. Pilot test using mock-ups (cheaper than reprogramming) and engage users in design. Evaluate at multiple steps along the way. Ellen Balka

27 Evaluation strategies End user engagement in design (varied methods) Lab based usability tests (is the interface ok?) Field based observations (how is it being used?) Hybird methods (creating use settings) Collection of user stats (via cmpt. & human) Logging of trouble reports, one time vs. multiple users etc. Should be articulated in logic model & Ellen budgeted Balka for in development costs.

28 Take Away Messages. Access should not be confused with use; Access and use reflect several forms of literacy General literacy, Computer literacy, Information Literacy, Health Literacy, Scientific Literacy Complex processes characterize health information sense making; information seekers often go to health information intermediaries after unsuccessful internet searches Internet health information seeking is undertaken by a largely English speaking well education population.

29 Issues, continued: Patterns of off-line health information consumption persist on-line, where women are a majority of on-line health information seekers. The need for information intermediaries is evident from several studies. What are the best ways to support such roles? What are the consequences of failing to support such roles? On-line information seeking is predominantly an activity of highly educated people. What health information options are available for others?

30 Policy Issues nformation technology on its own will not solve health problems. Need to insure that: content is relevant (e.g., refers to Canadian content); human resources are in place to act as information intermediaries and assist with issues related to health literacy and computer literacy; Technological infrastructure needs to be adequate; be supported (technically and socially); More emphasis needs to be placed on who target audiences are, and what their informational needs are and information consumption patterns. Greater emphasis on pre-implementation planning and attention towards development of multi-jurisdictional governance structures and mechanisms for adding value to on-line resources.

31 Back to brief exercise Think of a health communication problem or issue. In one sentence, write down what that problem is; write down how technology might be used to solve that problem. Now- write down all the questions you will ask and other strategies you will use before deciding if your planned intervention is appropriate

32 Questions or comments? For more information about the studies referred to, see