IUPUI School of Computing and Informatics
S644 / I635 Consumer Health Informatics
Week 5: Public Health and Consumer Uses of Health Information
Contents
Week 5 Learning Goals and Objectives......................................................................................................... 1
Week 5 Introduction ..................................................................................................................................... 1
Week 5 Readings ........................................................................................................................................... 5
Week 5 Independent Learning Activities ...................................................................................................... 6
Week 5 Forum Discussion ............................................................................................................................. 7
Week 5 Learning Goals and Objectives
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Define and characterize ‘public health’.
Explore and discuss the role of CHI in public health issues.
Define and describe 'targeted' vs. ‘tailored health messages’.
Explore, reflect on, and discuss the role of targeted and tailored health
messages.
Explore, reflect on, and discuss the roles of consumer health informatics
technologies in improving public health.
Apply principles of public health and effective health communication to consumer
health informatics.
Week 5 Introduction
Week 5 ends Module B: Setting the Stage -- Background and Significance of Consumer
Health Informatics.
Over the past few weeks (2 - 5), we have learned about contemporary healthcare
environments and the impact of technology-based information on consumer healthcare
decision making.
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We have also learned about changes in consumer-provider relationships as a result of
consumer health information technologies. Finally, we have learned that economics,
politics, and legal, ethical and social forces all impact on consumer health informatics.
This week, we will finish ‘setting the stage’ as we explore the use of telecommunications
technology for improving the health of the public.
This is about PUBLIC HEALTH: issues and challenges that face the bulk of our
citizens.
It is less about an individual's relationship with his or her doctor, nor about the
individual's wellness. Instead, public health is about a national policy and nationwide
procedures that contribute to/ and impact on the health of ALL people: our nation as a
whole.
When talking about public health, we focus on the health issues that are relevant to the
groups of people, rather than individuals.
For example, in 1854 London, public health was about understanding the causes of the
cholera epidemic... It was Dr. John Snow who discovered that the outbreak stemmed
from an infected water pump on Broad Street! He basically did a visualization technique
-- tracking outbreaks on a map. It quickly became clear that there were patterns in the
outbreaks; and the common denominator was a public water pump. This was the
source of contaminated water – hence the epidemic. No one believed him or listened to
his warnings, but he stands as an historical leader in public health because he used
research methods that were novel for that time.
In 1918, public health in the U.S. was about dealing with the fallout from the
Spanish influenza pandemic during which millions of Americans died.
In 2014, the Affordable Care Act will have a major impact on the public health of our
nation. Think about how this might play out in terms of the overall health of the
American public.
These days, public health concerns often also focus on obesity, for example,
and the diseases that come from the unhealthy lifestyle choices that stem from societydriven and society-sanctioned overeating and limited food choices.
What other public health issues are emerging today?
Traditionally, successful public health campaigns have used mass media channels to
influence health behavior change. Today, consumer health information specialists use
technology to deliver personalized health information through “mass customization”
(information TARGETING) to reach populations in need.
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Furthermore, large databases of health information are readily available to assist public
health practitioners in decision making.
These technological advances, coupled with the increasing interest in the personal
health record, signal a new era of public health.
You know, they say that "politics makes strange bed fellows," but I find that public
health makes strange bed fellows too!
For example, I had read (in 2012) that Kris Jenner (of TV's famed Kardashian family)
talked about her bladder problems and her mammogram on TV. In response,
thousands of American women went to their doctors for their own bladder issues; and
upwards of 30,000 American women were likewise motivated to get their
mammograms! It's amazing to me that a reality TV star can have such a tangible
impact on other women's motivation to seek healthcare.
Kris Jenner never set-out to participate in a public service campaign. But simply by
being whom she is, Kris Jenner had a huge impact on public health! This is an
example of the power of mass media; and the power of the 'personality' to influence
others' behavior. Strange bed fellows indeed!
(...For those of you who are not actively engaged in reality television these days, Kris
Jenner is married to athlete Bruce Jenner, and mother of the famed Kardashian sisters,
who have several reality TV shows going...)
Now onto our more serious overview by Dr. McDaniel...
Guest Lecturer, Dr. Anna McDaniel, Dean of Nursing at the University of Florida:
Tailored health promotion interventions have emerged as a promising public health
strategy for influencing attitudes and behaviors.
Tailored interventions are defined as “any combination of information and behavior
change strategies intended to reach one specific person, based on characteristics that
are unique to that person, related to the outcome of interest, and derived from individual
assessment” (Krueter, et al., 2000). Tailoring healthy messages is supported by
communication theory and research that has found that the more relevant information is
to an individual, the more likely it is to be processed and lead to attitude change, and
ultimately a change in behavior. With the advent of computer technology, it is possible
to develop programs that will deliver personally relevant information to large numbers of
individuals.
A New Beginning is an interactive computer program designed to encourage inner-city
women to stop smoking. The program design and content were developed using
principles of user-centered design (Nielsen, 1993) and the Persuasive Health Message
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framework (Witte et al., 2001). According to this framework, messages must address
constant and transient factors to effectively motivate health behavior change.
Constant factors consist of: health threat balanced with an efficacy message; structure
and organization of the message; and demographic/cultural profile of the targeted
audience.
Transient factors vary by audience and include salient beliefs about the perceived
health threat and response efficacy.
In designing the content of the program messages, we were guided by the findings of
focus groups with women who were demographically similar to the target audience
(McDaniel et al., 2005). The women who participated in the focus groups expressed a
preference for learning about diagnosis and treatment options from a health care
professional, but wanted information about instrumental behavior change (e.g., going on
a diet or starting an exercise program) from “real people”. Salient beliefs about smoking
included skepticism of messages perceived as “scare tactics”.
Personal knowledge of smoking-attributable disease, such as a relative with cancer,
was more believable and trustworthy and increased the feeling of personal vulnerability
to the deleterious health effects of smoking. This information was used in the
development of the smoking cessation program. For example, content that was focused
on knowledge of the health risks of smoking were presented in a video clip of a health
care professional or a simple graphic.
Message content that was intended to influence the user’s affective domain (e.g.,
attitudes toward smoking or motivation to quit) were presented in vignettes of former
smokers who were similar in age and ethnicity to the intended audience.
We conducted a usability study to assess the acceptability and effectiveness of the
tailored interactive program. A non-probability sample of 100 women who receive care
at an inner-city community health center in Indianapolis participated in the usability
study. Women completed the computer program in the clinic following baseline data
collection. Next, participants completed a brief satisfaction instrument.
Data on cognitive and behavioral outcomes of the program were obtained by telephone
interview one week later. Satisfaction with the program was high (mean satisfaction
score was 60.2 with 70 indicating highest possible satisfaction). Average time for
completing the computer program was 13.6 minutes. Overall, 79% of the participants
reported at least one behavioral change related to smoking. The results indicate that
interactive computer technology may be useful for promoting smoking cessation in lowincome women.
The results of this project show the promise of using computer technology to deliver
tailored health information.
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The three categories of potential breakthroughs are directly related to our discussion
this week: consumer empowerment, health improvement, and public health protection.
References
Kreuter, M., Farrell, D., Olevitch, L., & Brennan, L. (2000). Tailored
health messages: Customizing communication with computer
technology. Mahwah, New Jersey: Lawrence Erlbaum Associates,
Publishers.
McDaniel, A.M., Casper, G.R., Hutchison, S., & Stratton, R. (2005).
Design and testing of an interactive smoking cessation intervention for
inner-city women. Health Education Research: Theory and Practice. 20,
379-384.
Nielsen, J. (1993) Usability engineering. Academic Press, Boston.Office
of the National Coordinator for Health Information Technology (ONC)
(2005). American Health Information Community Potential
Breakthroughs. Retrieved March 26, 2006 from
http://www.hhs.gov/healthit/breakthrough.html
Meyer G, Martell D. Effective health risk messages. Thousand Oaks,
CA, Sage, 2001.
Week 5 Readings
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Nielsen-Bohlman, pp. 267 – 285
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Nelson and Ball, Chapter 4
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Lewis, Chapter 3
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When vaccines go viral: an analysis of HPV vaccine coverage on YouTube.
Briones R. Nan X. Madden K. Waks L. Health Communication. 27(5):478-85,
2012.
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Kaplan B. Litewka S. Ethical challenges of telemedicine and telehealth.
Cambridge Quarterly of Healthcare Ethics. 17(4):401-16, 2008.
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Health literacy and public health: a systematic review and integration of
definitions and models. [Review] Sorensen K. Van den Broucke S. Fullam J.
Doyle G. Pelikan J. Slonska Z. Brand H. (HLS-EU) Consortium Health Literacy
Project European. BMC Public Health. 12:80, 2012.
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Health literacy and public health: a framework for developing skills and
empowering citizens.
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Rowlands G. Perspectives in Public Health. 132(1):23-4, 2012 Jan.
Week 5 Independent Learning Activities
A. Explore the Public Health Information Network website, considering the contributions
it makes to improved public health.
The Public Health Information Network (http://www.cdc.gov/phin/) is CDC’s vision for
advancing fully capable and interoperable information systems in the many
organizations that participate in public health.
How could health consumers or professionals use this and similar resources to improve
the nation’s health?
What are the key features of this site? What content would you particularly recommend?
B. Watch these YouTube presentations:
U.S. Department of Health & Human Services: Childhood Obesity Prevention
featuring Shrek's Donkey
http://www.youtube.com/watch?v=r-zEDbl04NY
Lyme Disease, A Clear and Present Danger
http://www.youtube.com/watch?v=gLX4KF7xzv0
What is the primary theme of these messages?
Who is/are the primary audience(s) of these productions?
Consider and discuss the ways in which popular culture can be used to develop
messages that impact on public health.
Are these messages TAILORED or TARGETED?
B. FYI... you should follow this site: it's a great resource: Office of the National
Coordinator for Health Information Technology (ONC) HealthIT website
(http://www.healthit.gov/)
HIT Twitter feeds: https://twitter.com/#!/ONC_HealthIT and
https://twitter.com/#!/fema
ADDITIONAL RELATED RESOURCES FYI
Digital Nation: 21st Century America's Progress Toward Universal Broadband Internet
Access details the access for Americans: http://www.ntia.doc.gov/report/2010/digitalnation-21st-century-america-s-progress-towards-universal-broadband-internetaccess (scroll down to the Nov. 2011 link)
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Pew findings re: smart phones, digital
apps: http://pewresearch.org/pubs/2054/smartphone-ownership-demographics-iphoneblackberry-android
Nielsen: 2011 U.S. Media Universe." Nielsen. Web. 16 Feb. 2012.
http://blog.nielsen.com/nielsenwire/mediauniverse/.
Cleveland Clinic's MyChart mobile app: http://my.clevelandclinic.org/mobileapps/mychart-app.aspx
140 Health Care uses for Twitter = http://philbaumann.com/2009/01/16/140-health-careuses-for-twitter/
Ball, MJ, MY Costin, and C Lehmann. "The Personal Health Record: Consumers
Banking on Their Health."Studies in Health Technology and Informatics. 134 (2008): 3546. Print.
Wakefield B., & Kienzie, M., (2010) A clinic in every home. Consumer Informatics;
Applications and Strategies in Cyber Health Care. R. Nelson and M. Ball, Editors.
Springer Publishing. New York. pp 40-57.
PBS program, US healthcare: The Good News? http://video.pbs.org/video/2198039605/
Hospital Comparisons from Medicare: http://hospitalcompare.hhs.gov/
Week 5 Forum Discussion
This week’s framing questions are listed here. Also refer back to Dr. McDaniel's minilecture.
What are the roles of consumer health informatics in public health?
What is a tailored health message? What is a targeted health message? Give examples
and discuss the impact of these messages.
What role do healthcare practitioners and information specialists (nurses, librarians,
informaticians) have in improving the health of the public? What are the challenges that
we face in promoting health among our client and patients?
How can technologies be used to improve public health?
What implications are there for using technology to improve public health through the
delivery of a tailored health messages?
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What kinds of public health messages are best delivered via technologies? Why so?
How does the delivery mechanism itself impact on the uptake of the message?
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