Dataset Information

Access to electronic health knowledge in five countries in Africa: a descriptive study.

ABSTRACT:

Background

Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives.

Methods

Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use.

Results

In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords.

Conclusion

Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.

SUBMITTER: Smith H

PROVIDER: S-EPMC1885254 | biostudies-literature | 2007 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Access to electronic health knowledge in five countries in Africa: a descriptive study.

Smith Helen H Bukirwa Hasifa H Mukasa Oscar O Snell Paul P Adeh-Nsoh Sylvester S Mbuyita Selemani S Honorati Masanja M Orji Bright B Garner Paul P

BMC health services research 20070517

<h4>Background</h4>Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives.<h4>Methods</h4>Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externall ...[more]

PMID: 17509132

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Project description:BACKGROUND:Electronic health record (EHR) access and audit logs record behaviors of providers as they navigate the EHR. These data can be used to better understand provider responses to EHR-based clinical decision support (CDS), shedding light on whether and why CDS is effective. OBJECTIVE:This study aimed to determine the feasibility of using EHR access and audit logs to track primary care physicians' (PCPs') opening of and response to noninterruptive alerts delivered to EHR InBaskets. METHODS:We conducted a descriptive study to assess the use of EHR log data to track provider behavior. We analyzed data recorded following opening of 799 noninterruptive alerts sent to 75 PCPs' InBaskets through a prior randomized controlled trial. Three types of alerts highlighted new medication concerns for older patients' posthospital discharge: information only (n=593), medication recommendations (n=37), and test recommendations (n=169). We sought log data to identify the person opening the alert and the timing and type of PCPs' follow-up EHR actions (immediate vs by the end of the following day). We performed multivariate analyses examining associations between alert type, patient characteristics, provider characteristics, and contextual factors and likelihood of immediate or subsequent PCP action (general, medication-specific, or laboratory-specific actions). We describe challenges and strategies for log data use. RESULTS:We successfully identified the required data in EHR access and audit logs. More than three-quarters of alerts (78.5%, 627/799) were opened by the PCP to whom they were directed, allowing us to assess immediate PCP action; of these, 208 alerts were followed by immediate action. Expanding on our analyses to include alerts opened by staff or covering physicians, we found that an additional 330 of the 799 alerts demonstrated PCP action by the end of the following day. The remaining 261 alerts showed no PCP action. Compared to information-only alerts, the odds ratio (OR) of immediate action was 4.03 (95% CI 1.67-9.72) for medication-recommendation and 2.14 (95% CI 1.38-3.32) for test-recommendation alerts. Compared to information-only alerts, ORs of medication-specific action by end of the following day were significantly greater for medication recommendations (5.59; 95% CI 2.42-12.94) and test recommendations (1.71; 95% CI 1.09-2.68). We found a similar pattern for OR of laboratory-specific action. We encountered 2 main challenges: (1) Capturing a historical snapshot of EHR status (number of InBasket messages at time of alert delivery) required incorporation of data generated many months prior with longitudinal follow-up. (2) Accurately interpreting data elements required iterative work by a physician/data manager team taking action within the EHR and then examining audit logs to identify corresponding documentation. CONCLUSIONS:EHR log data could inform future efforts and provide valuable information during development and refinement of CDS interventions. To address challenges, use of these data should be planned before implementing an EHR-based study.

Project description:Background: Nutrition-related knowledge (NRK) and nutrition-related attitudes (NRAs) are necessary for dietary changes toward healthier dietary patterns. In turn, healthier dietary patterns can be beneficial in maintaining health of older adults. Therefore, the aim of this cross-sectional study was to investigate whether NRK and NRAs were associated with lifestyle and health features among older adults (65+ years) from five European countries (France, Italy, Poland, the Netherlands and United Kingdom). Methods: Within the European project NU-AGE, 1,144 healthy elderly volunteers (65-79 years) were randomly assigned to two groups: intervention (NU-AGE diet) or control. After 1-year of follow-up, both NRK and NRAs were assessed during exit interviews, in combination with a number of lifestyle and health variables (e.g., physical activity, smoking, alcohol use, BMI, self-assessed health status). Multivariable linear regression models were used in data analysis. Results: In the NU-AGE study sample, good NRK was associated with lower BMI and higher physical activity. More positive NRAs were related to lower BMI and self-reported very good or good appetite. Moreover, both NRK and NRAs were associated with some socio-economic determinants, like financial situation, age, education, living area (for NRK), and country (for NRAs). Participants in the intervention group showed a better NRK (? = 0.367 [95% CI: 0.117; 0.617], p = 0.004) and more positive NRAs (? = 0.838 [95% CI: 0.318; 1.358], p = 0.002) than those in the control group. Higher self-evaluated knowledge was also significantly related to more positive NRAs (p < 0.001). The most popular sources of nutrition information were food labels, books and magazines on health, the dietitian and the doctor's office, although their importance varied significantly among countries, and, to a lesser extent, between women and men and between intervention and control group. Conclusion: Higher NRK and NRA scores were associated with lower BMI and higher physical activity level. Therefore, a good nutrition-related knowledge and positive nutrition-related attitudes can strongly and positively influence the health status and quality of life among the older population. These results offer a great opportunity for policy makers to implement educational programs in order to counteract the epidemic of obesity and to improve the health span of European population.

Project description:BackgroundElectronic health record (EHR) patient portals are designed to provide medical health records to patients. Using an EHR portal is expected to contribute to positive health outcomes and facilitate patient-provider communication.ObjectiveOur objective was to examine how portal users report using their portals and the factors associated with obtaining health information from the internet. We also examined the desired portal features, factors impacting users' trust in portals, and barriers to using portals.MethodsAn internet-based survey study was conducted using Amazon Mechanical Turk. All the participants were adults in the United States who used patient portals. The survey included questions about how the participants used their portals, what factors acted as barriers to using their portals, and how they used and how much they trusted other web-based health information sources as well as their portals. A logistic regression model was used to examine the factors influencing the participants' trust in their portals. Additionally, the desired features and design characteristics were identified to support the design of future portals.ResultsA total of 394 participants completed the survey. Most of the participants were less than 35 years old (212/394, 53.8%), with 36.3% (143/394) aged between 35 and 55 years, and 9.9% (39/394) aged above 55 years. Women accounted for 48.5% (191/394) of the survey participants. More than 78% (307/394) of the participants reported using portals at least monthly. The most common portal features used were viewing lab results, making appointments, and paying bills. Participants reported some barriers to portal use including data security and limited access to the internet. The results of a logistic regression model used to predict the trust in their portals suggest that those comfortable using their portals (odds ratio [OR] 7.97, 95% CI 1.11-57.32) thought that their portals were easy to use (OR 7.4, 95% CI 1.12-48.84), and frequent internet users (OR 43.72, 95% CI 1.83-1046.43) were more likely to trust their portals. Participants reporting that the portals were important in managing their health (OR 28.13, 95% CI 5.31-148.85) and that their portals were a valuable part of their health care (OR 6.75, 95% CI 1.51-30.11) were also more likely to trust their portals.ConclusionsThere are several factors that impact the trust of EHR patient portal users in their portals. Designing easily usable portals and considering these factors may be the most effective approach to improving trust in patient portals. The desired features and usability of portals are critical factors that contribute to users' trust in EHR portals.

Project description:BackgroundAs the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information.ObjectiveThis study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet.MethodsWe used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy-focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women's internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use.ResultsApproximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24).ConclusionsThe differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans.

Project description:BACKGROUND:Health information technologies (HITs) such as electronic health records (EHR) and telemedicine services are currently used to assist clinicians provide care to patients. There are many barriers to HIT adoption, including mismatches between investments and benefits, disruptions in the workflow, and concerns about privacy and confidentiality. The lack of HIT training of health professionals as a workforce is an increasingly recognized and understudied barrier. OBJECTIVE:The purpose of this study is to describe what courses on HIT topics are available at the graduate level for future health professionals in the European Union (EU) and to explore possible determining factors for their exposure to these courses. METHODS:A cross-sectional descriptive study of EU medical schools was performed to explore the prevalence of HIT courses. The curricula of all identified higher learning institutions that offer a medical degree were manually explored to identify graduate-level courses that offer specific training on HIT topics. HIT topics were defined as courses or subjects that provided knowledge on the design, development, use, and implementation of HIT. Associations among potential factors such as population, yearly medical graduates, total number of physicians, EHR presence, and gross domestic product (GDP) were explored. RESULTS:A total of 302 medical schools from the 28 member states of the EU were explored. Only about one-third (90/302, 29.80%) of all medical degree curricula offered any kind of HIT course at the graduate level; in the medical schools that offered HIT courses, the courses were often mandatory (58/90, 64.44%). In most EU countries, HIT courses are offered in less than half of the medical schools, regardless of the country's GDP per capita. Countries with the highest percentages of HIT course presence have the lowest GDP per capita. There seems to be a weak inverse correlation (-0.49) between the two variables (GDP per capita and HIT course presence). There is a trend between the availability of medical human resources and an increase in the presence of HIT courses, with Romania, Croatia, and Greece as outliers in this respect. CONCLUSIONS:The current state of medical training in the EU leaves much room for improvement. Further studies are required for in-depth analysis of the content and manner of instruction that would fit present and future needs of HIT.

Dataset Information

Access to electronic health knowledge in five countries in Africa: a descriptive study.

Background

Methods

Results

Conclusion

Publications

Access to electronic health knowledge in five countries in Africa: a descriptive study.

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