Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.
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ABSTRACT: Background
This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools.Methods
A mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65-79 years. Respondent data were weighted to the study population for the cross-sectional analyses.Results
Older seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities.Conclusions
The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.
SUBMITTER: Gordon NP
PROVIDER: S-EPMC5872546 | biostudies-literature | 2018 Mar
REPOSITORIES: biostudies-literature
Publications
Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.
Gordon Nancy P NP Hornbrook Mark C MC
BMC health services research 20180327 1
<h4>Background</h4>This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modali ...[more]
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Project description:BackgroundDiabetes management is a growing health care challenge worldwide. eHealth can revolutionize diabetes care, the success of which depends on end user acceptance.ObjectiveThis study aims to understand the readiness and acceptance of eHealth services for diabetes care among the general population, perceived advantages and disadvantages of eHealth, and factors associated with eHealth readiness and acceptance in a multiethnic Asian country.MethodsIn this cross-sectional epidemiological study, participants (N=2895) were selected through disproportionate stratified random sampling from a population registry. Citizens or permanent residents of Singapore aged >18 years were recruited. The data were captured through computer-assisted personal interviews. An eHealth questionnaire was administered in one of four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant. Bivariate chi-square analyses were performed to compare the sociodemographic characteristics and perception of advantages and disadvantages of eHealth services between the diabetes and nondiabetes groups. Multivariable logistic regression models were used to determine factors associated with eHealth readiness and acceptance. All analyses were weighted using survey weights to account for the complex survey design.ResultsThe sample comprised participants with (n=436) and without (n=2459) diabetes. eHealth readiness was low, with 47.3% of the overall sample and 75.7% of the diabetes group endorsing that they were not ready for eHealth (P<.001). The most acceptable eHealth service overall was booking appointments (67.4%). There was a significantly higher preference in the diabetes group for face-to-face sessions for consultation with the clinician (nondiabetes: 83.5% vs diabetes: 92.6%; P<.001), receiving prescriptions (61.9% vs 79.3%; P<.001), referrals to other doctors (51.4% vs 72.2%; P<.001), and receiving health information (34% vs 63.4%; P<.001). The majority of both groups felt that eHealth requires users to be computer literate (90.5% vs 94.3%), does not build clinician-patient rapport compared with face-to-face sessions (77.5% vs 81%), and might not be credible (56.8% vs 64.2%; P=.03). Age (≥35 years), ethnicity (Indian), and lower education status had lower odds of eHealth readiness. Age (≥35 years), ethnicity (Indian), lower education status (primary school), BMI (being underweight), and marital status (being single) were associated with a lower likelihood of eHealth acceptance. Among only those with diabetes, a longer duration of diabetes (4-18 years), higher education (degree or above), and younger age (23-49 years) were associated with eHealth readiness, whereas younger age and income (SGD 2000-3999 [US $1481-$2961]) were associated with acceptance.ConclusionsOverall, an unfavorable attitude toward eHealth was observed, with a significantly higher number of participants with diabetes reporting their unwillingness to use these services for their diabetes care. Sociodemographic factors associated with acceptance and readiness identified a group of people who were unlikely to accept the technology and thus need to be targeted for eHealth literacy programs to avoid health care disparity.International registered report identifier (irrid)RR2-10.1136/bmjopen-2020-037125.
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Project description:Objectives:Interprofessional Education (IPE) provides an environment where learners demonstrate the knowledge, skills and attitude required to manage the complex clinical scenarios in a collaborative and interprofessional manner. The actual sphere of influence of Interprofessional Education in many medical schools has been limited. Therefore, the present study aim was to evaluate the medical students' readiness and perception of Interprofessional Education in a medical college in Saudi Arabia. Methods:This questionnaire based cross sectional study was executed in the Department of Physiology, College of Medicine, King Saud University during the period September 2016 to December 2017, using the 19-item Readiness for Interprofessional Learning Scale (RIPLS) with four subscales teamwork and collaboration, negative professional identity, positive professional identity and roles and responsibilities. The questionnaire was e-mailed to 1411 medical students and responses were analyzed using 5-point Likert scale. Results:A total of 158 medical students and trainees responded to the survey, 69 (43.6%) were males and 89 (56.4%) were females. The majority of participants 122-148 (77-94%) acknowledged the positive impact of IPE on teamwork and collaboration, more than two thirds 105 (64.45%) disagreed with negative attitude and 110-126 (70-80%) showed positive professional identity. Conclusions:Medical students showed a positive perception and ready to adopt the Interprofessional Educational allied activities in medical schools. The shared academic events would improve in clarifying the roles and responsibilities of medical students in health care professions.
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Project description:BackgroundThe rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.ObjectiveWe explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.MethodsOur study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.ResultsAge (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).ConclusionsThis study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.
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Project description:BACKGROUND:eHealth provides individuals with new means of accessing health information and communicating with providers through online channels. Prior evidence suggests that patients use eHealth to find information online when they receive care that is low in patient centeredness. However, it is unclear how other problems with the healthcare-delivery system motivate the use of eHealth, how these problems relate to different kinds of eHealth activities, and which populations are most likely to use eHealth when they receive low-quality care. OBJECTIVE:We aimed to determine how two types of negative care experiences-low patient centeredness and care coordination problems-motivate the use of different eHealth activities, and whether more highly educated individuals, who may find these tools easier to use, are more likely to use eHealth following negative experiences than less highly educated individuals. METHODS:Using nationally representative data from the 2017 Health Information National Trends Survey, we used factor analysis to group 25 different eHealth activities into categories based on the correlation between respondents' reports of their usage. Subsequently, we used multivariate negative binomial generalized linear model regressions to determine whether negative healthcare experiences predicted greater use of these resulting categories. Finally, we stratified our sample based on education level to determine whether the associations between healthcare experiences and eHealth use differed across groups. RESULTS:The study included 2612 individuals. Factor analysis classified the eHealth activities into two categories: provider-facing (eg, facilitating communication with providers) and independent (eg, patient-driven information seeking and communication with non-providers). Negative care experiences were not associated with provider-facing eHealth activity in the overall population (care coordination: P=.16; patient centeredness: P=.57) or among more highly educated respondents (care coordination: P=.73; patient centeredness: P=.32), but respondents with lower education levels who experienced problems with care coordination used provider-facing eHealth more often (IRR=1.40, P=.07). Individuals engaged in more independent eHealth activities if they experienced problems with either care coordination (IRR=1.15 P=.01) or patient-centered communication (IRR=1.16, P=.01). Although care coordination problems predicted independent eHealth activity across education levels (higher education: IRR=1.13 P=.01; lower education: IRR=1.19, P=.07), the relationship between low perceived patient centeredness and independent activity was limited to individuals with lower education levels (IRR=1.25, P=.02). CONCLUSIONS:Individuals use a greater number of eHealth activities, especially activities that are independent of healthcare providers, when they experience problems with their healthcare. People with lower levels of education seem particularly inclined to use eHealth when they have negative healthcare experiences. To maximize the potential for eHealth to meet the needs of all patients, especially those who are traditionally underserved by the healthcare system, additional work should be performed to ensure that eHealth resources are accessible and usable to all members of the population.
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Project description:BackgroundHealth information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.ObjectiveThe objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions.MethodsThe study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years.ResultsThe percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users.ConclusionsHealth care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients' use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources.
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Project description:BackgroundMobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases.ObjectiveThe aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases.MethodsBetween December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences.ResultsOf the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information.ConclusionsPatients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology.
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