Medical Communications FINAL EXAM Cumulative
HON
"Health on the Net"
Patient Diversity - Institute of Medicine's report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
"Racial and ethnic minorities are burdened with higher rates of disease, disability, and death, and tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as insurance status and income, are taken into account.
Timing Exposure, Awareness, and Effects -
"an understanding of the factors that converge to affect the shape of exposure and outcome curves can inform an evaluator's decisions about when to begin to collect data, how many survey waves to conduct, and when to terminate data collection."
Knowledge gap hypothesis:
"as the infusion of mass media information into a social system increases, higher socioeconomic status segments tend to acquire this information faster than lower socioeconomic-status population segments so that the gap in knowledge between the two tends to increase rather than decrease".
"Campaign messages compete with 'background noise' from other messages for the attention of target audiences." You need to detect an environmental noise factor for example; environmental scanning through key informant interviews and monitoring news media coverage, and strategies for reducing the effects of noise for example;
"using propensity scores to handle several covariates simultaneously, being sensitive to over-interpretation and the problem of reciprocal causation of exposure and outcome".
Exemplar Study
- - University of Kentucky Rural Cancer Prvention Center promotion of HPV vaccine - High school-basedvVaccination Project with adolescent males and females and Merck Investigator Initiated Program. - 1-2-3 Pap DVD Intervention - Cervical Cancer-Free Kentucky Initiative for mothers and young women - GlaxoSmithKline unrestricted grant
Common Mental Illnesses
- 18% Anxiety Disorders such as - 10% Mood Disorders such as depression or bipolar disorder. - 9% Personality Disorders such as..... - 5% Eating Disorders such as..... - 1% Schizophrenia
Information Sharing - Sermo.com
- 200,000 MDs/Dos - 68 specialties
Prevalance of Mental Illness
- 25% of the population has...... - 50% will be affected........
Free and colleagues in 2013 - 75 controlled trials of mobile technology-base health intervention:
- 26 use of mobile technology to change health behaviors - 59 use of mobile technology to manage disease
Information Sharing - Social networking for patients
- 34% follow someone else's experience - 23% follow a friend's experience
Information Sharing - Social networking for providers
- 65% of nurses interested in social networking - 60% of physicians interested in social networking
Advance Directives or living will statistics:
- 70-80% of us will be unable to make our own medical choices at some point - 1991 Patient Self-determination act mandates that healthcare institutions offer all adult patients the opportunity to complete an advance directive - What is your experience with advance directives?
Information Sharing - PatientsLikeMe.com
- 72% of users found information helpful - 71% of HIV patients took their lab values more seriously - 29% of HIV patients decided to take antiretroviral drugs
Medical Error Statistics
- 98,000 deaths attributable to medical errors - Communication problems are at the heart - What is a healthcare provider's ethical obligation to disclose medical errors? - Why aren't medical errors reported more often?
Types of Health Care Teams
- Ad-hoc team - Nominal care team
Media Theories - Media Effects
- Agenda Setting - Priming - Framing
Advantages of eHealth
- Anonymity - Automated data collection - Appeal - Convenience - Flexible/modifiable - Information access - Interactivity
C = CHECK for understanding - continued
- Ask the doctor to repeat or clarify any information that is unclear. Then repeat or paraphrase what he or she told you to make sure you understand.
Larry - CBS News report
- At 77, has been walking all over his hometown of Anderson, S.C.- and the surrounding towns -- basically begging for a kidney. - And on out on the street, wearing a signboard - "Need kidney 4 wife" - After taking to the streets, S.C. man finds kidney for wife.
Negative consequences of mental illnesses - It affects people's:
- Attentiveness, - Concentration - Classroom conduct - Ability to organize - Ability to communicate
Ethnicity
- Attribution all dimension - Relational dimension
Suggestions for Patients - from Dupre' 2016
- Be explicit about your feelings - Ask 3 question
Theory of Reasoned Action: 4 things to remember
- Beliefs - Attitudes - Subjective Norms - Intentions
Social Uncertainty Type examples:
- Belly dancing on campus - NFL players doing ballet
Future Directions
- Better understand the role of technology in health decision making and behavior. - Consider the role of interpersonal communication in influencing program effects. - Analysis of secular trends.
eHealth - Transdisciplinary
- Blends the best of mass communication (reach) with the best of interpersonal communication (efficacy) - Interactive (reciprocal message exchange) - Medium: interact with a computer - Human: interact with a person through media
Overview 8- 14
- Campaigns and interventions - Community-based and school-based interventions - Theories - Campaign design, implementation, and evaluation - Exemplar campaigns
Campaigns versus interventions
- Campaigns and interventions are similar because they both seek to educate people and ultimately lead them to make positive, health behavior changes. - They differ, however, in that community- and school-based interventions actively "intervene" in the lives of the target audience, whereas campaigns rely on presentation of messages to persuade people.
There are different types of interpreters:
- Chance - Untrained - Bilingual - On-site - Telephone
Campaign Design, Implementation, and Evaluation
- Communication Design - Campaign Design - Campaign Implementation - Campaign Evaluation
Campaign design
- Communication design has a complementary relationship to theory - Design does not compete with theory but involves figuring out how a theory can be deployed given the properties of a site of intervention and the characteristics of the interactants. - Communication design strategies enhance other theoretical approaches by taking into account factors that might facilitate or hinder the effectiveness of messages, protocols, interventions.
Campaign design - continued
- Communication design is both unique and iterative. What works in one site may not work in another, and practices that may be unimportant from a theoretical perspective may be the cause of failure for an intervention from a design perspective. - Communication design can help reveal unintended consequences We can achieve our goal and still have other unanticipated negative (or positive) outcomes.
INTERPRETIVE APPROACH
- Communication is a form of social action - Process in fine detail - turn taking, word choice. - Process in gross detail - sequence organization.
Direct-to-Consumer Advertising - Disadvantages
- Companies spend more in advertising than development - Prescription drug prices has increased - People may believe that high priced medicines are better - Unrealistic expectations - Cyberchondriacism
Dimensions
- Complexity of the illness - Quality of information - Probability of diagnosis, prognosis, treatment outcome - Structure of information - order, integration. - Lay epistemology
Uncertainty dimensions
- Complexity of the illness. - Quality of information. - Probability of diagnosis, prognosis, treatment outcome. - Structure of information - order integration. In which order and amount? - Lay epistemology
Medical interpreter views:
- Conduit view - Semiotic view - Utilitarian view - Critical view
Direct-to-Consumer Advertising - Advantages
- Consumer can know the options available - Only 1 in 4 patients raises the topic of a specific drug - Active competition can inspire product development
QUANTITATIVE methodology makes generalizations and includes:
- Content analysis - Surveys - Experiments
Suggestions for Providers - from Dupree 2016
- Create shame-free environments. - Gauge literacy levels. - Be attentive and respectful. - Let patients know what is expected. - Use metaphors and pictures to help explain complex ideas. - Use the teach-back method to make sure patients understand.
Media Theories - Media Learning
- Cultivation - Social Cognitive Theory
2 views of Culture
- Culture as Variable - Culture as Context
Organ Donation
- Currently more than 117,000 people are waiting for organs. - In 2012, just over 25,000 received them. - Nearly 95% of Americans support organ donation, but only 53% have signed up to become donors. - Why the discrepancy?
Examples of Direct-to-Consumer Advertising
- Cymbalta - Alli - Viagra
Direct-to-Consumer Advertising
- DTCA: Promoting prescription medications to lay audiences through print and electronic media - Currently, $5 billion is spent per year on DTCA. - FDA regulation - Product ads, reminder ads, help-seeking ads - Print ads must provide "fine print"; TV ads must offer sources for additional information
Poole and Real in 2002 observed that teams vary on:
- Degree of interaction - Interdependence - Boundness - Commonality - Motivation
Messages are tailored on...
- Demographics - Psychosocial variables - Behavioral variables
Mental Illness in Relationships - Interpersonal theory of depression - Coyne, 1976
- Depressed people induce negative affect in others - Others reject them, primarily through nonverbal means - Rejection leads to increased need for reassurance and depressive symptoms
Interpersonal Theory of Depression - Coyne 1976
- Depressed people induce negative affects on others. - Others reject them, primarily through nonverbal means. - Rejection leads to increased need for reassurance and depressive symptoms.
Campaign evaluation - Formative Evaluation - Needs Assessment
- Determines who needs the communication program/intervention, how great the need is, and what can be done to best meet the need. -Involves audience research and informs audience segmentation and marketing mix or 4 P's strategies.
Process Evaluation things to consider:
- Did we respect the budget? - How did we work as a team?
Culture as Context
- Disease - Illness
Factors of Health Literacy
- Education level - Comprehension - Competency - Technology and Access to technology - Level of literacy
The difference between healthcare giver and health care provider:
- Education level - Personal level
Campaign Evaluation
- Effectiveness of Programs - Systematic Process - Reaching our target audience - was goal reached?
Health information technology
- Electronic health records - Telemedicine
Overview of Final Section
- Ethical principles - Informed consent - Advance directives - Organ donation - Medical errors * Rank these principles in terms of importance
Suggestions for Public Care Healthcare Professionals - from Dupre' 2016 - continued
- Evaluate messages for effectiveness and cultural appropriateness - Audience reaction is the ultimate gauge of how effective messages are. Pilot health messages with target audience members before disseminating them, and then assess their impact afterwards. - Focus on action - Specific suggestions for health behavior can be more valuable than lengthy explanations.
Campaign Evaluation continued
- Evaluation results can be used to maintain or improve program quality and to ensure that future planning can be more evidence-based. - Evaluation constitutes part of an ongoing cycle of program planning, implementation, and improvement Patton, 1987.
Campaign Evaluation
- Evaluations are concerned with the effectiveness of programs. While common sense evaluation has a very long history, evaluation research which relies on scientific methods is a young discipline that has grown massively in recent years (Spiel, 2001). - Evaluation is a systematic process to understand what a program does and how well the program does it.
Mental health problems can lead to other problems such as:
- Experimenting with drugs or alcohol - Being hostile and aggressive - Taking risks in behavior
If you know someone, get immediate help:
- Find a health care provider - Participate in a clinical trial - Help for service?
Work Scheduling
- Flexible work arrangements
Health 4 U uses
- Formative evaluation - Summative evaluation
Incredible variety
- Formats (e.g., letters, calendars, computers) - Channels (e.g., kiosk, Internet, mobile device) - Behaviors (>20 behaviors, including bullying) - Populations (e.g., adolescents, military personnel)
What can I do? If you or someone you know has a mental health problem, there are ways to get help.
- Get immediate help: National Suicide Prevention Lifeline (1-800-273-8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network - Find a Health Care Provider or Treatment - Participate in a Clinical Trial - Help for Service Members and Their Families - Learn More about Mental Disorders
Medical Errors
- Have any of you experienced or know someone who has experienced a medical error? - How did the healthcare providers respond? - How did you or the patient respond? - What are reasonable standards for not committing medical errors? - Zero tolerance? - Three strikes and you're out?
Theories
- Health Belief Model - Extended Parallel Process Model - Transtheoretical Model of Behavior Change
Patient Diversity
- Health disparity - Demographic trends
Patient diversity
- Health disparity - Demographic trends
Types of Health game
- Health video games - Exergames e.g., Wii fit
2 Reasons for interventions
- Help families - Reduce stigmas
Extended Parallel Process Model includes
- High Threat, Low Threat - High Efficacy, Low Efficacy - Danger Control - Lesser Amount of Danger Control - Fear Control - No Response
Scientific Approach- Positive outcomes:
- Higher patient satisfaction - Better patient adherence - Lower patient anxiety
Mental Illness in Relationships - Inconsistent nurturing as control theory - Le Poire, 1995:
- Highlights the paradox of a relational partner's nurturing and controlling behavior over time - Cycle of punishment, support, punishment can reinforce depressive behavior
Inconsistent nurturing as control theory - Le Poire 1995
- Highlights the paradox of a relational partner's nurturing and controlling behavior over time. - Cycle of punishment
Future Directions
- How does communication promote overall good mental health? - What is the impact of mental health on sibling relationships? - How can we use information communication technologies to support and treat those with mental illness? - How can we encourage friends, family, and co-workers to intervene?
Patient diversity
- How does diversity influence health? - How does diversity influence healthcare? - How does diversity influence health communications?
Campaign Design
- Hydrated versus Dehydrated - Skin Cancer awareness -
Model of Stigma Communications:
- Identify and categorize people as stigmatized - Suggest that stigmatized people pose risks to others. - Imply that stigmatized people are responsible for the stigma.
Risky Behaviors among Adolescents - Methods
- Identify at risk persons - Develop interventions: Message Design, Information..
Organ Donation - continued
- If a man wishes to give his only remaining kidney - which will lead to his death - to his daughter who will die without the organ, should he be allowed to do this? - Should people be allowed to ask for an organ using social media?
Telemedicine is not appropriate
- If the patient doesn't have access to technology. - If it's a life or death situation. - If the equipment is hacked. - If there is a language barrier. - If the issue issue has persisted for a long time. - If dealing with an incredibly anxious patient. - If the health care provider doesn't feel comfortable discussing a diagnosis online. - Level of severity of medical condition. - When the person doesn't know how to use technology. - What if the internet freezes.
Advantages of eHealth - continued
- Increased access through Internet-driven delivery system - Low cost - Multimedia platform - Networkability - Simulated environment - Tailoring potential
What are the components of patient participation? Cegala 2011
- Information seeking - Assertive utterances - Information provision - Expression of concern
Health 2.0
- Information seeking - Information sharing - Personal health management
Culture as Context
- Interpretive and Critical- Cultural Paradigms - Qualitative - Descriptive
What did Beckman and Frankel (1984), Marvel et al. (1999), and Dyche and Swiderski (2005) find out about physicians interrupting patients?
- Investigated how physicians' behavior influences their patients' ability to describe their reasons for making an office visit. - Only 23% were able to state the reason for their visit before they were interrupted. - Patients were able to speak for 18 seconds before they were interrupted. - Most patients finished their statements in less than a minute.
C = CHECK for understanding.
- It is really important that you understand everything the doctor is telling you about your condition, the treatment, and any medications that are prescribed. It's your responsibility as a patient to speak up if you don't understand something.
Extended parallel process model examples
- Just Slow Down Campaign - UK Campaign Don't Text and Drive
Media Theories - Media power and inequalities
- Knowledge gap hypothesis - Communication inequality
Negative Consequences of Mental Illness
- Lead to new problems such as drug abuse, alcoholism
Social media can be used to:
- Listen to consumers and learn how they think about a particular health issue - Establish and promote a brand - Disseminate information to the public - Expand the reach of a particular health communication initiative or campaign - Foster public engagement and partnerships
How to Sort Good from Bad
- Look for the HONcode symbol - HON "Health on the Net" Foundation established in 1995 - Non-profit NGO dedicated to ensuring useful and reliable health information online - Used by more than 7,300 certified websites across more than 100 countries
Management Style
- Managers are well trained and good people managers. - Managers are not autocratic, authoritarian, controlling, and aggressive. - Employees are not blamed or punished for mistakes.
Conflicting results -
- Mann 1997 - Segrin et al. 2011
Conflicting Results - 2 Studies
- Mann 1997: women increased eating disorders - Sergin: Men with prostate cancer.....
Campaigns and Interventions
- Mass Media Campaign - Community/ School-based Intervention
Exemplar Campaigns
- Mass media campaign: ONDCP Marijuana Initiative - Community-based intervention: Web-based Support for Community Tobacco Control Coalitions - School-based intervention: All Stars
Exemplar Campaigns
- Mass media campaign: ONDCP Marijuana Initiative - Community-based intervention: Web-based Support for Community Tobacco Control Coalitions - School-based intervention: All Stars - The Tamale Lesson
Campaign evaluation - Summative Evaluation - Impact Evaluation
- Measures community-level change or longer-term results for example; changes in disease risk status, morbidity, and mortality, that have occurred as a result of the communication program/intervention. - These impacts are the net effects, typically on the entire school, community, organization, society, or environment.
Campaign evaluation - Summative Evaluation - Outcome Evaluation
- Measures effect and changes that result from the campaign. Investigates to what extent the communication program/intervention is achieving its outcomes in the target populations. - These outcomes are the short-term and medium-term changes in program participants that result directly from the program such as new knowledge and awareness, attitude change, beliefs, social norms, and behavior change, etc. Also measures policy changes.
Outcome Evaluation
- Measures effects and changes. - Investigates to what extent the program achieves outcomes.
Campaign evaluation - Formative Evaluation - Process Evaluation
- Measures effort and the direct outputs of programs/interventions - what and how much was accomplished for example; exposure, reach, knowledge, attitudes, etc.. - Examines the process of implementing the communication program/intervention and determines whether it is operating as planned. It can be done continuously or as a one-time assessment. Results are used to improve the program/intervention.
Media
- Media, plural for medium: channels through which a message is sent: newspaper, TV, websites, magazines
Uncertainty Types
- Medical - Social - Personal
Uncertainty Types
- Medical Uncertainty - Social Uncertainty - Personal Uncertainty
Treatments for Illness:
- Medical treatment - Psychotherapy - Self-help and Peer led.....
Treating Mental Illness
- Medical treatment - Psychotherapy - Self-help and peer-led interventions
Overview of 9-17
- Mental illness - Stigma - Mental illness in the media - Mental illness in relationships - Treating mental illness
Personal Health Management - SparkPeople.com
- More than 15 million registered users - Health information - Data tracking - Social support - Teams - Message boards - Blogs - SparkFriends
Cervical Cancer-Free Kentucky Initiative
- Mothers and young women. - GlaxoSmithKiline unrestricted grant
Campaign evaluation - Formative Evaluation
- Needs Assessment - Process Evaluation - Outcome Evaluation - Impact Evaluation
Forms of Formative Evaluation
- Needs Assessment - Process Evaluation - Outcome Evaluation - Impact Evaluation
What did Beckman and Frankel (1984), Marvel et al. (1999), and Dyche and Swiderski (2005) find out about physicians interrupting patients? continued
- Only 23% were able to state the reason for their visit before they were interrupted. - Most patients finished their statements in less than a minute.
Communication
- Open communication between management and employees. - Human resource professionals and managers are approachable. - Discussions are kept confidential.
Good Communication
- Operationalized - Cues - measuring level of happiness - Non-verbal cues - body language
Media Misinformation - Wakefield in 1998, The Lancet - Conflicts of interest
- Paid by solicitors who needed evidence against vaccine manufacturers - Applied for patents for rival MMR vaccine Manipulated data to lead to false conclusions about autism - Media feeding frenzy - Biggest science story of 2002: 1,257 articles written, mostly by non-expert commentators - Article was retracted, but the damage was done
2 types of Medical Interpreters
- Patient advocate - Co-diagnostician
Information Sharing - Patient and Physician Blogs
- Patient blogs CaringBridge - Physician blogs Dr. Kevin Pho
Factors that affect communication:
- Patient characteristics - Physician characteristics
External Challenges
- Patient diversity - Community challenges - Policy Issues
External Challenges
- Patient diversity - Community challenges - Policy issues
What did Beckman and Frankel (1984), Marvel et al. (1999), and Dyche and Swiderski (2005) find out about physicians interrupting patients?
- Patients were able to speak for 18 seconds before they were interrupted.- Investigated how physicians' behavior influences their patients' ability to describe their reasons for making an office visit.
The Recruitment Process: Lack of accrual due to several barriers:
- Patients' characteristics - Physicians' characteristics Contextual factors
Work Environment
- People are friendly, empathetic, understanding, and supportive. - Bullying, harassment, and discrimination are not tolerated. - Not a high-stress environment, no hostility or conflict.
Overwhelmingly, mental illness is portrayed negatively and stereotypically in the media.
- People who are mentally ill are characterized negatively. - Mental health professionals are mischaracterized. - Treatments of mental illness are presented in biased ways. What are the effects of these media representations and misrepresentations?
Health Belief Model
- Perceived Susceptibility - Perceived Severity - Perceived Benefits - Perceived Barriers - Cues to Action - Self-efficacy
Media literacy examples: Gyntalk.com, webmd.com, ER, Grey's Anatomy, House
- Perception of smoking or organ donation - Advertising has changed perceptions from good to bad. - Positive messages through entertainment. - Reducing social fears and to create proactive viewers.
Culture as Context - PEN-3 Mode
- Person, Extended family, Neighborhood - Health education - cultural identity - Educational diagnosis of health behavior - relationships and expectations - Cultural appropriateness of health behavior - cultural empowerment.
3 Spheres to personal health:
- Personal Sphere - Public Sphere - Technical Sphere
Personal Health Management - Concerns
- Privacy - Health Insurance Portability and - Accountability Act or HIPAA contains security rules and privacy rules about electronic communication of health information - Motivating people to use the technology - Technology is always changing - Resources
3 Ways to think about patient diversity
- Race - Sex - Education
3 ways to think about diversity:
- Race - Sex - Education
Campaigns versus Interventions - Campaigns
- Reach: high - Researcher/practitioner involvement: low - Audience involvement: low - Cost per person: low - Internet assistance: high
Campaigns versus Interventions - Interventions
- Reach: low - High for schools - Researcher/practitioner involvement: high Audience involvement: high Cost per person: high* Internet assistance: high
Nonverbal Behaviors
- Reading potential participants - Mirroring nonverbal behaviors - Specific behaviors - Smiling, voice, body position, eye contact, touch, physical appearance.
Informed Consent
- Required for participation in research of medical and social science and to receive medical treatment
Free and colleagues in 2013
- Research question: is mHealth an effective way to deliver health messages to health-care consumers? - mHealth: The provision of health-related services using mobile technology
Bioethical Principles of Medicine
- Respect for autonomy - Non-maleficence - Beneficence - Justice
Bioethical Principles of Medicine
- Respect for persons - Nonmaleficence - Beneficence - Justice * Rank these principles in terms of importance again. How has your ranking changed?
2 Health Care Team Protocols
- SBAR - COMFORT
3 Paradigmatic approaches to health communication:
- Scientific - Interpretive - Critical-cultural
Culture as Variable
- Scientific Paradigm - Quantitative - Experimental and Intervention
2 methods of analysis
- Scientific analysis - Interpretive analysis
Extended Parallel Process Model Theory p. 405
- Self efficacy - Severity - Succ......
Organ Donation Questions
- Should the United States use an opt-in, an opt-out, or a mandated choice system for determining organ donation status? - Are you an organ donor? Why or why not?
Free and colleagues in 2013 - continued
- Simple medication reminders delivered by SMS showed no effect. - No or small benefits for diet and diet with physical activity interventions. - Benefits for reminders for vaccine appointments attendance and cardiopulmonary resuscitation training. - Short term benefits for asthma control, physical activity, and psychological support interventions.
Advance Directives Talking with your parents
- Start now - Use third parties - Talk about goals and values, not necessarily specific treatment
Risky Behaviors among Adolescents
- Substance abuse - Risky sexual behavior - Gender-based violence - Cyberbullying
3 criteria of Informed Consent:
- Sufficient information - Decision-making competence - Voluntariness
More on Informed Consent - Should informed consent be required for:
- Taking an X-ray? - Drawing blood? - Conducting a physical exam? - Prescribing medication? - Giving a flu shot? - Giving a gynecological exam?
Mobile Programs
- Text messaging: persuading in 160 characters or less... Text2stop smoking campaign - Health apps: Many are available, but few have been evaluated
Entertainment-Education
- The Norman Lear Center at USC Annenberg (Hollywood Health and Society): "The" source for E-E - 550+ HH&S-assisted storylines over past three years
Article 2 - Doctor Patient Communication in the e-Health Era.
- The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and populations. - Online Facebook or text used to find cures - Digital copy of your medical records - easy to transfer to another doctor.
Theories
- Theories are important to guide the development of both campaigns and interventions
4 Dimensions of Sensation seeking
- Thrill and adventure seeking - Experience seeking - Disinhibition - Boredom susceptibility
Reporting Health News - Story presentation influences perceptions
- Through agenda setting, priming, and framing, stories create knowledge and meaning can lead to inaccurate perceptions: ^Sensationalism ^Unbalanced coverage ^Certain frames - Cancer coverage: types of cancer, causes of cancer, cancer prevention
Advance Directives are difficult to interpret
- Too general - for example: no heroic measures. - Too specific - for example: use oxygen, suction, and manual treatment of airway obstruction as needed for comfort.
Informed Consent:
- Tuskeegee Syphilis Experiment - Jewish Chronic Disease Hospital - Willowbrook - Belmont Report in 1978
Internal challenges
- Uncertainty - Health literacy - Patient Participation
Internal Challenges
- Uncertainty - Health literacy - Patient participation
Uncertainty - Is uncertainty a good, bad, or neutral experience?
- Uncertainty appraised as danger= reduce uncertainty - Uncertainty appraised as opportunity = maintain or increase uncertainty
Use Sen-tar - Sensation seeking Targeting:
- Use sensation Seeking to segment audience - Conduct FG to determine which message would appeal to HSS. - Develop PSA - public service announcement - -
In Zhang and Siminoff (2003), what method did they use to collect data, how did they analyze the data, and what did they find?
- Used software to create themes - Used Qualitative method - Examined decision making experiences of stage 4 lung cancer patients - Results illustrated a lack of communication between caregiver and patients.
Culture as Context exemplar studies:
- Wang in 2012 - Ho and Bylund in 2008
Suggestions for Public Care Healthcare Professionals - from Dupre' 2016
- Watch your language - Use multiple formats - Evaluate messages for effectiveness and cultural appropriateness - Focus on action
Suggestions for Public Care Healthcare Professionals - from Dupre' 2016
- Watch your language - words such as pandemic, influenza, and prevalence can frighten and confuse rather than inform. it is better to use everyday language instead. - Use multiple formats - A combination of words, diagrams, and videos help to appeal to people with diverse learning styles and literacy resources.
Future Directions of ehealth
- We need to test the efficacy of various eHealth applications. - We need to consider how eHealth applications can be disseminated into a practice setting. - We need to focus on new and emerging technologies in eHealth. - What do you think eHealth tools will look like 10 or 20 years from now?
Racism
- Weathering - Microaggressions
Ask Me 3 - Use of Cards and Infographics - Every time you talk to your doctor, nurse, or pharmacist, ask these questions:
- What is my main problem? - What do I need to do? - Why is it important for me to do this?
Ask Me 3
- What is my main problem? - What do I need? - Why is it so important for me to do this?
PolicyIssues
- Why should we pay for care? - Who should receive care -citizens, residents, visitors? - Should there be more incentives to be healthy - no smoking, no drinking, no fat? - Should morally controversial procedures be covered - abortion, vaccination, birth control?
Policy Issues - Obamacare
- Why should we pay for care? - Who should receive care? Citizens, residents? Visitors? - Should there be incentives to be healthy? - Should morally controversial procedures like abortion, vaccination, and birth control be covered?
Work-life Balance
- Work-life balance is promoted - Employees are encouraged to take vacation - Employees not expected to respond to email 24/7
Mentally healthy workplace
- Workload - Work Scheduling - Work-Life Based - Work Environment - Management Style - Communication
Workload
- Workloads are monitored - Face time does not equal better job performance - Overtime is compensated
"1-2-3 Pap" Intervention
- Young adult women - CDC Cooperative Agreement
California Health Happens Campaign
- Your zip code DOES predict how long you will live. - Your zip code shouldn't predict how long you will live.
High school-based HPV Vaccination Project
- adolescent males and females. - Merck Investigator-Initiated Studies Program.
What kind of data did Segrin in 2011 collect, how did they analyze the data, and what did they find? (Conflicting Results)
- found that for men with more advanced prostate cancer, social support was associated with improvements in depression. - Not all the patients need the same.... - Men with prostate cancer - Initial questionnaire - Contrary to previous studies - social support differs depending on stage of illness.......
Socio-Economic Status - or SES
- it's an overarching term that factors in education, income, employment level, and similar variables. - Individuals with a low SES suffer from poor health because they typically receive less health and dental care in comparison with people of higher SES.
What are the different ways in which medical interpreters can act?
-Conduit -Clarifier -Cultural broker
What is the difference between the scientific, interpretive, and critical-cultural paradigms in terms of (a) how each paradigm approaches truth and (b) the research methods usually employed in each paradigm?
-Interpretive uses values, focus group -Critical-cultural uses power, orig methods.
Barriers
......
2 Forms of Formative Evaluation
........
The HBM is based on the understanding that a person will take a health-related action i.e., use condoms if that person:
1 Feels that a negative health condition i.e., HIV can be avoided, 2 Has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition i.e., using condoms will be effective at preventing HIV, and 3 Believes that he/she can successfully take a recommended health action i.e., he/she can use condoms comfortably and with confidence.
Mental Illness in the Media
1) What movies or TV shows do you remember seeing that deal with mental illness? 2) How is mental illness depicted? 3) How might this influence what you and others think about mental illness?
The process
1. Formative research 2. Use of theory 3. Audience segmentation 4. Message design - targeted to audience 5. Channels and message placement 6. Process evaluation and high message exposure 7. Outcome evaluation
Note:
1.Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., ... & Walker-Smith, J. A. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351, 637641.
Common Mental Illnesses
18% Anxiety disorders - examples include: OCD, PTSD, panic attacks, generalized anxiety 10% - examples include: Mood disorders (depression, bipolar 9% - examples include: Personality disorders (borderline, antisocial, avoidant, narcissistic) 5% - examples include: Eating disorders (anorexia, bulimia, binge eating) 5% - examples include: ADHD 1% examples include: Schizophrenia
Prevalence of Mental Illness
25% of the population currently has a mental illness 50% of the population will face a mental illness at some point WHO estimates that by the year 2020, depression will be a leading cause of disability among citizens of the world - second only to cardiac disease
SOLER
5 elements of engaging with patient through eye contact and touch.
Information Seeking - Everybody's doing it! 80% of Internet users search for health information online. Of Internet users...
66% have looked up info about a disease/condition 56% about medical treatment, meds, procedures 44% about a healthcare provider 36% about a hospital or clinic 25% about health insurance, Medicare/Medicaid
INFORMATION SEEKING - Everybody's doing it!
80% of Internet users search for health information online.
TELEMEDICINE "Jennifer's Story"
A case study that uses video conference to save time and travel.
Meta
A prefix that means "about".
Cultural Competency
A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.
Metatheory
A theory about a theory. In essence, metatheory encompasses a paradigmatic perspective.
Sen-tar - Sensation seeking Targeting:
A theory-based and empirically tested model that recognizes need for messages to be novel in order to increase the likelihood that they will be noticed and processed by high-sensation seeking people.
Paradigmatic perspective
A way of looking at the world.
Smith's 2007 Model of Stigma Communication described how messages:
A) identify and categorize people as stigmatized B) suggest that stigmatized people pose risks to others C) imply that stigmatized people are responsible for the stigma.
Interpretive paradigm
According to this paradigm, there are multiple socially constructed truths that can be understood - usually through qualitative methods.
Critical-cultural paradigm
According to this paradigm, there are multiple socially constructed truths that can be understood in terms of power.
Scientific paradigm
According to this paradigm, there is one objective Truth that can be discovered - usually through quantitative methods.
What is the difference between the various types of health care teams?
Ad-hoc team multi disciplin interdisicplined transdiscipli
Advance Directives
Advance directive aka living will: documents that describe what medical treatments a person does not want to be given in the event that the person loses the ability to make decisions in the future .
Direct-to-Consumer Advertising
Advantages and Disadvantages
Everything went perfectly. Now Larry says he has two new missions: to find other donors for other people, and to find a way to properly thank the woman who gave him his wife back.
After a full year of searching, this week, Larry Swilling finally met his miracle. She's a 41-year-old retired Navy lieutenant commander named Kelly Weaverling.
Health Care Teams
An intact group of health care providers motivated to communicate with each other regarding the care of specific patients.
Theory
An organized set of concepts and explanations about a phenomenon.
Mental Illness
Any diagnosable disorder that impairs a person's mood, thoughts, and behaviors.
Relational lens
Assumes that human understanding.....
Temporal stability
Based on providers' history of working together in the past and an expectation of working together in the future.
P = PRESENT detailed information about how you are feeling.
Be specific: Are you experiencing pain? If so, is it a sharp pain or a dull ache? Does it come and go or is it constant? Has anything helped alleviate the pain? What have you tried?
PATIENT CENTERED APPROACH
Best method because it is targeted to the patient.
Future Directions
Better understand the role of technology in health decision making and behavior. Consider the role of interpersonal communication in influencing program effects.
Untrained
Bilingual staff in the healthcare organization.
COMFORT protocol
C - Communication O - Orienting M - Mindfulness F - Family O - Openings R - Relating T - Team
Secular Trends
Changes over time - Recurrent crisis boom and slump - combined in chart
Action:
Changing
Scientific analysis
Coding frequency and type of talk.
Information seeking
Component of patient participation that involves asking medically-related questions and verifying information provided by the doctor.
Expression of concern
Component of patient participation that involves expressing fear, anxiety, or worry related to health.
Information provision
Component of patient participation that involves responding to questions from the doctor or volunteering medically related information.
Assertive utterances
Component of patient participation that involves stating opinions, preferences, suggestions, recommendations, disagreements, or requests.
Multidisciplinary team
Composed of practitioners from multiple disciplines who work in conjunction with each other but function independently.
The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review
Conclusions: Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimized interventions are required to evaluate effects on objective outcomes.
A medical interpreter who prides herself on translating the healthcare provider's words verbatim for the patient is what type of medical interpreter?
Conduit - not clarifier - not cultural broker - not patient advocate
Medical interpreters can assume several roles:
Conduit, Clarifier, and Culture Broker
The study by Ellington in 2008 in which she questioned the assumptions of the healthcare system by examining the case study of communication between healthcare providers and patients at a dialysis clinic is an example of which paradigm?
Critical Paradigm - not Scientific paradigm, Interpretive paradigm, nor Ontology.
Components of health literacy
Cultural and conceptual knowledge, listening and speaking, writing and reading, and numeracy.
Why is cultural communication training needed?
Cultural communication is needed because there is evidence that subconscious biases among providers lead to health disparities based on patient's race, education, sex, and ethnicity.
Biopsychosocial model
Defines the patient as a whole person by focusing on psychological, social, and relational issues.
Campaign Implementation
Delivery of message - Deseminated
Relational dimension
Describes characteristics of the relationship between an ethically defined group and the society in which it is situated.
Restitution narrative
Describes how a person gets sick, suffers, receives treatment, and then is restored to health.
Quest narrative
Describes how a person has suffered illness, but that through the illness, something positive comes of the illness experience.
Chaos narrative
Describes how a person's condition gets worse and worse, which leads to suffering, despair, and hopelessness.
Attributional dimension
Describes the unique sociocultural characteristics of groups.
Applied research
Designed to solve a problem.
Basic research
Designed to test and refine theoretical models.
Uncertainty
Exists when information is ambiguous, complex, probabilistic, unavailable, or inconsistent.
Evaluators need to address secular trends, or changes over time that are based on behavioral or other changes not attributable to the programme itself. "A good way to refute a charge that a secular trend was wholly responsible for an observed behavior change may be to employ a 'switch-back' design.
Experimental and control conditions are switched after more change is observed in the experimental community than in the control community. If change levels off in the new control site and accelerates in the new experimental site, then attributing cause solely to a secular trend can be ruled out."
All patients want to be involved in making their own medical decisions.
False
In general, culture, race, and ethnicity are the same thing?
False
Support is always helpful.
False
The COMFORT protocol is a formula for talking to patients to facilitate information exchange.
False
The interpretive paradigm embraces quantitative methods.
False - The interpretive paradigm embraces QUALITATIVE methods.
As a culture, we tend to like chaos narratives.
False - We like quest narratives
All patients want to be involved in making their own medical decisions.
False. - paternalistic approach - uncertainty - implies hope in some cases
Sensation seeking has no relationship to risky behavior.
False????????
Second order patients
Family caregivers share in the suffering of patients and experience their own personal losses as a result of providing patient care.
Community-Based versus School-Based Interventions - Community-Based
Focus on engaging with members of the community, organizational representatives - local businesses or media outlets, and health experts.
Community-Based versus School-Based Interventions - School-based
Focuses on engaging with those in a school or classroom setting.
Critical-culture paradigm
Forces us to question the assumptions we make about what it means to be healthy or sick and who has the authority to say what counts as health promotion or disease prevention behavior. It encourages us to find ways to change the system to promote greater fairness and equality.
Ad-hoc team
Forms for a limited period of time to address a problem and disbands when they achieve their goals.
Mann 1977
Found that when women had recovered from eating disorders presented a primary prevention session, symptoms of eating disorders actually INCREASED among participants.
HIPAA
Guarantees that patient health information is safe in the hands of the healthcare providers they visit.
Interpretive Paradigm aka humanistic
Has little interest in conducting experiments and counting words or doing anything that attempts to make generalizations or predict or control behavior. Instead, the real interest lies in uncovering and understanding the subjective, situated meanings of human behavior.
Health Information Technology - HIT
Health Information Exchange - HIE
ELECTRONIC HEALTH RECORDS - EHRs:
Health records in digitalized format - accessed through a computer, over a network.
Mass Media Campaign
High Reach
Campaign Evaluation
How can you know a campaign worked?
Degree of interaction
How frequently group members communicate.
Severity
How grave is the .......
Medical Uncertainty Type example:
How many hours should I practice?
Reporting Health News
How might new media (e.g., twitter, facebook, tumblr) improve or worsen the problems journalists face in the development and reporting of health-related stories?
Interdependence
How much group members rely on others in the group.
Authority differentiation
How tasks are divided among providers and how decision-making power is viewed in different situations.
E =EXPRESS concerns about the recommended treatment. - continued
If you are having trouble, be sure to explain why and offer to work with your doctor to find a modified or alternative treatment.
E =EXPRESS concerns about the recommended treatment.
If you have concerns about the recommended treatment; for example, difficulty swallowing pills , speak up. Be honest with your doctor by explaining how you are following the treatment; for example, taking all, some, or none of your medication or doing all, some, or none of your at home physical therapy.
Campaign Implementation
Implementation: creating informational and persuasive messages that are disseminated via traditional mass media, new technologies, and interpersonal networks
Campaign Implementation
Implementation: creating informational and persuasive messages that are disseminated via traditional mass media, new technologies, and interpersonal networks.
Theory of Planned Behavior
Important....need to research
Chaos narrative - continued
In this narrative, the condition continues to get worse, pain and suffering increase, relationships and jobs suffer, patients are dragged into healthcare bureaucracies that cause frustration and anxiety, stress increases, family and work responsibilities cannot be met, and the people around the ill person become less supportive , more demanding, and less patient.
People who adopt an interpretive paradigm, which methods are most likely to use among those listed?
In-depth interviews - not content analysis, survey, nor experiment.
Information seeking
Includes asking medically related questions and attempting to verify information the doctor has provided.
Patient-centered model
Includes consideration of patients' needs and experiences, provision of opportunities to patients to participate in their care, and enhancement of the provider-patient relationship.
Health Disparities
Inequalities in heathcare quality based on demographic factors such as race, sex, and income.
Sample informed consent document: Informed Consent Document Tips
Informed consent documents explain to potential participants: - the nature of the research project, - why they are candidates for the research, - what risks, benefits, and alternatives are associated with the research, and - what rights they have as research subjects.
Campaign Design - Input-output model
Input variables: source, message, channel, audience Output variables: learning, yielding, actual behavior
Semiotic view
Interpreters USE SYMBOLS to negotiate meaning.
Conduit view
Interpreters are neutral translators.
Utilitarian view
Interpreters face obstacles in interpreting.
Critical view
Interpreters swing between system and life-world-associated roles.
The study of Desantis in 2002 in which he explored how cigar smokers construct arguments to counter anti-smoking messages is an example of which paradigm?
Interpretive - not Scientific - not Critical - not Ontology
The biopsychosocial model of care most closely reflects which paradigm?
Interpretive - not scientific - not critical - not ontology
Communication as construction of meaning uses
Interpretive paradigm.
Jill plays the role of an unannounced standardized patient with a hidden audio recorder to see how physicians respond when she asks open-ended versus closed-ended questions. This is an example of which research method?
Intervention research method - not Interpretive analytic method, scientific analytic method, nor naturalistic research method.
Communication Design
Involves both creation and critique.... - simply create...... - Communication design has a complementary relationship to theory - Communication design is both unique and iterative??????????? - Communication design can help reveal unintended consequences.
Interdisciplinary research
Involves researchers from multiple disciplines collaboratively investigating multiple dimensions of either a health problem in general or the communication aspect of a health problem.
Multidisciplinary research
Involves researchers from multiple disciplines independently investigating the communication dimension of a health problem.
Socio-cultural influences
Issues that contribute to and frame understandings of health and illness.
SBAR protocol: information exchange
It provides a structured method to communicate about patient care.
Advance Directives or a living will may not accurately affect person's wishes
It's difficult to predict the future!
Universal medical symbol
It's easy to be confused when faced with health information; especially if in another language.
EXAMPLE of ELECTRONIC HEALTH RECORDS
Lee Memorial Health System (What is your experience with HIT?)
The text mentions several different factors that can mediate the association between social support and health outcomes. Which of the following is one of the mediating factors?
Loneliness - not communication avoidance - not caregiver burden - not privacy management
Community/ School-based Intervention
Low Reach
Intervention Research
Manipulates some aspect of patient-provider communication to see what effect the manipulated variable has on outcomes of the interaction. - Uses audiovisual recordings, surveys, or interviews to capture as much detail as necessary.
Advance Directives - Margo
Margo is a white woman in her 50s who, despite having dementia, is very happy. Before she developed dementia, she completed an advance directive saying that if she ever has dementia, she wants to refuse any life-sustaining treatment. Margo now has pneumonia, which requires antibiotic treatment. Without the treatment, she will die. Margo - with dementia - says that she WANT TO receive the treatment.
Impact Evaluation
Measures community-level change or longer-term results.
Process Evaluation
Measures effort and the direct output of programs and interventions. - Results are used to improve program and interventions. - Evaluate process - Assessments
Mass Media and Health
Media
Framing:
Media influence how audiences think about issues
Priming:
Media influence issue accessibility and evaluation
Agenda Setting:
Media influence what audiences think about
Cultivation:
Media portrayals shape the way we view the world
Social Cognitive Theory:
Media promote observational learning
Bilingual
Medical providers who learn additional languages.
Sergin
Men with prostate cancer......
Mental Illness
Mental illness: any diagnosable disorder that impairs a person's mood, thoughts, or behaviors
What are the brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial, gender, sexual-orientation, and religious slights and insults to the target person or group? (Week7 Class12 slides)
Micro-agressions -not Health disparities - not Othering - not Weathering
Work Load
Monitored, "Face time" doesn't equal better performance.
Mental health problems lead to new problems with friends, family, law enforcement or school officials
National Mental Health Association, 1997
Jill sits in the waiting room of an outpatient surgery clinic to describe how family members interact while they wait for a patient to come out of surgery. This is an example of which research method?
Naturalistic research method - not Interpretive analytic method - not Scientific analytic method - not Intervention research method
Not allowing a father to give his only kidney to his dying daughter who needs a kidney transplant upholds which of the following principle of medical ethics?
Non-maleficence - not Beneficence - not Justice - not Respect for Autonomy
Article 1 - The Recruitment Process - The Role of Nonverbal Communication Behaviors in Clinical Trial and Research Study Recruitment - Morgan
Nonverbal Behaviors: - Recruiters - CAT = Communication Accommodation Theory - Reading potential participants - Mirroring nonverbal behavior - Specific behaviors - Respectful tone of voice Smiling, voice, body position, eye contact, touch, physical appearance.
Video Sheldon from The Biog Bang Theory
O.C.D. - Obsessive Compulsive Disorder
Mental Illness in the Media
OCD obsessive compulsive disorder and germophobia
Othering
Occurs when a dominant group and it's characteristics, beliefs, and practices are considered the norm or standard by which any differences from that standard are marked as deficient.
Shared decision making
Occurs when providers relinquish total control of healthcare decisions in favor of a more collaborative process that aims to help patients and families understand key issues with the diagnosis and treatment options.
Health disparity
Occurs when someone receives better or worse healthcare based on demographic factors, such as race, sex, or socio-economic status.
Advance Directives or living will is not always practical
Only 1 in 3 Americans has an advance directive Even if they do, their doctor may be unaware
Uni-disciplinary team
Organized around a single discipline or healthcare profession, such as nursing or surgery.
Theory
Organized set of concepts and explanations about a phenomenon.
Background Noise
Other campaigns similar......
Race and Ethnicity
Othering, Culturalism
Mental Health in the Media
Overwhelming mental illness is portrayed negatively.
What are the guidelines in the PACE communication skills training protocol?
P = PRESENT detailed information about how you are feeling. A = ASK questions. C = CHECK for understanding. E =EXPRESS concerns about the recommended treatment.
Metatheory
Paradigmatic perspective - a way of looking at the world.
Patient participation: Scientific perspective
Patient participation is measured as the extent to which patients communicate actively during their interactions with their providers.
Patient participation: Interpretive perspective
Patient participation is studied as part of the communication process by examining how patients do or do not actively contribute to the various activities throughout the medical visit.
Policy Issues - Medical practice changes:
Patient-Centered Medical Home - PCMH model.
Expression of concern
Patients express fear, anxiety, or worry in relation to their medical condition.
Information provision
Patients responding to questions from the doctor or volunteering medically related information on their own.
Assertive utterances
Patients state an opinion, preference, suggestion, recommendation, disagreement, or request.
Transtheoretical model continued
People move through a series of stages when modifying behavior. While the time a person can stay in each stage is variable, the tasks required to move to the next stage are not. The stage construct represents a temporal dimension. Change implies phenomena occurring over time.
Chance
People who happen to be nearby during an exchange between a patient and healthcare provider.
Quest narrative - continued
People who have suffered serious or debilitating illness who go through the journey and face it head-on with the belief that something positive will come of the experience.
Concordance
Perceived similarity between physicians and patients.
Lay caregiver
Person who provides unpaid patient care, including help with medication, activities of daily living, transportation, and scheduling medical visits.
Lay caregiver aka Second order patients
Person who provides unpaid patient care, including help with medication, activities of daily living, transportation, and scheduling medical visits.
Electronic Health Record - EHR
Personal Health Record - PHR
Health literacy includes all of the following aspects except:
Personal medical history - not cultural knowledge, writing, and listening.
PATERNALISTIC APPROACH
Physician is the expert. It has positive and negative results.
Scientific paradigm example:
Physician word choice. "Something else" versus "Anything else". Patients were significantly more likely to mention "unmet concerns, but if physicians asked about "anything else", it didn't affeclt patient behavior. Word choice affected behavior in a predictable and therefore potentially a controllable way.
Scientific paradigm example:
Physician word choice. "Something else" versus "Anything else". Patients were significantly more likely to mention "unmet concerns, but if physicians asked about "anything else".
Communication training is important for which of the following providers?
Physicians Nurses Clinical trials recruiters -->All of the above
Randomized Controlled Trial - RCT
Pilot test the efficacy of the planned communication strategy. - increased scores on pre and post test.
Beginning
Plan how you will track and evaluate the success of a campaign.
Interdisciplinary team
Practitioners from two or more disciplines working independently in the same setting, communicating to share information from various disciplines and to integrate care. For example: car accident victim is treated by dentist, surgeon.
Leo is a smoker, and he's never even thought about quitting. According to the Transtheoretical model, what stage is Leo in?
Pre-contemptlation - not Contemplation - not Preparation - not Action
Theory of Reasoned Action
Predicts behavior by considering a person's beliefs, attitudes, norms, and intentions.
Components of the PACE communication skills training protocol
Present detailed information about how you are feeling, ask questions, check for understanding, and express concerns about the recommended treatment.
Lola's physician tells her that she has a "good chance" of getting a kidney transplant. He tells her that she will probably have to wait at least a year for the kidney. Lola is confused because waiting for a year doesn't seem like a "good chance" to her. What dimension of uncertainty is reflected by Lola's confusion? (Chapter 7 page 183)
Probability - Not complexity of illness - Not Quality of information - Not Structure of information
Telephone
Professional bilingual people who have received training as medical interpreters who translate over the phone.
On-site
Professional bilingual people who have received training as medical interpreters.
Patient diversity - Culturally and linguistically appropriate services principle standard:
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Paternalistic model
Provider-directed, hierarchical, task-oriented.
Nominal care team
Provides care through independent consultation of professionals directed by a primary care physician.
Campaigns and Interventions
Purposive attempts to inform or influence behaviors in large audiences within a specified time period using an organized set of communication activities and featuring an array of mediated messages in multiple channels generally to produce noncommercial benefits to individuals and society.
Patient diversity - Institute of Medicine's report on Unequal Treatment - Confronting Racial and Ethnic Disparities in Health Care
Racial and ethnic minorities are burdened with higher rates of disease, disability, and death, and tend to receive lower quality of health care than non-minorities, even when access-related factors, such as insurance status and income, are taken into account.
Activation Model of Information Exposure - AMIE
Recognizes that people vary in their willingness to attend to a message, and that variance is related to theri differing needs for novelty and sensation.
Biomedical model
Reflects a scientific approach by focusing exclusively on physiological, biochemical, and genetic issues.
Mental Illness in Relationships
Relational lens
Mental Illness in Relationships:
Relational lens
TELEMEDICINE ABC News "HealthBeat"
Report on new ways of treating patients remotely.
Quantitative methods
Require data in numerical form so that the data can be analyzed through statistical techniques. The goal of qualitative research usually involves making generalizations about groups of people or phenomena.
Quantitative methods
Require data in numerical form that allow for statistical analysis so that researchers can make generalizations about groups of people or phenomena.
Qualitative methods
Require data that allow for in-depth analysis of the socially constructed meaning of language and behavior so that researchers can develop a rich understanding of particular experiences.
Qualitative methods continued
Require data that allow for in-depth analysis of the socially constructed meaning of language and behavior. The goal of qualitative research usually involves developing a rich understanding of particular experiences.
Applied research
Research designed to solve a specific problem.
Basic research
Research designed to test and refine theoretical models.
Textual analysis
Research method in which the researcher analyzes participants' written accounts.
Semi-structured interviews
Research method in which the researcher asks each participant open-ended questions.
Participant observation
Research method in which the researcher observes participants in group settings.
Ethnographic fieldwork
Research method in which the researcher observes participants in their natural environment.
Transdisciplinary research
Research that spans disciplinary boundaries to create new theories and methods that integrate knowledge from multiple disciplines to address complex social problems.
Transdisciplinary research
Researchers creating new theories and methods that integrate knowledge from multiple disciplines to address complex social problems.
Interdisciplinary research
Researchers from multiple disciplines collaboratively investigating complex social problems.
Multidisciplinary research
Researchers from multiple disciplines independently investigating complex social problems.
STIGMA
Results from a person processing a "deeply discrediting" character that makes the person different from the "normal". Smith 2007
SBAR protocol
S - Situation B - Background A - Assessment R - Recommendation
SOLER
S - Squarely O -Open L - Lean toward E - Eye contact R - Relaxed
Survey research methods are most likely to be used in research from which paradigm?
Scientific - not Interpretive - not not critical - not ontology
The biomedical model of care most closely reflects which paradigm?
Scientific - not Interpretive paradigm, critical paradigm, nor ontology.
Intervention Research uses the
Scientific Approach/ Interperative Approaches
Communication as information exchange uses
Scientific paradigm.
Patient participation:
Scientific perspective and Interpretive perspective
Lay caregivers are also called
Second order patients - not lay patients - not not burdened caregivers - not family supporters
Naturalistic research
Seeks to describe settings, episodes, and interactions in terms of what is said, how it is said, where it is said, and who said it.
Research that segments the audience based on sensation seeking, conducts fosus groups to determine what messages appeal to high sensation seekers, develops PSAs for televsion based on this input, and airs these PSAs during programs that appeal to high sensation seekers illustrates which theoretical model?
Sen-Tar -not Activation Model of Information Exposure - not Theory of Reasoned Action - not Social Cognitive Theory
Culture
Set of beliefs, rules, and practices that are shared by a group of people.
Patient Diversity
Sex disparities in diagnosis and treatment of illness, especially in regard to coronary heart disease (CHD).
Which occurs when providers collaborate with patients to choose treatment options?
Shared decision making - not clinical equipoise - not paternalistic communication - not concordance
Commonality
Shared knowledge, experiences, values, and norms.
Advance Directives - Margo continued
Should doctors give the treatment to Margo or not? Does Margo (with dementia) have decision-making capacity? What if the required treatment is CPR or mechanical ventilation?
Provider
Someone whose primary task is to deliver healthcare services to individuals, families, and communities.
Ellington 2008
Spent more than 100 hours observing patient and staff interactions at the clinic. Ellington used a grounded theory approach for data analysis, which means she did not use a particular theory to guide analysis but instead let meaning emerge from the data.
Epistemology
Study of the nature of knowledge.
Ontology
Study of the nature of reality.
Axiology
Study of the role of values in research.
Social Cognitive Theory
Suggests that a person's learning is a product of a continuous interaction between cognitive, behavioral, and environmental factors.
As a culture, we tend to like restitution narratives.
TRUE. - We like positive outcomes. - Quest narratives not chaos narratives.
Transdisciplinary team
Team members are proficient in their own specialty and, through cross-training and working together on the team, develop overlapping skills.
Extended Parallel Process Model
The Extended Parallel Processing Model also widely known as Threat Management or Fear Management describes how rational considerations - efficacy beliefs - and emotional reactions - fear of a health threat - combine to determine behavioral decisions.
Describe a theory of your choice, indicating its variables and the relationship among them.
The Extended Parallel Processing Model also widely known as Threat Management or Fear Management describes how rational considerations - efficacy beliefs - and emotional reactions - fear of a health threat - combine to determine behavioral decisions. The degree to which a person feels threatened by a health issue determines his or her motivation to act, while one's confidence to effectively reduce or prevent the threat determines the action itself.
Health Belief Model
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s.
Transtheoretical model
The Transtheoretical Model of Behavior Change is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. The TTM seeks to include and integrate key constructs from other theories into a comprehensive theory of change that can be applied to a variety of behaviors, populations, and settings—hence, the name Transtheoretical.
Phenomenon of silence
The absence of vocalized concerns among family members regarding illness-related issues.
Unique challenges: Who has the tougher job?
The are all difficult at different levels. example: Dentists deal with anxiety, Nurses deal with more patients, and Pediatricians must deal with child and parent.
Microaggressions
The brief and commonplace daily verbal, behavioral, and environmental indignities, whether international or unintentional, that communicate hostile, derogatory, or negative, racial,gender,sexual-orientation, and religious slights and insults to the target person or group.
Health literacy
The capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Weathering
The cumulative effect of social, economic, and political exclusion and the physical burden of dealing with these exclusions over time.
Health literacy
The degree to which individuals have the capacity to obtain process, and understand basic health information and services needed to make appropriate health decisions.
Skill differentiation
The degree to which members have specialized knowledge of functional capacities that makes it more or less difficult to substitute members.
Illness
The experience, perception, and meaning of symptoms - lay health beliefs, Voice of the Lifeworld.
Boundness
The extent that members report to a supervisor within the team.
Patient participation
The extent to which patients produce verbal responses that have the potential to significantly influence the content and structure of the interaction as well as the health care provider's beliefs and behaviors.
Patient participation
The extent to which patients produce verbal responses that have the potential to significantly influence the content and structure of the interaction as well as the health care provider's beliefs and behaviors. - How is this studied from a scientific perspective? - How is this studied fro an interpretative perspective?
Caregiver burden
The impact of administering lay care, including tasks that are usually time consuming, overwhelming, and unanticipated or sudden.
Epistemology
The nature of knowledge.
Ontology
The nature of reality.
Sensation seeking
The need for varied, novel, and complex sensations and experiences and the willingness to take physical and social risks for the sake of such experiences.
Disease
The professional medical diagnosis and description of a disorder - medical beliefs, Voice of Medicine.
mHealth:
The provision of health-related services using mobile technology
Axiology
The role of values in research.
Health
The state of complete physical, mental, and social well-being.
Communication
The study of how people use messages to generate meaning within and across various contexts, cultures, channels, and media.
Health communication
The study of messages that create meaning in relation to physical, mental, and social well-being.
Culturalism
The tendency to treat problems as a matter of cultural differences.
Social support
The things people do or say to help one another.
Clinical equipoise
There are equivalent pros and cons for more than one treatment option for a patient's condition.
Interpretive Paradigm aka humanistic continued
There are multiple subjective "truths" that are socially constructed by humans in everyday interaction.
Scientific paradigm - aka post-postivist, objectivist
There is one objective "Truth" that is out there to be discovered. The scientific paradigm embraces quantitative methods, although qualitative methods also can play a role.
How does diversity influence health? Race and ethnicity
There's the assumption that poverty is equivalent to less health care availability.
What Do These Findings Mean?
These findings provide mixed evidence for the effectiveness of health intervention delivery to health-care consumers using mobile technologies. Moreover, they highlight the need for additional high- quality controlled trials of this mHealth application, particularly in low- and middle-income countries. Specifically, the demonstration that text messaging interventions increased adherence to antiretroviral therapy in a low-income setting and increased smoking cessation in a high-income setting provides some support for the inclusion of these two interventions in health-care services in similar settings. However, the effects of these two interventions need to be established in other settings and their cost-effectiveness needs to be measured before they are widely implemented. Finally, for other mobile technology-based interventions designed to change health behaviors or to improve self- management of chronic diseases, the results of this systematic review suggest that the interventions need to be optimized before further trials are undertaken to establish their clinical benefits.
Entertainment-Education
Think about a time when you experienced an especially effective example of entertainment-education. What made it so effective?
A = ASK questions.
Thinking about what you want to ask before your office visit and writing it down will make sure you ask what is important to you. You may want to ask, "How serious is my condition? What should I do if it gets worse? How long before I start feeling better?"
A = ASK questions.
Thinking about what youi want to ask before your office visit and writing it down will make sure you ask what is important to you. You may want to ask, "How serious is my condition? What should I do if it gets worse? How long before I start feeling better?"
Ellington continued
Through an extensive coding process, she ultimately developed categories to describe the communication behavior she witnessed in the dialysis clinic.
Article 1 - The Recruitment Process
To bridge social distance and produce positive affect but appear to function to help potential participants more clearly understand information that is relevant to clinical trial participation.
Motivation
To work together - how invested members feel to work as a group.
Decision aid
Tool that physicians and patients use to help guide decisions about medical treatment and screening.
Translational research
Translating knowledge to practice what allows health communication research to make contributions to the promotion of health and well-being.
Translational research
Translating knowledge to practice.
According to the Principle of Informed Consent, as a recent case in Ohio illustrates, having sex with a person so drunk that she or he does not have the capacity to say "no" is considered rape.
True
According to the interpretive paradigm, there are multiple socially constructed truths.
True
According to the scientific paradigm, there is one objective Truth that can be discovered.
True
Communication is central to establishing and maintaining good mental health and preventing and treating mental illness.
True
Effective campaigns segment the audience.
True
It is not enough for providers to have patient-centered communication skills; they must also be motivated to engage in patient-centered communication.
True
Most of the illness, injury, and premature deaths in our nation can be prevented.
True
Some patients want to maintain their uncertainty.
True
Subconscious biases among providers lead to health disparities on patients' race, education, sex, and ethnicity.
True
Lay caregivers experience similar suffering and loss to what patients themselves experience.
True - Second order patients
Timing Expose, Exposure, Awareness, and Effect
Understanding of the factors that converge.....
Austin is a surgeon who works with other surgeons as well as several surgical nurses to develop a new protocol for use in the operating room. This is an example of which type of health care team?
Unidisciplinary team - not Nominal care team - not Multidisciplinary team - not Transdisciplinary team
Interdisciplinary research example:
University of Kentucky project for the HPV vaccine to be effective, women need to receive three injections over a six-month time period.
In the following paragraph, please explain how would you develop and evaluate a public health campaign/ intervention.
Use the 7 steps: 1. Use Formative Research 2. Use of Theory 3. Audience Segmentation 4. Message Design - Targeted to audience 5. Channels and message placement 6. Process evaluation and high message exposure 7. Outcome evaluation
Health 2.0 Example
WebMD
Health 2.0 example:
WebMD
Information Seeking - A gazillion websites:
WebMD, NIH, Mayo Clinic, etc. YouTube (can be gross...) Topic-specific sites (e.g., diabetes, HIV)
Needs Assessment
What are barriers? Benefits? Defines goals and procedures before you start ccomp......
Future Directions
What do you think health technologies will look like in the future?
Media Effects?
What do you think? Should the media have to consider how their programs might influence the health behavior of audience members?
Campaign Evaluation
What methodologies are used to assess the success of campaigns?
NPR conversation: Reed Vreeland, communications director at the Sero Project, which advocates for people with HIV:
What types of dimensions of uncertainty was Reed experiencing?
Uncertainty - NPR Sunday Conversation with Reed Vreeland, communications director at the Sero Project, which advocates for people with HIV
What types of dimensions of uncertainty was Reed experiencing?
When a campaign cannot be evaluated with a randomized controlled trial (RCT), experimental procedures may be used to pilot-test the efficacy of the planned coWhen a campaign cannot be evaluated with a randomized controlled trial (RCT), experimental procedures may be used to pilot-test the efficacy of the planned communication strategy in a small geographic area prior to the formal campaign launch. pressure to respond rapidly and at full scale to health issues of widespread concern."
While such strategies are "ethically and fiscally responsible" they "have been omitted in the past because of political
Background. Every year, millions of people die from cardiovascular diseases (diseases of the heart and circulation), chronic obstructive pulmonary disease (a long-term lung disease), lung cancer, HIV infection, and diabetes. These diseases are increasingly important causes of mortality (death) in low- and middle-income countries and are responsible for nearly 40% of deaths in high-income countries. For all these diseases, individuals can adopt healthy behaviors that help prevent disease onset. For example, people can lower their risk of diabetes and cardiovascular disease by maintaining a healthy body weight, and, if they are smokers, they can reduce their risk of lung cancer and cardiovascular disease by giving up cigarettes. In addition, optimal treatment of existing diseases can reduce mortality and morbidity (illness). Thus, in people who are infected with HIV, antiretroviral therapy delays the progression of HIV infection and the onset of AIDS, and in people who have diabetes, good blood sugar control can prevent retinopathy (a type of blindness) and other serious complications of diabetes.
Why Was This Study Done? Health-care providers need effective ways to encourage "health-care consumers" to make healthy lifestyle choices and to self-manage chronic diseases. The amount of information, encouragement and support that can be conveyed to individuals during face-to- face consultations or through traditional media such as leaflets is limited, but mobile technologies such as mobile phones and portable computers have the potential to transform the delivery of health messages. These increasingly popular technologies—more than two-thirds of the world's population now owns a mobile phone—can be used to deliver health messages to people anywhere and at the most relevant times. For example, smokers trying to quit smoking can be sent regular text messages to sustain their motivation, but can also use text messaging to request extra support when it is needed. But is "mHealth," the provision of health-related services using mobile communication technology, an effective way to deliver health messages to health-care consumers? In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers assess the effectiveness of mobile technology-based health behavior change interventions and disease management interventions delivered to health-care consumers.
Demographic trends
With increasing patient diversity, there is a need for culturally competent healthcare. - Race and Ethnicity - Gender - Income and Class
Mentally Healthy Workplace - 3
Work Load, Work Environment, Management Style, Communication.
Culture as Context - Community- based participatory research:
Working and serving with partners in communities to determine the agenda and purpose for research.
Patient Diversity - Socio-economic disparities:
Zip codes can predict life expectancy.
Telemedicine:
a means provided by advanced technologies of allowing distant medical resources to meet unfulfilled demands in healthcare services
Health game:
a rule-based activity that involves a challenge to reach a goal that provides feedback on progress made toward that goal
Tailoring:
any combination of strategies and information intended to reach one specific person, based on characteristics that are unique to that person, related to the outcome of interest, and derived from an individual assessment.
Health 2.0:
applications, services, and tools that are available via Web 2.0 technology that allow people to seek, share, and manage health information on
Health 2.0:
applications, services, and tools that are available via Web 2.0 technology that allow people to seek, share, and manage health information online
Relational lens:
assumes that human understanding and behavior arise from our interactions with other people, especially people in close relationships
Interpretive analysis
coding single cases, collections of cases, or deviant cases for key interactional features.
CONCERNS - Privacy: Health Insurance Portability and Accountability Act
contains security rules and privacy rules about electronic communication of health information.
Communication inequality:
differences in the ability of social groups to generate, manipulate, and distribute information
Most frequently used as part of a multi-component campaign
e.g., Heart Truth, VERB
Entertainment-Education:
embedding health-related information into popular media narratives with the goal of changing knowledge, attitudes, and behaviors.
Interpretive researchers
employ qualitative methods such as interviewing, and participant observation, gathering detailed, descriptive data that they can mine for meaning.
Interprative researchers
employ qualitative methods such as interviewing, and participant- observation, gathering detailed, descriptive data that they can mine for meaning.
Researchers work with the entertainment industry to infuse useful and accurate health information into television and movie storylines
example is from an excerpt from a Friends episode which tells about the possible outcomes of risky sexual behavior.
Segrin in 2011
found that for men with more advanced prostate cancer, social support was associated with improvements in depression.
Mann in 1997
found that when women who had recovered from eating disorders presented a primary prevention session, symptoms of eating disorders actually increased among participants presumably because the presenters may have unintentionally normalized the disorders.
Psychotherapy:
from a licensed and trained mental healthcare professional
Medical treatment:
from a primary care physician or psychiatrist
Self-help and peer-led interventions:
from people who themselves have mental illness
Preparation:
getting ready to change
Non-maleficence:
healthcare providers should "do no harm" to their patients
Beneficence:
healthcare providers should act in the patient's best interest
Transtheoretical model describes
how to determine where the target audience is in their progress toward behavior change for a specific health behavior
Input-process-output model
illustrates how communication structures shape communication processes and how these processes can then influence health care teams outcomes.
QUALITATIVE methodology uses
in depth interviews.
Patient diversity - Sex disparities
in diagnosis and treatment of illness, especially in regard to coronary heart disease -CHD.
Intervention research method
is Interactive - almost like a mystery shopper. - Manipulates some aspect of patient-provider communication to see what effect the manipulated variable has on outcomes of the interaction.
Mobile-based interventions -Health 4 U
is an innovative research project which is developing new and exciting ways of promoting health among African communities in Nottingham. In a time where the majority of people own a mobile phone, the Health 4 U project aims to develop a text messaging service which will provide information and advice on a range of important health issues, including HIV.
Cultural communication training
is needed because there is evidence that SUBCONSCIOUS BIASES among providers lead to health disparities based on patient's race, education, sex, and ethnicity.
The difference between the theories
is what exactly you want to focus on. - An example is Integrated for an enivornmental study
Uncertainty appraised as opportunity =
maintain or increase uncertainty.
Justice:
mandates the equal distribution of medical benefits and risks
Pre-contemplation:
not even thinking about a change
Health disparity
occurs when someone receives better or worse healthcare based on demographic factors, such as race, sex, or socio-economic status.
Naturalistic research uses
patient observation and audiovisual recording to capture as much detail as possible.
Internet-Based Interventions:
primarily self-guided, interactive Web-based programs, created with the goals of assisting users to make behavior changes that will prevent disease, monitor health status, and/or improve response to clinical treatment.
Respect for autonomy:
protecting a person's right to make his or her own decisions about medical treatment
Patient Diversity - Culturally and linguistically appropriate services principle standard:
provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
When evaluation funds are scarce, evaluation should be limited in focus to the highest priority questions;
rank-ordering program aims and related research questions on the basis of a theory-derived logic model is considered best practice.
Uncertainty appraised as danger =
reduce uncertainty.
Stigma
results from a person possessing a "deeply discrediting" characteristic that makes the person different from "normal"
What Did the Researchers Do and Find? The researchers identified 75 controlled trials (studies that compare the outcomes of people who do and do not receive an intervention) of mobile technology-based health interven- tions delivered to health-care consumers that met their predefined criteria. Twenty-six trials investigated the use of mobile technologies to change health behaviors, 59 inves- tigated their use in disease management, most were of low quality, and nearly all were undertaken in high-income countries. In one high-quality trial that used text messages to improve adherence to antiretroviral therapy among HIV- positive patients in Kenya, the intervention significantly reduced the patients' viral load but did not significantly reduce mortality (the observed reduction in deaths may have happened by chance). In two high-quality UK trials, a
smoking intervention based on text messaging (txt2stop) more than doubled biochemically verified smoking cessa- tion. Other lower-quality trials indicated that using text messages to encourage physical activity improved diabetes control but had no effect on body weight. Combined diet and physical activity text messaging interventions also had no effect on weight, whereas interventions for other conditions showed suggestive benefits in some but not all cases.
Contemplation:
starting to think about a change
Maintenance:
sticking with the change
Health literacy is
the capacities and degree which people can understand health methods.
Health literacy
the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Health literacy
the capacity to obtain, process, and understand basic health information and services needed to make approproiate health decisions.
What is the definition of health literacy, and what four components are included in health literacy?
the degree to which individuals have the capacity to obtain process, and understand basic health information and services needed to make appropriate health decisions. - Cultural and conceptual knowledge - Listening and speaking - Writing and reading - Numeracy
Patient participation
the extent to which patients have medical knowledge and engage in self-care.
Patient advocate
the medical interpreter actively works on behalf of the patient to facilitate better care.
Co-diagnostician
the medical interpreter assumes the provider's communication goals, editorializes information for medical emphasis, initiates information-seeking behavior, participates in diagnosis tasks, and volunteers medical information to patients.
Culture Broker
the medical interpreter draws on unique knowledge of the patient's culture to situate the healthcare provider's message within the cultural context of the patient.
Clarifier
the medical interpreter makes adjustments to convey the correct meaning.
Conduit
the medical interpreter translates the healthcare provider's message.
Health
the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Communication
the study of how people use messages to generate meaning within and across. various contexts, cultures, channels, and media.
eHealth:
the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care
Input-process-output model
the way in which communication occurs in health care teams - process - is shaped by the communication structures of the team.
COMFORT protocol
to assist professionals who work in end-of-life or palliate care. The emphasis is on the TASK and RELATIONAL COMMUNICATION.
The degree to which a person feels threatened by a health issue determines his or her motivation to act,
while one's confidence to effectively reduce or prevent the threat determines the action itself. (Extended Parallel Process Model)
Demographic trends
with increasing patient diversity, there is a need for culturally competent healthcare. - Race - Gender - Income and class
INFORMATION SHARING - Sermo.com
• 200,000 MDs/Dos • 68 specialties
INFORMATION SHARING - Social networking for patients
• 34% follow someone else's experience •23% follow a friend's experience
INFORMATION SHARING - Social networking for providers
• 65% of nurses interested in social networking • 60% of physicians interested in social networking
Of Internet users...
• 66% have looked up info about a disease/condition • 56% about medical treatment, meds, procedures • 44% about a healthcare provider • 36% about a hospital or clinic • 25% about health insurance, Medicare/Medicaid
INFORMATION SHARING - PatientsLikeMe.com
• 72% of users found information helpful • 71% of HIV patients took their lab values more seriously • 29% of HIV patients decided to take antiretroviral drugs
INFORMATION SHARING - Patient blogs
• CaringBridge
PERSONAL HEALTH MANAGEMENT - SparkPeople.com evaluations
• Downie - 2009 • Hwang et al. - 2010
INFORMATION SHARING - Physician blogs
• Dr. Kevin Pho
Health information technology
• Electronic health records • Telemedicine
TELEMEDICINE Disadvantages:
• Legal issues (licensing, liability) • Patient privacy • Health insurance coverage • Technical knowledge and maintenance
HOW TO SORT GOOD FROM BAD
• Look for the HONcode symbol HON - "Health on the Net" • Foundation established in 1995 Non-profit NGO dedicated to ensuring useful and reliable health information online. • Used by more than 7,300 certified websites across more than 100 countries
Four aspects to the definition of telemedicine:
• Medical • Technological • Spatial • Benefits
PERSONAL HEALTH MANAGEMENT - SparkPeople.com
• More than 15 million registered users •Health information • Data tracking • Social support • Teams •Message boards • Blogs • SparkFriends
CONCERNS - Privacy:
• Motivating people to use the technology • Technology is always changing • Resources
ELECTRONIC HEALTH RECORDS - Included information:
• Patient demographics • Medical history • Medicine and allergy lists - including immunization. • Laboratory test results • Radiology images • Billing records • Insurance information
TELEMEDICINE Advantages:
• Transcend geographic boundaries • Transcend temporal boundaries • Cost effectiveness • Increase patient satisfaction • Digitize health information through Web-based services
INFORMATION SEEKING - A gazillion websites
• WebMD, NIH, Mayo Clinic, etc. • YouTube (can be gross...) • Topic-specific sites (e.g., diabetes, HIV)
FUTURE DIRECTIONS
• What do you think health technologies will look like in the future? • Would you want to live in a world like this?
Health 2.0
•Information seeking •Information sharing •Personal health management