Amanda K. Hall

Mobile Text Messaging for Health: A Systematic Review of Reviews

The aim of this systematic review of reviews is to identify mobile text-messaging interventions designed for health improvement and behavior change and to derive recommendations for practice. We have compiled and reviewed existing systematic research reviews and meta-analyses to organize and summarize the text-messaging intervention evidence base, identify best-practice recommendations based on findings from multiple reviews, and explore implications for future research. Our review found that the majority of published text-messaging interventions were effective when addressing diabetes self-management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy. However, we found limited evidence across the population of studies and reviews to inform recommended intervention characteristics. Although strong evidence supports the value of integrating text-messaging interventions into public health practice, additional research is needed to establish longer-term intervention effects, identify recommended intervention characteristics, and explore issues of cost-effectiveness.

Health Benefits of Digital Videogames for Older Adults: A Systematic Review of the Literature

OBJECTIVE This article is a systematic review conducted of the research literature on digital videogames played by older adults and health outcomes associated with game play. Findings from each study meeting the inclusion criteria were analyzed and summarized into emergent themes to determine the impact of digital games in promoting healthy behaviors among older adults. MATERIALS AND METHODS A systematic review of the research literature was conducted through multiple academic databases for works, published between the years 2000 and 2011, looking at digital videogame interventions with adults 65 years of age and older. Multiple combinations of search terms and Boolean operators relevant to digital videogames and older adults were queried. A criteria matrix was created to code and evaluate studies. RESULTS Thirteen studies met specific criteria for inclusion and were analyzed in the final review. Significant mental, physical, and social health factors, type of digital game platform, study design, and measurements are among emergent themes summarized from the reviewed research literature. Significant mental health outcomes of digital game interventions were found in the majority of the reviewed studies, followed by physical and lastly social health outcomes in older adults. CONCLUSIONS A majority of the studies revealed significant positive effects on health outcomes associated with digital videogame play among older adults. With current advancements in technology, including advanced motion sensing, digital game platforms have significant potential for positive health impact among older populations. More robust and rigorous research designs are needed to increase validity and reliability of results and establish stronger causal relationships on the health benefits of digital videogame play for older adults.

Social marketing at the right place and right time with new media

Purpose – The purpose of this paper is to seek to discuss how the new media revolution can improve social marketing by bringing the “place” (one of four Ps from the marketing mix) closer to the consumer.Design/methodology/approach – This paper describes current new media trends related to social media and mobile communication technologies and discusses the implications of these technologies for social marketing by exploring examples of their use in commercial marketing, social change, and public health.Findings – The rapid growth of online social networks and near ubiquity of mobile phones in much of the world offers social marketers enormous potential for engaging consumers in radically new ways. The nature of these new communication platforms differs from traditional media in important ways that can make them more effective for marketing, most notably the potential for deeper consumer engagement, multi‐directional information exchange, and location‐based tracking and messaging.Practical implications – ...

The Digital Health Divide Evaluating Online Health Information Access and Use Among Older Adults

Objective. Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults’ limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide debate. This study evaluated the potential digital health divide in relation to characteristic and belief differences between older adult users and nonusers of online health information sources. Methods. A cross-sectional survey design was conducted using a random sample of older adults. A total of 225 older adults (age range = 50-92 years, M = 68.9 years, SD = 10.4) participated in the study. Results. Seventy-six percent of all respondents had Internet access. Users and nonusers of online health information differed significantly on age (M = 66.29 vs. M = 71.13), education, and previous experience with the health care system. Users and nonusers of online health information also differed significantly on Internet and technology access, however, a large percentage of nonusers had Internet access (56.3%), desktop computers (55.9%), and laptop computers or netbooks (43.2%). Users of online health information had higher mean scores on the Computer Self-Efficacy Measure than nonusers, t(159) = −7.29, p < .0001. Conclusion. This study found significant differences between older adult users and nonusers of online health information. Findings suggest strategies for reducing this divide and implications for health education programs to promote HIT use among older adults.

New Media for Health Education A Revolution in Progress

In a 2001 editorial titled, “Health Education and the Internet: The Beginning of a Revolution,” the authors noted that the Internet had the potential to completely revolutionize health education research and practice by providing far more powerful ways of “. . . compiling, facilitating, developing, packaging and delivering health information to and between individuals and communities” (Bernhardt & Hubley, 2001, p. 643). In 2013, Internet-enabled new media continue to have enormous potential to revolutionize health education with diverse populations by enhancing our ability to implement evidence-based behavior change strategies in manners that are often far more effective and efficient than were possible in the past. For example, new media can now be used to do the following: improve the ability to deeply engage large numbers of targeted individuals and communities over a sustained period of time; facilitate the real-time solicitation and analysis of in-depth health-related data and feedback from participants and collaborators to identify and aggregate health needs and priorities for planning health education programs; design and deliver highly relevant and personalized health education messages that are sent through the most accessible and persuasive channels at the most appropriate and influential times; and assess the effectiveness of interventions by enabling the electronic collection and storage of process and impact data from participants. Therefore, new media can contribute to and improve on virtually all steps in the health education planning, intervention development, and evaluation process. In 2001, there were an estimated 500 million Internet users throughout the world (Bernhardt & Hubley, 2001) and more than 20,000 health-related websites (Eng et al., 1998). The International Telecommunication Union (2013) currently estimates that there are more than 2.3 billion global Internet users; and there are almost 3.5 billion results available when searching for “health” on Google. In 2001, the dominant Internet-based channels besides the web and e-mail included newsgroups, chat rooms, instant messaging, and file exchange servers (Bernhardt & Hubley, 2001). In 2013, social media and information sharing sites, such as Facebook, YouTube, and Twitter, are among the most accessed websites on the Internet with more than 1 billion, 800 million, and 500 million users, respectively (Facebook, 2013; Lawler, 2012; Lunden, 2012). The technology revolution has spawned the rapid growth of new media channels, tools, devices and gadgets that leverage the Internet’s access to vast collections of information. The Pew Internet & American Life Project (2013) data show that laptop computer use is now favored over desktop computer use, and music players, video game consoles, electronic book readers, and tablet computers have all grown rapidly since their introduction (see Figure 1). However, the most explosive growth has been in the use of mobile phones, most of which feature the ability to make voice phone calls and send and receive SMS (or text) messages. At the turn of the millennium, it was estimated that nearly two thirds of the world’s population did not and would not possess the ability to make a phone call (Wang, 2000). Yet total mobile cellular subscriptions reached almost 6 billion by the end of 2011, representing a global penetration of 86% (International Telecommunication Union, 2013). Smartphones, which contain many features in addition to voice and SMS, such as mobile web access, sending and receiving e-mails, and running small downloadable programs called “apps,” have also grown rapidly. According to Nielsen, smartphones represent approximately half of all mobile phones used in the United States and two thirds of new phones that are purchased (Pollicino, 2012). Additionally, there were more than 1 billion mobile-broadband subscriptions globally by the end of 2011 (International Telecommunication Union, 2013). Health education researchers have continued to explore creative new ways to leverage the Internet and diverse new media applications to increase the efficacy of their interventions. The number of new media and health education studies continues to grow, as does the number of manuscripts related to new media that are submitted to Health Education & Behavior. In this issue, we selected five articles (each were submitted and accepted through the journal’s standard peerreview process) to be published together as a “theme section” on the topic of New Media for Health Education. These articles explore many of the most popular new media channels available for health education research and practice today, including smartphone apps, mobile-based text messages, webbased tailored messages, and video games. Together, these 483140 HEBXXX10.1177/1090198113483140 Health Education & BehaviorBernhardt et al. 2013

Older Adults’ Current and Potential Uses of Information Technologies in a Changing World: A Theoretical Perspective

Technologies have become a major force in people’s lives. They change how people interact with the environment, even as the environment changes. We propose that technology use in the setting of changing environments is motivated by essential needs and tensions experienced by the individual. We apply three developmental and behavioral theories (Erikson’s stages of psychosocial development, Maslow’s hierarchy of needs, and Bronfenbrenner’s ecological model) to explain technology-related behaviors among older adults. We consider how technology use has addressed and can address major ecological changes, in three areas: health promotion, natural disasters, and disparities. We propose that considering these theories can help researchers and developers ensure that technologies will help promote a healthier world for older adults.

IT-based wellness tools for older adults: Design concepts and feedback

ABSTRACT Objective: To explore older adults’ preferences regarding e-health applications through use of generated concepts that inform wellness tool design. Methods: The 6-8-5 method and affinity mapping were used to create e-health design ideas that were translated into storyboards and scenarios. Focus groups were conducted to obtain feedback on the prototypes and included participant sketching. A qualitative analysis of the focus groups for emerging themes was conducted, and sketches were analyzed. Results: Forty-three older adults participated in six focus group sessions. The majority of participants found the wellness tools useful. Preferences included features that supported participants in areas of unmet needs, such as ability to find reliable health information, cognitive training, or maintaining social ties. Participants favored features such as use of voice navigation, but were concerned over cost and the need for technology skills and access. Sketches reinforced these wants, including portability, convenience, and simplicity. Conclusions: Several factors were found to increase the desirability of such devices including convenient access to their health and health information, a simple, accessible interface, and support for memory issues. Researchers and designers should incorporate the feedback of older adults regarding wellness tools, so that future designs meet the needs of older adults.

Examining Korean and Korean American older adults’ perceived acceptability of home-based monitoring technologies in the context of culture

ABSTRACT Objective: Despite the increasing use of home-based monitoring technologies by older adults, few studies have examined older adults’ acceptance of these technologies, especially among people from diverse cultural groups. The purpose of this study was to explore Korean and Korean American older adults’ attitudes toward and perceptions of home-based monitoring technologies in a cultural context. Methods: A qualitative analysis of focus groups and individual interviews using inductive coding methods and a constant comparative approach for emerging themes was conducted.Results: Several cultural factors that determine the acceptability of home-based monitoring technologies were identified. Most notably, the necessity of living alone due to loosened filial tradition and immigration was a main motivator for adopting these technologies for both Korean and Korean Americans. The level of satisfaction with the health care system or therapeutic interaction affected participants’ perceived need for technologies. Compared with the Korean American group, Korean older adults regarded the government’s role as more important in increasing adoption and use of new technologies. Conclusions: Contextual factors need to be considered when explaining perceptions of home-based monitoring technologies among older adults from various ethnic groups and developing diffusion strategies according to end users’ attitudes, experiences, and cultural backgrounds.

Acceptance and perceived usefulness of robots to assist with activities of daily living and healthcare tasks

ABSTRACT As the number of older adults living with chronic conditions continues to rise, they will require assistance with activities of daily living (ADL) and healthcare tasks to continue living independently in their homes. One proposed solution to assist with the care needs of an aging population and a shrinking healthcare workforce is robotic technology. Using a cross-sectional survey design, we purposively sampled adults (≥18 years old) to assess generational acceptance and perceived usefulness of robots to assist with ADLs, healthcare tasks, and evaluate acceptance of robotic healthcare assistance across different settings. A total of 499 adults (age range [years] 18–98, Mean = 38.7, SD = 22.7) responded to the survey. Significant differences were found among young, middle-aged, and older adults on perceived usefulness of robots for cleaning, escorting them around town, acting as companionship, delivering meals, assessing sadness and calling for help, providing medical advice, taking vital sign assessments, and assisting with personal care (p < 0.05). The majority of younger adults reported that they would like a robot to provide healthcare assistance in the hospital, compared to middle-aged and older adults (p < 0.001). Results of this study can guide the design of robots to assist adults of all ages with useful tasks.

The Patient-Centered Electronic Health Record and Patient Portals

Personal health records (PHR), particularly the patient portal, are touted as instrumental to the future of medical care and health management. The patient portal could be a powerful means to engage patients and empower them to manage their own health. Studies show that patients are interested in patient portals, specifically in the self-management and administrative aspects. However, some studies also show little evidence to support claims of improvement in health outcomes, cost measures, or health care utilization. This chapter presents an overview of personal health records and patient portals, beginning with the evolution of these technologies. We next cover the data and functionality components of personal health records and patient portals. Then, we discuss the context in which personal health records and patient portals are situated, including political forces, Meaningful Use, user access and usability, and data issues. Finally, throughout the chapter we consider future directions for personal health records and patient portals.