Francisco Lupiáñez-Villanueva

Opportunities and challenges of Web 2.0 within the health care systems: an empirical exploration

The Internet has become one of the main drivers of e-health. Whilst its impact and potential is being analysed, the Web 2.0 phenomenon has reached the health field and has emerged as a buzzword that people use to describe a wide range of online activities and applications. The aims of this article are: to explore the opportunities and challenges of the Web 2.0 within the health care system and to identify the gap between the potential of these online activities and applications and the empirical data. The analysis is based on: online surveys to physicians, nurses, pharmacist and patient support groups; static web shot analysis of 1240 web pages and exploration of the most popular Web 2.0 initiatives. The empirical results contrast with the Web 2.0 trends identified. Whereas the main characteristic of the Web 2.0 is the opportunity for social interaction, the health care system at large could currently be characterised by: a lack of interactive communication technologies available on the Internet; a lack of professional production of health care information on the Internet, and a lack of interaction between these professionals and patients on the Internet. These results reveal a scenario away from 2.0 trends.

Patient Use of Email for Health Care Communication Purposes Across 14 European Countries: An Analysis of Users According to Demographic and Health-Related Factors

Background The use of the Internet for health purposes is growing steadily, yet the use of asynchronous communication tools for health care purposes remains undeveloped. The introduction of email as a method of communication in health care has the potential to impact on both patients and health care professionals. Objective This study aims to describe the characteristics of people who have sent or received an email to or from their doctor, nurse, or health care organization, by country and in relation to demographics, health care resource use, and health status factors. Methods We conducted a secondary analysis of data (N=14,000) collected from the online Citizens and Information Communication Technology for Health survey, a project undertaken in 2011 by the Institute for Prospective Technology Studies of the European Commission’s Joint Research Centre. The survey was developed to understand and characterize European citizens’ use of information communication technologies for health. Descriptive and statistical analyses of association were used to interpret the data. Results Denmark reported the highest level of emails sent/received (507/1000, 50.70%). The lowest level reported was by participants in France (187/1000, 18.70%). Men used email communication for health care more than women, as did respondents in the 16-24 age group and those educated to tertiary level or still within the education system. As self-reported health state worsens, the proportion of people reporting having sent or received an email within the context of health care increases. Email use, poor health, multimorbidity, and number of visits to a physician are positively correlated. Conclusions The use of email communication within the context of European health care is extremely varied. The relationship between high email use, poor health, doctor visits, and multimorbidity is especially pertinent: provision of asynchronous communication for such groups is favored by policymakers. Low reported email use by country may not necessarily reflect low interest in using email for health care: local health policies and technical infrastructures may be significant factors in the delay in implementation of alternative forms of routine health communication.

User-Generated Online Health Content: A Survey of Internet Users in the United Kingdom

Background The production of health information has begun to shift from commercial organizations to health care users themselves. People increasingly go online to share their own health and illness experiences and to access information others have posted, but this behavior has not been investigated at a population level in the United Kingdom. Objective This study aims to explore access and production of user-generated health content among UK Internet users and to investigate relationships between frequency of use and other variables. Methods We undertook an online survey of 1000 UK Internet users. Descriptive and multivariate statistical analyses were used to interpret the data. Results Nearly one-quarter of respondents (23.7%, 237/1000) reported accessing and sharing user-generated health content online, whereas more than 20% (22.2%, 222/1000) were unaware that it was possible to do this. Respondents could be divided into 3 groups based on frequency of use: rare users (78.7%, 612/778) who accessed and shared content less than weekly, users (13.9%, 108/778) who did so weekly, and superusers (7.5%, 58/778) who did so on a daily basis. Superusers were more likely to be male (P<.001) and to be employed (P<.001), but there were no differences between the groups with respect to educational level (P=.99) or health status (P=.63). They were more likely to use the Internet for varied purposes such as banking and shopping (P<.001). Conclusions Although this study found reasonably widespread access of user-generated online health content, only a minority of respondents reported doing so frequently. As this type of content proliferates, superusers are likely to shape the health information that others access. Further research should assess the effect of user-generated online content on health outcomes and use of health services by Internet users.

Using Data Envelopment Analysis to Analyse the Efficiency of Primary Care Units

In this paper we analyse the efficiency of primary care centres (PCCs) adopting Information and Communication Technology (ICT) devices, using a new database on primary care centres in the Basque Region in Spain. Using a four-stage Data Envelopment Analysis methodology, we are able to explicitly take into account the role of ICT in affecting the efficiency of primary care centres. We understand that this is the first time that ICT enters into the determination of efficiency of the health sector. The role of exogenous factors is explicitly considered in this analysis and shows that including these variables is not neutral to the efficiency evaluation, but leads to an efficiency indicator that only encompasses the effect of managerial skills. The paper provides some useful policy implications regarding the role of ICT in improving the efficiency of primary care units.

Salud e internet: más allá de la calidad de la información

The public are now able to search for health-related information on the Internet, which is only the tip of the iceberg of the phenomenon most widely known as eHealth. This term, which came into being at the end of the nineties, includes the application of information and communication technologies (ICT), especially the Internet, in the area of health. This application involves not only a technological change, but also economic, organizational, social and cultural changes that have occurred during the most recent decades. Health systems, and society as a whole, have become faced with a transition period from an industrial society to a network society: a new type of society that originated in the seventies due to the convergence and interaction between three independent processes: the ICT revolution, the industrial crisis and restructuring, and liberal social and cultural movements. Progress in genetics, the evolving media and information systems, development of telemedicine, and citizens’ increasing autonomy and responsibility for their own health are just some of the examples that characterize this transition stage. The different health system actors can use the Internet as a source of information, a means of communication, a tool for service rendering, and lastly, an arena for public health. These possibilities, which have a huge potential to transform healthcare practice based on the virtual exchange of information, have been broken down into 5 main study areas: the quality of health information available on the Internet, how this information is used, the effects of the Internet on the relationship between the healthcare professional and the patient, virtual communities and online support groups, and finally, the provision of health-based information services. In this context, the study published in the Revista Espanola de Cardiologia on the quality of information available on the Internet about aortic aneurysm and its endovascular treatment, by San Norberto et al., reveals that there is a lack of information regarding accessibility, usefulness, and reliability. It also shows that it is difficult to read and, more importantly, explains the challenges that the public and the healthcare professionals have to face when integrating the Internet into their health management and their healthcare practice, respectively. Given that, due to the nature of

Pathos & ethos: emotions and willingness to pay for tobacco products

In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust. JEL Classification C26, C99, D03, I18 PsycINFO classification 2360; 3920

Pan-European Survey of Practices, Attitudes and Policy Preferences as regards Personal Identity Data Management

This study presents the results of the largest survey ever conducted in Europe and elsewhere about people’s behaviours, attitudes and regulatory preferences concerning data protection, privacy and electronic identity, both on the Internet and otherwise in their daily lives. The report draws conclusions in direct relation to four key Digital Agenda areas: Authentication and Identification, e-Commerce, Social Networking Sites, and Medical Information as Personal Data. The survey was conducted in the 27 Member States of the EU between the 25 November and 17 December 2010. 26,574 Europeans aged 15 and over resident in each EU Member States were interviewed. The methodology used is that of the Standard Eurobarometer. The study finds that personal data disclosure is increasingly prevalent in the European society, largely due to the expansion of the Information Society. In turn, most services provided in the digital economy rest on the assumption that this data and associated electronic identities are collected used and disposed of according to existing legislation. The survey shows very clearly how Digital Europe is shaping up. About two thirds of EU27 citizens use the Internet frequently, more than one third uses Social Networking Sites (SNS) to keep in touch with friends and business partners and almost 4 out of 10 shop online. In both of these contexts, people disclose vast amounts of personal information, and also manage a large and growing number of electronic identities. However, there are equally significant differences among Member States and considerable digital exclusion, mainly due to socio-demographic differences in affluence, education and age. Europeans know that if they want to benefit from using the Internet to its full potential they have to disclose their data (biographical, social, financial or medical) and manage online identities. Almost three in four Europeans accept that revealing personal data, so as to benefit from online services, is part of everyday life. While nearly all disclose biographical data (i.e. name, nationality, online account identity) to access a service, users shopping online also disclose address information and financial information and users of social networking sites disclose more social information but not financial. There is significant use of business-issued rather than public-issued credentials for all Internet transactions, especially for eCommerce; in part, this depends on the fact that although many countries issue credentials these are seldom directly usable online for commercial purposes. This implies that: A transaction system based on the use of third-party credentials, rather than on direct disclosure of bank or credit related information, and in general other ways of pegging ‘virtual identity’ to real identity may enhance accountability and be useful to stimulate cross-border shopping. b) The offer of interoperable, easy to use national and cross-border systems with similar look and feel and more uniform protection of the rights of consumer and their personal data across the EU contribute to making it easier to transact cross-border. But online users are also very much aware of risks in transacting online and are naturally concerned. The perception of risk is greater for more ‘mature/active’ users but it does not seem to curb abuse and misuse – such as data loss and identity theft. Providentially, these are still uncommon in Europe. People trust institutions more than companies, especially medical institutions, to protect the data they are entrusted with; they are slightly less sanguine about whether Governments and Banks are to be trusted and concur as to the perception that private companies such as Internet service providers, e-shops and telephone companies are not to be trusted with their data.

The challenges and opportunities of ‘nudging’

Consider the following selective evidence of human behaviour in the domain of healthcare. The numeric-cognition feeds typically provided during public vaccination campaigns are less effective than affect-based perception of risk.1 It is common to avoid seeing doctors and/or doing health checks because of anxiety and fear of receiving bad results. The latter means that a perceived ‘loss today’ in the health status has a stronger impact than a ‘gain tomorrow’, namely preventing or curing a potential disease.2 Clinicians fail to act on available knowledge and guidelines despite the intention to do so.3 Instead, consider now the following couple of examples of choice architectures capable of offsetting erroneous conducts. Recent trial studies show that it is enough to change the default settings of electronic order sets to dramatically ‘improve’ clinicians prescribing behaviours.4 A lottery-based financial incentive increased warfarin adherence and anticoagulation control.5 What do these examples have in common? They exemplify the heuristics and biases and the counteracting ‘nudges’ that in the past decade have been presented as part of a behavioural sciences-dictated policy agenda. Altering prescription activities by changing defaults in electronic order sets, for instance, is just a very simple example of a ‘nudge’ leveraging the ‘status quo bias’ to steer clinicians toward a ‘normatively’ defined ‘better’ behaviour. This is achieved by framing the choice set without restricting available options, in other words, acting over presentation of the decision problem, and not on the constraints for the decision maker. This philosophy of policy intervention has been labelled ‘libertarian paternalism’ because by not affecting the options available in the choice set it can be deemed to be libertarian from a consequentialist point of view, while being paternalistic in the sense of trying to induce ‘better’ choices.6 The approach is grounded in behavioural economics (BE), …

International health IT benchmarking: learning from cross-country comparisons.

Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons. Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.

Actitudes hacia los programas de prevención on-line del VIH y las ITS, y perfil de los usuarios de Internet en los hombres que tienen sexo con hombres

OBJECTIVES To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs. METHOD A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis. RESULTS Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not interested in online prevention among those with a lower educational level, bisexual men and HIV-positive men. Conversely, those most receptive to online prevention were men self-identified as gay, those with a bachelors degree, those who had been tested for HIV and those who were HIV-negative. CONCLUSION The internet can facilitate sexual health promotion among MSM. Characterization of user profiles offers the possibility of segmenting prevention programs and of combining online and offline strategies.