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Cyber patients surfing the medical web: Computer-mediated medical knowledge and perceived benefits

Information and communication technologies have introduced new and impressive tools for information sharing and building computer-mediated knowledge repositories in a global context. Clinicians and researchers pay particular attention to technology as a promising tool to empower patients through self-health care management skills and to improve health care communication with providers. This represents a significant step in modern medicine of computer-integrated patient self-health care. This paper aims to examine perceived informational and decisional benefits of computer-mediated health and medical information, more specifically of cancer web-sites, and presents the results of two separate statistical models of perceived benefits. Multivariate hierarchical regression analyses showed that the frequency and time spent visiting medical web-sites are significant predictors of perceived benefits of computer-mediated knowledge. The results also indicated that computer-mediated medical information empowers health consumers to make informed decisions for their health care. The discussion section of the paper contextualizes the findings within the current sociomedical trends of self-health care and partnership with health providers. It is important to understand the perceived benefits of using computer-mediated medical knowledge, so that information and communication technologies can be targeted to educate patients to make informed decisions and to develop patient self-health-care management competencies.

Being an Informed Consumer of Health Information and Assessment of Electronic Health Literacy in a National Sample of Internet Users: Validity and Reliability of the e-HLS Instrument

Background The Internet, with its capacity to provide information that transcends time and space barriers, continues to transform how people find and apply information to their own lives. With the current explosion in electronic sources of health information, including thousands of websites and hundreds of mobile phone health apps, electronic health literacy is gaining an increasing prominence in health and medical research. An important dimension of electronic health literacy is the ability to appraise the quality of information that will facilitate everyday health care decisions. Health information seekers explore their care options by gathering information from health websites, blogs, Web-based forums, social networking websites, and advertisements, despite the fact that information quality on the Internet varies greatly. Nonetheless, research has lagged behind in establishing multidimensional instruments, in part due to the evolving construct of health literacy itself. Objective The purpose of this study was to examine psychometric properties of a new electronic health literacy (ehealth literacy) measure in a national sample of Internet users with specific attention to older users. Our paper is motivated by the fact that ehealth literacy is an underinvestigated area of inquiry. Methods Our sample was drawn from a panel of more than 55,000 participants maintained by Knowledge Networks, the largest national probability-based research panel for Web-based surveys. We examined the factor structure of a 19-item electronic Health Literacy Scale (e-HLS) through exploratory factor analysis (EFA) and confirmatory factor analysis, internal consistency reliability, and construct validity on sample of adults (n=710) and a subsample of older adults (n=194). The AMOS graphics program 21.0 was used to construct a measurement model, linking latent factors obtained from EFA with 19 indicators to determine whether this factor structure achieved a good fit with our entire sample and the subsample (age ≥ 60 years). Linear regression analyses were performed in separate models to examine: (1) the construct validity of the e-HLS and (2) its association with respondents’ demographic characteristics and health variables. Results The EFA produced a 3-factor solution: communication (2 items), trust (4 items), and action (13 items). The 3-factor structure of the e-HLS was found to be invariant for the subsample. Fit indices obtained were as follows: full sample: χ2 (710)=698.547, df=131, P<.001, comparative fit index (CFI)=0.94, normed fit index (NFI)=0.92, root mean squared error of approximation (RMSEA)=0.08; and for the older subsample (age ≥ 60 years): χ2 (194)=275.744, df=131, P<.001, CFI=0.95, NFI=0.90, RMSEA=0.08. Conclusions The analyses supported the e-HLS validity and internal reliability for the full sample and subsample. The overwhelming majority of our respondents reported a great deal of confidence in their ability to appraise the quality of information obtained from the Internet, yet less than half reported performing quality checks contained on the e-HLS.

Informational and decisional empowerment in online health support communities: initial psychometric validation of the Cyber Info-Decisional Empowerment Scale (CIDES) and preliminary data from administration of the scale

PurposeThis article presents initial psychometric validation of an instrument developed to measure cyber informational and decisional empowerment. The article provides preliminary insights into the extent to which cyber patients view the digital environment of peer-based information and support as a resource for informed and empowered participation in self health care management.MethodsData come from cancer patients (N = 350) who participated in the Study of Virtual Health Networks for Cancer Patients of the 21st Century. Data were first analyzed using exploratory factor analysis with principle component extraction and Varimax rotation. Age-based split-sample analysis (≥51 and ≤50) was performed on a subsample, which consisted of only women (N = 255), in order to cross-validate psychometric data obtained from the full sample. A confirmatory factor analysis was conducted using AMOS 19.0. to further validate the scale.ResultsThe composite scale is unidimensional with excellent internal consistency reliability. The highest average scores were obtained for informational empowerment items. The lowest average was for the item that measured empowerment to seek second opinion from additional health care professionals.ConclusionsThe ability of this composite measure to provide information about the extent to which computer-connected patients view digital peer support as an empowerment tool makes it a valuable addition to the literature in health informatics, supportive cancer care, and health quality of life research.

Satisfaction with health status among cyber patients: testing a mediation model of electronic coping support

There has been a growing interest among researchers about the Internet-based social support. However, not much is known about whether electronic support is associated with subjectively reported patient health outcomes. This study examines variation in satisfaction with physical health status among users of self-help groups for patients with cancer (N = 350). The analytical approach of the study differs from previous work in that satisfaction with physical health is modelled not as a predictor, but as an outcome variable. The study tested the hypothesis that perceived ability to cope with cancer mediates the association between electronic support and health satisfaction. Path analyses using ordinary least squares multiple regressions showed that there is an indirect association between electronic support and health satisfaction via perceived ability to cope with cancer. Electronic support increased perception of control over cancer, which in turn led to higher levels of satisfaction with health status. External health locus of control was associated with greater benefits derived from electronic support. This article concludes that the evaluation of physical health status includes not only clinical indicators but also subjective assessment of coping ability. Thus, the cyber social context in which health perceptions are developed has important medical implications for patient outcomes.

I Am Proud and Hopeful: Age-Based Comparisons in Positive Coping Affect Among Women Who Use Online Peer-Support

How do women who seek psychosocial support on the Internet by participating in cancer peer support groups respond to the process of coping with cancer? The current study examines whether older women with cancer have different perceptions about and are influenced to a different extent by online peer support than younger women. The study also explores age-based variations in outlook on coping with cancer as a result of using online support. Separate multivariate regression models estimated the effects of covariates on (1) positive coping affect (PCA) (2) positive coping affect-hopeful (PCA-H), and (3) positive coping affect-proud (PCA-P). A stratified analysis examined variations within age-based subsamples (≥51 and ≤50). Positive coping affect includes feeling proud about coping with cancer from a position of strength and empowerment rather than being a victim and being hopeful for a healthier future postdiagnosis. Online support was found to increase PCA significantly. This finding is consistent across age groups but was more pronounced for older patients. The only exception is that younger women perceive more benefit from using online support in terms of feeling proud. As severity of the symptoms increased, though the younger women increased the amount of time they were online, the older women increased the number of groups they participated in. The study concludes that the Internet might be particularly helpful for older adults who feel helpless to cope with cancer in old age. Online peer support services may help improve the patients’ outlook on fighting with cancer and help them to feel more in control of their health.

Shared Decision-Making in Nursing Homes Factors Associated With the Empowerment of Direct Care Workers

Objective: The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. Method: The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. Results: Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. Discussion: SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.

Burnout among direct-care workers in nursing homes: Influences of organisational, workplace, interpersonal and personal characteristics

AIMS AND OBJECTIVES The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes. BACKGROUND Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. METHODS A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. RESULTS Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. CONCLUSIONS The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. RELEVANCE TO CLINICAL PRACTICE While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

Digitized Emotions in the Pocket: Social Computing and Mobile Mental Health (mMH) Applications

This chapter is motivated by the substantial research and clinical implications in an emerging field of mobile mental health (mMH) with a specific focus on smartphone applications. In an era when there are nearly 332 million mobile phone users in the United States and 5.6 billion worldwide, it is important to explore the clinical, research, and behavioral implications of mMH applications. mMH can be understood as a generic term to describe the use of digital technologies and new media for the delivery of information, health promotion, prevention, intervention, treatment, or relapse prevention to support and improve mental health conditions and mental health care. The purpose is to review literature that examined the use of smartphone applications as mobile platforms for delivery of mental health information and interventions. The chapter addresses how smartphones are altering the face of clinical and behavioral research, social support provision, patient care, and service delivery.

CHANGING HEALTH CARE EXPERIENCES AND PERSPECTIVES OF OLDER ADULTS: COMPARISON OF HMO AND FEE-FOR-SERVICE ENROLLEES

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care. Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.