Maxine L. Rockoff

Consumers' Perceptions of Patient-Accessible Electronic Medical Records

Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually engaging, and have user-friendly navigation.

User Acceptance of HIV TIDES—Tailored Interventions for Management of Depressive Symptoms in Persons Living with HIV/AIDS

OBJECTIVE The Tailored Interventions for management of DEpressive Symptoms (TIDES) program was designed based on social cognitive theory to provide tailored, computer-based education on key elements and self-care strategies for depressive symptoms in persons living with HIV/AIDS (PLWHAs). DESIGN AND MEASUREMENT Based on an extension of the Technology Acceptance Model (TAM), a cross-sectional design was used to assess the acceptance of the HIV TIDES prototype and explore the relationships among system acceptance factors proposed in the conceptual model. RESULTS Thirty-two PLWHAs were recruited from HIV/AIDS clinics. The majority were African American (68.8%), male (65.6%), with high school or lower education (68.7%), and in their 40s (62.5%). PARTICIPANTS spent an average of 10.4 minutes (SD = 5.6) using HIV TIDES. The PLWHAs rated the system as easy to use (Mean = 9.61, SD = 0.76) and useful (Mean = 9.50, SD = 1.16). The high ratings of behavior intention to use (Mean = 9.47, SD = 1.24) suggest that HIV TIDES has the potential to be accepted and used by PLWHAs. Four factors were positively correlated with behavioral intention to use: perceived usefulness (r = 0.61), perceived ease of use (r = 0.61), internal control (r = 0.59), and external control (r = 0.46). Computer anxiety (r = -0.80), tailoring path (r = 0-.35) and depressive symptoms (r = -0.49) were negatively correlated with behavioral intention to use. CONCLUSION The results of this study provide evidence of the acceptability of HIV TIDES by PLWHAs. Individuals are expected to be empowered through participating in the interactive process to generate their self-care plan. HIV TIDES enables information sharing about depression prevention and health promotion and has the potential to reframe the traditional patient-provider relationship.

Findings from an Organizational Network Analysis to Support Local Public Health Management

We assessed the feasibility of using organizational network analysis in a local public health organization. The research setting was an urban/suburban county health department with 156 employees. The goal of the research was to study communication and information flow in the department and to assess the technique for public health management. Network data were derived from survey questionnaires. Computational analysis was performed with the Organizational Risk Analyzer. Analysis revealed centralized communication, limited interdependencies, potential knowledge loss through retirement, and possible informational silos. The findings suggested opportunities for more cross program coordination but also suggested the presences of potentially efficient communication paths and potentially beneficial social connectedness. Managers found the findings useful to support decision making. Public health organizations must be effective in an increasingly complex environment. Network analysis can help build public health capacity for complex system management.

The Usability of Electronic Personal Health Record Systems for an Underserved Adult Population

Objective: The goals of this study were to identify the demands associated with using electronic personal health records (PHRs) and to evaluate the ability of adults of lower socioeconomic status and low health literacy to use PHRs to perform health management activities. Background: PHRs are proliferating in clinical practices and health care organizations. These systems offer the potential of increasing the active involvement of patients in health self-management. However, little is known about the actual usability of these tools for health consumers. Method: We used task analysis and health literacy load analysis to identify the cognitive and literacy demands inherent in the use of PHRs and evaluated the usability of three currently available PHR systems with a sample of 54 adults. Participants used the systems to perform tasks related to medication management, interpretation of lab/test results, and health maintenance. Data were also gathered on the participants’ perception of the potential value of using a PHR. Results: The results indicated that a majority of the participants had difficulty completing the tasks and needed assistance. There was some variability according to task and PHR system. However, most participants perceived the use of PHRs as valuable. Conclusions: Although considered a valuable tool by consumers, the use of PHR systems may be challenging for many people. Strategies are needed to enhance the usability of these systems, especially for people with low literacy, low health literacy, or limited technology skills. Application: The data from this study have implications for the design of PHRs.

Digital divide and information needs for improving family support among the poor and underserved

Despite of its emotional benefits, communication with family members who live abroad can present a large financial burden for low-income foreign-born individuals. The aims of this study were (1) to explore the current technologies available for low-cost communication with family living abroad and (2) to assess the level of awareness and use of low-cost technologies for family communication as well as related information needs among low-income foreign-born individuals. This mixed-methods study included an environmental scan, survey, and focus groups with low-income foreign-born individuals living in East Harlem in New York City. Low-income individuals who have family members living abroad face financial stress with complicated technology choices for communication with family living abroad and they have many information needs. They would welcome interactive and convenient educational tools that (1) build skills for utilization of various technologies and (2) provide decision support to simplify choosing among the vast array of available communication options.

Empowering patients and community online: Evaluation of the AIDS community information outreach program

The AIDS Community Information Outreach Program (ACIOP) was created in 1994 to assist the affected community in utilizing electronic HIV/AIDS information resources. Nearly 300 competitive awards have been made to mostly community-based organizations. A formal evaluation was undertaken to determine the performance and impact of the ACIOP. A mixed methods design combined quantitative abstractions and summarization of 47 awardee final reports from 44 organizations, and qualitative telephone interviews with 17 individuals representing 20 projects. Findings revealed that project objectives were mostly met; high-risk populations were reached; low resource organizations were funded; community partnerships were significant; projects built on existing efforts; information resources and training were tailored to local needs; and most projects overcame barriers experienced. Needed modifications centered on: 1) enhancing evaluation capacity at the individual project level and 2) revising project reporting requirements to increase the amount of information available to assess the ACIOP; both have been implemented.

Information outreach to a local public health department: a case study in collaboration

The delivery of essential public health services depends on the effective use of relevant information by public health employees [1, 2]. Yet, despite the importance of information to the practice of public health, the complex information needs of the public health workforce are not well met [3–8]. This paper describes how the New York Medical College Health Sciences Library and School of Public Health (NYMC) and the New York Academy of Medicine (NYAM) successfully collaborated in collecting data for two separate projects that addressed the information needs of employees in the Dutchess County Department of Health (DCDOH) in New Yorks Hudson Valley. NYAM additionally partnered with researchers at Columbia University in the Department of Biomedical Informatics and School of Nursing. Each project required all DCDOH employees to fill out a lengthy survey, and some data elements were common to both surveys. Both projects were funded by the National Network of Libraries of Medicine with the charge that the projects “collaborate when appropriate” because they targeted the same population. DCDOH welcomed the collaboration because it reduced the response burden for its employees.