Category Archives: Health Communication

Enhanced data gathering through active collaboration with Healthcare Actors

Social determinants of Health and ICT for Health (eHealth) conceptual framework

Lately I have been designing, launching and gathering an online panel survey to a representative sample of Internet users in 14 European countries (approximately 14,000 responses). To ground the questionnaire I have developed a conceptual framework inspired and based on the two main sources. On the one hand, the Marmot Review team:

On the other hand, a Framework for Digital Divide Research developed by Jan van Dijk in several publications:

In a recent presentation about Health and Web 2.0 I tried to match both frameworks and I have posted about Inverse care law 2.0  several times using different scientific and statistical sources.  It is worth pointing out (and obviously reasonable) that I have not found any references or mentions to ICT for Health in the literature about social determinants of Health gathered through Marmot Review team website.

a-conceptual-framework-for-action-on-the-social-determinants-of-health-discussion-paper-for-the-commission-on-social-determinants-of-health

However, both frameworks (see red boxes in both figures) mention individual and social characteristics as social determinants of health and of the Internet usage. Furthermore, van Dijk includes HEALTH and ABILITY as a personal category (and I have added Health as a sphere of participation in Society and emphasis the Divides).

deeping-digital-divide

Based on and inspired by this two frameworks I have developed Social determinants of Health and ICT for Health (eHealth) conceptual framework.

social-determinants-of-health-and-ict-for-health-conceptual-framework

All concepts and boxes  of this framework are based on scientific references and the relationships established by arrows have been empirical or theoretical driven. I’m currently working on it, however I have shared this framework to gather inputs to improve it. I would love to know your comments and ideas.

UPDATE: Citizens and ICT for Health in 14 EU countries: results from an online panel survey

Innovation, Active patients and Diabetes

Yesterday I participated in a workshop about Innovation, active patients and Diabetes. I would like to share some of the scientific references I used for my presentation

Glasgow, R. E., Kurz, D., King, D., Dickman, J. M., Faber, A. J., Halterman, E., et al. (2011). Twelve-month outcomes of an Internet-based diabetes self-management support program. Patient Educ Couns, .

Osborn, C. Y., Mayberry, L. S., Mulvaney, S. A., & Hess, R. (2010). Patient web portals to improve diabetes outcomes: a systematic review. Curr Diab Rep, 10(6), 422-435.

Greene, J. A., Choudhry, N. K., Kilabuk, E., & Shrank, W. H. (2011). Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Intern Med, 26(3), 287-292.

Weitzman, E. R., Cole, E., Kaci, L., & Mandl, K. D. (2011). Social but safe? Quality and safety of diabetes-related online social networks. J Am Med Inform Assoc, 18(3), 292-297.

I would like to thank Joan Carles March (@joancmarch) for the invitation.

Health-related Information as Personal Data in Europe: Results from a Representative Survey in Eu27

On behalf of my co-authors, Wainer Lusoli, Margherita Bacigalupo, Ioannis Maghiros, Norberto Andrade, and Cristiano Codagnone from Information Society Unit – European Commission, DG JRC Institute for Prospective Technological Studies (IPTS), Seville, Spain, I’m presenting “Health-related Information as Personal Data in Europe: Results from a Representative Survey in EU27″ at Medicine 2.0’11 (Stanford University, USA).

Abstract published at Medicine 2.0 website here:

ABSTRACT

Emerging technological and societal developments have brought new challenges for the protection of personal data and individuals’ rights. The widespread adoption of social networking, participation, apomediation, openness and collaboration stretches even further the concepts of confidentiality, privacy, ethics and legality; it also emphasizes the importance of electronic identity and data protection in the health field.

Governments across the Atlantic have adopted legal instruments to defend personal data and individuals’ rights, such as the Health Information Portability and Accountability Act (1996) in USA, the Recommendation No. R(97)5 on the Protection of Medical Data issued by the Council of Europe (1997) in addition to specific legislation adopted by each EU Member State as part of the Data protection Directive 48/95 transposition process. These reflect policy makers’ concerns about the need to safeguard medical and health-related information. On the other hand, bottom up developments such as the widespread usage of “PatientLikeMe” and the availability of industry based platforms for user-owned electronic medical records (i.e. Google Health or Microsoft Health Vault) are often pointed at, arguing that users do not really care about data protection as long as sharing such data produces more value than it destroys. There is, however, a clear evidence gap as to the attitudes of Europeans with respect to this issue.

The purpose of this paper is to identify and characterize individuals’ perception, behaviors and attitudes towards health-related information and health institutions regarding electronic identity and data protection. The research is based on Eurobarometer 359 “The State of Electronic Identity and Data Protection in Europe”, a representative sample of people in EU27 conducted in December 2010. The survey was conducted in each 27 EU Member States via a national random-stratified samples of ~ 1,000 interviews; overall, 26,574 Europeans aged 15 and over were interviewed face-to-face in their homes. The questionnaire asked questions about data disclosure in different context, including health. Specifically, it included questions related to health and personal information, disclosure in Social Networking Sites and on eCommerce sites, trust in health institutions, approval required for disclosure and sensitivity of DNA data. Specifically, we will provide an encompassing portrait of people’s perceptions, behaviors and attitudes across EU27, we will examine the influence of socio-demographic traits and Internet use on such attitudes and behaviors. We will explore significant differences across major regional block. Finally, we will present results from factor analysis that aimed to identify commonalities between variables, and from cluster analysis, use to create typologies of individuals concerning health-related behaviors. Empirical analysis allows to broaden and deepen understanding of the consequences of data protection in Medicine 2.0. Our data also call for further, joint research on this issue, which links demand and supply of medical and health-related data. Indeed, not all people need or want the same level of detail: researchers and physicians clearly need to access more while end users or insurance companies can live with less information. This is one of the crucial points regarding the revision of the Data Protection Directive in Europe (Directive 95/46).

No eHealth without eInclusion in Europe – Eurostat 2010

Recently, EUROSTAT has published the results from ICT usage household survey 2010. I have been analysing these data developing a Digital Health Care Demand in Europe and I would like also to share my analysis of  “individuals who  used the Internet for seeking health information on injury, disease or nutrition” (European Union 27 Member States), inspired by The Power of Mobile written by Susannah Fox. In my case, I would like to emphasis the raise of the inverse care law 2.0 to justify that there is no eHealth without eInclusion, in other words quoting Europe’s Digital Competitiveness Report 2010:

“In addition, while health-on-the-web may empower in various ways those who have access to the internet, the flip side of this is that those without internet access may become relatively more disadvantaged in health matters. For them, the experience may be more one of disempowerment through inability to take advantage of new opportunities. Factors linked to existing health divides, including lower health literacy and less proactive health attitudes, continue to contribute significantly to unequal health experiences and outcomes among less advantaged socio-economic groups. There is already some evidence that these groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides.”

Firstly, since 2004 the percentage of individuals who used the Internet for seeking health information on injury, disease or nutrition (total individuals and individuals who have used the Internet in the last three months) has increased, even though from 2009 we can see a slower increase, specially in those who used the Internet. These trends facilitate the identification of a first gap between users and non-users.

i_ihif_analysis_19821_image001

To better capture this gap, I have divided the analysis in two part. On the one hand, considering the total individuals we can see the differences between groups of age and level of education.

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Furthermore, we can also identify this gap if we focus on age and education together:

i_ihif_analysis_19821_image004

i_ihif_analysis_19821_image005

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On the other hand, considering  individuals who have used the Internet in the last three months, you can see that there is still a difference between groups of age, level of education and both together:

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It has to be remarked that most of these trends show that the divides are not going to disappear with time, in some cases these divides will get wider.  Therefore some groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides. THUS, THERE IS NO eHEALTH WITHOUT eINCLUSION. Social care, Health care, Health Professionals and Social workers may work together and play a role not just in eHealth or on eInclusion but both to avoid ‘double jeopardy’ and  the inverse care law 2.0.

Note: I have developed the same analysis for all Member States and the gaps are even wider in some countries.

Personal Health Record Seminar

On October 29th 2010 I had the opportunity to participate in the Personal Health Record Seminar organized by TICSALUT Foundation I would like to share my presentation and the video recorded.

Seminari sobre la carpeta Personal de Salut – Dr. Francisco Lupiañez from Fundació TicSalut on Vimeo.

Digital Health Care Demand or eHealth Care Demand in Europe – Eurostat

Lately, I have been working with aggregate data from Eurostat ICT usage household survey focused on the usage of the Internet and Health by European citizens. It is worth mentioning that this is a working in progress. Below you can find all variables available per year.

Table 1. Variables available per year at Eurostat ICT usage household survey

Caption Years
The type of goods and services I ordered over the Internet in the last 12 months for on-work use are: Medicine 2009
The type of goods and services I ordered over the Internet in the last 12 months for non-work use are: Non-prescribed medicine 2009
The type of goods and services I ordered over the Internet in the last 12 months for non-work use are: Prescribed medicine 2009
I would like to do on-line: health-related services (eg interactive advice on availability of services in different hospitals, appointments for hospitals) I_GOVHLP *** 2006
I’ve already done on-line: health-related services (eg interactive advice on availability of services in different hospitals, appointments for hospitals) I_GOVHLY *** 2006
I have used Internet, in the last 3 months, for seeking medical advice online with a practitioner I_IHAD 2003 2004 2005
I used Internet, daily, for seeking medical advice online with a practitioner 2003 2004
I used Internet, monthly, for seeking medical advice online with a practitioner 2003 2004
I rarely used Internet for seeking medical advice online with a practitioner 2003 2004
I used Internet, weekly, for seeking medical advice online with a practitioner 2003 2004
I have used Internet, in the last 3 months, for making an appointment online with a practitioner I_IHAP 2003 2004 2005
I used Internet, daily, for making an appointment online with a practitioner 2003 2004
I used Internet, monthly, for making an appointment online with a practitioner 2003 2004
I rarely used Internet for making an appointment online with a practitioner 2003 2004
I used Internet, weekly, for making an appointment online with a practitioner 2003 2004
I have used Internet, in the last 3 months, for seeking health information on injury, disease, nutrition, improving health, etc.) I_IHIF 2003 2004 2005 2006 2007 2008 2009
I used Internet, daily, for seeking health information on injury, disease or nutrition 2003 2004
I used Internet, monthly, for seeking health information on injury, disease or nutrition 2003 2004
I rarely used Internet for seeking health information on injury, disease or nutrition 2003 2004
I used Internet, weekly, for seeking health information on injury, disease or nutrition 2003 2004
I have used Internet, in the last 3 months, for requesting a prescription online from a practitioner I_IHPR
2003 2004 2005
I used Internet, daily, for requesting a prescription online from a practitioner 2003 2004
I used Internet, monthly, for requesting a prescription online from a practitioner 2003 2004
I rarely used Internet for requesting a prescription online from a practitioner 2003 2004
I used Internet, weekly, for requesting a prescription online from a practitioner 2003 2004

Due to the data available, I have chosen 2005 to carry out a cluster analysis to develop a typology of Digital Health Care Demand or eHealth Care Demand in Europe. This is just a first step, the aim is to analyse the drivers and barriers of eHealth in Europe from the demand side. The next table shows the percentage of total individuals by country, (I_GOVHLP and I_GOVHLY  2006)

Table 2. eHealth variables available 2005 at Eurostat ICT usage household survey

COUNTRY I_IHIF I_GOVHLP I_GOVHLY I_IHAD I_IHAP I_IHPR
AT 0,160251 0,227954 0,029526 0,004705 0,007748 0,002626
BE 0,1914 0,183276 0,017496
BG 0,122097 0,009661
CA 0,58
CY 0,080042 0,195897 0,00136 0,002788 0,000551 0,001706
CZ 0,034713 0,096489 0 0,003308 0,003896
DE 0,325024 0,021079
DK 0,238382 0,41458 0,030644 0,02493 0,016902 0,007123
EA 0,162218 0,251884 0,017979 0,005567 0,003255
EA16
EE 0,163774 0,19904 0,030725 0,108567 0,083567 0,049192
EL 0,021608 0,131537 0,001472 0,003506 0,001282 0,000433
ES 0,12751 0,035553 0,024121 0,004409 0,000907
EU15 0,181379 0,245943 0,021312 0,019812 0,005783 0,004567
EU25 0,160867 0,227894 0,019862 0,017239 0,005385 0,004105
EU27 0,160867 0,216619 0,018973 0,017239 0,005385 0,004105
FI 0,38971 0,273988 0,012912 0,027487 0,033743
FR
HR
HU 0,096088 0,119384 0,053411 0,007618 0,004358 0,001954
IE 0,104775 0,043551 0,008591 0,006391 0,001092 0,000679
IS 0,394597 0,388167 0,119582 0,027373 0,013017 0,007694
IT 0,087271 0,17439 0,008182 0,015709 0,003513 0,001996
LT 0,085267 0,179464 0,020233 0,012467 0,002665 0
LU 0,410491 0,367017 0,015976 0,016174 0,006943 0,007728
LV 0,073536 0,156269 0,009821 0,004649 0,001445 0,00052
MK
MT 0,161734 0,122316 0,010373 0,004483 0,003271 0,001495
NL 0,407242 0,387001 0,008289 0,017196 0,007235 0,014481
NO 0,257325 0,36145 0,021409 0,0113 0,008636 0,002586
PL 0,071422 0,174514 0,00652 0,004253 0,001301 0,000916
PT 0,100267 0,174263 0,003997
RO 0,062036
RS
SE 0,232107 0,295204 0,061132 0,042376 0 0,009893
SI 0,153678 0,268123 0,011941 0
SK 0,091329 0,214051 0,013288 0,000493 0,001545 0,000192
TR 0,031177 0,002588 0,000698 0,000024
UK 0,254573 0,200448 0,02922 0,044428

With these values I have constructed new categorical variables considering  descriptive statistics (percentiles per each variable) as follow: less than 25% is LOW, between 25% and 75% is MEDIUM and more than 75% is HIGH.

In order to develop a typology of countries’ utilization of the Internet related with Health, a Non-Hierarchical Cluster Analysis of K-means was undertaken, to five of the five variables identified above I_IHIF, I_GOVHLP, I_GOVHLY, I_IHAD, I_IHAP (Table 2). These factors were selected due to their significance within the cluster analysis.

Table 3. Results of K-means—quick cluster analysis. Method of analysis: non-hierarchical cluster, final cluster centroids.

Clusters

1. Digital Health Care Demand Leaders (n=8)

2. Digital Health Care Demand Primary Strivers (n=3)

3. Digital Health Care Demand Secondary Strivers (n=12)

ANOVA

Sig.

I_IHIF

2,5

3

1,67

12,733

0

I_GOVHLY

3

1,67

1,58

18,345

0

I_GOVHLP

2,5

3

1,58

14,053

0

I_IHAD

2,5

2,33

1,67

6,793

0,006

I_IHAP

2,5

2,67

1,92

4,173

0,031

Cluster one consists of countries where citizens place a greater emphasis on the Internet for health purposes, specially those variables related with health care services. This group is thus referred to as representing ‘Digital Health Care Demand Leaders’. Cluster two is characterised by a minimum difference, with less emphasis on variables related with health care services (transactions) and more emphasis on information, so are consequently labelled ‘Digital Health Care Demand Primary Strivers. Finally, Cluster 3 is labelled ‘Digital Health Care Demand Secondary Strivers

And now… the floor is yours…. pick up a country a put it on a cluster… soon I will post the characterization of the cluster analysis, including traditional, non-digital, variables from the health systems. Furthermore… what about 2010?

Austria AT
Belgium BE
Bulgaria BG
Cyprus CY
Czech Republic CZ
Germany DE
Denmark DK
Estonia EE
Greece EL
Spain ES
Finland FI
France FR
Croatia HR
Hungary HU
Ireland IE
Iceland IS
Italy IT
Lithuania LT
Luxembourg LU
Latvia LV
Macedonia MK
Malta MT
Netherlands NL
Norway NO
Poland PL
Portugal PT
Romania RO
Sweden SE
Slovenia SI
Slovakia SK
Turkey TR
United Kingdom UK
EU (15 countries) EU15
EU (25 countries) EU25
EU (27 countries) EU27

THANKS indeed Ismael Peña for his inspiring work

E-patients, Cyberchondriacs, and Why We Should Stop Calling Names – European Perspective

On August 30, 2010, Susannah Fox posted E-patients, Cyberchondriacs, and Why We Should Stop Calling Names starting a discussion about names. I think the discussion could be summarised in two main trends.

On the one hand, e-patients name is still useful as a brand to spread the message of individuals utilising the Internet for health purposes. Therefore, using the Internet for seeking health information on injury, disease, nutrition, improving health, etc could be consider as a “proxy” to understand the diffusion of e-patients phenomenon or normalization and routinization of technological resourcefulness, mentioned by Carl May. Susannah Fox has been analysing data from USA since 2000. It looks like that the use of the Internet for health in this country has reached a “saturation” point among Internet users, however non-Internet users and minorities, mentioned by Gilles Frydman, are still far away from this saturation point. As a part of this digital divide in Health, it is different to engage young or elderly populations. For the first group, talk about e-patient does not make any sense because, in plain English, they are digital natives while for elderly population is totally different. However, digital natives will be the patients of the near future.

To tackle the situation in Europe I have collected some data from Eurostat checking Information society statistics based on the surveys on ICT usage in enterprises and households. They have gathered the following question “I have used Internet, in the last 3 months, for seeking health information on injury, disease, nutrition, improving health, etc.)”. I have developed charts of European countries and of EU 15, EU 25 and EU 27 for ‘% of individuals’ and ‘% of individuals who used Internet in the last 3 months’. All charts revealed a positive trend but Europe is still behind USA, even the penetration of broadband in Europe is bigger than in USA.

Click on the image below to enlarge the chart to full viewing size

On the other hand, we have to realise that this proxy does not tackle the complexity of this phenomenon and its relationships with other variables, including digital and non-digital aspects of individuals daily live. Therefore, e-patient name could be considered as an inhibitor of this complexity and it does not help us to go deeper in our analysis.  I guess we may have to find a balance between get bored spreading the message and get excited about deeper analysis.

Austria AT
Belgium BE
Bulgaria BG
Cyprus CY
Czech Republic CZ
Germany DE
Denmark DK
Estonia EE
Greece EL
Spain ES
Finland FI
France FR
Croatia HR
Hungary HU
Ireland IE
Iceland IS
Italy IT
Lithuania LT
Luxembourg LU
Latvia LV
Macedonia MK
Malta MT
Netherlands NL
Norway NO
Poland PL
Portugal PT
Romania RO
Sweden SE
Slovenia SI
Slovakia SK
Turkey TR
United Kingdom UK
EU (15 countries) EU15
EU (25 countries) EU25
EU (27 countries) EU27

The integration of Information and Communication Technology into Community Pharmacists practice

Although I have not posted about Pharmacists and the use of the Internet and I have not found many research on this topic,  it’s clear that these health professionals are playing an important role in healthcare. Therefore, they also have a role in relationship with the Internet, specially Community Pharmacists, who are probably the most accessible health professional and are daily dealing with all kind of patients. Health promotion, Health prevention, Health Literacy, patients’ education,… are just some of the fields where Community Pharmacists can encourage patients to become more engaged in their own health care or their relatives health care.

Following our analysis of the integration of Information and Communication Technologies into medical practice and into nursing practice, we have analysed Community Pharmacists. The specific objectives were to develop and characterise a typology of CPs based on their ICT utilization and to identify factors that can enhance or inhibit the use of these technologies.

Cluster one consists of CPs whose information needs place a greater emphasis on international and national information; on activities related to professional education and information from the Pharmacists Association as well as workplace and pharmaceutical industry. This group also emphasizes ICT use for activities such as information search, communication and the dissemination of information as well as for corporate activities. This group is thus referred to as representing ‘integrated Community Pharmacist’. The label is used descriptively in order to capture the sense that for this group ICT are a mundane and valued resource. Cluster two is characterised by notably different features to the previous one. The second profile represents those CPs placing less emphasis on ICT so are consequently labelled as ‘non-integrated Community Pharmacist‘.

Statistical analysis of the relationship between these profiles  revealed that ‘integrated Community Pharmacist‘ are more likely to start using Internet at an earlier stage, to consider it very useful, to use this tool on a daily basis, to have a blog and to consider Internet health information very relevant. No significance association related to age, gender or pharmacy ownership was found.

Further analysis of the relationship between the two profiles and the pharmacist-patient relationship resulted in ‘integrated Community Pharmacist‘ being more likely than ‘non-integrated Community Pharmacist‘ to recommend that patients go online to find health information and to have more patients that discuss such information during a consultation. ‘Integrated Community Pharmacist‘ are also more likely to believe that patients going online for health information improve their autonomy and their quality of life as well as improving both the health professional/patient relationship and  the pharmacist/patient relationship. Finally, ‘integrated Community Pharmacist‘ are more likely to be found on the Internet searching or providing advice on professional forums. Additionally, drivers for ICT use such as improving communication with other health care professionals and improvement in work productivity are likely to have a higher impact on ‘integrated Community Pharmacist‘ while barriers such as lack of training or lack of time are less likely to challenge them.

It was observed that factors related with ‘intensive use of Internet’ (every day), ‘emphasis on Internet for communication and dissemination’ as well as information needs from the Pharmacists Professional Association play a positive and significant role in the probability of being an ‘integrated Community Pharmacist‘. Recommending patients going on-line for health information and discussing or sharing patients’ Internet health information findings also have a positive and significant role.

Acknowledgements

The research reported is part of a broad study supported by Departament de Salut de la Generalitat de Catalunya (Catalonia Health Department) and directed by Prof. Manuel Castells. Survey launched is a result of collaboration between the Internet Interdisciplinary Institute at Open University of Catalonia and the Pharmacist Association of Barcelona (Col.legi Oficial de Farmacèutics de Barcelona).

The integration of Information and Communication Technology into medical practice

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into medical practice” has been accepted and is already in press at the  International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

PREPRINT

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

ABSTRACT

OBJECTIVES:

To identify doctors’ utilization of ICT; to develop and characterise a typology of doctors’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice.

METHODS:

An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken.

RESULTS:

Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as ‘integrated doctors’. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled ‘non-integrated doctors’. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an ‘integrated doctor’.

CONCLUSIONS:

The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands.

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link