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:
- Solar O & Irwin A (2007). A conceptual framework for action on the social determinants of health. Discussion paper for the Commission on Social Determinants of Health. Geneva, World Health Organization.
- Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
- Marmot M et al. (2010). Interim first report on social determinants of health and the health divide in the WHO European Region. Copenhagen, WHO Regional Office for Europe.
- Marmot M et al. (2011). Interim second report on social determinants of health and the health divide in the WHO European Region. Copenhagen, WHO Regional Office for Europe.
- Jan van Dijk and Ken Hacker (2003). The ‘Digital Divide’ as a Complex and Dynamic Phenomenon. The Information Society. Vol. 19, Nr. 4, 315-326.
- Jan van Dijk (2005).The Deepening Divide, Inequality in the Information Society. Thousand Oaks, London, New Delhi: Sage, 240 p.
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.
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).
Based on and inspired by this two frameworks I have developed Social determinants of Health and ICT for Health (eHealth) 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.
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, .
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.
This is a guest post by Jessica Mark, healthfinder.gov and Outreach Program Manager, Health Communication and eHealth Team in the Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services
The result of this invitation is entitled Making Strides Toward Improving Health Literacy Online where Jessica Mark highlighted part of the work done by the Office of Disease Prevention and Health Promotion. I really enjoy her post so I commented this:
Wonderful post! I wonder if eHealth literacy could be also a tool to integrate the elderly into Information Society / Network Society. It could be a tool to engage them within the tremendous potential of the Internet for other aspects of their lives. Health contents could be just an excuse to capture their attention (e-awareness) and help them to be online (e-readiness)
and Jessica Mark replied:
Francisco, thank you! I love the idea of eHealth literacy as a catalyst to overall digital literacy too. I’d love to hear/talk more about how that might work.
First of all, I would like to quote the main message of Prof. Jan van Dijk‘s book “The Deepening Divide: Inequality in the Information Society”
“The digital divide is deepening where it has stopped widening. In places where most of peopel are motivated to gain access and physical access is spreading, differences in skill and usage come forward. The more information and communication technology is immersed in society and pervades everyday life, the more it becomes attached to all exiting social divisions. It tends to strengthen them, as it offers powerful tools for everyone engaged. This occurs in the context of the evolving information society and network society. This type of society makes both digital and social divisions even more critical” (…) The digital divide is conceived of as a social and political problem, not a technological one. Physical access is portrayed as only one kind of (material) access among at least four: motivational, material, skills, and usage” (p.2-3)
As a part of his framework for understanding the digital divide, Prof. van Dijk has developed “A Causal and Sequential model of Digital Technology Access by individuals in Contemporary Societies” (p.24). I have included HEALTH as a field of participation in Society.
“The core argument of the book sets particular relationships between four states of affairs, in a process creating more or less information and communication inequality in using digital technologies (p.14):
- A number of personal and positional categorical inequalities in society
- The distribution of resources relevant to this type of inequality
- A number of kinds of access to ICTs
- A number of fields of participation in society
1 and 2 held to be the causes, and 3 is the phenomenon to be explained, together with 4, the potential consequences of the whole process (…). The core argument can be summarized in the following statements, which comprise the core of a potential theory of the digital divide (p.15):
- Categorical inequalities in society produce an unequal distribution of resources.
- An unequal distribution of resources causes unequal access to digital technologies.
- Unequal access to digital technologies also depends on the characteristics of these technologies.
- Unequal access to digital technologies brings about unequal participation in society.
- Unequal participation in society reinforces categorical inequalities and unequal distribution of resources.
The general term access to digital technologies has been divided into four specific, successive kinds of access to digital technology, computes, and the Internet connections (p.21):
- Motivational access (motivation to use these technologies)
- Material or physical access (possession of computers and Internet connection or permission to use them and their contents)
- Skills access (possession of digital skills: operational, informational, and strategic)
- Usage access (number and diversity of application, usage time)
I have posted before about the importance of eInclusion and eHealth and Inverse Care Law 2.0 talking about the successive kinds of access to digital technology but I have not posted about what are the reasons for not having access to the Internet at home to explain why eHealth literacy could be a catalyst to overall digital literacy among the elderly.
Eurostat’s survey on ICT usage in households and by individuals (2010) stated that the main reasons not to access the Internet at home in almost all countries are related with MOTIVATIONAL ACCESS (does not need to; does not want to) and SKILLS ACCESS
Individuals between 55-74 emphasised the importance of SKILLS ACCESS and MOTIVATIONAL ACCESS. Following the framework and the figures above mentioned, eHealth literacy could be a catalyst to overall digital literacy among the elderly because:
- Health could be a motivation for the elderly to use the Internet (e-awareness)
- This motivation could be used as a trigger to learn how to use this technology (e-readiness)
- Health professional and/or health care workers as well as relatives and/or friends could facilitate this learning process (ehealth literacy)
- Use of the Internet for health could open new fields of participation in society for the elderly.
- These new fields of participation in society could diminish categorical inequalities and unequal distribution of resources.
In my last post about The economics of eHealth (I) I quoted OECD. (2010). Improving Health Sector Efficiency: The Role of Information and Communication Technologies. Health Policy Studies to point out that this study mentioned an absence, in general, of independent, robust monitoring and evaluation of programmes and projects to determine the actual payoff from the adoption and use of ICT. A few days ago, PLoS Medicine has published:
Black AD, Car J, Pagliari C, Anandan C, Cresswell K, et al. (2011) The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Med 8(1): e1000387. doi:10.1371/journal.pmed.1000387
I would recommend you to read the whole systematic overview. However, I would like to highlight the conclusions that are align with The Economics of eHealth (I) before mentioned:
There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology’s life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.
This conclusion also challenges researchers to apply and develop new methods with “attention to socio-technical factors”, work with other discipline and combine strong quantitative and/or qualitative approaches.
I have posted several times about the “inverse care law” and eHealth. Following some conversations with @drbonis and @rcofinof I have decided to entitle this post “Inverse Care Law 2.0″ to embed my presentation (Spanish) at “V Jornada de debate sobre eficacia y seguridad en la utilización de medicamentos”.
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.
|EU (15 countries)||EU15|
|EU (25 countries)||EU25|
|EU (27 countries)||EU27|
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.
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).