This dissertation investigated relevant issues among undergraduate students at two institutions and how these issues could be incorporated into an introductory personal health course. By illustrating how these issues can attract student attention, relevancy, confidence, and satisfaction, educators can make these introductory personal health courses more responsive, thereby increasing student motivation to learn. This study used a qualitative research design. Focus groups and interviews were conducted in order to gain insight into issues students felt were relevant to their lives, their satisfaction with their personal health course, and how these courses could be updated in terms of content and delivery. The ARCS Model of Motivation was used as a theoretical framework for development of questions as well as to organize emergent themes. This model has been shown to increase student motivation to learn, and the current study aimed to expand this to include health courses, which could lead to an increase in adopting healthier or risk-reductive behaviors. After five focus groups and two interviews, data saturation was met, and analysis was conducted. Findings indicate a strong desire among undergraduate students for a larger focus of content to include mental health issues (e.g., stress, time management, pressure, and healthy coping mechanisms), physical health issues, and harm reductive issues surrounding the areas of sexual health and alcohol and substance use. Additionally, students reported better recall and a preference for active learning over a more didactic method of instruction. By understanding relevant issues facing college students and incorporating those within an introductory personal health course, educators can enhance the responsiveness of these courses by illustrating relevancy of topics and teaching students how they can confidently learn to adopt healthy behaviors and practice harm reduction. This is particularly useful among undergraduate students as they are in a time of transition and emerging adulthood and are willing to learn and establish new patterns of behaviors. If educators can balance what they as experts want students to know and what students say are relevant to their lives and what they want to know, these introductory personal health courses could be an effective tool for increasing overall health and wellness of students.

Yes / Background: Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. Objective: This study aimed to examine factors associated with patients’ use of ePHRs in England. Methods: The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. Results: Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. Conclusions: This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.

Följande kandidatuppsats undersöker hur en elektronisk hälsoapplikation kan utformasför att öka medvetenheten om den personliga dagliga hälsan, fokuserat på huden och atthålla den frisk. Det sker genom att en prototyp har utformats där användaren genombilder samt text får instruktioner för att utföra en självkontroll. Prototypen innehållerockså en bildregistrering där användaren kan ladda upp bilder på en leverfläck ochgenom registreringen kan om leverfläcken utvecklas över tid. Syftet med prototypen äratt undersöka om en elektronisk hälsoapplikation utformad med fokus på återkopplingkan göra det möjligt för en person som inte är utbildad inom ämnet att undersöka sinhud samt se och följa förändring i en leverfläck genom bildanalys. Detta undersöktesgenom två tester. Ett frågeformulär där svarspersonen fick försöka avgöra om enleverfläck var frisk eller inte. Ett användartest där testpersonen fick testa bildanalysen,det som testades var om personen kunde ladda upp en bild samt se skillnad i bildernagenom bildregistreringen.Resultatet visar att majoriteten av enkätsvaren var korrekta svar, närmare bestämt 76,9procent. Personerna kunde identifiera om leverfläcken var frisk eller sjuk med hjälp avinformationen som tilldelades. Resultatet av användartesten visade att personerna kundeladda upp en bild på webbplatsen och sedan förstå bildanalysen. / This bachelor thesis examins how a electronic health application can be made toincrease awareness about personal daily health, with focus on individual skin andkeeping it healthy. This was made by creating a prototype where the user get usefulinformation on how to perform a self examination through text and images. Theprototype also contains functionality that allows the user to upload images of a moleand by an image registration follow possible changes over long periods of time. Thepurpose of the prototype is to investigate if an electronic health application with focuson feedback can make it possible for a person who is not educated in this area to examinthe skin and also discover possible changes over time with the image registration. Twotests were made to examin if this was possible. The first test was an questionnaire wherethe respondet tried to determine if a mole was healthy or not. The second test was a usertest where the test person got to try out the functionality with image registration in theprototype. The person got to upload an image and see the differences through the imageregistration.The results showed that the majority of the collected repsonses from the quetsionnairewas correct, with a percentage of 76,9 correct answers. The respondent could identify ifthe mole was healthy or not through the information that was presented. The results ofthe user test showed that all test persons could perform and understand the functionalityof uploading an image and then analyze the results throgh image registration.

Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use include lack of computer and internet access, poor computer or health literacy, security concerns, and provider disengagement. PHRs may help those living in rural areas and those with chronic conditions such as heart failure, monitor and manage their disease, communicate with their health care team and adhere to clinical recommendations. To provide some much needed actual research, a descriptive mixed methods study of the usability, usefulness, and disease management potential of PHRs for rural heart failure patients was conducted. Fifteen participants were enrolled. Usability issues fell into three categories: screen layout; applying consistent, standard formatting; and providing concise, clear instructions. Participants used PHR features that were more convenient than other methods or that had some additional benefit to them. There was no difference between rural and urban participants. A heart failure nurse promoted recording daily heart failure symptoms in the PHR. Most participants did so at least once, but many found it cumbersome. Reasons for recording included the comfort of having clinical staff monitor the data. Participants who were stable did not find recording as useful as did those who were newly diagnosed or unstable. Participants used asynchronous communication to send messages to the heart failure nurse that they would not otherwise have communicated. The study expands the knowledge of PHR use by addressing useful functionality and disease management tools among rural patients with heart failure. The patients were able to complete tasks they found useful. The increased communication and disease management tools were useful to some.

A obesidade transpassa a esfera da saúde e se torna uma condição social do cotidiano da sociedade moderna. Cresce cada vez a necessidade de entender a obesidade no cotidiano da sociedade e os aspectos que influenciam as ações clínicas e da condução da sua terapêutica. O cuidado à saúde apesar de seu aspecto técnico, compartilha valores culturalmente construídos. Ambiguidades emergem entre o conhecimento reivindicado como técnico-profissional e o que é sentido na relação terapêutica. O objetivo deste estudo é compreender como a obesidade é abordada através da perspectiva cientifica e reinterpretada pela cultura. Trata-se de um estudo qualitativo com entrevistas e observações de campo em unidades básicas de saúde de duas localidades brasileiras distintas: uma em cidade pequena do interior e outra em uma capital no litoral. Foram entrevistados 17 profissionais de saúde (médicos, enfermeiros e agentes comunitários de saúde (ACS)) além de observação das rotinas em ambas unidades. A análise de dados foi conduzida pela análise temática de Braun e Clarke. Inicialmente foram elaborados 20 códigos iniciais, depois agrupados em cinco temas iniciais e reagrupados nos três temas finais. Após a primeira etapa de análise, o pesquisador principal retornou à cada localidade para questionar e abordar o pontos que surgiram durante as análises iniciais. Os temas obtidos mostram as implicações diferente de como as construções culturais moldam a abordagem da obesidade. Os temas são: Obesidade como doença social; Tratamento da obesidade, ferramentas e contextos; Obesidade individual. No cotidiano terapêutico a obesidade é encarada como uma comorbidade ou um fator de risco apesar da sua definição como doença pela comunidade científica. O profissional de saúde, durante o ato terapêutico, mostra seus conhecimentos científicos atrelados à aspectos culturais. A produção de cuidado na saúde não está imune das crenças culturais que permeiam a sociedade atrelando os significados construídos pelos próprios usuários e profissionais sobre o que consideram saúde, doença e tratamentos ideias para cada condição. A obesidade não é vivida como doença, ela é vivida como uma condição e um plano de fundo para outras doenças. / Obesity passes over the health sphere and becomes a social condition of daily life in modern society. It is growing the need to understand obesity in everyday society and the influence on the clinical actions and therapy. The health care despite the technical training, share culturally constructed values. Ambiguities arise between knowledge claimed as technical-professional and what is felt in the therapeutic relationship, which is part of cultural values. The aim of this study is to understand how obesity is addressed by the scientific perspective and reinterpreted by culture. This is a qualitative study with interviews and field observations in basic health units in two different locations in Brazil: one in small town and another in a capital on the coast. We interviewed 17 health professionals (doctors, nurses and community health workers (CHW)) as well as observation of the routines in both units. Data analysis was conducted by thematic analysis of Braun and Clarke. Initially were developed 20 initial codes, then grouped into five initial themes grouped in the three final themes. After the first analysis stage, the main investigator returned to each location to question and address the points raised during the initial analysis. The themes obtained show the different implications of cultural constructions shaping the approach of obesity. The themes are: Obesity as a social disease; Obesity treatment, tools and contexts; Individual obesity. In daily obesity therapy, obesity is perceived as comorbidity or a risk factor despite its definition as a disease by the scientific community. The health professional during the therapeutic act shows their scientific knowledge linked to cultural aspects. The health care is not immune to cultural beliefs that permeate society. It is linked meanings built by the users and professionals on WHAT consider health, disease and treatment ideas for each condition. Obesity is not experienced as a disease, it is experienced as a condition and a background for other diseases.

A personal health record (PHR) contains health data about a patient, which is maintained by the patient. Patients may share their PHR data with a wide range of users such as healthcare providers and researchers through the use of a third party such as a cloud service provider. To protect the confidentiality of the data and to facilitate access by authorized users, patients use Attribute-Based Encryption (ABE) to encrypt the data before uploading it onto the cloud servers. With ABE, an access policy is defined based on users' attributes such as a doctor in a particular hospital, or a researcher in a particular university, and the encrypted data can only be decrypted if and only if a user's attributes comply with the access policy attached to a data object. Our critical analysis of the related work in the literature shows that existing ABE based access control frameworks used for sharing PHRs in a storage cloud can be enhanced in terms of scalability and security. With regard to scalability, most existing ABE based access control frameworks rely on the use of a single attribute authority to manage all users, making the attribute authority into a potential bottleneck regarding performance and security. With regard to security, the existing ABE based access control frameworks assume that all users have the same level of trust (i.e. they are equally trustworthy) and all PHR data files have the same sensitivity level, which means that the same protection level is provided. However, in our analysis of the problem context, we have observed that this assumption may not always be valid. Some data, such as patients' personal details and certain diseases, is more sensitive than other data, such as anonymised data. Access to more sensitive data should be governed by more stringent access control measures. This thesis presents our work in rectifying the two limitations highlighted above. In doing so, we have made two novel contributions. The first is the design and evaluation of a Hierarchical Attribute-Based Encryption (HABE) framework for sharing PHRs in a storage cloud. The HABE framework can spread the key management overheads imposed on a single attribute authority tasked with the management of all the users into multiple attribute authorities. This is achieved by (1) classifying users into different groups (called domains) such as healthcare, education, etc., (2) making use of multiple attribute authorities in each domain, (3) structuring the multiple attribute authorities in each domain in a hierarchical manner, and (4) allowing each attribute authority to be responsible for managing particular users in a specific domain, e.g. a hospital or a university. The HABE framework has been analyzed and evaluated in term of security and performance. The security analysis demonstrates that the HABE framework is resistant to a host of security attacks including user collusions. The performance has been analyzed in terms of computational and communication overheads and the results show that the HABE framework is more efficient and scalable than the most relevant comparable work. The second novel contribution is the design and evaluation of a Trust-Aware HABE (Trust+HABE) framework, which is an extension of the HABE framework. This framework is also intended for sharing PHRs in a storage cloud. The Trust+HABE framework is designed to enhance security in terms of protecting access to sensitive PHR data while keeping the overhead costs as low as possible. The idea used here is that we classify PHR data into different groups, each with a distinctive sensitivity level. A user requesting data from a particular group (with a given sensitivity level) must demonstrate that his/her trust level is not lower than the data sensitivity level (i.e. trust value vs data sensitivity verification). A user's trust level is derived based on a number of trust-affecting factors, such as his/her behaviour history and the authentication token type used to identify him/herself etc. For accessing data at the highest sensitivity level, users are required to get special permissions from the data owners (i.e. the patients who own the data), in addition to trust value vs data sensitivity verification. In this way, the framework not only adapts its protection level (in imposing access control) in response to the data sensitivity levels, but also provides patients with more fine-grained access control to their PHR data. The Trust+HABE framework is also analysed and evaluated in term of security and performance. The performance results from the Trust+HABE framework are compared against the HABE framework. The comparison shows that the additional computational, communication, and access delay costs introduced as the result of using the trust-aware approach to access control in this context are not significant compared with computational, communication, and access delay costs of the HABE framework.

Background: Low participation in sport and physical activity pose a continuing public health challenge. In response, partnership approaches have commonly been employed in community public health interventions. However, evidence concerning sport and physical activity partnerships remains underdeveloped. Aim and methods: The aim of the research was to investigate the attitudes, perceptions, and experiences of community stakeholders participating in Community Sports Networks (CSNs) in England. A mixed methods research design was adopted. The quantitative component consisted of a sample of 171 CSN members from across England. The qualitative component consisted of a sample of 23 key informants from a single county in the South West of England. A synthesised grounded theory approach was used to integrate data. This involved: 1. Analysis of survey responses. 2. Analysis of interview transcripts. 3. Analysis of additional data including notes from CSN meetings and secondary documents. In addition, inferential statistical analyses were conducted on the quantitative data to assess the contributions from sets of predictor variables on the value of binary outcome variables. The results showed: 1. Participation in CSNs could be explained by a conceptual model which located 'searching for value' as the core category. Four sub-categories of notionally endorsing, speculating, scrutinising, and embedding helped to explain the participation process. 2. Perceived costs (OR = 0.89, 95% Cl 0.82 to 0.94, P < 0.05) were more important than perceived benefits (OR = 1.05, 95% Cl 0.98 to 1.14, P > 0.05) for predicting sense of satisfaction. Perceived costs (OR= 0.83, 95% Cl 0.74 to 0.94, P < 0.05) and communication (OR= 0.83, 95% Cl 0.67 to 0.81, P < 0.05) were strong predictors of sense of ownership. 3. Perceived benefits may have to be at least twice the level of perceived costs for a favourable cost-benefit ratio. Conclusions: Factors facilitating the creation of value promote stakeholder participation in CSN activities. However, the participation process is subject to a range of challenges which require constant attention.

Background: Diabetes prevalence in Scotland is increasing at ~4.6% annually; 247,278 (4.7%) in 2011. My Diabetes My Way (MDMW) is the NHS Scotland information portal, containing validated educational materials for people with diabetes and their carers. Internet-based interventions have potential to enhance self-management and shift power towards the patient, with electronic personal health records (PHRs) identified as an ideal method of delivery. In December 2010, a new service was launched in MDMW, allowing patients across Scotland access to their shared electronic record. The following thesis aims to identify and quantify the benefits of a diabetes-focused electronic personal health record within NHS Scotland. Methods: A diabetes-focused, population-based PHR was developed based on data sourced from primary, secondary and tertiary care via the national diabetes system, Scottish Care Information - Diabetes Collaboration (SCI-DC). The system includes key diagnostic information; demography; laboratory tests; lifestyle factors, foot and eye screening results; prescribed medication and clinical correspondence. Changes are tracked by patients over time using history graphs and tables, data items link to detailed descriptions explaining why they are collected, what they are used for and what normal values are, while tailored information links refer individuals to facts related to their condition. A series of quasi-experimental studies have been designed to assess the intervention using subjectivist, mixed-methods approaches incorporating multivariate analysis and grounded theory. These studies assess patient expectations and experiences of records access, system usage and uptake and provide preliminary analysis on the impact on clinical process outcomes. Survey questionnaires were used to capture qualitative data, while quantitative data were obtained from system audit trails and from the analysis of clinical process outcomes before and after the intervention. Results: By the end of the second year, 2601 individuals registered to access their data (61% male; 30.4% with type 1 diabetes); 1297 completed the enrolment process and 625 accessed the system (most logins=346; total logins=5158; average=8.3/patient; median=3). Audit trails show 59599 page views (95/patient), laboratory test results proving the most popular (11818 accesses;19/patient). The most utilised history graph was HbA1c (2866 accesses;4.6/patient). Users are younger, more recently diagnosed and have a heavy bias towards type 1 diabetes when compared to the background population. They are also likely to be a more highly motivated ‘early adopting’ cohort. Further analysis was performed to compare pre- and post-intervention clinical outcomes after the system had been active for nearly two and a half years. Results of statistical significance were not forthcoming due to limited data availability, however there are grounds for encouragement. Creatinine tests in particular improved following 1 year of use, with type 1 females in particular faring better than those in patient other groups. For other clinical tests such as HbA1c, triglycerides, weight and body mass index improvements were shown in mean and/or median values.96% of users believe the system is usable. Users also stated that it useful to monitor diabetes control (93%), improve knowledge (89%) and enhance motivation (89%). Findings show that newly diagnosed patients may be more likely to learn more about their new condition, leading to more productive consultations with the clinical team (98%). In the pre-project analysis, 26% of registrants expressed concerns about the security of personal information online, although those who actually went on to use it reported 100% satisfaction that their data were safe. Engagement remains high. In the final month of year two, 44.6% of users logged in to the system. 55.3% of users had logged in within the previous 3 months, 78.9% within the previous 6 months and 91.4% within the previous year. Some legacy PHRs have failed due to lack of uptake and deficiencies in usability, so as new systems progress, it is essential not to repeat the mistakes of the past. Feedback: "It is great to be able to view all of my results so that I can be more in charge of my diabetes".Conclusion: The MDMW PHR is now a useful additional component for the self-management of diabetes in Scotland. Although there are other patient access systems available internationally, this system is unique in offering access to an entire national population, providing access to information collected from all diabetes-related sources. Despite its development for the NHS Scotland environment, it has the potential to connect to any electronic medical record. This local and domain-specific knowledge has much wider applicability as outlined in the recommendations detailed, particularly around health service and voluntary sector ownership, patient involvement, administrative processes, research activities and communication. The current project will reach 5000 patients by the end of 2013.

Tese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 2010

As individuals are increasingly benefiting from the use of online services, there are growing concerns about the treatment of personal information. Society’s ongoing response to these concerns often gives rise to privacy policies expressed in legislation and regulation. These policies are written in natural language (or legalese) as privacy agreements that users must agree to, or presented as a set of privacy settings and options that users must opt in or out of in order to receive the service they want. But comprehensibility of privacy policies and settings is becoming increasingly challenging as agreements become longer and there are many privacy options to choose from. Additionally, organizations face the challenge of assuring compliance with policies that govern collecting, using, and sharing of personal data. This thesis proposes frameworks for personalized privacy and privacy auditing to address these two problems. In this thesis, we focus our investigation on the comprehensibility issues of personalized privacy using the concrete application domain of personal health data as recorded in systems known as personal health records (PHR). We develop the Privacy Goals and Settings Mediator (PGSM) model, which is based on i* multi-agent modelling techniques, as a way to help users comprehend privacy settings when employing multiple services over a web platform. Additionally, the PGSM model helps privacy experts contribute their privacy knowledge to the users’ privacy decision-making task. To address the privacy auditing problem, we propose two light-weight ontologies, L2TAP and SCIP, that are designed for deployment as Linked Data, an emerging standard for representing and publishing web data. L2TAP (Linked Data Log to Transparency, Accountability and Privacy) provides flexible and extensible provenance-enabled logging of privacy events. SCIP (Simple Contextual Integrity Privacy) provides a simple target for mapping the key concepts of Contextual Integrity and enables SPARQL query-based solutions for two important privacy processes: compliance checking and obligation derivation. This thesis validates the premise of PHR users’ privacy concerns, attitudes and behaviour through an empirical study. The usefulness of the PGSM model for privacy experts is evaluated through interviews with experts. Finally, the scalability and practical benefits of L2TAP+SCIP for log-based privacy auditing are validated experimentally.