The internet has radically changed the way people obtain and interact with information about diseases, treatments, and conditions. Yet, our understanding of how people access and use health information to make decisions- in other words, their health literacy- has not progressed. The overall aim of this thesis is to assess the extent to which health literacy is a valid and useful construct for policy and practice related to online health resources. A mixed-methods research programme of five studies was undertaken, influenced by realist evaluation methodology. First, to ascertain engagement with user-generated online health content (UGC) in the UK, analysis of a large European survey was undertaken. Then, the uncertainty regarding the relationship between health literacy and outcomes was addressed by a systematic review and qualitative analysis of health literacy measures. Results of these two studies informed interviews carried out with 13 'key informants': policymakers and primary care clinicians in the UK with a particular interest in health literacy and/or online information. A systematic review, incorporating a traditional narrative review and a realist review, evaluated existing trials addressing how effects of online resources vary by health literacy level. Finally, data were analysed from a feasibility randomized controlled trial, comparing usage and outcomes of accessing a 'personal experiences'-based asthma website (representing curated user-generated content) versus a 'facts and figures'-based website. Participant health literacy was assessed using an index identified from the systematic review of measures, and website usage was tracked. Approximately 25% of UK internet users engage with UGC at least monthly. The most frequent users were younger, more likely to be male, and to be carers for someone with a long-term illness. Three themes were identified from health literacy measurement: 'appropriate health decisions', 'ability to obtain healthcare services', and 'confidence'. Key informants noted the lack of clarity about how health literacy influences outcomes, and suggested that personal preferences and digital access and skills may be more relevant than health literacy for policy and practice. Existing trials of online resources in which participant health literacy was measured were mostly at high risk of bias; some possible explanations of how these interventions should work in people with low health literacy were that they may experience higher data entry burden related to chronic diseases, and that they may prefer simulated face-to-face communication. Finally, there were no differences between health literacy groups in the feasibility trial regarding usage or outcomes related to either the 'facts and figures' or 'personal experiences' websites. Taken together, these results question the validity and appropriateness of health literacy as a key objective or consideration in the development or use of online resources. While health literacy has value as a general idea, this thesis demonstrates that it may no longer be the right construct to guide intervention development and implementation to improve health outcomes.

No description available.

Information and communication technologies can be used to deliver healthcare services and improve the healthcare system. Any electronic healthcare system whose usage results in the efficient and enhanced quality of healthcare is an eHealth system and can be beneficial for medical enterprises. Despite the advantages that eHealth systems offer, medical enterprises are often reluctant to abandon their paper-based systems and embrace eHealth solutions. Through a review of existing eHealth literature, this study identified generic technologies used within South African medical enterprises. Fourteen (14) technologies, that represent a basket of eHealth systems for supporting the business management, professional clinical informatics, patient information storage and consumer health informatics functional areas, were identified. The study then aimed to determine the state of adoption of these technologies as well as the factors influencing adoption. The technological, organisational and environmental (TOE) factors that contributed to the current state of adoption were identified through a review of existing TOE literature. A model that explores the effects of these pre-determined TOE factors on the propensity to adopt eHealth was developed and tested. A cross-sectional, quantitative study was carried out and survey data was collected from a sample of 130 medical enterprises in South Africa. Data was collected using a structured questionnaire. Correlation analysis was used to test the model’s hypotheses and hierarchical regression was used to test the overall TOE model. By using the TOE framework, the study has provided a theoretical contribution and addressed a gap in the literature into the barriers and determinants of the adoption of information and communication technologies (ICTs) in healthcare. The results of the study show that South African medical enterprises use systems that range from simple electronic fund transfer systems to more complex electronic record and clinical decision support systems. Of the 14 technologies that were identified, business information systems such as medical aid claims submission systems and electronic record systems for patient and fee related information were the most adopted while a steady, but continued increase in the adoption of clinical health information systems was observed. Specifically, the study reveals that electronic fund transfer systems are the most adopted systems while ePrescription systems are the least used. Furthermore, the study shows that in addition to the enterprises’ operating period, perceived benefits, IT infrastructure, senior clinician involvement, resource commitment and external pressure are correlated with the propensity to adopt while system complexity is a barrier to technology adoption.

Abstract The potential of information technologies to enable fundamental and enduring change in individuals’ health and well-being activities has recently gained significant research and policy attention. Moreover, there has been increasing interest in persuasive systems that are designed to induce and influence people to change their attitudes and behaviors. This dissertation consists of five studies, including two qualitative studies and three quantitative field studies (including 616 real users of such persuasive systems), that are closely related and successively build upon each other to jointly address the central research question: To what extent persuasive systems design has an influence on consumers’ intention to adopt health behavior change support systems? The foremost conceptual foundation is the work on persuasive systems design, which further elaborates the features, affordances, and capabilities of systems that can be effective in inducing short-term as well as sustained behavior. The focal point is on the four distinct categories of persuasive systems design: (i) primary task support; (ii) dialogue support; (iii) perceived system credibility; and (iv) social influence. The interplay between the categories and other related constructs, such as unobtrusiveness and design aesthetics, is investigated through rigorous statistical analyses, including partial least structural equation modeling. The results demonstrate that persuasive systems design has a significant impact on consumers’ adoption of health behavior change support systems in different stages of adoption. The work addresses a problem salient to research, policy, and practice and builds upon strong theoretical and conceptual foundations. The research also extends prior technology adoption literature in information systems in a useful way by examining questions related to the design of systems in a novel and consequential domain. / Tiivistelmä Informaatioteknologian rooli ja potentiaali yksilöiden terveyden ja hyvinvoinnin edistämisessä on viime aikoina saanut merkittävää huomiota sekä tutkimuskentällä että julkisessa keskustelussa. Kasvavaa kiinnostusta on osoitettu erityisesti vakuuttaviin tietojärjestelmiin, jotka ovat suunniteltu vaikuttamaan ihmisten asenteisiin ja käyttäytymiseen. Väitöskirja koostuu yhteensä viidestä tutkimuksesta, joista kaksi on laadullisia tutkimuksia ja kolme määrällisiä kenttätutkimuksia. Kenttätutkimuksissa järjestelmiä on tutkittu yhteensä 616 loppukäyttäjällä. Väitöstyön tutkimukset liittyvät läheisesti toisiinsa ja vastaavat yhdessä keskeiseen tutkimuskysymyksen: missä määrin vakuuttavien järjestelmien suunnittelumenetelmillä on vaikutusta kuluttajien aikomukseen ottaa käyttöön terveyskäyttäytymisen muutoksia tukevia järjestelmiä? Työn tärkein käsitteellinen perusta kytkeytyy vakuuttavien järjestelmien suunnitteluun, jossa käsitellään yksityiskohtaisesti järjestelmien ominaisuuksia, käyttömahdollisuuksia ja valmiuksia, jotka voivat olla tehokkaita sekä lyhyen aikavälin että pysyvän käyttäytymisen muutoksen tukemisessa. Väitöstyön keskeinen näkökulma on neljässä vakuuttavan suunnittelun kategoriassa: (i) ensisijaisen tehtävän tukemisessa; (ii) käyttäjän ja järjestelmän välisen vuoropuhelun tukemisessa; (iii) järjestelmän koetussa uskottavuudessa ja (iv) sosiaalisessa vaikutuksessa. Kyseisten kategorioiden vuorovaikutusta ja yhteyksiä on tutkittu tilastollisten analyysien ja rakenneyhtälömallien kautta. Sen lisäksi työssä on paneuduttu aiheeseen tiiviisti liittyvien tekijöiden, kuten teknologian “tunkeilemattomuuden” ja suunnitteluestetiikan merkitykseen teknologian käyttöönotossa. Väitöskirjan tulokset osoittavat, että vakuuttavien järjestelmien suunnittelumenetelmillä on merkittävä vaikutus kuluttajien aikeisiin ottaa käyttöön ja käyttää terveyskäyttäytymisen muutoksia tukevia järjestelmiä. Väitöstyö perustuu vahvaan teoreettis-käsitteelliseen viitekehykseen ja käsittelee tutkimusongelmaa, joka on relevantti tutkimuksen, käytännön sekä julkisen päätöksenteon kannalta. Väitöstutkimus lisää hyödyllisellä ja uudella tavalla tietojärjestelmätieteen tietämystä teknologioiden käyttöönottoon liittyen.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The objective of this experiment was to evaluate the effect of diet with high grain diets on the carcass tissue composition, the centesimal composition and the profile of the fatty acids deposited in the meat of Lambs finished in confinement, as well as the economical viability of the system. Thirty - eight male lambs, castrated, of the Texel breed, born of simple birth and weaned at approximately 50 days of age, were used. The treatments were constituted by different types of grains, unprocessed, being: corn grain, white oat grain, black oat grain or rice grain with bark. The animals were slaughtered when they reached the pre-established slaughter weight of 32 kg, which corresponds to 60% of the adult weight of their mothers. The lambs of the different treatments presented similarity as to the proportion of muscle. However, corn-based treatment lambs presented lower percentage of bone and higher amount of fat. Considering the cholesterol variable, the animals treated with black oats presented results lower than 90mg / 100g, and human health could be considered healthy in this approach. Grouping the fatty acids evaluated by degree of saturation, corn-based treatment lambs had the lowest results when compared to the others, but when evaluating these lipids individually, the animals of this treatment contained the highest proportion of fatty acids Undesirable when compared to treatments based on white oats, shelled rice or black oats. The polyunsaturated: saturated ratio also presented superior results for the lambs fed the corn grain diet when compared to the others. In order to evaluate the economic issue, consecutive historical quotations from 2003 to 2016 were considered. The univariate analysis was characterized by a completely randomized design, with four treatments and eight replications. The multivariate analysis consisted of clustering. By the univariate analysis, the only treatment that proved advantageous was the corn grain base, where values were found for gross margin of R $ 16.55; Net margin of R $ 10.45; Profit of R $ 12.59; Net present value of R $ 11.44; Benefit index: cost of 1.05; Additional return on investment of 2.4% a.m.; Internal rate of return of 3.3% a.m. and discounted payback of 1.91 months. By cluster analysis, corn treatment was also the one that presented the greatest discrepancy in relation to the other treatments, while the treatments based on white oats and black oats were the ones that presented the closest ones. Thus, meat from lambs confined to a high-fat diet, because it presents results close to those recommended for healthy consumption, can be ingested without risk to consumers, since human food consists not only of sheep meat but must be nutritionally balanced. The joint analysis of the financial indicators indicated the feasibility of the confinement of lambs with a high grain diet only for the treatment based on corn grain, determining economic unviability in this study for the other evaluated treatments. / O presente experimento, conduzido no Laboratório de Ovinocultura da Universidade Federal de Santa Maria, teve como objetivo avaliar o efeito da alimentação com dietas de alto grão, sobre a composição tecidual da carcaça, a composição centesimal e o perfil dos ácidos graxos depositados na carne de cordeiros terminados em confinamento, bem como a viabilidade econômica do sistema. Foram utilizados 32 cordeiros machos, castrados, da raça Texel, nascidos de parto simples e desmamados com aproximadamente 50 dias de idade. Os tratamentos foram constituídos por diferentes tipos de grãos, não processados, sendo: grão de milho, grão de aveia branca, grão de aveia preta ou grão de arroz com casca. Os animais foram abatidos quando atingiram o peso vivo de abate pré-estabelecido de 32 kg, que corresponde a 60% do peso adulto de suas mães. Os cordeiros dos diferentes tratamentos apresentaram similaridade quanto a proporção de músculo. Porém, os cordeiros do tratamento a base de grão de milho apresentaram menor percentagem de osso e superior quantidade de gordura. Já considerando a variável colesterol os animais tratados com aveia preta apresentaram resultados inferiores a 90mg/100g, podendo ser considerado salutar a saúde humana nesta abordagem. Agrupando os ácidos graxos avaliados por grau de saturação, os cordeiros do tratamento a base de grão de milho apresentaram os menores resultados quando comparados aos demais, mas ao avaliar individualmente estes lipídios contatou-se que os animais desse tratamento continham a maior proporção de ácidos graxos não desejáveis quando comparado aqueles dos tratamentos a base de aveia branca, arroz com casca ou aveia preta. A relação poliinsaturado:saturado também apresentou resultados superiores para os cordeiros alimentados com a dieta a base de grão de milho quando comparado aos demais. Para avaliar a questão econômica foram consideradas cotações históricas consecutivas dos anos de 2003 a 2016. A análise univariada caracterizou-se por delineamento inteiramente casualizado, com quatro tratamentos e oito repetições. A análise multivariada consistiu em agrupamento (cluster). Pela análise univariada, o único tratamento que se mostrou vantajoso foi o a base de grão de milho, onde foram encontrados valores para margem bruta de R$ 16,55; margem líquida de R$ 10,45; lucro de R$ 12,59; valor presente líquido de R$ 11,44; índice benefício:custo de 1,05; retorno adicional sobre o investimento de 2,4% a.m.; taxa interna de retorno de 3,3% a.m. e payback descontado de 1,91 meses. Pela análise de cluster, o tratamento a base de milho também foi o que apresentou maior discrepância em relação aos demais tratamentos, enquanto que os tratamentos a base de aveia branca e aveia preta foram os que se apresentaram mais próximos. Assim a carne proveniente de cordeiros confinados com dieta de alto grão, por apresentar resultados próximos aos preconizados para o consumo salutar, pode ser ingerida sem proporcionar risco aos consumidores, uma vez que a alimentação humana não consiste apenas em carne ovina devendo ser nutricionalmente balanceada. A análise conjunta dos indicadores financeiros indicou viabilidade do confinamento de cordeiros com dieta de alto grão somente para o tratamento a base de grão de milho, determinando inviabilidade econômica neste estudo para os demais tratamentos avaliados.

Health information technology (HIT) aims to improve healthcare services by means of technological tools. Patient centered technologies such as personal health records are relatively new HIT tools that enable individuals to get involved in their health management activities. These tools enable the transformation of health consumer behavior from one of passive health information consumers to that of active managers of their health information. This new role is more interactive and engaged, and with such tools, patients can better navigate their lives, and exercise more control over their treatments, hence potentially also leading to improvement in the quality of health services. Despite the benefits of using personal health record systems for health consumers, the adoption rate of these systems remains low. Many free and paid services have not received the uptake that had been anticipated when these services were first introduced. This study investigates some factors that affect the adoption of these systems, and may shed light on some potential reasons for low adoption rates. In developing the theoretical model of this study, social cognitive theory (SCT) and technology acceptance model (TAM) were utilized. The theoretical model was validated through a quantitative survey-based methodology, and the results were derived using structural equation modeling techniques. The key findings of this study highlight the role of individual and environmental factors as determinants of end-user behavior in the adoption of personal health records. The results show that in addition to perceptions of usefulness and ease of use, factors such as social norms and technology awareness are also significantly associated with various factors that directly and indirectly affect intention to use PHRs Based on the results obtained in this study, recommendations are offered for technology providers, and possible directions are proposed for academic researchers.

abstract: Sensitive data sharing presents many challenges in case of unauthorized disclosures, including stigma and discrimination for patients with behavioral health conditions (BHCs). Sensitive information (e.g. mental health) warrants consent-based sharing to achieve integrated care. As many patients with BHCs receive cross-organizational behavioral and physical health care, data sharing can improve care quality, patient-provider experiences, outcomes, and reduce costs. Granularity in data sharing further allows for privacy satisfaction. Though the subjectivity in information patients consider sensitive and related sharing preferences are rarely investigated. Research, federal policies, and recommendations demand a better understanding of patient perspectives of data sensitivity and sharing. The goal of this research is to enhance the understanding of data sensitivity and related sharing preferences of patients with BHCs. The hypotheses are that 1) there is a diversity in medical record sensitivity and sharing preferences of patients with BHCs concerning the type of information, information recipients, and purpose of sharing; and 2) there is a mismatch between the existing sensitive data categories and the desires of patients with BHCs. A systematic literature review on methods assessing sensitivity perspectives showed a lack of methodologies for characterizing patient perceptions of sensitivity and assessing the variations in perceptions from clinical interpretations. Novel informatics approaches were proposed and applied using patients’ medical records to assess data sensitivity, sharing perspectives and comparing those with healthcare providers’ views. Findings showed variations in perceived sensitivity and sharing preferences. Patients’ sensitivity perspectives often varied from standard clinical interpretations. Comparison of patients’ and providers’ views on data sensitivity found differences in sensitivity perceptions of patients. Patients’ experiences (family history as genetic data), stigma towards category definitions or labels (drug “abuse”), and self-perceptions of information applicability (alcohol dependency) were influential factors in patients’ sensitivity determination. This clinical informatics research innovation introduces new methods using medical records to study data sensitivity and sharing. The outcomes of this research can guide the development of effective data sharing consent processes, education materials to inform patients and providers, granular technologies segmenting electronic health data, and policies and recommendations on sensitive data sharing. / Dissertation/Thesis / Doctoral Dissertation Biomedical Informatics 2020

eHealth is commonly defined as health services and information provided through the Internet and related technologies. Health educators have taken advantage of Internet and social media venues to disseminate health information essential to health risk management, disease prevention, and disease management and did not have a validated theoretical model to explain their experiences. The goal of this study was to create and test an integrated model of eHealth communication specific to 18-30 year old college students based on five research questions that identified and confirmed the factors most highly correlated with the presentation of health information on Internet or social media venues that improve eHealth literacy and provoke eHealth behavioral intention among college students. A sample of over 1400 18-30 year old college students was surveyed about their general and health information related use of the Internet and social media. As a result of exploratory factor analysis and subsequent structural equation modeling, the proposed theoretical model was revised and tested for statistical power. Two revised integrative models of eHealth communication, one for Internet and one for social media, were developed and validated. The model for social media shows statistically significant paths throughout the model; however, the model for the Internet reveals that the path between two constructs and Online Health Behavior are not statistically significant and is worthy of further examination. This study has important practical implications for eHealth educators, organizations dedicated to informing the public about specific diseases or health promotion techniques, health practitioners seeking improved strategies for effective eHealth message design, and to health information professionals.

Background: Cancer is a leading cause of death around the world and often is a chronic long term disease. This calls for an expanded workforce to include non-traditional health care providers. Objective: To determine effectiveness of a cancer information training project with clergy from selected rural Appalachian areas to improve comfort and willingness to work as part of the cancer health care team. Methods: Clergy were trained in the consumer health database of the National Library of Medicine MedlinePlus.gov. Exercises were required that were done using an iPad tablet with an online curriculum. They were also taught how to do a population health assessment of their particular area and develop a health ministry for their church. Results: Three key elements were confirmed that would enable replication of the pilot: access to medlineplus, programmed learning modules using mobile technology such as iPads, and staff support including librarians and medical staff. With these key elements, the cancer project is potentially replicable with other groups beyond clergy. Conclusion: about population health, built on new awareness and topical health knowledge, and using new skills to identify relevant information and library resources, could open minds and enhance community support for preventive and medical interventions.

La utilització d'Internet com a font d'informació sanitària és molt freqüent. La qualitat d'aquesta informació és extraordinàriament variable. Els segells de qualitat presents a les webs mediques, concedits per sistemes d'acreditació, constitueixen un instrument de millora dels serveis d'informació sanitària a Internet.A la present tesi s'analitzen les propostes i recomanacions de les principals iniciatives d'acreditació, s'estudia la percepció que tenen els responsables de webs mediques respecte a la utilitat dels segells d'acreditació i la prevalença d'ús d'aquests segells en les webs de contingut sanitari.Conclusions: la gran diversitat de recomanacions d'acreditació dificulta l'estandardització, els responsables de webs sanitàries reconeixen que el segell de WMA influeix positivament en la qualitat d'aquestes webs i existeix un ús moderat dels segells de qualitat i les webs que els presenten acostumen a ser de millor qualitat que el resta. / La utilización de Internet como fuente de información sanitaria es muy frecuente. La calidad de esta información es extraordinariamente variable. Los sellos de calidad presentes en las webs médicas, otorgados mediante sistemas de acreditación, constituyen un instrumento de mejora de los servicios de información sanitaria en Internet.En la presente tesis se analizan las propuestas y recomendaciones de las principales iniciativas de acreditación, se estudia la percepción que tienen los responsables de webs médicas respecto a la utilidad de los sellos de acreditación y la prevalencia de uso de dichos sellos de calidad en las webs de contenido sanitario. Conclusiones: la gran diversidad de recomendaciones de acreditación dificulta la estandarización, los responsables de webs sanitarias reconocen que el sello de WMA influye positivamente en la calidad de dichas webs, existe un uso moderado de los sellos de calidad y las webs que los presentan acostumbran a ser de mejor calidad que el resto. / The use of Internet as a health information source is very common. The quality of this information is widely variable. The quality seals and trust marks owned by the medical websites and granted by accreditation programmes, are good tools to improve the health services on the Internet. In this dissertation the different guidelines of the main accreditation programmes are analysed. The perception of the responsible personnel in charge of medical websites on the accreditation seal usefulness is studied as well as the prevalence usage of the quality seals in these web sites. Conclusions: the standardization is very difficult considering the wide number of guidelines and quality criteria. The responsible personnel in charge of medical websites admit that the WMA seal has a positive influence in the quality of their websites and that the seals are moderately used although the webs presenting them are usually of a higher quality then the rest.