Objective: The population for this project is Hispanic migrants who have limited English proficiency. They have a low education level, and this is accompanied by a lack of exposure to health education. The objective is too increase health knowledge of participants about: diabetes, importance of early prenatal care, and importance of early detection of breast cancer, as well as increase awareness of drug and alcohol abuse and depression. Methods: The project will partner with the church, Nueva Esperanza, to provide health education to the Hispanic migrant and seasonal farmworker population in the area. The church’s existing theater group will be trained to be volunteer lay health promoters and will get additional training in using theater to provide health education. Skits will be performed at migrant farmworker camps, parks, and churches on the following topics: alcohol and drug abuse, depression, diabetes, early prenatal care, and breast cancer. The goal is that 12 volunteer promoters will be able to provide basic health education in their community so that 640 people will receive health education in at least 2 of the following topics: depression, drug and alcohol abuse, diabetes, early prenatal care, and early detection of breast cancer.

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Saudi Arabia is among the countries that have very high prevalence rates of diabetes and hypertension, with prevalence rates of almost 18% and 25%, respectively. The majority of patients with diabetes and hypertension fail to manage their diseases and to show up for their follow up appointments. Mhealth technology is among the interventions that have been recently adopted to overcome these issues and improve the quality of healthcare services. This study aims to evaluate the effectiveness of a mobile phone application named diabetes and hypertension application (DHA Tracking) to promote adherence for patients with diabetes and hypertension in Mecca, Saudi Arabia. The proposed intervention was designed to promote adherence via two features, namely, refill medication reminder (RMR) and doctor appointment reminder (DAR). The third feature, which is managing the number of unnecessary visits, was covered by the cumulative blood sugar test (Hemoglobin A1c) for patients with their doctors. The study examined the difference in adherence level before the intervention and after the intervention with samples of n = 199 and n = 165 for diabetes and hypertension, respectively. The mhealth intervention was found to have significant effects on both the refill medication reminder and the doctor's appointment reminder. Also, it was found that the intervention was efficient in reducing the number of unnecessary follow-up visits to around 20%. This study supports the evidence in the literature on the effectiveness of mhealth in promoting adherence to medication for patients with chronic diseases in the developing countries and specifically in Saudi Arabia. Positive social change that may result from this study is for better management of chronic disease symptoms and increase the awareness of using mhealth applications. This would improve the quality of life for patients, their families, and the community.

The Mountain Gorillas of Central Africa are one of the most highly endangered species in the world, with only 740 individuals surviving. One of the greatest threats to this species is disease. Health of wildlife is continually garnering more attention in the public arena due to recent outbreaks of diseases such as West Nile and High Pathogenic Avian Influenza. However, no system currently exists to facilitate the management and analysis of wildlife health data. The research conducted herein was the development and testing of a health information monitoring system for the mountain gorillas entitled Internet-supported Management Program to Assist Conservation Technologies or IMPACT?. The system functions around a species database of known or unknown individuals and provides individual-based and population-based epidemiological analysis. The system also uses spatial locations of individuals or samples to link multiple species together based on spatial proximity for inter-species comparisons. A syndromic surveillance system or clinical decision tree was developed to collect standardized data to better understand the ecology of diseases within the gorilla population. The system is hierarchical in nature, using trackers and guides to conduct daily observations while specially trained veterinarians are used to confirm and assess any abnormalities detected. Assessment of the decision tree indicated that trackers and guides did not observe gorilla groups or individuals within groups similarly. Data suggests that, to be consistent, trackers and guides need to conduct observations even on the day that veterinarians collect data. Validity and reliability remain to be tested in the observation instrument. Assessment of pathogen loads and distributions within species surrounding the gorillas indicates that humans have the greatest pathogen loads with 13 species, followed by cattle and chimpanzees (11), baboon (10), gorillas (9), and rodents (3). Spatial aggregation occurred in Cryptosporidium, Giardia, and Trichuris; however, there is reason to question the test results of the former 2 species. These data suggest that researchers need to examine the impact of local human and domestic animal populations on gorillas and other wildlife.

The first part of this dissertation evaluates the effectiveness of food assistance by gathering evidence from developing countries and the United States. The first essay applies a multi-market model to three developing countries and simulate recent spikes in staple prices and food aid impacts. Results indicate that higher food prices would result in reduction in household real income and deterioration of household welfare. Food aid in the form of cash transfers targeted at low-income groups could improve household real income of the target group after world price shocks and, partially or completely, offset the negative impacts of higher food prices. The impact of cash transfer on untargeted groups is ambiguous. It is likely to be positive for households that are net producers of the commodities that have increased production and prices under cash transfer and the production surplus is sufficiently large. The second essay focuses on the Food Stamp Program (FSP), a cornerstone of food assistance safety net efforts in the U.S. to reduce household food insecurity, particularly among children. The essay examines the dynamic relationship between FSP participation and child food security using monthly measures. Empirical estimates using the Panel Study of Income Dynamics demonstrate that child food security declines in the months immediately prior to FSP entrance, but then partially recovers following program entrance. These dynamic FSP effects are masked when annual measures are employed. The third paper of this dissertation studies the potential impacts of patient's widespread use of online health information. In particular, the essay employs a principal agent model and focuses on the quality of online health information. The model shows that when the quality of health information improves, since medical consultations become more efficient and less costly, a higher effort will be induced or contracted from the physician. Diagnosis becomes more accurate, because physicians will try exert more effort in diagnosing patients and patients will suffer less loss from their illnesses. / Ph. D.

Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.

This thesis explores the statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. The research has been conducted in the broad Interpretist tradition, seeking to understand rather than merely explain human behaviour. A model depicting the health information and knowledge environment has been developed to show the how the infonnation behaviour of the various populations in the research are interpreted and where they are placed. The provision, access and use of health information by consumers is the focus of the inner core of the model and is the first theme of the thesis. Several discrete groups of the information poor are investigated to explore their information needs and behaviour. The middle layer of the model depicts the second theme of this thesis focusing on the attitudes of academics, health and social care professionals in their use and access of health information and IT in everyday practice. The information behaviour of the health information and library professional is the focus of the third theme of the thesis and is represented by the outer layer of the model. This theme explores the detail and the contribution of the role to the clinical team, the use of Evidence Based Medicine and Clinical Governance. Conclusions support the opening statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. Recommendations are made to promote better and more frequent use of health information and health information professionals in the everyday practice of health and social care; to improve the access and provision of health information for consumers.

Use of the Internet to retrieve health information is increasingly. Young adult search the Internet for health information more than any other group. The authors surveyed 789 undergraduate students at 12 academic institutions to examine their Internet use. This research intended to investigate the usage of web health information through structural questionnaires based on intention sampling from the Taiwanese undergraduates, including those who study after work. The amounts of returned questionnaires are summed up to 789 excluded those unanswered item of gender, age, and departments. This research used SPSS/PC10.0 as the statistic software. There are 520 females ¡]65.9%¡^ and 267 males¡]34.1%¡^ in the study¡FThe youngest one is 19 and the oldest is 55 while the average age is 22.7 years old and the standard error is 4.71.¡FThere are 385 students in health related departments ¡]48.8%¡^ and 404 students are in non-health related ones ¡]51.2%¡^. The main result of research is that almost 90% Taiwanese undergraduates started to use internet and E-mail before high school ¡FMost of them use internet at home ¡]91.8%¡^and the purpose is to search non-varsity work related information ¡]61%¡^. The main channel for these undergraduates to obtain health-related information is through radio station ¡]64.6%¡^while the internet placed the second choice¡]49.4%¡^. As to health information, there are 65.7% undergraduates have used the internet to search health information, there are high correlation between whether or not they use the internet and the students¡¦ age and departments, women has higher utilization rate than men and also non-health department has the same results. Those who ever use internet for health information are much more worried about the accuracy of internet health information than those who never use it. The non-health department students were anxious about using the internet for health information will lead to the ignorance of other ways to search health information. These students browse the internet at least once a month mainly for exercise or body-building information and then diet and nutrition. Women and health-related department perform higher rate on browsing frequency of internet health information than men and non-health related ones. The main reason for the willingness to use the internet as the tool to understand health information of these students is the facility of searching through internet. Compared with none-health related department students, health-related ones are much more willing to choose internet because they can obtain the information anonymously. For those who ever use internet health information, clearly classification of website information which met their need will be the first consideration, they also ask for the writers¡¦ profession at the same time. Therefore, these students conceptually have the ability to evaluate health information on internet. The health related department students will even address their questions or suggestions when they have problems with the information on internet. There are more than 70 percent of students agree that using internet health information have positive influence on them. It is a pity that only 107 students have ever browsed the health department websites of county or city government which are trusted by the public. There are only 63 students know the prompted of excellent mark for health information website by the department of health executive Yuan. However if they got the chance to see the mark of ¡§this website were appraise of excellent health information website by the department of health executive Yuan,¡¨ they will take great value on it and visit with high frequency. Finally, it is suggested that non-health related department should emphasize more on the propaganda of health information to the department with high proportion of male students, and to provide better environment to complement the regardless ness of health information among undergraduates. The government should also emphasize on promote excellent health information website and improve the proportion of access the website of health department in order to bring out better outcomes.

A decade ago, only 10% of U.S. healthcare organizations used an electronic health record (EHR), whereas more than 99% do today. The rapid adoption of EHRs has radically transformed communication of health information. Previously, health records consisted of providers handwriting notes in paper charts, rarely seen by outsiders. Today, EHRs integrate information from dozens of sources, to be used by providers, administrators, researchers, and increasingly, patients. Last year alone, an estimated 100 million Americans interacted with their own health records through patient-facing systems. This information has been used to prevent medical errors, reduce nonadherence to treatment, increase shared decision-making, and improve health outcomes. However, failure to comprehend this information can negate any potential benefits and even cause medically-harmful miscommunication. Therefore, it is critical to represent health information using methods that promote patients' comprehension. Despite the need for better representation, today's patient-facing systems do little more than present unexplained data, and limited guidance has been given by research or policy. In this thesis, we present new evidence about representation of health information in patient-facing systems, and we use this evidence to develop informatics methods that promote comprehension. Two aims center on (1) medical abbreviations and acronyms, one of the biggest barriers to patients' comprehension of their health records, and (2) changes in patient-reported outcomes, one of the most important informants of chronic disease management. We assess challenges with representing this information to patients, using randomized trials and qualitative studies. Then, we develop and evaluate an array of informatics methods for overcoming challenges, specifically: (1) machine learning methods for automated expansion of medical abbreviations and acronyms, and (2) information visualization methods for representing changes in patient-reported outcomes. In the future, these interventions can be implemented in patient-facing systems to optimize comprehension. Our evidence will guide strategies for meaningful communication that, ultimately, will build trust between patients and the healthcare system that serves them.

Indiana University-Purdue University Indianapolis (IUPUI) / The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system.