1. Chapter 16 by Kathleen Mastrian and Dee McGonigle
Supporting Consumer Information and Education Needs

2. Objectives Define health literacy and eHealth.
Explore various technology-based approaches to consumer health education.
Identify barriers to us of technology and issues associated with health-related consumer education.
Imagine future approaches to technology-supported consumer education.

3. Key Terms Defined Blog Digital Divide Domain Name Dynamic Media
Blog - Interactive, online “weblogs”; sometimes it is a combination of what is happening on the Web as well as what is happening in the blogger or the creator's life; unique as the blogger or person creating them; thought of as a diary and guide.
Digital Divide - Is the term used to describe the gap between those who have and those who do not have access to online information. Fox (2007b) reports that the current estimate of connectivity among Americans is 71%.
Domain Name - Series of alphanumeric characters that forms part of the Internet address or URL such as psu.edu that denotes Penn State’s address.
Dynamic Media - Health care organizations (HCOs) use a wide variety of approaches and tools to promote patient education and health literacy. While the old standby for disseminating information was and sometimes still is the paper-based flyer some HCOs are recognizing that today’s consumers are more attracted to a dynamic rather than static medium. In addition, the cost of designing and of printing pamphlets and flyers becomes prohibitive when one considers the rapidity of change of information. That is, the brochure may be outdated almost as soon as it is printed.

4. Key Terms Defined eBrochure eHealth eHealth Initiative Empowerment
eBrochure - Electronic brochure Patient education material that is typically tied to an agency web site, and may include such information as descriptions of diseases and their management, medication information, or where to get assistance with a health care issue.
eHealth - The development of nutrition education programs as interactive computer games, video games, and cartoons referred to as ‘edutainment’ (Flores 2006). These eHealth programs are developed specifically to appeal to the generational (highly connected and computer literate) and cultural needs of this group.
eHealth Initiative - Was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange, health literacy and health care delivery.
Empowerment - Promoting self-actualization; achieve power or control one’s own life.

5. Key Terms Defined Grey Gap Health Literacy HON Code Interactive Media
Grey Gap -A term used to reflect the age disparities in computer connectivity; there are fewer persons over age 65 who use computer technology than those in younger age groups. only 32% of persons over the age of 65 have ever gone online or lived in a connected household. Similarly, in another report from the Pew Internet group, Fox (2007a) describes connectivity disparities among various races and ethnicities, including Latinos, non-Hispanic whites, and non-Hispanic blacks, and analyzes the influences of English speaking ability and level of education on connectivity.
Health Literacy - The acquisition of knowledge that promotes the ability to understand and to manage one’s health. Some current technologies will be used increasingly to support health literacy. For example, audio and video podcasts may become more commonplace in health education, and be provided as free downloads from the web sites of HCOs. Voice recognition software used to navigate the web may reduce the frustration and confusion associated with attempting to spell complex medical terms. On the other hand, the confusion and frustration may increase if the patient/client is unable to pronounce the terms. Voice interactivity should help to reduce the disparity associated with those who have limited keyboard or mousing skills.
HON Code - The Health on the Net (HON) Foundation Survey (2005) describes the certifications and accreditation symbols that identify trusted health sites. The HONcode and Trust-e were identified as the two most common symbols that power users look for. The survey also indicates that Internet users look at the domain name and will frequently gravitate toward university sites (.edu), government sites (.gov) and HCO sites (.org). Fifty percent of the survey respondents were in favor of the use of a .health domain name to identify quality health information web sites.
Interactive Media - Communication media that permits the recipient to be an active participant.

6. Key Terms Defined Know-do Gap Static Media Trust-e Voice Recognition
Know-do Gap - reflects the fact that solutions to global health problems exist but are not implemented in a timely fashion because of the lack of access to important health information. The Internet connections in developing countries are widely scattered and may not be efficient/sufficient for viewing health care information. They describe the use of a free-standing hard drive that has been loaded with hundreds of CDs of health related information in a web page format that responds to a search command. This is a great example of providing technologies that work with the constraints of the situation. Another example of addressing the digital divide is the growing number of health related web sites that support a Spanish language format.
Static Media - Cannot be updated; the print-based brochure may be outdated almost as soon as it is printed.
Trust-e - The Health on the Net (HON) Foundation Survey (2005) describes the certifications and accreditation symbols that identify trusted health sites. The HONcode and Trust-e were identified as the two most common symbols that power users look for. The survey also indicates that Internet users look at the domain name and will frequently gravitate toward university sites (.edu), government sites (.gov) and HCO sites (.org). Fifty percent of the survey respondents were in favor of the use of a .health domain name to identify quality health information web sites.
Voice Recognition - Software used to navigate the web may reduce the frustration and confusion associated with attempting to spell complex medical terms. On the other hand, the confusion and frustration may increase if the patient/client is unable to pronounce the terms. Voice interactivity should help to reduce the disparity associated with those who have limited keyboard or mousing skills.

7. Key Terms Defined Web Quest Weblog
Web Quest - Search the www for information.
Weblog- “A blog (a portmanteau of web log) is a website where entries are commonly displayed in reverse chronological order. "Blog" can also be used as a verb, meaning to maintain or add content to a blog.Many blogs provide commentary or news on a particular subject; others function as more personal online diaries. A typical blog combines text, images, and links to other blogs, web pages, and other media related to its topic” (Wikipedia, 2008, ¶ 1).

8. Consumer Demand for Information
Consumer Empowerment
The Pew Internet and American Life Project Survey and It’s Limits
Digital Divide
More and more people, in a trend known as consumer empowerment, are interested in taking control of their health and are not satisfied being dependent on a health care provider to supply them with information.
The Pew Internet and American Life Project survey report of 2006 (Fox 2006) indicates that 8 in 10 of Americans who are online have searched for health information.
It is important to note that this survey is limited to those who are online, and does not reflect the health information needs or demands of those who are not online.
The digital divide is the term used to describe the gap between those who have and those who do not have access to online information.

9. Consumer Demand for Information
Impact of Technology
The Know-Do Gap
Missen and Cook (2007), discuss the potential impact that technology based health information dissemination can have on the know-do gap in developing countries.
The know-do gap reflects the fact that solutions to global health problems exist but are not implemented in a timely fashion because of the lack of access to important health information.

10. Health Literacy and eHealth Initiatives
The Goal of Health Literacy
Informed Patients vs. Poorly Informed
Healthy People 2010
The eHealth Initiative
The goal of health literacy for all is one that is widely embraced in many sectors of health care, and a major goal of Healthy People 2010.
Those of us who have been practicing for some time recognize that informed patients have better outcomes and pay more attention to their overall health and changes in their health than those who are poorly informed.
Healthy people 2010 defines health literacy as, "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions".
The eHealth Initiative (eHI) was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange, health literacy and health care delivery.

11. Health Care Organization Approaches to Education
Patient Education Information is Stored Electronically
HCO Sponsored Health Promotion Education Classes
HCO’s Taking Advantage of Informed Patients and Families
Information Must Get to All
One approach is to have patient education information stored electronically so that changes can be made as needed or information can be better tailored to the specific patient situation and then printed out and reviewed with the patient.
Many HCO’s sponsor health promotion education classes as a way of marketing their facilities and showcasing some of their expert practitioners.
HCO’s are now also taking advantage of the fact that patients and families are captive audiences in waiting rooms and promote education via pamphlet distribution, health promotion programs broadcast on TV, and health information kiosks.
One caution, however, is that just because the information is made available does not mean that people will participate or that they will understand what they have experienced.

12. Promoting Health Literacy in School Aged Children
The Challenges of Promoting Health Literacy
The Children’s Nutrition Research Center
Interdisciplinary WebQuest
Interdisciplinary Approach of The Quest
Promoting health literacy in school aged children presents special challenges to health educators.
The Children’s Nutrition Research Center has responded to these challenges by supporting the development of nutrition education programs as interactive computer games, video games, and cartoons referred to as ‘edutainment’ (Flores 2006).
Donovan (2005) describes an Interdisciplinary WebQuest designed to appeal to older school aged children.
The Quest is interdisciplinary in that it requires reading comprehension, critical thinking, presentation, and writing so that core skills and health literacy skills are learned in a single assignment.

13. Promoting Health Literacy in School Aged Children
Nursing and The Computer Age
Patients and The Computer Age
Nurses and other health care providers need to embrace the Internet as a source of health information for patient education and health literacy.
Patients are increasingly turning there for ‘instant’ information about their health maladies.

14. Patient Education The Health on the Net (HON) Foundation Survey
The HONcode and Trust-e
The Pew Internet Survey.
MedlinePlus
The Health on the Net (HON) Foundation Survey (2005) describes the certifications and accreditation symbols that identify trusted health sites.
The HONcode and Trust-e were identified as the two most common symbols that power users look for.
The Pew Internet Survey (2006) indicates that nearly 75% of online searchers do not check the date or the source of information they are accessing on the web and 3% of online health seekers report knowing someone who was harmed by following health information found on the web.
The US National Library of Medicine and the National Institutes of Health sponsor MedlinePlus a web site that has a tutorial for learning how to evaluate health information as well as an electronic guide to web surfing that is available in both English and Spanish.

15. Future Directions Predicting the Future
Interactive Behavior Change Technology
The Goal of the IBCT
Predicting future directions for technology based health education is somewhat difficult, because we may not be able to completely envision the technology of the future.
Piette (2007) describes the use of Interactive Behavior Change Technology (IBCT) to improve the effectiveness of diabetes management.
The goal of the IBCT is to improve communication between patients and health care providers and provide educational interventions to promote better disease management between visits.

16. Thought Provoking Questions
How do you envision technology enhancing patient education in your setting?
Formulate a plan evidencing a potent patient education episode on MRSA. Provide a rationale for each approach and describe a tool you would use to educate the patient and his/her family.