Sabrina Kurtz-Rossi - eHealth and Older Adults

transcript

Sabrina KurtzSabrina Kurtz--Rossi, M.Ed.Rossi, M.Ed. Health Literacy ConsultantHealth Literacy Consultant

KurtzKurtz--Rossi & AssociatesRossi & Associates

Sabrina_kurtzSabrina_kurtz--rossi@comcast.netrossi@comcast.net

Member Clear Language GroupMember Clear Language Group

www.clearlanguagegroup.comwww.clearlanguagegroup.com

Eighty-three year old Virgil Heidbrink has found

what he thinks is the perfect place to retire. He’s met

interesting people there. They share their life stories

and favorite jokes. And he’s convinced that the new

social connections are keeping him young in spirit.

Case Example

Bob Moos, The Dallas Morning News Oct 12, 2009

Mr. Heidbrink spends 3 – 4 hours a

day on the Internet where he writes his

blog and answers email. A computer

coach helped the resident at the

Edgemere retirement community in

Dallas build and maintain his website.

www.virgilsviews.com

Case Example

Objectives – Workshop

Discuss the opportunities and challenges of the Internet for older adults

Apply strategies to improve the health information literacy skills of seniors and their caregivers

Review teaching resources to support seniors and caregivers use the Internet to find health information

Identify features that improve the usability of health information websites for seniors

What are the Challenges?

Health literacy among older adults

Readability of health information

Access to computers and the Internet

Accuracy and reliability of information

Health information literacy skills

Health Literacy in the U.S.

Over 75 million adults have Basic and Below Basic health literacy

Seniors have the lowest health literacy

Only 12% total (3% seniors) have proficient health literacy

Number & Percent of Adults in Each Health Literacy Level

Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

Readability of Health Information

Numerous studies show the mismatch between patient skills and the readability of health materials (Meade 1989, Davis 1990, Dollahite 1995, Stevens 2007, Vallance 2008, Bergman 2010 )

More recent studies look at the readability and usability of health information on the Internet (Berland 2001, D’Allesandro 2001, Fogel 2003, Birru 2004, Leroy 2008, McInnes 2011)

Medicare Website

www.medicare.gov

Activity

Use www.Medicare.gov to find the following:

Tips for how to prevent fraud

Medicare & You Handbook in Spanish

Eligibility criteria for home health care services

List of Medicare Health Plans with drug coverage in your area

Medicare Website Usability Study

69% could not determine eligibility for home health care services

80% could not find their local agency

57% could not make decision about Medicare Part D

72% could not follow the steps needed to select a plan

Source: Czaja, S. et al. (2008) Usability of Medicare Health Web Site. JAMA. 300(7):790-792. Available at: http://jama.ama-assn.org/cgi/content/full/300/7/790-a

The Fastest Growing Online Population – Seniors!

2004 2005 2006 2011

29% 34%

Internet Use by Seniors Age 65 and Older Over Time Percent

Source: Fox, S. (2004). Older Americans and the Internet; Fox, S. (2006). Online Health Searches; Usage Over Time. Pew Internet and American Life Project. Available at: http://www.pewinternet.org

Seniors Online

42% of adults age 65 and older are online

Seniors with higher incomes more likely to be online

Seniors with higher education more likely to be online

Source: Kaiser Family Foundation (2005). E-Health and the Elderly: How Seniors Use the Internet For Health Information. Available at: www.kff.org

Seniors Off-line

Majority of non-users are age 65 and older

“Truly Unconnected” tend to be even older

Concerned about content and safety

Too expensive, don’t have the time

Don’t need it, and don’t want it

Too complicated and hard to use

Don’t have a computer or Internet access

Source: Lenhart, A. (2003). The Ever-Shifting Internet Population. Pew Internet and American Life Project. Washington, DC. Available at: www.pewinternet.org/pdfs/PIP_Shifting_Net_Pop_Report.pdf

Health Information and the Internet

80% of Internet users search for health information

86% do not seek advice about which websites to use

72% express trust in most or all information found online

75% rarely or never check for source and date

Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American Life Project. Available at: http://www.pewinternet.org/PPF/c/5/topics.asp

42% of adults age 65 and older are online

Caregivers Online

Half of health searches are for someone else

Among e-caregivers (those who help others)

36% found health care advice

34% found health care services

26% found information to compare options

58% said the Internet was their most important resource

Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC. Available at: www.pewinternet.org

Affects on Health

58% said the Internet affected a decision they made about treatment

55% changed their approach to maintaining their health

44% changed the way they think about diet, exercise, or stress

39% changed how they cope with chronic disease or chronic pain

Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC. Available at: http://www.pewinternet.org

A real drug. A real disorder. A spoof

Focused Outreach Health Information Literacy

National Network of Libraries of Medicine – New England Region (NN/LM NER) http://nnlm.gov/ner/

Program Goals

Increase access health information for communities experiencing health disparities

Collect formative and summative evaluation data for program improvement

Three Phases, Two Communities

1. Community Assessment Key informant interviews

2. Focused Outreach Implementation Tailored efforts based on assessment findings

Community-based partnerships

3. Evaluation Outcome measures: pre-post training evaluations,

follow-up assessment

Process measures: story-based evaluation, community partner exit interviews

1. Western Maine (rural)

2. Providence, RI (Latino)

Community Assessment Western Maine, Rural Seniors

Findings (n=9)

Rural with growing senior population

Growing African immigrant community

Healthy communities coalitions as partners

Strong school health program

Broadband is limited

Libraries offer public access

Focused Outreach Implementation Western Maine, Rural Seniors

Tailored Approach

Core outreach activities (professional trainings, consumer education, and materials) targeted to the needs of seniors

Established partnerships with healthy communities coalitions and provided stipends for outreach activities

Promoted NLM resources (MedlinePlus, NIHSeniorHealth) via trainings, exhibits, libraries, senior services, etc.

Evaluation Results Western Maine – Rural Seniors

Outputs

Consumers reached (n=154)

Consumer pre-/post-training evaluations (n=85)

Consumer follow-up (n=13 )

Service providers trained (n=98)

Service provider pre-/post-training evaluations (n=82)

Service provider follow-up (n=28 )

Consumer Pre-training: Age of Respondents

0.0% 3.7%

18 - 24 years old

25 - 34 years old

35 - 49 years old

50 - 64 years old

Over 64 year old

Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School

Consumer Pre-training: Use of the Internet

Never 34.9%

Sometimes 27.7%

Every day 36.1%

Never Sometimes Every day

Consumer Pre-training: Where Respondents Access the Internet

Home School Work Library I don't use the Internet

Consumer Pre/Post-training: Ever Used NLM Resources

MedlinePlus NIHSeniorHealth

Pre-Training

Post-Training

Pre N=82

Post N=62

Consumer Pre/Post-training: Confidence in Ability to Find Health Information Using the Internet

Confident Not Sure Not Confident

Pre-training

Post-training

Pre N=81

Post N=65

Consumer Post-training: Likely to Use MedlinePlus in the Future

Likely 67.7%

Not sure 16.1%

Not likely 16.2%

Likely

Not sure

Not likely

Consumer Post-training: Likely to Use NIHSeniorHealth in the Future

Likely 66.1%

Not sure 15.4%

Not likely 18.4% Likely

Not sure

Not likely

Consumer Follow-up: Used NLM Resources

Service Provider Post-training: Likely to Use NIHSeniorHealth in their Work

Likely 83%

Not Sure 14%

Not Likely 3%

Likely

Not Sure

Not Likely

Service Provider Follow-up: Used NLM Resources

Service Provider Follow-up: Shared NLM Resources with Others

N=27 69%

Co-worker / other service provider

Client / other community member

Teaching Observations

Seniors are hungry for health information

Seniors are eager to learn

Learning a new technology is very stressful to some

Very few seniors are “truly unconnected”

Auburn Public Library Computer Training Class

NIHSeniorHealth: Helping Older Adults Search for Health Information Online: A Toolkit for Trainers

Teaching Resources

http://nihseniorhealth.gov/toolkit/toolkit.html

Health Information Literacy

Health information literacy is the ability to:

Recognize a health information need

Identify sources and use them to find health information

Assess the quality of the information and its usefulness

Understand and use the information to make informed health care decisions

Definition of Health Information Literacy Medical Library Association (MLA) Task Force, 2003

Core Content

How do you know if the information you find on the Internet is accurate (correct) and reliable (trustworthy)?

Who developed the website? Do you trust them?

When was it last updated? Is it current?

What is the purpose? Is it biased in anyway?

Source: Kurtz-Rossi S, Duguay P. (2010). Health Information Literacy Outreach: Improving Health Literacy and Access to Reliable Health Information in Rural Oxford County Maine. Journal of Consumer Health on the Internet. 14:4, 325-340. http://www.pewinternet.org

Teaching Tips

Provide hands-on practice

Repetition, go slow

Use health topics of interest

Provide access to computers

Teach small groups

Usability Issues

Vision: non-text, color, small print, PDF files

Hearing: audio files, video, tutorials

Motor: key board, small links

Cognition: complex content or navigation

Literacy: technical language, too much information

Universal Design

Section 508 Standards

Federal requirements for technology accessibility

Online tools to test 508 accessibility

http://www.cynthiasays.com/

http://wave.webaim.org

Source: Eichner, J. Accessible Health Information Technology (IT) for Populations with Limited Literacy. AHRQ, US DHHS. (2007). Available at: http://www.heatlhlit.ahrq.gov

Plain Language 2.0

Use “living room” language

Speak in active voice

Provide glossary

Use headers

Chunk information

Avoid acronyms

Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at: http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf

Plain Language 2.0

Design

Use larger (12 or 14 point) sans serif font

Limit use of bold, italics and other font features

Leave plenty of white space

Use upper and lower case letters

Be careful with colors

Include text with icons

Plain Language 2.0

Navigation

Minimize scrolling

Step by step navigation, show “breadcrumbs”

Consistent layout

Include non web-based contact information

Make buttons large and easy to use

Provide search function

Plain Language 2.0

Multi-Media

Use short segment to reduce download time

Provide text alternative (e.g. open caption or print version) for all animation, video, audio

NIHSeniorHealth.gov

NIHSeniorHealth Videos

NIHSeniorHealth.gov

MedlinePlus.gov

MedlinePlus.gov 49

Healthfinder.gov 50

Healthfinder.gov 51

Recommend Websites

MedlinePlus.gov

NIHSeniorHealth.gov

Healthfinder.gov

cdc.gov/aging

Recommended Resources

NIHSeniorHealth Toolkit http://nihseniorhealth.gov/toolkit/toolkint.html

Health literacy online: A guide to writing and designing easy-to-use health Web sites http://www.health.gov/healthliteracyonline/ Web_Guide_Health_Lit_Online.pdf

Questions and Comments

Sabrina Kurtz-Rossi Health Literacy Consultant

Kurtz-Rossi & Associates

Phone: 781-835-6488; Fax 781-391-4409

sabrina_kurtz-rossi@comcast.net

Member Clear Language Group

www.clearnlanguagegroup.com

Thank you