Rebecca Hegel, MS, RNTeresa Smith, MS, RNKim Stote, PhD, MPH, RD

MOBILE LEARNING INCONSUMER HEALTH

Objectives

•Define health literacy and its impact on vulnerable populations

• Identify criteria to determine credibility of online sites for health care

•Explore mobile applications for use in consumer health

Health Literacy

•What is Health Literacy?

•Significance

•Vulnerable Populations

•Relationship between Literacy & Health

•Research• Cancer, Diabetes, and Hypertension

Interactive Activity

Google, Yahoo, MSN (Bing), AOL• Calories in an Apple

Google: CalorieKing: 53, CalorieCount.about.com: 77Yahoo: CalorieKing: 53, Juicingforweigtloss.com: 53Bing: CalorieKing: 53, Apple.net: 77AOL: ????

•High Blood PressureGoogle: WebMD, www.nhlbi.nih.govYahoo: Health.Yahoo.com, WikipediaBing: Health.msn.comAOL: ?

Health Literacy

• Ability to understand health information and use that information to make good decisions about your health and medical care

• About 1/3 of the population of the United States has limited health literacy

•Did you know…..• …..studies show that 40% - 80% of what is said by your

doctor is forgotten by the time you leave the office

Factors that Affect Health Literacy

• Health care language – use of words that patients don’t understand

• Low educational skills – reading skills

• Cultural barriers to health care

• Limited English proficiency

• Learning disabilities

• Cognitive decline

Vulnerable Populations•Older adults (age +65)

•Minority populations

• Immigrant populations

• Low income

• The medically underserved

• People with chronic mental and/or physical conditions

What does the Research Say?•Low health literacy is linked with:

•Higher rates of hospitalization

•Higher use of emergency services

• Poorer health outcomes

Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf

Cancer and Health Literacy•Low literacy adversely impacts:

• Incidence of cancer

•Mortality from cancer

•Quality of Life

Diabetes and Health Literacy

•Low literacy is independently associated with:

•Worse blood sugar (glycemic) control

•Higher rates of eye disease that may affect vision (retinopathy)

•More diabetes-related complications

Hypertension and Health Literacy

•Low health literacy in this population (48%) even with formal educational classes, showed:

• Significantly less knowledge of the disease

• Less lifestyle modification

• Lower self-management skills

Health Literacy References

•National Network of Libraries of Medicine (2012). Health literacy. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

• Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf

Credibility of Medical Websites

•Americans use search engines more than doctors for obtaining health and medical information• Marketingcharts.com

•Google is most often the first place of contact for health information• Business Noise - Vandergriend.com

•Several popular sites related to health information

Most Popular Medical Websites

Marketing Information

Varies somewhat by the marketing research

#1 site overall…?

WebMD

Other Popular Sites

Yahoo!HealthMedicineNet.comHealthCentral.comMayoClinic.comNIH.govCDC.govHealth A to Z

(myoptumhealth.com)

Wrong Diagnosis (.com)

Medical Library Association•Criteria for Site Selection

• The site’s sponsor should be easy to identify; this may be evident in the address itself (.gov, .edu, .org, .com)

• The site should be updated frequently with the date of most recent revisions apparent

• Information should be clear, factual, and evidence-based

• Clear information on the intended audience should be provided (consumer versus professional)

• http://www.mlanet.org/resources/userguide

Health on the Internet (HON) Code of Conduct

• “HON was founded to encourage the dissemination of quality health information for patients and professionals and the general public, and to facilitate access to the latest and most relevant medical data through the use of the internet.”

• “The HONcode certification is an ethical standard aimed at offering quality health information. It demonstrates the intent of a website to publish transparent information. The transparency of the website will improve the usefulness and objectivity of the information and the publishment of correct data.”

• http://www.hon.ch/HONcode/Patients/Visitor/visitor.html

MLA – Deciphering Medspeak

MLA’s “Top Ten”…

• NOAH: New York Online Access to Health (http://www.noah-health.org/• MedlinePlus (http://medlineplus.gov/)• MayoClinic (http://www.mayoclinic.com/)• Kidshealth® (http://www.kidshealth.org/)• HIV InSite (http://hivinsite.ucsf.edu/)• Healthfinder® (http://www.healthfinder.gov/)• familydoctor.org (http://familydoctor.org/)• Centers for Disease Control and Prevention (http://www.cdc.gov/)• Cancer.gov (http://www.cancer.gov/)

MLA – Recommends Sites for:

•Cancer

•Diabetes

•Heart Disease

Complementary and Alternative Medicinehttp://nccam.nih.gov/health/webresources

Internet Search: A hypochondriac’s best friend?• “Details of a new study examining how symptoms presented online influence people’s reactions to possible medical conditions will be presented in Psychological Science, a journal of the Association for Psychological Science” (Newberg, 2012).• People are more likely to go online to search on symptoms

than go to their doctor• > 60% of people feeling ill go to the internet for information• Follow-up with a doctor is based on what they find

• Research on cancer-seeking information • People perceive a higher disease risk when symptoms are

identified in “streaks” – sequences of items on a list

Medical Implications of the Study•Presentation of symptoms online:

• To increase awareness of an emerging health issue that requires treatment, group symptoms together that will more likely be checked off in sequence.

• According to Votruba, “If there are concerns that the perceptions of disease risk are too high, possibly resulting in over utilization of health services, then symptom lists should alternate common and specific symptoms or create longer symptom lists” (as cited in Newberg, 2012).

• “Previous research shows that perception of risk of disease is a powerful predictor of health preventative behavior (such as going to the doctor),” Kwan said. “How information is presented online will make a substantive difference in behavior (as cited in Newberg, 2012).

• Newberg, J. (2012, May 12). Internet search: A hypochondriac's best friend? [Peer commentary on research by Virginia Kwan, Sean Wojcik, Talya Miron-shatz, Ashley Votruba, and Christopher Olivola ]. Retrieved from http://researchmatters.asu.edu/stories/internet-search-hypochondriacs-best-friend-2183

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Mobile Technology

•Computer devices that are intended to be always on and carried on the person throughout the day (i.e., during normal daily activities)

•Mobile technologies support the collection and analysis of health-related information in real-time and in the real world

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Mobile Technology

• Pew Internet and American Life Project:

• 82% of American adults have a cell phone

• approximately three in 10 Americans have accessed medical information

• 10% have Apps that assist in managing a health condition

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Health and Medical Apps

• Apps• Sophisticated programs or special applications designed for mobile technology

• Sources of •Health and medical information (education)• Patient self-management tools

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Health and Medical Apps

• Rapid growth

• iTunes App Store • 8600 health and medical Apps

• Health insurance payers (Blue Cross Blue Shield), healthcare providers (Mayo Clinic), laboratory companies (Quest Diagnostics)

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Health and Medical Apps• Driven by:

• Consumer demand (improved productivity and cost reduction)

• Provider acceptance

• Participation of major technology companies (Microsoft, Intel, Google, Qualcomm, Apple, Nokia)

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Mobile Health

• Limited evidence about how well and under what circumstances mobile technology compare with or enhance current means to improve health and healthcare

• Concerns with availability of mHealth to all segments of the population

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Activity

• What do you want in a health and medical App?

• What is your favorite health and medical App?

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Health Conditions - Apps

•Heart Health •HeartWise Blood Pressure Tracker•Quickly records and keeps track of systolic and diastolic blood pressure, resting heart rate and weight

http://itunes.apple.com/us/app/heartwise-blood-pressure-tracker/id311716888?mt=8

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Health Conditions - Apps

•Blood Sugar Tracker

• Blood Sugar Tracker allows the user to easily log blood sugar levels, set target blood glucose ranges, and view history and simple graphs to quickly identify numbers that are out of range

http://itunes.apple.com/us/app/blood-sugar-tracker-by-healthycloud.com/id398293939?mt=8

Health Conditions - Apps•Vree for Diabetes

• Vree for Diabetes is a portable resource for managing diabetes

• The app includes diabetes education resources to better understand Type 2 diabetes and the requirements to manage it, blood glucose tracking, nutrition tracking, activity tracking, medication tracking, progress charts and blood pressure tracking

• http://itunes.apple.com/us/app/vree-for-diabetes/id355923059?mt=8

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Nutrition/Weight Management - Apps

•Calorie Counter

• Tracks food, exercise, weight and all the nutrients listed on a Nutrition Facts label • Also includes daily inspirational articles, healthy recipes and an easy-to-understand Help section

http://itunes.apple.com/us/app/calorie-counter/id492244010

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Nutrition/Weight Management - Apps

•Calorie Counter & Diet Tracker by MyFitness Pal

• This app may be created by MyFitness Pal, but the nutrition analysis features will make this app your best nutrition friend. The app includes a combination of both, on a daily and weekly section

http://itunes.apple.com/us/app/calorie-counter-diet-tracker/id341232718?mt=8

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Mind-Body Medicine - Apps•Awareness

• The app provides insight and breaks patterns of emotions, attitudes, and behavior through awareness and inspirational practices

• Developed by psychotherapist Ronit Herzfeld

• http://itunes.apple.com/us/app/awareness-pro/id402123427?mt=8

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Addiction Recovery Support - Apps

•Smoking Cessation

• The main focus of the app is to show how long it has been since you last smoked and how much money you have saved as a result

•http://itunes.apple.com/us/app/quitter/id284944935?mt=8

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Conclusions• Mobile health medical applications and

internet resources may have the potential to play a significant role in health education and disease management by providing easy tracking, motivational sophistication, and improved adherence.

For any health concerns, follow-up with your health care practitioner