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Sabrina Kurtz-Rossi - eHealth and Older Adults

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"Senior Surfing: eHealth and Older Adults" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Sabrina Kurtz-Rossi, MEd, Principal, Kurtz-Rossi & …

"Senior Surfing: eHealth and Older Adults" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Sabrina Kurtz-Rossi, MEd, Principal, Kurtz-Rossi & Associates.

Description: This session will provide participants with information about eHealth literacy and techniques for helping older adults use the Internet to find health information for informed decision making and self-management of chronic disease.

Published in: Education, Health & Medicine
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  • 1. Sabrina Kurtz-Rossi, M.Ed. Kurtz-Health Literacy ConsultantKurtz-Kurtz-Rossi & AssociatesSabrina_kurtz-Sabrina_kurtz-rossi@comcast.netMember Clear Language Groupwww.clearlanguagegroup.com 1
  • 2. Case Example 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. Bob Moos, The Dallas Morning News Oct 12, 2009 2
  • 3. Case Example 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 Bob Moos, The Dallas Morning News Oct 12, 2009 3
  • 4. 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 4
  • 5. 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 5
  • 6. 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 Number & Percent of Adults in Each Health Literacy Level health literacy 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 6
  • 7. 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) 7
  • 8. Medicare Website www.medicare.gov 8
  • 9. 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 9
  • 10. 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 planSource: 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 10
  • 11. The Fastest GrowingOnline Population – Seniors! Internet Use by Seniors Age 65 and Older Over Time Percent 45% 40% 35% 30% 25% 42% 20% 34% 29% 15% 22% 10% 5% 0% 2004 2005 2006 2011 YearSource: Fox, S. (2004). Older Americans and the Internet; Fox, S. (2006). Online Health Searches; Usage OverTime. Pew Internet and American Life Project. Available at: http://www.pewinternet.org 11
  • 12. 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 onlineSource: Kaiser Family Foundation (2005). E-Health and the Elderly: How Seniors Use the Internet For HealthInformation. Available at: www.kff.org 12
  • 13. 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 accessSource: 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 13
  • 14. 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 42% of adults age 65 and older are online  75% rarely or never check for source and dateSource: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & AmericanLife Project. Available at: http://www.pewinternet.org/PPF/c/5/topics.asp 14
  • 15. 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 resourceSource: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC.Available at: www.pewinternet.org 15
  • 16. 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 painSource: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC.Available at: http://www.pewinternet.org 16
  • 17. A real drug. A real disorder. A spoof 17
  • 18. Focused OutreachHealth 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 18
  • 19. Three Phases, Two Communities1. Community Assessment 1. Western  Key informant interviews Maine (rural) ** *2. Focused Outreach Implementation  Tailored efforts based on assessment findings  Community-based partnerships *3. Evaluation 2. Providence, RI  Outcome measures: pre-post training evaluations, (Latino) follow-up assessment  Process measures: story-based evaluation, community partner exit interviews 19
  • 20. Community AssessmentWestern 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 20
  • 21. Focused Outreach ImplementationWestern 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. 21
  • 22. Evaluation ResultsWestern 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 ) 22
  • 23. Evaluation Results Western Maine – Rural Seniors  Consumer Pre-training: Age of Respondents 0.0% 3.7% N=82 7.3% 18 - 24 years old 25 - 34 years old 35 - 49 years old 50 - 64 years old 57.3% Over 64 year old 31.7%Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 23
  • 24. Evaluation Results Western Maine – Rural Seniors  Consumer Pre-training: Use of the Internet Never 34.9% N=83 Every day 36.1% Never Sometimes Every day Sometimes 27.7%Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 24
  • 25. Evaluation Results Western Maine – Rural Seniors  Consumer Pre-training: Where Respondents Access the Internet 60.0% N=71 52.1% 50.0% 40.0% 36.6% 30.0% 20.0% 14.1% 10.0% 5.6% 0.0% 0.0% Home School Work Library I dont use the InternetFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 25
  • 26. Evaluation Results Western Maine – Rural Seniors  Consumer Pre/Post-training: Ever Used NLM Resources 45% Pre N=82 40% 39% Post N=62 35% 30% 29% 25% Pre-Training 20% Post-Training 15% 10% 5% 2% 1% 0% MedlinePlus NIHSeniorHealthFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 26
  • 27. Evaluation Results Western Maine – Rural Seniors  Consumer Pre/Post-training: Confidence in Ability to Find Health Information Using the Internet 90% 79% 80% Pre N=81 70% Post N=65 60% 51% 50% 46% Pre-training 40% 33% Post-training 30% 20% 16% 17% 10% 0% Confident Not Sure Not ConfidentFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 27
  • 28. Evaluation Results Western Maine – Rural Seniors  Consumer Post-training: Likely to Use MedlinePlus in the Future Not likely 16.2% N=62 Likely Not sure 16.1% Not sure Not likely Likely 67.7%Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 28
  • 29. Evaluation Results Western Maine – Rural Seniors  Consumer Post-training: Likely to Use NIHSeniorHealth in the Future N=65 Not likely 18.4% Likely Not sure Not likely Not sure 15.4% Likely 66.1%Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 29
  • 30. Evaluation Results Western Maine – Rural Seniors  Consumer Follow-up: Used NLM Resources 50% 46% 45% 40% 35% 30% 25% 23% 20% 15% N=15 N=13 10% 5% 0% MedlinePlus NIHSeniorHealthFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 30
  • 31. Evaluation Results Western Maine – Rural Seniors  Service Provider Post-training: Likely to Use NIHSeniorHealth in their Work Not Likely 3% N=87 Not Sure 14% Likely Not Sure Not Likely Likely 83%Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 31
  • 32. Evaluation Results Western Maine – Rural Seniors  Service Provider Follow-up: Used NLM Resources 90% 82% 80% 70% N=27 60% 50% 41% 40% 30% 20% 10% 0% MedlinePlus NIHSeniorHealthFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 32
  • 33. Evaluation Results Western Maine – Rural Seniors  Service Provider Follow-up: Shared NLM Resources with Others 80% 69% N=27 70% 60% 56% 50% 40% 30% 20% 10% 0% Co-worker / other service Client / other community provider memberFunded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Healthand Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 33
  • 34. 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 Auburn Public Library Computer Training Class unconnected” 34
  • 35. Teaching Resources NIHSeniorHealth: Helping Older Adults Search for Health Information Online: A Toolkit for Trainershttp://nihseniorhealth.gov/toolkit/toolkit.html 35
  • 36. 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 36
  • 37. 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 toReliable Health Information in Rural Oxford County Maine. Journal of Consumer Health on the Internet. 14:4, 325-340.http://www.pewinternet.org 37
  • 38. Teaching Tips Provide hands-on practice Repetition, go slow Use health topics of interest Provide access to computers Teach small groups 38
  • 39. 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 39
  • 40. Universal Design  Section 508 Standards  Federal requirements for technology accessibility  Online tools to test 508 accessibility  http://www.cynthiasays.com/  http://wave.webaim.orgSource: Eichner, J. Accessible Health Information Technology (IT) for Populations with Limited Literacy. AHRQ, USDHHS. (2007). Available at: http://www.heatlhlit.ahrq.gov 40
  • 41. Plain Language 2.0  Text  Use “living room” language  Speak in active voice  Provide glossary  Use headers  Chunk information  Avoid acronymsSource: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthliteracy 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 41
  • 42. 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 iconsSource: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthliteracy 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 42
  • 43. 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 functionSource: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthliteracy 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 43
  • 44. 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, audioSource: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthliteracy 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 44
  • 45. NIHSeniorHealth.gov 45
  • 46. NIHSeniorHealth.gov 46
  • 47. NIHSeniorHealth Videos NIHSeniorHealth.gov 47
  • 48. MedlinePlus.gov 48
  • 49. MedlinePlus.gov 49
  • 50. Healthfinder.gov 50
  • 51. Healthfinder.gov 51
  • 52. Recommend Websites  MedlinePlus.gov  NIHSeniorHealth.gov  Healthfinder.gov  cdc.gov/aging 52
  • 53. 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 53
  • 54. 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 54

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