Mpla 2009 The Impact Of Technology On Searching For Health Danielle De Jager Loftus
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Mpla 2009 The Impact Of Technology On Searching For Health Danielle De Jager Loftus



The Internet and other technologies are increasing opportunities for people to access health information. The Internet is significant in mediating the relationship between information and involvement ...

The Internet and other technologies are increasing opportunities for people to access health information. The Internet is significant in mediating the relationship between information and involvement in one’s own health care. Exchanges about health on the Internet are not just about disseminating information, or packaged health messages, but often involve linking to a shared community. Participation in health-related online social networks provides valuable support. A digital divide still exists, however the widespread acceptance of wireless communication and technologies by consumers who currently don’t have access to the Internet suggests that we should not underestimate the potential audience for technology innovation.
Name:: Danielle De Jager-Loftus
Institution:: The University of South Dakota. I.D. Weeks and Lommen Health Science Libraries



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Mpla 2009 The Impact Of Technology On Searching For Health Danielle De Jager Loftus Mpla 2009 The Impact Of Technology On Searching For Health Danielle De Jager Loftus Presentation Transcript

  • The Impact of Technology on  Searching for Health Information:  Searching for Health Information: Online Communities of Support Danielle De Jager‐Loftus, MFA, MSLIS Asst. Professor, Technology/Medical Librarian The University of South Dakota, University Libraries I.D. Weeks and Lommen Health Sciences Libraries
  • Session Goals Session Goals • Health seeking behaviors Health seeking behaviors –Online communities of support –Technology • Providing consumer health  information / reference tips information / reference tips • Questions
  • Current Electronic Health Influences Current Electronic Health Influences • 40% of MD’s use at least one of 40% of MD s use at least one of  the these tools:  electronic prescribing electronic medical records electronic medical records remote disease monitoring  • 80% f ll 80% of all patients search for  i hf health information online
  • Consumer Health Then & Now… Consumer Health Then & Now… 1972 – Patient Bill of Rights g • 2002 – Pew Internet and American Life • 2006 – “ “Googling for a diagnosis”  [BMJ] f ” • 2006 – Pew Internet and American Life •
  • Looking for Information Looking for Information • Pew Internet & American Life survey said the top Pew Internet & American Life survey said the top  four health topics searched online were:  • specific diseases;  • specific medical treatment; specific medical treatment;  • diet, nutrition and nutritional supplements;  • and exercise or fitness.  d i fit
  • Health Seeker Profile Health Seeker Profile • 72 % of Females as compared to 51% 72 % of Females as compared to 51%  of Males • 71% of those between 50 and 64 years  of age as compared to 53% of those  between 18 and 29 years of age *There  are no significant differences in these  are no significant differences in these percentages when compared by  ethnicity. ethnicity
  • Harris Poll Harris Poll
  • How do we use the Internet ? How do we use the Internet ? • Growing numbers of internet users look for Growing numbers of internet users look for  health information – helps them have better conversations with their helps them have better conversations with their  doctors • Big impact on the knowledge of patients Big impact on the knowledge of patients • The questions they ask their doctors • Is therefore changing the doctor‐patient  relationship and the practice of medicine.
  • Google? • The sight of clinic patients clutching  internet print‐outs fills some doctors  it t i t t fill dt with dread Murray E, Lo B, Pollack L, Donelan K, Catania J, White M, et al. The impact of health  information on the internet on the physician‐patient relationship: patient  perceptions. Arch Intern Med. 2003;163:1727‐34
  • Googling for a Diagnosis Googling for a Diagnosis • Article was widely reported in the lay  press • Doctors/ patients could magically  become diagnosticians simply by using  web search engines? Tang H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet  based study. BMJ. (published 10 November 2006).
  • Googling for a Diagnosis Googling for a Diagnosis • Study of ‘mystery illnesses’ in New England  Journal of Medicine case records • Web search used by experts to ‘fish’ for  information on a rare clinical problem  p before confirming by more rigorous search  methods Tang H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet  based study. BMJ. (published 10 November 2006)
  • Google? • U d i bl th t b th d t Undeniable that both doctors and d p patients use the internet as an  important source of health  information if i Cullen RJ. In search of evidence: family practitioners’ use of the Internet for clinical  yp information. J Med Libr Assoc 2002;90:370‐379 Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients‘ use of the  Internet for medical information. J Gen Intern Med. 2002;17:180‐5
  • Googling for Health Googling for Health • A recent study showed that almost 19% A recent study showed  that almost 19%  percent of youth surveyed had used a general  word search on Google, Wikipedia or Yahoo to  word search on Google Wikipedia or Yahoo to find information about their health concerns.  • A total of about 3 percent used, or Moreno, MA; parks, MR; Zimmerman, FJ; Brito, TE; Christakis, DA. (2009) Display of  Health Risk Behaviors on MySpace by Adolescents: Prevalence and Associations.  Arch Pediatric Adolesc Med., 163, 37‐34
  • Googling for Health Googling for Health • Teens don’t really know where to Teens don t really know where to  look or whom to ask online • Neither do adults – the 2006 Pew  Internet and American Life report  announced the same results announced the same results Moreno, MA; parks, MR; Zimmerman, FJ; Brito, TE; Christakis, DA. (2009) Display of  Health Risk Behaviors on MySpace by Adolescents: Prevalence and Associations.  Arch Pediatric Adolesc Med., 163, 37‐34
  • • The authors of the 2006 Pew  Internet and American Life report  point to the need for online  point to the need for online health resources with offline  referrals or communities that  incorporate peer advice incorporate peer advice Moreno, MA; parks, MR; Zimmerman, FJ; Brito, TE; Christakis, DA. (2009) Display of  Health Risk Behaviors on MySpace by Adolescents: Prevalence and Associations.  Arch Pediatric Adolesc Med., 163, 37‐34
  • Information Age Insight: Information Age Insight: quot;Medical knowledge is a social  process: The conversations that  h i h occur around artifactual data are  f always more important than the  data themselves. data themselves quot; Lester, J. Director of Information Technology, Department of Neurology, Massachusetts  General Hospital. 
  • Social Networking Social Networking • What is social networking?  at s soc a et o g? • A social networking Web site provides a  virtual community for people interested in  virtual community for people interested in a particular subject or just to quot;hang outquot;  together. (PC Magazine)  g ( g ) • MySpace and Facebook are online  community websites that allow friends and  community websites that allow friends and family to communicate. 
  • Internet Support Communities Internet Support Communities • These online groups each devoted to a single These online groups, each devoted to a single  medical topic (e.g., breast cancer or  depression), usually communicate via postings  depression) usually communicate via postings on Web‐based forums or electronic mailing  lists.  lists • Participants share their thoughts, feelings, and  experiences, and ask and reply to questions.  experiences and ask and reply to questions Ferguson T. Found on the net: What e‐Patients do line: A tentative taxonomy. The  Ferguson Report, No. 9, September  2002 .
  • Internet Support Communities Internet Support Communities • They exchange information on medical studies  and clinical trials, discuss current treatment  d li i l i l di options • They recommend treatment centers and  professionals with special expertise in the  shared condition.  Ferguson T. Found on the net: What e‐Patients do line: A tentative taxonomy. The  Ferguson Report, No. 9, September  2002 .
  • Internet Support Communities Internet Support Communities • As with “Googling for Diagnoses”, some  As with  Googling for Diagnoses some researchers express concern about  potential for inaccurate info or faddish  t ti l f i t if f ddi h treatment • Researchers found there were self‐ correcting mechanisms inherent in many  correcting mechanisms inherent in many online support groups Feenberg, A. L., Licht, J. M., Kane, K. P., Moran, K. and Smith, R. A. The online patient    meeting. J Neurol Sci. 1996;139:129–131.
  • Internet Support Communities Internet Support Communities • Over 85% of members on a cancer  forum stated  contact with others  f ttd t t ith th who have undergone similar  experiences was the most beneficial  aspect of the forum aspect of the forum Fernsler J. I., Manchester L. J.  Evaluation of a computer‐based cancer support  network. Cancer practice 1997;5(1):46‐51.
  • • Wh t b t What about consumers of  f health info that don t have  health info that don’t have a wireline a wireline device? • Studies mentioned are Studies mentioned are  desktop access…
  • Digital Divide Digital Divide • Term has been used to describe  decreased access to information and  communication technologies (ICT),  communication technologies (ICT) particularly the Internet –ffor racial and ethnic minorities i l d th i i iti – persons with disabilities – rural populations l l – those with low socioeconomic status Chang Betty L, Bakken Suzanne, Brown S Scott, Houston Thomas K, Kreps Gary L,  Kukafka Rita, Safran Charles, Stavri P Zoe. Bridging the digital divide: reaching  vulnerable populations. J Am Med Inform Assoc. 2004;11(6):448–57
  • Digital Divide Digital Divide • Falling Through the Net: Toward Digital  Inclusion reported that Hispanics and reported that Hispanics and  blacks are significantly less likely than the  national average to own a computer, to  ti l t tt have Internet access, and to access the  Internet at home Falling Through the Net: Toward Digital Inclusion—A Report on Americans' Access to  Technology Tools. Washington, DC: National Telecommunications and Information  Administration, 2000. 
  • Digital Divide Digital Divide • Internet access is increasing at all income  levels, but continues to be significantly higher  levels, but continues to be significantly higher for those with higher incomes.  • For example 89% of households earning more For example, 89% of households earning more  than $75,000 have Internet access at home  compared with 55% with household incomes  compared with 55% with household incomes less than $30,000. Horrigan J. Pew Internet Project Data Memo. Washington, DC: Pew Internet and  American Life, 2004.
  • Digital Divide Digital Divide • Urban use of the Internet  continues to be higher than that  i b hi h h h in rural areas (65% vs. 48%).  in rural areas (65% vs. 48%). Horrigan J. Pew Internet Project Data Memo. Washington, DC: Pew Internet and  American Life, 2004.
  • Digital Divide Digital Divide •The number of “wired” seniors is  increasing, with 22% using the  i i ih % i h Internet, and 66% of  wired Internet, and 66% of “wired”  seniors have used the Internet to  search for health information Fox S. Older Americans and the Internet. Washington, DC: Pew Internet and  American Life, 2004
  • Disparities •Elimination of health disparities a major goal for next decade  identified in Healthy People 2010 identified in Healthy People 2010 Office of Disease Prevention and Health Promotion. Healthy People 2010:  Understanding and Improving Health. Washington, DC: Office of Disease Prevention  and Health Promotion (ODPHP), United States Department of Health and Human  Services, 2000. 
  • Disparities • Advisory Commission on Consumer Protection  and Quality in the Health Care Industry  suggested that “telemedicine and similar  innovations … should be assessed as  approaches for improving the access to care  of those facing … barriers to appropriate  care.” Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Quality First: Better Health Care for All Americans. Available at:
  • Mobile Technologies Mobile Technologies • At least 62% of all adults owned a mobile phone in 2001  p and by 2003, 66% of all U.S. households owned mobile  phones. • A ith ll As with all costly technologies, there looms the concern of  tl t h l i th l th f a digital divide.  • Low‐income families are more likely to have no or  y suboptimal cell phones. • However, even among families of  underrepresented minorities, the penetration  rate of this technology is high. Sax U, Kohane I, Mandl KD. Wireless technology infrastructures for authentication of  patients: PKI that rings. J Am Med Inform Assoc 2005;12:(3):263‐268May‐Jun.
  • Mobile Technologies Mobile Technologies • Mobile/cordless/DECT phone (Digital Mobile/cordless/DECT phone (Digital  Enhanced Cordless Technology) • WI FI/WLAN ( i l l l WI‐FI/WLAN (wireless local area network) t k) • WiMAX (Worldwide Inter‐operability for  Microwave Access) • Handheld PCs, PDAs, messaging Handheld PCs, PDAs, messaging  devices, electronic organizers and  smart phones smart phones
  • Smart Phone  Emulator htt // /d ht l •Developer edition •Test your Webpages
  • Mobile Revolution  Mobile Revolution • Over 850 million/about 14 percent of the Over 850 million/about 14 percent of the  world population owns one or more  mobile phones bil h • Mobile Internet and wireless  technologies have expanded current  Internet sales into more immediate and  Internet sales into more immediate and personalized mobile environments Siau, K., & Shen, Z. (2006, June). Mobile healthcare informatics. Medical Informatics &  the Internet in Medicine, 31(2), 89‐99.
  • The Mobile Difference  The Mobile Difference • “Mobile connectivity is now a powerful Mobile connectivity is now a powerful  differentiator among technology users. Those  who plug into the information and  who plug into the information and communications world while on‐the‐go are  notably more active in many facets of digital  notably more active in many facets of digital life than those who use wires to jack into the  internet and the 14% of Americans who are and the 14% of Americans who are  off the grid entirely.” Horrigan J. Technology User Types, Mobile, Digital Divide.  Washington, DC: Pew  Internet and American Life, Mar 25, 2009
  • Realities of Health Care Today Realities of Health Care Today • Patients are now asked to make Patients are now asked to make  decisions about their own disease  process. • Most info consumers do not have the Most info consumers do not have the  tools to make these kinds of  decisions • Libraries can help! Libraries can help!
  • Scenario • A familiar woman approaches you while you A familiar woman approaches you while you  are working on the reference desk at a public  library. She tells you that her mercury fillings  have been poisoning her and then hands you  a article she found on the web. She says that  she is trying to decide whether to remove her  hi i d id h h h fillings and wants some more information to  help her make up her mind. She finishes by  help her make up her mind She finishes by mentioning that the “other librarian” was no  help at all.  help at all
  • Questions • What are some issues to consider?  • How would you behave in this situation?  y • What kind of evidence would you use to  answer this question? answer this question? • What if this “frequent flyer” doesn’t like the  information you find? What if she comes  information you find? What if she comes back? 
  • What are some good sources? What are some good sources? • Journal of the American Dental Association Journal of the American Dental Association,  “Dental Amalgam FAQs”  • U.S. Food and Drug Administration, CDRH  Consumer Information,  Questions and  Consumer Information “Questions and Answers on Dental Amalgam”: htt // fd / d h/ / l ht l
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • General Tips for Reference  Interviews
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Librarians can't answer questions about  individual medical cases or offer medical  advice, because we are not doctors, nurses, or  pharmacists. We can help you find health  information resources.
  • Challenges of the reference interview  in the context of health information h fh l h f Not being familiar with the resources • Medical terminology Medical terminology • Knowing how much to ask • Using open ended questions • Being aware of body language g y gg • Others? •
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Put together web‐based and  g print directories of a FEW consumer health resources
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Practice compassionate Practice compassionate  reference: Listen, observe,  empathize
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Keep information Keep information  confidential
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? •K Keep personal opinions to  l ii t yourself
  • As Info Professionals  As Info Professionals How Can/Should We  Provide Help? • Anticipate common Anticipate common  concerns or worries (i.e.,  ( financial repercussions,  physician reprimand) 
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Teach basics of sound  internet searching
  • As Info Professionals As Info Professionals How Can/Should We  Provide Help? • Promote
  • The “Best” Sources of  Consumer Health Information • Are written for a consumer audience Are written for a consumer audience  (grade 6 to 8 reading level) • Are written by medical authorities • Include references to evidence‐based Include references to evidence‐based  sources
  • The “Best” Sources of  Consumer Health Information • Have a review board   • Are updated regularly • D ’t i l d d ti Don’t include advertisements  t
  • Q Questions to ask when picking a  p g resource • Is the information age‐appropriate?  • Is the information culturally appropriate? Is the information culturally appropriate?  • Is the information understandable to the  patron?  t? • Does the information answer the patron’s  questions?  • Is the information accessible? i.e., Can you  increase the font size? 
  • Consumer Health Resources Consumer Health Resources •AboutKidsHealth: •NIHSeniorHealth: http://nihseniorhealth gov/ •NIHSeniorHealth: •Asian American Health (Includes materials in Chinese,  Filipino and Japanese): •General Consumer Health ‐ MedlinePlus:
  • Subscription Clinical Databases  with Patient Handouts • ACP PIER  • MD Consult • Micromedex • UpToDate p
  • Collections • How do I begin collecting consumer  health materials?  h lh il?
  • Collections  Considerations • “Consumer health” not used as LC subject  heading.  (hint: try your medical term followed  by “popular works”) i.e., Dentistry–Popular  works.  • Order books for a “general audience” 
  • Collections  Considerations • Base collections decisions on patron requests  and local demographic information –Ask for  patron feedback • Hand‐pick –check currency, authority,  references, publisher, etc... p • Consider audio/visual materials as well as  print
  • As Info Professionals As Info Professionals • Challenge
  • Controlled Reference Interview Vocabulary V bl MARC MeSH Thesauri Concept Codes Info Literacy Info Literacy Classification UDC Verification Acquisitions Boolean Doc Types Negotiation
  • Web 2.0 Screencasts Blogs Bl AJAX XML FRBR CMS XHTML Perl CSS HTML RSS MODS Wikis JavaScript PodCasts Library 2.0 Second Life Twitter
  • As Info Professionals As Info Professionals • Challenge • Keeping Up with Technology Keeping Up with Technology • Integrating All for Our Users Integrating All for Our Users
  • Questions… Questions • and Thanks! and Thanks! • dl f dd • Blog: • Slideshare: http://www slideshare net/dloftus Slideshare: