The document discusses positioning a web-based women's health risk assessment tool (WHRA) at BC Women's Hospital. It summarizes an environmental scan and literature review conducted to understand existing HRAs and their effectiveness. The scan found 14 websites with 47 HRAs, but none in BC comparable to the multi-condition WHRA. The review concluded web-based HRAs can effectively promote health if they provide tailored messaging and address barriers like digital divide. The WHRA has potential for positive impact if it considers women of all backgrounds and socioeconomic status.

1. Exploring Online Tools for Health Promotion:
Positioning a Web-Based Women’s Health Risk Assessment
Samantha Aro, MPH candidate, BSc
BC Women’s Hospital + Health Centre
Preceptor: Dr. Ann Pederson Senior Supervisor: Dr. Malcolm Steinberg
Rationale
BC Women’s Hospital + Health Centre (BC Women’s)
provides specialized health care for women in British
Columbia. This includes maternity, neonatal care and a
variety of gynecological services.
Within BC Women’s, the Population Health Promotion
(PHP) department provides resources and programming
to promote population health.
One tool that PHP is in the process of acquiring is a
mobile compatible, web-based women’s health risk
assessment tool (WHRA). This tool was developed
through a joint initiative between the University of British
Columbia and the Canadian Men’s Health Foundation,
who have recently developed a web-based health risk
assessment for men. Currently, BC Women’s is finalizing
the licensing rights to use the WHRA and the tool itself is
in final testing phases to ensure functionality.
The WHRA examines a woman’s risk for the top 10
causes of disability adjusted life years, based on the
World Health Organization’s global disease data 1.
Objectives
• Examine current practices and existing research for
the use, effectiveness and impact of web-based
health risk assessments (HRAs).
• Recommend strategies for BC Women’s to employ so
as to operationalize the WHRA.
Strategies
• Conduct an environmental scan to determine what
types of HRAs exist broadly.
• Conduct a scoping review examining what evidence
exists showing the impact of web-based HRAs.
• Conduct a sex and gender based analysis, as well as
a health equity analysis regarding web-based HRAs.
• Draft a business case to identify strategic alignment
of the WHRA with provincial mandates, as well as
propose context and promotion of the WHRA.
Acknowledgements
I would like to acknowledge the following people for their
guidance and support:
• Dr. Ann Pederson and AJ Murray from the PHP
department at BC Women’s,
• Andrea Bever and Owanari Kingson, my fellow MPH
candidates at BC Women’s,
• Dr. Malcolm Steinberg, my Senior Supervisor.
Capstone
For my capstone, I intend to design a program plan and
evaluation plan for the WHRA at BC Women’s. Should this
not be feasible due to the timing of the legal acquisition of
the WHRA, I intend to explore other evaluation or
knowledge translation projects with BC Women’s and the
PHP department.
Reflection
My practicum placement was a transformative learning
experience on many levels.
I have an improved understanding of the field of women’s
health and in particular a better organizational
understanding of the strengths and challenges of working
within a provincial health authority.
I have enhanced my literature review skills, including
scoping the literature, refining search terms and
organizing the findings. As a result, I am confident in my
ability to scope and synthesize a large body of research,
in a fast and efficient manner.
It was exciting to see theory bridged into practice, both in
the work I was directly completing, as well as in the
activities of my PHP colleagues. Witnessing the
incorporation of an intersectional framework, the use of
sex and gender based analysis as well as the spirit of
knowledge translation and evidenced-based research
have reinforced my passion for working in women’s
health in Canada.
Scoping Review Results
The environmental scan identified 14 websites featuring 47 HRAs. Most
require the user to complete multiple HRAs to assess different disease
risks, often resulting in the generation of redundant or conflicting lifestyle
recommendations. The WHRA is unique in its “multi-condition”,
women-centred approach.
After examining the websites of the provincial and regional health
authorities, it was concluded that there is no comparable HRA currently
being promoted by any health authority in BC.
The literature review concluded the following:
• Web-based HRAs can be an effective primary or secondary
prevention strategy for chronic diseases.
• Web-based initiatives can be as effective as in-person initiatives
• Tailored messaging that is customized to a user’s characteristics has
a greater impact on health behaviour.
• Women of higher socioeconomic status are most likely to access
HRAs and more likely to change subsequent health behaviours than
other group.
HRAs can be an effective and efficient health promotion strategy, however
there are limitations:
• The digital divide is the gap between those who have internet access
and those who do not. It persists in Canada, especially in rural,
Northern, and low income communities. As such, any web-based
initiative may exclude these groups.
• Web-based HRAs may downplay the impact of the social
determinants of health, placing undue emphasis on the individual.
• Patterns of usage in that non-Caucasian women and women of lower
socioeconomic status are less likely to use HRAs.
The literature supports the WHRA’s potential for positive impact, provided
the drawbacks listed above are addressed.
Factors
contributing to
WHRA’s potential
for impact
80% of internet
users are looking
for health
information, & there
are increasing
levels of high speed
internet access in
Canada2.
There is an abundance of
health information available
online, however there is a
gap in terms of free, tailored,
health risk assessments3.
Women are more likely than
men to seek and
operationalize web-based
health information4.
Currently, there
are no multi
condition health
risk assessments
focused on
women’s health
issues.
1. Lozano, R., et al., Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systema=c analysis for the Global Burden of Disease Study 2010. The Lancet, 2012. 380(9859): p. 2095-2128.
2. Haight, M., A. Quan-Haase, and B.A. CorbeH, Revisi=ng the digital divide in Canada: the impact of demographic factors on access to the internet, level of online ac=vity, and social networking site usage. InformaLon, CommunicaLon & Society, 2014. 17(4): p. 503-519.
3. Suggs, L.S. and C. McIntyre, Are We There Yet? An Examina=on of Online Tailored Health Communica=on. Health EducaLon & Behavior, 2009. 36(2): p. 278-288.
4. Harle, C.A., J.S. Downs, and R. Padman, A clustering approach to segmen=ng users of internet-based risk calculators. Methods Of InformaLon In Medicine, 2011. 50(3): p. 244-252.