Copy of Health literacy for seniors
To make an impact in healthcare, we need to build and test mHealth tools with the biggest consumers of healthcare. Yet, our ability to adopt technology is influenced by age, income and education. This presentation discusses why older adults are an important mHealth demographic and why we should build to their abilities and needs.
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PRESENTATION OUTLINE
Agenda
- What do you need to know
- Why it matters
- Where can you look
- KPL Workshop
- New research Study
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Medications should make us feel better or prolong our life.
The whole reason to take a medication is to either relieve a symptom or prevent/slow/cure a disease. If you don't know why you've been prescribed something, it's good to do some research on your own and/or ask a your prescriber or your pharmacist.
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The benefits should clearly outweigh the risks.
Once you have an idea of WHY you've been prescribed something, you need to figure out a few things.
1. Benefit vs. risk: Almost all drugs come with some risk. You may experience a side effect--mild or severe. You could also be at risk of a drug-drug interaction or a drug food interaction. Some drugs have a higher risk of overdose as well.
1. Benefit vs. risk: Almost all drugs come with some risk. You may experience a side effect--mild or severe. You could also be at risk of a drug-drug interaction or a drug food interaction. Some drugs have a higher risk of overdose as well.
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You should also be able to understand how to take it.
Once you have an idea of WHY you've been prescribed something, you need to figure out a few things (cont...).
2. Instructions: Up to half of people have a hard time following the prescriptions on a medication vial, especially when the instructions are complex (e.g., take two tablets twice a day).
Davis TC, Federman AD, Bass PF, Jackson RH, Middlebrooks M, Parker RM, et al. Improving patient understanding of prescription drug label instructions. J Gen Intern Med 2009;24(1):57-62
2. Instructions: Up to half of people have a hard time following the prescriptions on a medication vial, especially when the instructions are complex (e.g., take two tablets twice a day).
Davis TC, Federman AD, Bass PF, Jackson RH, Middlebrooks M, Parker RM, et al. Improving patient understanding of prescription drug label instructions. J Gen Intern Med 2009;24(1):57-62
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And you should know if you need to adjust your diet.
Once you have an idea of WHY you've been prescribed something, you need to figure out a few things (cont...).
3. Food: You also need to figure out what you can and cannot eat with your drugs.
3. Food: You also need to figure out what you can and cannot eat with your drugs.
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Half of people with diabetes do not take or incorrectly take their medications within 12 months...
Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008;62(1):76-87
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For heart disease it's 6 months.
Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006;166(17):1842-1847.
Kramer JM, Hammill B, Anstrom KJ, Fetterolf D, Snyder R, Charde JP, et al. National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance. Am Heart J 2006;152(3):454.e1-454.e8.
Kramer JM, Hammill B, Anstrom KJ, Fetterolf D, Snyder R, Charde JP, et al. National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance. Am Heart J 2006;152(3):454.e1-454.e8.
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For mental health it's 3 months.
Chong WW, Aslani P, Chen TF. Effectiveness of interventions to improve antidepressant medication adherence: a systematic review. Int J Clin Pract 2011;65(9):954-975
Arvilommi P, Suominen K, Mantere O, Leppämäki S, Valtonen H, Isometsä E. Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders - an 18-month prospective study. J Affect Disord 2014;155:110-117
Arvilommi P, Suominen K, Mantere O, Leppämäki S, Valtonen H, Isometsä E. Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders - an 18-month prospective study. J Affect Disord 2014;155:110-117
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The reasons are many
- No benefit
- Side effects
- Complex regimen
- We forget
- Too expensive
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353(5):487-497.
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Mind the divide when
looking up information.
When learning how to look information up online, you need to consider where you fall on the digital divide.
AGE
INCOME
EDUCATION
Yes, older adults are less likely to have Internet access but we are divided by more than age. We are divided by age PLUS income and gender.
StatsCan Data (2009)
Canadian data shows that the people who are online tend to be younger and wealthier. The people who are not online (a minority of the population who fits into Roger's "laggard" category) tend to be older, have a less income and be less educated.
McConnaughey J et al. Online and on point: broadband usage in Canada and in the US. J Information Policy 2013: 123-157. http://jip.vmhost.psu.edu/ojs/index.php/jip/article/download/120/78
McConnaughey J et al. Online and on point: broadband usage in Canada and in the US. J Information Policy 2013: 123-157. http://jip.vmhost.psu.edu/ojs/index.php/jip/article/download/120/78
Canada Internet Use Survey (2012)
More recent Canadian data supports this. People in higher income brackets are more likely to have internet access.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Canada Internet Use Survey (2012)
People with more education are more likely to have internet access.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Canada Internet Use Survey (2012)
In other words, almost 100% of young people who have a high income are online but only 1 in 4 older adults who have a low income are online.
That's the digital divide.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
That's the digital divide.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Desktop Ownership
When thinking of your peer group, be careful to avoid making assumptions. For example, did you know that two thirds of seniors have a desktop computer? In other words, the majority of people over age 65 have a computer at home.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Handheld Ownership
Similarly, even though older adults are less likely to own a smartphone or tablet, a good one third of people over age 65 do own one. That's a lot of people.
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)
Pew: 3 in 4 look for health info online
As it stands, 72% of people who are online use the Internet to look up health information.
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
Half of online searches are on behalf of someone else.
And they often search for that information on behalf of someone else such as a child, spouse, parent or friend.
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
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Pew: 1 in 3 self-diagnose online
In addition, 35% of Internet users use the internet to find a diagnosis.
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
Women are more likely to look online for a diagnosis.
Fox & Duggan. Health Online 2013. http://www.pewinternet.org/2013/01/15/health-online-2013/
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DIGITAL LITERACY
Digital literacy is a family affair. Children and adults learn well from one another.
This is a photo of my mom reading with my 2 year old. They have matching books and they read together every day. My mom also works on reading with my 5 year old.
This is a photo of my mom reading with my 2 year old. They have matching books and they read together every day. My mom also works on reading with my 5 year old.
Untitled Slide
The Lily model of eHealth literacy is a nice way of exploring the skills we need to build up our digital literacy. As you can see, there are 6 different types of literacy that we need to build up to become fully eHealth/digitally literate.
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Traditional literacy and numeracy is being able to read and understand words and numbers.
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Photo by Camera Eye Photography
Information literacy is knowing how knowledge is organized and knowing where to find it and how to use it.
Final Report. Washington, DC: American Library Association; 1989. URL: http://www.ala.org/ala/acrl/acrlpubs/whitepapers/presidential.htm#opp
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
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Media literacy is thinking critically about knowledge.
Feuerstein M. Media literacy in support of critical thinking. Journal of Educational Media 1999;24(1):43-54.
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
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Health literacy is knowing how to act on health info in daily life.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA 1999 Feb 10;281(6):552-557. [Medline] [CrossRef]
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Photo by University of Salford
Science literacy is understanding how knowledge is created in a systematic manner.
Laugksch RC. Scientific literacy: a conceptual overview. Science Education 2000;84(1):71-94.
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Photo by jimmiehomeschoolmom
Computer literacy is knowing how to use a computer or touchscreen to find information.
Laugksch RC. Scientific literacy: a conceptual overview. Science Education 2000;84(1):71-94.
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
Norman CD, Skinner HA
eHealth Literacy: Essential Skills for Consumer Health in a Networked World
J Med Internet Res 2006;8(2):e9
DOI: 10.2196/jmir.8.2.e9
PMID: 16867972
PMCID: PMC1550701
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In other words, digital health literacy takes a lot of practice.
WHERE DO YOU START?
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Start by searching for drug names online - brand or generic.
The first step is to open a browser and to search for your drug.
Untitled Slide
When I searched for the brand name of a drug, this is what showed up.
1. Notice that the first website is an ad from the company that makes the drug. I usually ignore the ads.
2. Next, notice that the main websites that showed up in my search are Drugs.com, MedicineNet.com and Wikipedia.
1. Notice that the first website is an ad from the company that makes the drug. I usually ignore the ads.
2. Next, notice that the main websites that showed up in my search are Drugs.com, MedicineNet.com and Wikipedia.
What sites are good?
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Untitled Slide
A quick way to sort out the more questionable sites is to look for HON certification.
HON was founded in 1995 in Geneva, Switzerland. It is a not-for-profit organization and the goal is to "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world.""
Websites can apply to get HON certified if they meet these 8 criteria.
http://www.hon.ch/Global/index.html
HON was founded in 1995 in Geneva, Switzerland. It is a not-for-profit organization and the goal is to "promote the effective and reliable use of the new technologies for telemedicine in healthcare around the world.""
Websites can apply to get HON certified if they meet these 8 criteria.
http://www.hon.ch/Global/index.html
Untitled Slide
To find out if the site you're looking at is HON certified, look at the bottom of the page for this logo. If you don't see it there, look under the website's "About Us" section. Some sites that are not HON certified are still good but you should be more skeptical.
Drugs.com
The Drugs.com website is HON certified.
The information on Drugs.com comes from four independent medical-information publishers: Wolters Kluwer Health, American Society of Health-System Pharmacists, Cerner Multum and Micromedex from Truven Health.
According to the webiste, "individual drug (or drug-class) content compiled by these sources is delivered complete and unaltered by Drugs.com."
The information on Drugs.com comes from four independent medical-information publishers: Wolters Kluwer Health, American Society of Health-System Pharmacists, Cerner Multum and Micromedex from Truven Health.
According to the webiste, "individual drug (or drug-class) content compiled by these sources is delivered complete and unaltered by Drugs.com."
Mayoclinic.com
MayoClinic.com is HON certified.
The information on this site is reviewed by clinicians. It is easy to read and access. It includes health information, drug information, a symptom tracker and patient blogs.
The information on this site is reviewed by clinicians. It is easy to read and access. It includes health information, drug information, a symptom tracker and patient blogs.
MedicineNet.com
MedicineNet.com is HON certified.
A team of medical writers and doctors create content on MedicineNet for consumers. MedicineNet has a sister site for health professionals called Medscape. MedicineNet was created in 1995 and purchased by WebMD in 2004.
http://www.medicinenet.com/script/main/art.asp?articlekey=128
A team of medical writers and doctors create content on MedicineNet for consumers. MedicineNet has a sister site for health professionals called Medscape. MedicineNet was created in 1995 and purchased by WebMD in 2004.
http://www.medicinenet.com/script/main/art.asp?articlekey=128
WIKI means "What I know is"
Wikipedia is not HON certified. It is an online encyclopedia created by the people. Anyone can edit it.
On this page, notice the warning at the top. An editor has flagged the ramipril site as being "too technical for most readers to understand". That means someone needs to go in and make it simpler. Anyone can do that.
Dr. James Heilman, an emergency room physician in Alberta, is doing just that under the WikiProject Medicine. Wikipedia is not a perfect resource right now, but it is likely to improve dramatically in the coming years. http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine
On this page, notice the warning at the top. An editor has flagged the ramipril site as being "too technical for most readers to understand". That means someone needs to go in and make it simpler. Anyone can do that.
Dr. James Heilman, an emergency room physician in Alberta, is doing just that under the WikiProject Medicine. Wikipedia is not a perfect resource right now, but it is likely to improve dramatically in the coming years. http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine
It also means "quick" in Hawaiian.
Rule of 3: Find 3 websites including one government source. All should say roughly the same thing.
We've created the "rule of 3" to consumers to search for information. It came from one of our research participants and we've adopted it into our own teaching.
The rule of 3 is a way of making sure you consider the various sources of information - not just the first thing you read. It's also a way of supporting someone in searching for information on blogs or in less traditional sites, while still encouraging them to consider the science behind the drug or the treatment.
The rule of 3 is a way of making sure you consider the various sources of information - not just the first thing you read. It's also a way of supporting someone in searching for information on blogs or in less traditional sites, while still encouraging them to consider the science behind the drug or the treatment.
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HealthLinkBC.ca
I like this government site. The HealthLinkBC.ca website is highly accessible. It includes information on drugs, diseases and symptoms.
When you find something you like but aren't sure, print it out and take it to your pharmacist.
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Ask friends where they look.
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Talk with family about digital health literacy.
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Take Homes
- Start with Google
- Follow the rule of 3
- Be skeptical
- Ask around
- Run it by your pharmacist
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KPL in the spring: Digital Health Literacy Workshop.
Look at the upcoming KPL schedule for a new program on digital health literacy starting in May 2015.
New study in April: Better password options for older adults living with chronic disease.
If you are interested in participating in our research, email me at kgrindrod [at] uwaterloo dot ca.
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UWaterloo & McMaster Standardized Patient Program
If you are interested in being a standardized patient, you can follow-up with our Standardized Patient Trainer Aaron Sousa at wrspp@mcmaster.ca.
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