Traffic-light labels could reduce population intakes of calories, total fat, saturated fat, and sodium

Traffic-light labelling has been proposed as a public health intervention to improve the dietary intakes of consumers.

OBJECTIVES

to model the potential impact of avoiding foods with red traffic lights on the label on the energy, total fat, saturated fat, sodium, and sugars intakes of Canadian adults.

METHODS

Canadian adults aged 19 and older (n = 19,915) who responded to the Canadian Community Health Survey (CCHS), Cycle 2.2. The nutrient levels in foods consumed by Canadians in CCHS were profiled using the United Kingdom's criteria for traffic light labelling. Whenever possible, foods assigned a red traffic light for one or more of the profiled nutrients were replaced with a similar food currently sold in Canada, with nutrient levels not assigned any red traffic lights. Average intakes of calories, total fat, saturated fat, sodium, and sugars under the traffic light scenario were compared with actual intakes of calories and these nutrients (baseline) reported in CCHS.

RESULTS

Under the traffic light scenario, Canadian's intake of energy, total fat, saturated fat, and sodium were significantly reduced compared to baseline; sugars intakes were not significantly reduced. Calorie intake was reduced by 5%, total fat 13%, saturated fat 14%, and sodium 6%.

CONCLUSION

Governments and policy makers should consider the adoption of traffic light labelling as a population level intervention to improve dietary intakes and chronic disease risk.

False Balance in Public Health Reporting? Michele Bachmann, the HPV Vaccine, and "Mental Retardation"

This content analysis of media coverage of Michele Bachmann's erroneous comments that the HPV vaccine causes mental retardation explores the relationship between truth-telling (the presentation of accurate information) and balance (presenting opposing perspectives of an issue equally and legitimately) in public health reporting. Of 200 articles analyzed, about 50% provided correction and about 40% provided a counterpoint. We also found that health reporters tended to engage in truth-telling and balance more than political reporters. Implications for theory and practice are discussed.

The "New Public" and the "Good Ol' Press": Evaluating Online News Sources During the 2013 Polio Outbreak in Israel

The current research focuses on the 2013 polio outbreak in Israel as a case study to analyze the sources of information used in new media platforms, examining whether the new media have changed the ways in which we communicate about health issues. Specifically, we tracked and coded polio-related references on Hebrew news websites, blogs, forums, and Facebook posts. Overall, 24,388 polio-related references constituted our sampling frame. The findings suggest that there is a moderate-level correlation between the platform and the type of sources chosen by users. Beyond the differences between various platforms, we found that online information platforms rely not only on popular or pseudoscientific sources, but also on high-quality information. In fact, the analysis indicates that online news websites, forums, blogs, and Facebook posts create a unique blend of information, including scientific literature, medical professionals, and government representatives, as well as pseudoscientific research. These findings suggest a more optimistic view of the Internet as a source for health-related information in times of crises. Although the fact that members of the public are exposed to scientific sources does not indicate to what degree this affects their actual decision making. Exposure to a wider variety of sources may enhance health literacy, resulting in a better understanding of information needed to make informed decisions.

Factors Influencing Communication with Doctors via the Internet: A Cross-Sectional Analysis of 2014 HINTS Survey

Based on Street's (2003) ecological framework of communication in medical encounters, this study examined personal, interpersonal, and media factors that could influence patients' use of the Internet to communicate with doctors. Results from data analysis of responses from the 2014 Health Information National Trends Survey showed that patient activation and ease of Internet access were two positive predictors of online doctor-patient communication. In addition, patients' trust in doctors positively moderated the relationships between patient activation and online doctor-patient communication, and between perceived health status and online doctor-patient communication. Finally, the quality of patients' past experiences communicating with doctors had a positive moderation effect on the association between health information seeking behavior and online doctor-patient communication. Implications and limitations are discussed.

Serious Illness Conversations With Doctors: Patients Using Information Obtained From Sources Other Than Their Doctors

The purpose of this study was to examine how people with serious illnesses communicate information they have acquired about their illness from the Internet and social or mass media to their doctors. Twenty-two in-depth interviews of patients with serious or life-threatening illnesses were conducted and analyzed. Street's ecological perspective of communication was used to understand the processes that influence when and how patients bring information that they obtained from external sources to their doctors. The reactions patients received from their doctors affected their future communication with them. Results indicate doctors who have a dominant communication style often discourage patients from bringing outside information to them, and in some cases this results in patients changing doctors. On the other hand, doctors who are more attentive make patients feel more comfortable about bringing outside information to them, and this leads to more meaningful and beneficial conversations.

An e-health intervention to support the transition of young people with long-term illnesses to adult healthcare services: Design and early use

OBJECTIVE

Co-design information and website to support adolescents and young adults with long-term illnesses in their transition to adult healthcare.

METHODS

A participatory iterative process involving a survey (n=207), twenty-one interviews, six participatory workshops, six video recordings, two advisory groups, and a co-design group to identify needs and preferences for e-health and information provision, was used to develop an appropriate intervention.

RESULTS

Adolescents and young people expressed preferences for information that was trustworthy, empowering, colorful, easily downloaded online and written using non-patronizing language. They desired video testimonials of experiences from young adults who had transitioned to adult healthcare and wanted advice about becoming more independent, managing their condition, preparing for the transition, and information about medications and the differences between child and adult healthcare. They also wanted information about the location and configuration of adult healthcare, key hospital personnel, and frequently asked questions.

CONCLUSION

The participatory iterative process led to the development of an online resource specifically tailored to the adolescents and young people's transition needs and information preferences. Preliminary feedback indicates that it is a valued resource.

PRACTICE IMPLICATIONS

The www.SteppingUP.ie website has the potential to help prepare its target population group for the transition to adult healthcare.

The Internet versus pediatricians as a source of infant teething information for parents in Turkey

OBJECTIVES

Parents are increasingly searching the Internet to gather information about their children's health care. This study compared infant teething information obtained from publically employed pediatricians in Istanbul with that obtained from different Turkish websites (parenting, health, professional, news and commercial).

METHODS

This study had two parts. The first part used a descriptive design, with two checklists to assess the quality and comprehensiveness of the teething-specific content on 62 parenting or health websites. The second part was a cross-sectional study of 75 pediatricians at public hospitals who completed a structured self-administered questionnaire.

RESULTS

In total, 54 websites (87.1%) described infant teething as a normal developmental process. The lists that were found on the websites identified the most frequent signs of infant teething as fever and drooling/perioral rash. The most frequent management strategies were chewing non-chilled and chilled objects. For teething problems, some pediatricians recommended teething rings and oral benzocaine, while 23 pediatricians recommended nothing.

CONCLUSIONS

Parents should be informed by health professionals, especially regarding specific treatment strategies.

Mother knows breast: A content analysis of breastfeeding in television network news

Major health organizations worldwide have touted the benefits of breastfeeding and engaged in campaigns to increase rates of practice. This study content analyzes network television news transcripts (N = 475) to investigate the coverage of breastfeeding over a 15-year time period (1999-2013) across three networks (ABC, NBC, CBS). Results revealed that although television news reports on breastfeeding have steadily increased, topics have become more trivial. Reports were also found to heavily rely on episodic frames and primarily appear in morning news programs. Such coverage may have the ability to diminish the importance breastfeeding has on society and to deter policy advancement. Theoretical and practical implications for campaign development and promotion are discussed.

Designing Health Websites Based on Users' Web-Based Information-Seeking Behaviors: A Mixed-Method Observational Study

BACKGROUND

Laypeople increasingly use the Internet as a source of health information, but finding and discovering the right information remains problematic. These issues are partially due to the mismatch between the design of consumer health websites and the needs of health information seekers, particularly the lack of support for "exploring" health information.

OBJECTIVE

The aim of this research was to create a design for consumer health websites by supporting different health information-seeking behaviors. We created a website called Better Health Explorer with the new design. Through the evaluation of this new design, we derive design implications for future implementations.

METHODS

Better Health Explorer was designed using a user-centered approach. The design was implemented and assessed through a laboratory-based observational study. Participants tried to use Better Health Explorer and another live health website. Both websites contained the same content. A mixed-method approach was adopted to analyze multiple types of data collected in the experiment, including screen recordings, activity logs, Web browsing histories, and audiotaped interviews.

RESULTS

Overall, 31 participants took part in the observational study. Our new design showed a positive result for improving the experience of health information seeking, by providing a wide range of information and an engaging environment. The results showed better knowledge acquisition, a higher number of page reads, and more query reformulations in both focused and exploratory search tasks. In addition, participants spent more time to discover health information with our design in exploratory search tasks, indicating higher engagement with the website. Finally, we identify 4 design considerations for designing consumer health websites and health information-seeking apps: (1) providing a dynamic information scope; (2) supporting serendipity; (3) considering trust implications; and (4) enhancing interactivity.

CONCLUSIONS

Better Health Explorer provides strong support for the heterogeneous and shifting behaviors of health information seekers and eases the health information-seeking process. Our findings show the importance of understanding different health information-seeking behaviors and highlight the implications for designers of consumer health websites and health information-seeking apps.

Online health information seeking: how people with multiple sclerosis find, assess and integrate treatment information to manage their health

BACKGROUND AND OBJECTIVE

The Internet is increasingly prominent as a source of health information for people with multiple sclerosis (MS). But there has been little exploration of the needs, experiences and preferences of people with MS for integrating treatment information into decision making, in the context of searching on the Internet. This was the aim of our study.

DESIGN

Sixty participants (51 people with MS; nine family members) took part in a focus group or online forum. They were asked to describe how they find and assess reliable treatment information (particularly online) and how this changes over time. Thematic analysis was underpinned by a coding frame.

RESULTS

Participants described that there was both too much information online and too little that applied to them. They spoke of wariness and scepticism but also empowerment. The availability of up-to-date and unbiased treatment information, including practical and lifestyle-related information, was important to many. Many participants were keen to engage in a 'research partnership' with health professionals and developed a range of strategies to enhance the trustworthiness of online information. We use the term 'self-regulation' to capture the variations in information seeking behaviour that participants described over time, as they responded to their changing information needs, their emotional state and growing expertise about MS.

CONCLUSIONS

People with MS have developed a number of strategies to both find and integrate treatment information from a range of sources. Their reflections informed the development of an evidence-based consumer web site based on summaries of MS Cochrane reviews.

Tweeting About Prostate and Testicular Cancers: Do Twitter Conversations and the 2013 Movember Canada Campaign Objectives Align?

Prostate cancer is the most frequently diagnosed cancer of the reproductive system in men. Mass media campaigns have long been a tool for raising awareness of important health issues and changing health behavior. The Movember campaign was launched in Canada in 2007 with the goal of creating conversations about men's health in order to raise awareness and understanding about prostate cancer. In 2012, testicular cancer was added to the Movember Canada campaign agenda. Social networking sites such as Twitter are popular platforms for conversations in the digital age. Our objective was to determine if the Movember Canada 2013 campaign accomplished the goal of creating conversations about prostate and testicular cancers on the social media platform of Twitter. We conducted a content analysis of 4222 Canadian tweets posted during the November 2013 Movember Canada campaign to investigate whether tweets were health-related or non-health-related and to determine what topics of discussion were present in the tweets. There were significantly fewer health-related (n = 673) than non-health-related (n = 3549) tweets (p < 0.05). Few tweets (0.6 % of all tweets) referenced prostate or testicular cancers. Community engagement activities as well as moustache and grooming references were the most frequent topics in the health-related (10.49 and 1.97 %) and non-health-related (32.83 and 32.76 %) categories, which were significantly different by topic (p < 0.05). Findings from Twitter suggest that the Movember Canada 2013 did not meet the stated campaign objective of creating conversations about men's health and, specifically, about prostate and testicular cancers.

Visual presentations of efficacy data in direct-to-consumer prescription drug print and television advertisements: A randomized study

OBJECTIVE

To determine whether visual aids help people recall quantitative efficacy information in direct-to-consumer (DTC) prescription drug advertisements, and if so, which types of visual aids are most helpful.

METHODS

Individuals diagnosed with high cholesterol (n=2504) were randomized to view a fictional DTC print or television advertisement with no visual aid or one of four visual aids (pie chart, bar chart, table, or pictograph) depicting drug efficacy. We measured drug efficacy and risk recall, drug perceptions and attitudes, and behavioral intentions.

RESULTS

For print advertisements, a bar chart or table, compared with no visual aid, elicited more accurate drug efficacy recall. The bar chart was better at this than the pictograph and the table was better than the pie chart. For television advertisements, any visual aid, compared with no visual aid, elicited more accurate drug efficacy recall. The bar chart was better at this than the pictograph or the table.

CONCLUSION

Visual aids depicting quantitative efficacy information in DTC print and television advertisements increased drug efficacy recall, which may help people make informed decisions about prescription drugs.

PRACTICE IMPLICATIONS

Adding visual aids to DTC advertising may increase the public's knowledge of how well prescription drugs work.

Innovations in health information technologies for chronic pulmonary diseases

Asthma and chronic obstructive pulmonary disease (COPD) are common chronic obstructive lung disorders in the US that affect over 49 million people. There is no cure for asthma or COPD, but clinical guidelines exist for controlling symptoms that are successful in most patients that adhere to their treatment plan. Health information technologies (HITs) are revolutionizing healthcare by becoming mainstream tools to assist patients in self-monitoring and decision-making, and subsequently, driving a shift toward a care model increasingly centered on personal adoption and use of digital and web-based tools. While the number of chronic pulmonary disease HITs is rapidly increasing, most have not been validated as clinically effective tools for the management of disease. Online communities for asthma and COPD patients are becoming sources of empowerment and support, as well as facilitators of patient-centered research efforts. In addition to empowering patients and facilitating disease self-management, HITs offer promise to aid researchers in identifying chronic pulmonary disease endotypes and personalized treatments based on patient-specific profiles that integrate symptom occurrence and medication usage with environmental and genomic data.

Internet use by pregnant women seeking pregnancy-related information: a systematic review

BACKGROUND

The Internet has become one of the most popular sources of information for health consumers and pregnant women are no exception. The primary objective of this review was to investigate the ways in which pregnant women used the Internet to retrieve pregnancy-related information.

METHODS

We conducted a systematic review to answer this question. In November 2014, electronic databases: Scopus, Medline, PreMEDLINE, EMBASE, CINAHL and PubMed were searched for papers with the terms "Internet"; "pregnancy"; "health information seeking", in the title, abstract or as keywords. Restrictions were placed on publication to within 10 years and language of publication was restricted to English. Quantitative studies were sought, that reported original research and described Internet use by pregnant women.

RESULTS

Seven publications met inclusion criteria and were included in the review. Sample size ranged from 182 - 1347 pregnant women. The majority of papers reported that women used the Internet as a source of information about pregnancy. Most women searched for information at least once a month. Fetal development and nutrition in pregnancy were the most often mentioned topics of interest. One paper included in this review found that women with higher education were three times more likely to seek advice than women with less than a high school education, and also that single and multiparous women were less likely to seek advice than married and nulliparous women. The majority of women found health information on the Internet to be reliable and useful.

CONCLUSION

Most women did not discuss the information they retrieved from the Internet with their health providers. Thus, health providers may not be aware of potentially inaccurate information or mistaken beliefs about pregnancy, reported on the Internet. Future research is needed to address this issue of potentially unreliable information.

Perceptions and risky behaviors associated with Leptospirosis in an endemic area in a village of Ubon Ratchathani Province, Thailand

BACKGROUND

Leptospirosis, a disease caused by Leptospira species, a spirochaete bacterium that can develop in an appropriate environment and/or grow in human and/or animal hosts, is a serious problem for the Ministry of Public Health, Thailand.

OBJECTIVE

To investigate people's perceptions and behavioral risks regarding leptospirosis infection.

METHODS

The cross-sectional descriptive study collected data in May, 2013. Data on individuals' perceptions and risky behaviors concerning leptospirosis were collected from 104 completed questionnaires.

RESULTS

Regarding perceptions of leptospirosis, we found them to be at a high level (97.1%) and risky behaviors regarding leptospirosis were reported at a moderate level (74.0%). The study found no correlation between perceptions and risky behaviors regarding leptospirosis (r 0.186, p-value 0.059).

CONCLUSION

This study suggest that people in these areas have good knowledge about leptospirosis. However, some people have risky behavior associated with leptospirosis. Thus, a behavioral change campaign should be promoted to encourage people awareness of the dangers of such behavior.

Time to break the continence taboo

Millions of people in the UK experience continence problems that can have a devastating effect on quality of life. Nurse experts welcome new care guidance from NHS England but say that healthcare staff need to do more to raise patient awareness of available treatment options.

Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications

Rising ownership of smartphones and tablets across social and demographic groups has made mobile applications, or apps, a potentially promising tool for engaging patients in their health care, particularly those with high health care needs. Through a systematic search of iOS (Apple) and Android app stores and an analysis of apps targeting individuals with chronic illnesses, we assessed the degree to which apps are likely to be useful in patient engagement efforts. Usefulness was determined based on the following criteria: description of engagement, relevance to the targeted patient population, consumer ratings and reviews, and most recent app update. Among the 1,046 health care-related, patient-facing applications identified by our search, 43 percent of iOS apps and 27 percent of Android apps appeared likely to be useful. We also developed criteria for evaluating the patient engagement, quality, and safety of mobile apps.

Parental health literacy and its impact on patient care

The process of navigating through the modern American health care system is becoming progressively challenging. The range of tasks being asked of patients in the digital age is vast and complex and includes completing intricate insurance applications, signing complex consent forms, and translating medical data and prescription medication directions. Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely offered by medical providers. Mounting evidence now supports a growing awareness that general health literacy is the greatest individual factor affecting a person's health status.

Effects of interventions on use of hearing protectors among farm operators: A randomized controlled trial

OBJECTIVE

The purpose of this study was to compare the effectiveness of three interventions designed to promote hearing protector device (HPD) use.

DESIGN

Randomized controlled trial.

STUDY SAMPLE

Farm operators (n = 491) were randomly assigned to one of five intervention groups: (1) interactive web-based information with mailed assortment of HPDs; (2) Interactive web-based information only; (3) static web-based information with mailed assortment of HPDs; (4) Static web-based information only; or (5) mailed assortment of HPDs only. Data were analysed using a mixed model approach.

RESULTS

HPD use increased among all participants, and increased more among participants receiving the mailed HPDs (with or without information) compared to participants receiving other interventions. Participants receiving the interactive web-based information had comparable increased use of HPDs to those receiving the static web-based information. Participants receiving the mailed HPDs had more positive situational influences scale scores than other participants. Program satisfaction was highest among mailed and web-based information groups.

CONCLUSIONS

A mailed assortment of hearing protectors was more effective than information. Interactive and static information delivered via web were similarly effective. Programs interested in increasing HPD use among farmers should consider making hearing protectors more available to farmers.

The Communication of Global Cardiovascular Risk by Avatars

Communicating numerical estimates of cardiovascular risk (CVR) to patients encourage risk reduction actions. Avatars may enhance the risk messages ability to improve persuasion to adhere to healthy behaviors. We compared the efficacy of a computer-based aid communicating CVR with and without animated avatars for improving intention to adhere to lifestyle changes. Males with intermediate to high CVR received their risk message in 2 versions: an avatar using voice; voice only. Forty-one participants completed the study. Intent to change lifestyle showed a significant effect favoring the avatar (moderate effect size). Intent to follow medical treatments also showed a significant effect favoring the avatar (moderate effect size). An avatar-based computer aid significantly increased participants' intention to adhere to positive behavioral changes.

Application of Citizen Science Risk Communication Tools in a Vulnerable Urban Community

A public participatory geographical information systems (PPGIS) demographic, environmental, socioeconomic, health status portal was developed for the Stambaugh-Elwood (SE) community in Columbus, OH. We hypothesized that soil at SE residences would have metal concentrations above natural background levels. Three aims were developed that allowed testing of this hypothesis. Aim 1 focused on establishing partnerships between academia, state agencies and communities to assist in the development of a community voice. Aim 2 was to design and conduct soil sampling for residents of the SE community. Aim 3 was to utilize our interactive, customized portal as a risk communication tool by allowing residents to educate themselves as to the potential risks from industrial sources in close proximity to their community. Multiple comparisons of means were used to determine differences in soil element concentration by sampling location at p < 0.05. The results demonstrated that eight metals (As, Cd, Cu, Pb, Mo, Se, Tl, Zn) occurred at statistically-significantly greater levels than natural background levels, but most were below risk-based residential soil screening levels. Results were conveyed to residents via an educational, risk-communication informational card. This study demonstrates that community-led coalitions in collaboration with academic teams and state agencies can effectively address environmental concerns.

Assessing the Acceptability and Usability of an Internet-Based Intelligent Health Assistant Developed for Use among Turkish Migrants: Results of a Study Conducted in Bremen, Germany

The Internet offers a new chance for health professionals to reach population groups not usually reached through traditional information channels, for example, migrants. Criticism has, however, been raised that most health information on the Internet is not easy to read and lacks cultural sensitivity. We developed an Internet-based bilingual health assistant especially for Turkish migrants in Germany, tested its acceptance, and evaluated its usability in a participatory research design with families with and without Turkish migrant background. The interactive health assistant covered the following: nutrition, physical activity, overweight, diabetes, as well as pregnancy and pregnancy support. The idea of an Internet-based health assistant was generally accepted by all participants of the evaluation study, as long as it would be incorporated in existing appliances, such as smartphones. The bilingual nature of the assistant was welcomed especially by first generation migrants, but migrant participants also indicated that not all health information needed to be made available in a culture-specific way. The participants were least satisfied with the nutrition component, which they felt should include recipes and ingredients from the culture of origin, as well as specific aspects of food preparation.

Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial

PURPOSE

To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern.

METHODS

From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern.

RESULTS

580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23).

CONCLUSIONS

A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01830933.

The e-patient and medical students

The recent publicity around the tragic case of Bronte Doyne has highlighted a pressing need in healthcare delivery: the need for doctors to know that their patients, "e-patients," know medicine. In turn, this requires our medical students to be trained in how best to utilise the potential of e-patients in healthcare delivery. "I can't begin to tell you how it feels to have to tell an oncologist they are wrong, it's a young person's cancer. I had to, I'm fed up of trusting them." - Bronte Doyne (Vize 2015).