Disposition toward privacy and information disclosure in the context of emerging health technologies

Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review

BACKGROUND

International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses.

OBJECTIVE

This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses.

METHODS

A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach.

RESULTS

Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level.

CONCLUSIONS

There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.

Personal Location as Health-Related Data: Public Knowledge, Public Concern, and Personal Action

OBJECTIVES

Personal health information (PHI), including health status and behaviors, are often associated with personal locations. Smart devices and other technologies routinely collect personal location. Therefore, technologies collecting personal location do not just create generic questions of privacy, but specific concerns related to PHI.

METHODS

To assess public opinion on the relationship between health, personal location, and privacy, a national survey of US residents was administered online in March 2020. Respondents answered questions about their use of smart devices and knowledge of location tracking. They also identified which of the locations they could visit were most private and how to balance possibilities that locations may be private but can also be useful to share.

RESULTS

Of respondents that used smart devices (n = 688), a majority (71.1%) indicated they knew they had applications tracking their location, with respondents who were younger (P < .001) and male (P = .002) and with more education (P = .045) more likely to indicate "yes." When all respondents (N = 828) identified the locations on a hypothetical map they felt were most private, health-related locations (substance use treatment center, hospital, urgent care) were the most selected.

CONCLUSIONS

The historical notion of PHI is no longer adequate and the public need greater education on how data from smart devices may be used to predict health status and behaviors. The COVID-19 pandemic brought increased attention to personal location as a tool for public health. Given healthcare's dependence upon trust, the field needs to lead the conversation and be viewed as protecting privacy while usefully leveraging location data.

Sharing health information across online platforms: A systematic review

Advanced Web 2.0 communication technologies have facilitated health-related information (HRI) sharing on the Internet. Especially, the COVID-19 pandemic and lockdowns around the world have forced more people to turn to the Internet for HRI. A better understanding of users' sharing content and sharing behavior can help communicators improve health literacy, raise community awareness, and facilitate social support exchanges. This paper reports the results of a systematic review of online HRI sharing literature, including key research topics, theories and methods used in past studies, and key factors of sharing behavior across online platforms. Following the PRISMA procedure for a systematic review, 58 articles were identified and analyzed using keyword matching, thematic analysis, and expert review. Guided by the platform theory, our findings differentiated five types of online platforms that differently influenced online users' sharing content and sharing purposes, including micro-blogs, social network sites, online health communities, social question and answer sites, and Wikis. The findings also clarify five main research topics and applicable theories used in each topic, including personal health sharing, health-related knowledge sharing, general health message diffusion, outcomes of HRI sharing, and exploratory research. Key factors of sharing behavior and potential sharing outcomes are also reviewed and summarized in the research framework developed from the motivation theory. Our study contributes to the understanding of online sharing behavior and provides implications for health communicators to develop effective health campaigns. Potential research directions are also identified and discussed.

Consumer Views on Privacy Protections and Sharing of Personal Digital Health Information

IMPORTANCE

Digital health information has many potential health applications, but privacy is a growing concern among consumers and policy makers. Consent alone is increasingly seen as inadequate to safeguard privacy.

OBJECTIVE

To determine whether different privacy protections are associated with consumers' willingness to share their digital health information for research, marketing, or clinical uses.

DESIGN, SETTING, AND PARTICIPANTS

This 2020 national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample with oversampling of Black and Hispanic individuals. Willingness to share digital information across 192 different scenarios reflecting the product of 4 possible privacy protections, 3 uses of information, 2 users of information, and 2 sources of digital information was evaluated. Each participant was randomly assigned 9 scenarios. The survey was administrated between July 10 and July 31, 2020, in Spanish and English. Analysis for this study was conducted between May 2021 and July 2022.

MAIN OUTCOMES AND MEASURES

Participants rated each conjoint profile on a 5-point Likert scale measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results are reported as adjusted mean differences.

RESULTS

Of the 6284 potential participants, 3539 (56%) responded to the conjoint scenarios. A total of 1858 participants (53%) were female, 758 (21%) identified as Black, 833 (24%) identified as Hispanic, 1149 (33%) had an annual income less than $50 000, and 1274 (36%) were 60 years or older. Participants were more willing to share health information with the presence of each individual privacy protection, including consent (difference, 0.32; 95% CI, 0.29-0.35; P < .001), followed by data deletion (difference, 0.16; 95% CI, 0.13-0.18; P < .001), oversight (difference, 0.13; 95% CI, 0.10-0.15; P < .001), and transparency of data collected (difference, 0.08; 95% CI, 0.05-0.10; P < .001). The relative importance (importance weight on a 0%-100% scale) was greatest for the purpose of use (29.9%) but when considered collectively, the 4 privacy protections together were the most important (51.5%) factor in the conjoint experiment. When the 4 privacy protections were considered separately, consent was the most important (23.9%).

CONCLUSIONS AND RELEVANCE

In this survey study of a nationally representative sample of US adults, consumers' willingness to share personal digital health information for health purposes was associated with the presence of specific privacy protections beyond consent alone. Additional protections, including data transparency, oversight, and data deletion may strengthen consumer confidence in sharing their personal digital health information.

Associations Between Privacy-Related Constructs and Depression and Suicide Risk in Health Care Professionals, Trainees, and Students

PURPOSE

The University of California, San Diego screens health care professionals, trainees, and students for depression and suicide risk. Individuals complete a voluntary, anonymous online screening tool and choose whether to provide personal demographic information. This study assessed the relationship between privacy-related constructs and self-rated depression and suicide risk.

METHOD

The authors analyzed responses to the screening tool collected from January 2018 to December 2019. Measures of depression, suicidal ideation and behaviors, and worry about stigma for seeking mental health services (i.e., privacy-related concern) were gathered. The number of demographic item nonresponses (i.e., age, gender, ethnicity/race, professional position) was operationalized as privacy-related behavior. Linear and logistic regression models were used to determine associations between privacy-related constructs (concern and behavior) and depression and suicide measures.

RESULTS

A total of 1,224 respondents were included. On average, respondents reported mild depression (mean = 9.12, standard deviation = 5.94), but 43% (524/1,224) reported at least moderate depression. One in 5 respondents (248/1,224) reported worry about stigma for seeking mental health services, and more than 17% (212/1,224) skipped at least 1 demographic question. Privacy-related concern was statistically significantly and positively associated with recent depression and suicidal ideation and behaviors (odds ratios [ORs] = 3.13-7.02; 95% confidence interval [CI], 2.23-19.20; P's < .001) and with lifetime suicide attempts (OR = 1.76; 95% CI, 1.08-2.86; P = .02). Privacy-related behavior was statistically significantly and positively associated with suicide action (OR = 2.23; 95% CI, 1.24-4.02; P = .008).

CONCLUSIONS

Privacy-related constructs may be meaningful correlates of mental health as respondents who endorsed these constructs had increased odds of worse depression and suicidal ideation and behaviors. Considering privacy-related constructs may be useful for identifying health care professionals, trainees, and students experiencing distress and in need of imminent mental health resources.

Consumer Willingness to Share Personal Digital Information for Health-Related Uses

IMPORTANCE

Consumers routinely generate digital information that reflects on their health.

OBJECTIVE

To evaluate the factors associated with consumers' willingness to share their digital health information for research, health care, and commercial uses.

DESIGN, SETTING, AND PARTICIPANTS

This national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample, with oversampling of Black and Hispanic panel members. Participants were randomized to 15 scenarios reflecting use cases for consumer digital information from a total of 324 scenarios. Attributes of the conjoint analysis included 3 uses, 3 users, 9 sources of digital information, and 4 relevant health conditions. The survey was conducted from July 10 to 31, 2020.

MAIN OUTCOMES AND MEASURES

Participants rated each conjoint profile on a 5-point Likert scale (1-5) measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results reflect mean differences in this scale from a multivariable regression model.

RESULTS

Among 6284 potential participants, 3543 (56%) responded. A total of 1862 participants (53%) were female, 759 (21%) identified as Black, 834 (24%) identified as Hispanic, and 1274 (36%) were 60 years or older. In comparison with information from electronic health care records, participants were less willing to share information about their finances (coefficient, -0.56; 95% CI, -0.62 to -0.50), places they visit from public cameras (coefficient, -0.28; 95% CI, -0.33 to -0.22), communication on social media (coefficient, -0.20; 95% CI -0.26 to -0.15), and their search history from internet search engines (coefficient, -0.11; 95% CI, -0.17 to -0.06). They were more willing to share information about their steps from applications on their phone (coefficient, 0.22; 95% CI, 0.17-0.28). Among the conjoint attributes, the source of information (importance weight: 59.1%) was more important than the user (17.3%), use (12.3%), and health condition (11.3%). Four clusters of consumers emerged from the sample with divergent privacy views. While the context of use was important, these 4 groups expressed differences in their overall willingness to share, with 337 participants classified as never share; 1116 classified as averse to sharing (mean rating, 1.64; 95% CI, 1.62-1.65); 1616 classified as uncertain about sharing (mean rating, 2.84; 95% CI, 2.81-2.86); and 474 classified as agreeable to sharing (mean rating, 4.18; 95% CI, 4.16-4.21). Respondents who identified as White and non-Hispanic, had higher income, and were politically conservative were more likely to be in a cluster that was less willing to share (ie, never or averse clusters).

CONCLUSIONS AND RELEVANCE

These findings suggest that although consumers' willingness to share personal digital information for health purposes is associated with the context of use, many have strong underlying privacy views that affect their willingness to share. New protections may be needed to give consumers confidence to be comfortable sharing their personal information.

Biobank Participants' Attitudes Toward Data Sharing and Privacy: The Role of Trust in Reducing Perceived Risks

Biobank participants are often unaware of possible uses of their genetic and health information, despite explicit descriptions of those uses in consent forms. To explore why this misunderstanding persists, we conducted semi-structured interviews and knowledge tests with 22 participants who had recently enrolled in a research biobank. Results indicated that participants lacked understanding of privacy and data-sharing topics but were mostly unconcerned about associated risks. Participants described their answers on the knowledge test as largely driven by their trust in the healthcare system, not by a close reading of the information presented to them. This finding may help explain the difficulties in increasing participant understanding of privacy-related topics, even when such information is clearly presented in biobank consent forms.

A policy Delphi study to validate the key implications of data sharing (KIDS) framework for pediatric genomics in Canada

BACKGROUND

The highly sensitive nature of genomic and associated clinical data, coupled with the consent-related vulnerabilities of children together accentuate ethical, legal and social issues (ELSI) concerning data sharing. The Key Implications of Data Sharing (KIDS) framework was therefore developed to address a need for institutional guidance on genomic data governance but has yet to be validated among data sharing practitioners in practice settings. This study qualitatively explored areas of consensus and dissensus of the KIDS Framework from the perspectives of Canadian clinician-scientists, genomic researchers, IRB members, and pediatric ethicists.

METHODS

Twelve panelists participated in a three-round online policy Delphi to determine the desirability, feasibility, relative importance and confidence of twelve individual statements of the KIDS Framework. Mean and IQR were calculated from panelists' ratings to determine the strength of consensus and polarity. Qualitative content analysis of panelists' written responses was used to assess degree of support. Statements were validated when their combined ratings and qualitative rationales indicated high-moderate consensus (at least 70% agreement across two contiguous categories), low to no polarity (IQR at least 1.0) and strong support.

RESULTS

Nine original, and one new statement reached consensus. These statements outlined essential elements of the informed consent process, including a realistic evaluation of benefits and risks and assurance of future ethics oversight for secondary data use. Discrepant views on appropriate protections for anonymized and coded i.e. de-identified genomic data were primary sources of dissensus.

CONCLUSIONS

The validated statements provide institutions with empirically supported best practices for sharing genomic and associated clinical data involving children from the perspectives of key stakeholders. Concerted efforts to quantify informational risks that can be conveyed to patients and families are further needed to align data sharing policy with stakeholder priorities.

Special Section on Ethics in Health Informatics

OBJECTIVE

To summarize significant research contributions on ethics in medical informatics published in 2019.

METHODS

An extensive search using PubMed/Medline was conducted to identify the scientific contributions published in 2019 that address ethics issues in medical informatics. The selection process comprised three steps: 1) 15 candidate best papers were first selected by the two section editors; 2) external reviewers from internationally renowned research teams reviewed each candidate best paper; and 3) the final selection of three best papers was conducted by the editorial committee of the Yearbook.

RESULTS

The three selected best papers explore timely issues of concern to the community and demonstrate how ethics considerations influence applied informatics.

CONCLUSION

With regard to ethics in informatics, data sharing and privacy remain primary areas of concern. Ethics issues related to the development and implementation of artificial intelligence is an emerging topic of interest.