Virtually exposed: privacy and e-health

eSexualHealth: Preferences to use technology to promote sexual health among men who have sex with men and trans and gender diverse people

Objectives

Gay, bisexual and other men who have sex with men (GBMSM) and trans and gender diverse (TGD) people are disproportionately affected by poorer sexual health outcomes compared to heterosexual populations. We aimed to explore the preferences of GBMSM and TGD for using eHealth for sexual health (eSexualHealth).

Methods

We distributed an anonymous online survey from April to August 2021among the lesbian, gay, bisexual, transgender, intersex, queer and other people of diverse sexuality or gender (LGBTIQA+) community in Australia. The survey collected data on sociodemographic characteristics and sexual behaviors, their preferences for app/website functions and preferred HIV and sexually transmitted infection (STI) testing reminders. We used descriptive statistics to summarize the characteristics of the study population. Free-text responses were thematically analyzed.

Results

Of 466 participants included, most identified as cisgender males (92.7%). The median age was 48 [interquartile range (IQR): 37-56]. For accessing sexual health-related information, 160 (34.6%) would use either a website or an app, 165 (32.7%) would prefer a website, 119 (25.8%) would prefer an app, and 33 (7.1%) would not use either platform. There was no significant difference between GBMSM and TGD people. Participants were most interested in information about STI clinics, HIV/STI hotspots, and sexual health education. Participants stressed the need for privacy and anonymity when using eHealth. Regarding reminders to test for HIV/STIs, receiving regular SMS was most popular (112/293, 38.2%), followed by regular emails (55/293 18.8%) and a reminder function on their phone (48/293, 16.4%).

Conclusion

Our study suggests a promising future for eHealth among GBMSM and TGD people. Sexual health is still a stigmatized area, and eHealth may circumvent barriers this population faces.

The Effects of Public Concern for Information Privacy on the Adoption of Health Information Exchanges (HIEs) by Healthcare Entities

The implementation of Health Information Exchanges (HIEs) by healthcare organizations may not achieve the desired outcomes as consumers may request that their health information remains unshared because of information privacy concerns. Drawing on the insights of concern for information privacy (CFIP) literature, this work extends the application of CFIP to the HIE domain. This study attempts to develop and test a model centered on the four dimensions of CFIP construct (collection, errors, unauthorized access, and secondary use) and their antecedents to predict consumers' opt-in behavioral intention toward HIE in the presence of the perceived health status' effects. We conducted an online survey in the United States using 826 samples. The results demonstrate that the perceived health information sensitivity and computer anxiety meaningfully contribute to information privacy concerns and CFIP construct significantly impedes consumers' opt-in decision to HIEs. Interestingly, contrary to our expectation, perceived poor health status considerably attenuates the negative effects exerted by CFIP on opt-in intention. The model proposed by this study can be used as a useful conceptual tool by both further studies and practitioners to examine the complex nature of patients' reactions to information privacy threats associated with the use of HIE technology in the healthcare industry.

Ethical aspects in eHealth – design of a privacy-friendly system

Purpose

– The medical advances and historical fluctuations in the demographics are contributing to the rise of the average age. These changes are increasing the pressure to organize adequate care to a growing number of individuals. As a way to provide efficient and cost-effective care, eHealth systems are gaining importance. However, this trend is creating new ethical concerns. Major issues are privacy and patients’ control over their data. To deploy these systems on a large scale, they need to offer strict privacy protection. Even though many research proposals focus on eHealth systems and related ethical requirements, there is an evident lack of practical solutions for protecting users’ personal information. The purpose of this study is to explore the ethical considerations related to these systems and extract the privacy requirements. This paper also aims to put forth a system design which ensures appropriate privacy protection.

Design/methodology/approach

– This paper investigates the existing work in the area of eHealth systems and the related ethical considerations, which establish privacy as one of the main requirements. It lists the ethical requirements and data protection standards that a system needs to fulfil and uses them as a guideline for creating the proposed design.

Findings

– Even though privacy is considered to be a paramount aspect of the eHealth systems, the existing proposals do not tackle this issue from the outset of the design. Consequently, introducing privacy at the final stages of the system deployment imposes significant limitations and the provided data protection is not always to the standards expected by the users.

Originality/value

– This paper motivates the need for addressing ethical concerns in the eHealth domain with special focus on establishing strict privacy protection. It lists the privacy requirements and offers practical solutions for developing a privacy-friendly system and takes the approach of privacy-by-design. Additionally, the proposed design is evaluated against ethical principles as proposed in the existing literature. The aim is to show that technological advances can be used to improve quality and efficiency of care, while the usually raised concerns can be avoided.

E-health: potential benefits and challenges in providing and accessing sexual health services

Background

E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location.

Discussion

The paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services. There are important issues in relation to utilising and providing online sexual health services. For healthcare providers, e-health can act as an opportunity to enhance their clients’ sexual health care by facilitating communication with full privacy and confidentiality, reducing administrative costs and improving efficiency and flexibility as well as market sexual health services and products. Sexual health is one of the common health topics which both younger and older people explore on the internet and they increasingly prefer sexual health education to be interactive, non-discriminate and anonymous. This commentary presents and discusses the benefits of e-sexual health and provides recommendations towards addressing some of the emerging challenges.

Future directions

The provision of sexual health services can be enhanced through E-health technology. Doing this can empower consumers to engage with information technology to enhance their sexual health knowledge and quality of life and address some of the stigma associated with diversity in sexualities and sexual health experiences. In addition, e-sexual health may better support and enhance the relationship between consumers and their health care providers across different locations. However, a systematic and focused approach to research and the application of findings in policy and practice is required to ensure that E-health benefits all population groups and the information is current and clinically valid and effective, including preventative approaches for various client groups with diverse needs.

The ethical and policy implications of e-health and telemedicine: an ageing-focused review

E-health and telemedicine programmes and systems offer much potential for supporting the health and wellbeing of older people, and are set to be promoted within the changing health-care landscape. This evolving model of technology-centred health care raises a number of ethical and regulatory issues, such as privacy, data protection, online professional practice, consent, accessibility and risk of confinement. Through this review we sought to analyse the European debate on the ethical and policy implications of e-health and telemedicine by identifying key ethical and regulatory issues and considering them against potential policy solutions.

Variation in health blog features and elements by gender, occupation, and perspective

This study explores whether there are gender and occupational differences in the health blogosphere and whether there are differences by blogger perspective. Data were derived from content analysis of 951 health blogs identified between June 2007 and May 2008. Results indicate that male, physician bloggers were more likely to have blogs that feature a SiteMeter, sponsorship, and advertising, which also were more prevalent among those blogging from a professional perspective. Women, bloggers in non-health-related employment, and patient/consumer and caregiver bloggers were more likely to blog about disease and disability; men, bloggers in health-related employment, and professional bloggers were more likely to blog about provider experiences, health research/news, and health policy, business, law, and technology. Because the Internet is becoming a primary source of health information, establishing normative guidelines regarding information quality, patient privacy, and conflicts of interest is essential. Future research should build on these findings using national surveys of health bloggers and textual analysis of blog content.

e-Health Technologies in Home Care Nursing

The innovative impact of advancing e-Health technologies is more frequently being discussed in nursing science. Nurses play an important role in collecting data and giving support to other users, especially in home care. Since issues of acceptance play a major role, the following article, which presents findings based on a focus group consisting of the elderly, caretaking relatives and professional nurses, is discussed from an ethical point of view in the context of international debate. It is interesting to note, that to some extent there is substantial ambivalence in the willingness to integrate such technologies into daily care. A need for technical assistance is clearly recognizable, however, limits as well. The authors’ findings indicate that a fundamental discussion on the relevance of e-Health methods in professional nursing needs to be held. It should address the ethical questions of often conflicting interests and rights (protection of identity, privacy and safety) in situations of high vulnerability.

Privacy and health in the information age: a content analysis of health web site privacy policy statements

This article reports a content analysis of the privacy policy statements (PPSs) from 97 general reference health Web sites that was conducted to examine the ways in which visitors' privacy is constructed by health organizations. PPSs are formal documents created by the Web site owner to describe how information regarding site visitors and their behavior is collected and used. The results show that over 80% of the PPSs in the sample indicated automatically collecting or requesting that visitors voluntarily provide information about themselves, and only 3% met all five of the Federal Trade Commission's Fair Information Practices guidelines. Additionally, the results suggest that the manner in which PPSs are framed and the use of justifications for collecting information are tropes used by health organizations to foster a secondary exchange of visitors' personal information for access to Web site content.

Emerging technologies for cancer prevention and other population health challenges

Emerging technologies, such as information and communication technologies (including future versions of the Internet), microelectromechanical systems, nanotechnologies, genomics, robotics, artificial intelligence, and sensors, provide enormous opportunities for enhancing health and quality of life. Population health technologies (PHTs) encompass the various applications of emerging technologies to improve the health of populations and communities. These technologies may change many population health paradigms, including those related to cancer prevention and control. In the future, emerging technologies will allow true customization of health communication to individuals, and existing tailoring approaches will be considered very crude. Environmental monitoring systems based on emerging technologies could also provide real-time information that health officials and community residents could use immediately to ameliorate potential carcinogenic or unhealthy exposures. Accelerating the application and diffusion of emerging technologies to population health challenges will require a multipronged approach, including new transdisciplinary programs, increased funding, supportive infrastructure, and policy changes.

Population health technologies: emerging innovations for the health of the public

At the beginning of the 21st century, we are at the dawn of a possibly unprecedented era of scientific discovery and promise. Emerging technologies, including information and communication technologies, genomics, microelectromechanical systems, robotics, sensors, and nanotechnologies, provide enormous opportunities for population health improvement. Population health technology refers to the application of an emerging technology to improve the health of populations. Emerging technologies present an opportunity for addressing global health challenges-in both developed and developing countries. Health issues ripe for the application of new technologies include disease surveillance and control, environmental monitoring and pollution prevention, food safety, health behavior change, self-care, population screening, and chronic disease and injury prevention and control. If appropriately applied, population health technologies may greatly enhance existing health intervention models. However, potential adverse consequences could arise related to privacy, confidentiality, and security; quality and effectiveness; sustainability; and the technology divide. To ensure the optimal development and diffusion of population health technologies will require balancing these risks and benefits while simultaneously adopting new mechanisms of public and private support for research and development in this potentially important new domain of public health.

The changing legal and conceptual shape of health care privacy

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.

While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice.

Regulating genetic privacy in the online health information era

As the clinical implications of the genetic components of disease come to be better understood, there is likely to be a significant increase in the volume of genetic information held within clinical records. As patient health care records, in turn, come on-line as part of broader health information networks, there is likely to be considerable pressure in favour of special laws protecting genetic privacy. This paper reviews some of the privacy challenges posed by electronic health records, some government initiatives in this area, and notes the impact that developments in genetic testing will have upon the 'genetic content' of e-health records. Despite the sensitivity of genetic information, the paper argues against a policy of 'genetic exceptionalism', and its implications for genetic privacy laws.

Beyond the hype: a taxonomy of e-health business models

This paper describes a business model of e-commerce, its application to health care, and the reasons why the health policy community should monitor its development. The business model identifies the market barriers health e-commerce firms must overcome and provides perspective on opportunities for building a health care data infrastructure that is capable of delivering both a private and a public good.