Consuming Health Information and Vulnerable Populations: Factors of Engagement and Ongoing Usage.

OBJECTIVES: To summarise the state of the art during the year 2021 in consumer health informatics and education, with a special emphasis on "Inclusive Digital Health: Addressing Equity, Literacy, and Bias for Resilient Health Systems". METHODS: We conducted a systematic search of articles published in PubMed using a predefined set of queries. In order to build queries, we have used a common understanding of digital inclusion. Leaving no one behind in the digital age requires not only reaching the most vulnerable populations, but also those people and population groups that are not digitally literate. It implies appropriate access, digital skills, and usability and navigability aspects in the development of technological solutions. Thus, we identified 126 potential articles for review. These articles were screened according to topic relevance and 13 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers were discussed in a consensus meeting. Four papers received the highest score from the expert panel, and these papers were selected to be representative papers on consumer informatics for exploring inclusive digital health in the year 2021. RESULTS: Bibliometrics analysis conducted on words found in abstracts of the candidate papers revealed five clusters of articles, where the clustering outcomes explained 93.58% of the dispersion. The first cluster analysed the use of mobile apps to improve quality of communications between racial subgroups (e.g., Black patients and their family members) and healthcare professionals, and reduce racial disparities in core palliative care outcomes. The second cluster revealed studies reporting health literacy and experience of patients with specific diseases or impairments (e.g., type 2 diabetes, asthma and deaf people). The third focused assessing the effectiveness of interactive social media interventions on changing health behaviors, health outcomes and health equity in the adult population. The fourth targeted people with limited health literacy, as well as potentially disadvantaged or marginalized groups (people with cerebrovascular or cancer problems, students with mental problems, African American Young adults), and explored how social media may help reduce health disparities and improve health outcomes. The last explored health literacy levels among groups who experience difficulties with health service engagement and retention (patients with cancer or lay consumers of online disease information). CONCLUSIONS: Although the query was built to address consumer inclusiveness and digital health, without specifying any health status or disease, COVID-19 was the topic in a lot of retrieved papers. Beyond the classic health issues targeted by social media (e.g., influencing health behaviors, from smoking and diet adherence to preventative screening and exercise habits), the pandemic has exposed many situations of vulnerability and health inequality. There is universal agreement on the necessity of a healthcare policy that addresses issues of gender, age, sexual orientation, and different cultures to ensure health equity for all, regardless of age or resources available. The place of digital health is studied both as a solution and a possible factor of accentuating healthcare disparities, inequalities, and exclusions. Healthcare providers should implement a digital health literacy plan to make sure health information technology is an option for everyone. Public health policies and health promotion strategies must focus on strengthening and adapting the digital health literacy in known vulnerable subgroups (ethnic and racial minorities, sexual and gender minorities, children and adolescents, elderly people, students population, impaired people, patients with cancer and chronic diseases) increasing citizen technology engagement and guaranteeing equity in access to information and in the skills to manage, discriminate, and apply information to health.

Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review.

BACKGROUND: Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE: The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS: This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS: A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS: Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION: PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.

Consumer workarounds during the COVID-19 pandemic: analysis and technology implications using the SAMR framework.

OBJECTIVE: To understand the nature of health consumer self-management workarounds during the COVID-19 pandemic; to classify these workarounds using the Substitution, Augmentation, Modification, and Redefinition (SAMR) framework; and to see how digital tools had assisted these workarounds. MATERIALS AND METHODS: We assessed 15 self-managing elderly patients with Type 2 diabetes, multiple chronic comorbidities, and low digital literacy. Interviews were conducted during COVID-19 lockdowns in May-June 2020 and participants were asked about how their self-management had differed from before. Each instance of change in self-management were identified as consumer workarounds and were classified using the SAMR framework to assess the extent of change. We also identified instances where digital technology assisted with workarounds. RESULTS: Consumer workarounds in all SAMR levels were observed. Substitution, describing change in work quality or how basic information was communicated, was easy to make and involved digital tools that replaced face-to-face communications, such as the telephone. Augmentation, describing changes in task mechanisms that enhanced functional value, did not include any digital tools. Modification, which significantly altered task content and context, involved more complicated changes such as making video calls. Redefinition workarounds created tasks not previously required, such as using Google Home to remotely babysit grandchildren, had transformed daily routines. DISCUSSION AND CONCLUSION: Health consumer workarounds need further investigation as health consumers also use workarounds to bypass barriers during self-management. The SAMR framework had classified the health consumer workarounds during COVID, but the framework needs further refinement to include more aspects of workarounds.

Consumer Informatics and COVID-19 Pandemics: Challenges and Opportunities for Research.

OBJECTIVE: To summarise the state of the art during the year 2020 in consumer health informatics and education, with a special emphasis on "Managing Pandemics with Health Informatics - Successes and Challenges". METHODS: We conducted a systematic search of articles published in PubMed using a predefined set of queries, which identified 147 potential articles for review. These articles were screened according to topic relevance and 15 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers were discussed in a consensus meeting. Three papers received the highest score from the expert panel, and these papers were selected to be representative papers on consumer informatics for managing pandemics in the year 2020. RESULTS: Bibliometrics analysis conducted on words found in abstracts of the candidate papers revealed 4 clusters of articles, where the clustering outcomes explained 77.04% of the dispersion. The first cluster composed of articles related to the use of mobile apps for video consultation and telehealth during the pandemic. The second revealed studies reporting the lived experience of healthcare workers and patients during COVID-19. The third focused on ways people used the internet to seek for health information during the pandemic and the dissemination of fake news. The last cluster composed of articles reporting the use of social listening methods (e.g., via tweet hashtags) to explore the spread of the virus around the world. CONCLUSIONS: The pandemic outbreak of the novel coronavirus disease (COVID-19) constitutes a grave risk to the global community and sparks a significant increase in public interest and media coverage, especially on social media. Consumers are facing a new set of challenges that were not considered before COVID-19, often finding themselves in a world that is constantly changing-blended with facts and fake information-and unable to decide what to do next. Despite most people understanding the good will behind public health policies, one must not forget it is individuals we are supporting and that their personal circumstances may affect how they perceive and comply with these policies. Consumers more than ever need help to make sense of the uncertainty and their situation and we need to help them navigate the best option in a world that is constantly evolving.