The Differential Effects of Social Media Sites for Promoting Cancer Risk Reduction.

Social media are potentially valuable tools for disseminating cancer education messages, but the differential effects of various sites on persuasive outcomes are unknown. In an effort to inform future health promotion, this research tested the effects of Facebook, YouTube, Twitter, and blogs for delivering a cancer risk reduction message. Using an experimental design, participants were randomly placed in several conditions that delivered the same message but with different forms of social media. Effects on comprehension and attitudes were examined, as they are important variables in the behavior change process. YouTube led to higher comprehension and stronger attitudes toward cancer risk reduction than Twitter, but there were no differences between other sites. Additionally, YouTube led to stronger attitudes toward cancer risk reduction as compared to Facebook, but not any other sites. These results demonstrate that, even if the message is kept constant, the form of social media used to deliver content can have an effect on persuasive outcomes. More research is needed to determine the mechanisms behind the differences found, however. Altogether, this line of research is valuable for any individuals seeking to use social media for health promotion purposes and could have direct implications for the development of cancer risk reduction campaigns.

The State and Sustainability of Telepsychiatry Programs.

Telepsychiatry, or the provision of psychiatric care across a distance using communication technologies, has become widespread and has been used successfully for treating a variety of mental illnesses. Little is known, however, about the sustainability of telepsychiatry programs and their long-term success. The goal of this study was to determine current trends in telepsychiatry by completing an extensive literature review and to follow-up with the authors of telepsychiatry research to examine the current status of their programs and success factors or barriers associated with their experiences. Results indicated that modern telepsychiatry programs often target veteran/military or child populations and that many rely on either federal or internal funding. Interestingly, several researchers indicated that they wished to improve current funding mechanisms, while others wished for improvements in the technology used. Implications of these findings for behavioral health researchers are discussed, along with suggestions for improving future telepsychiatry programs.

Including men in prenatal health: the potential of e-health to improve birth outcomes.

BACKGROUND: The U.S. infant mortality rate is the highest in the developed world, and disparity impacts underserved populations. Traditional maternal health focuses on women, excluding men from information affecting family health. Scholars advocate including men in prenatal health to reduce infant mortality, a proven strategy in developing nations. This study explored the role of U.S. men in prenatal health, barriers to involvement, and the use of e-health. Special attention was given to health literacy; research indicates e-health is effective in educating low health-literate audiences. MATERIALS AND METHODS: This study interviewed men with an average age of 33 years (n=32). The sample was 38% Hispanic, 28% African American, 28% white, and 6% multiracial. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of the tablet, and willingness to use similar applications. RESULTS: Men believe it is important to be involved in pregnancy to help ensure healthy births. Most use mobile devices and computers for health information and found the application to be useful and interesting. Most concluded they would use a similar application to learn about pregnancy. Health literacy had minimal impact on participants' use of the tablet and information. CONCLUSIONS: This study explored the role men play in prenatal health, a promising avenue toward better birth outcomes. Using e-health is an opportune approach-it can reach men unavailable to attend prenatal programs because of work or feeling unwelcome at programs deemed "only for women."

BARRIERS AND CONTRIBUTORS TO SUCCESS IN TELEMEDICINE: A QUALITATIVE STUDY OF A STRUGGLING TELEPSYCHIATRY PROJECT AND A SAMPLING OF HIGHLY SUCCESSFUL PROGRAMMES.

Telemedicine programmes, though popular and increasingly effective, can sometimes fail with little indication as to why they did so. This study provides first a qualitative analysis of the authors' failed telepsychiatry project, and second, an interview study completed with personnel from successful telepsychiatry programmes. Together, these shed light on what went wrong with the authors' project, and also provide insight about critical factors for telepsychiatry success. Findings suggest the sophistication or features of the technology are not key factors in failure or success. Instead, community, patient-based, and study-specific barriers were most commonly cited as issues that inhibited study recruitment and enrolment. Based on these findings, recommendations are provided to address common barriers and increase the likelihood of success in telepsychiatry.

Tools for assessing the quality and accessibility of online health information: initial testing among breast cancer websites.

Health websites are used frequently, but there are many concerns about their value as information sources. Additionally, there are numerous personal barriers that prevent individuals from wholly benefitting from them. In order to assess the quality of health websites and their accessibility to users, we created tools based on previous research that examine design aspects, information validity, motivational health content and literacy content. To test these tools, we examined 155 breast cancer websites and created scores for each assessment tool to describe the percent of constructs on the average website. Results demonstrated that websites performed best on the design tool followed by the information validity, motivational health content and literacy assessment tools. The average website contained the majority of the design and information validity constructs, but only about a third of the motivational health or literacy constructs. Multiple items from the motivational health content and literacy assessment tools were not found on any of the websites, and many were only represented on a handful of sites. Overall, the assessment tools were useful in evaluating the quality of websites, and could serve as valuable resources for health website developers in the future.

Comparison of social support content within online communities for high- and low-survival-rate cancers.

People experiencing cancer use the Internet for many reasons, particularly for social support. This study sought to determine how social support content within online support communities for different cancers varied according to cancer survival rate. A quantitative content analysis was conducted on 3717 posts from eight online communities focused on cancers with high and low 5-year relative survival rates. Using Optimal Matching Theory, we predicted that low-survival-rate communities would have more emotional support content than high-survival-rate communities, and high-survival-rate communities would have more informational support content than low-survival-rate communities. Emotional support content was consistently more common than informational support. Overall, high-survival-rate communities had a greater proportion of posts containing emotional support content (75%) than low-survival-rate communities (66%) (χ1 = 20.89 [n = 2235], P < .001). Furthermore, low-survival-rate communities had a greater proportion of posts containing informational support content (46%) than high-survival-rate communities (36%) (χ1 = 21.13 [n = 2235], P< .001). Although the relationships between survival rate and support types were significant, they were not as hypothesized. Deviations from theoretically predicted results suggest that individuals experiencing low-survival-rate cancers may have a greater desire for informational support online than individuals experiencing high-survival-rate cancers.

An examination into audience targeting and the use of storytelling or statistical evidence on breast cancer websites.

OBJECTIVE: This research sought to address the presence of information targeting low literacy, racially diverse, non-English speaking, and age diverse audiences on breast cancer websites. In addition, this study documented the utilization of evidence strategies, either statistics or storytelling, for these audiences. METHODS: This research examined these relationships on 157 breast cancer websites through content analysis. RESULTS: Nearly half of websites did not contain any of the elements targeting diverse literacy, racial/ethnic, language, and age audiences. Websites with multiple languages were more likely than monolingual websites to use statistics, and websites with low literacy sections were less likely than others to do so. Websites with ethnic or racial diversity and age diversity were more likely than other websites to use first person storytelling about breast cancer. CONCLUSION: Current breast cancer websites demonstrate promising use of targeting specific audiences and employing evidence strategies prescribed as effective by past research, however there is room for improvement. PRACTICE IMPLICATIONS: Tip sheets for incorporating audience targeting, readability, and storytelling should be created for health organizations to use in the process of developing their websites, as these constructs were found only sparingly on the assessed sites.

An evaluation of telehealth websites for design, literacy, information and content.

We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.

An independent investigation into the deployment of the federal communications commissions' rural health care pilot program.

OBJECTIVE: the goal of this study was to provide an independent and objective evaluation of the implementation of the Federal Communications Commission's Rural Health Care Pilot Program. MATERIALS AND METHODS: thirty-nine of the programs that were provided funding through this program were interviewed and asked about their project deployment, network planning, and the involvement of their state in implementation. RESULTS: RESULTS showed that programs recruited project team members from a variety of fields to fulfill different roles. Network partners were often chosen because they were stakeholders in the outcome of the project and because they had a past working relationship with the grant-receiving programs. In terms of deployment, many programs had made progress in filling out necessary paperwork and were tracking milestones, but had experienced changes since first receiving funding, such as losing participants. Additionally, many encountered challenges that inhibited deployment, such as coping with rule fluctuations. Many of the programs received support from their respective state governments in project development, often through matching funds, but few states were involved in the actual management of projects. CONCLUSIONS: as rural healthcare facilities often lack the information technology infrastructure compared with many urban facilities, it is important to understand the implementation process for programs such as the Rural Health Care Pilot Program and to examine what contributes to progress, stagnation, or disintegration. Although the programs reported some success, almost all had encountered challenges that inhibited implementation. A follow-up study is planned to further investigate deployment and determine the implications of Federal Communications Commission funding.

Keys to a successful and sustainable telemedicine program.

OBJECTIVES: The aim of this study was to determine organizational characteristics evident in successful telemedicine programs. The study proposed four research questions to identify the key organizational characteristics for successful telemedicine programs. METHODS: Data were collected through an online survey using modified unified theory of acceptance and use of technology (UTAUT) and organizational change readiness (ORC) validated assessments. RESULTS: Using the UTAUT instrument and the ORC assessment, themes of successful telemedicine programs emerged. Overarching themes of successful programs included being formally structured, forward thinking, seeking to improve the quality of patient care, and being financially stable. CONCLUSIONS: This research provides a data-driven understanding of organizational issues that serve to maximize a telemedicine program's ability to achieve the overall goals and mission of a healthcare organization.

Challenges of the rural healthcare pilot program broadband initiative.

The Federal Communication Commission initiated the Rural Healthcare Pilot Program Broadband Initiative in 2007 to provide funds for deployment of broadband networks to rural areas. The purpose of this paper is to highlight some of the preliminary findings of the first phase of a larger study designed to assess the implementation and effectiveness of the Rural Healthcare Pilot Program. Interviews with 40 organizations (response rate = 64.5%) that were awarded funds from the Federal Communication Commission for this project were conducted. Two questions from the interviews were coded, and overall themes are presented here. The questions are, "Did unexpected issues/challenges emerge during the planning stage?" and "What were they?" Ninety percent of the respondents stated that they had encountered challenges. The types of challenges reflect two overarching themes: program deployment issues and communication issues. The ultimate goal of this research project is to improve awareness of the challenges that telemedicine grantees often face when they receive funds from external agencies and also to use this information to facilitate this process.

Managing asthma with mobile phones: a feasibility study.

Asthma is a chronic disease and a growing health problem worldwide. The objective of this pilot study was to test the feasibility and utilization of tracking asthma symptoms through an innovative mobile phone application. The subjects for this research project consisted of 4 individuals who are currently receiving treatment for asthma from a primary care physician in Ingham County, Michigan. Participants took their peak flow reading each day and used the short message service (SMS) function on their phone and sent it to a Web server. If they did not send it by 11 AM, they received a reminder via an automated SMS to their phone. The resulting data suggest that this method of management is feasible. The data also demonstrate participants' satisfaction in monitoring their asthma in this manner. Using mobile phones for asthma management could improve compliance with asthma action plans and reduce adverse asthma events. Future research could further demonstrate that mobile phones are a new and effective method for providing healthcare.

Telehospice: reasons for slow adoption in home hospice care.

We investigated why hospice nurses were slow to adopt videophones to care for their patients. We used the unified theory of acceptance and use of technology (UTAUT) model and the organizational readiness for change (ORC) assessment via interviews and focus groups with hospice staff. Twenty-five hospice employees participated. Eighteen (72%) were in clinical positions and seven were in non-clinical positions (28%). Thirty-nine percent of respondents reported no videophone training, despite the fact that every employee had received training. Only four staff members actually used a videophone with patients. The respondents overwhelmingly stated that they had the organizational resources necessary to use the videophone and that it was easy to operate. Despite initial enthusiasm, leaders in the hospice agency did not endorse the videophones for work, nor offer incentives for using the videophones or providing them to patients. It is important to note that videophone technology is not meant to replace face-to-face visits, but to supplement them and to provide an additional tool for the nurses.

St. Vincent's Home telehealth for congestive heart failure patients.

St. Vincent's Homecare implemented a remote monitoring project in which researchers studied whether the telehome health patients exhibit enhanced clinical outcomes and patient perceptions of telehome healthcare. Fifty congestive heart failure patients (n = 50) participated in this program. Data collection included pre and post Outcome and Assessment Information Set items, 12-Item Short-Form Health Survey and Minnesota Living with Heart Failure Questionnaire, and data from patient charts were used to capture demographic information. In addition, interviews were conducted in order to assess overall perceptions and attitudes. Results indicate significant changes occurring among respondents in three important aspects that impact their quality of life, namely, physical, behavioral, and emotional improvements. Specifically, statistical significance was documented at the 0.05 level regarding improvement for home telehealth patients in shortness of breath, management of oral medications, ability to engage in moderate activities, amount of energy, swelling in legs/ankles, need to sit/lie down during day, fatigue, need for hospitalization, side effects from treatment, and worry. Additionally, patients found the service easy to use and perceived the care they received via telehealth to be as good as regular in-person care.

A series of papers for those yearning to propel telehealth to new heights.

If you are taking the time to read this essay, you are most likely interested in telemedicine and its future in some capacity. This introductory essay and accompanying series of white papers have a relatively simple goal, namely, to highlight a broad array of issues that must be addressed in order to propel telemedicine to its next stage in evolutionary development.

Critical steps to scaling telehealth for national reform.

Telehealth services show great promise to expand access to care while improving patient safety and reducing costs of care for all Americans. The expansion of telehealth has been slowed by a host of factors, including limited reimbursement, legal and regulatory barriers, limited provider capacity, and a lack of general public knowledge and/or acceptance of telehealth technologies and services. To hasten the expansion of telehealth requires a multifaceted and coordinated approach that will include healthcare professionals, regulators, payers, lawmakers, and patients. This paper will outline the steps necessary to scale telehealth services to a level that will help to address issues such as access to care, patient safety, quality, provider shortages, licensure and preparedness, all important elements of healthcare reform.

Provider utilization of telemedicine: the elephant in the room.

This paper addresses the challenge of provider underutilization of telehealth which continues to surface as an ongoing problem. In addition, this essay offers a list of ideas to serve as a starting point from which to address this key issue.

Use of telemedicine for haemodialysis: perceptions of patients and health-care providers, and clinical effects.

In Michigan, the use of telemedicine for dialysis patients began in three centres in 2005. A total of 747 clinical consultations was conducted in the following 22 months. Telephone surveys were conducted with 34 patients and four providers. The patients and providers all had positive perceptions of the telemedicine system and the care that was delivered. Most of the clinical measures of the patients met or exceeded the recommendations made by Renal Network 11. In addition to the clinical work, the telemedicine equipment was used for educational events. Twenty-six professional educational events were provided with a total audience of 105 individuals, and 35 administrative meetings were provided with 286 staff members in attendance. The study showed that patients and providers could participate in educational events that might not be available locally. Despite the success of dialysis telemedicine, the Marquette General Health System discontinued its use in 2007 when the Center for Medicare and Medicaid Services re-affirmed that dialysis centres were not approved sites for telemedicine.