Health Heritage© a web-based tool for the collection and assessment of family health history: initial user experience and analytic validity.

A detailed family health history is currently the most potentially useful tool for diagnosis and risk assessment in clinical genetics. We developed and evaluated the usability and analytic validity of a patient-driven web-based family health history collection and analysis tool. Health Heritage(©) guides users through the collection of their family health history by relative, generates a pedigree, completes risk assessment, stratification, and recommendations for 89 conditions. We compared the performance of Health Heritage to that of Usual Care using a nonrandomized cohort trial of 109 volunteers. We contrasted the completeness and sensitivity of family health history collection and risk assessments derived from Health Heritage and Usual Care to those obtained by genetic counselors and genetic assessment teams. Nearly half (42%) of the Health Heritage participants reported discovery of health risks; 63% found the information easy to understand and 56% indicated it would change their health behavior. Health Heritage consistently outperformed Usual Care in the completeness and accuracy of family health history collection, identifying 60% of the elevated risk conditions specified by the genetic team versus 24% identified by Usual Care. Health Heritage also had greater sensitivity than Usual Care when comparing the identification of risks. These results suggest a strong role for automated family health history collection and risk assessment and underscore the potential of these data to serve as the foundation for comprehensive, cost-effective personalized genomic medicine.

Prenatal alcohol education for low-income women with interactive multimedia.

Prenatal alcohol use is a major cause of birth defects and other adverse outcomes of pregnancy. Educating expectant mothers concerning the need to limit alcohol consumption has been advocated as a method to decrease alcohol-related birth problems, however providing this service for low-income women is increasingly difficult due to ongoing changes in obstetrical practice patterns. The purpose of this work was to develop and test a computer-based multimedia prenatal alcohol education program which would be appropriate for use in a poor rural patient population. We first review the effect of alcohol consumption during pregnancy and previously employed intervention strategies. Then the design, development, and evaluation of the program is described. The content of the program reflects user beliefs and attitudes and takes advantage of a computer-based multimedia approach. This format provides numerous opportunities for user interaction, requires little reading ability and offers the potential to increase levels of health education efforts with no increase in staff. The program was found to be well accepted, to provide new information and to demonstrate potential for effecting change in behavioral intention. Possible uses of this technology for educating similar populations and the use of computers for health screening are discussed.