Feasibility and Reliability of the System for Observing Play and Leisure Activity in Youth (SOPLAY) for Measuring Moderate to Vigorous Physical Activity in Children Visiting an Interactive Children's Museum Exhibition.

PURPOSE: To test the feasibility and reliability of a direct observation method for measuring moderate to vigorous physical activity (MVPA) in children visiting an interactive children's museum exhibition. DESIGN: Direct observation was used to assess MVPA in children visiting an interactive children's museum exhibition on 2 weekend days in winter 2013. SETTING: The Children's Museum of Manhattan's EatSleepPlay™: Building Health Every Day exhibition. PARTICIPANTS: Children (group level) visiting the museum exhibition. MEASURES: System for Observing Play and Leisure Activity in Youth (SOPLAY). ANALYSES: Interobserver reliability was analyzed for MVPA and activity type. Two-group analyses were conducted using a series of Wilcoxon rank sum tests. RESULTS: A total of 545 children were observed over 288 observations. No significant differences were found between observers for MVPA ( r = .91, P = .6804) or activity type (κ = .90, P = .6334). Children participated in MVPA during 35.2% of all observations. No significant differences were found for participation in MVPA between boys (37.6%) and girls (32.8%, P = .1589). CONCLUSION: The SOPLAY may be a useful tool for measuring MVPA in interactive children's museum exhibitions. Research with multiple museum settings and diverse groups of children over longer periods of time is warranted to further establish the feasibility and reliability of the SOPLAY for measuring MVPA in this novel setting.

The usability of electronic personal health record systems for an underserved adult population.

OBJECTIVE: The goals of this study were to identify the demands associated with using electronic personal health records (PHRs) and to evaluate the ability of adults of lower socioeconomic status and low health literacy to use PHRs to perform health management activities. BACKGROUND: PHRs are proliferating in clinical practices and health care organizations. These systems offer the potential of increasing the active involvement of patients in health self-management. However, little is known about the actual usability of these tools for health consumers. METHOD: We used task analysis and health literacy load analysis to identify the cognitive and literacy demands inherent in the use of PHRs and evaluated the usability of three currently available PHR systems with a sample of 54 adults. Participants used the systems to perform tasks related to medication management, interpretation of lab/test results, and health maintenance. Data were also gathered on the participants' perception of the potential value of using a PHR. RESULTS: The results indicated that a majority of the participants had difficulty completing the tasks and needed assistance. There was some variability according to task and PHR system. However, most participants perceived the use of PHRs as valuable. CONCLUSIONS: Although considered a valuable tool by consumers, the use of PHR systems may be challenging for many people. Strategies are needed to enhance the usability of these systems, especially for people with low literacy, low health literacy, or limited technology skills. APPLICATION: The data from this study have implications for the design of PHRs.

Consumer Attitudes and Perceptions on mHealth Privacy and Security: Findings From a Mixed-Methods Study.

This study examined consumers' attitudes and perceptions regarding mobile health (mHealth) technology use in health care. Twenty-four focus groups with 256 participants were conducted in 5 geographically diverse locations. Participants were also diverse in age, education, race/ethnicity, gender, and rural versus urban settings. Several key themes emerged from the focus groups. Findings suggest that consumer attitudes regarding mHealth privacy/security are highly contextualized, with concerns depending on the type of information being communicated, where and when the information is being accessed, who is accessing or seeing the information, and for what reasons. Consumers frequently considered the tradeoffs between the privacy/security of using mHealth technologies and the potential benefits. Having control over mHealth privacy/security features and trust in providers were important issues for consumers. Overall, this study found significant diversity in attitudes regarding mHealth privacy/security both within and between traditional demographic groups. Thus, to address consumers' concerns regarding mHealth privacy and security, a one-size-fits-all approach may not be adequate. Health care providers and technology developers should consider tailoring mHealth technology according to how various types of information are communicated in the health care setting, as well as according to the comfort, skills, and concerns individuals may have with mHealth technology.

Emerging roles of health care providers to mitigate climate change impacts: a perspective from East Harlem, New York.

Professional associations of health care workers are issuing policy statements on climate change and health with greater frequency, calling on their members to act in their duty to protect and fulfill the right to health. These health care providers' perceptions of their roles in the intersection of climate and health, however, have not been well-studied. This article presents results from a qualitative study using focus groups conducted with health care providers serving the low-income, ethnic minority population in East Harlem, New York. The focus groups sought to identify and explore providers' perceived health threats of climate change, as well as their perceived role as frontline disseminators of information and detectors of disease for their patients. Extreme heat events were used to frame the discussion in each group. Three major themes emerged: 1) environmental awareness, 2) an "ecohealth" lens, and 3) heat and health vulnerability. The participants demonstrated their interest in playing a role in climate change adaptation by identifying at-risk patients and helping to tailor clinical care to better serve these individuals.

Muscle invasive bladder cancer: examining survivor burden and unmet needs.

PURPOSE: Although improvements in perioperative care have decreased surgical morbidity after radical cystectomy for muscle invasive bladder cancer, treatment side effects still have a negative impact on patient quality of life. We examined unmet patient needs along the illness trajectory. MATERIALS AND METHODS: A total of 30 patients (26.7% women) treated with cystectomy and urinary diversion for muscle invasive bladder cancer participated in the study. Patients were recruited from the Department of Urology at Mount Sinai and through advertisements on the Bladder Cancer Advocacy Network (BCAN) website between December 2011 and September 2012. Data were collected at individual interviews, which were audiotaped and transcribed. Transcribed data were quantitatively analyzed to explore key unmet needs. RESULTS: At diagnosis unmet informational needs were predominant, consisting of insufficient discussion of certain topics, including urinary diversion options and their side effects, self-care, the recovery process and medical insurance. Unmet psychological needs related to depression, and worries about changes in body image and sexual function were reported. Postoperative unmet needs revolved around medical needs (eg pain and bowel dysfunction) and instrumental needs (eg need of support for stomal appliances, catheters and incontinence). During survivorship (ie 6 to 72 months postoperatively) unmet needs centered around psychological support (ie depression, poor body image and sexual dysfunction) and instrumental support (eg difficulty adjusting to changes in daily living). CONCLUSIONS: Meeting patient needs is imperative to ensure adequate patient involvement in health care and enhance postoperative quality of life. An effective support provision plan should follow changes in patient needs.

Consumers' perceptions of patient-accessible electronic medical records.

BACKGROUND: Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. OBJECTIVE: The objective of the study was to identify vulnerable consumers' response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. METHODS: This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. RESULTS: Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor's visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. CONCLUSIONS: Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually engaging, and have user-friendly navigation.

Using public health detailing and a family-centered ecological approach to promote patient-provider-parent action for reducing childhood obesity.

BACKGROUND: This paper describes the research and development of the Obesity in Children Action Kit, a paper-based chronic disease management tool of the Public Health Detailing Program (PHD) at the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). It also describes PHD's process for developing the Obesity in Children detailing campaign (targeting healthcare providers working with children aged 2-18) and its results, during which the Action Kit materials were a focal point. The campaign goals were to impact healthcare provider clinical behaviors, improve the health literacy of parents and children, instigate patient-provider-parent dialogue, and change family practices to prevent obesity. METHODS: Qualitative research methods consisted of healthcare provider in-depth interviews and parent focus groups to aid campaign development. Evaluation of the Obesity in Children campaign included self-reported data on uptake and usage of clinical tools and action steps of matched assessments from 237 healthcare provider initial and follow-up visits, material stock counts, and DOHMH representative qualitative visit excerpts. RESULTS: Key themes identified in parent focus groups were concerns about childhood diabetes and high blood pressure, awareness of cultural pressure and our "supersize" culture, frustration with family communication around overweight and obesity, lack of knowledge about food quality and portion size, economic pressures, and the availability of healthy and nutritious foods. During the Obesity in Children campaign, six representatives reached 161 practices with 1,588 one-on-one interactions, and an additional 461 contacts were made through group presentations. After these interactions, there was a significant increase in the percentage of physicians self-reported use of key recommended practices: Use of BMI percentile-for-age to assess for overweight or obesity at every visit increased from 77% to 88% (p < 0.01); counseling all patients and their parents/caregivers about healthy eating and physical activity increased from 67% to 85% (p < 0.01); counseling all patients on reducing sugar-sweetened beverages increased from 63% to 78% (p < 0.01); and working with families to set realistic goals increased from 64% to 86% (p < 0.01). Clinical tools such as a soda bottle showing sugar content, pediatric plate planners, and goal setting posters were widely adopted (62%, 78%, and 41% respectively). CONCLUSIONS: The Obesity in Children campaign, as well as its predecessor, the Adult Obesity campaign and Action Kit, were amongst the best-received and most successful campaigns PHD has conducted since the inception of the program. They have elicited the most attention from healthcare providers and staff, with Obesity in Children Action Kit materials being requested throughout NYC, as well as nationally.

The simplicity complex: exploring simplified health messages in a complex world.

A challenge in individual and public health at the start of the 21st century is to effectively communicate health and science information about disease and complex emergencies. The low health literacy of millions of adults in the USA has been referred to as a 'silent killer'. A popular approach to improving health communication and health promotion to low health literate consumers has been to simplify the language of health information. The expected result has been that individuals and groups will better understand information and will then make informed decisions about their health and behaviors. This expectation has grown to include the belief that the public will be better prepared to take appropriate action in complex natural and man-made emergencies. Demonstrating the efficacy of this approach remains, in large part, uninvestigated. And it is becoming more evident that health literacy itself is complex and multifaceted. This article applies linguistic and sociolinguistic models in order to better articulate the role of simplification in health communication and health promotion. Focusing on two models from sociolinguistics-pragmatics and text theory-the article discusses their usefulness in rethinking message simplification. The discussion proposes that a richer, more theory-based understanding of text structures and functions, along with other powerful constructs, including cultural appropriateness, relevancy and context, are needed to close the gaps between health messages, health messengers and patients/the public. The article concludes by making recommendations for future study to empirically test the strengths and limitations of these models and constructs.

Introducing abortion patients to a culture of support: a pilot study.

Currently in the United States, women who have abortions face a societal culture in which disapproval, stigma, and misinformation about the risks and sequelae of abortion are common. The purpose of this study is to pilot test an intervention that introduces abortion patients to a "culture of support" by providing validating messages and information about groups and services that support women in their reproductive decisions, addressing stigma, and providing information to help women identify and avoid sources of abortion misinformation. Twenty-two women who completed their post-operative exam after abortion were enrolled to take part in the study intervention. In-depth interviews were conducted to explore patient experiences and responses to the intervention. All (22/22) participants responded that they believed that interventions like the one studied could help women avoid letting the judgmental actions and attitudes of others "get to them so much". All (20/20) participants felt that the intervention was personally helpful to them. An intervention that introduces women having abortions to a "culture of support" was well-received. This study provides a framework for future research about the content, strength, and effect of societal and cultural influences on women having abortions and for additional research about interventions to promote resilience after abortion.

Understanding health literacy: an expanded model.

A long and yet unfinished history of investigating how individual capabilities and social processes explain or predict health indicates that poor education, low literacy, poor health and early death are strongly linked around the world. However, the complexity of those relationships is not fully understood. In this article, we propose an expanded model of health literacy characterized by four domains: fundamental literacy (reading, writing, speaking and numeracy), science literacy, civic literacy and cultural literacy. To explore the utility of this model, we examine selected pieces of the public discourse about terrorism and bioterrorism that dominated the mass media during the anthrax threat in the United States during 2001. We conclude that this model of health literacy is useful to analyze health communication, to aid in constructing more understandable and appropriate health communication, and ultimately can lead to the development of a new measure to assess health literacy skills in individuals.

Children's asthma experience and the importance of place.

Asthma is increasing dramatically among poor, inner-city children. Fourteen children with, and twelve without, asthma were interviewed and observed to examine how children with asthma understand their illness and how the asthma experience shapes their sense of place. Quantitative data showed no difference in objective preferences for particular places, but qualitative analysis showed important differences. We identified eight place-related themes, and on seven there were clear differences between children with and without asthma--offering freedom, being aesthetically pleasing, being comfortable, nature of social contact, being isolating, being familiar and being safe. Children experienced asthma as an interruption in daily life that influences time spent outside, being active and being with friends. Children with asthma are more sensitive to places that are 'dirty' or contain asthma triggers, are less likely to explore new or people-free places and emphasize family interactions, while children without asthma emphasize friendships and are sensitive to neighborhood violence.

Unweaving the Web: an exploratory study of low-literate adults' navigation skills on the World Wide Web.

For traditionally underserved populations, the Web can potentially unlock resources that could fundamentally improve health and wellbeing. However, there are many barriers to using Web-based content. While physical access issues are well documented, there is little understanding of how nonmainstream populations use or will use the Web. Based on an ethnographic study of a group of low-literate adults, we have identified specific navigational and content issues that present barriers to this population. We discuss preliminary assumptions that can be used to inform the development of Web tools for this target audience, and directions for future applied research.