Topic: Governance, Compliance, and Health PolicyVisit the National Center for Biotechnology Information (NCBI) website and read the article “The Impact of Health Literacy on a Patient’s Decision t
CLASSMATE 1 BY DENEKA SAMPSON:
Does your position in society influence your health literacy scale? Health literacy is defined as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Noblin, Wan, & Fottler, 2012, “Introduction”, para. 3). The Institute of Medicine definition examines health literacy as a set of individual capabilities in the four domains of cultural and conceptual knowledge, speaking and listening skills, writing and reading skills, and numeracy (Nutbeam, 2008, “Different approaches to health literacy”, para. 4). This conceptualization of health literacy as a set of capacities also implies that health literacy is partly knowledge based, and may be developed through educational intervention (Nutbeam, 2008, “Different approaches to health literacy”, para. 4). With growing technological advances educational tools on improving one’s abilities to understand the usage of new healthcare technology is needed to improve health literacy. However, your position in society is not always the determining factor to how much you know about your health.
This brings me to look at Hypothesis 1 of Noblin, Wan, & Fottler’s study: patients who are younger, are more educated, and have higher income are more willing to adopt the PHR than those who are older, less educated, and with lower income (Noblin, Wan, & Fottler, 2012, “Hypothesis”, para. 1). At first glance, I would agree, the younger generation is growing up in this technologically advanced stage and are learning these advance practices in schools. While, the older generation is having to navigate these advances on their own at times or through assistance from the younger generation. However, I do not perceive income to be a hinderance, because more and more individuals are finding access to technology. As later pointed out in the study neither age or income had a significant barring in adoption of a personal health record. A personal health record is, an electronic, lifelong resource of health information needed by individuals to make health decisions Noblin, Wan, & Fottler, 2012, “Introduction”, para. 1).
Are individuals taking more control of their health than before? Personal health records are designed to promote an individual’s engagement, involvement, and self-management of their ongoing healthcare. The healthcare system that I work for in North Carolina, has been steadily promoting the use of their MyCarolinas health portal to help patients be able to monitor their health outcomes from doctors’ visits. It allows them a look into their current medications, lab results, doctors notes and discharge information, etc. The Mycarolinas portal has 200, 000+ patients enrolled to use the online patient portal (Hunter, 2016, “Care by the numbers”, para. 1). Patients are becoming more aware of their health needs and adapting to the use of online portals to assist with knowing more about their healthcare; even among concerns about safeguarding their medical information. An estimated 2.3 million Americans were victims of medical information identity theft during or before 2014 and nearly one third of the US population having been subject to some form of health information security breach during 2015 (Flaumenhaft & Ben-Assuli, 2017, “background”, para. 4). Patients are still showing interest in the ability to have access to their health information but advances in privacy and security are a need to prevent medical information theft.
1 Peter 5:8, “be sober-minded; be watchful. Your adversary the devil prowls around like a roaring lion, seeking someone to devour” (English Standard Version). With growing advances in technology, there are growing advances in hackers and people seeking to steal information. We must be watchful of our information and trust that it will be safe.
CLASSMATE 2 BY DAVID STEWART
Health literacy is a concept that describes a patient's ability to understand materials provided by physicians or other providers. Several factors, including education level, income, and age, can influence health literacy (Noblin, Wan, & Fottler, 2012, p. 1). Understanding what is health literacy and how it affects physicians and patients is very critical. Health literacy helps individual’s health outcomes based on their understanding of their high or low health literacy level. The article by Alice M. Noblin, Ph.D. and his colleagues did a research over a six week period to see if patients would be willing to accept Personal Health Record (PHR) technology. They considered several factors such as education level, income, and age to see if these factors would influence the health literacy test. In order to measure these results, they used the eHealth Literacy Scale (eHEALS). Which is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (Noblin, Wan, & Fottler, 2012, p. 1). As healthcare evolves, the practices of keeping records need to change as well. The PHR method helps in many areas such as, “doctor/patient relationship, adherence to medications, implementation of the management plan, self-management of chronic illness, hospital admissions, emergency department attendances, health inequalities, and lifestyle behaviors” (Benyon, 2014, p. 438). One of the biggest seller to adopt PHR in many facilities is the communication between the doctors and patients. With all the records being online the patient can easily access them and read up on the charts and look up terminologies that they may not be familiar with and exactly know what is going on with their acute/chronic illness. When patients have high health literacy levels it can lead to maintaining and understanding the illness. Which will help patients become more proactive in changing their lifestyle to combat their illness. On the other hand, a low health literacy will lead to poor outcomes, such as longer and more frequent hospitalizations, higher usage of emergency rooms, and inability to manage chronic diseases as asthma and diabetes (Noblin, Wan, & Fottler, 2012, p. 1).
According to Ajzen and Fishbein, a patient’s attitude about their ability to find, use, and evaluate e-health meant that the more favorable the reaction, the more willing the patient would be to adopt and use the PHR (Noblin, Wan, & Fottler, 2012, p. 2). Ajzen and Fishbein also mention that “subjective norms” play a role in how a patient will adopt the PHR. Subjective norms mean that the more others of influence feel that something is important, the more likely the individual will change their behavior.
The study made two hypotheses:
1. Patients who are younger, are more educated, and have higher income are more willing to adopt the PHR than those who are older, less educated, and with lower income. This hypothesis was not supported because none of the factors (age, education, and income) were found to be statistically significant with chi-square testing when compared to the willingness to adopt a PHR.
2. Patients who have high levels of e-health literacy are more willing to adopt the PHR than those with low levels of e-health literacy. This hypothesis was supported because the e-health literacy questions were significant at the p < .01 level based on Pearson chi-square testing.
The results of the two hypothesis testing results were interesting, in the sense, they thought people who were more educated and made more money would be open to the PHR technology. On the contrary, it had almost nothing to do with social or economic status. Rather it had to do with if they felt comfortable and were able to understand and access the records easily and simplistically.
Their hypotheses results:
• Hypothesis 1: Patients who are younger, are more educated, and have higher income are more willing to adopt the PHR than those who are older, less educated, and with lower income. This hypothesis was not supported because none of the factors (age, education, and income) were found to be statistically significant with chi-square testing when compared to the willingness to adopt a PHR.
• Hypothesis 2: Patients who have high levels of e-health literacy are more willing to adopt the PHR than those with low levels of e-health literacy. This hypothesis was supported because the e-health literacy questions were significant at the p < .01 level based on Pearson chi-square testing.
In the study regarding health literacy and PHR, 562 patients were sampled over the course of six weeks. The patient’s adoption of PHR, as well as their health literacy, was evaluated. Results showed that 74% of the participants would adopt the PHR, of that percentage, patients 41-55 years old were among the most common age group. Over 52% of patients had a high school education or less and 59% of patients were of low socioeconomic (less than $20,000 annually) background. The results of the eHEALS (8 questions that assess the patient's level of using technology for e-health) revealed that 65% of the patients who wanted to adopt a PHR as well as 38% of patients who didn’t want to take a PHR all had high perceived health literacy levels. 35% of patients who did want to take a PHR but did not feel comfortable with their ability to use the information they had received for health decisions, had a low perceived health literacy level.
In conclusion, the PHR has a long way to go according to Braunstein. He mentions in his textbook that as easy to use and improve the healthcare industry as a whole. He fears that ultimately people express the concerns about the privacy and security of their health records/data. As seen in this research their lots of benefits to moving towards PHR systems, but it might take some time for doctors and patients to fully understand and trust the system. I do believe as we develop more secure platforms, the healthcare industry will start to implement the PHR system as part of their daily life. Bible Verse:
