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MOBILE LEARNING IN
  CONSUMER HEALTH



           Rebecca Hegel, MS, RN
           Teresa Smith, MS, RN
           Kim Stote, PhD, MPH, RD
Objectives

• Define health literacy and its impact on vulnerable
  populations

• Identify criteria to determine credibility of online
  sites for health care

• Explore mobile applications for use in consumer
  health
Health Literacy

  •What is Health Literacy?

  •Significance

  •Vulnerable Populations

  •Relationship between Literacy & Health

  •Research
   • Cancer, Diabetes, and Hypertension
Interactive Activity

 Google, Yahoo, MSN (Bing), AOL
  • Calories in an Apple
              Google: CalorieKing: 53, CalorieCount.about.com: 77
              Yahoo: CalorieKing: 53, Juicingforweigtloss.com: 53
              Bing: CalorieKing: 53, Apple.net: 77
              AOL: ????

  • High Blood Pressure
              Google: WebMD, www.nhlbi.nih.gov
              Yahoo: Health.Yahoo.com, Wikipedia
              Bing: Health.msn.com
              AOL: ?
Health Literacy

• Ability to understand health information and use that
  information to make good decisions about your health and
  medical care

• About 1/3 of the population of the United States has limited
  health literacy

• Did you know…..
  • …..studies show that 40% - 80% of what is said by your doctor is forgotten
    by the time you leave the office
Factors that Affect Health Literacy

• Health care language – use of words that patients don’t understand

• Low educational skills – reading skills

• Cultural barriers to health care

• Limited English proficiency

• Learning disabilities

• Cognitive decline
Vulnerable Populations
• Older adults (age +65)

• Minority populations

• Immigrant populations

• Low income

• The medically underserved

• People with chronic mental and/or physical conditions
What does the Research Say?

• Low health literacy is linked with:

 • Higher rates of hospitalization

 • Higher use of emergency services

 • Poorer health outcomes


  Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from
  http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf
Cancer and Health Literacy
• Low literacy adversely impacts:

 • Incidence of cancer

 • Mortality from cancer

 • Quality of Life
Diabetes and Health Literacy

• Low literacy is independently associated with:

 • Worse blood sugar (glycemic) control

 • Higher rates of eye disease that may affect vision
   (retinopathy)

 • More diabetes-related complications
Hypertension and Health Literacy
• Low health literacy in this population (48%) even
  with formal educational classes, showed:

 • Significantly less knowledge of the disease

 • Less lifestyle modification

 • Lower self-management skills
Health Literacy References

• National Network of Libraries of Medicine (2012). Health
  literacy. Retrieved from
  http://nnlm.gov/outreach/consumer/hlthlit.html

• Agency for Healthcare Research and Quality. (2011). Literacy
  and health outcomes. Retrieved from
  http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/lit
  eracyup.pdf
Credibility of Medical Websites

 • Americans use search engines more than doctors
   for obtaining health and medical information
   • Marketingcharts.com



 • Google is most often the first place of contact
   for health information
   • Business Noise - Vandergriend.com



 • Several popular sites related to health
   information
Most Popular Medical Websites

Marketing Information    Other Popular Sites

Varies somewhat by the    Yahoo!Health
 marketing research        MedicineNet.com
                           HealthCentral.com
#1 site overall…?         MayoClinic.com
                           NIH.gov
                           CDC.gov
WebMD
                           Health A to Z (myoptumhealth.com)
                           Wrong Diagnosis (.com)
Medical Library Association
• Criteria for Site Selection

 • The site’s sponsor should be easy to identify; this may be
   evident in the address itself (.gov, .edu, .org, .com)

 • The site should be updated frequently with the date of most
   recent revisions apparent

 • Information should be clear, factual, and evidence-based

 • Clear information on the intended audience should be
   provided (consumer versus professional)

 • http://www.mlanet.org/resources/userguide
Health on the Internet (HON) Code of Conduct

• “HON was founded to encourage the dissemination of quality
  health information for patients and professionals and the general
  public, and to facilitate access to the latest and most relevant
  medical data through the use of the internet.”

• “The HONcode certification is an ethical standard aimed at offering
  quality health information. It demonstrates the intent of a website
  to publish transparent information. The transparency of the
  website will improve the usefulness and objectivity of the
  information and the publishment of correct data.”

• http://www.hon.ch/HONcode/Patients/Visitor/visitor.html
Mobile Learning in Consumer Health
MLA – Deciphering Medspeak
MLA’s “Top Ten”…

• NOAH: New York Online Access to Health (http://www.noah-
  health.org/
• MedlinePlus (http://medlineplus.gov/)
• MayoClinic (http://www.mayoclinic.com/)
• Kidshealth® (http://www.kidshealth.org/)
• HIV InSite (http://hivinsite.ucsf.edu/)
• Healthfinder® (http://www.healthfinder.gov/)
• familydoctor.org (http://familydoctor.org/)
• Centers for Disease Control and Prevention (http://www.cdc.gov/)
• Cancer.gov (http://www.cancer.gov/)
MLA – Recommends Sites for:

•Cancer

•Diabetes

•Heart Disease
Complementary and Alternative Medicine
http://nccam.nih.gov/health/webresources
Internet Search: A hypochondriac’s best friend?
• “Details of a new study examining how symptoms presented online
  influence people’s reactions to possible medical conditions will be
  presented in Psychological Science, a journal of the Association for
  Psychological Science” (Newberg, 2012).
 • People are more likely to go online to search on symptoms than go to their
   doctor
 • > 60% of people feeling ill go to the internet for information
 • Follow-up with a doctor is based on what they find


• Research on cancer-seeking information
 • People perceive a higher disease risk when symptoms are identified in
   “streaks” – sequences of items on a list
Medical Implications of the Study

• Presentation of symptoms online:
 • To increase awareness of an emerging health issue that requires treatment,
   group symptoms together that will more likely be checked off in sequence.

 • According to Votruba, “If there are concerns that the perceptions of disease
   risk are too high, possibly resulting in over utilization of health services, then
   symptom lists should alternate common and specific symptoms or create
   longer symptom lists” (as cited in Newberg, 2012).

 • “Previous research shows that perception of risk of disease is a powerful
   predictor of health preventative behavior (such as going to the doctor),” Kwan
   said. “How information is presented online will make a substantive difference
   in behavior (as cited in Newberg, 2012).

 • Newberg, J. (2012, May 12). Internet search: A hypochondriac's best friend? [Peer commentary on research by Virginia Kwan,
   Sean Wojcik, Talya Miron-shatz, Ashley Votruba, and Christopher Olivola ]. Retrieved from
   http://researchmatters.asu.edu/stories/internet-search-hypochondriacs-best-friend-2183
Mobile Technology

• Computer devices that are intended to be always on
  and carried on the person throughout the day (i.e.,
  during normal daily activities)

• Mobile technologies support the collection and
 analysis of health-related information in real-time and
 in the real world




                                                        24
Mobile Technology

• Pew Internet and American Life Project:

  • 82% of American adults have a cell phone

  • approximately three in 10 Americans have accessed
    medical information

  • 10% have Apps that assist in managing a health condition


                                                               25
Health and Medical Apps

  •   Apps
      • Sophisticated programs or special applications
        designed for mobile technology

  • Sources of
      • Health and medical information (education)
      • Patient self-management tools




                                                         26
Health and Medical Apps

 • Rapid growth

 • iTunes App Store
    • 8600 health and medical Apps


 • Health insurance payers (Blue Cross Blue
   Shield), healthcare providers (Mayo Clinic),
   laboratory companies (Quest Diagnostics)


                                                  27
Health and Medical Apps
 • Driven by:

   • Consumer demand (improved productivity and cost
     reduction)

   • Provider acceptance

   • Participation of major technology companies
     (Microsoft, Intel, Google, Qualcomm, Apple, Nokia)


                                                          28
Mobile Health

• Limited evidence about how well and under what
  circumstances mobile technology compare with or
  enhance current means to improve health and
  healthcare

• Concerns with availability of mHealth to all
  segments of the population



                                                    29
Activity

• What do you want in a health and medical App?

• What is your favorite health and medical App?




                                                  30
Health Conditions - Apps

•Heart Health

 • HeartWise Blood Pressure Tracker
 • Quickly records and keeps track of systolic and diastolic blood
   pressure, resting heart rate and weight

   http://itunes.apple.com/us/app/heartwise-blood-pressure-
   tracker/id311716888?mt=8




                                                                 31
Health Conditions - Apps

 •Blood Sugar Tracker

  • Blood Sugar Tracker allows the user to easily log blood
    sugar levels, set target blood glucose ranges, and view
    history and simple graphs to quickly identify numbers
    that are out of range

    http://itunes.apple.com/us/app/blood-sugar-tracker-by-
    healthycloud.com/id398293939?mt=8



                                                              32
Health Conditions - Apps
•Vree for Diabetes

 • Vree for Diabetes is a portable resource for managing diabetes

 • The app includes diabetes education resources to better
   understand Type 2 diabetes and the requirements to manage
   it, blood glucose tracking, nutrition tracking, activity tracking,
   medication tracking, progress charts and blood pressure
   tracking

• http://itunes.apple.com/us/app/vree-for-diabetes/id355923059?mt=8
Nutrition/Weight Management - Apps

 •Calorie Counter

  • Tracks food, exercise, weight and all the nutrients
    listed on a Nutrition Facts label
  • Also includes daily inspirational articles, healthy recipes
    and an easy-to-understand Help section

    http://itunes.apple.com/us/app/calorie-counter/id492244010




                                                                  34
Nutrition/Weight Management - Apps
  •Calorie Counter & Diet Tracker by
   MyFitness Pal

  • This app may be created by MyFitness Pal, but the
    nutrition analysis features will make this app your best
    nutrition friend. The app includes a combination of
    both, on a daily and weekly section

    http://itunes.apple.com/us/app/calorie-counter-diet-
    tracker/id341232718?mt=8



                                                               35
Mind-Body Medicine - Apps
•Awareness

  • The app provides insight and breaks
                                      patterns of emotions,
  attitudes, and behavior through awareness and inspirational
  practices

  • Developed by psychotherapist Ronit Herzfeld

  • http://itunes.apple.com/us/app/awareness-pro/id402123427?mt=8




                                                                    36
Addiction Recovery Support - Apps

•Smoking Cessation

 • The main focus of the app is to show how long it has been
 since you last smoked and how much money you have
 saved as a result

 •http://itunes.apple.com/us/app/quitter/id284944935?mt=8




                                                               37
Conclusions
• Mobile health medical applications and internet
  resources may have the potential to play a
  significant role in health education and disease
  management by providing easy tracking,
  motivational sophistication, and improved
  adherence.

          For any health concerns, follow-up with your
                               health care practitioner


                                                     38

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Mobile Learning in Consumer Health

  • 1. MOBILE LEARNING IN CONSUMER HEALTH Rebecca Hegel, MS, RN Teresa Smith, MS, RN Kim Stote, PhD, MPH, RD
  • 2. Objectives • Define health literacy and its impact on vulnerable populations • Identify criteria to determine credibility of online sites for health care • Explore mobile applications for use in consumer health
  • 3. Health Literacy •What is Health Literacy? •Significance •Vulnerable Populations •Relationship between Literacy & Health •Research • Cancer, Diabetes, and Hypertension
  • 4. Interactive Activity Google, Yahoo, MSN (Bing), AOL • Calories in an Apple Google: CalorieKing: 53, CalorieCount.about.com: 77 Yahoo: CalorieKing: 53, Juicingforweigtloss.com: 53 Bing: CalorieKing: 53, Apple.net: 77 AOL: ???? • High Blood Pressure Google: WebMD, www.nhlbi.nih.gov Yahoo: Health.Yahoo.com, Wikipedia Bing: Health.msn.com AOL: ?
  • 5. Health Literacy • Ability to understand health information and use that information to make good decisions about your health and medical care • About 1/3 of the population of the United States has limited health literacy • Did you know….. • …..studies show that 40% - 80% of what is said by your doctor is forgotten by the time you leave the office
  • 6. Factors that Affect Health Literacy • Health care language – use of words that patients don’t understand • Low educational skills – reading skills • Cultural barriers to health care • Limited English proficiency • Learning disabilities • Cognitive decline
  • 7. Vulnerable Populations • Older adults (age +65) • Minority populations • Immigrant populations • Low income • The medically underserved • People with chronic mental and/or physical conditions
  • 8. What does the Research Say? • Low health literacy is linked with: • Higher rates of hospitalization • Higher use of emergency services • Poorer health outcomes Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf
  • 9. Cancer and Health Literacy • Low literacy adversely impacts: • Incidence of cancer • Mortality from cancer • Quality of Life
  • 10. Diabetes and Health Literacy • Low literacy is independently associated with: • Worse blood sugar (glycemic) control • Higher rates of eye disease that may affect vision (retinopathy) • More diabetes-related complications
  • 11. Hypertension and Health Literacy • Low health literacy in this population (48%) even with formal educational classes, showed: • Significantly less knowledge of the disease • Less lifestyle modification • Lower self-management skills
  • 12. Health Literacy References • National Network of Libraries of Medicine (2012). Health literacy. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html • Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/lit eracyup.pdf
  • 13. Credibility of Medical Websites • Americans use search engines more than doctors for obtaining health and medical information • Marketingcharts.com • Google is most often the first place of contact for health information • Business Noise - Vandergriend.com • Several popular sites related to health information
  • 14. Most Popular Medical Websites Marketing Information Other Popular Sites Varies somewhat by the Yahoo!Health marketing research MedicineNet.com HealthCentral.com #1 site overall…? MayoClinic.com NIH.gov CDC.gov WebMD Health A to Z (myoptumhealth.com) Wrong Diagnosis (.com)
  • 15. Medical Library Association • Criteria for Site Selection • The site’s sponsor should be easy to identify; this may be evident in the address itself (.gov, .edu, .org, .com) • The site should be updated frequently with the date of most recent revisions apparent • Information should be clear, factual, and evidence-based • Clear information on the intended audience should be provided (consumer versus professional) • http://www.mlanet.org/resources/userguide
  • 16. Health on the Internet (HON) Code of Conduct • “HON was founded to encourage the dissemination of quality health information for patients and professionals and the general public, and to facilitate access to the latest and most relevant medical data through the use of the internet.” • “The HONcode certification is an ethical standard aimed at offering quality health information. It demonstrates the intent of a website to publish transparent information. The transparency of the website will improve the usefulness and objectivity of the information and the publishment of correct data.” • http://www.hon.ch/HONcode/Patients/Visitor/visitor.html
  • 19. MLA’s “Top Ten”… • NOAH: New York Online Access to Health (http://www.noah- health.org/ • MedlinePlus (http://medlineplus.gov/) • MayoClinic (http://www.mayoclinic.com/) • Kidshealth® (http://www.kidshealth.org/) • HIV InSite (http://hivinsite.ucsf.edu/) • Healthfinder® (http://www.healthfinder.gov/) • familydoctor.org (http://familydoctor.org/) • Centers for Disease Control and Prevention (http://www.cdc.gov/) • Cancer.gov (http://www.cancer.gov/)
  • 20. MLA – Recommends Sites for: •Cancer •Diabetes •Heart Disease
  • 21. Complementary and Alternative Medicine http://nccam.nih.gov/health/webresources
  • 22. Internet Search: A hypochondriac’s best friend? • “Details of a new study examining how symptoms presented online influence people’s reactions to possible medical conditions will be presented in Psychological Science, a journal of the Association for Psychological Science” (Newberg, 2012). • People are more likely to go online to search on symptoms than go to their doctor • > 60% of people feeling ill go to the internet for information • Follow-up with a doctor is based on what they find • Research on cancer-seeking information • People perceive a higher disease risk when symptoms are identified in “streaks” – sequences of items on a list
  • 23. Medical Implications of the Study • Presentation of symptoms online: • To increase awareness of an emerging health issue that requires treatment, group symptoms together that will more likely be checked off in sequence. • According to Votruba, “If there are concerns that the perceptions of disease risk are too high, possibly resulting in over utilization of health services, then symptom lists should alternate common and specific symptoms or create longer symptom lists” (as cited in Newberg, 2012). • “Previous research shows that perception of risk of disease is a powerful predictor of health preventative behavior (such as going to the doctor),” Kwan said. “How information is presented online will make a substantive difference in behavior (as cited in Newberg, 2012). • Newberg, J. (2012, May 12). Internet search: A hypochondriac's best friend? [Peer commentary on research by Virginia Kwan, Sean Wojcik, Talya Miron-shatz, Ashley Votruba, and Christopher Olivola ]. Retrieved from http://researchmatters.asu.edu/stories/internet-search-hypochondriacs-best-friend-2183
  • 24. Mobile Technology • Computer devices that are intended to be always on and carried on the person throughout the day (i.e., during normal daily activities) • Mobile technologies support the collection and analysis of health-related information in real-time and in the real world 24
  • 25. Mobile Technology • Pew Internet and American Life Project: • 82% of American adults have a cell phone • approximately three in 10 Americans have accessed medical information • 10% have Apps that assist in managing a health condition 25
  • 26. Health and Medical Apps • Apps • Sophisticated programs or special applications designed for mobile technology • Sources of • Health and medical information (education) • Patient self-management tools 26
  • 27. Health and Medical Apps • Rapid growth • iTunes App Store • 8600 health and medical Apps • Health insurance payers (Blue Cross Blue Shield), healthcare providers (Mayo Clinic), laboratory companies (Quest Diagnostics) 27
  • 28. Health and Medical Apps • Driven by: • Consumer demand (improved productivity and cost reduction) • Provider acceptance • Participation of major technology companies (Microsoft, Intel, Google, Qualcomm, Apple, Nokia) 28
  • 29. Mobile Health • Limited evidence about how well and under what circumstances mobile technology compare with or enhance current means to improve health and healthcare • Concerns with availability of mHealth to all segments of the population 29
  • 30. Activity • What do you want in a health and medical App? • What is your favorite health and medical App? 30
  • 31. Health Conditions - Apps •Heart Health • HeartWise Blood Pressure Tracker • Quickly records and keeps track of systolic and diastolic blood pressure, resting heart rate and weight http://itunes.apple.com/us/app/heartwise-blood-pressure- tracker/id311716888?mt=8 31
  • 32. Health Conditions - Apps •Blood Sugar Tracker • Blood Sugar Tracker allows the user to easily log blood sugar levels, set target blood glucose ranges, and view history and simple graphs to quickly identify numbers that are out of range http://itunes.apple.com/us/app/blood-sugar-tracker-by- healthycloud.com/id398293939?mt=8 32
  • 33. Health Conditions - Apps •Vree for Diabetes • Vree for Diabetes is a portable resource for managing diabetes • The app includes diabetes education resources to better understand Type 2 diabetes and the requirements to manage it, blood glucose tracking, nutrition tracking, activity tracking, medication tracking, progress charts and blood pressure tracking • http://itunes.apple.com/us/app/vree-for-diabetes/id355923059?mt=8
  • 34. Nutrition/Weight Management - Apps •Calorie Counter • Tracks food, exercise, weight and all the nutrients listed on a Nutrition Facts label • Also includes daily inspirational articles, healthy recipes and an easy-to-understand Help section http://itunes.apple.com/us/app/calorie-counter/id492244010 34
  • 35. Nutrition/Weight Management - Apps •Calorie Counter & Diet Tracker by MyFitness Pal • This app may be created by MyFitness Pal, but the nutrition analysis features will make this app your best nutrition friend. The app includes a combination of both, on a daily and weekly section http://itunes.apple.com/us/app/calorie-counter-diet- tracker/id341232718?mt=8 35
  • 36. Mind-Body Medicine - Apps •Awareness • The app provides insight and breaks patterns of emotions, attitudes, and behavior through awareness and inspirational practices • Developed by psychotherapist Ronit Herzfeld • http://itunes.apple.com/us/app/awareness-pro/id402123427?mt=8 36
  • 37. Addiction Recovery Support - Apps •Smoking Cessation • The main focus of the app is to show how long it has been since you last smoked and how much money you have saved as a result •http://itunes.apple.com/us/app/quitter/id284944935?mt=8 37
  • 38. Conclusions • Mobile health medical applications and internet resources may have the potential to play a significant role in health education and disease management by providing easy tracking, motivational sophistication, and improved adherence. For any health concerns, follow-up with your health care practitioner 38

Notas do Editor

  1. Introductions:Me: I’ll be talking to you about health literacyTeresa: Most Reputable Websites in terms of Consumer HealthKim: Mobile Applications and Interactive ActivityOverall this presentation is designed to provide an overview of mobile learning and consumer health, discuss credibility of web resources, review commonly used mobile applications and devices, and lastly look at evaluation and EBP around this issue.
  2. Intro: Health Literacy & Interactive Activity: Rebecca Hegel (10 minutes)• Define health Literacy & demographicFurther Discussion about Health Literacy: Rebecca Hegel (8-10 minutes)• Why does this matter• Who’s Vulnerable & Why• Complexity b/w literacy & health• What does the research say about the impact of literacy on health?o Cancer, Diabetes, & Hypertension
  3. Please take out your mobile devices, laptops, kindle, What ever you've got with you! Calorie King is a paid weight loss program, however they were chimed in on Times best of 2011 mobile sites Before I begin my discussion on health literacy, lets go ahead for a moment and look at the information from WebMD… Gold Standard: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Other clinically recognized forms of hypertension include: isolated, secondary, malignant, hypertensive emergency, masked, and white-coat syndrome. No matter what form of hypertension an individual is diagnosed with, this disorder affects the entire cardiovascular system. Patients with hypertension are at an increased risk for organ disease, stroke, and myocardial infraction -