Digital Literacy & Oral Health (August 14, 2019)

Digital Literacy &
Oral Health
นพ.นวนรรน ธีระอัมพรพันธุ์
SlideShare.net/Nawanan

Outline
•Digital Literacy & Health Literacy
•Oral Health Literacy
•Roles of IT in Oral Health
•E-Patient & Participatory Medicine
•Summary

Literacy
Literacy
Computer
Literacy
IT Literacy
Information
Literacy
Digital
Literacy
Health
Literacy
Media
Literacy

Literacy
•Literacy: the quality or state of being literate
•Literate:
a : educated, cultured
b : able to read and write
•Literacy: “the ability to read, write and
otherwise deal with information using the
technologies and formats of the time”
Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies
and practices. : Peter Lang; 2008.

Literacy
Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.

Digital Divide & Literacy
https://www.itu.int/en/ITU-D/Statistics/Documents/Global%20ICT%20Developments%202001-2018%20-%20original.jpg

Digital Divide & Literacy (2016)
https://en.wikipedia.org/wiki/List_of_countries_by_number_of_Internet_users

Thailand ICT Statistics (2018)
“Thailand has an
extensive broadband
network with a current
focus on increasing
speeds and extending
access to remote
villages. Mobile
broadband take-up has
been astonishing, with
barely any 2G
subscriptions left
following the award of
3G spectrum in 2012.”
https://www.itu.int/en/ITU-D/Statistics/Documents/publications/misr2018/MISR-2018-Vol-2-E.pdf

Computer Literacy
•Mainly used through the 1980s
•Skill sets that enable one to be “able to operate
commonly used software packages effectively”
(Bawden, 2008)
Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.

Information Literacy
•Broader than “Computer Literacy”
•A Multifaceted Concept
•Encompasses “aspects of evaluation of information, and
an appreciation of the nature of information resources”
•While still focuses on computerized information
believed to be most problematic to users, also includes
use of printed resources
•Hence, overlap with library literacy & media literacy

•American Library Association proposed a 6-stage model
in 1989, comprising six aspects of a linear process of
information handling
Recognizing
Need for
Information
Identifying What
Information is
Needed
Finding
Information
Evaluating
Information
Organizing
Information
Using
Information

•UK Society of College, National, and University Libraries
(SCONUL) developed the “seven pillars” model in 2006
Recognizing
Information
Need
Distinguish Ways
of Addressing
Gap
Construct
Strategies for
Locating
Locate &
Access
Compare &
Evaluate
Organize,
Apply &
Communicate
Synthesize &
Create

•Goes beyond skill-based computer literacy model,
by including softer skills such as:
•Evaluation of information
•Recognition of information need
•But still a “prescriptive & formulaic approach”
(widely used for training in academic libraries)

• In 1990s, focus on information literacy shifted from a series of
competences to be mastered toward a set of general
knowledge & attitudes to be possessed. (Bawden, 2008)
• An information literate person is one who: (Bruce, 1994, 1997)
• Engages in independent self-directed learning
• Uses information processes
• Uses a variety of IT & systems
• Has internalized values that promote information use
• Has a sound knowledge of the world of information
• Approaches information critically
• Has a personal information style

• Shapiro & Hughes (1996)
Computer
Literacy
Tool
Literacy
Resource
Literacy
Social-
Structural
Literacy
Research
Literacy
Publishing
Literacy
Emerging
Technologi
es Literacy
Critical
Literacy
(Technology
Evaluation)

Digital Literacy
•Gilster (1997): “An ability to
understand and to use
information from a variety of
digital sources”
•Gilster: DL “is about mastering
ideas, not keystrokes”
•Bawden (2008), referring to
Gilster’s definition: “Simply
literacy in the digital age”
Gilster (1997)

Digital Literacy Skills & Competences
(Gilster, 1997)
• “knowledge assembly,” building a “reliable information
hoard” from diverse sources
• retrieval skills, plus “critical thinking” for making
informed judgements about retrieved information, with
wariness about the validity and completeness of
internet sources
• reading and understanding non-sequential and dynamic
material
• awareness of the value of traditional tools in
conjunction with networked media
• awareness of “people networks” as sources of advice
and help
• using filters and agents to manage incoming information
• being comfortable with publishing and communicating
information, as well as accessing it
Gilster (1997)
Bawden, In Kankshear &
Knobel (2008)
Gilster (1997), via Bawden (2008)

Digital Literacy
Digital
Literacy
Internet
Searching
Hypertext
Navigation
Knowledge
Assembly
Content
Evaluation
Gilster (1997)

Digital Literacy (Bawden, 2008)
4 generally agreed components of DL
1. Underpinnings
• Literacy
• Computer/ICT Literacy
2. Background Knowledge
• The World of Information
• Nature of Information Resources
3. Central Competencies
• Reading & Understanding Digital &
Non-Digital Formats
• Creating & Communicating Digital
Information
• Evaluation of Information
• Knowledge Assembly
• Information Literacy
• Media Literacy
4. Attitudes & Perspectives
• Independent Learning
• Moral/Social Literacy

Health Literacy
•“The degree to which individuals have the
capacity to obtain, process, and understand basic
health information and services needed to make
appropriate health decisions”
(Ratzan & Parker, 2000; Selden et al., 2000; HHS, 2000)

Health Literacy

Health Literacy
http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm

ฉลากยา รพ.ระยอง และ รพ.สต.
https://www.hfocus.org/content/2017/04/13820

Health-Literate Organizations

Health Literacy
•“หญิงไทย 74 ปี อ่านจาก Line ว่า กระชายดาลดไขมัน +
บารุงกระดูก จึงไปซื้อกระชายดามาปั่น กินวันละ 3 ขีด +
กินมะม่วงหาวมะนาวโห่ วันละ 8 ลูก + งาดาวันละ 2 เม็ด
(มี Sales มาขายที่บ้าน บอกว่าลดไขมัน ลดเบาหวาน ลด
ความดัน รักษามะเร็งได้ด้วย ราคาแพง ซื้อต่องวด 5,700
บาท)”
จากบันทึกของแพทย์ท่านหนึ่งในเวชระเบียนของผู้ป่วยรายหนึ่ง

Oral Health Literacy
•“The degree to which individuals have the
capacity to obtain, process, and understand basic
health information and services needed to make
appropriate oral health decisions”
(Adapted from Ratzan & Parker, 2000)
Institute of Medicine 2013. Oral Health Literacy: Workshop Summary. Washington, DC: The National Academies Press.

Oral Health Literacy

Health
Information
Technology
Goal
Value-Add
Tools

ภาพรวมของงานด้าน Health IT
Intra-Hospital IT
• Electronic Health Records &
Health IT for Quality & Safety
• Digital Transformation
• AI, Data Analytics
• Hospital IT Quality
Improvement (HA-IT)
Inter-Hospital IT
• Health Information
Exchange (HIE)
Extra-Hospital IT
• Patients: Personal
Health Records (PHRs)
• Public Health: Disease
Surveillance & Analytics
Patient
at Home

Strategic
Operational
ClinicalAdministrative
LIS
Health Information ExchangeBusiness
Intelligence
Word
Processor
Social
Media
PACS
Personal Health Records
Clinical Decision Support Systems
Computerized Physician Order Entry
Electronic Health Records
Admission-Discharge-Transfer
Master Patient Index
Enterprise Resource Planning
Vendor-Managed Inventory
Customer Relationship Management
4 Quadrants of Intra-Hospital IT

Hospital A Hospital B
Clinic D
Policymakers
Patient at
Home
Hospital C
HIE Platform
Health Information Exchange (HIE)
PHRs

Hersh (2009)
• PHR: “Patient-controlled aspect of the health record,
which may or may not be tethered to one or more EHRs
from health care delivery organizations”
Markle Foundation’s Connecting for Health (2003)
• PHR: “An electronic application through which individuals
can access, manage and share their health information,
and that of others for whom they are authorized, in a
private, secure, and confidential environment”
Emphasis in the definitions added by the presenter.
Personal Health Records (PHRs)

Tang et al. (2006)

Kaelber et al. (2008)

Areas of Health Informatics
Patients &
Consumers
Providers &
Patients
Healthcare
Managers, Policy-
Makers, Payers,
Epidemiologists,
Researchers
Copyright  Nawanan Theera-Ampornpunt (2018)
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics

Incarnations of Health IT
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
HIS/CIS
EHRs
Computerized Physician
Order Entry (CPOE)
Clinical Decision
Support Systems
(CDS) (including AI)
Closed Loop
Medication
PACS/RIS
LIS
Nursing
Apps
Disease Surveillance
(Active/Passive)
Business
Intelligence &
Dashboards
Telemedicine
Real-time Syndromic
Surveillance
mHealth for Public
Health Workers &
Volunteers
PHRs
Health Information
Exchange (HIE)
eReferral
mHealth for
Consumers
Wearable
Devices
Social
Media

Roles of IT in Consumer Health
• Access to information
• Networking opportunities
• Education/Self-study
• Personalization
• Effective & efficient communications
• With providers
• Among patients
• Empowerment
• “User Experience”

IT & Participatory Medicine
• Richard Davies deBronkart Jr.
• Cancer survivor & blogger
• Found proper cancer
treatment through online
social network after diagnosis
• Activist for participatory
medicine & patient
engagement through
information technology
http://www.epatientdave.com/

E-Patient
•Not “Electronic” Patient
•Engaged
•Equipped
•Empowered
•Educated
•Enlightened
•Etc.
http://www.epatientdave.com/

IT in Oral Health
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
Oral Health
Hygiene
Personalized
Oral Health
Education
Symptom-
Specific
Information
Social Media
for Oral
Health
Oral Health/Dental
Personal Health
Records (PHRs)
mHealth for
Education &
Engagement
Oral Health Service
Directory, Access,
Insurance & Quality
Reporting
Teledentistry
Dental Electronic
Health Records
(EHRs)
Dental Health
Information
Exchange (HIE)
Dental e-Referral
Dental Clinical
Decision Support
Systems (CDS)
mHealth for Oral
Health Public
Health Workers
Syndromic Oral
Health Disease
Surveillance
Water Fluoridation &
Environmental Surveillance &
Public Reporting
School
Health
Services

Where We Are Today...
Copyright  Nawanan Theera-Ampornpunt (2018-9)
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
Technology that
focuses on the sick,
not the healthy
Silos of data
within hospitalPoor/unstructured
data quality
Lack of health data
outside hospital
Poor data
integration across
hospitals/clinics
Poor data integration
for monitoring &
evaluation
Poor data quality (GIGO)
Finance leads
clinical outcomes
Poor IT change
management
Cybersecurity
& privacy risks
Few real examples
of precision
medicine
Little access
to own
health data
Poor patient
engagement
Poor accuracy
of wearables Lack of evidence
for health values
Health literacy
Information 
Behavioral
change
Few standards
Lack of health IT
governance

Healthtech Startup Ecosystem
www.facebook.com/HealthTechThailand/ No endorsements implied

Nawanan’s 3Cs of Oral Health
•Content
•Oral Health Knowledge & Information
•Generic vs. Personalized
•Channel
•Traditional Media
•IT Tools
•Culture
•Digital Literacy
•(Oral) Health Literacy
•Critical Thinking & Life-Long Learning

Summary (Requires Mathematical Literacy)
•Digital Literacy ≠ Computer Literacy
•Computer Literacy ⊂ Digital Literacy
•Digital Literacy ≠ Health Literacy
•Digital Literacy ∩ Health Literacy ≠ ∅
•Oral Health Literacy ⊂ Health Literacy
•Digital Literacy ∪ Oral Health Literacy ⇒ ↑ Oral Health
•... (See Next Slide)

Summary
Digital Literacy +
Oral Health Literacy +
Consumer Health IT Tools +
Good Oral Health Content
= Oral Health

Digital Literacy & Oral Health (August 14, 2019)

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Digital Literacy & Oral Health (August 14, 2019)