Category Archives: DOME Consortium

Explaining age-related variation in the use of patient accessible electronic health records

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A new article reporting findings on age-related variation in how people use patient accessible electronic health records has been published in Information Technology and People. The study is collaborative work between HIBA project and Swedish DOME research consortium and is freely available as open access.

The results show that younger respondents of a survey study conducted in Sweden were more likely to be interested in PAEHR contents for general interest. They did not value online access to the information as high as older ones. Older respondents were instead inclined to use medical records information to understand their health condition, prepare for visits, become involved in their own healthcare and think that technology has a much potential. Moreover, the oldest respondents were more likely to consider the information in the patient accessible electronic health records useful and aimed for them but to experience the technology as inherently difficult to use.

The study shows also how people in different ages think differently about information and technology, and how information technologies like patient accessible electronic health records should be studied separately from information and technology perspectives. People can have different views of technologies and the information they are used to make available. To understand the different views, the study suggests to look not only to people’s technological but also to their informational frames of reference.

Citation

Huvila, I., Cajander, Å., Moll, J., Enwald, H., Eriksson-Backa, K. and Rexhepi, H.(2021), “Technological and informational frames: explaining age-related variation in the use of patient accessible electronic health records as technology and information”, Information Technology & People, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/ITP-08-2020-0566

Abstract

Purpose

Data from a national patient survey (N = 1,155) of the Swedish PAEHR “Journalen” users were analysed, and an extended version of the theory of technological frames was developed to explain the variation in the technological and informational framing of information technologies found in the data.

Design/methodology/approach

Patient Accessible Electronic Health Records (PAEHRs) are implemented globally to address challenges with an ageing population. However, firstly, little is known about age-related variation in PAEHR use, and secondly, user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other. The purpose of this study is to investigate these two under-studied aspects of PAEHRs and propose a framework based on the theory of technological frames to support studying the second aspect, i.e. the interplay of information and technology–related perceptions.

Findings

The results suggest that younger respondents were more likely to be interested in PAEHR contents for general interest. However, they did not value online access to the information as high as older ones. Older respondents were instead inclined to use medical records information to understand their health condition, prepare for visits, become involved in their own healthcare and think that technology has a much potential. Moreover, the oldest respondents were more likely to consider the information in PAEHRs useful and aimed for them but to experience the technology as inherently difficult to use.

Research limitations/implications

The sample excludes non-users and is not a representative sample of the population of Sweden. However, although the data contain an unknown bias, there are no specific reasons to believe that it would differently affect the survey’s age groups.

Practical implications

Age should be taken into account as a key factor that influences perceptions of the usefulness of PAEHRs. It is also crucial to consider separately patients’ views of PAEHRs as a technology and of the information contained in the EHR when developing and evaluating existing and future systems and information provision for patients.

Social implications

This study contributes to bridging the gap between information behaviour and systems design research by showing how the theory of technological frames complemented with parallel informational frames to provide a potentially powerful framework for elucidating distinct conceptualisations of (information) technologies and the information they mediate. The empirical findings show how information and information technology needs relating to PAEHRs vary according to age. In contrast to the assumptions in much of the earlier work, they need to be addressed separately.

Originality/value

Few earlier studies focus on (1) age-related variation in PAEHR use and (2) user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other.

Keywords

  • Information seeking behaviour
  • End users
  • Technology
  • Theoretical concepts

New HIBA publications

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HIBA research group has published new results from the project during the past months.

Huvila, I., Hirvonen, N., Enwald, H., & Åhlfelt, R.-M. (2019). Differences in Health Information Literacy Competencies Among Older Adults, Elderly and Younger Citizens. In Kurbanoğlu, S.; Špiranec, S.; Ünal, Y.; Boustany, J.; Huotari, M. L.; Grassian, E.; Mizrachi, D. & Roy, L. (Ed.), Information Literacy in Everyday Life. ECIL 2018. Communications in Computer and Information Science(pp. 136–143). Cham: Springer. https://doi.org/10.1007/978-3-030-13472-313. Open access post-print of the article.

Abstract: To address the research gap on age-based differences in health information literacy (HIL), we investigated how younger (born 1960-) and older adults (1946-1960), and elderly citizens (-1945) differed from each other by their HIL competencies. Data were collected with an online survey of patients using the Swedish national electronic health record system. Altogether, 2,587 users responded. One-way ANOVA with post hoc tests revealed several differences between the groups: younger adults were less likely to value health information than older adults; older adults and elderly were least likely to compare information from multiple sources and had trouble in determining health information needs; older adults were most likely to have trouble understanding health terminology and the elderly to have difficulties in understanding medicinal package labels. The study shows that HIL is not necessarily improving or declining but adapting to challenges of advanced age.

Huvila, I.; Moll, J.; Enwald, H.; Hirvonen, N.; Åhlfeldt, R.-M. & Cajander, Å. (2019) Age-related differences in seeking clarification to understand medical record information. Information Research, 24(1), paper isic1834. Open access.

Abstract: Introduction Patient accessible electronic health records can be used to inform and empower patients. However, their use may require complementary information seeking since they can be difficult to interpret. So far, relatively little is known of the information seeking that takes place in connection to health record use, and especially the way it varies in different age groups. A better understanding of patients’ preferences of where and how to find explanatory information provides valuable input for the development of health information provision and counselling services.
Method. The analysis is based on the results of a national survey of Swedish individuals (N=1,411) who had used a national patient accessible electronic health record system (Journalen).
Analysis. The data were analysed in SPSS 24.0 using Kruskal-Wallis tests for detecting group-wise differences and Jonckheere-Terpstra tests for discovering age-related trends in the data.
Findings. Older patients were more likely to use a telephone and younger patients to use social contacts to ask for clarification. Generally, older adults born between 1946-1960 appear as passive information seekers.
Conclusion. Age groups differ in their preferences on how to seek clarification, which underlines the importance of a better understanding of individual differences in delivering not only technically but also intellectually accessible health information. Calling by telephone could be a habit of present older generations whereas, to a degree, searching information online could be a comparable habit of current younger generations.

HIBA at the Finnish Information Studies Symposium 2018

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HIBA project is organising a session on health information at the Finnish national Information Studies Symposium 2018 in Turku/Åbo Finland with two papers presenting the findings from the project. Links to extended abstracts of all presentations can be found below.

Hälsoinformation och e-hälsa / Terveystieto ja e-terveys / Health
information and e-health

MIE and VITALIS in Gothenburg, April 2018

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Medical Informatics Europe (MIE) conference was arranged in Gothenburg, Sweden in 24.-26.4.2018. At the same time Scandinavian eHealth event, VITALIS, took place in the same premises.

MIE covers a wide range of topics relating to medical informatics – from health literacy, different eHealth tools to data mining.

The first MIE was hosted in Cambridge, UK in 1978 and therefore MIE2018 marked the 40th anniversary for the conference. MIE2018 offered around 200 oral and 150 poster presentations. In addition, there were around 50 workshops, demonstrations and tutorials to attend to.

MIE2018 and Vitalis

Tuesday started early with a set of sessions and workshops. From HIBA research group Heidi Enwald was one of the organizers and presenters of the workshop “Re-defining eHealth Literacy for the 21st century. Discussing the evolution of the concept from different perspectives”.

In the workshop and, also afterwards, different definitions and measures of eHealth literacy were discussed. It was seen that we also need to get forward from discussing these issues; we need to identify what differentiates eHealth literacy from other health related literacy concepts, what are the future skills and abilities that relate to this concept and how should they be addressed. Heidi Enwald represents HIBA group in eHealth literacy network that continues discussion around the topic.

After Opening ceremony a Keynote speech was given by Patricia Flatley Brennan, the director of National Library of Medicine.

Keynote speech by Patricia Brennan

She spoke, among other things, about data-powered health that includes optimizing medication effectiveness, more efficient pathogen detection and targeted therapies. She mentioned that the nature of evidence in evidence-based medicine is also about to change. Furthermore, data does not take care of itself and therefore, e.g., data savvy librarians are needed.

As mentioned, MIE2018 provided many overlapping sessions to choose from and the decision was not always easy. Aging did not rise as a topic in many presentations, but there were some. For instance, Madeleine Blusi from Umeå University talked about aging in rural areas and their project that utilizes participatory design and attempts to create a service for including aged people into social activities they would otherwise no longer be able to join.

Madeleine Blusi from Umeå University

The VITALIS exhibition area was also available to visit by the participants of MIE2018.

Several kind of meetings were made possible by MIE2018 and VITALIS

The exhibition mostly contained booths of Swedish eHealth companies and made possible also the discussions between, e.g., researchers and advocates of industry.

The proceedings book of the conference is open access and can be found from the website:

https://mie2018.org/home/proceedings/

Anticipating ageing

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A new article Anticipating ageing: Older adults reading their medical records (full-text for subscribers) on older adults perceptions of reading their medical record and using e-health services, written in collaboration between HIBA project and researchers of Swedish DOME Consortium has been published in Information Processing & Management. A post-print version of the article can be found at http://www.istohuvila.se/node/560

Abstract

In spite of the general interest in health information behaviour, there is little earlier research on how older adults, who are still active in working life but approaching retirement, differ from other age groups. A survey with Swedish patients who had ordered and read their medical record was conducted to map the preferences and motivations of older adults (born 1946-1960) ordering a copy of their medical record, and using medical records based e-health and information services in the future. The results do not indicate an obvious linear relationship between age and motivation to use online health information but show several differences between the age groups. Older adults were less interested in communication with their medical doctor by e-mail. Yet, they had searched health information in the Internet during the last week more likely than young. They were more inclined to read medical record to get an overview of their health than young, but less confident that they understood most of the content or turn to their family and friends to seek help than the elderly. When compared to younger adults and elderly people, older adults are the least confident and least motivated to use online health information. It is suggested that older adulthood can be seen as a transitory stage of life when the need of health information increases and engagement with health changes. The results agree with prior research on the potential usefulness of (online) medical records as a way to inform citizens. However, specific provision strategies may be necessary to match the needs and motivations of different age groups.