HIBA gästar eHealth@LU

HIBA-projektet gästar eHealth@LU, Lunds universitets ehälsoplattform, på ett  webbinarium den 4 mars 2021, kl 9–10 svensk tid då Isto berättar om HIBA och projektets resultat.

Mer information på eHealthLU hemsida: http://www.ehealth.lth.se/activities/workshops/20th-webinar/

Registrera dig här till webbinarium med Isto Huvila: http://www.ehealth.lth.se/activities/registration-form-webinar-20/

Deadline av registreringen: 2 mars 2021

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

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.


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



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.


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.


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.


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.


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

Classifying Health Information Interactions and their Motivations

Some more HIBA findings were presented at the International Conference on Health Information Management Research (ISHIMR) organized online by Linnaeus University and the University of Sheffield. Material for the presentation that focused on developing a classification of the types of interactions with electronic patient portals and health records can be found below.


Current research on electronic patient portals and electronic health records shows a broad range of benefits to both patients, healthcare professionals and healthcare when patients are allowed to take part of their medical record information. There are, however, shortcomings in the current knowledge about patients’ and other stakeholders’ information interactions with electronic health record systems and what motivates them to use these. We present a tentative classification of information interactions with an electronic patient portal, the stakeholders involved in the interactions and reasons that motivate patients to interact with electronic health record information. The purpose with the classification scheme is 1) to inform the design of useful health information access systems, and simultaneously to 2) contribute to the broader information interaction research by acting as a first step in developing a more generic classification that brings together information interactions, their stakeholders and stakeholder motivations to engage with information.

HIBA @ ASIS&T-EC Health Information Behaviour Symposium

Results from several past and on-going HIBA studies were featured in a presentation held by Heidi at the Information Science Trends symposium on Health Information behaviour organised by the ASIS&T European Chapter this week.


New e-health services and technologies are developed around the world with expectations of multiple individual and system-wide benefits. Even if there is no single reason why many e-health projects have failed to deliver their expected gains, one central contributing factor has been their narrow focus on technology and a failure to understand the use of e-health in the context of citizens’ general health information behaviour. Here we report key findings from the ongoing research project Taking Health Information Behaviour into Account: implications of a neglected element for successful implementation of consumer health technologies on older adults, funded by the Academy of Finland (2015-2020). The project aims at explicating premises for the development of e-health services that are comprehensible, meaningful, and useful in the context of how older adults seek, use and manage information, and more specifically health information, in their everyday lives.

ASIST 2019

The Annual Meeting of Association for Information Science and Technology (ASIS&T) was organized in Melbourne, Australia at 19th to 23rd October 2019.

The theme of the conference was INFORMATION… ANYONE, ANYWHERE, ANY TIME, ANY WAY

ASIST could be considered as one of the main conferences of Library and Information Science (LIS) field. This year conference was already 82nd meeting of this research community. This was the second time ever outside of North America and first time it was organized in Australia!

The keynote speakers

In her opening keynote ‘Mixing reality for cultural proliferation’ Mikaela Jade discussed her journey as an Indegenous woman building a technology company Indigital. The company works to develop new ways to digitise and translate knowledge and culture from remote communities.


Opening keynote photo from ASIST 2019 pages

Helena Teede, an Endocrinologist, the Executive Director of Monash Partners Academic Health Sciences Centre and Director of the Monash Centre for Health Research and Implementation, School of Public Health, Monash University gave the closing keynote ‘Changing the Paradigm: Driving Disruption Through Collaboration to Create a Learning Health System’.

She talked about the lack of strategic planning of research, silos & lack of systems approaches. The ideas of data-driven healthcare improvement were strongly present in her statements and she also called for metrics to guide action in healthcare.

General notions and an example of a panel

Regarding to education in LIS field, data science seemed to be a hot topic, especially in the USA. Several sessions related to this discussion. Past was pondered, e.g., in a panel named Does Information Science Need History and Foundations? Furthermore, also the future of the field raised in the discussions. ASIST has always presentations and panels from a wide spectrum of topics and this year was not an exception. Everything between Breaking Social Media Bubbles for Information Globalization to Research Data Sharing Across National Borders. The Final Program Booklet can be found from here.

As an example of the several interesting panel discussions available in the conference we highlight here one.

Kristina attended a panel discussion about digital equity for marginalized and displaced people. The panellists were Gregory Rolan and Sue McKemmish, both from Monash University, Australia, Kathy Carbone from UCLA, USA, and Barbara Reed from Recordkeeping Innovation in Australia. The theme included for example refugees, stateless people or otherwise geographically displaced people but also children taken into custody. Digital equity was seen as equity for all in new and emerging digital information systems, also those who do not participate within the digital sphere. Documentation overall was seen as central, both the right to having ones information kept in records, and to know where possible records exist, what they contain and why they have been created. These records can be of different kinds, including digital health records. In addition to more formal records, also, for example, children in care could have apps where they can keep their own records.

HIBA project

The members of HIBA were well presented in the panel discussion “Information Behaviour and Practices Research Informing Technology and Service Design”.

The panel discussion, lead by Noora Hirvonen, included short presentations from Isto Huvila (via a video), Ying-Shang Liu, Kristina Eriksson-Backa and Heidi Enwald.

The panel discussion, lead by Noora Hirvonen, included short presentations from Isto Huvila (via a video), Ying-Shang Liu, Kristina Eriksson-Backa and Heidi Enwald. After the presentations the discussion was openned and we received many interesting and lively questions and comments.

Isto discussed archaeology-related information work and practices in relation to development of documentation and information management technologies and services. Heidi talked about her research about health promotion e-health services design and HIL from the projects MOPO, GASEL and PrevMetSyn.

Ying-Hsang Liu from Australian National University in Canberra presented his work with engineers in the aerospace industry, for whom he is a consultant. According to him, industry understands challenges but may not have solutions and hence IBP models and theories are important. Engineers are also interested in metrics and hence we need to communicate with them about metrics, what results can be expected. In industry, time is valuable; results might be needed within a certain time limit. There is also a challenge with working with industry projects in that they are concerned about intellectual property and thus results might have to be kept secret.

Kristina presented the HIBA project and three of the studies conducted within it: the online survey study on diabetes risk test users by Hai Nguyen, the focus group study of older adults’ views on MyKanta and the recently conducted national survey of 1500 Finns aged 55-70 years, and their health information behaviour and views of e-health services. Some implications concerning the format and contents of e-health services based on the results were presented.

More info about our panel:

Huvila I, Enwald H, Eriksson-Backa K, Liu Y-H & Hirvonen N (2019) Information behaviour and practises research informing technology and service design. Proceedings of the Association for Information Science and Technology , 56(1), 541-545. ASIS&T 2019, Melbourne, Australia, 19-23 October 2019. (Panels and alternative events) https://asistdl.onlinelibrary.wiley.com/doi/full/10.1002/pra2.86?af=R

We also had time to go and meet some penguins!

About ASIST: https://www.asist.org/

2020 ASIS&T Annual Meeting goes to Pittsburgh!

Visiting Australian researchers

ASIST 2019 conference was organised in Melbourne in the end of October 2019. Members of HIBA participated this conference, but as you travel so far from Finland, it also makes sense to visit local researchers that work on topics interesting to HIBA. Luckily, I had an opportunity to do exactly this.


In Sydney I visited professor Kirsten McCaffery, the leader of Health Literacy Lab in the University of Sydney. They are a research group at the University of Sydney School of Public Health.

University of Sydney

Furthermore, I spend a day with the faculty members of IKM and Digital Studies Program, University of Technology Sydney (UTS). I had the priviledge to have Senior lecturer Bhuva Narayan as my host for this visit. The discussions varied from differences of countries statuses in eHealth, research on older adults to teaching Information Studies related topics.

Bhuva and Heidi and inspiring discussions!

UTS, University of Technology Sydney


In Wollongong I was taken a good care by the faculty members of Centre for Persuasive Technology and Society, in University of Wollongong. During a two day visit I also met local PhD students.

Workshop together with local PhD students


In Canberra I met several researchers from Australian National University (ANU).

From ANU Institute for Communication in Health Care professor Diana Slade kindly found time to chat with me about the research done in their research group and in HIBA.

I also had lively discussion with Associate Professor Hanna Suominen, originally from Turku. The topics varied from strategic Our Health in Our Hands research initiate to differences of doing research and living in Finland and in Australia.

Enthusiastic visitor

Dr Ying-Hsang Liu showed me kindly around the campus and Canberra and future research topics were invented e.g., over a lovely japanese dinner.

Heidi and Ying-Hsang


Before the conference, and arrival of HIBA colleagues Kristina and Noora, I had a really nice unofficial breakfast meeting with Rebecca French from Victorian Health Promotion Foundation.

Meeting Rebecca

During my visit, in addition to researchers, I also saw a lot of beautiful landscapes, big cities and also some native animals 🙂 Overall the trip was a success!

Wallabi said Hi!

Planning the final year of HIBA

The current project group gathered for a two-day work meeting in Turku/Åbo for reviewing  past and planning the forthcoming work during the final year of the HIBA project. Analysis of data from a set of focus group interviews conducted in 2018 is going on and data from a national survey conducted during the summer is about to start. There are several publications reporting new findings from the project coming out during the next few months and the project is also organising a panel session at the forthcoming Association for Information Science and Technology Annual Meeting in Melbourne, Australia on the role of information behaviour technology and service design.

What is usefulness and how to use it?

Noora, Heidi and Isto were participating in the 10th Conceptions in Library and Information Science Conference (CoLIS) in Ljubljana, Slovenia the week before midsummer. Heidi presented together with Isto a co-authored paper with Noora and Kristina titled The concept of usefulness in library and information science research discussing the notion of usefulness and its relation to other concepts and ways of seeing information, systems and services useful and approachable. The study is a part of HIBA project and aims at a better understanding of the different aspects of how e-health services can be experienced useful by their users.


Introduction. There is not much doubt that information, information services and systems need to be useful. In this light, the relatively lack of conceptual elaboration of the concept of usefulness in the library and information science literature can be regarded as somewhat surprising.
Method. This paper provides a conceptual overview of the use of the notion of usefulness in library and information science literature, explicates its relation to key parallel concepts, and on the basis of an empirical vignette in the context of health information research, discusses the potential limits and advantages of referring to usefulness instead of and together with other related concepts.
Analysis. A review of literature relating to the concept of usefulness was conducted to examine how it has been used in library and information science.
Results. A close reading of the literature shows an overlap between related concepts but at the same time, diverging foci of interest in and emphasis on what and how information, information services and, for instance, information systems are considered beneficial or suitable for their users and particular uses.
Conclusion. There is a need for better conceptual clarity in the literature regarding usefulness and related concepts. The review shows that usefulness can be literally a useful concept for addressing the user and use (versus e.g. system, content or topic) perspective to engagements with people, services, systems and beyond.

New HIBA publications

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 informationInformation 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

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