COMM 3302 e Health & Telemedicine

COMM 3302eHealth & Telemedicine • Shawn McCombs • UH School of Communication http://soc.class.uh.edu/~smccombs © 2006 UH School of Communication - Health Communication Lecture Series - All Rights Reserved

COMM 3302eHealth & Telemedicine Kiosks and Digital Health • Shawn McCombs • UH School of Communication http://soc.class.uh.edu/~smccombs

Topics • Key Terms • Kiosks: A Brief History • Computers in a Box • Kiosks and NHS • Practical Applications: Kiosks in Action

Public Services Online Key Terms • Major Topics: • Kiosk Adoption, Demographical Use and Preferences • Logical Progression and the Kiosk • Building Systems that meet the LCD • Average US Reading Level • Kiosks • System Fatigue • “Prints Made” • Linear • Sensorship • Logs • Log Data • AIDS • Cessation • Hierarchical File Structure • BIRC • HealthPoint • CyberCafe • Touch Screen • InTouch Systems • Methodology • Page Views • Embedded • Literacy • Senses • Perception

Overview • Kiosks are publicly located technologies, designed to present similar content and formats of information on the Internet • Kiosks can reach those who otherwise would would not be reached: • Access to the Internet is not universal, even in countries like the U.S. and U.K. • The digital have-nots tend to be predominantly those people who need the greatest help in terms of their health.

Overview, Continued... • eHealth & Telemedicine can take a variety of forms • Not Just the Internet • Kiosks a Legacy Technology: • Often use Computer Mediated Applications on stand-alone computing equipment • Public Access for All • The Kiosk can be placed virtually anywhere, allowing for a potentially unlimited audience

Overview, Continued... • Kiosks are not a new technology: • They represent a technological progression from the leaflet or written instructions to the modern day Internet and iDTVs • Modern versions incorporate the best of legacy technologies with newer advances, such as touch-screen navigation, dynamic web transactional delivery and multimedia-rich content.

Overview, Continued... • Some people may be physically unable to get to specific locations-even when close by. • Relatively little research has been done on the usability and application effectiveness of kiosks. • The average American, despite sometimes advanced levels of education, reads on an 8th grade level. • The average piece of healthcare literature is written on 10th grade reading level. • *Significance = Reading Level Mismatch - ICT’s must reach audience

Overview, Continued... • Kiosk: An electronic device that provides information (via a display), is interactive in nature (a multimedia combination), and allows for input (via an input device such as a touch screen or a keyboard).☤

A Brief History: eHealth before it was called eHealth... • - From Keystroke to Touch Screen • - Early Use of Computers in Health Comm • - The Success of HealthPoint

At the Outset... • A Kiosk is NOT the Internet, but can contain Internet capabilities in modern versions. • However, according to the W3C (World Wide Web Consortium), “Kiosk” represents one of the major categories of types of web sites...

Kiosks: A Brief History • Internet achieved Critical Mass (CM) by the mid 1990’s • With the help of the World Wide Web and Gvt. deregulation • Prior to this, Kiosks and Computer Medicated Applications dominated • Served as primary mechanisms for telehealth and telemedicine comm. • Early Kiosks in Public Lobbies for saturation

Kiosks: A Brief History, Continued... • HealthPiont operated the kiosk-type device in 1988/1989. It was developed by a research team at Glasgow University. • Findings of Nicholas, Williams, and Huntington (2000): • Fewer than one in five users (18%) were over 55. • Older people trust doctors as a primary source of health info and feel less comfortable using IT sources. • Kiosks were thought to be an excellent medium by which nurses could keep informed.

Kiosks: A Brief History, Continued... • Early prototypes focused on major social health issues: • AIDS • Smoking • Contraception • Drugs and Drug Abuse • ...Note the topics: The main focus was aimed at the younger audience, which might suggest early familiarity with target market and audience

Computers in a Box:...Some Unique Elements of the eHealth Kiosk • Navigation & Methodological Issues • Apples to Oranges: eHealth in a Paperless Environment • A Common Connection: One Size Fits All

Using the Kiosk • Methodological Issues: The Two Faces of ICT’s • Kiosks not just for information dissemination: • a. delivery of health information, communication, and services • b. Monitoring and Gathering of useful statistical data ranging from demographics to usage satisfaction

Using the Kiosk, Continued... • Data Gathering and Kiosk Use • Gathering, studying, and interpreting useful statistical information about kiosk users takes two primary forms: • a. “Prints Mode” • tracking page printing and delivery • b. Kiosk Capacity • monitoring page views or “hits”

Using the Kiosk, Continued... • Methodological Issues: Using the Kiosk • There were usability issues concerning the kiosk menus • Users must navigate a number of menu screens before they find the information page they need • Kiosk navigation must be intuitive and efficient for the end user or they will not use the services

Using the Kiosk, Continued... • Digital Versus Paper Sources • In several areas there wasn’t a significant difference between the kiosks and the pamphlets. • The touch screen systems were more expensive. • 52% of patients preferred the touch-screen, 24% the paper version, and 24% had no preference.

Using the Kiosk, Continued... • Clear cut demographics: • Younger consumers embraced kiosks and older populations avoided them • On the issue of Convergence: • While measuring this distinction, it should be noted that convergent media allows for the modern kiosk to include printing and Internet as additional components

Using the Kiosk, Continued... • Use by Health Professionals and Laypeople: The Brain Injury Resource Center (BIRC) • The benefits of BIRC were perceived differently by the health care professionals and patients and families. • Patients generally believed that the provision of background info was a real benefit, whereas only one third of the health care professionals agreed. • Both groups believed that the system stimulated questions and reinforced info directly obtained from professionals.

Using the Kiosk, Continued... • BIRC, Continued... • Patients, more than professionals, also felt the info could help calm their anxieties. • Patients regarded computer-based education as central to their quest for info, whereas professionals regarded it as a supplementary source.

Using the Kiosk, Continued... • Nurses tended to report using the system more than doctors. • Both doctors and nurses referred patients to the terminal. • Children were able to use the system for school projects, and on behalf of their parents and grandparents. • The kiosks could provide access to far more info than it was physically or economically viable to provide in leaflet form.

Successful Implementation:...A Look at the Kiosk as a component to NHS Direct... • - Government Initiatives in GB: Revisiting NHS Direct (1998)

Government Initiatives • NHS Direct in 1998 • Though the telephone initially dominated NHS, Kiosk and Internet became increasingly popular • NHS Direct Online established, extending the telephone system to a web-based kiosk service • Kiosks were used an average of 12 times a day

Government Initiatives, Continued... • Initial Findings (Nicholas, et. al., 2000): • There was an inverse relation of use with age. • The heaviest users were aged 36 to 55 and 16 to 35, and the lightest users were aged over 75. • The topic of the greatest interest was medical conditions (41.5% of all inquiries).

Government Initiatives, Continued... • Findings, Continued... • Kiosk use varied significantly across geographical locations. • Females used the system a little more than men, and most users were under the age of 35.

Practical Applications:Kiosks in Action • Demographic Preferences / Differences When Using Kiosks • Location, Location, Location • Making and Marking Time: Measuring Actual Usage and Time Factors

Kiosks In Action • Individual Differences in Use of Kiosks: • Research with cancer patients found that older patients (especially males) expressed greater satisfaction with kiosks content than did younger users. • There were issues raised with regard to privacy • The easier the system was to use, the longer users used it and the greater number of pages they searched and viewed.

Kiosks In Action, Continued... • Individual Differences, Continued... • Women aged under 55 and men aged 56 to 75 made greater use of the kiosk than other groups. • Many older users failed to get beyond the initial menu pages. • Kiosk users were categorized into four groups: curious, specific inquiry, instructed to use it, and other • Use of the kiosks was also linked to whether respondents used other information technologies.

Kiosks In Action, Continued... • Kiosk Location: • Touch-screen kiosks can be found in many different locations, such as prisons, libraries, railway stations, walk-in centers, doctor’s offices, pharmacies, and supermarkets. • Some locations may be physically more convenient to visit than others and be open at more convenient times.

Kiosks In Action, Continued... • Kiosk Location, Continued... • Kiosks located in information centers were used the most in terms of volume • Doctors’ office attracted slightly more males (52%), but in general these locations earned the poorest scores.

Kiosks In Action, Continued... • Use over Time: • Continued use depended on patients’ perceived or real info needs, the natural propensity of patients to actively seek health info, and the extent to which kiosks use was promoted by medical staff at a kiosk location. • Any health center that took a proactive stance with regard to kiosk use tended to exhibit higher than average volume of kiosk use.

Kiosks In Action, Continued... • Use Over Time, Continued... • Once patients’ info needs had been satisfied there was no reason for them to return to a kiosk in the short term. • Some patients did not return because the kiosk failed to meet their specific needs, or it was difficult to retrieve the information needed.

COMM 3302eHealth & Telemedicine More To Come... • Shawn McCombs • UH School of Communication http://soc.class.uh.edu/~smccombs © 2006 UH School of Communication - Health Communication Lecture Series - All Rights Reserved

COMM 3302 e Health & Telemedicine