“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Daniel López presentation: Reframing telecare: an ethical discussion concerning ageing-in-place, independence and care.

Telecare has been presented by policy-makers and developers as a simple and cheap technology that enable ageing-in-place with autonomy. The aim of this presentation is to critically discuss what ageing-in-place with autonomy mean for elderly people using telecare. According to some results from ethnography conducted 4 years ago in a catalan telecare service, there are different ways of being autonomous enacted and, given that, also different conceptions of the body and of living at home. By presenting these complexities we want to put forward several ethical questions concerning the current telecare developments. First of all, what new arrangements, practices, collectives and relationships of care arise with the implementation of telecare and smart home systems in care for older people? How do these arrangements shape existing care practices? What definitions of care, and good care, are implied and embodied in the new care arrangements? How do these built-in definitions and normativities differ from and change existing practice? What implications do they have for the meanings of place, distance and home in care? These questions, among other, are being discussed in a FP7 project currently carried out by different research teams in Barcelona, Lancaster, Amsterdam and Oslo and coordinated by Maggie Mort. So in order to conclude, I would like to present these questions and make some remarks based on some insights taken from the current fieldwork and from the former research projects.

Daniel López

Assistant Professor at the Universitat Oberta de Catalunya. Currently working on the implementation of new technologies in care settings like Home Telecare from an STS perspective. The main areas of interest are: a) the emergence of new spatialities and temporalities of care; b) the emergence of new practices of caring and security due to the increasing importance of technologies of accountability; and c) the enactment of hybrid forms of autonomy and independence. Currently involved in an FP7 project called “Ethical Frameworks for Telecare Technologies for older people at home (EFORTT) concerned with the implications of the introduction of remote care technologies worn, installed or embedded in the homes of older citizens/frail older people (see http://www.lancs.ac.uk/efortt/index.html) and also a project funded by the Ministerio called CONDEPCIU concerned with the techno-scientific controversies around the new Spanish care policies addressed to elderly/frail people.

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 26th and 27th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Eulàlia Hernández’s presentation - Providing resources for caregivers trough the Internet.

Internet is a common tool in our daily living that offers new possibilities for communicating and delivering health care treatments. One of these possibilities is to use Internet to create a community where professionals (such as psychologists) and caregivers can work together in order to generate processes to improve the quality of life, by providing caregivers with resources to cope with difficult situations. From this perspective, in this session, two projects aimed to improve quality of life of caregivers will be discussed.

Eulàlia Hernández

Professor of Psychology at the Open University of Catalonia. She is also the head of PSINET research group at the IN3 Institute. Her research focus is the improvement of quality of life in several health problems trough the use of Information and Communication Technologies.

I have read Nijland, N., van Gemert-Pijnen, J. E. W. C., Boer, H., Steehouder, M. F., & Seydel, E. R. (2009). Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation. International Journal of Medical Informatics, In Press, Corrected Proof.

Abstract

Objective
To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).

Methods
We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.

Results

In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups – the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors – were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.

Conclusion
In order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.

Summary points

What was already known on the topic?

• The increased public interest in medical information regarding health issues are driving forces for the growth of health services on the Internet. However, the growth of e-consultation in primary care has been minor.
• Access to healthcare and information technology is often most difficult for those populations who need it most. E-consultation can be beneficial for certain patient groups, such as frequent GP visitors and chronic users of medication. Yet, it is unclear whether access to e-consultation is most difficult for these populations.

What did this study add to our knowledge?

• Non-use of e-consultation was primarily due to lack of availability among GPs and to information deficits among patients, such as unawareness of the existence of the service and the possibilities of e-consultation. Proper education and instructions are necessary to increase the use of e-consultation.
• Patient groups who were most motivated to use e-consultation e.g., elderly patients, less-educated patients, chronic medication users and frequent GP-visitors, perceived the greatest barriers towards econsultation.
• Web-based triage systems may be promising, because this study indicates that patients are motivated to use such systems for primary evaluation of medical complaints and for self-care advice.

Again, the results of the empirical research revealed the gap between the potencial of ICTs uses in healthcare and the facts that shape these uses. The inverse care law is still working in the transition of healthcare systems to Network Society.

Today, I have been invited by StopSida to participate in a workshop about “Internet, Sex and Men who have sex with men“. Here goes my presentation (in Spanish) which tries to show an overview about the Internet, Citizens and Health: challenges and opportunities.

Finally, I would like to share my presentation and also to thank Katy and Percy for the wonderful organization of the event that allows us to think and learn about prevention and public health and the roles of NGO, Government and Private sector (as Bakala.org) on these issues. Due to the dynamic of the workshop the debate was very interestig, I wil try to translate to English some of my notes and also some of the participants’ interventions.

First of all, I would like to thank Max Senges and Josep M. Duart as organizators of the roundtable with Howard Rheingold at Open University of Catalonia. Ismael Peña has alredy posted about Rheingold wonderfull talk, but here comes my notes and my reflection.

Online Social Networks

• enable people to co-operate;
• have always existed, but ICT empower and transform them;
• are places where communities can growth.

Cultivating Online Communities

• promote social capital;
• support Life Long Learning and teaching
• connect people and build relationship
• develop a community memory and knowledge sharing

Participatory Media

• From text based only community to participatory media;
• Transforms social structures, culture, community, power, wealth ans is characterized by: many to many, consumers/producers, active participation and amplification of network capabilities;
• Changes literacy.

Online Social Community requires

• Marketing is the foundation of online community planning.
• Design Social Architecture.
• Technological planning.

Watch an eight minute intro screencast of the SMC, created by Howard Rheingold

Howard Rheingold talk was wonderful, his discourse could be applied to any virtual community. But, in this case, the debate was focused on education and how can we develop online social networks in this field at Open University of Catalonia (UOC), a virtual university with 40,000 students.

On one hand, I think online social networks as a “formal” learning/teaching environment challenge educational, organizational and technological model of my university because it causes a tremendous tension between the need of flexibility   to develop those kind of initiatives and the need of bureaucracy to maintain 40,000 online students within the virtual campus. It just strains all the actors who are involved in the teaching and learning process: teachers, students, managers…

On the other hand, a digital identity is needed to generate online social networks, but how many students or faculty members have develop this digital identity? how many students or faculty members have participatory media literacy?.

Finally, the interaction between this new media landscape based on ICT and the social structure could generate smart mobs, are we ready to take this kind of risk?. I’m ready as well as my institution -I guess- and I’m trying to open the virtual classroom to this new media landscape, it’s fun and most of my students enjoy it too. But as an experiment it has to be evaluated and assessed so… further research is needed each semester. I will present the results here to discuss.

Notes from the conference: Internet Research 9.0: Rethinking Community, Rethinking Space. Copenhagen October 15 – 18, 2008. Mimi Ito: Hanging Out, Messing Around and Geeking Out: Youth Participation in Networked Publics.

Mimi Ito is a cultural anthropologist studying new media use, particularly among young people in Japan and the US. Her research right now focuses on digital media use in the US and portable technologies in Japan. Her last works published are: Networked Publics and Beyond Barbie® and Mortal Kombat: New Perspectives on Gender and Gaming. I strongly recommend the reading of her blog.

Her presentation was based on Digital Youth Research project:

Since the early 1980s, digital media have held out the promise of more engaged, child-centered learning opportunities. The advent of Internet-enabled personal computers and mobile devices has added a new layer of communication and social networking to the interactive digital mix. While this evolving palette of technologies has demonstrated the ability to capture the attention of young people, the innovative learning outcomes that educators had hoped for are more elusive. Although computers are now fixtures in most schools and many homes, there is a growing recognition that kids’ passion for digital media has been ignited more by peer group sociability and play than academic learning. This gap between in-school and out-of-school experience represents a gap in children’s engagement in learning, a gap in our research and understandings, and a missed opportunity to reenergize public education. This project works to address this gap with a targeted set of ethnographic investigations into three emergent modes of informal learning that young people are practicing using new media technologies: communication, learning, and play +info.

Mimi Ito stars with the team members of the project and with the objectives:

The first objective is to describe kids as active innovators using digital media rather than as passive consumers of popular culture or academic knowledge.

The second objective is to think about the implications of kids’ innovative cultures for schools and higher education and to engage in a dialogue with educational planners.

The third objective is to advise software designers about how to use kids’ innovative approaches to knowledge and learning in building better software.

Then she explains the methodology based on ethnographic research in both local neighborhoods in Northern and Southern California, and in virtual places and networks such as online games, blogs, messaging, and online interest groups. Mimi Ito also remarks the amount of data collected: 594 semi structure interviews; 79 informal interviews; 67 groups; 28 diary studies; 4146 questionnaires and also more than 5000 hours of observation of 10468 profiles; 15 on-line forums; 389 videos; 50 events and classroom observation.

After that she introduces to the audience the term networked publics as “an alternative to terms such as audience or consumer. Rather than assume that everyday media engagement is passive or consumptive, the term publics foregrounds a more engaged stance. Networked publics takes this further; now publics are communicating more and more through complex networks that are bottom-up, top-down, as well as side-to-side. Publics can be reactors, (re)makers and (re)distributors, engaging in shared culture and knowledge through discourse and social exchange as well as through acts of media reception”.

Mimi Ito remarks that Youth Networked Publics like traditional youth publics are based on: local scale of interaction, many to many and peer to peer forms of participating, sharing and learning. But unlike traditional youth publics are also based on: accesibility 24/7, persistence, networked peer space, access to more specialized and niche publics, broader contexts for publication and privacy.

Networked publics are sources of diversity about identity, culture and practice. Further beyond  access issues, Mimi Ito identifies two main drivers:

1. Friendship-driven learning and participation: peer to peer sharing and reputation.

Kids prefer to hang out, participate, socialize off-line but time, space and structural restrictions encourage them to go on-line. Research results reveals that most of the kids prefer to meet people first off-line and after that face to face meeting go on-line. Otherwise, you can be consider as a freak or a geek by your own friends “Meeting people first on-line is not cool”.

Mimi Ito uses the term peer pressure to identify some practice among kids “If I put someone in my top ten friend on Facebook or MySpace, that someone is supposed to do the same with me”. On-line reputation has consequences on off-line reputation. Another way of peer pressure was the consequences of private data available on SNS as amplifiers of “drama” thinking about the changes on engaged or falling in love in the personal profile.

Finally, Mimi Ito states that kids share social practice… they help each other to create, produce and distribute content through social technology.

2. Interest-driven learning and participation. Still a minority of youth is driven by interest. Two case studies based on FANSUBBING and ANIME MUSIC VIDEOS.

After the explanation of these two case studies Mimi Ito finishes her talk with some considerations about the diversity in genres of youth participation on-line;  peer based learning, participation and reputation; the scale of networked communities and the youth access to broader audiences; new forms of litarecy and media social practice used by youth to produce knowledge without the constrictions of the adul world.

I really enjoy Mimi Ito speech and her work but I wonder why her research project does not take into account the traditional categories like education level, parents’ wages, family structure,… Do they matter? Am I old fashion?

Update - Video Mimi Ito Keynote @ IR9.0

Today I have attended to Catalonia Health Promoting Hospitals Network kick off meeting. This Network, coordinated by Cristina Iniesta, has organised a conference about Health Literacy with Rima Rudd as key speaker. Rima Rudd conference was marvellous. Here comes my notes from the conference:

She started talking about income and education as the fundamental axis of health, beyond health care services, and health literacy as a pathway to health outcomes.

She stated that Health Literacy is a function of individuals’ skills and social demands. Core skills of health literacy are: Reading (also on the screen) Writing Numeracy Oral exchange (speaking and listening) Literacy skills influences one’s ability to access information and to navigate in highly literate environments of modern societies. After this definition she talked about how literacy skills of individuals constrained participation in economy and in society. Furthermore, she explained how these constrains influenced health care demand taking into account that health literacy is an interaction between individual factors and health sector factors

Individual factors:

• Literacy and numeracy skills;
• Language skills;
• Emotional state;
• Heath status;
• Experience and background knowledge

Health sector factors:

• Communication skills of health care workers;
• Institutional features;
• Procedures and processes;
• Material in use;
• Assumptions.

After this introduction she reviewed her main research findings. At this point I would like to suggest that you may visit her great website Health Literacy Studies. I also may suggest to check her presentation slide presentation Literacy and Health and her literature revision.

I have uploaded her presentation to SlideShare to spread her wonderful work

| View | Upload your own

Finally, I would like to thank Cristina Iniesta and the rest of the Catalonia Hospital Promoting Health Network for the organization of the event. I’m sure they will become a reference in Health Literacy soon.

The Spanish Health Minister has published a press release talking about its collaboration with Microsoft to launch Robot Robin, a Windows Live Messenger Assistant that helps young people through the Messenger to resolve doubts about health issues related with sex, pregnancy and alcoholic drinks. It is said that people can add Robin to the personal contact list and interact with him taking into account legal, privacy and security issues.

This initiative points out some trends detected in relation with health and the Internet as Innovative Health Technology:

• The importance of the private sector and the interest of the big companies like Microsoft and Google to get into this huge market.
• The importance of analyze the supply and the demand side, in this case digital natives as a heavy Internet users (demand) and the Internet as a tool to reach this audience, taking into account the possible digital divide.
• The importance of the understanding about how people use existing technologies everyday to develop new uses.

It has come to my notice that MedlinePlus has a new page on Health Literacy where Health literacy is defined as “the ability to understand health information and to use that information to make good decisions about your health and medical care. Health information can overwhelm even people with advanced literacy skills”.

eHealth has been tackled the issue of literacy (see as an example eHealth Literacy: Essential Skills for Consumer Health in a Networked World) putting the emphasis on “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem”.

Talk about health literacy in the Network Society may include aspect related to the Internet, not as a separate world but as an integrate world where this technology is embedded, directly or not directly, in many aspects of our life. According to that it’s difficult to understand why the word Internet doesn’t appear on the first page of the Health Literacy or on the Quick Guide to Health Literacy  page. It’s probably time to integrate the Internet in all the activities related to health and try to avoid the “e” label.

Just two trends done by Blogpulse. Does they mean Digital Natives are interested in International Student Assessment?