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.

On Friday, June 13th, 2008, Catalonia Health Promoting Hospitals Network will be presented at CosmoCaixa. The Network has organised a very interesting meeting titled Health Literacy with Rima Rudd (Senior Lecturer on Society, Human Development, and Health at Harvard School of Public Health) as a key speaker.

Rima Rudd is a health educator whose work centers on the design and evaluation of public health programs for social change. She has worked primarily in school and community settings. Her interests focus on pedagogy, health and literacy links, and participatory and collaborative strategies for learning and for change [+info]

The aim of the meeting is: to provide a forum for ideas and discussion about new communication trend between hospitals and citizens within healthcare system in developed countries.

A month ago I was invited by Cristina Iniesta to participate in one of the network meetings to present Internet, Health and Society. Implications for health promotion in Catalonia. I would like to congratulate Cristina Iniesta and her partners for the organization of the meeting.

I have been invited by Government of La Rioja, through the Regional Ministry of Health, to participate in the International Seminar “Aplicación de las nuevas tecnologías a la prevención y asistencia en adicciones (”New technologies applications to prevention and assistance of addictions” (26th and 27th, June) located at CIBIR, the Biomedical Research Centre of La Rioja. The seminar is organized by Drojnet an European project that evaluates the usefulness of new media in informing teenagers about drugs and their effects on their health. Deadline for registration is June 13, 2008.

I’m going to participate in the track “Health , Communication and New technologies” talking about “Health and the Internet. The transition of health system to Network Society: an empirical analysis of Catalonia” based on E-Health and Society: an empirical study of Catalonia directed by Prof. Castells.

I’m excited about this Seminar for many reasons: I will meet interesting people who are working in eHealth in Spain and Europe; Drojnet project looks like a good initiative to explore eHealth and Digital Natives topics and I will have the opportunity to talk with their authors; and it will be a good opportunity to know Regional Ministry of Health of La Rioja initiatives in eHealth. Finally, I would like to thank to the organization of the seminar for the invitation.

I’m glad to announce that Health and Web 2.0 in the Information Age videos are available at YouTube.

Health in the Information Age by Rita Espanha

Health and Web 2.0 by Michael Hardey

Health and Web 2.0: initiatives from Catalonia Government by Joan Guanyabens

Enjoy them! Thanks again to those who made this conference possible. Of course, Feedbacks are welcome!

First of all I would like to thank Gustavo Cardoso, Miquel Angel Mayer and indeed Rita Espanha and Michael Hardey for the marvellous working days we had in Barcelona. It was a honour to have the opportunity to share during three days thoughts, reflections, past researches and ideas about health and the Internet. I’m sure those are just the beginning of future collaborations. Thank you very much for such a wonderful days.

The conferences matched the audience’s expectations. Michael and Rita have allowed me to upload their presentations to the Internet as long as many people have showed their interest in the conference but they were not able to attend to Barcelona. I ‘m pleasure to announce that both conferences were video recorded and will be available in two week at UOC YouTube Channel.

Rita Espanha and Gustavo Cardoso have been reserching the transition to Network Society in Portugal. Most of the researches are available at OberCom. OberCom (Observatory for the Media) is directed by Gustavo Cardoso. He and Rita Espanha supervise the centre’s scientific research development; manage the centre research networking and institutional relations. OberCom is a non-profit research centre whose main goal is the production of data and diffusion of information about the Media, thus contributing to better knowledge of the field of communications in Portugal.

As I posted before, they have developed a research project titled Health in the Information Age. Their main conclusions were showed in Rita’s presentation

In 1999 Michael Hardey wrote Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise. He was one of the first researchers who started to analyse Health and the Internet and the transformation of the relation between health professions and their clients/users/patients. In 2001, “E-Health”: the Internet and the transformation of patients into consumers and producers of health knowledge was published. Is it sound like Web 2.0?. His forthcoming paper will be Hardey, M. (2008) Public health and Web 2.0, Journal of the Royal Institute of Health Promotion 128(4):171-179

Finally, I would like to thank International Graduate Institute (Open University of Catalonia) and TicSalut Foundation for sponsoring the conference.

On 23th and 24th of April I was at Lisbon invited by Gustavo Cardoso and Rita Espanha to the presentation of the research project Health in the Information Age supported by Fundação Calouste Gulbenkian

Brief description:
The first objective of the study is to analyse in what way and in what measure the ICT’s, especially the Internet, are appropriated in the health field (internet and information systems) in the following domains: ICT’s and the Health Professionals; Users and ICT’s; The Health Information Systems; ICT’s and Media contents about Health.

Research funding:
Serviço de Saúde e Desenvolvimento Humano da Fundação Calouste Gulbenkian.

Project Coordinators:
Rita Espanha and Gustavo Cardoso

Results are already available in Portuguese.

This research project had been developed at the same time as E-health and Society: An empirical study of Catalonia. During that time, methodological issues were shared so comparative studies will be done in further collaborations.

I would like to thank indeed Gustavo and Rita for their invitation to the meeting and their hospitality. It’s a pleasure to have the opportunity to collaborate with you. Congratulations for you work!

I would like to thank indeed Ruslan David, eHealthNews.EU Portal Administrator/Editor, for his help to disseminate the results of the research project E-Health and Society: An Empirical Study of Catalonia and also for his wonderful job as Editor of eHealthNews.EU - the First European eHealth News Portal.

Checking my RSS I have found a interesting post titled Health Care’s Broke: Physician Rating and Quality Indicators where the author mentions some physicians’ and hospitals’ opinions about Web 2.0 rating tools:

You’re only going to get the extreme patients to evaluate you (and often the unhappy ones)

The unhappy patients will have the opportunity to publicly say how terrible the doctor is, but because of privacy rules, the doctor or hospital cannot comment or defend him or herself

There is too much emphasis on bedside manner and convenience, and not enough information on outcomes — “How Good A Doctor Am I?”

Even if there is information on outcomes (like in the hospitals’ cases) if this determines payment or discourages future patients because of a bad rating of outcomes, the physician will be much less likely to risk treating a very sick patient, who will likely have a bad outcome no matter what

These systems also ignore where a hospital operates or where a doctor works — hospitals with large populations of poor patients are likely to be sicker than hospitals in affluent areas. Academic hospitals which often care for many incredibly complex, sick patients might be compared to relatively straightforward, simple patients at another hospital down the street.

After this, the author suggests some relationship between “Pay for Performance” and Web 2.0 rating tools and he gives some advices for hospitals and physicians.

A few moths ago I posted about Web 2.0 challenges the tools for rating quality of health information on the Internet and I wondered if Web 2.0 could really change the production and consumption of health information and the consequences of this virtual shift on quality and on expert and lay knowledge.

Right now, I also have to wonder about the consequences of Web 2.0 on patients’ preferences when they are looking for a hospital. Could this kind of application really move the demand side of healthcare market? What is the social scalability of Web 2.0 initiatives to be worth?

Between 2005 and 2007 I worked in a research project titled Project Internet Catalunya - Technological Modernisation, Organisational Change and Service Delivery in the Catalan Public Health System (PIC Salut) directed by Prof. Castells and supported by Catalonia Government. I’m glad to announce that the English summary is already available: E-HEALTH AND SOCIETY: An Empirical Study of Catalonia (see Spanish version PIC Salud - Modernización tecnológica, cambio organizativo y servicio a los usuarios en el sistema de salud de Catalunya).

Summary

This study examines the health related uses of the Internet and information and communication technologies (ICTs) in Catalonia. It is a multilevel study that comprises the observation of the population at large, of health professionals, and of health care organizations, such as Primary Care and Hospitals.

It is based on 7,784 on-line interviews, and on 106 face to face interviews, as well as on extensive field work research and direct observation of health organizations in Barcelona, Vic, Sabadell, Palamós, and Tarragona. It was conducted between April 2005 and July 2007.

Conclusions

The different studies we have conducted show a generally positive feeling among health
care professionals, patients, and the population at large on the uses of Internet and ICTs in the health care processes. Furthermore, most professionals, doctors and nurses alike, are intensive Internet users at home. Patients are eager to consult health matters on the web.

Primary care centers and hospitals are also gradually using e-health management and service delivery systems, although the introduction of SAP-Health is still exceptional and the training of the personnel to use advanced health care systems is limited and critically perceived by the nurses and auxiliary personnel.

While the uses of Internet and Intranets for information are widespread, the uses for communication are very limited, with the exception of communication among physicians and among researchers. Patients are largely excluded from online interaction with health care professionals and their online support groups rarely receive permanent advice. While doctors are positive towards the health uses of the Internet, they distrust the use that patients could make of unguided information and prefer to maintain the traditional, personal interaction with their patients.

Thus, the uses of ICTs in the health system do not seem to yield significant increases in productivity, efficiency and quality because their introduction is rarely accompanied by the organizational, managerial, and cultural changes necessary to set up an interactive network at the heart of the health delivery system. ICTs are tools confined in specific functions, not a platform permeating the entire process of health delivery. Furthermore, the updating of the technological infrastructure of the health system would require considerable investment whose justification is not obvious in the absence of an organizational restructuring of the health care units, particularly of the large public hospitals.

Thus, cultural resistances and organizational routines present a major obstacle to the technological overhauling of the health care system, a project that appears to be indispensable to be able to simultaneously control health costs and improve health care quality.

Empirical data of chapter one and two and the results of another research project titled Citizens, Health and the Internet in Catalonia directed by Prof. Castells and based on a telephone survey (2,000 interviews) are the materials of my dissertation. So comments will be very welcome, specially those related to chapter one, chapter two and conclusions.

After two years of hard working, I’m glad to announce the research Project Internet Catalonia about Health directed by Prof. Castells and titled “Technological Modernisation, Organisational Change and Service Delivery in the Catalan Public Health System” has been published (PIC Salut)

This study analysed the interaction between organizational change, cultural values and technological change in the Catalan health system. The study is subdivided in five distinct parts. The first one is a content analysis of the webs related to health in Catalonia. The second is a study of the uses of Internet in health related issues among the population at large, the patients’ associations, and the health professionals, on the basis of an Internet survey adapted to each one of these groups. The third is a field work study of the experimental programs conducted by the Catalan government in several local areas and hospitals to integrate electronically the patients’ clinical history. The fourth is a study of the organizational implications of the introduction of information systems in the management of hospitals and primary care centres in the Catalan Institute of Health, the major public health provider in Catalonia, on the basis of an Internet survey and in-depth interviewing. The fifth is a case study of the organizational and social effects of the introduction of information and communication technologies in one of the leading hospitals of Catalonia, the Clinic Hospital of Barcelona. The study was conducted between May 2005 and July 2007.

During the next month, January 2008, a synthesis report in English will be published.

As a part of this research project under Prof. Castells’ direction I have been directly involved in the second study (a study of the use of the Internet in health related issues among the Internet users, the patients’ associations, and the health professionals, had been done using Internet surveys adapted to each one of these groups). I have been working on some of the results talking about “Health and the Internet: still Web 1.0″. See below some of the key findings:

• Professionals are connected to Internet and make an intensive use of the Net, mainly for questions related to the search and consultation of information.

• The use of the Internet as a communication medium with other professionals of the sector is extended among all the professionals, but the levels of use of the Internet or the electronic mail to communicate or interact with their patients is scarce.

• The increase of the information flows available in the Internet has not been accompanied by an increase in its interaction.

• However, we have to emphasize a tendency that indicates that those professionals who develop their professional practice in competitive markets make more intensive use of the Internet and the electronic mail to interact with their patients or users.

• Most professionals positively value the relevance of the contents available in the Internet and they do not consider that the patient search for information is negative either for the professional - patient relationship or for the patients’ management of their health.

• However just a small percentage of professionals recommend their patients to consultation health information on the Internet or even talk about the Internet with them. This is probably due to the lack of time during their face to face visits.

• Nevertheless, the behaviour of the pharmacists shows us a new case where the factors related to the market oriented context are the key. These professionals do not have time constrictions and are more accessible that the rest of the professionals, given the physical distribution of the pharmacies.

The Internet survey carried out by Internet users shows us:

• Internet users are characterized by: the high proportion of women, a high education level, easy access to the Internet from their own home, and a high frequency of use. They integrate the use of different sources of information in their activities related to the health. However, physicians are the key source.

• Women have a more active role than men with all the sources, including the Internet

• The frequency of use of the Internet for questions related to health is far from the levels that would allow us to talk about ciberchondriacs.

• The people’s interest on patients support groups as an information source remind us of the importance of lay knowledge, since the utility and the confidence of this source is very high.

• The main consequence of the Internet use for questions related to health is the increase of information available. Just a low percentage of people makes decisions relative to the diagnosis or treatments of their health problem. This data supports the hypothesis of the people’s consciousness when they manage the inherent tension to the use of the Internet, emphasizing the need of the physicians as an expert.

Now is time to focus on my thesis and try to publish some of the findings on academic journals. Any suggestion will be welcomed