eHealth Survey System for Public Health: Feasibility and Usability

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DESCRIPTION (provided by applicant): Millions of dollars are spent annually by American corporations to sponsor health behavior modification programs for their employees. These organizations need better tools to enable both effective design and convenient assessment of the effectiveness of these programs. We have developed an enhanced web-based version of a well-known, thoroughly documented, and highly successful telephonic health survey instrument with questions from the Behavioral Risk Factor Surveillance System (BRFSS). Our prototype, eHealth Survey, was built using a novel technology we call Survey Markup Language (SuML), an XML modular survey system for electronically collecting, storing, accessing, analyzing, and reporting data over the web. The SuML engine and instrument itself can be distributed as open source. The eHealth Survey instrument is made up of public domain content and can be used to estimate baseline risk profiles; design programs tailored to specific groups of "at-risk" employees; assess the effectiveness of employee benefits, workplace policies, and health promotion programs; and benchmark employee populations' risks over time, across employers, and with national and state data. We are developing the prototype into a production system. Here, we seek to demonstrate the feasibility of the SuML-engine eHealth Survey technology as a population assessment tool by enhancing the systems capabilities, and evaluate the usability of the SuML technology-eHealth Survey instrument in an applied setting. We will incorporate emerging World Wide Web Consortium (W3C) standards such as XForms into the architecture and add modules to support stratified random sampling, automated reminders, and tracking despite de-identification. We will recruit a small group of paid volunteers for user testing sessions and follow-up interviews aimed at evaluating usability eHealth Survey. Results from testing will drive design changes. In year two we will use a user-centered approach in large WA State employers, to develop a set of specifications for the components of an epidemiologically sound population tracking back-end administrative interface. These findings could influence how health data is collected in a variety of settings. SuML is a new potential standard for disseminating web-based surveys and standardized instruments. This study will enable us to demonstrate the potential of this Public Health Informatics method and, if shown to be feasible, promote its widespread application. In Section 2, we provide the specific aims. The rationale for these enhancements are detailed in Section 3 and are informed by prior work and pilot testing in partnership with the State of Washington Uniform Medical Plan, a long-time collaborator with our Centers. Section 4 outlines our prior research in the survey technology field and evidence of longstanding health promotion relationships to Northwest employers. Section 5 details the methods used to accomplish the Specific Aims of this proposal.