eHealth Literacy Barriers and Solutions for Consumer Use of a Health Portal

描述（由申请人提供）：互联网为消费者提供了前所未有的高质量健康信息，并逐渐成为健康教育、决策和管理的中介。不断发展的医疗保健系统越来越需要健康消费者在管理自己的健康方面发挥更积极的作用。然而，有许多障碍阻碍了健康消费者充分受益于一系列基于技术的消费者健康应用。近年来，健康素养已经成为一个有用的预测指标，可以区分哪些消费者或多或少可能从这些应用程序中受益。尽管健康素养的范围相当大，但其他素养对于有效使用互联网介导的健康技术也至关重要。电子卫生素养包括一整套知识和技能，使消费者能够充分参与电子卫生工具并从中受益。本研究的总体目标是开发一套基于电子健康素养框架的分析工具，并将其应用于消费者健康门户网站，以表征消费者在使用系统提供的各种信息资源和工具时可能面临的复杂性和挑战。为此，我们正在与“最先进”的门户网站consumerreporthealth.org合作。该网站旨在帮助消费者根据现有的最佳研究证据做出最佳的医疗保健决定。第一个目标是建立框架的信度和效度，我们建议进行一系列形成性研究活动，包括评分者之间的信度和预测效度研究。我们开发了一套认知任务分析方法，用于评估给定站点上电子健康素养任务的复杂性。我们建议在consumerreporthealth.org网站上分析20个不同复杂程度的任务。这些任务包括健康信息搜索、决策（例如，权衡治疗方案）和评级（医院和医生）任务。我们还将应用两种自动诊断工具：一种是可读性评估指标，它集成了文档的语言特征，以确定其可读性水平；另一种是词汇复杂性分析工具，它表明文档中的哪些健康术语不太可能被健康消费者理解。在我们对复杂性分析的基础上，我们将选择3个复杂程度的10个任务用于健康消费者的认知研究。我们将进行认知研究，其中2组20名受试者（40名）被要求执行上述10项任务。第一批人将从ConsumerReportsHealth.org的付费订阅者中选出，他们可能受教育程度更高，计算机知识水平更高，而第二批人将从东哈莱姆的社会服务和社区中心Union Settlement Association选出。机构审查委员会将在这两个地点和哥伦比亚大学寻求。该提案的主要优势在于，我们正在使用一个基于理论的框架来解决一个相当重要且日益重要的问题，该框架大大扩展了电子健康素养评估的范围。

DESCRIPTION (provided by applicant): The Internet provides unprecedented consumer access to high quality health information, and progressively serves as a mediator of health education, decision making and management. The evolving healthcare system increasingly necessitates that health consumers play a more active role in managing their health. However, there are numerous barriers that preclude health consumers from fully benefiting from the range of technology- based consumer health applications. In recent years, health literacy has emerged as a useful predictor to differentiate between those consumers who are more or less likely to benefit from these applications. Although the scope of health literacy is considerable, other literacies are also critical for productive use of Internet- mediated health technologies. eHealth literacy encompasses the set of knowledge and skills that allow consumers to fully engage in and benefit from eHealth tools. The overall objective of this study is to develop a set of analytic tools based on an eHealth literacy framework and apply it to a consumer health portal in view to characterize the complexity and challenges consumers are likely to confront in using the various information resources and tools offered by the system. Towards that end, we are partnering with a "state of the art" web portal, ConsumerReportsHealth.org. The site aims to help consumers make the best healthcare decisions based on the best available research evidence. The first goal is to establish the reliability and validity of the framework and we are proposing to undertake a set of formative research activities including inter-rater reliability and predictive validity studies. We have developed a set of cognitive task analytic methods for evaluating the eHealth literacy complexity of tasks on a given site. We propose to analyze 20 tasks of varying levels of complexity on the ConsumerReportsHealth.org site. The tasks include health information seeking, decision-making (e.g., weighing treatment options), and rating (hospitals and doctors) tasks. We will also apply two automated diagnostic tools: a readability assessment metric, which integrates linguistic features of a document to determine its level of readability, and a vocabulary complexity analysis tool, which signals which health terms in a document are unlikely to be understood by a health consumer. On the basis of our analysis of complexity, we will select 10 tasks of 3 levels of complexity to be used in a cognitive study with health consumers. We will conduct cognitive studies in which 2 cohorts of 20 subjects (40) are asked to perform the set of 10 tasks identified above. The first cohort will be drawn from paid subscribers to ConsumerReportsHealth.org and are likely to be more educated and have higher levels of computer literacy than the second cohort who will be drawn from Union Settlement Association, a social service and community center in East Harlem. Institutional Review Board will be sought at the two sites and at Columbia University. A primary strength of this proposal is that we are addressing an issue of considerable and growing importance using a theoretically-grounded framework that greatly expands the scope of eHealth literacy assessment.