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

描述(申请人提供)：互联网为消费者提供了前所未有的获取高质量健康信息的途径，并逐渐成为健康教育、决策和管理的中介。不断发展的医疗体系越来越需要健康消费者在管理他们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从一系列基于技术的消费者健康应用中充分受益。近年来，健康素养已成为一种有用的预测指标，可以区分哪些消费者或多或少可能从这些应用中受益。尽管卫生知识普及的范围很大，但其他文化知识对于有效利用互联网媒介的卫生技术也是至关重要的。电子健康素养包括一套知识和技能，使消费者能够充分参与并受益于电子健康工具。这项研究的总体目标是开发一套基于电子健康扫盲框架的分析工具，并将其应用于消费者健康门户网站，以表征消费者在使用该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，我们正在与一家“最先进”的门户网站Consumer erReportsHealth.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决策。第一个目标是建立框架的信度和效度，我们建议开展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来评估给定站点上任务的电子健康素养复杂性。我们建议分析Consumer ReportsHealth.org站点上的20项不同复杂程度的任务。这些任务包括寻求健康信息、决策(例如，权衡治疗方案)和评级(医院和医生)任务。我们还将应用两个自动诊断工具：可读性评估指标，它整合了文档的语言特征以确定其可读性级别；以及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。在复杂性分析的基础上，我们将选择3个复杂性水平的10个任务用于与健康消费者的认知研究。我们将进行认知研究，其中20名受试者(40名)的2个队列被要求执行上述10项任务。第一批人将来自Consumer ReportsHealth.org的付费订户，他们可能比第二批人受过更高的教育，计算机素养也更高，而第二批人将来自东哈莱姆区的社会服务和社区中心联合结算协会。将在这两个地点和哥伦比亚大学设立机构审查委员会。这项提议的一个主要优点是，我们正在使用一个理论上有基础的框架来解决一个相当重要且日益重要的问题，该框架极大地扩大了电子健康扫盲评估的范围。

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.