E Volution: Health Education In The Information Age

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E Volution Health Education In The Information
Age

• Robert S. Gold
• Nancy L. Atkinson

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• As for the future,
• your task is not to foresee,
• but to enable it
• www.phi.umd.edu

- Antoine de Saint-Exupery, The Wisdom of the
Sands
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Before we start?
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The Digital Divide?
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Or Does It Look Like This?
ACCESS
LITERACY
LANGUAGE
DIVERSITY
QUALITY
JUDGEMENT
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Purpose

• What role do divides such as access and
  literacy play in the future of health education?
• What are the implications of the digital
  e-volution for health and health education?
• What are the challenges and opportunities for
  health education?
• What are the opportunities?

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ACCESS

• Healthy People 2010 Objective 11-1 Increase the
  proportion of households with access to the
  Internet at home.
• Target 80 percent.
• Baseline 26 percent of households had access to
  the Internet at home in 1998.
• Data source Computer and Internet Use Supplement
  to the Current Population Survey, U.S. Department
  of Commerce, Bureau of the Census.
• National Educational Technology Goal 1 All
  students and teachers will have access to
  information technology in their classrooms,
  schools, communities and homes.

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People with disabilities
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LITERACY

• Healthy People 2010 Objective 11-2
  (Developmental) Improve the health literacy of
  persons with inadequate or marginal literacy
  skills.
• Potential data source National Adult Literacy
  Survey, 2002, U.S. Department of Education.
• National Education Technology Goal 3 All
  children will have technology and information
  literacy skills

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World Health Organization (WHO)

• has recently defined health literacy more
  broadly, as follows
• Health literacy represents the cognitive and
  social skills which determine the motivation and
  ability of individuals to gain access to,
  understand and use information in ways which
  promote and maintain good health.
• Health literacy means more than being able to
  read pamphlets and successfully make
  appointments.
• By improving peoples access to health
  information and their capacity to use it
  effectively, health literacy is critical to
  empowerment. (WHO, 1998)

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Health literacy . . .

• This definition significantly broadens the scope
  of the content of health education, indicates
  that health literacy may have both personal and
  social benefits, and has profound implications
  for education methods.

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One direction . . .
Or two?
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How do you know when youve made it in todays
world?
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• If we can decode this

Why cant we decode this?
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• If we can figure out how to read this

Why cant we figure out how to read this?
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• If we can land here

Why cant we land here?
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• If we can build this

Why cant we build this?
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• If we know how to tailor messages

Why cant we figure out how to tailor
interventions?
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• If this is a cultural phenomenon

Why cant we figure out how to effectively apply
this kind of technology for health education?
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• If we have so many best practices

• Why cant we figure out how to get health
  educators to use them effectively?

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So here we are!
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Core Technologies

• EDI
• Advanced satellites
• Digital imaging
• Simulations
• Fuzzy logic
• Superconductors
• Fiber optics

• Digital electronics
• Optical data storage
• Advanced video displays
• Advanced computers
• Distributed computing
• Expert systems
• Object oriented programming
• The Web

• Wireless applications
• Handheld technologies
• Biometrics

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Appropriate technology can revolutionize

• The delivery system of products and services
• The way we communicate
• The way we use and view television
• The way we individualize and personalize
  education
• The way we internalize, understand, and use
  massive amounts of data

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Is This Vision Possible?

• Visit The Neighborhood

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Vision Statement

• Equitable access to information technology
• Ability to use information technology effectively
• Quality health promotion interventions and
  information for all audiences
• Ability to evaluate the quality of information
  delivered through new media

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Vision Effective Use

• Just supplying hardware and software is
  insufficient
• Need to provide training and technical assistance
  on computer and Internet use
• Need to provide support staff for computer
  maintenance and trouble shooting
• Need to prepare gate keepers (e.g., teachers) to
  use technology with their constituents / end
  users (e.g., students)

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Vision Quality Information Interventions

• How do we maintain and improve on the efficiency
  of current public health interventions without
  dramatically increasing cost?
• How do we contribute to the reduction in the
  disparity in morbidity and mortality for
  underserved populations?
• How do we take appropriate advantage of advanced
  communications technologies to accomplish the
  first two?

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• The dominant training and public health
  educational media strategies today, and
  electronic media are insufficient to accommodate
  the full potential of todays and tomorrows
  needs.
• More effective educational and communication
  tools are necessary.

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If we are to . . .

• motivate ever larger numbers to achieve their
  potential
• deliver and track our efforts to remote and
  diverse populations
• build societal databases that allow us to monitor
  the multiplicity of factors that determine the
  capacity and productivity of individuals,
  families, communities, and nations

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Given the context of

• A favorable atmosphere for building on technology
  infrastructure
• Growing recognition of the importance of
  alternative technology based solutions to human
  problems, needs and interests and,
• The philosophical guideposts provided by public
  healths traditions and vision

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Then

• . . . we must establish and act on a vision of a
  communications technology research and
  development paradigm that propels public health
  into its future of choice.
• We must invest in a complex, diverse, well
  organized technology research and development
  infrastructure that will ensure that our vision
  is realized.

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• . . . it is an opportune time to examine ways to
  apply communications technologies to catalyze,
  instigate, guide, support, and monitor our
  progress. Yet, at the same time, we must
  recognize the importance of putting the tools
  and capacity in the hands of communities rather
  than limit them to governments and/or
  professionals

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Imagine . . .

• an array of strategies and tools that facilitate
  the active and systematic engagement of
  communities in defining and dealing equitably and
  intersectorally with their real issues and
  concerns.
• Not only will we do good work
• we will also do good.

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Heres where we are today

• e-networks
• Exquisite illustrations of effective community
  building
• Second and third generation tailoring
  technologies
• Fully developed computer and web-based education
  and training courses and programs
• Real-time data collection and analyses for
  assessments, survey and other research
• Web-based data access, data-mining
• Early, and some well developed decision-support
  systems
• Interesting and useful simulations
• Real time interaction with and without video

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Where do we need to look?

• To more highly refined applications for
  individuals
• To an understanding and application of group
  applications
• To an understanding and application of
  system-level applications

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Heres where were going

• More of the same, only highly refined
• e-meeting technologies
• Smart card technologies
• Knowledge engineering
• Understanding new types of data (e.g., video,
  audio)
• Tacit knowledge
• Knowledge management
• High end decision-support and expert systems
• Simulations
• Neural networks
• Real world systems

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• As for the future,
• your task is not to foresee,
• but to enable it
• www.phi.umd.edu

- Antoine de Saint-Exupery, The Wisdom of the
Sands
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The Internet
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Digital inclusion
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People online (in millions)
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Population characteristics
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Extent of the problem

• A recent study of health literacy among Medicare
  enrollees in a managed care organization
  (Gazmararian, JA. JAMA, Feb 10, 1999) found that
  low health literacy was far more widespread than
  expected.
• Overall 33.9 of English-speaking respondents had
  inadequate or marginal health literacy
• 53.9 of Spanish-speaking respondents had low
  health literacy and,
• Researchers found that health literacy declined
  dramatically with age, even after researchers
  made adjustments for years of school completed
  and cognitive impairment.

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• A 1995 study (Williams, MV. JAMA, December 6,
  1995), found
• that 33 of patients at two public hospitals did
  not understand instructions for a common
  radiographic procedure written at the 4th grade
  level
• from 24.3 to 58.2 of patients did not
  understand directions to take medication on an
  empty stomach
• 20 of patients answered questions incorrectly
  regarding information on an appointment slip, and
  
• 40.7 to 74.5 of patients surveyed did not
  understand the standard informed consent
  document.
• The inability to understand informed consent
  documents is especially troubling because of the
  implied legal and ethical implications.

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• The estimated additional health care expenditures
  due to low health literacy skills are about 73
  billion in 1998 health care dollars. This
  includes an estimated 30 billion for the
  population that is functionally illiterate plus
  43 billion for the population that is marginally
  literate.

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Literacy for the 21st Century

• Literacy involves a complex set of abilities to
  understand and use the dominant symbol systems of
  a culture for personal and community development.
  The need and demand for these abilities vary in
  different societies.
• In a technological society, the concept is
  expanding to include the media and electronic
  text in addition to alphabets and numbers.
• Individuals must be given life-long learning
  opportunities to move along a continuum that
  includes reading, writing, and the critical
  understanding and decision-making abilities they
  need in their communities.
• The center for literacy of Quebec
  http//www.nald.ca/province/que/litcent/litWD.htm

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QUALITY JUDGEMENT

• Healthy People 2010 Objective 11-4
  (Developmental) Increase the proportion of
  health-related World Wide Web sites that disclose
  information that can be used to assess the
  quality of the site.
• Potential data sources Health on the Net
  Foundation Health Internet Ethics (Hi-Ethics)
  Internet Healthcare Coalition.
• National Educational Technology Goal 4 Research
  and evaluation will improve the next generation
  of technology applications for teaching and
  learning.