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Dianne Rees

'Ignorance is bliss sometimes': constraints on the emergence of the 'informed patient' ... - 0 views

  • Recent work in medical sociology suggests that there continues to be a gap between the partnership and ‘negotiation’ models of practitioner-patient relations and the empirical reality of everyday practice.
  • Lupton (1997) has drawn attention to the fact that patients have agency here, too.
  • in their interactions with doctors and other health care workers, lay people may pursue both the ideal type ‘consumerist’ and the ‘passive patient’ subject position simultaneously or variously, depending on the context (1997: 373).
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  • For Lupton, ‘late modernist notions of reflexivity … fail to recognise the complexity and changeable nature of the desires, emotions and needs that characterise the patient-doctor relationship’ (1997: 373).
  • He argues that the health care practitioners who participate in these online self-help networks are also experiencing an identity shift, moving from authority figure to facilitator.
  • nformation technology and consumerism are synergistic forces that promote an ‘information age healthcare system’ in which consumers can, ideally, use information technology to gain access to information and control their own health care, thereby utilising health care resources more efficiently (2000: 1714, our emphasis).
  • Is there a direct link between information access and empowerment?
  • Such detailed empirical studies of Internet use can tell us much about the significance of this medium in the everyday lives of specific user groups and about the emergent relations and communities that may accompany such use. Thus, studies of online health communities tell us much about how the Internet can support community building which is valuable and interesting in its own right. They also demonstrate well the point made by science and technology studies (STS) that users of technologies ‘shape’ those technologies to fit their needs and that the context of use, in particular, is central to understanding the significance of such technologies
  • (Bijker and Law 1992, MacKenzie and Wajcman 1999, Lie and Sørensen 1996, Silverstone and Hirsch 1992). There is, however, a danger that such work will be interpreted and/or used to imply that the Internet is, in itself, empowering of patients, and it is this type of technological determinism that we wanted to avoid in our own study. In the next section, we explain how we designed our study to do this.
  • In order the better to understand how these women located themselves within the landscape of health information, the very first question we asked them was:What, if anything, do you do when you first feel something isn’t quite right with your health?
  • Thirty-two women were recruited through a GP practice (family doctor) or gynaecological clinic in a city in the south east of England. Women who were taking, had considered taking, or had recently stopped taking HRT were all considered for inclusion in the study.
  • The interview schedule included questions about health information practices in general before going on to ask about HRT-related health information practices.
  • Thus, results suggest that our participants access a range of different information sources and media, but the interesting questions remain. How keen are they to become more informed about their health? Does access to information necessarily lead to feelings of empowerment? Does access to the Internet enhance information-related empowerment? Below, we explore the constraints on the emergence of the ‘informed patient’ under three headings: taking responsibility; information literacy; and the medical encounter
  • Have you ever looked something up for yourself before going to see a doctor, nurse or other health care practitioner?
  • Eighteen of the 32 participants had never looked anything up for themselves before a visit to a doctor or other healthcare practitioner. Eleven of these offered no explanation for this and many seemed surprised by the question.
  • Two kinds of explanation were offered by the seven other participants. The first suggested a reluctance to take the kind of responsibility for self-care suggested by the ‘informed patient’ discourse. The feeling here was that it was the doctor's job to know about such matters.
  • Thus, we cannot assume that everyone sees the importance of taking on more responsibility for their health, especially where that involves ‘becoming informed’ outside of the traditional medical encounter. This particular group of mid-life women felt either that it was a doctor's job to inform patients about their health or that there would be problems in trying to work in partnership with doctors in the way suggested by the informed patient discourse.
  • Becoming informed involves skills and competencies that relate both to the information itself and to the medium used to access that information. Amongst our participants we found women who had very few information literacy skills and others who lacked general computer literacy skills and/or web searching skills. Below, we discuss how lack of competency in these areas can inhibit the emergence of the informed patient identity. To illustrate this point, we compare more and less ‘literate’ participants, some of whom have access only to the more traditional media, others who have access to the Internet as well.
  • Information literacy
  • Taking responsibility
  • Information landscapes
  • Recruitment and interview focus
  • The Internet and patient empowerment
  • Information literacy skills are crucial when searching on the web. Awareness of sources (individual or organisation publishing the information) is one means by which one can begin to assess the validity of the information found on the web. While Marge is our least information-literate Internet user, many others were similarly uninterested in information source and validity issues, displaying low levels of information literacy.
  • Clearly, Jane is unwilling to trust the information about dairy products from producers of dairy products but is, at the same time, more than happy to accept what producers of soya products say about the benefits of soya.
  • Clearly, whilst medical sites are a signpost to trustworthiness for some, this is not a universal experience.
  • In particular, those with an interest in alternative or complementary therapies may well find conventional medical sites restrict and circumscribe their ‘informed choice’, just as some healthcare practitioners were reported to have done in the context of the medical encounter, discussed next.
  • The medical encounter
  • When discussing the first constraint on the emergence of the informed patient –‘taking responsibility’– we found that 14 of the 32 women had, at some point, actively searched for information about their health prior to a visit to the doctor
  • These women were asked whether they disclosed what they already knew. As with those who did not look up information for themselves, there was, amongst the more informed participants, still a great concern about appearing to over-step the boundary between ‘expert’ and ‘patient’ here
  • The last example is particularly interesting for the way in which the patient, here, feels the need to protect the doctor from the ‘informed patient’ who she sees as exerting extra pressures on an already busy professional.
  • You have to be very careful because they come back with – and I don’t blame them at all – they say, ‘don’t believe what you read in the paper, you’re here with me now and I’m telling you this’. I don’t blame them, because it must be very hard, when you go and say, ‘Oh, I read this in the paper’. It's not easy for them … (Pat).
  • Annie shows us that it is perfectly possible to be very engaged with one's own health and informed about treatment options through traditional information media and sources but, at the same time constrained in the full development of an informed patient identity because of a reluctance to challenge the doctor.
  • Despite nearly half the women in our sample being willing and able to look things up for themselves prior to visits to healthcare professionals, in no instance did it seem to be the case that disclosing what was already known about their particular health problems and their treatments was a completely straightforward process for these women.
  • Exceptions might be the one woman who stated that she would feel confident disclosing to a complementary therapist (though not to her GP), and another who felt that ‘a lot of doctors now know that some people know their bodies better than what [the doctors] do’ and that things were, therefore, getting better over time. In general, however, for this particular group of mid-life women, it seems that the boundary between the expert healthcare professional and the patient is still fairly robust.
  • A second constraint on the emergence and enactment of the informed patient identity has to do with skills and competencies in what we might call ‘information literacy’. These skills involve general awareness of where to find information, information retrieval, understanding the context of the information being provided, and interpretation and communication of that information in the context of health-care decision-making. This point becomes all the more pertinent when we come to look at Internet use. Although almost half of our participants had used the Internet for accessing health information, we found that the search strategies used were very unsystematic. In addition, we found, as did Eysenbach and Köhler (2002) in their qualitative study of health information searching on the Web, there was almost no awareness of who or what organisation was publishing the information being accessed. Indeed, for some, the information ‘media’ and ‘source’ were collapsed and the Internet was itself considered a source of health information and, for many, a good one at that.
  • Conclusions
  • First, many patients do not want to take responsibility or seek out information for themselves – they are more than happy to trust their GPs and leave decisions to them. There may be many different reasons for this as Lupton (1997) has suggested but it is important that the patient perspective is acknowledged nevertheless.
  • The third constraint in the emergence of informed patients and partnership relations comes from the apparent reluctance of practitioners to take on this new role
Dianne Rees

BioMed Central | Full text | Consumer e-health education in HIV/AIDS: a pilot study of ... - 0 views

  • despite the promise of online health resources, few studies have looked at how they are used by individuals coping with health problems, including HIV." (p. 48). Therefore, this research was designed to investigate how a web-based resource that included CMC, video, and support documents was used by HIV/AIDS community members.
  • Individual learning preference was one theme shared by some participants
  • These comments demonstrate a variety of preferences for learning. Of the four participants who shared comments, one preferred print, another audio, and two liked the integration of multi-media.
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  • In summary, some participants did not use CMC at all and one did not trust it as a source. The other three shared that they used this form of communication but not usually to learn about HIV/AIDS treatment information.
  • When participants were asked about their views and practices regarding the use of CMC, responses were varied, from having no interest in using the technology to finding it quite useful.
  • Many using the Internet are very savvy about visual media, having already watched copious amounts of television and motion pictures. With few exceptions most have seen countless hours of video in which production quality is very high. Further, many have read large amounts of text-based information, which has been professionally edited and type-set. As a result, some participants in this study may have been negatively impacted components containing imperfections. As one participant (P12) said, "...that's a whole thing about the Internet, it needs a good edit". An interface must be very "clean" before effects or impact of learning on participants can be measured for effect on learning or health improvements [21].
  • Use of the technology appears to be, in some cases, an adjunct to other offline resources.
leoreeves

Health and wellness: Summer skin useful Tips - 0 views

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    Summer skin useful Tips
Dianne Rees

Internet Skills Performance Tests: Are People Read... [J Med Internet Res. 2011] - PubM... - 0 views

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    "Despite the amount of online health information, there are several barriers that limit the Internet's adoption as a source of health information. One of these barriers is highlighted in conceptualizations of the digital divide which include the differential possession of Internet skills, or "eHealth literacy". Most measures of Internet skills among populations at large use self-assessments. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance tests."
rizwanyonis516

The Power of Laser and Ultrasound - Medium - 0 views

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    Laser surgery uses laser light to remove diseased tissues or treat bleeding blood vessels. Laser surgery may also be used to remove wrinkles, sunspots, tattoos, or birthmarks.
Amy Nut

A Secondary And Effective Source To Fulfill Your Financial Responsibilities ! - 0 views

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    Payday loans for unemployed are the best source of finance without any credit check issue or long wait hassle. You can obtain same day cash aid with us.
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fnfdoc

Pregnancy Calculator Guide For Pregnant Women | Health Blog - 0 views

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    Pregnancy calculator guide or how to use pregnancy calculator? There are some questions which you are curious to find the answer about these. We covered briefly this topic for you. You will get the answer here also, What are pregnancy symptoms and due date calculation procedures?
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    After getting married, every couple certainly wants to have a baby. So, when a wife gets pregnant, both she and the husband want to know as soon as possible when she will give birth. Usually, a married couple will go to a hospital and follow USG test to know the predicted birth date. However, you can actually calculate it by your own. You should know when your last period was started so then you are able to find a due date. Today, there is what is called pregnancy calculator. It can be used by everyone. If you are curious about it, let's pay attention to the following discussion.
kamagraseller

How to use Kamagra 100mg Oral Jelly & Pills - Kamagra Seller - 0 views

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    How to Use Kamagra 100mg Oral Jelly & Pills in India for Erectile Dysfunction. Buy our best Oral Jelly 100mg & Pills from India Suppliers & Exporters online Kamagra Seller.
Dr. Steffany Mohan

World No Tobacco Day: How Tobacco Affects Your Oral Health - - 0 views

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    It's important to recognize the significance of World No Tobacco Day and create awareness about tobacco use. Learn how tobacco affects your oral health.  
Leena Marilda

Fifth Avenue Physical Therapy | NYC Rehabilitation Medicine - 0 views

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    What is physical therapy? Who are physical therapists? Your #physical therapist helps you in a lot of ways; #health care profession that involves treatment of a #disease, injury or deformity. Your physical therapist helps achieve the improvement mobility and motion, managing pain effectively without long term use of #medication.
socialsushant

Tips To Stay Protected During Monsoons - 0 views

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    Severe weather conditions during monsoons are no stranger to us. Storms, flash floods, and water puddles everywhere. And how can we forget the increased chances of falling sick. Rain brings with itself infections like dengue, malaria, conjunctivitis..
Dianne Rees

Nutrition Literacy Toolkit - 1 views

  • The Nutrition Literacy Toolkit (Toolkit) is not a curriculum, but a tool from which schools and communities can design a curriculum using a menu of effective nutrition education resources. 
Dianne Rees

HealthLiteracyReport.pdf (application/pdf Object) - 1 views

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    Views of health literacy in NC, but chapters 2 & 3 are generally useful
Dianne Rees

Usability Home | Usability.gov - 1 views

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    "a one-stop source for government web designers to learn how to make websites more usable, useful, and accessible"
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    For govt web designers but has good tips and templates applicable to health info web design generally
Dianne Rees

Office Practice Patient Survey for Health Literacy | ImpactBC - 0 views

  • This is an example of how an office practice could monitor their progress on improving health literacy. Instruction document on how to use this survey can be found here.
Tom Bond

Patients still not knowing the use of Patient Portal Development system features - 0 views

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    Aegis Healthcare professionals are sharing this post with global patient portal users and development community to let them know about patient awareness of portal availability. This will help the vendors to make fine approaches for promoting their portal development services and spreading awareness of portal features among users and patients.
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