Developing and Evaluating Online Education to Improve Older Adults Health Information (California)

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Summary:

Americans of all ages use the Internet to obtain medical information because it is convenient and allows them to inexpensively search at any time for sensitive information in a relatively anonymous fashion.  Internet usage among older adults has significantly risen, as well as their use of online searching for health information. Because information on the Internet is largely unregulated, information obtained with these searches may be of poor quality, incorrect, misleading, or incomplete. It is thus important that individuals of all ages know how to identify quality health information online.          

This project aimed to improve older adults’ knowledge of and confidence in identifying high-quality online health information by developing and evaluating Your Health Online: Guiding eSearches, an interactive, educational Web site. The Web site was designed for older adults who are current users of the Internet.          

The specific aims of this project were to:

  • Convene focus groups to identify older adults' preferences for online learning about health. 
  • Develop an interactive online educational program to teach older adults to improve their knowledge and skills in identifying high-quality health Web sites and enhance their ability to efficaciously communicate with their physicians.
  • Pilot test the feasibility of the program.
  • Evaluate the outcomes of the new program compared to an alternative.         

Focus groups, in-person interviews, and pilot tests were conducted with 94 community-dwelling adults to determine their health needs and online preferences for learning. Most of the participants reported using the Internet to search for information on medical conditions and procedures. The information gained from participants was utilized to develop the Web site’s interactive content and format. A subsequent evaluation was conducted by randomizing the participants to use of the new site versus taking a non-interactive tutorial with similar objectives. Knowledge, self-efficacy, and Internet use was compared between the two groups.          

Nearly all participants agreed that interactive education was important. Both groups learned a similar amount, and reported being as self-efficacious. Those using the Web site gave high ratings to its appearance, usability, and usefulness, reporting that the information they learned would likely improve their next Internet health search. The project team noted that such a tool was both feasible to create and acceptable in a community setting for older users.

Participants recommended increasing the number of exercises, links to sites, and online articles on the site.  In the future the team would like to evaluate the program’s ability to improve the way older adults conduct their searches for health information, and whether those improvements lead to better health and quality of life.

Developing and Evaluating Online Education to Improve Older Adults’ Health Information - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-268: Small Research Grant to Improve Health Care Quality Through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 019745
  • Project Period: 
    September 2010 – September 2012
  • AHRQ Funding Amount: 
    $52,119
  • PDF Version: 
    (PDF, 320.16 KB)

Summary: Although an increasing number of Americans, including seniors, are turning to the Internet for information about health care, it can be difficult to identify accurate, high-quality health Web sites. There is little data about older consumers’ awareness of the varying quality of health care information on the Internet, and whether or not seniors are able to distinguish between high- and low-quality Web-based health information.

The goal of this project was to develop and evaluate “Your health online: Guiding eSearches,” the first theory-based online health education program for people aged 55 and older. The program aimed to improve older adults’ ability to identify high-quality health Web sites and to promote self-efficacy for communicating with physicians.

The project team conducted focus groups to identify older adults’ preferences for online learning about health topics to inform the design of an interactive online educational program. The use of “Your health online” was compared to a program of educational materials developed by the National Library of Medicine (NLM) that are not interactive or intended for older adults specifically. Interviews with users of each of the two programs documented differences in participants’ knowledge of and ability to identify trustworthy health Web sites and communicate with physicians. The project resulted in a theory-based educational program developed with cooperation and advice from older health consumers.

Specific Aims:

  • Convene focus groups to identify older adults’ preferences for online learning about health. (Achieved) 
  • Develop an interactive online educational program to teach older adults to improve their knowledge and skills in identifying high-quality health Web sites and enhance their ability to efficaciously communicate with their physicians. (Achieved) 
  • Pilot test the feasibility of the program. (Achieved) 
  • Evaluate the outcomes of the new program compared to an alternative. (Achieved) 

2012 Activities: The team finalized the Your health online: Guiding eSearches educational program. Informed by the focus groups, the goal of the Your health online Web site was to present interactive, highquality information without over-simplifying or over-complicating the material. Sixty-five participants were recruited for a randomized controlled trial to evaluate the program. Patients were randomized to the Your health online arm (intervention) or the education NLM PowerPoint arm (control). Participants were asked to complete a survey about their experience with the intervention Web site or the NLM PowerPoint slides. The survey contained questions specific to the study arm assignment as well as general shared questions about user experience, knowledge, and confidence level.

As last reported in the AHRQ Research Reporting System, project progress was completely on track and budget spending was on target. This project was completed in September 2012.

Impact and Findings: The focus group questions focused on Web sites used for health searches, topics of interest, ways to inform older people about the proposed program, the role of friends and families in guiding health-information Web searches, and how to evaluate the accuracy of Web-based health information. The findings indicated that most of the 18 participants use Google as an initial portal for health information. Several participants, upon recommendations from their providers, used sites associated with well-known medical institutions. There was general agreement that aside from cross-checking multiple Web sites, participants had no systematic method or criteria for evaluating health information. Participants agreed that a list of high-quality sites and criteria for evaluating information would be useful. The overwhelming amount of information on the Web was reported to be a major barrier to effective use. There was nearuniform agreement that an education tool with exercises to test one’s skills would be beneficial. The project team compared the findings from patients 55 to 65 years old with findings from patients 65 to 75 years old. The younger group of patients was more interested in a multimedia approach to disseminate health information, an evaluation or feedback component, and supplemental information such as links from the Web site to other resources. Many participants from the younger age group noted that current Web sites are static and therefore not very engaging. Participants from both groups, regardless of age or education level, were not good at identifying high-quality health information on the Web.

The surveys about Your health online were first piloted with four people, all of whom reported that the Web site was important and that they would be likely to use it in the future. Next, the surveys were distributed to 65 participants: 36 in the intervention arm, and 29 in the control arm. Participants in the intervention and control groups demonstrated ample knowledge about seeking health information using the Internet. Seventy-eight percent of the intervention group and 70 percent of the control group were confident about their ability to identify valid health information, but improvements were not observed between the intervention and control groups for any other measures. Participants in both groups reported that involvement in the study will improve their Internet searches for health information in the future. Overall, the study demonstrated the feasibility and acceptability of developing and implementing an interactive online education program.

Target Population: Adults, Elderly*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation.

*This target population is one of AHRQ’s priority populations.

Developing and Evaluating Online Education to Improve Older Adults Health Information - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 019745
  • Project Period: 
    September 2010 - September 2012
  • AHRQ Funding Amount: 
    $52,119
  • PDF Version: 
    (PDF, 500.56 KB)

Summary: As an increasing number of Americans, including seniors, are turning to the Internet for information about health care, the ability to identify accurate, high-quality health Web sites can be difficult. There is little data about older consumers' awareness of the varying quality of health care information on the Internet, and whether or not seniors are able to distinguish between high- and lowquality Web-based health information.

The goal of this project is to develop and evaluate the first theory-based online health educational program for people aged 55 and older. The program aims to improve older adults' ability to identify high-quality health Web sites and to promote self-efficacy for communicating with physicians.

The project conducted focus groups to identify older adults' preferences for online learning about health topics to inform the design of an interactive online educational program. The use of this program will be compared to a program of educational materials, developed by the National Library of Medicine (NLM), that are not interactive and not geared specifically to older adults. Interviews with users of each of the two programs will document differences in participants' knowledge and skill in identifying trustworthy health Web sites and in communicating with physicians. The project will result in a theory-based educational program developed with the cooperation and advice of older health consumers.

Specific Aims:

  • Convene focus groups to identify older adults' preferences for online learning about health. (Achieved)
  • Develop an interactive online educational program to teach older adults to improve their knowledge and skills in identifying high-quality health Web sites and enhance their ability to efficaciously communicate with their physicians. (Achieved)
  • Pilot test the feasibility of the program. (Ongoing)
  • Evaluate the outcomes of the new program compared to an alternative. (Upcoming)

2011 Activities: The project team conducted patient focus groups to identify older adults' online learning preferences. Participants were recruited by a community partner through flyers, newsletters, articles in the local newspaper, and mailings. The focus groups were conducted in a flexible semi-structured format to allow participants to bring up topics that matter to them, to build conversation from what other group members discussed, and to allow the moderator to probe for deeper insight into discussions. Questions focused on Web sites used for health searches, topics of interest, ways to inform older people about the proposed program, the role of friends and families in guiding health information Web searches, and how to evaluate the accuracy of Web-based health information.

Based on the results of the focus groups, the project team developed the content for the Web-based educational program. The goal of the Web site is to present interactive, high-quality information without over simplifying the material or making it overly technical. Two surveys are being created to assess the end-users' perceptions and experiences with the program as compared to the current standard, a noninteractive presentation developed by the NLM.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project budget spending is on target.

Preliminary Impact and Findings: The preliminary findings from the focus groups indicated that the majority of participants use Google as an initial portal for health information. Several participants, upon recommendations from their providers, use sites associated with well-known medical institutions. There was general agreement that participants had no systematic method or criteria for evaluating health information, aside from cross-checking multiple Web sites. Participants agreed that a list of highquality sites and criteria for evaluating information would be very useful. The overwhelming amount of information on the Web was reported to be a major barrier to effective use. There was near-uniform agreement that an education tool with trial exercises would be beneficial.

The project team compared the findings from patients 55 to 65 years old with patients 65 to 75 years old. The younger group of patients was more interested in a multimedia approach to disseminate health information, an evaluation or feedback component, and supplemental information such as links from the Web site to other resources. Many participants from the younger age group noted that the current Web sites are static and therefore not very engaging. As a result, Dr. Fink has incorporated a more interactive approach to content presentation. Participants from both age groups, regardless of age and education level, were not good at identifying high-quality health information on the Web.

Target Population: Adults, Elderly*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Developing and Evaluating Online Education to Improve Older Adults Health Information - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 019745
  • Project Period: 
    September 2010 – September 2012
  • AHRQ Funding Amount: 
    $52,119
  • PDF Version: 
    (PDF, 665.9 KB)


Target Population: Adults, Elderly*

Summary: An increasing number of Americans, including seniors, are turning to the Internet for information about health care. However, the ability to identify accurate, high-quality health Web sites can be difficult. There is little data about older consumers' awareness of varying quality of health care information on the Internet, and whether or not seniors are able to distinguish between high- and low-quality Web-based health information.

The goal of this project is to develop and evaluate the first theory-based online health educational program for people 55 years-of-age and older. The program aims to improve older adults' ability to identify high-quality health Web sites and to promote self-efficacy for communicating with physicians.

The project will conduct focus groups to identify older adults' preferences for online learning about health topics to inform the design of an interactive online educational program. The use of the interactive educational program will be compared to educational materials that are not interactive and not geared specifically to older adults. Interviews with users of each of the two programs will document differences in participants' knowledge and skill in identifying high-quality health Web sites and self-efficacy in communicating with physicians. The project will result in a theory-based educational program developed with the cooperation and advice of older health consumers.

Specific Aims:
  • Convene focus groups to identify older adults' preferences for online learning about health. (Ongoing)
  • Develop an interactive online educational program to teach older adults to improve their knowledge and skills in identifying high-quality health Web sites and enhance their ability to efficaciously communicate with their physicians. (Upcoming)
  • Pilot test the feasibility of the program. (Upcoming)
  • Evaluate the outcomes of the new program compared to an alternative. (Upcoming)

2010 Activities: During the first quarter of the project, Dr. Fink conducted three patient focus groups to identify older adults' online learning preferences. Participants were recruited by a community partner through flyers, newsletters, articles in the local newspaper, and mailings. The focus groups were conducted in a flexible semi-structured format to allow participants to bring up topics that matter to them, to build conversation from what other group members discuss, and to allow the moderator to probe for deeper insight into discussions. Questions focused on Web sites used for health searches, topics of interest, ways to inform older people about the proposed program, the role of friends and families in guiding health information Web searches, and how to evaluate the accuracy of Web-based health information.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Project milestones and aims are completely on track. The project budget is somewhat underspent to conserve resources for program development, the most cost-intensive part of the project.

Preliminary Impact and Findings: The preliminary findings from the focus groups indicate that the majority of participants use Google as an initial portal for health information, while several participants, upon recommendations from their providers, use sites associated with well-known medical institutions. There was general agreement that participants had no systematic method or criteria for evaluating health information, aside from cross-checking multiple Web sites. Participants agreed that a list of high-quality sites and criteria for evaluating information would be very useful. The overwhelming amount of information on the Web was reported to be a major barrier to effective use. There was near uniform agreement that an education tool with trial exercises would be beneficial.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*AHRQ Priority Population

Developing and Evaluating Online Education to Improve Older Adults Health Information - Final Report

Citation:
Fink A. Developing and Evaluating Online Education to Improve Older Adults Health Information - Final Report. (Prepared by Langley Research Institute under Grant No. R03 HS019745). Rockville, MD: Agency for Healthcare Research and Quality, 2012. (PDF, 645.48 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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