By Austine Duru, MDiv, MA, BCC
In this issue of Vision, in lieu of publishing a research article, we present eight resources in hopes of assisting readers to sample a broad range of research and research related topics by chaplains and non-chaplain collaborators. Each resource is related to our current Vision theme, “Spiritual Care Meets Social Media and Technology.” A link to a safe, open access site has been included to aid in further detailed reading.
Moreno, M. A., Christakis, D. A., Egan, K. G., Jelenchick, L. A., Cox, E., Young, H., Villiard, H., & Becker, T. (2012). A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.
Journal of Behavioral Health Services & Research. Vol. 39 (3). rd.springer.com/article/10.1007%2Fs11414-011-9258-7.
Social media has been variously identified as a powerful means of communication among young people. Most families will agree that the “sacredness” of dinner time and other family gatherings has been routinely violated by teenagers who continuously text or check their Facebook profile during meal time. Little wonder then that the authors of the study chose to track the Facebook profiles of these young people in an effort to glean some helpful information regarding mental illness. In their study, Megan Andreas Moreno, et.al. believe that social media play a vital role in the life of young college-age people. This work draws on available research that shows young people display higher levels of self-disclosure when chatting on the computer, partly due to the sense of anonymity it offers.
They reviewed 307 Facebook profiles of freshmen, sophomore and junior undergraduates in two large U.S. universities. Their objective was to “examine the validity of references to depression symptoms on public Facebook profiles by comparing these references to self-reported depression symptoms using the Patient Health Questionnaire (PHQ-9) depression screening tool.” The results were quite impressive and revealing. “A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.” The study hints at the value of innovative ways to identify and provide appropriate mental health intervention to at-risk college-age students. (41 references)
Avancha, S., Baxi, A., & Kotz, D. (2012). Privacy in mobile technology for personal healthcare.
ACM Computing Surveys (CSUR), 45(1), 3. www.cs.dartmouth.edu/~dfk/papers/avancha-survey.pdf
The impact of information technology on the quality, efficiency and cost of healthcare cannot be underestimated. Recent healthcare reform laws seem to target information sharing among clinicians as one aspect that has the potential to curtail the ballooning cost of healthcare nationally. This article is the result of a survey of mobile computing (mHealth) technologies that can allows physicians to monitor the progress of patients from a remote location, and also give individuals the opportunity to effectively take control of their own health. These capabilities, though a blessing, raise serious privacy issues and ethical questions. The authors of this survey took a stab at some of the issues raised by recent innovations in health technology. They surveyed literature on the topic and developed a conceptual privacy framework for mHealth. They itemized what they called “privacy properties” needed in mHealth systems and discussed the “technologies that could support privacy-sensitive mHealth systems.” Their work uniquely includes open research questions that could take the conversation further in various settings, including a CPE training program for chaplains and chaplain educators. (132 references)
Van Velsen, L., Wentzel, J., & Van Gemert-Pijnen, J. E. (2013). Designing eHealth that matters via a multidisciplinary requirements development approach.
JMIR research protocols, 2(1), e21.
If you have been asked to adopt a new technology in the workplace, chances are you have experienced the frustration that results from poorly designed programs that tend to complicate the workflow instead of enhancing and streamlining the process. Developing reliable electronic health designs that support effective delivery of healthcare can be a puzzling adventure for healthcare providers in general. The authors of this article present a practical, holistic, multidisciplinary requirement development approach for creating eHealth that matters; this approach is holistic and human-centered. It enhances collaboration among clinicians and healthcare professionals that results in a user-friendly end product. The authors developed a five-phase requirement approach for eHealth, which aims at streamlining the development process and minimizing unnecessary mismatches that result from lack of collaboration between health, engineering, and social science departments. It is a model that merges end-user needs with the design and contextual organizational goals. It creates an opportunity for the chaplains to maintain control of their day-to-day work flow, while collaborating effectively with an interdisciplinary team. (59 references)
Quinn, C. C., Shardell, M. D., Terrin, M. L., Barr, E. A., Ballew, S. H., & Gruber-Baldini, A. L. (2011). Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control.
Diabetes Care, 34(9), 1934-1942. care.diabetesjournals.org/content/34/9/1934.full.html
An aspect of healthcare benefiting from the integration of modern technology into self-care and health outcomes involves the management of diabetes in all its forms. A well-documented example is the WellDoc’s Diabetes Manager. Dr. Charlene Quinn and colleagues at the University of Maryland School of Medicine, in a year-long study, found that there is a positive correlation between access to WellDoc mobile app and low glycated hemoglobin (A1c). In effect, patients who had access to the WellDoc mobile app for treatment and behavioral coaching lowered their glycated hemoglobin (A1c), a measure of long-term blood glucose control. This is significantly higher than those who received care only during occasional doctor visits and through self-management. The study was designed to test whether the impact of adding mobile application coaching and patient/provider web portals to community primary care would cause a reduction in glycated hemoglobin levels in patients with type-2 diabetes compared to standard diabetes management. The results led the authors to conclude that “the combination of behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data individually analyzed and presented with evidence-based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year” (Quinn, et. al., 2011). This is a study that contributes to our knowledge of the relationships between mobile technology, health and coping with diabetes. It is hoped that it will trigger follow-up research. (25 references).
Unertl, K. M., Johnson, K. B., & Lorrenzi, N. M. Health information exchange technology on the front lines of healthcare: Workflow factors and patterns of use.
Journal of American Medical Information Association. Vol. 19, (2012): 396-400. 220.127.116.11/content/19/3/392.full.
This study was done over a period of nine months in six emergency room departments and eight ambulatory clinics, all located in Memphis, TN. The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into the work process of clinicians at multiple clinical sites. Through direct observations, the authors of this study collected information based on oral interviews during observation concurrently with the care providers used of the HIE. One of the key findings of the study was that different clinicians use the HIE differently based on the nature of their clinical work. With this insight, the authors developed two distinct workflow models – one for nurses, and another one for physicians. This made it possible to customize workflows to fit the needs of each clinical group and to ensure efficiency and ease of use. This research has significant implications for health information technology, electronic health records and associated financial implications. It also offers opportunity for chaplains to collaborate with other healthcare professionals as end-users and to develop electronic records that support accountability in pastoral care. (30 references)
Elias, E. R., Murphy, N. A., Liptak, G. S., Adams, R. C., Burke, R., Friedman, S. L., & Wiley, S. E. (2012). Home care of children and youth with complex health care needs and technology dependencies.
Pediatrics, 129(5), 996-1005. www.macpeds.com/documents/HomeCareofChildrenandYouthWithComplexHealthCareNeeds.pdf
Technology dependency is becoming a huge problem and health concern in our contemporary society. The rise in the complex health issues associated with technology dependency is most visible among the highly vulnerable and most likely population to use and adopt new and innovative technologies – young people and children. Among this population, too, are children with life-sustaining technological devices that support their care either at home or at the hospital. The extensive use of such devices inevitably results in life-long dependency due to serious complications related to feeding and respiration. In this clinical report, Elias Ellen Roy and colleagues present an approach that will ensure the smooth transition of a child with complex medical needs with technological dependencies, from hospital to home and also continue to address the evolving needs of the patient and family in the home setting. Most of these children require round-the-clock care and repeated hospitalizations due to infections or other complications. To maintain a continuum of care, the care team must work together to provide for the needs of such patients at all stages of their hospitalization and discharge.
The chaplain can certainly play a significant role as a member of the team in this instance. The authors identified specific pastoral care needs such as counseling, palliative and hospice care, advance care plan, out of hospital do-not-resuscitate order, etc. In spite of the awareness of these needs, the report fails to identify the chaplain as an integral part of the interdisciplinary team of care providers or community support structure. Reflecting on the study’s results, however, provides an opportunity for chaplains and chaplain educators to begin to think creatively about adapting traditional facility-based pastoral care to the medical home, or home health model, especially in the wake of the new Affordable Care Act and in the context of the Accountable Care Organization. (40 references)
Kerns, J. W., Krist, A. H., Longo, D. R., Kuzel, A. J., & Woolf, S. H. (2013). How patients want to engage with their personal health record: a qualitative study.
BMJ open, 3(7). bmjopen.bmj.com/content/3/7/e002931.full.html
This qualitative study offers good reading on how electronic personal health record systems (PHRs) support patient-centered healthcare by making medical records and other relevant information accessible to patients and physicians, aiding in better self-management and provider/patient relationships. However, fewer patients than expected seem to be motivated to fully adopt these new and innovative technologies related to top personal health records. The authors of this study aim to broaden our understanding of how patients want to engage and use such advanced information tools. It assesses factors related to the use and non-use of the sophisticated interactive preventive health record (IPHR) designed to ease the process of adopting 18 recommended clinical preventive services.
For this study, three focus groups of IPHR users and two focus groups of IPHR non-users were studied. The findings suggest that participants would prefer their personal clinicians to use the IPHR. In particular, “participants’ comments linked the IPHR use to: (1) integrating the IPHR into current care, (2) promoting effective patient-clinician encounters and communication and (3) their confidence in the accuracy, security and privacy of the information.” It is obvious that many IPHRs are physician-oriented and, as such, when applied to primary care, IPHRs may need to put into consideration patient-clinician relationships and the unique workflow of each aspect of care. The significance of these findings is relevant for a number of stakeholders, including policymakers, information technology industry workers, and clinicians, especially pastoral care providers. (62 references)
Klasnja, P. & Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions.
Journal of biomedical informatics, 45(1), 184-198. www.ncbi.nlm.nih.gov/pmc/articles/PMC3272165/pdf/nihms323686.pdf
Healthcare providers are concerned about how repeated hospitalization and non-compliant patients can impact their “health grade.” If this study is accurate, there are ways to leverage technology to ensure that patients are given the tools to monitor and report their health information utilizing mobile-phone health devices so small that they could literarily fit in one’s “pocket.” Predrag Klasnja and colleagues explore the increasing use of mobile phone platforms to enhance the delivery of healthcare. To encourage physical activity and healthy diets, monitor symptoms of asthma and heart disease, to communicate reminders about upcoming appointments, to support smoking cessation, and for a range of other health problems, clinicians are increasingly turning to mobile technology as a reliable platform for executing some of these tasks. It is not, perhaps, an overstatement to conclude that mobile health devices are here to stay.
This study makes reference to the growing body of work around this topic to identify and describe the “features of mobile phones that make them a particularly promising platform for health interventions.” In addition, it identifies “five basic intervention strategies that have been used in mobile-phone health applications across different health conditions.” Finally, the authors summarize the “directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions.” Chaplains and other healthcare providers should pay attention to the developments in this aspect of healthcare delivery for clues that may help them adapt to the changing landscape of healthcare. (98 references)
Austine Duru is staff chaplain at Franciscan St. Margaret Health in Dyer, IN. He is also adjunct professor of philosophy at Calumet College in Whiting, IN.