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1.  Health-Care Provider Preferences for Time-Sensitive Communications from Public Health Agencies 
Public Health Reports  2014;129(Suppl 4):67-76.
The Rapid Emergency Alert Communication in Health (REACH) Trial was a randomized control trial to systematically compare and evaluate the effectiveness of traditional and mobile communication modalities for public health agencies to disseminate time-sensitive information to health-care providers (HCPs). We conducted a sub-study to identify the communication channels by which HCPs preferred receiving public health alerts and advisories.
Enrolled HCPs were blindly randomized into four message delivery groups to receive time-sensitive public health messages by e-mail, fax, or short message service (SMS) or to a no-message control group. Follow-up interviews were conducted 5–10 days after the message. In the final interview, additional questions were asked regarding HCP preferences for receiving public health alerts and advisories. We examined the relationship between key covariates and preferred method of receiving public health alert and advisory messages.
Gender, age, provider type, and study site showed statistically significant associations with delivery method preference. Older providers were more likely than younger providers to prefer e-mail or fax, while younger providers were more likely than older providers to prefer receiving messages via SMS.
There is currently no evidence-based research to guide or improve communication between public health agencies and HCPs. Understanding the preferences of providers for receiving alerts and advisories may improve the effectiveness of vital public health communications systems and, in turn, may enhance disease surveillance, aid in early detection, and improve case finding and situational awareness for public health emergencies.
PMCID: PMC4187309  PMID: 25355977
2.  How 2 txt: an exploration of crafting public health messages in SMS 
BMC Research Notes  2014;7(1):514.
Health care providers are an important target audience for public health emergency preparedness, response and recovery communications. Short Message Service or text messaging to cell phones may be a promising supplemental or alternative technique for reaching health care providers with time-sensitive public health information. However, studies to date have yet to investigate the message content and formatting requirements of providers with respect to public health alerts and advisories or sought to understand how to meet these needs using Short Message Service technology.
Data collection was completed using a two-part online survey. In the first part, health care providers identified their use of different technologies for receiving information and provided input on the message components most important in a public health message. In the second part, health care providers participated in an exercise in which they shortened three public health emergency messages, ranging from 2024–2828 characters per message, to meet the 160-character limitation for text delivery. Results were analyzed to determine associations between provider types, age ranges, gender, access to various media (text, email, fax, social media, etc.), and smart phone ownership.
The following components were most frequently selected as essential for a public health message: Topic, Recommendation, Geographic Location, Signs & Symptoms, Population Affected, and Link to Additional Information. There was no statistically significant association between message component selection and provider type, age ranges, or gender. In the message conversion exercise, we found a statistically significant association between providers who reported receiving information by SMS and/or smart phone ownership and including a link to additional information in the converted message, ranging from 61% to over 72% on a per message analysis.
A substantive recommendation derived from this study is that public health agencies include a link to additional website information when sending messages in SMS format. SMS could be a useful public health tool for communicating with health care providers but further investigation of how to effectively use SMS and other mobile technologies is needed to inform public health decisions regarding adoption of messaging systems utilizing these newer technologies.
PMCID: PMC4267116  PMID: 25113387
Communications; Emergency preparedness and response; Health care providers; Public health; Short message service; SMS; Text messaging
3.  Clinical Versus Public Health Perceptions of Notifiable Disease Reporting Burden 
PMCID: PMC4050821
Public health surveillance; Notifiable condition reporting; Qualitative methods; Public health informatics
4.  Technical Description of the Distribute Project: A Community-based Syndromic Surveillance System Implementation 
This paper describes the design of a syndromic surveillance system implemented for community-based monitoring of influenza-like illness. The system began as collaboration between colleagues from state and large metropolitan area health jurisdictions, academic institutions, and the non-profit, International Society for Disease Surveillance. Over the six influenza seasons from 2006 to 2012, the system was automated and enhanced, with new features and infrastructure, and the resulting, reliable, enterprise grade system supported peer comparisons between 44 state and local public health jurisdictions who voluntarily contributed summarized data on influenza-like illness and gastrointestinal syndromes. The system was unusual in that it addressed the needs of a widely distributed, voluntary, community engaged in real-time data integration to support operational public health.
PMCID: PMC3959914  PMID: 24678377
syndromic surveillance; secondary use of health data; Internet; public health standards; surveillance practice
5.  Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol 
Health information exchange (HIE) is the electronic sharing of data and information between clinical care and public health entities. Previous research has shown that using HIE to electronically report laboratory results to public health can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting. This article describes a study protocol that uses mixed methods to evaluate an intervention to electronically pre-populate provider-based notifiable disease case reporting forms with clinical, laboratory and patient data available through an operational HIE. The evaluation seeks to: (1) identify barriers and facilitators to implementation, adoption and utilization of the intervention; (2) measure impacts on workflow, provider awareness, and end-user satisfaction; and (3) describe the contextual factors that impact the effectiveness of the intervention within heterogeneous clinical settings and the HIE.
The intervention will be implemented over a staggered schedule in one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation will be conducted utilizing a concurrent design mixed methods framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention.
By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community.
PMCID: PMC3819468  PMID: 24171799
Evaluation; Health information exchange; Mixed methods; Public health reporting
6.  Public health communications and alert fatigue 
Health care providers play a significant role in large scale health emergency planning, detection, response, recovery and communication with the public. The effectiveness of health care providers in emergency preparedness and response roles depends, in part, on public health agencies communicating information in a way that maximizes the likelihood that the message is delivered, received, deemed credible and, when appropriate, acted on. However, during an emergency, health care providers can become inundated with alerts and advisories through numerous national, state, local and professional communication channels. We conducted an alert fatigue study as a sub-study of a larger randomized controlled trial which aimed to identify the most effective methods of communicating public health messages between public health agencies and providers. We report an analysis of the effects of public health message volume/frequency on recall of specific message content and effect of rate of message communications on health care provider alert fatigue.
Health care providers enrolled in the larger study (n=528) were randomized to receive public health messages via email, fax, short message service (SMS or cell phone text messaging) or to a control group that did not receive messages. For 12 months, study messages based on real events of public health significance were sent quarterly with follow-up telephone interviews regarding message receipt and topic recall conducted 5–10 days after the message delivery date. During a pandemic when numerous messages are sent, alert fatigue may impact ability to recall whether a specific message has been received due to the “noise” created by the higher number of messages. To determine the impact of “noise” when study messages were sent, we compared health care provider recall of the study message topic to the number of local public health messages sent to health care providers.
We calculated the mean number of messages that each provider received from local public health during the time period around each study message and provider recall of study message content. We found that recall rates were inversely proportional to the mean number of messages received per week: Every increase of one local public health message per week resulted in a statistically significant 41.2% decrease (p < 0.01), 95% CI [0.39, .87] in the odds of recalling the content of the study message.
To our knowledge, this is the first study to document the effects of alert fatigue on health care providers’ recall of information. Our results suggest that information delivered too frequently and/or repetitively through numerous communication channels may have a negative effect on the ability of health care providers to effectively recall emergency information. Keeping health care providers and other first-line responders informed during an emergency is critical. Better coordination between organizations disseminating alerts, advisories and other messages may improve the ability of health care providers to recall public health emergency messages, potentially impacting effective response to public health emergency messages.
PMCID: PMC3751004  PMID: 23915324
7.  Traditional and Mobile Public Health Alert Communications with Health Care Providers 
To systematically compare mobile (SMS) and traditional (email, FAX) communication strategies to identify which modality is most effective for communication of health alerts and advisories between public health agencies and health care providers in order to improve emergency preparedness and response.
The effectiveness of emergency preparedness and response systems depends, in part, on the effectiveness of communication between agencies and individuals involved in emergency response, including health care providers who play a significant role in planning, event detection, response and communication with the public. Although much attention has been paid to the importance of communicating clinical data from health care providers to public health agencies for purposes of early event detection and situational awareness (e.g., BioSense) and to the need for alerting health care providers of public health events (e.g., Health Alert Networks), no studies to date have systematically identified the most effective methods of communication between public health agencies and community health care providers for purposes of public health emergency preparedness and response.
The REACH (Rapid Emergency Alert Communication in Health) study is a 4-year randomized controlled trial to evaluate and compare the effectiveness of mobile (SMS) and traditional (email, FAX) communication strategies for sending public health messages to health care providers—physicians, pharmacists, nurse practitioners, physician’s assistants and veterinarians.
Providers were recruited from three sites (King County, WA; Spokane County, WA; and across the state of Montana; N=845) and randomized to receive time-sensitive public health messages via email, Fax, short message service (SMS) or to a control group that did not receive messages. For one year, alerts based on real events of public health interest were sent quarterly with follow-up telephone interviews conducted 5–10 days after the delivery date. Interviews consisted of approximately six questions that elicited information about message receipt, recall of its content and perceived credibility and trustworthiness of the message and source. In addition, provider access to online alert information and delivery success or failure was collected.
Frequency of receipt, timeliness, content awareness, perceived credibility and perceived trustworthiness were measured and compared across communication delivery systems. On average 84.0% of participants were contacted in each follow-up survey following all alerts and across all three sites. Primary data analysis was designed to measure differences between the three communication groups using intent-to-treat methods. A set of secondary analyses examined the outcomes excluding providers who could not have received messages (due to incorrect contact information, known technical failures, or because providers could not receive messages by the assigned delivery message—for example, a provider without a Fax number randomized to the Fax group).
We will discuss preliminary results of intent-to-treat analyses regarding rate of recall of study alert message content between traditional and mobile communications and perceived trustworthiness and credibility of message and message source by providers. In addition, we will report on frequency of accessing online alert information between traditional and mobile delivery groups.
There is currently no evidence-based research to guide or improve the practice of public health communication between public health agencies and health care providers before, during and after a public health emergency. Improving this communication via the use of effective media can enhance disease surveillance, which will aid in early detection and enhance case finding and situational awareness for public health emergencies. By systematically evaluating the relative effectiveness of mobile and traditional message delivery systems for emergency preparedness and response communications, the REACH study contributes to building the evidence base for novel and effective approaches to emergency communications.
PMCID: PMC3692770
Emergency Preparedness and Response; Public Health Communication; Surveillance and Alerting
8.  Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance 
Online Journal of Public Health Informatics  2012;4(3):ojphi.v4i3.4277.
Public health professionals engage in frequent exchange of health information while pursuing the objectives of protecting and improving population health. Yet, there has been little study of the information work of public health workers with regard to information exchange. Our objective was to gain a better understanding of information work at a local health jurisdiction before and during the early stages of participation in a regional Health Information Exchange.
We investigated the information work of public health workers engaged in disease surveillance activities at a medium-sized local health jurisdiction by conducting semi-structured interviews and thematically analyzing interview transcripts.
Analysis of the information work of public health workers revealed barriers in the following areas: information system usability; data timeliness, accuracy and completeness; and social interaction with clients. We illustrate these barriers by focusing on the work of epidemiologists.
Characterizing information work and barriers to information exchange for public health workers should be part of early system design efforts. A comprehensive understanding of the information practice of public health workers will inform the design of systems that better support public health work.
PMCID: PMC3615831  PMID: 23569649
Public Health Informatics; Public Health Practice; Disease Notification; Communication Barriers; Information Services; Health Information Technology
9.  Timeliness and Data Element Completeness of Immunization Data in Washington State in 2010: a Comparison of Data Exchange Methods 
Health information systems receive data through various methods. These data exchange methods have the potential to influence data quality. We assessed a de-identified 2010 dataset including 757,476 demographic records and 2,634,101 vaccination records from Washington State’s Immunization Information System (IIS) to describe timeliness and completeness of IIS data across several data exchange methods: manual entry, HL7, and flat file upload. Overall, manually-entered data and HL7 records were more timely than records imported as flat files. Completeness, though very high overall, was slightly higher for records arriving via flat file. Washington State IIS users, including clinicians and public health, rely on its data to inform patient care and determine population coverage of immunizations. Our results suggest that although data element completeness in systems like Washington’s IIS will likely not be immediately or significantly impacted by provider’s migration to HL7 connections with IISs, timeliness could be substantially improved when using HL7 connections.
PMCID: PMC3540489  PMID: 23304304
10.  Applying the XForms Standard to Public Health Case Reporting and Alerting 
Online Journal of Public Health Informatics  2011;3(2):ojphi.v3i2.3656.
Notifiable condition reporting and alerting are two important public health functions. Today, a variety of methods are used to transfer these types of information. The increasing use of electronic health record systems by healthcare providers makes new types of electronic communication possible. We used the XForms standard and nationally recognized technical profiles to demonstrate the communication of both notifiable condition reports and patient-tailored public health alerts. This demonstration of bi-directional communication took placein a prototypical health information exchange environment. We successfully transferred information between provider electronic health record systems and public health systems for notifiable condition reporting. Patient-specific alerts were successfully sent from public health to provider systems. In this paper we discuss the benefits of XForms, including the use of XML, advanced form controls, form initialization and reduction in scripting. We also review implementation challenges, the maturity of the technology and its suitability for use in public health.
PMCID: PMC3615786  PMID: 23569609
alerting; bi-directional communication; notifiable condition reporting; public health informatics; public health practice
11.  Perceived usefulness of a distributed community-based syndromic surveillance system: a pilot qualitative evaluation study 
BMC Research Notes  2011;4:187.
We conducted a pilot utility evaluation and information needs assessment of the Distribute Project at the 2010 Washington State Public Health Association (WSPHA) Joint Conference. Distribute is a distributed community-based syndromic surveillance system and network for detection of influenza-like illness (ILI). Using qualitative methods, we assessed the perceived usefulness of the Distribute system and explored areas for improvement. Nine state and local public health professionals participated in a focus group (n = 6) and in semi-structured interviews (n = 3). Field notes were taken, summarized and analyzed.
Several emergent themes that contribute to the perceived usefulness of system data and the Distribute system were identified: 1) Standardization: a common ILI syndrome definition; 2) Regional Comparability: views that support county-by-county comparisons of syndromic surveillance data; 3) Completeness: complete data for all expected data at a given time; 4) Coverage: data coverage of all jurisdictions in WA state; 5) Context: metadata incorporated into the views to provide context for graphed data; 6) Trusted Data: verification that information is valid and timely; and 7) Customization: the ability to customize views as necessary. As a result of the focus group, a new county level health jurisdiction expressed interest in contributing data to the Distribute system.
The resulting themes from this study can be used to guide future information design efforts for the Distribute system and other syndromic surveillance systems. In addition, this study demonstrates the benefits of conducting a low cost, qualitative evaluation at a professional conference.
PMCID: PMC3146436  PMID: 21672242
12.  Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review 
BMC Public Health  2011;11:337.
Health care providers (HCPs) play an important role in public health emergency preparedness and response (PHEPR) so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications.
A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1) What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2) Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3) What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs?
We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems.
We found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available are rarely evaluated in any systematic fashion. To meet present-day and future information needs for emergency preparedness, more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.
PMCID: PMC3121631  PMID: 21592390
13.  Reusable design: A proposed approach to Public Health Informatics system design 
BMC Public Health  2011;11:116.
Since it was first defined in 1995, Public Health Informatics (PHI) has become a recognized discipline, with a research agenda, defined domain-specific competencies and a specialized corpus of technical knowledge. Information systems form a cornerstone of PHI research and implementation, representing significant progress for the nascent field. However, PHI does not advocate or incorporate standard, domain-appropriate design methods for implementing public health information systems. Reusable design is generalized design advice that can be reused in a range of similar contexts. We propose that PHI create and reuse information design knowledge by taking a systems approach that incorporates design methods from the disciplines of Human-Computer Interaction, Interaction Design and other related disciplines.
Although PHI operates in a domain with unique characteristics, many design problems in public health correspond to classic design problems, suggesting that existing design methods and solution approaches are applicable to the design of public health information systems. Among the numerous methodological frameworks used in other disciplines, we identify scenario-based design and participatory design as two widely-employed methodologies that are appropriate for adoption as PHI standards. We make the case that these methods show promise to create reusable design knowledge in PHI.
We propose the formalization of a set of standard design methods within PHI that can be used to pursue a strategy of design knowledge creation and reuse for cost-effective, interoperable public health information systems. We suggest that all public health informaticians should be able to use these design methods and the methods should be incorporated into PHI training.
PMCID: PMC3053242  PMID: 21333000
14.  Accelerating Public Health Situational Awareness through Health Information Exchanges: An Annotated Bibliography 
Online Journal of Public Health Informatics  2010;2(2):ojphi.v2i2.3212.
In 2008, the Centers for Disease Control and Prevention awarded contracts to health information exchanges in Indiana, New York and Washington/Idaho to accelerate public health situational awareness. Awardees in each state have disseminated their findings and lessons at professional conferences and in peer-reviewed journals. The dissemination formats ranged from papers, oral presentations, posters, panels and demonstrations at interoperability showcases. With a focus on health information exchange and public health, topics included biosurveillance, electronic laboratory reporting, broadcast messaging, and notifiable disease surveillance. Each presentation is summarized in this bibliography, and the authors affiliated with each site are highlighted.
PMCID: PMC3615759  PMID: 23569582
biosurveillance; situational awareness; electronic laboratory reporting; health information exchange; notifiable diseases
15.  From the ground up: information needs of nurses in a rural public health department in Oregon 
The research identified and assessed information needs and resources of public health nurses in a local health department.
Semi-structured in-depth interviews were conducted with seventeen public health nurses at a local health department in rural Oregon. Interview transcripts were analyzed using a constant comparative method to assess the information nurses sought and used in their work.
Public health nurses performed a wide variety of roles and associated tasks. Major themes that emerged from analyses of interview transcripts included: (1) differences in information needs depending on position and role; (2) colleagues as the most efficient and trusted source of information; (3) limitations of existing knowledge-based resources; (4) need for up-to-date and pertinent information; and (5) need for personal computers, basic communications software, and expanded Internet access.
Lack of Internet access is a significant barrier to use of information resources, and information tools tailored to meet the needs diverse public health nursing roles and facilitate information sharing among colleagues are needed. Librarians and informaticians can assist by addressing these needs and improving the organization of content and interface design for commonly used websites.
PMCID: PMC2568844  PMID: 18974810
17.  A knowledgebase system to enhance scientific discovery: Telemakus 
With the rapid expansion of scientific research, the ability to effectively find or integrate new domain knowledge in the sciences is proving increasingly difficult. Efforts to improve and speed up scientific discovery are being explored on a number of fronts. However, much of this work is based on traditional search and retrieval approaches and the bibliographic citation presentation format remains unchanged.
Case study.
The Telemakus KnowledgeBase System provides flexible new tools for creating knowledgebases to facilitate retrieval and review of scientific research reports. In formalizing the representation of the research methods and results of scientific reports, Telemakus offers a potential strategy to enhance the scientific discovery process. While other research has demonstrated that aggregating and analyzing research findings across domains augments knowledge discovery, the Telemakus system is unique in combining document surrogates with interactive concept maps of linked relationships across groups of research reports.
Based on how scientists conduct research and read the literature, the Telemakus KnowledgeBase System brings together three innovations in analyzing, displaying and summarizing research reports across a domain: (1) research report schema, a document surrogate of extracted research methods and findings presented in a consistent and structured schema format which mimics the research process itself and provides a high-level surrogate to facilitate searching and rapid review of retrieved documents; (2) research findings, used to index the documents, allowing searchers to request, for example, research studies which have studied the relationship between neoplasms and vitamin E; and (3) visual exploration interface of linked relationships for interactive querying of research findings across the knowledgebase and graphical displays of what is known as well as, through gaps in the map, what is yet to be tested. The rationale and system architecture are described and plans for the future are discussed.
PMCID: PMC524025  PMID: 15507158
18.  Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study 
BMJ : British Medical Journal  2004;328(7449):1159.
Objective To describe the experiences of patients with type 2 diabetes in a web based disease management programme based on an interactive electronic medical record.
Design Qualitative analysis of semistructured interviews with patients enrolled in a diabetes care module that included access to their electronic medical record, secure email, ability to upload blood glucose readings, an education site with endorsed content, and an interactive online diary for entering exercise, diet, and medication.
Setting Patients' homes in Washington state, United States.
Participants Nine participants aged 45-65 completed interviews before and after they used the programme.
Results Six themes emerged: feeling that non-acute concerns are uniquely valued; enhanced sense of security about health and health care; frustration with unmet expectations; feeling more able to manage; valuing feedback; and difficulty fitting the programme into activities of daily life. Three themes—valuing non-acute concerns, feeling secure, and unmet expectations—have particular relevance to the design and use of web based tools for care of patients with diabetes and chronic medical conditions.
Conclusion Participants' experiences support further study of open access to the electronic medical record and online communication between patients and their care providers. The development of web based disease management programmes should take into account the specific needs and expectations of patients, and patients and providers should have candid discussions about what web based care can and cannot provide.
PMCID: PMC411089  PMID: 15142919
19.  A Two-way Messaging System to Enhance Antiretroviral Adherence 
Failure to adhere to complex antiretroviral regimens can lead to resistance and treatment failure among HIV-positive persons. In this study of the feasibility of an automated two-way messaging system to improve adherence, participants received multiple short daily messages designed to remind, educate, encourage adherence, and solicit responses concerning side effects and self-reported adherence. Twenty-five participants remained in the study for a median of 208 days, receiving 17,440 messages and replying to 14,677 (84%). Participants reported missing one or more doses on 36% of 743 queries and reported medication side effects on 26% of 729 queries. Participants expressed high satisfaction with the messaging system and reported that it helped with medication adherence. The study suggests that it is feasible to use an automated wireless two-way messaging system to communicate with HIV-positive patients over an extended period of time.
PMCID: PMC150355  PMID: 12509353
20.  Review of Computer-generated Outpatient Health Behavior Interventions 
Objective: To evaluate evidence of the effectiveness of computer-generated health behavior interventions—clinical encounters “in absentia”—as extensions of face-to-face patient care in an ambulatory setting.
Data Sources: Systematic electronic database and manual searches of multiple sources (1996–1999) plus search for gray literature were conducted to identify clinical trials using computer-generated health behavior interventions to motivate individuals to adopt treatment regimens, focusing on patient-interactive interventions and use of health behavior models.
Study Selection: Eligibility criteria included randomized controlled studies with some evidence of instrument reliability and validity; use of at least one patient-interactive targeted or tailored feedback, reminder, or educational intervention intended to influence or improve a stated health behavior; and an association between one intervention variable and a health behavior.
Data Extraction: Studies were described by delivery device (print, automated telephone, computer, and mobile communication) and intervention type (personalized, targeted, and tailored). We employed qualitative methods to analyze the retrieval set and explore the issue of patientinteractive computer-generated behavioral intervention systems.
Data Synthesis: Studies varied widely in methodology, quality, subject number, and characteristics, measurement of effects and health behavior focus. Of 37 eligible trials, 34 (91.9 percent) reported either statistically significant or improved outcomes. Fourteen studies used targeted interventions; 23 used tailored. Of the 14 targeted intervention studies, 13 (92.9 percent) reported improved outcomes. Of the 23 tailored intervention studies, 21 (91.3 percent) reported improved outcomes.
Conclusions: The literature indicates that computer-generated health behavior interventions are effective. While there is evidence that tailored interventions can more positively affect health behavior change than can targeted, personalized or generic interventions, there is little research comparing different tailoring protocols with one another. Only those studies using print and telephone devices reported a theoretic basis for their methodology. Future studies need to identify which models are best suited to which health behavior, whether certain delivery devices are more appropriate for different health behaviors, and how ambulatory care can benefit from patients' use of portable devices.
PMCID: PMC134592  PMID: 11141513
22.  Implementation of a Phase I Clinical Information Tool Using Contextual Inquiry Outcomes 
The Primeanswers Project has developed a phase I web-based information tool, based on the findings from a contextual inquiry, to deliver clinically relevant information to primary care providers at University of Washington. Key design features are selection of best available resources and reduction of the number of steps needed to obtain answers. The ultimate goal is to achieve a seamless single integrated system that is incorporated into clinical work practice.
PMCID: PMC2243625

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