About this Issue

This issue of the Health Risk Communicator is dedicated to communicating the role of interactive technologies in health risk communication. The articles provide useful information on current and ongoing agency interactive health risk communication programs, activities, and outcomes. 

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Panel Identifies Strategies and Tools to Improve Quality of Interactive Health Communication

Cynthia Baur, Ph.D., Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services 

The panel defines IHC as "the interaction of an individual ... with or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue." IHC applications can have a variety of functions, many of which can be combined as part of the same application. For example, this type of communication can be used to relay health information on demand; enable informed decision making; promote healthy behaviors, peer information exchange and emotional support, and selfcare; and manage the demand for health services. Some of the benefits of IHC include improved access to individualized health information and support on demand; more choices of health information products; greater confidentiality for users who seek sensitive information; greater ability to promote interaction and social support among users and between consumers and health professionals; and enhanced ability to provide widespread dissemination and immediate updates. 

However, IHC also has the potential to cause harm. IHC applications may direct people to inappropriate treatment, cause them to delay seeking care, or be in error. Also, patients may come to rely more on IHC than their own physicians, which may cause mistrust and conflict in the physician-patient relationship. IHC use may cause violations of privacy because many applications require personal information that may not be kept confidential and secure. Lastly, without equitable access to technology, IHC may create greater inequities in access to services and information. 

IHC applications should be required to undergo formative, process, and outcome evaluations according to the Science Panel. The key evaluation criteria are (1) accuracy of content, including currency and validity of information; (2) appropriateness of content, including applicability and intelligibility to the user; (3) usability, which is how easily the user can get the application to perform as intended; (4) maintainability, which refers to explicit plans to implement and accomplish changes as content and users change; (5) impartiality, including disclosure of funding sources and the background, training, and philosophy of developers; and (6) efficacy and effectiveness, to measure if the application has its intended impact. 

The four strategies that the Panel identified encompass multiple recommendations focused on application development and evaluation. The first strategy, to strengthen evaluation and quality of applications, recommends that purchasers demand that developers integrate evaluation in product development and implementation as a condition of purchase. Developers should also disclose all relevant information about the application and its development process so that purchasers can make informed choices. Developers should also adopt voluntary quality standards, and those who rate IHC applications should include information about evaluation results. 

The second strategy, to improve basic knowledge and understanding of IHC, focuses on the building of a consensus research agenda and an infrastructure to support research, evaluation, and policy- making. The Panel recommends that the public and private sectors should establish a formal process to identify knowledge gaps and priority areas for research, development, and demonstration projects. One way to support priority initiatives and maximize resources is to coordinate federal and state funding in IHC. Knowledge and understanding of IHC would also be improved if the public and private sectors committed to a long-term initiative to monitor and assess the health, economic, and social impact of IHC. Monitoring and analyzing trends in IHC would also help to improve policymaking in this area, particularly in the area of privacy, confidentiality, and security of IHC-related information.

The third strategy, to enhance capacity of stakeholders to develop and use IHC, comprises several action steps, including the development of a clearinghouse for public domain materials that can be used in IHC development; the fostering of academic-industry partnerships to facilitate technology transfer and support those developers committed to the quality agenda; improvement of the public's scientific and technical literacy so that they can make critical judgements about IHC quality; training of health professionals to promote the integration of IHC with clinical practice; and modeling of organizational and financial factors that are relevant to IHC development and use.

The final strategy, to ensure equitable access to IHC for all populations, aims to improve public and professional access to the IHC applications most relevant to their needs. In addition to having greater access to the technologies themselves, the public, as well as health professionals, need more information about which applications are appropriate and high quality. Development of IHC applications that may be relevant to specific populations, instead of mass audiences, should be supported to ensure that all needs are being addressed. 

Wired for Health and Well-Being contains several tools to help stakeholders make decisions about IHC quality. Two tools—the evaluation reporting template and the disclosure statement—are to help them communicate the results of evaluations of IHC applications to others who are considering purchasing or using an application. The evaluation reporting template contains more than 30 questions or requests for information to learn more about how an application was developed and how it works. The disclosure statement condenses the evaluation reporting template to quickly communicate to users core information about an application. There are evaluation checklists for purchasers and consumers to help identify those applications that are compatible with their needs and to assist them in the interpretation of evaluation results, as well as several suggestions for clinicians to encourage them to develop an "information-friendly" practice. The report's bibliography provides numerous examples of existing IHC applications. Mary Jo Deering, Ph.D., Director of Health Communication and Telehealth, ODPHP, observes, "We have found a lot of support in the public and private sectors for the message that the quality and effectiveness of IHC and health resources on the Web need to be evaluated. ODPHP will continue to promote the quality standards agenda and work with stakeholders to develop consensus criteria for quality." 

For more information about the Science Panel's report or quality standards for IHC, contact Cynthia Baur, PhD at ODPHP, HHS, 200 Independence Avenue, SW, 738G, Washington, D.C. 20201; telephone (202) 205-2311; fax (202) 205-0463; email cbaur@osophs.dhhs.gov. 
 

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NASA Launches Global Interactive Health Communication Initiative

Catherine M. Angotti, RD, LD, National Aeronautics and Space Administration 

The OLMSA initiative also sought to promote the concept that NASA's delivery of health care represented a seamless continuum from the ground, through the atmosphere, into space. The resulting videoteleconference series (ViTS) shares and enhances health care through multicultural continuing education by building more effective communication links. We also believe that these efforts will support the goal of external accreditation and recognition of NASA's health care delivery systems.

Since the summer 1997, OHA has produced five ViTS workshop series. The series presented include: Occupational Health Policies, Programs and Research in the United States- A Federal Perspective; Public Health Policies, Programs and Research in the U.S. Department of Agriculture Federal Perspective; An Overview of Public Health Policies, Programs and Research in Seven Foreign Countries and Their Comparison to the United States; Overview of Bioethics in the United States and Select Countries; and Health Surveillance/Maintenance in the Workplace-Perspectives in the United States and Selected Countries. The selected countries include Russia, France, Canada, Germany, China, Japan, and India. A total of 59 domestic and international speakers have lectured in 25 sessions to an audience of physicians, nurses, other health care professionals, and the interested public. OLMSA's Associate Administrator, Arnauld Nicogossian, MD concludes each series with a cultural/social/economic vision for narrowing international health care disparities.

The NASA ViTS series connects live seminars to international partners at the Institute for Biomedical Problems in Russia, the European Institute of Telemedicine in Toulouse France, NASA's 14 Field Centers and its Commercial Space Center for Medical Informatics and Applied Technology at the Medical College of Virginia, USUHS, and the Health Sciences Center at West Virginia University. Through Internet technology applications utilizing the multicast/MBONE (Multicast Back Bone) systems, interested parties across the globe, who own a computer, can view the series at their desktop by using the Universal Resources Locator, https://extranet.hq.nasa.gov/multicast/. NASA is also developing video-on-demand capability for viewing published seminar proceedings and videotaped sessions on the OLMSA web site, http://www.hq.nasa.gov/office/olmsa/.

Even though the Multicast System uses a broader bandwidth, it is still one-way transmission prohibiting real-time interaction by the connected sites. Future plans include establishing an e-mail address at NASA Headquarters' ViTS Center, from which the majority of speakers broadcast, for the purpose of receiving questions from desktop viewers. The final series in 1999 will address emerging diseases including infectious diseases. A ViTS series is already planned for 2000 covering such topics as aging and hearing conservation.

For more information about NASA's International Health Education Initiative, contact Ms. Catherine Angotti, NASA, Office of Health Affairs, 300 E. Street SW, Mail Code UH, Washington, D.C. 20546; telephone (202) 358-1794; fax (202) 358-3038; e-mail cangotti@hq.nasa.gov. 
 

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NASA's Occupational Health Website Racks Up Awards

Catherine M. Angotti, RD, LD, National Aeronautics and Space Administration 

The new website has received awards for its professionalism, technical presentations, and hot links to other websites. The Hardin MD Clean Bill of Health Award was presented to NASA for the "best of the best" site that has a hot link connection rate of at least 93 percent.  Also, the website is designated as a HealthLinks Select Site and has been added to the HealthLinks directory. This designation is a result of the high interest from health care professionals, the sites excellence in tone and presentation, and the professionalism of the site's structure, graphic design, and high level of integrity and credibility. NASA's OHP website has also been added to the Medinex directory and awarded the Medinex Seal of Approval for medical and health sites that abide by the Medinex Code of Ethics. 

Most recently, the website was chosen as a Top Rated Website on the MedExplorer and is listed in the Top Rated section for Government sites based on its usefulness, content, design, speed, and ability to meet the needs of the targeted audience. Log on to the OHP website for information on NASA's Agency Safety Initiative and specific information on selected Administrator topics such as skin cancer prevention and lightning safety. For more information on this award-winning OHP website contact Ms. Catherine Angotti, NASA, Office of Health Affairs, 300 E. Street SW, Mail Code UH, Washington D.C.  20546; telephone (202) 358-1794; fax (202) 358-3038; e-mail cangotti@hq.nasa.gov.