Student-Friendly Health Information Portals
Woods, Shannon Lee
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Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: Studies show that health information portals that include online information and interventions are successful at increasing health promotion and disease prevention activities among university students. A literature search finds the major themes related to the use of online resources are internet use, importance to user, access motivates action, interactive components, and the internet/portal as an adjunct to other healthcare resources (Cugelman, Thelwall, & Dawes, 2011; Davies, Morriss, & Glazebrook, 2014; Fraeyman, Van Royen, Vriesacker, De Mey, & Van Hal, 2012; Kattelmann et al., 2014; Lau et al., 2012; Percheski & Hargittai, 2011; Skar, Sniehott, Molloy, Prestwich, & Araugo-Soares, 2011). Use of the internet has risen as availability has increased. Students tend to use the internet as one of the main sources to obtain health related information (Percheski & Hargittai, 2011). Portals and web-based interventions are most successful if the content is geared to the user and considered personally related to the user's goals. Development of online interventions are found to be most efficacious if they are related to consequences of behavior, help in personal goal achievement, skill set learning, and normative pressure (Cugelman et al., 2011). These findings are similar to those by other authors which showed that alignment of health goals is important in implementation of web-based interventions. Knowing the health concerns of the population of interest is important in designing portals. Areas showing the greatest health concerns for students include tobacco use/abuse, alcohol and illicit drug use/abuse, sexual health and behaviors, dietary patterns, mental health, and physical activity (Kattelmann et al., 2014; Skar et al., 2011). Students report these healthcare concerns motivate them and/or are a part of their goals for change in health promotion and disease prevention activities. Thus the use of portals is one way that nurses can reach and potentially impact a greater number of individuals. This impact is population-based with a larger number of individuals able to access healthcare, point-of-care service without travel and transportation restrictions, and cost effective in manpower hours for the healthcare field. The literature is in agreement that online interventions have a place in the delivery of the healthcare needs of a changing society and are cost-effective in doing so (Clayton, Chin, Blackburn, & Echeverria, 2010; Cugelman et al., 2011; Davies et al., 2014; Fraeyman et al., 2012; Lau et al., 2012; Skar et al., 2011; Soleimanpour, Geirerstanger, Kaller, McCarter, & Brindis, 2010). Portals encourage students to access care through self-help behaviors. Self-help behavior is an acquired skill, and online interventions can provide empowerment and increase decision-making capabilities. Studies show that through online information students are more willing to take steps to access healthcare or seek out information from healthcare providers (Kattelemann et al., 2014; Lau et al., 2012). The ability to use technology in web-based health applications and personalize the interactions is an advantage of portals. Interactive components are shown to increase student motivation and participation in healthcare endeavors online (Cugelman et al., 2011; Davies, et al., 2014). Examples of interactive components are online streaming graphics, videos, interactive activities, and music. Other interactive interventions include fully automated chat rooms, 'ask the expert' online services, and role model videos that relate to individual characteristics gleaned from the interactive components of the website. Recommendations are made that online interventions should be used but in combination with other healthcare resources (Cugelman et al., 2011; Kattelman et al., 2014; Percheski & Hargittai, 2011). In a technologically advancing world, the loss of face-to-face evaluation and communication is not considered to be in the best interest of those seeking healthcare. Both online intervention and traditional avenues of care can work together for positive outcomes (Cugelman et al., 2011; Kattelmann et al., 2014). More studies will need to search the avenues of long-term change interventions and adherence within the online environment. With the recent advances in technology and delivery of interventions using technology longitudinal studies will add to the discussion. The modalities of online delivery are varied but show consensus in what constitutes a successful intervention. These include the identified five key themes mentioned above and this constitutes the guide for development of the portal in conjunction with the health concerns of the target population. Agreement is reached by the majority that online interventions can effect change and encourage empowerment of health related actions with university students. In order to institute valid and reliable online health resources it is recommended that The National Libraries of Medicine (2014) online evaluation criteria be used. The criteria include accuracy, authority, bias/objectivity, currency/timeliness, and coverage. To institute a portal a search for health information took place. After evaluation of the available information using the criteria mentioned Microsoft Word was used to develop each individual page along with Uniform Resource Locators (URLs) to guide the development within the web-based portal. The literature review guided the development in order to make the portal of importance to the student population. Interactive components and graphic design that was part of the literature review recommended 'best practices' for development were also used. Links to valid and reliable outside resources that were more in-depth were also included to enhance the availability of health information. The project manager (author) worked with the webmaster to upload and deploy the portal page-by-page. Prior to going 'live,' representatives from the administrative team, faculty, staff, and students trialed the site and provided feedback. The individuals trialing the site provided positive and supportive responses with minor revisions recommended. These revisions were made based upon the feedback and the portal went 'live' following fall break 2015. Marketing occurred to garner interest in the portal. Emails, ecards, flyers, business cards with quick response codes (QRCs), scrolling screen applications throughout campus, classroom visits, and presentations to faculty senate were used. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. Influenza and influenza vaccination portal webpages were added in order to determine an increase in knowledge based upon the portal. An Influenza Survey obtained and modified for use with permission from the Centers for Disease Control and Prevention (CDC, 2012), was used for demographic and influenza knowledge and activity information. The survey has been used in data extraction and publication for numerous years thus providing a valid, reliable, sensitive, and precise instrument. The post-survey used the test-retest method and further questions, beyond influenza and vaccination, were added regarding the online information and portal. The questions regarding online interventions were found in public domain (University of Virginia, 2015) and have been used in two previous research studies. Quasi-experimental design will be used to measure influenza vaccination uptake from pre to post portal intervention, along with knowledge increase/decrease in the ability to correctly answer questions regarding influenza and vaccination. Responses on use of the portal and its value in changed behavior and actions will be rated using the post-survey Likert scale data. In addition, tracking of the number of 'views' (times accessed) of each informative page and the influenza portal took place and continue to be tallied on a weekly basis with the assistance of the webmaster. These numbers in comparison to overall access to the entire university website will be compared to determine interest and use of the portal for sustainability. This evidence-implementation project is ongoing with a target completion date of April 2016. To date the pre-survey has been administered and the post-survey is in the process of being administered. The qualitative feedback within the surveys and from personal interactions with the students, faculty, and staff at the university show a positive response to the health information portal. The current number of 'views' of the portal webpages has shown that they are some of the most viewed, upwards of 70% per day, within the university website. This project shows that technology, in the form of online portals, can be used as an adjunct to nursing practice in the promotion of health and prevention of disease. Lessons learned are that online health information has a place in helping nurses teach and disseminate information on healthy behaviors. Healthcare providers who work with and have interaction with students can assist by educating on reliable information. Translational evidence-based methods could use the constructs discussed as a way to develop resources for many different populations based upon their needs. The increasing use of social media is a strong force that should be used for the delivery of health information that benefits all people. The value of real time access to health advice can promote self-efficacy and the resulting improvement in health outcomes will have far-reaching implications to nursing and the quality of care provided.