Review Conference Scene For reprint orders, please contact: [email protected]
2014
Opportunities and challenges of using technology to address health disparities
Brian M Rivers*,1,2, Jay M Bernhardt3, Linda Fleisher4 & Bernard Lee Green1,2
6th American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved Atlanta, GA, USA, 6–9 December 2013.
9
2
2 1 7 /
uture
nges of health
ture , UK
During a panel presentation at the American Association for Cancer Research Cancer Health Disparities Conference titled ‘Opportunities and challenges of using technology to address health disparities’, the latest scientific advances in the application and utilization of mobile technology and/or mobile-health (mHealth) interventions to address cancer health disparities were discussed. The session included: an examination of overall population trends in the uptake of technology and the potential of addressing health disparities through such media; an exploration of the conceptual issues and challenges in the construction of mHealth interventions to address disparate and underserved populations; and a presentation of pilot study findings on the acceptability and feasibility of using mHealth interventions to address prostate cancer disparities among African–American men. The 6th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved was held in Atlanta (GA, USA) in December 2013. The mission of AACR, the world’s oldest and largest professional organization, is to prevent and cure cancer through research, education, communication and collaboration. The conference was supported through partnerships with Susan G Komen, the National Cancer Institute Center to Reduce Cancer Health Disparities and the Minorities in Cancer Research Council of the AACR. This conference provided attendees with a venue to discuss cancer health disparities, including differences in the incidence, prevalence, mortality and burden of cancer, and related adverse health conditions that exist among specific population groups in the USA [1] , in the context of the varied levels of basic, population, clinical and transdisciplinary research. The conference brought together scientists, professionals and health advocates working in a variety of disciplines to discuss the latest findings in the field, to foster interdisciplinary interactions, and to stimulate the development of new research in cancer health disparities. The conference was organized
Keywords
• African–American men • cancer health disparities • community-based
participatory research
• health communication • health disparities • health education • health promotion • mobile health • mobile technology • prostate cancer disparities
MRC-CANCONT, Moffitt Cancer Canter & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA Center for Equal Health, a NIH-NIMHD P20 Center of Excellence, University of South Florida & Moffitt Cancer Center & Research Institute, Tampa, FL, USA 3 Center for Digital Health & Wellness, University of Florida, Gainesville, FL, USA 4 Children’s Hospital of Philadelphia, Philadelphia, PA, USA 5 Fox Chase Cancer Center, Cheltenham, PA, USA *Author for correspondence: Tel.: +1 813 745 6448; Fax: +1 813 745 6525; [email protected] 1 2
10.2217/FON.14.17 © 2014 Future Medicine Ltd
Future Oncol. (2014) 10(4), 519–522
part of
ISSN 1479-6694
519
Conference Scene Rivers, Bernhardt, Fleisher & Green by the Scientific Planning Committee, which consisted of three cochairpersons and a 14-member Program Committee. Over 300 abstracts were received and reviewed by the Scientific Review Committee for consideration of either podium or poster presentations. The conference presentations focused on recent developments in basic science, clinical research, population science and behavioral research. Four educational sessions provided updates on tools, techniques and resources for disparities research, and scientific updates were provided through plenary sessions, concurrent sessions and special sessions. The topics presented in the first plenary session, titled ‘Opportunities and challenges of using technology to address health disparities’, are discussed in greater detail below. Can mobile bridge the digital divide? Cell phones and mobile technologies are now used by more than 90% of adults in the USA and the rates continue to increase [2] . Smartphones, such as iPhones and Android-based phones, now represent the majority of new phones sold and more than half of all phones currently being used in the USA [3] . Unlike ‘feature phones’ that may only allow users to make and receive calls and text messages, smartphones are powerful mobile computers with many advanced features. Smartphone users perform many interactive and/or internetbased activities on their devices, such as sending or receiving text messages, accessing the internet, sending or receiving email, downloading application programs (apps), using maps or locationbased services, listening to music, watching videos and participating in a video call or chat [3] . Although African–American (A A) and Spanish-speaking Latino individuals report lower levels of home broadband access and home computer internet use than white individuals [4] , AA and English-speaking Latino individuals are more likely to own a mobile phone than white individuals and more likely to use their phone for internet and interactive activities such as text messaging, accessing the internet, recording and watching videos, and accessing social media [5] . As a result of widespread use of mobile technologies among minorities, traditionally ‘hard to reach’ populations are now reachable with mobile health (mHealth) interventions. mHealth interventions can leverage the diverse technological features of the mobile device to deliver interventions that are highly interactive, personalized, easily accessible and culturally appropriate. Unfortunately, limited research has been conducted to date on the
520
Future Oncol. (2014) 10(4)
application and evaluation of mHealth technologies with minority populations to assess its feasibility and impact on health behaviors and outcomes. Exploring mHealth from a health communications lens: best practice considerations Given that technologies such as smart phones are mechanisms to disseminate and exchange information, as well as to motivate and educate, it is important to consider how this information is developed, constructed and delivered to ensure that it is understandable and can be acted on [6] . There are three issues to consider: health literacy, language and community engagement. Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services they need to make appropriate health decisions” [7,8] . In 2003, the National Assessment of Adult Literacy found that 43% of adults in the USA have either basic or below basic health literacy skills [9] . The problem of low health literacy is a crisis that affects everyone, but there are particular groups that bear a disproportionate burden: older people, nonwhite individuals, immigrants, nonhigh school graduates and those with low socioeconomic status [9] . Given this trend, it is clear that mHealth interventions need to be developed using best practice strategies to present information in ways that are understandable to each intended audience. Effective mHealth interventions take place within an ecological context [10] and those models may be different for racially and linguistically diverse populations in the USA. Thus, it is important to understand the needs of target audiences in the development and delivery of these interventions. Stakeholder and community involvement should inform development through the implementation phases of mHealth interventions and can help ensure that the interventions are relevant and meaningful [11,12] . Through a systematic process addressing design elements, user testing, content development and evaluation approaches, mHealth interventions can be appropriately developed. Acceptability & usability of an mHealth intervention to address prostate cancer disparities: a community-based participatory approach Recent advances in mobile technologies have transformed the way we communicate and obtain
future science group
Opportunities & challenges of using technology to address health disparities information. These technological advances present a tremendous opportunity to impact cancer health disparities. A commonly known cancer health disparity is the disproportionate impact of prostate cancer on AA men in the USA, who experience a 60% higher incidence and 2.4-times-higher death rate than their white counterparts [13] . Utilization of mHealth interventions, such as apps delivered via mobile tablet technology, provide the ability to standardize the message received through community-based education [14] in nonclinical settings. However, research is needed to determine whether AA men are receptive to utilizing mobile tablet technology to receive health education and health promotion messaging, and secondarily whether they would be amenable to messaging via an app. In a two-phased, community-based study to assess the acceptability and feasibility of an mHealth intervention to address prostate cancer disparities, investigators surveyed 152 AA men to evaluate the acceptability of using mobile tablet technology, specifically an iPad. An acceptability score was computed for each participant and independent-sample t-tests were conducted to assess the role of income, marital status and education. The results indicate the majority (91%) of the participants would accept the use of mobile tablet technology. Education (p = 0.01) and income (p = 0.048) significantly impacted participants’ acceptance of mobile tablet technology; however, marital status and age did not have a significant influence. Subsequently, 53 AA adults, 30 males and 23 females were surveyed to evaluate the usability of a Knowledge Model on Prostate Cancer delivered via an app on a mobile tablet. Participants agreed that the application was easy to use (91%) and navigate (76%); participants felt comfortable using the References 1
2
3
4
National Cancer Institute. Center to Reduce Cancer Health Disparities. http://crchd.cancer.gov/disparities/defined. html Pew Internet and American Life Project (2013). Trend Data (Adults), Adult gadget ownership over time. www.pewinternet.org/Trend-Data-(Adults)/ Device-Ownership.aspx
5
Smith A (2013). Smartphone ownership: 2013 update. Pew Research Center’s Internet and American Life Project. http://pewinternet.org/Reports/2013/ Smartphone-Ownership-2013.aspx
6
future science group
Conference Scene
app (88%), reported ease to see and read text on the tablet screen (85%) and felt comfortable with the format of the app (79%). Concluding remarks Although health disparities remain a significant public health challenge in the USA, particularly related to cancer prevention and treatment outcomes, the widespread access and utilization of mobile technologies offer a new and powerful strategy for reaching and engaging with diverse and underserved populations with technologically advanced and personally tailored health interventions. Early research indicates that mobile technologies may be accessible, feasible and essential tools for reducing health disparities. However, the technology needs to be developed based on evidence and health communications best practices to ensure that it is designed and deployed to address the unique needs of at-risk populations. More research and program evaluation are needed to demonstrate efficacy and expand our understanding of best practices in this constantly evolving arena. Without attention to audience preferences and characteristics, including health literacy and linkage to communitybased resources and structures, these mHealth interventions may not fulfil their promise. Financial & competing interests disclosure This study was funded by the National Institute on Minority Health and Health Disparities, NIH (3P20MD00337502S1). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. Smith A (2010). Technology Trends Among People of Color. Pew Research Center’s Internet and American Life Project. www.pewinternet.org/Commentary/2010/ Septmebre/Technology-Trends-AmongPeople-of-Color.aspx Smith A (2010). Mobile Access 2010. Pew Research Center’s Internet & American Life Project. www.pewinternet.org/Reports/2010/ Mobile-Access-2010/Part-2.aspx Chou WY, Hunt YM, Beckjord EB, Moser RP Heese BW. Social media use in the United States: implications for health communication. J. Med. Int. Res. 11(4), e48 (2009).
7
Institute of Medicine of the National Academies. Health Literacy: a Prescription to End Confusion. The National Academies Press, Washington, DC, USA (2004).
8
Healthy People 2010: Understanding and Improving Health. US Department of Health and Human Services, Washington, DC, USA (2003).
9
Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: a First Look at the Findings of the National Adult Literacy Survey. US Department of Education, Washington, DC, USA (1993).
10 Green L, Kreuter M. Health Promotion
Planning: an Educational and Ecological
www.futuremedicine.com
521
Conference Scene Rivers, Bernhardt, Fleisher & Green Approach (4th Edition). McGraw-Hill, OH, USA (2004). 11 Minkler M, Wallerstein N, Wilson N.
Improving health through community organization and community building. In: Health Behavior and Health Education: Theory, Research and Practice. Glanz K, Rimer
522
BK, Viswanath K (Eds). John Wiley & Sons Inc., NY, USA (2008). 12 CDC. Principles of Community Engagement
(Second Edition). Public Health Practice Program Office, GA, USA (1997). 13 American Cancer Society. Cancer Facts &
Figures for African Americans 2013–2014.
Future Oncol. (2014) 10(4)
American Cancer Society, GA, USA (2013). 14 Witmer A, Seifer SD, Finocchio L, Leslie J,
O’Neil EH. Community health workers: integral members of the health care work force. Am. J. Public Health 85, 1055–1058 (1995).
future science group
2014
Opportunities and challenges of using technology to address health disparities
Brian M Rivers*,1,2, Jay M Bernhardt3, Linda Fleisher4 & Bernard Lee Green1,2
6th American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved Atlanta, GA, USA, 6–9 December 2013.
9
2
2 1 7 /
uture
nges of health
ture , UK
During a panel presentation at the American Association for Cancer Research Cancer Health Disparities Conference titled ‘Opportunities and challenges of using technology to address health disparities’, the latest scientific advances in the application and utilization of mobile technology and/or mobile-health (mHealth) interventions to address cancer health disparities were discussed. The session included: an examination of overall population trends in the uptake of technology and the potential of addressing health disparities through such media; an exploration of the conceptual issues and challenges in the construction of mHealth interventions to address disparate and underserved populations; and a presentation of pilot study findings on the acceptability and feasibility of using mHealth interventions to address prostate cancer disparities among African–American men. The 6th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved was held in Atlanta (GA, USA) in December 2013. The mission of AACR, the world’s oldest and largest professional organization, is to prevent and cure cancer through research, education, communication and collaboration. The conference was supported through partnerships with Susan G Komen, the National Cancer Institute Center to Reduce Cancer Health Disparities and the Minorities in Cancer Research Council of the AACR. This conference provided attendees with a venue to discuss cancer health disparities, including differences in the incidence, prevalence, mortality and burden of cancer, and related adverse health conditions that exist among specific population groups in the USA [1] , in the context of the varied levels of basic, population, clinical and transdisciplinary research. The conference brought together scientists, professionals and health advocates working in a variety of disciplines to discuss the latest findings in the field, to foster interdisciplinary interactions, and to stimulate the development of new research in cancer health disparities. The conference was organized
Keywords
• African–American men • cancer health disparities • community-based
participatory research
• health communication • health disparities • health education • health promotion • mobile health • mobile technology • prostate cancer disparities
MRC-CANCONT, Moffitt Cancer Canter & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA Center for Equal Health, a NIH-NIMHD P20 Center of Excellence, University of South Florida & Moffitt Cancer Center & Research Institute, Tampa, FL, USA 3 Center for Digital Health & Wellness, University of Florida, Gainesville, FL, USA 4 Children’s Hospital of Philadelphia, Philadelphia, PA, USA 5 Fox Chase Cancer Center, Cheltenham, PA, USA *Author for correspondence: Tel.: +1 813 745 6448; Fax: +1 813 745 6525; [email protected] 1 2
10.2217/FON.14.17 © 2014 Future Medicine Ltd
Future Oncol. (2014) 10(4), 519–522
part of
ISSN 1479-6694
519
Conference Scene Rivers, Bernhardt, Fleisher & Green by the Scientific Planning Committee, which consisted of three cochairpersons and a 14-member Program Committee. Over 300 abstracts were received and reviewed by the Scientific Review Committee for consideration of either podium or poster presentations. The conference presentations focused on recent developments in basic science, clinical research, population science and behavioral research. Four educational sessions provided updates on tools, techniques and resources for disparities research, and scientific updates were provided through plenary sessions, concurrent sessions and special sessions. The topics presented in the first plenary session, titled ‘Opportunities and challenges of using technology to address health disparities’, are discussed in greater detail below. Can mobile bridge the digital divide? Cell phones and mobile technologies are now used by more than 90% of adults in the USA and the rates continue to increase [2] . Smartphones, such as iPhones and Android-based phones, now represent the majority of new phones sold and more than half of all phones currently being used in the USA [3] . Unlike ‘feature phones’ that may only allow users to make and receive calls and text messages, smartphones are powerful mobile computers with many advanced features. Smartphone users perform many interactive and/or internetbased activities on their devices, such as sending or receiving text messages, accessing the internet, sending or receiving email, downloading application programs (apps), using maps or locationbased services, listening to music, watching videos and participating in a video call or chat [3] . Although African–American (A A) and Spanish-speaking Latino individuals report lower levels of home broadband access and home computer internet use than white individuals [4] , AA and English-speaking Latino individuals are more likely to own a mobile phone than white individuals and more likely to use their phone for internet and interactive activities such as text messaging, accessing the internet, recording and watching videos, and accessing social media [5] . As a result of widespread use of mobile technologies among minorities, traditionally ‘hard to reach’ populations are now reachable with mobile health (mHealth) interventions. mHealth interventions can leverage the diverse technological features of the mobile device to deliver interventions that are highly interactive, personalized, easily accessible and culturally appropriate. Unfortunately, limited research has been conducted to date on the
520
Future Oncol. (2014) 10(4)
application and evaluation of mHealth technologies with minority populations to assess its feasibility and impact on health behaviors and outcomes. Exploring mHealth from a health communications lens: best practice considerations Given that technologies such as smart phones are mechanisms to disseminate and exchange information, as well as to motivate and educate, it is important to consider how this information is developed, constructed and delivered to ensure that it is understandable and can be acted on [6] . There are three issues to consider: health literacy, language and community engagement. Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services they need to make appropriate health decisions” [7,8] . In 2003, the National Assessment of Adult Literacy found that 43% of adults in the USA have either basic or below basic health literacy skills [9] . The problem of low health literacy is a crisis that affects everyone, but there are particular groups that bear a disproportionate burden: older people, nonwhite individuals, immigrants, nonhigh school graduates and those with low socioeconomic status [9] . Given this trend, it is clear that mHealth interventions need to be developed using best practice strategies to present information in ways that are understandable to each intended audience. Effective mHealth interventions take place within an ecological context [10] and those models may be different for racially and linguistically diverse populations in the USA. Thus, it is important to understand the needs of target audiences in the development and delivery of these interventions. Stakeholder and community involvement should inform development through the implementation phases of mHealth interventions and can help ensure that the interventions are relevant and meaningful [11,12] . Through a systematic process addressing design elements, user testing, content development and evaluation approaches, mHealth interventions can be appropriately developed. Acceptability & usability of an mHealth intervention to address prostate cancer disparities: a community-based participatory approach Recent advances in mobile technologies have transformed the way we communicate and obtain
future science group
Opportunities & challenges of using technology to address health disparities information. These technological advances present a tremendous opportunity to impact cancer health disparities. A commonly known cancer health disparity is the disproportionate impact of prostate cancer on AA men in the USA, who experience a 60% higher incidence and 2.4-times-higher death rate than their white counterparts [13] . Utilization of mHealth interventions, such as apps delivered via mobile tablet technology, provide the ability to standardize the message received through community-based education [14] in nonclinical settings. However, research is needed to determine whether AA men are receptive to utilizing mobile tablet technology to receive health education and health promotion messaging, and secondarily whether they would be amenable to messaging via an app. In a two-phased, community-based study to assess the acceptability and feasibility of an mHealth intervention to address prostate cancer disparities, investigators surveyed 152 AA men to evaluate the acceptability of using mobile tablet technology, specifically an iPad. An acceptability score was computed for each participant and independent-sample t-tests were conducted to assess the role of income, marital status and education. The results indicate the majority (91%) of the participants would accept the use of mobile tablet technology. Education (p = 0.01) and income (p = 0.048) significantly impacted participants’ acceptance of mobile tablet technology; however, marital status and age did not have a significant influence. Subsequently, 53 AA adults, 30 males and 23 females were surveyed to evaluate the usability of a Knowledge Model on Prostate Cancer delivered via an app on a mobile tablet. Participants agreed that the application was easy to use (91%) and navigate (76%); participants felt comfortable using the References 1
2
3
4
National Cancer Institute. Center to Reduce Cancer Health Disparities. http://crchd.cancer.gov/disparities/defined. html Pew Internet and American Life Project (2013). Trend Data (Adults), Adult gadget ownership over time. www.pewinternet.org/Trend-Data-(Adults)/ Device-Ownership.aspx
5
Smith A (2013). Smartphone ownership: 2013 update. Pew Research Center’s Internet and American Life Project. http://pewinternet.org/Reports/2013/ Smartphone-Ownership-2013.aspx
6
future science group
Conference Scene
app (88%), reported ease to see and read text on the tablet screen (85%) and felt comfortable with the format of the app (79%). Concluding remarks Although health disparities remain a significant public health challenge in the USA, particularly related to cancer prevention and treatment outcomes, the widespread access and utilization of mobile technologies offer a new and powerful strategy for reaching and engaging with diverse and underserved populations with technologically advanced and personally tailored health interventions. Early research indicates that mobile technologies may be accessible, feasible and essential tools for reducing health disparities. However, the technology needs to be developed based on evidence and health communications best practices to ensure that it is designed and deployed to address the unique needs of at-risk populations. More research and program evaluation are needed to demonstrate efficacy and expand our understanding of best practices in this constantly evolving arena. Without attention to audience preferences and characteristics, including health literacy and linkage to communitybased resources and structures, these mHealth interventions may not fulfil their promise. Financial & competing interests disclosure This study was funded by the National Institute on Minority Health and Health Disparities, NIH (3P20MD00337502S1). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. Smith A (2010). Technology Trends Among People of Color. Pew Research Center’s Internet and American Life Project. www.pewinternet.org/Commentary/2010/ Septmebre/Technology-Trends-AmongPeople-of-Color.aspx Smith A (2010). Mobile Access 2010. Pew Research Center’s Internet & American Life Project. www.pewinternet.org/Reports/2010/ Mobile-Access-2010/Part-2.aspx Chou WY, Hunt YM, Beckjord EB, Moser RP Heese BW. Social media use in the United States: implications for health communication. J. Med. Int. Res. 11(4), e48 (2009).
7
Institute of Medicine of the National Academies. Health Literacy: a Prescription to End Confusion. The National Academies Press, Washington, DC, USA (2004).
8
Healthy People 2010: Understanding and Improving Health. US Department of Health and Human Services, Washington, DC, USA (2003).
9
Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: a First Look at the Findings of the National Adult Literacy Survey. US Department of Education, Washington, DC, USA (1993).
10 Green L, Kreuter M. Health Promotion
Planning: an Educational and Ecological
www.futuremedicine.com
521
Conference Scene Rivers, Bernhardt, Fleisher & Green Approach (4th Edition). McGraw-Hill, OH, USA (2004). 11 Minkler M, Wallerstein N, Wilson N.
Improving health through community organization and community building. In: Health Behavior and Health Education: Theory, Research and Practice. Glanz K, Rimer
522
BK, Viswanath K (Eds). John Wiley & Sons Inc., NY, USA (2008). 12 CDC. Principles of Community Engagement
(Second Edition). Public Health Practice Program Office, GA, USA (1997). 13 American Cancer Society. Cancer Facts &
Figures for African Americans 2013–2014.
Future Oncol. (2014) 10(4)
American Cancer Society, GA, USA (2013). 14 Witmer A, Seifer SD, Finocchio L, Leslie J,
O’Neil EH. Community health workers: integral members of the health care work force. Am. J. Public Health 85, 1055–1058 (1995).
future science group
