citizens and ict for health in 14 eu countries: results from an
TRANSCRIPT
www.jrc.ec.europa.eu
Serving societyStimulating innovationSupporting legislation
11
9 November 2012
Citizens and ICT for Health in 14 EU countries: results from an online panel
survey
Disclaimer: "The views expressed in this presentation are purely those of the authors and may not in any circumstances be regarded as stating an official position of the European Commission“
Elena Villalba, Francisco Lupiañez, Ioannis Maghiros - JRC – IPTS, IS Unit
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Objectives
• To develop typologies of digital healthcare users and measure the impact of ICT and the Internet on health status, health care demand and health management.
• To identify factors that can enhance or inhibit the role and use of Personal Health Systems from citizens' perspective with special emphasis on mHealth, RMT, disease management, Telecare, Telemedicine, Wellness.
• To obtain evidence-based knowledge on the citizens’ needs and expectations.
Analysing the demand side
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From theoretical framework and empirical evidence to policy-making
1. Define and contextualise the theoretical framework for policy-making
2. Design and gather relevant information grounded within robust and consolidate theoretical framework to support policy-making
3. Multivariate statistical analysis to find underlying dimensions: from questionnaire items to concept
4. Identify key relationships between concepts to understand ICT for Health as a complex ecosystem
5. Policy lessons
Steps
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1. Define and contextualise the theoretical framework for policy-making
5World Health Organization., A conceptual framework for action on the social determinants of health.
Discussion Paper Series on Social Determinants of Health,. 2010, Geneva: World Health Organization. 76 p.
Social determinants of Health
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Divides
Motivational
Material
Skills
Usage
Social determinants of Health
Social determinants of ICT
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Social determinants of Health
+
Social determinants of ICT
=
Social determinants of ICT for Health
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Health Information Sources
Trust
AwarenessMaterialSkillsUsage
ICT for Health READINESSEvaluationUsefulnessLearningSocial life
ICT for Health ASSESSMENT
Health care Demand
Health Management
Health care Quality ICT for Health IMPACT
Individual uses
Social uses
BARRIERSEMPOWERMENTTRIGGERS
ICT for Health MOTIVATION
MotivationMaterialSkillsUsage
ICT ACCESS
Social cohesion &
Social capital
Distribution of Health
and well-being
Material circumstancesPsychosocial factorsBehaviourBiological factors
Intermediarydeterminants
Health System
Technological properties of ICT (hardware, software, content)
Social determinants of IC
T for Health
SOCIOECONOMIC AND POLITICAL CONTEXT
Personal categories- Age/generation- Sex/gender- Race/ethnicity- Intelligence- Personality- HEALTH/ABILITY
Positional categories- Labor- Education- Household- Nation
Structural determinants
Willingness to use ICTfor Health
ICT FOR HEALTH ACCESS
PARTICIPATORY HEALTH
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2. Design and gather relevant information grounded within robust and consolidate theoretical framework
to support policy-making
METHODS
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Methods
• Block A: Health status and health care and social care services use
• Block B: ICT for Health Motivation and Health Information sources
• Block C: ICT Access
• Block D: ICT for Health Readiness and Impact Evaluation
• Block E: Socio demographic profile of participants
Questionnaire Design
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Methods Data collection
PopulationCitizens aged from 16 to 74 years old who have used the Internet in the last
three months.
Scope of
countries
Austria, Belgium, Germany, Denmark, Estonia, Finland, France, Italy,
Netherlands, Sweden, Slovenia, Slovakia, Spain, United Kingdom
Type of survey Online
Sample size1,000 interviews per country.
14,000 interviews in total.
Quotas
Country
Gender (Female/Male)
Age Group (16-24/ 25-54/ 55-74)
Sampling error
+0.85% for overall data and +3.16% for country-specific data. In all cases, a
maximum indeterminate probability (p=q=50), for a confidence level of 95.5%
is applicable for each one of the reference populations
WeightingProportional allocation for each country.
Weighting by country to be able to interpret the overall data.
Sampling Individuals have been sampled in a completely random manner.
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Methods Data collection
The fieldwork period ran from 20 July 2011 to 20 August 2011. Three consecutive launches were established from the outset:
1. The first launch took place in the United Kingdom (20.7.11) and Spain (21.7.11), which were the countries in which the pilot study took place.
2. Secondly, and after having checked that no significant incidences existed, the launch went ahead in France and Italy on 26.7.11.
3. Finally, a joint launch was to take place in the remaining countries on 29.7.11. Delays occurred in Finland (launched on 1.8.11), Slovenia (3.8.11) and Slovakia (4.8.11) due to issues with the optimisation of the questionnaire translations.
The fieldwork process included a pilot study to check the validity and reliability of the research design and the questionnaire.
Field work process
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Methods
Data analysis
Statistical analyses were performed using SPSS version 19.0 following three steps:
1. Descriptive statistical analysis. This analysis includes frequencies of all items and cross tabulation with socio-demographics and health status. To attribute statistical significance to the differences obtained an associated Chi-square test was carried out.
2. Factor analysis was used to identify common relationships between similar items, allowing the items to be categorized into various factors (dimensions). An analysis of the correlation matrix (KMO and Bartlett’s test of sphericity) was carried out to check that the correlation matrixes were factorable.
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Methods
2. Data reductions were undertaken by principal components analysis using the Varimax option to identify possible underlying dimensions. Factors identified reveal a pattern of correlations within a set of observed variables related to the main blocks of our conceptual framework.
3. ANOVA test and correlations were carried out to identify the relationship among the dimensions previously identified and to characterise different typologies of users, behaviours, motivations. To attribute statistical significance to the differences obtained associated tests were carried out.
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3. Statistical analysis to find underlying dimensions: from questionnaire results to concepts
RESULTS
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HEALTH STATUS AND HEALTH SERVICESSOCIODEMOGRAPHICS
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Demographics
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Health Status
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Health Status
Health care and social care services use (mean of visits)
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ICT ACCESS
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ICT access
Basic uses
Individual uses - eComm
Tech uses
Social – Web 2.0 uses
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ICT FOR HEALTH MOTIVATION(TRIGGERS, EMPOWERMENT AND BARRIERS)
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Social & Services oriented
Individual-oriented
ICT for Health Usage Triggers
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Empowerment, broadly understood as thedevelopment of personal involvement and responsibility
Assuming responsibility is a more active form of control
“Competence” refers to aptitudes or qualities that make it possible to be more autonomous and take a role in decision-making
One of the goals of prevention, promotion and protection in health campaigns across the world for several years
Perspectives of personal empowerment seem to coexist with respect toHealth
• an aptitude to comply with expert advice (professional perspective)• self-reliance through individual choice (consumer perspective)• social inclusion through the development of collective support (community perspective)
ICT for Health Access - Empowerment
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Competence oriented
Control oriented
Empowerment
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Empowerment
Control oriented
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Barriers
Lack of confidence
Lack of readiness
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ICT FOR HEALTH READINESS (USAGE), WILLINGNESS AND IMPACT
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ICT for Health Readiness
Information and Communication
Usage
Awareness
Skills
Willingness
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Services and DevicesUsage
Awareness
Skills
Willingness
ICT for Health Readiness
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Web 2.0 uses
Internet Health
Information
Assuming that you were provided the possibility, state how likely it is that you would do the following during the next year?
ICT for Health WILLINGNESS
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Services and Devices
Assuming that you were provided the possibility, state how likely it is that you would do the following during the next year?
ICT for Health WILLINGNESS
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Qua
lity
of c
are
and
Hea
lthy
beha
vior
sH
ealth
car
eac
cess
ICT for Health Impact
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4. Identify key relationships between concepts to understand ICT for Health as a complex ecosystem
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Health care Demand
Health Management
Health care Quality
Health Information Sources Trust
Tech usesSocial uses - Web 2.0
Individual uses - eComBasic uses
ICT USAGE
Usefulness - LearningSocial life
ICT for Health IMPACT
PARTICIPATORY HEALTH
Information & CommunicationServices & Devices
Willingness to use ICT for Health
ICT for Health MOTIVATION
ICT for Health ASSESSMENT
Personal categories- Age/generation- Sex/gender- Race/ethnicity- Intelligence- Personality- HEALTH/ABILITY
Positional categories- Labor- Education- Household- Nation
Material circumstancesSocial CohesionPsychosocial factorsBehaviourBiological factors
SOCIOECONOMIC AND POLITICAL CONTEXT
Distribution of Health
and well-being
Intermediarydeterminants
Structural determinants
Health System
ICT FOR HEALTH ACCESS
Social cohesion &
Social capital
Technological properties of ICT (hardware, software, content)
A1 – A2 – A3
A4 – A5 – A6 – A7 – A8
A11-A12
E1E2
E5E7
E9,E10,E11,E12
Traditional sourcesHealth professionalsSocial media sources
InstitutionalCompanies
Information and professional Interaction and organisation
TriggersIndividual oriented
Social & Services oriented
EmpowermentCompetences
Control
BarriersLack of confidenceLack of readiness
Internet Health information useServices & devices use
Web 2.0 uses
Quality of care & healthy behavioursHealth care access
Individual usesSocial uses
ICT for Health USAGE
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Tech usesWeb 2.0
Basic uses
Individual uses
ICT Readiness ICT for Health Usage
Services &devices
Information & Communication
++
+
++
+
+
+
+
++++
+
Quality &
Healthy behavior
Healthcare access
ICT for Health Impact
-
ICT for Health Triggers
Social & Servicesoriented
Individual oriented
Competenceoriented
Controloriented
Empowerment
MOTIVATION
Confidence
Readiness
Barriers+
+
++
Stru
ctur
al
dete
rmin
ants
Inte
rmed
iary
de
term
inan
ts
Health System
++
Health problems
Social determinants of ICT for Health
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SOCIAL ENGAGEMENT
BEYOND INFORMATION
FOSTERING ADVANCE USES
ICT for Health Willingness and Age
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CURE, CARE ANDINDEPENDENT LIVING
HEALTH PREVENTION AND
PROMOTION AS SERVICES
ICT for Health Impact and Age
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Cor
rela
tion
ICT
usag
es/ #
Hea
lthpr
oble
ms
Yes – No / Chronic illness reported
ICT for Health Usage and Chronic
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# IC
T fo
rHea
lthac
tiviti
es(m
ean)
ICT for Health Skills and Age
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5. Conclusions – Policy lessons
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High potential of ICT for Health to promote active and healthy individuals and increase empowerment.
• Even though our findings are related with Internet users, it is worth pointing out that new health inequalities are emerging due to the impact of the "traditional determinants of health" on ICT readiness.
• These ICT for Health divides specially impact on the elderly. This also could be an opportunity to engage them within Information Society through ICT for Health
• eInclusion policies related with ICT for Health are needed to ensure that individuals with low socio-economic status and worse health status are able to benefit from these types of technologies.
Conclusions
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The different typologies of ICT Access and ICT for Health Motivation, Readiness and Impact (life events)
• Young individuals are already using this type of technologies mostly related to wellness and healthy live style. These uses enable an entire world of possibilities related with health promotion and prevention as a services, specially considering that young individuals are heavy Web 2.0 users.
• Middle age individuals are also active users of ICT for Health acting as gatekeepers of this type of technologies within the household. Therefore these individuals could act as enablers for others, both the elderly and the youth within the households.
• The elderly are basically using ICT for Health for information and communication purposes. There is a gap between this type of uses and services and devices uses with could be more effective in relation with cure and chronic conditions.
Conclusions
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Chronic conditions
• Young and middle age individuals with chronic conditions; undergoing long-term treat and with more than one health problem are more likely to use ICT for Health than individuals without these type of health problems. Health status as a driver for these periods of life.
• Healthier elderly are more likely to utilise ICT for Health, specially Information and Communication, than non healthy elderly.
• This group of individuals will be pushing in the short term health systems to provide them with new solutions (services and devices) when they will tackle a health problem.
• This pressure will be increased during the next decade when middle age individuals will become elderly.
Conclusions
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Ready for new users’ typologies? Short and middle term?• Organisations• Professionals• Health policy and planning
New ICT for Health inequalities? Opportunity to include the elderly within Information Society?
ICT for Health along life?• Prevention and Promotion• Care and Cure• Independent living
Challenges
4646
9 November 2012
Citizens and ICT for Health in 14 EU countries: results from an online panel
survey
Disclaimer: "The views expressed in this presentation are purely those of the authors and may not in any circumstances be regarded as stating an official position of the European Commission“
Thank you Questions?