Consumer Consumer HealthHealthIntroduction and Consumer Health Introduction and Consumer Health IssuesIssuesDr. Ebtisam FetohyDr. Ebtisam FetohyCHS 488-lecture 4CHS 488-lecture 4

Healthy People 2010-2020

Health Communication

Health professional-patient relations

Individuals’ exposure to, search for, and use of health information

Individuals’ adherence to clinical recommendations

Construction of public health messages & campaigns

Dissemination of individual & population health risk information

Images of health in the mass media and the culture at large

Education of consumers about how to gain access to health care systems

Develop telehealth applicationsتطبيقات

Healthy People 2010-2020

Effective Health Communication

Accuracy Availabilityتوفر Balance Consistency Cultural competence

Evidence base Reach Reliability Repetition Timeliness Understandability

Healthy People in Healthy Communities

Educate and empower individuals and families to adopt healthy behaviors and lifestyles

Educate consumers to make informed health and health care decisions, and

Build community capacity to improve health.

Issues

Misleading Information Quackeryالدجل and Health Fraudاحتيال Problems with Products Problems with Services Problems with Costs The Need for Consumer Protection Intelligent Consumer Behavior

Consumer health Consumer health encompassesencompasses تحيط- تحيط-تشمل all aspects all aspects تشملof the marketplace related to the of the marketplace related to the purchasepurchase of:

A. Health products and

B. Services.

Although health care in America is potentially the Although health care in America is potentially the world's best, many problems exist:world's best, many problems exist:

A. Health information is voluminous and complex.

B. Many practitioners fall short يخفقون of the ideal, and

C. some are completely unqualified. Quackery .is widespread الدجل

D. The marketplace is overcrowded with products, many of which are questionable.

E. Rising costs and lack of adequate insurance coverage have reached crisis levels.

F. Consumer protection is limited.

Only well-informed individuals can Only well-informed individuals can master the complexity of the health master the complexity of the health

marketplace. marketplace. Intelligent consumers:Intelligent consumers: Maintain a healthy lifestyle,

Seek reliable sources of information and care, and

Avoid products and practices that lack scientific substantiation إثبات.

Issue1Issue1

Misleading InformationMisleading Information High volume and complex Media influence

Radio & TVMagazines & newspapers

FunctionsEntertain, تسلInform, Carry advertisements andMake money

News, commentary News, commentary تعليقتعليق & talk & talk showsshows الحوار الحوار برامج برامج

Issues and TrendsIssues and Trends The environment for communicating The environment for communicating

about health has changed significantly. about health has changed significantly. These changes include:These changes include:

1. Dramatic increases in the number of communication channels and the number of health issues vyingمنافس for public attention as well as.

2. Consumer demands for more and better quality health information, and

3.3. The increased sophisticationThe increased sophisticationتطورتطور of of marketing and sales techniques, marketing and sales techniques, such as:such as:

A. Direct-to-consumer advertising of prescription drugs and

B. Sales of medical devices and medications over the Internet

The expansion of communication The expansion of communication channels and health issues on the channels and health issues on the public agenda increases competition public agenda increases competition for:for:

A.A. People’s timePeople’s time and

B.B. AttentionAttention; at the same time,

C.C. PeoplePeople have more opportunities to select information based on their personal interests and preferences.

The trend toward commercialization of The trend toward commercialization of the Internet suggests that the marketing the Internet suggests that the marketing

model of other mass media will be model of other mass media will be applied to emerging media, which has applied to emerging media, which has important consequences for the ability important consequences for the ability

of::

A. Noncommercial and

B. Public health-oriented health communications to stand out in a

cluttered health information environment.

Issue 2Issue 2

Quackery and Health FraudQuackery and Health Fraud DefinitionsDefinitions• QuackeryQuackeryالدجلالدجل : Promotion of a false or unproven

method for profit• FraudFraud االحتيال involves deceit.خداع How it is done

Slogansشعارات & buzzwords الكلمات المشهورة

Make people feel their in controlمسيطرنهم Characteristics of Victims

Issue 3Issue 3

Problems with ProductsProblems with Products

Supplements Herbs Mail Order products Devices, audio& video tapes Exercise equipment

Issue 4Issue 4

Problems with ServicesProblems with Services Clinical careClinical care

OverprescribeUnnecessary surgeryWork to fast

Nutritionists& weight loss counselors “Alternative” practitioners Health facility services

Issue 5Issue 5

Problems with Costs (individual)Problems with Costs (individual) Cost of health care Waste Controlling Costs Insurance Prevention vs. Health CarePrevention vs. Health Care

Effectiveness

Evaluating Health Education Programs - 2 Year ResultsEvaluating Health Education Programs - 2 Year Results

Hypothesized RelationshipsKoreen Johannessen CLSW, U of Arizona.

Media

Presentationsin Classes Awareness Weeks,

Health Fairsمعارض Classes

in Halls, etc.

Stakeholders(Pres., VPs, Deans,

Directors)

Policies

Knowledge

Attitudes &Perceptions

Behaviors

Possible Relationships

Evaluating Health Education Programs - 2 Year Results

Effect Size RelationshipsKoreen Johannessen CLSW, U of Arizona.

Media

Presentationsin Classes

Awareness Weeks,Health FairsClasses

in Halls, etc.

Stakeholders(Pres., VPs, Deans, Directors)

Policies

Knowledge

Attitudes &Perceptions

Weak RelationshipsStrong Relationships - U of A and Social Norms by Haines 5 Yr

Behaviors

Issue 6Issue 6

Problems with Costs (health care)Problems with Costs (health care)

Issue 7Issue 7

Need for Consumer ProtectionNeed for Consumer Protection

Let the buyer beware Protective Forces:Protective Forces:

Federal, stateAccreditation التفويض- االعتمادInsuranceHospitalsProfessional organizations

Issue 7Issue 7

Intelligent Consumer BehaviorIntelligent Consumer Behavior Seek reliable sources of information Maintain a healthy lifestyle Select practitioners with care Assess own health Active health & illness management Use scientifically substantiated مثبتhealth products

and services Understand costs of health and illness Report fraudاالحتيال

SummarySummary

All aspects of the marketplaceHealth informationThe well-informed consumer

Thank youThank you

Separating Fact from Separating Fact from FictionFictionالخيالالخيال

Lecture 5Lecture 5

By By

Dr. Ebtisam FetohyDr. Ebtisam Fetohy

IssuesIssues Misleading InformationMisleading Information Quackery الدجل and Health

Fraudاالحتيال Problems with Products Problems with Services Problems with Costs The Need for Consumer Protection Intelligent Consumer BehaviorIntelligent Consumer Behavior

Issue1Issue1Misleading InformationMisleading Information

High volume and complex Media influenceMedia influence

Radio & TVMagazines & newspapers

FunctionsFunctionsEntertain, Inform, Carry advertisements and Make money

Issue 7Issue 7

Intelligent Consumer BehaviorIntelligent Consumer Behavior

Seek reliable sources of information Maintain a healthy lifestyle Select practitioners with care Assess own health Active health & illness management Use scientifically substantiated health products

and services Understand costs of health and illness Report fraud االحتيال

Key PointsKey Points

How facts are determined Selecting internet sites Magazines and periodicals النشرات الدورية

Healthy People 2020Healthy People 2020

Effective Health CommunicationEffective Health Communication

Accuracyالدقة Availability Balance Consistencyاالتساق Cultural

competenceالقدرة

Evidence base قاعدة دليل

Reach Reliabilityالثقة Repetition Timeliness Understandability

How Facts are DeterminedHow Facts are Determined

Research Basicsاساسيات Survey Research Experimental تجريبي and

Observational مالحظاتي Research Secondary Research

1. 1. Research BasicsResearch Basics

A.A. Types of StudiesTypes of StudiesA. Exploratoryاستطالعي as focus

groups

B. Descriptiveوصفي C. Causal سببيD. Predictive تنبؤي

B. The Research Process

C. Primary vs. Secondary Data

B. Research ProcessB. Research Process

Define the problem Deciding on the type of data to collect Determining through what means وسائلthe data

will be obtained Planning for the collection of data (selection of a

sample) Collecting and analyzing the data Drawing conclusions and reporting the findings

C. Primary vs. Secondary DataC. Primary vs. Secondary Data

Primary data are those generated by the researcher

Secondary data are those generated by someone else for some other purpose.

2.2. Survey ResearchSurvey Research

Types of Surveys Mail or internetMail or internet– usually accompanied by a cover letter and

postage-paid envelope. Letter should be, briefbrief, readable, explain who is doing the studyexplain who is doing the study. Should contain information on how information will be kept confidential and informed consent informed consent process.process.

Personal InterviewPersonal Interview – personal getting information in a “purposeful conversation.” This is an expensive process compared to mail or internet surveys.

Telephone interviewTelephone interview – good for getting information about what a person is doing at the time of the call. Like product using or food eating.

2. Survey Research/22. Survey Research/2

B. B. Questionnaire Questionnaire استفتاءاستفتاءDesign– 3 types: Design– 3 types:

1.1. Multiple choiceMultiple choice,

2.2. DichotomousDichotomous (2 choices) with sometime “don’t know” or no opinion),

3.3. Open endedOpen ended where respondent can expand on the subject of the question

The Sampling Process Errors in Survey Research

3. Experimental and Observational 3. Experimental and Observational ResearchResearch

ExperimentationExperimentation Identify cause and effect relationships Internal validityالصالحية External validity

Observational Research Experimental Research Experimental Research ('true scientific research')('true scientific research')

is that which tests causal relationships by observing the behavior

of the subject under conditions where some variables are

controlled and others manipulated.

Experimental Research Experimental Research ('true ('true scientific research')scientific research')

The classic format for an experiment is, according to LoBiondo-Wood and Haber (1994): Random Assignment to groups:Random Assignment to groups:

Experimental Group » Pre-test » Experimental Treatment »Post-test

Control Group » Pre-test » » » Post-test By definition, experimental research is always

quantitative.

Internal ValidityInternal Validity

Is the approximateتقريبي truth about inferencesاالستدالالت regarding cause-effect or causal relationships.

Thus, internal validity is only relevant in studies that try to establish a causal relationship.

It's not relevant in most observational or descriptive studies, for instance المثال سبيل . على

But for studies that assess the effects of social programs or interventions, as Health Education, internal validity is perhaps the primary consideration

External ValidityExternal Validity

The extent to which research results may be generalized to other populations and settings. E.g.: would reduction in smoking from 54% to 42% in Norway from 1974 to 1984 results of a tobacco ad ban be similar in the US or Britain as those found in Norway

ObservationalObservational researchresearch – relies on watching or listening, then counting or measuring. There are no respondentsمستجيبون

4.Secondary Research (Data)4.Secondary Research (Data)

Internal Sources External Sources Evaluating Secondary Data

Healthy People 2020Healthy People 2020

Objective 11-4 (Developmental)Objective 11-4 (Developmental) Increase the proportion of health-related Web sites

that disclose تكشف information that can be used to assess the quality of the site. Developers المطورون & sponsorsضامنون Purpose of siteOriginal sources of contentPrivacy & confidentiality of personal information

collectedHow content is updatedHow site is evaluated

Rating Media:Rating Media:accurateaccurateدقيقدقيق , appropriate, reliable, , appropriate, reliable, potentpotent فعالفعال (AARP)(AARP)

Where the information comes from Whether the information checks out How old the information is Whether the information soundsتبدو "too

good to be true." Whether the site is telling you to do

something.

Rating MediaRating MediaHealth on the Net (HON code)Health on the Net (HON code)

Authority Complementarityتكميلية Confidentiality Attribution التنسيب Justifiable

Honesty in advertising policy

Authorship التأليف

Rating Media

Quality Information ChecklistQuality Information Checklist

Is it clear who has written the information? Are the aims of the site clear? Does the site achieve its aims? Is the site relevant to me? Can the information be checked? When was the site produced? Is the information biased in any way? Does the site tell you about choices open to you?

Rating MediaRating MediaScience Panel Science Panel المستشارين المستشارين هيئة on on هيئةInteractive Communication and HealthInteractive Communication and Health

Background of SponsorsBackground of Sponsors PurposePurpose ContentContent ConfidentialityConfidentiality DesignDesign Evaluation Results & EffectivenessEvaluation Results & Effectiveness

Rating MediaRating MediaTufts University Nutrition NavigatorTufts University Nutrition Navigator

I. ContentI. ContentNutrition Accuracy (1-10)Depth of Nutrition information (1-7)Site last updated (1-3)

II. UsabilityII. UsabilityUser experience (1-5)

I. Content:I. Content:

1.1. Nutrition AccuracyNutrition Accuracy (1-10) has two parts: (1-10) has two parts: a. Evaluates the scientific accuracy of empirical a. Evaluates the scientific accuracy of empirical تجريبيةتجريبية datadata,

how well the information is referenced and if the information is current (1-5)

b. Assesses how information is placed in the context of generally accepted dietary advice, looking closely at any conclusionsconclusions the site may draw and any guidanceguidance it may provide.

Also evaluates how well the site provides a balanced coverage of nutrition issues, particularly those that are complex and multifaceted. األوجه (5-1 )متعددة

I. Content:/2I. Content:/2

Because accuracy is so important: Because accuracy is so important: If a site receives an accuracy score of 6 points or less, the

site is automatically rated "Not Recommended" If the site receives an accuracy score of 7, it cannot receive

an overall rating higher than "Average" 2. Depth of Nutrition information (1-7):

evaluates the depth (amount) of nutrition information provided relative to entire site content, and how well the site's objectives are met

3.Site last updatedSite last updated (1-3): (1-3): rates whether the site has been updated within past month (3), within past 4 months (2) or longer than 4 months or no information is given on updates (1)updates (1)

II. UsabilityII. Usability

User experienceUser experience (1-5): (1-5): assesses the site's use of: Effective and clear navigation tools, Accessibility وصولof information, Download time and timeliness of information

Popular Magazines and Health& Popular Magazines and Health& Nutrition PeriodicalsNutrition Periodicals

AmericanAmerican CouncilCouncil المجلسالمجلس onon ScienceScience andand HealthHealthProvision of factualواقعية informationObjective presentation of informationPresentation of sound صحيحة nutritional

recommendations ExcellentExcellent

Cooking LightParentsLadies’ Home Journal

Popular Magazines and Health & Popular Magazines and Health & Nutrition PeriodicalsNutrition Periodicals

GoodGoodBetter Homes and GardensGood HousekeepingConsumer ReportsConsumer ReportsReader's DigestRedbookWoman's Day, Glamourالبهجة , Self, Health,

Runner's World, Prevention, Shape, and Fitness

Popular Magazines and Health & Popular Magazines and Health & Nutrition PeriodicalsNutrition Periodicals

FairFairCosmopolitanعالمي Men’s Health

PoorPoorMen’s FitnessMuscle and Fitness

Dr. Barrett’sDr. Barrett’sNot RecommendedNot Recommended

Untrustworthy موثوق because غير Promoteيروج misinformationمضللة Espouse يربط unscientific theories Contain unsubstantiated مؤكدة advice, and/or fail to غير

distinguish between reliableموثوقة and unreliable sources of advice

Additional informationAdditional information (*) also carry ads for questionable products, services,

and/or publications (**) have been accompanied by questionable

solicitationsنداءات .

Dr. Barrett’sDr. Barrett’sNot RecommendedNot Recommended

Consumer Reports on Health FDA Consumer Focus on Alternative and Complementary Therapies

(FACT) National Council Against Health Fraud News The Scientific Review of Alternative Medicine The Scientific Review of Mental Health Practice Skeptical شكاك Briefs Tufts University Health & Nutrition Letter

SummarySummary

How facts are determined Selecting internet sites Magazines and periodicals