Page 58 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

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One participant said that while the approaches taken by the VA and
Harlem are different, they are related, and it is important to determine
which outcomes are desired by the different systems. It appears that VA
is looking at the more traditional outcomes such as utilization of services.
What outcomes is the Harlem project looking for?
Kukafka responded that the HHPC project is conducting a cohort
study with the entire user base to look at such things as changes in atti-
tudes, beliefs, the way the site is used, the extent to which different func-
tions of the system are used, and if the experts are being downloaded or
used more than the community generated material. Whether or not the
outcomes can be examined depends on funding.
In response, the same questioner said that it appears that HHPC has
recognized culture, language, and trust as large barriers and is attempt-
ing to design a system to inform users and so address those barriers. That
is incredibly important, but it also raises such questions as whether it
would be better to have a large number of people who engage in discus-
sions about flu shots or to have a higher rate of flu vaccination. How can
one handle such issues? Kukafka responded that it is hoped that if there
is a great deal of discourse around flu vaccination, then flu vaccinations
would increase. If that does not happen, however, then it will be impor-
tant to examine the discourse in detail, in order to determine what it was
about and why it did not lead to increased vaccinations. Ultimately, the
HHPC project is looking for both process and outcome measures. Under-
standing the process better should identify issues and barriers where new
interventions need to be developed, which would then, one hopes, lead
to improved outcomes.
One participant said that he was intrigued by the juxtaposition of two
approaches—one related to the Harlem project and the other related to the
VA. A great deal of research has demonstrated that the VA is incredibly
effective in eliminating or reducing health disparities and their approach
is very innovative, despite the fact that their population is elderly and has,
perhaps, low literacy. What is the VA doing that makes it so effective, that
results in it getting 15,000 hits a day?
Nazi responded that the VA has taken a very comprehensive strategy—
not just enacting technology, but also implementing technology in a way
that reaches people where they are. Knowing that veterans may not have
access to a computer, the VA made sure that computers were placed in
every medical center for use by veterans. Data show that while veterans
access their personal health record they are also accessing the health
education libraries. The most downloaded document on the site is a PDF
called 5 Steps For Safer Health Care.
Offering value also means offering such programs as online prescrip-
tion refills, which was of more importance to veterans than any other

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