Partnership with Native American Communities on Health Information Technology

Transcription

1 Partnership with Native American Communities on Health Information Technology Institute of Medicine March 24, 2015 Katherine Kim, PhD, MPH, MBA Assistant Professor 1

2 Outline Structural health disparities and digital divide Landscape of health technology efforts in Native American communities Opportunities for research and development 2

3 Structural health disparities and digital divide 3.7 M American Indian/Alaska Native people Indian Health Service serves 2.2 M Life expectancy 4.2 years less All cause mortality 1.2 times higher Indian Health Service Jan

4 Structural health disparities and digital divide Home Internet 96% for richest to 25% for poorest Home Broadband 69% of Asian Americans to 30% of Native Americans Different Uses for Broadband Users Rich and dynamic content News Job Seeking Blogging School Access 37% more students per Internet connected computer for high minority schools Warschauer

5 Landscape of health technology efforts in Native American communities Gates Foundation Native American Access to Technology Program Broadband Technology Opportunity Program Public and Tribal Libraries Provide Critical Access National Library of Medicine Native American Outreach Broadband Library Gordon 2003, Wood 2005, Burke 2007, Montague

6 Landscape of health technology efforts in Native American communities Adult and High School Online Learners Indian Health Service Telemedicine MyPreventiveCare PHR Mobile Health for Youth and STDs elearning Telemedicine Mobile Health Broadband Library Sanguins 2015, Kaler 2011, Carrol 2011, Doorenbos 2011, Craig Rushing 2011, Krist

7 Opportunities Culturally grounded evidence Culturally grounded technology enablement 7

8 Opportunities Culturally grounded evidence Coyhis and Simonelli 2008, National Congress of American Indians 8

9 National Congress of American Indians Policy Research Center Health Research Agenda 2007 Addiction Diabetes Healthcare Funding Workforce Other Issues Tribal Research Curriculum National Congress of American Indians

10 Youth with Mobile Technology as Drivers of Community Health Improvement: Enhancing Tribal Health and Food Security in the Klamath Basin 10

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12 Preliminary Results of Youth Led Health and Food Assessment N = % female, 34% aged 13 18, 4% 65 or older, Confidence in making healthy food choices is different among those who are and are not physically active. 150 physically active, 51 not physically active M = 1.16, 95% CI [0.32, 1.99], t(70) = 2.75, p =.01 12

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14 Opportunities Culturally grounded technology enablement Culturally Informed Design Framework Technology platform Functionality Content User interface Understanding of user culture Additional Participatory Design Elements Context Data Analytics Decisions Implications Valdez

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16 Opportunities Culturally grounded technology enablement User centered From the technologist perspective User empowered From the user perspective Participatory Research & Design Patient centered From the healthcare system perspective Person empowered From the person perspective Participatory Health & Shared Decision making Partnership 16

17 Acknowledgements Food Security/Karuk Youth Initiative USDA Agriculture and Food Research Initiative, Food Security Grant # Youth Researchers Karuk Tribe Department of Natural Resources: Leif Hillman, Lisa Hillman Mid Klamath Watershed Council Tribal Liaison: Grant Gilkison UC Berkeley: Jennifer Sowerwine San Francisco State University: Holly Logan, Alexandra Gee, Dustin Adams, Stephanie Jim Youth Leadership Institute: Matt Rosen UC Davis: Victoria Ngo 17

18 REFERENCES Carroll, M., Cullen, T., Ferguson, S., Hogge, N., Horton, M., & Kokesh, J. (2011). Innovation in Indian healthcare: using health information technology to achieve health equity for American Indian and Alaska Native populations.perspectives in health information management/ahima, American Health Information Management Association, 8(Winter). Coyhis D, Simonelli R. The native American healing experience. Substance use & misuse. 2008;43(12 13): Doorenbos AZ, Demiris G, Towle C, Kundu A, Revels L, Colven R, et al. Developing the Native People for Cancer Control Telehealth Network. Telemedicine and e Health. 2011;17(1):30 4. Gordon, A. C., Gordon, M., & Dorr, J. (2003). Native American technology access: the Gates Foundation in four corners. The Electronic Library, 21(5), Krist, A. H., Aycock, R. A., Etz, R. S., Devoe, J. E., Sabo, R. T., Williams, R.,... & Woolf, S. H. (2014). MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice based research networks serving disadvantaged patients a randomized cluster trial.implementation Science, 9(1). Montague, E., & Perchonok, J. (2012). Health and Wellness Technology Use by Historically Underserved Health Consumers: Systematic Review. Journal of Medical Internet Research, 14(3). National Congress of American Indians, Sanguins, H. (2015). Strength in Numbers: Learning Together in Online Communities A Learner Support System for Adult First Nation Students and Practitioners. Open Praxis, 7(1), doi: /openpraxis Valdez R, Gibbons MC, Siegel E, Kukafka R, Brennan P. Designing consumer health IT to enhance usability among different racial and ethnic groups within the United States. Health Technol. 2012;2(4): Warschauer M, Matuchniak T. New Technology and Digital Worlds: Analyzing Evidence of Equity in Access, Use, and Outcomes. In: Luke A, Green J, Kelly GJ, editors. Review of Research in Education, Vol 34, 2010: What Counts as Evidence in Educational Settings? Rethinking Equity, Diversity, and Reform in the 21st Century. Review of Research in Education p Wood, F. B., Siegel, E. R., Dutcher, G. A., Ruffin, A., Logan, R. A., & Scott, J. C. (2005). The National Library of Medicine's Native American outreach portfolio: a descriptive overview. Journal of the Medical Library Association,93(4 Suppl), S21. 18