Technology, Communication, Disparities and Government Options in Health and Health Care Services: Volume 32

This chapter provides both an introduction to the volume and a brief review of literature on technology, communications, and health disparities.

Literature review.

The chapter argues for the importance of greater examination of technology, communications, and their linkages to health disparities and other related factors.

Reviews the topic of technology, communication, and health disparities and previews this book.

Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health care. The purpose of this analysis is to compare how system-level differences affect IT implementation in health care (HIT) and the implications of these differences for health care equity.

We critically analyzed selected claims concerning the capacity of HIT to provide better care to more individuals at lower costs, thus contributing to health care equity, in the context of current health care reform efforts in the United States. We used the case of HIT implementation in Taiwan’s National Health Insurance system as a contrasting case.

We argue that however much HIT may yield in quality improvements or savings in the context of a universal and publicly financed single payer system, such savings simply cannot be accrued by a system of multiple health plans competing for better customers (i.e., less costly patients) and driven by profit.

It is important to define the level of analysis in debates about the potential of HIT to produce better health care at lower costs and the equity implications of this potential. In these debates, US policy makers should consider the commitment to health care equity that informed the design of Taiwan’s health care system and of HIT implementation in that country. HIT merely provides enabling tools that are of little value without major systemic changes

To our knowledge, the health IT expert literature has overlooked when not ignored the ethical principles informing health care systems, an omission which makes it difficult if not impossible to evaluate the potential of HIT to increase equity in health care.

Since 2000, there has been a dramatic increase in the number of individuals using the Internet, including for health purposes. Internet usage has increased from 46% of adults in 2000 to 79% in 2010. The purpose of this chapter is to examine changes in one type of Internet usage: online health searching. We examine the impact of traditional digital inequality factors on online health searching, and whether these patterns have changed over time.

Using data from five surveys ranging from 2002 to 2010 (n = 5,967 for all five surveys combined), we examine changing patterns of online health searching over the past decade.

Effects vary by inequality factor and time period examined. Despite the diffusion of the Internet, most of these gaps persist, and even strengthen, over time. Gender, age, and education gaps persist over time and appear to be increasing. An exception to this is the importance of broadband connection.

Since these data were collected, the use of mobile devices to access the Internet has increased. Research is needed on types of access and devices used for online health activities.

Larger scale inequalities play important roles in online health searching. Providing access and skills in evaluating online health information is needed for older and less educated groups. The results of this study have implications for the de-professionalization of medical knowledge.

This is the first study to examine digital inequality factors in online health information seeking over the breadth of this time period.

Improvements to supportive services targeting pregnant and parenting adolescents can enhance maternal and child outcomes (e.g., repeat pregnancy and child well-being). The purpose of this chapter is to advance the medical sociological literature by implementing multifaceted approaches including developing evidence-based media messaging device modalities as a forum to engage pregnant and parenting adolescents in social normative communication, self-reflection, and self-expression so that they can develop a tailored health prototype service model to accommodate their health and social needs.

We utilized a purposeful sample of pregnant adolescents or parenting adolescents (of an infant or toddler) ages 15–19 in a large Metropolitan Area in the Midwest. We employed a qualitative research design using two focus groups (n = 15) and participant observation (n = 8) to identify themes. Content analysis was performed to better understand the study participants’ experiences and perceptions.

Based on the focus group results, the custom journal was found to be the most popular outlet to offer self-expression and social support. Four main themes emerged from the data, including teen pregnancy overall is a problem, but having their own baby was not; strong desire for more health information and health education; perceived stigma from their teachers and parents; and frustration with the existing service programs.

The implications of the chapter are that the teen pregnancy norms fostered stigma and “social disgrace” that the pregnant and parenting adolescents experienced and ultimately thwarted their perceived and actual receipt of services. Future research should better understand the potential influences of internal and external pressures brought on by stigmatization as a contributing barrier to communicating social and health needs by pregnant and parenting adolescents.

This chapter developed, implemented, and evaluated media communication and found that it could structure social relations between pregnant and parenting adolescents and service providers. This chapter also extends development communication techniques, with its intellectual roots in rural sociology, by focusing on communication-oriented solutions and the development of new technologies to provide medical information with greater social equality and integrated support services for pregnant and parenting adolescents.

This study illustrates that differences across health-related websites, as well as different Internet usage patterns, have significant implications for how individuals view and interact with their health care providers.

We rely on a qualitative study of three health-related websites and an ordinary least squares regression analysis of survey data to explore how websites with different organizational motives frame health-related issues and how variations in Internet usage patterns affect patients’ perceptions of the patient-doctor interaction.

Results reveal differences across three health-related websites and show that both the number and the type of websites patients visit affect their perceptions of physicians’ responses. Specifically, visiting multiple websites decreased perceptions of how well doctors listened to or answered patients’ questions, whereas using nonprofit or government health-related websites increased evaluations of how well doctors listened to and answered questions.

This study suggests that practitioners and scholars should look more closely at how patients use the Internet to understand how it affects doctor-patient interactions. Future research could expand the analysis of website framing or use methods such as in-depth interviewing to more fully understand on-the-ground processes and mechanisms.

This study highlights the importance of fleshing out nuances about what it means to be an Internet-informed patient given that varying patterns of Internet use may affect how patients perceive their physicians.

The purpose of this research is to investigate how parents and caregivers describe their concerns about the HPV vaccine for their children on open Internet websites. The study examines what the discourse among parents reveals about their concerns regarding the HPV vaccine.

Our exploratory study utilized a grounded theory approach as a method of collecting data and simultaneously formulating research questions based on emerging themes from the data. We used purposeful sampling to select sets of comments posted on websites that provided news, scientific information, or parental support regarding HPV and its vaccine.

Findings suggest support for Bond and Nolan’s (2011) theory that familiarity with a disease is central to parents’ assessment of risk, and that dread of a serious disease such as cervical cancer is weaker than dread of unknown possible side effects in parents’ motivation to give or withhold the vaccine for their children.

Research limitations include our usage of a purposeful convenience sample of websites. The limitation of this sampling technique is that the comments made by website “users” and used in the analysis may not be representative of the wider population, and may include Americans as well as non-Americans.

Our research fills an important gap in the literature by looking at the ways in which parents share their concerns about the HPV vaccine on Internet websites as they consider whether to reject, delay, or consent to the vaccine.

This chapter analyses and discusses local government health promotion in Norway.

Institutional theory indicates that political and administrative jurisdictions are path dependent in their policy formation and implementation. By using data from different sources this assumption is analysed and discussed according to health promotion in Norwegian municipalities. The main methodology is cross tabulations, bivariate correlations and regression is carried out to supplement analyses.

Municipalities are path dependent in their health promotion policies. They acknowledge and prioritize health behaviour independent of experienced socio-economic challenges, municipal capacity as size and income, and local government political profile. Competence devoted to health promotion can create changes in policies.

The rhetoric on determinants and social determinants in particular is new in Norway. Rhetoric on, and interventions, that highlight the social determinants of health need to be coordinated.

The chapter presents new knowledge on Norwegian local government health promotion and how this is implemented in relation to the challenges experienced.

This chapter will review the evaluations of the newly developed elderly care system in Japan, Long Term Care Insurance, and its social implications with the focus on demographic change.

By reviewing literature, this chapter will examine how demographic and social change over the years has impacted the features of caregivers. Then, how this policy change has demedicalized the aging process will be described. Finally, this chapter will evaluate whether this insurance has shifted the responsibility for elderly care from the family to society as the governmental slogan advertised.

The new insurance has offered more options in different services and established a new norm of self-reliance and determination for one’s own aging however it is doubtful if this new insurance has shifted the responsibility from family to society.

Applying the implications of policy reforms for elderly care in Japan to the United States, one can assume the traditional U.S. norms and values can facilitate effective utilization of the elderly care system. However, since each nation faces different problems with its specific condition, continuous studies and observations on the relationship between elderly care, immigration issues, and demographic changes will be necessary in order to offer more specific suggestions for each aging nation.

As Japan’s new insurance scheme for the elderly has been studied by many aging nations, recommendations for more comprehensive plans are suggested including building a community-based support system into the Long Term Care Insurance scheme to prevent social isolation and respond to emergency situations for the elderly.

To present the view that harm arising from aggressive marketing and sales of health-related products and services (including dangerous and defective ones) in order to maximize profits should be a cause of concern for public health academics and practitioners.

The discussion is conducted using biomedical ethics principles and supported using various real-world examples.

Harm arising from aggressive marketing and sales of health-related products and services (including dangerous and defective ones) in order to maximize profits should be a cause of concern for public health academics and practitioners. In the area of products, the most obvious would be tobacco products. In the case of pharmaceutical drugs, it would include overuse or inappropriate use because of aggressive marketing. It would also include harm caused by the continued promotion and sale of a drug in the face of evidence that it has significant negative side effects. Brody and Light’s “Inverse Benefit Law,” that is, the benefit-to-harm ratio of drugs tends to vary inversely with how aggressively drugs are marketed is discussed. Harm is also evident in health-related services, for example, misuse of ultrasonography for sex-selective abortion. This chapter will discuss how the risk of harm is increased because of questionable marketing strategies used by drug companies.

One limitation is that no attempt to quantify the harm done (e.g., through economic evaluation techniques) is carried out.

This chapter presents the view that much more attention should be paid to this aspect of medicalization as a public health threat.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

This study tests the first two tenets of the fundamental causes theory – that socioeconomic status influences a variety of risk factors for poor health and that it affects multiple health outcomes – by examining the associations between adverse socioeconomic circumstances and five measures of health.

We employ bivariate and logistic regression analyses of data from the Centers Disease Control and Prevention 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) to test the individual and cumulative associations between three measures of socioeconomic position and five measures of health risk factors and outcomes.

The analysis demonstrates support for the fundamental causes theory, indicating that measures of adverse socioeconomic conditions have independent and cumulative associations with multiple health outcomes and risk factors among U.S. adults aged 18–64.

The findings of this chapter are generalizable to adults aged 18–64 living in the United States and may not apply to individuals living outside the United States, older Americans, and children.

Adverse socioeconomic circumstances are not only associated with self-rated health but are also associated with the two leading causes of death in the United States (cancer and heart disease) and risk factors that contribute to these causes of death (smoking and high blood pressure). Improving access to socioeconomic resources is critical to reducing health disparities in leading causes of death and health risk factors in the United States.

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.

A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.

RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.

The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.

RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

To examine aging Puerto Ricans’ experiences with and perceptions of depression treatment.

In-depth analysis of eight exemplary cases from ethnographic interviews with a subsample of 16 aging Puerto Ricans in the Boston area who are part of the Boston Puerto Rican Health Study.

The results show that respondents were resistant to accepting pharmacological treatment for their depression, and they often characterized antidepressants as “dope.” Moreover, they claimed that in addition to their health problems, social stressors such as financial strain, lack of jobs, housing problems, and social isolation are triggering or contributing to their depression. Because of this, they express reluctance in accepting clinical treatment only, and suggest that broader social issues and other health needs ought to be addressed as part of an effective treatment. For many, pharmacological treatment is acceptable only in the more severe forms of depression.

These results have important implications for improving the quality of depression treatment and reducing health disparities for mainland Puerto Ricans.

Even though recent studies continue to show a high frequency of depression among Puerto Ricans, issues of treatment quality are still understudied and ethnographic accounts are especially lacking. Our study offers an exploratory investigation of this unresolved research issue.