Biomedical subjects

Rita Kukafka

Publications and source records attributed to Rita Kukafka.

14 recordsLinked to original sources

PubMed2006

Design features of graphs in health risk communication: a systematic review.

This review describes recent experimental and focus group research on graphics as a method of communication about quantitative health risks. Some of the studies discussed in this review assessed effect of graphs on quantitative reasoning, others assessed effects on behavior or behavioral intentions, and still others assessed viewers' likes and dislikes. Graphical features that improve the accuracy of quantitative reasoning appear to differ from the features most likely to alter behavior or intentions. For example, graphs that make part-to-whole relationships available visually may help people attend to the relationship between the numerator (the number of people affected by a hazard) and the denominator (the entire population at risk), whereas graphs that show only the numerator appear to inflate the perceived risk and may induce risk-averse behavior. Viewers often preferred design features such as visual simplicity and familiarity that were not associated with accurate quantitative judgments. Communicators should not assume that all graphics are more intuitive than text; many of the studies found that patients' interpretations of the graphics were dependent upon expertise or instruction. Potentially useful directions for continuing research include interactions with educational level and numeracy and successful ways to communicate uncertainty about risk.

Audiovisual Aids↗

PubMed2006

Human and automated coding of rehabilitation discharge summaries according to the International Classification of Functioning, Disability, and Health.

OBJECTIVE: The International Classification of Functioning, Disability, and Health (ICF) is designed to provide a common language and framework for describing health and health-related states. The goal of this research was to investigate human and automated coding of functional status information using the ICF framework. DESIGN: The authors extended an existing natural language processing (NLP) system to encode rehabilitation discharge summaries according to the ICF. MEASUREMENTS: The authors conducted a formal evaluation, comparing the coding performed by expert coders, non-expert coders, and the NLP system. RESULTS: Automated coding can be used to assign codes using the ICF, with results similar to those obtained by human coders, at least for the selection of ICF code and assignment of the performance qualifier. Coders achieved high agreement on ICF code assignment. CONCLUSION: This research is a key next step in the development of the ICF as a sensitive and universal classification of functional status information. It is worthwhile to continue to investigate automated ICF coding.

Activities of Daily Living↗

PubMed2006

Reengineering clinical research with informatics.

The future success of the translational research spectrum depends on the clinical research enterprise's ability to break through the barriers that constrain its productivity. As more basic science discoveries emerge, our ability to effectively translate this knowledge into improved patient care rests squarely on the manner in which we answer clinical questions. Informatics--the science of effective information use--is poised to help advance the conduct of science. However, incorporating informatics into the enterprise comes with its own set of challenges. To harness the benefits of improved information use, it is important to first establish how information flows within research. A thoughtful implementation of informatics--one that factors in social and organizational nuances--will undoubtedly lead to a more efficient and effective clinical research enterprise.

Biomedical Research↗

PubMed2006

A new perspective in the promotion of e-health.

This paper proposes a new model that provides assistance in understanding the reasons why individuals would use new ICT (Information and Communication Technologies) to perform a healthcare change in their lifestyle. Achieving a lifestyle change by the use of ICT is a multifold issue that can be broadly addressed by analysing, in parallel two dimensions: the individuals' attitude towards their health condition and their approach and readiness to monitor and change their attitude by the use of ICT. Our work has been to conceive and develop a model that explains the different stages the user is at both in terms of the perception of healthcare and of the use of technology to perform any desired or recommended change. In order to place the user at each dimension a set of questionnaires were designed and implemented. These questionnaires assisted us in understanding what personalised information needs to be provided according to the stage the user is at as well as to other variables (such as age, cultural background, etc). The novelty of this model is that it proposes a general framework that may be applied to the conception, design and evaluation of any e-health application. Moreover, it can be applied to different application targets (medical informatics, public health informatics, etc) and to different audiences (healthy individuals, patients, professionals, etc) as it proposes an enhanced user modelling process by taking into account both healthcare behaviour aspects as well as technological issues, which up to this moment, have not been taken into account and may be part of the explanation of e-health uptake failure in the healthcare field. The application of this model promotes the empowerment of the individuals by providing tailored information, as well as guidance, monitoring, through ICT and it will certainly make an impact on health-related behaviour. Besides, it will allow to understand some of the reasons of the success or failure of different e-health platforms. Overall, this model is likely to provide deeper insights into the process of improving e-health so it can meet ongoing individuals' needs and become an increasingly valued part of health care services.

Health Promotion↗

PubMed2005

Qualitative assessment of the International Classification of Functioning, Disability, and Health with respect to the desiderata for controlled medical vocabularies.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF), a classification system published in 2001 by the World Health Organization (WHO), provides a common language and framework for describing functional status information (FSI) in health records. METHODS: Informed by ongoing research in coding FSI in patient records, this paper qualitatively assesses the ICF framework with respect to the desiderata for controlled medical vocabularies, an enumerated a list of desirable qualities for controlled medical vocabularies proposed by Cimino [J.J. Cimino, Desiderata for controlled medical vocabularies in the twenty-first century, Meth. Inform. Med. 37 (1998) 394-403]. RESULTS: The ICF satisfies 5 of the 12 desiderata. Five points were not satisfied and two points could not be evaluated. CONCLUSION: The ICF is a rich source of relevant terms, concepts, and relationships, but it was not developed in consideration of requirements for formal terminologies. Therefore, it could serve as a base from which to develop a formal terminology of functioning and disability. This assessment is a key next step in the development of the ICF as a sensitive, universal measure of functional status.

Decision Support Techniques↗

PubMed2005

Public health informatics: the nature of the field and its relevance to health promotion practice.

The purpose of this article is to introduce the relatively new field of public health informatics and provide examples of how informatics is currently being applied to health promotion activities. Additionally, the article illustrates how informatics is well positioned to play a central role and is likely to be central to disease prevention, health education, and health promotion as it will be practiced in the future.

Health Behavior↗

PubMed2005

Analyzing the structure and content of public health messages.

BACKGROUND: Health messages are crucial to the field of public health in effecting behavior change, but little research is available to assist writers in composing the overall structure of a message. In order to develop software to assist non-expert message writers in constructing effective messages, the structure of existing health messages must be understood, and an appropriate method for analyzing health message structure developed. METHODS: 72 messages from expert sources were used for development of the method, which was then tested for reproducibility using ten randomly selected health messages. Four raters analyzed the messages and inter-coder agreement was calculated. RESULTS: A method for analyzing the structure of the messages was developed using sublanguage analysis and discourse analysis. Overall kappa between four coders was 0.69, demonstrating "substantial agreement." CONCLUSION: A novel framework for characterizing health message structure and a method for analyzing messages appears to be reproducible.

Communication↗

PubMed2005

Extending a medical language processing system to the functional status domain.

The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) provides a common framework for describing functional status information (FSI) in health records. Given the expense of manual coding, we are investigating the use of natural language processing (NLP) for automated FSI coding. We used an existing NLP system that was originally designed to encode clinical information. The system's lexicon and coding table were modified and preprocessing and postprocessing programs were created, allowing for automated assignment of selected ICF codes.

Activities of Daily Living↗

PubMed2005

Improving patient compliance with best practices guidelines: a web based automated and personalized reminders system.

Health Reminders is a prototype application that delivers personalized guidelines and recommended testing to the patient at the appropriate time and through multiple communication channels such as email, web, cellular text messaging (Simplified Message Service), automatic insertion into Personal Information Managers (schedulers like MS Outlook) as appointments and tasks.

Humans↗

PubMed2004

Bridging the digital divide: reaching vulnerable populations.

The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

Financing, Organized↗

PubMed2003

Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use.

Many interventions to improve the success of information technology (IT) implementations are grounded in behavioral science, using theories, and models to identify conditions and determinants of successful use. However, each model in the IT literature has evolved to address specific theoretical problems of particular disciplinary concerns, and each model has been tested and has evolved using, in most cases, a more or less restricted set of IT implementation procedures. Functionally, this limits the perspective for taking into account the multiple factors at the individual, group, and organizational levels that influence use behavior. While a rich body of literature has emerged, employing prominent models such as the Technology Adoption Model, Social-Cognitive Theory, and Diffusion of Innovation Theory, the complexity of defining a suitable multi-level intervention has largely been overlooked. A gap exists between the implementation of IT and the integration of theories and models that can be utilized to develop multi-level approaches to identify factors that impede usage behavior. We present a novel framework that is intended to guide synthesis of more than one theoretical perspective for the purpose of planning multi-level interventions to enhance IT use. This integrative framework is adapted from PRECEDE/PROCEDE, a conceptual framework used by health planners in hundreds of published studies to direct interventions that account for the multiple determinants of behavior. Since we claim that the literature on IT use behavior does not now include a multi-level approach, we undertook a systematic literature analysis to confirm this assertion. Our framework facilitated organizing this literature synthesis and our analysis was aimed at determining if the IT implementation approaches in the published literature were characterized by an approach that considered at least two levels of IT usage determinants. We found that while 61% of studies mentioned or referred to theory, none considered two or more levels. In other words, although the researchers employ behavioral theory, they omit two fundamental propositions: (1) IT usage is influenced by multiple factors and (2) interventions must be multi-dimensional. Our literature synthesis may provide additional insight into the reason for high failure rates associated with underutilized systems, and underscores the need to move beyond the current dominant approach that employs a single model to guide IT implementation plans that aim to address factors associated with IT acceptance and subsequent positive use behavior.

Attitude to Computers↗

PubMed2003

Tailored health communication: crafting the patient message for HIV TIPS.

The HIV TIPS project will pilot and evaluate the use of web-based information technology on prescription errors and quality of care by providing tailored practice guidelines and patient education in ambulatory practice settings of the National AIDS Education and Training Centers (NAETC) network. In the first phase of the project, we tailored messages to guide patient adherence and self-care, using DHHS guidelines. We developed a method based on communication theory to ensure complete and effective messages.

Anti-Retroviral Agents↗

PubMed2003

Development of competency-based on-line public health informatics tutorials: accessing and using on-line public health data and information.

In response to training and information needs of the public health workforce, the New York City Department of Health and Mental Hygiene, in collaboration with the Department of Biomedical Informatics, Columbia University and the New York Academy of Medicine, is developing a series of on-line, interactive tutorials in public health informatics. The goal is to teach public health practitioners how to locate, use, and disseminate data and information on the Internet, while imparting basic informatics principles. Course content is based on Public Health Informatics Competencies, and evaluation will be performed by measuring changes in self-efficacy and knowledge as well as determining user satisfaction.

Competency-Based Education↗

PubMed2002

Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial.

This paper reports the effects of a tailored Web-based delivery system on self-efficacy as it relates to a patients' response to acute myocardial information (AMI) symptoms. The data reported are from MI-HEART, a randomized trial examining ways in which a clinical information system can favorably influence the appropriateness and rapidity of decision-making in patients suffering from symptoms of acute myocardial infarction. Participants were randomized into one of three groups: tailored Web-based, non-tailored Web-based and non-tailored paper based. A theoretically based behavioral-cognitive model was used to identify key variables upon which to tailor education material. A key variable in the model is self-efficacy, operationalized with a three-dimensional scaling. Results show trends in improved self-efficacy scores for all groups at 1-month follow up, with sustained significant increases in baseline to 3-month scores only in the tailored Web-based group. One possible explanation could be related to "hit-count", which was significantly higher in the tailored group. This study is a first step in quantifying the contribution of Web-based tailoring over non-tailoring in changing key determinants of patient delay to AMI symptoms.

Algorithms↗