This document discusses health literacy and the use of mobile applications to improve consumer health. It defines health literacy and examines how low health literacy negatively impacts vulnerable populations. The document explores criteria for evaluating the credibility of online health information and provides examples of popular medical websites and mobile apps that can help with conditions like diabetes, heart disease, and weight management. It concludes that mobile health apps have potential to enhance health education and management if used in conjunction with a health care provider's guidance.

1. MOBILE LEARNING IN
CONSUMER HEALTH
Rebecca Hegel, MS, RN
Teresa Smith, MS, RN
Kim Stote, PhD, MPH, RD

2. Objectives
• Define health literacy and its impact on vulnerable
populations
• Identify criteria to determine credibility of online
sites for health care
• Explore mobile applications for use in consumer
health

3. Health Literacy
•What is Health Literacy?
•Significance
•Vulnerable Populations
•Relationship between Literacy & Health
•Research
• Cancer, Diabetes, and Hypertension

4. Interactive Activity
Google, Yahoo, MSN (Bing), AOL
• Calories in an Apple
Google: CalorieKing: 53, CalorieCount.about.com: 77
Yahoo: CalorieKing: 53, Juicingforweigtloss.com: 53
Bing: CalorieKing: 53, Apple.net: 77
AOL: ????
• High Blood Pressure
Google: WebMD, www.nhlbi.nih.gov
Yahoo: Health.Yahoo.com, Wikipedia
Bing: Health.msn.com
AOL: ?

5. Health Literacy
• Ability to understand health information and use that
information to make good decisions about your health and
medical care
• About 1/3 of the population of the United States has limited
health literacy
• Did you know…..
• …..studies show that 40% - 80% of what is said by your doctor is forgotten
by the time you leave the office

6. Factors that Affect Health Literacy
• Health care language – use of words that patients don’t understand
• Low educational skills – reading skills
• Cultural barriers to health care
• Limited English proficiency
• Learning disabilities
• Cognitive decline

7. Vulnerable Populations
• Older adults (age +65)
• Minority populations
• Immigrant populations
• Low income
• The medically underserved
• People with chronic mental and/or physical conditions

8. What does the Research Say?
• Low health literacy is linked with:
• Higher rates of hospitalization
• Higher use of emergency services
• Poorer health outcomes
Agency for Healthcare Research and Quality. (2011). Literacy and health outcomes. Retrieved from
http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf

9. Cancer and Health Literacy
• Low literacy adversely impacts:
• Incidence of cancer
• Mortality from cancer
• Quality of Life

10. Diabetes and Health Literacy
• Low literacy is independently associated with:
• Worse blood sugar (glycemic) control
• Higher rates of eye disease that may affect vision
(retinopathy)
• More diabetes-related complications

11. Hypertension and Health Literacy
• Low health literacy in this population (48%) even
with formal educational classes, showed:
• Significantly less knowledge of the disease
• Less lifestyle modification
• Lower self-management skills

12. Health Literacy References
• National Network of Libraries of Medicine (2012). Health
literacy. Retrieved from
http://nnlm.gov/outreach/consumer/hlthlit.html
• Agency for Healthcare Research and Quality. (2011). Literacy
and health outcomes. Retrieved from
http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/lit
eracyup.pdf

13. Credibility of Medical Websites
• Americans use search engines more than doctors
for obtaining health and medical information
• Marketingcharts.com
• Google is most often the first place of contact
for health information
• Business Noise - Vandergriend.com
• Several popular sites related to health
information

14. Most Popular Medical Websites
Marketing Information Other Popular Sites
Varies somewhat by the Yahoo!Health
marketing research MedicineNet.com
HealthCentral.com
#1 site overall…? MayoClinic.com
NIH.gov
CDC.gov
WebMD
Health A to Z (myoptumhealth.com)
Wrong Diagnosis (.com)

15. Medical Library Association
• Criteria for Site Selection
• The site’s sponsor should be easy to identify; this may be
evident in the address itself (.gov, .edu, .org, .com)
• The site should be updated frequently with the date of most
recent revisions apparent
• Information should be clear, factual, and evidence-based
• Clear information on the intended audience should be
provided (consumer versus professional)
• http://www.mlanet.org/resources/userguide

16. Health on the Internet (HON) Code of Conduct
• “HON was founded to encourage the dissemination of quality
health information for patients and professionals and the general
public, and to facilitate access to the latest and most relevant
medical data through the use of the internet.”
• “The HONcode certification is an ethical standard aimed at offering
quality health information. It demonstrates the intent of a website
to publish transparent information. The transparency of the
website will improve the usefulness and objectivity of the
information and the publishment of correct data.”
• http://www.hon.ch/HONcode/Patients/Visitor/visitor.html

18. MLA – Deciphering Medspeak

19. MLA’s “Top Ten”…
• NOAH: New York Online Access to Health (http://www.noah-
health.org/
• MedlinePlus (http://medlineplus.gov/)
• MayoClinic (http://www.mayoclinic.com/)
• Kidshealth® (http://www.kidshealth.org/)
• HIV InSite (http://hivinsite.ucsf.edu/)
• Healthfinder® (http://www.healthfinder.gov/)
• familydoctor.org (http://familydoctor.org/)
• Centers for Disease Control and Prevention (http://www.cdc.gov/)
• Cancer.gov (http://www.cancer.gov/)

20. MLA – Recommends Sites for:
•Cancer
•Diabetes
•Heart Disease

21. Complementary and Alternative Medicine
http://nccam.nih.gov/health/webresources

22. Internet Search: A hypochondriac’s best friend?
• “Details of a new study examining how symptoms presented online
influence people’s reactions to possible medical conditions will be
presented in Psychological Science, a journal of the Association for
Psychological Science” (Newberg, 2012).
• People are more likely to go online to search on symptoms than go to their
doctor
• > 60% of people feeling ill go to the internet for information
• Follow-up with a doctor is based on what they find
• Research on cancer-seeking information
• People perceive a higher disease risk when symptoms are identified in
“streaks” – sequences of items on a list

23. Medical Implications of the Study
• Presentation of symptoms online:
• To increase awareness of an emerging health issue that requires treatment,
group symptoms together that will more likely be checked off in sequence.
• According to Votruba, “If there are concerns that the perceptions of disease
risk are too high, possibly resulting in over utilization of health services, then
symptom lists should alternate common and specific symptoms or create
longer symptom lists” (as cited in Newberg, 2012).
• “Previous research shows that perception of risk of disease is a powerful
predictor of health preventative behavior (such as going to the doctor),” Kwan
said. “How information is presented online will make a substantive difference
in behavior (as cited in Newberg, 2012).
• Newberg, J. (2012, May 12). Internet search: A hypochondriac's best friend? [Peer commentary on research by Virginia Kwan,
Sean Wojcik, Talya Miron-shatz, Ashley Votruba, and Christopher Olivola ]. Retrieved from
http://researchmatters.asu.edu/stories/internet-search-hypochondriacs-best-friend-2183

24. Mobile Technology
• Computer devices that are intended to be always on
and carried on the person throughout the day (i.e.,
during normal daily activities)
• Mobile technologies support the collection and
analysis of health-related information in real-time and
in the real world
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25. Mobile Technology
• Pew Internet and American Life Project:
• 82% of American adults have a cell phone
• approximately three in 10 Americans have accessed
medical information
• 10% have Apps that assist in managing a health condition
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26. Health and Medical Apps
• Apps
• Sophisticated programs or special applications
designed for mobile technology
• Sources of
• Health and medical information (education)
• Patient self-management tools
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27. Health and Medical Apps
• Rapid growth
• iTunes App Store
• 8600 health and medical Apps
• Health insurance payers (Blue Cross Blue
Shield), healthcare providers (Mayo Clinic),
laboratory companies (Quest Diagnostics)
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28. Health and Medical Apps
• Driven by:
• Consumer demand (improved productivity and cost
reduction)
• Provider acceptance
• Participation of major technology companies
(Microsoft, Intel, Google, Qualcomm, Apple, Nokia)
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29. Mobile Health
• Limited evidence about how well and under what
circumstances mobile technology compare with or
enhance current means to improve health and
healthcare
• Concerns with availability of mHealth to all
segments of the population
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30. Activity
• What do you want in a health and medical App?
• What is your favorite health and medical App?
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31. Health Conditions - Apps
•Heart Health
• HeartWise Blood Pressure Tracker
• Quickly records and keeps track of systolic and diastolic blood
pressure, resting heart rate and weight
http://itunes.apple.com/us/app/heartwise-blood-pressure-
tracker/id311716888?mt=8
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32. Health Conditions - Apps
•Blood Sugar Tracker
• Blood Sugar Tracker allows the user to easily log blood
sugar levels, set target blood glucose ranges, and view
history and simple graphs to quickly identify numbers
that are out of range
http://itunes.apple.com/us/app/blood-sugar-tracker-by-
healthycloud.com/id398293939?mt=8
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33. Health Conditions - Apps
•Vree for Diabetes
• Vree for Diabetes is a portable resource for managing diabetes
• The app includes diabetes education resources to better
understand Type 2 diabetes and the requirements to manage
it, blood glucose tracking, nutrition tracking, activity tracking,
medication tracking, progress charts and blood pressure
tracking
• http://itunes.apple.com/us/app/vree-for-diabetes/id355923059?mt=8

34. Nutrition/Weight Management - Apps
•Calorie Counter
• Tracks food, exercise, weight and all the nutrients
listed on a Nutrition Facts label
• Also includes daily inspirational articles, healthy recipes
and an easy-to-understand Help section
http://itunes.apple.com/us/app/calorie-counter/id492244010
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35. Nutrition/Weight Management - Apps
•Calorie Counter & Diet Tracker by
MyFitness Pal
• This app may be created by MyFitness Pal, but the
nutrition analysis features will make this app your best
nutrition friend. The app includes a combination of
both, on a daily and weekly section
http://itunes.apple.com/us/app/calorie-counter-diet-
tracker/id341232718?mt=8
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36. Mind-Body Medicine - Apps
•Awareness
• The app provides insight and breaks
patterns of emotions,
attitudes, and behavior through awareness and inspirational
practices
• Developed by psychotherapist Ronit Herzfeld
• http://itunes.apple.com/us/app/awareness-pro/id402123427?mt=8
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37. Addiction Recovery Support - Apps
•Smoking Cessation
• The main focus of the app is to show how long it has been
since you last smoked and how much money you have
saved as a result
•http://itunes.apple.com/us/app/quitter/id284944935?mt=8
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38. Conclusions
• Mobile health medical applications and internet
resources may have the potential to play a
significant role in health education and disease
management by providing easy tracking,
motivational sophistication, and improved
adherence.
For any health concerns, follow-up with your
health care practitioner
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