Evaluation of Health IT Tools and Resources Available at the AHRQ NRC for Health IT Web Site: Final Report
The Agency for Healthcare Research and Quality (AHRQ) Health IT Portfolio has a public Web site that offers more than 10,000 documents, presentations, articles, and tools to health information technology (IT) researchers, implementers, and policymakers. The National Resource Center of Health IT (NRC) Web site offers over 20 tools and resources to support health IT research and evaluation. AHRQ periodically reviews these tools and resources to ensure they are useful and easy to use, and that accurate and up-to-date information is offered to stakeholders.
AHRQ tasked RTI with evaluating the Health IT Literacy Guide (the Guide), which has been maintained on the NRC Web site since 2007. The Guide was intended to help ensure that consumer health IT applications are accessible for individuals with low literacy, which in the health context, reduces the capacity of an individual to obtain, communicate, process, and understand basic health information and services (Koh et al., 2012). Literacy has been conceptually broadened from the ability to read, write, and understand language, to the ability to "identify, understand, interpret, create, communicate, and compute, using printed and written materials associated with varying contexts" (UNESCO, 2003). It is this broadened concept of literacy that is most relevant in the health context. In the 2004 IOM Report, Health Literacy, a Prescription to End Confusion, health literacy is defined as having the capacity to "obtain, process, and understand basic health information and services needed to make appropriate health decisions." Health literacy is the term favored in this report, being similar in meaning to literacy, in a health context.
Limited health literacy remains a significant challenge for most of the U.S. population, making it difficult for most patients to understand and apply health information for a variety of life events. Since a growing amount of health information is accessed through health IT, usable health IT for individuals with limited literacy is an important aim (AHRQ, 2010; DeWalt et al., 2011; IOM, 2004; Koh et al., 2012). This report summarizes findings and develops recommendations based on an environmental scan, expert interviews, and focus groups conducted with the intended audience of the Health IT Literacy Guide: developers and purchasers of health IT.
The 26-page Health IT Literacy Guide introduces literacy challenges and states the importance of ensuring that health IT addresses the needs of as many users as possible, including those with limited access to technology or limited literacy. It provides some examples of health IT specifically geared toward individuals with limited literacy, identifies principles of accessible and usable health IT, provides a list of additional resources, and includes a checklist intended to help purchasers and developers identify best practices when purchasing or designing systems that support patients, especially those who might have limited literacy or limited access to health IT.
This report is organized into four chapters. Chapter 1 provides project background and context and then identifies the research questions that guided the evaluation of the Health IT Literacy Guide and served as the focus of this report. Chapter 2 summarizes the approach used to evaluate the Health IT Literacy Guide, which included (1) a focused environmental scan to identify a number of resources relevant to health IT design, usability, literacy, and health literacy (i.e., literacy in the health context); (2) individual interviews with nine experts in the areas of health literacy, usability, consumer health IT, and human-computer interaction (HCI); and (3) 10 focus groups—six with developers of health IT and four with purchasers of health IT—to explore their use of and views about the Guide. Chapter 3 summarizes the findings from the environmental scan, expert interviews, and focus groups by research question. Chapter 4 presents recommendations based on the research findings.
Evaluation results show that (1) developers and purchasers were largely unaware of the Guide; (2) developers and purchasers had limited agreement on definitions of health literacy or the role of health IT in supporting individuals with low literacy; (3) information in the Guide appeared to be outdated; (4) experts and focus group participants were highly interested in the checklist; and (5) the Guide could be useful during system development or product evaluation if it was used at appropriate points during product testing or system selection.
Chapter 4 contains several recommendations regarding the Health IT Literacy Guide. The first recommendation is that the Guide should be retained. There appears to be a gap in knowledge and use of available resources to improve health IT design for limited literacy users. Findings from the environmental scan, expert interviews, and focus groups confirm that limited health literacy remains an important barrier to health knowledge, decisionmaking, and engagement among patients, despite the increasing availability of mobile and Internet technologies to connect with health resources and increased consumer use of them.
The second recommendation is to take steps to disseminate the Guide much more broadly. Experts and focus group participants were largely unaware of the Guide, and Web statistics tracking page views show limited use. However, evaluation participants were enthusiastic about gaining access to the information in the Guide, especially the checklist, once they became familiar with the Guide.
The third recommendation is to enhance the checklist found at the end of the Guide to assist users in designing and selecting health IT, and to tailor the checklist for users who are in the process of making design or purchase decisions. In addition to redesigning and testing the checklist with actual users, the intended audience of the Guide should be expanded to include business decisionmakers in management or executive roles, since individuals with the authority to purchase health IT, and those responsible for the development of IT at a senior level, may not focus on its suitability for low-literacy users.
The fourth recommendation is to update the content of the Guide to address current technologies, advances in the use of the Internet and mobile devices, and new findings concerning the prevalence of limited health literacy. Although the content areas of the original Guide are an important starting place when planning updates to the Guide, they should not impose unnecessary constraints. For example, new methods such as computer-based assessment and tailoring content based on user needs may need additional attention in an updated Guide.
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