No abstract

As healthcare becomes increasingly digitized, the promise of improved care enabled by technological advances inevitably must be traded off against any unintended negative consequences. There is little else that is as consequential to an individual as his or her health. In this context, the privacy of one's personal health information has escalated as a matter of significant concern for the public. We pose the question: under what circumstances will individuals be willing to disclose identified personal health information and permit it to be digitized? Using privacy boundary theory and recent developments in the literature related to risk-as-feelings as the core conceptual foundation, we propose and test a model explicating the role played by type of information requested (general health, mental health, genetic), the purpose for which it is to be used (patient care, research, marketing), and the requesting stakeholder (doctors/hospitals, the government, pharmaceutical companies) in an individual's willingness to disclose personal health information. Furthermore, we explore the impact of emotion linked to one's health condition on willingness to disclose. Results from a nationally representative sample of over 1,000 adults underscore the complexity of the health information disclosure decision and show that emotion plays a significant role, highlighting the need for re-examining the timing of consent. Theoretically, the study extends the dominant cognitive-consequentialist approach to privacy by incorporating the role of emotion. It further refines the privacy calculus to incorporate the moderating influence of contextual factors salient in the healthcare setting. The practical implications of this study include an improved understanding of consumer concerns and potential impacts regarding the electronic storage of health information that can be used to craft policy.

Studies have identified an association between watching television (TV) and childhood obesity. This review adds context to existing research by examining the associations between TV viewing, whilst eating, and children's diet quality. Web of Science and PubMed databases were searched from January 2000 to June 2014. Cross-sectional trials of case control or cohort studies, which included baseline data, measuring the associations between eating whilst watching TV and children's food and drink intake. Quality of selected papers was assessed. Thirteen studies, representing 61,674 children aged 1-18 yrs, met inclusion criteria. Of six studies reporting overall food habits, all found a positive association between TV viewing and consumption of pizza, fried foods, sweets, and snacks. Of eight studies looking at fruit and vegetable consumption, seven identified a negative association with eating whilst watching TV (p < .0001). Four out of five studies identified a positive association between watching TV whilst eating and servings of sugar-sweetened beverages (p < .0001). Four studies identified an association between low socioeconomic status and increased likelihood of eating whilst watching TV (p ≤ .01). Family meals did not overcome the adverse impact on diet quality of having the TV on at mealtimes. Eating whilst watching television is associated with poorer diet quality among children, including more frequent consumption of sugar-sweetened beverages and high-fat, high-sugar foods and fewer fruits and vegetables. Although these differences in consumption are small, the cumulative effect may contribute to the positive association between eating whilst watching TV and childhood obesity.

BackgroundPersonal health records (PHRs) are an important tool for empowering patients and stimulating health action. To date, the volitional adoption of publicly available PHRs by consumers has been low. This may be partly due to patient concerns about issues such as data security, accuracy of the clinical information stored in the PHR, and challenges with keeping the information updated. One potential solution to mitigate concerns about security, accuracy, and updating of information that may accelerate technology adoption is the provision of PHRs by employers where the PHR is pre-populated with patients’ health data. Increasingly, employers and payers are offering this technology to employees as a mechanism for greater patient engagement in health and well-being.ObjectiveLittle is known about the antecedents of PHR acceptance in the context of an employer sponsored PHR system. Using social cognitive theory as a lens, we theorized and empirically tested how individual factors (patient activation and provider satisfaction) and two environment factors (technology and organization) influence patient intentions to use a PHR among early adopters of the technology. In technology factors, we studied tool empowerment potential and value of tool functionality. In organization factors, we focused on communication tactics deployed by the organization during PHR rollout.MethodsWe conducted cross-sectional analysis of field data collected during the first 3 months post go-live of the deployment of a PHR with secure messaging implemented by the Air Force Medical Service at Elmendorf Air Force Base in Alaska in December 2010. A questionnaire with validated measures was designed and completed by 283 participants. The research model was estimated using moderated multiple regression.ResultsProvider satisfaction, interactions between environmental factors (communication tactics and value of the tool functionality), and interactions between patient activation and tool empowerment potential were significantly (P<.05) associated with behavioral intentions to use the PHR tool. The independent variables collectively explained 42% of the variance in behavioral intentions.ConclusionsThe study demonstrated that individual and environmental factors influence intentions to use the PHR. Patients who were more satisfied with their provider had higher use intentions. For patients who perceived the health care process management support features of the tool to be of significant value, communication tactics served to increase their use intentions. Finally, patients who believed the tool to be empowering demonstrated higher intentions to use, which were further enhanced for highly activated patients. The findings highlight the importance of communication tactics and technology characteristics and have implications for the management of PHR implementations.

W ith the lack of timely and relevant patient information at the point of care increasingly being linked to adverse medical outcomes, effective management and exchange of patient data has emerged as a strategic imperative for the healthcare industry. Healthcare informaticians have suggested that electronic health record systems (EHRS) can facilitate information sharing within and between healthcare stakeholders such as physician practices, hospitals, insurance companies, and laboratories. We examine the assimilation of EHRS in physician practices through a novel and understudied theoretical lens of physicians' identities. Physician practices and the physicians that lead them occupy a central position in the healthcare value chain and possess a number of unique characteristics that differentiate them from other institutional contexts, including a strong sense of affiliation with other physicians, potent professional identities, and a desire for autonomy. We investigate two salient physician identities, those of careprovider and physician community, grounded in the roles physicians play and the groups with which they affiliate. We argue that these identities and their evolution, triggered by EHRS, manifest as both identity reinforcement and deterioration, and are important drivers of EHRS assimilation. We use survey data from 206 physician practices, spread across the United States, to test our theoretical model. Results suggest that physician community identity reinforcement and physician community identity deterioration directly influence the assimilation of EHRS. We further find that the effects of careprovider identity reinforcement and careprovider identity deterioration on EHRS assimilation are moderated by governmental influence. Theoretical and pragmatic implications of the findings are discussed.