BACKGROUND/RATIONALE:
VA is committed to providing electronic patient-facing resources, including mobile applications, tele-health, and MyHealtheVet, and kiosks to support patient-driven care. VHA stakeholders recognize the need to develop a holistic Veteran-centered approach to creating useful and user-friendly health information technology (HIT). This study was unique in its use of participatory research methods to complement operational efforts to implement HIT that is Veteran-centric, easy to use, and useful for user groups.

OBJECTIVE(S):
The aims were to: (1) Explore older Veterans with co-morbid conditions preferences using HIT resources; (2) Develop a HIT Digital Health Matrix Model with Veteran and Stakeholder Panel Member input; (3) Develop visual modeling simulations with VA Human factors team based on Veteran input; and (4) Complete Pairwise Comparisons with Veterans and Stakeholder Panel Members to understand why and how Veterans can use electronic resources to complete health related tasks.

METHODS:
This prospective descriptive study design included focus groups using participatory methods, in which Veterans participated as "expert informants." Snowball method used to invite VA stakeholder members to participate in an expert panel. The methods of analysis included descriptive content analysis, rank analysis and descriptive statistics, including frequencies and distributions.

FINDINGS/RESULTS:
The majority of participants (N=48) were older white males with an average age of 64 years, with an average of six conditions. Veterans were grouped by three primary conditions: (1) COPD/HBP/Diabetes; (2) mental health; and (3) women's health. Typical among HIT users, participants tended to have higher levels of education, socio-economic status, and health literacy.
Veteran Focus Group Round 1 Findings: Themes surfaced from the qualitative analysis including issues related to the current VA system and preferences for the VA system in the future. Participants provided feedback about their preferences for using electronic resources to complete health management tasks, including barriers and facilitators. Veterans reported a need, and made suggestions, to increase standardization, synchronization, and integration, as well as increased function and efficiency.
Visual Modeling Simulations: Data informed the development of visual modeling simulations for all major VA electronic resources.
Veteran Focus Group Round 2: Overall, Veterans felt the simulations reflected their preferences. Veterans overwhelming expressed positivity about function, synchronization and integration, including the idea of a one stop shop; full access; tracking & alerts; and improved communication. Veterans reported preferred methods, including a variety of mediums, to receive education and information about electronic resources.
HIT Digital Health Matrix Model: Provides a blueprint of currently available and future VA electronic resources, their features, availability and conditions for use, including an inventory of descriptions and details relevant to access, function, preferences, barriers, relevant tasks, etc.
Pairwise Comparisons: Data suggest there is no one resource that is best used for health task management. A full range of options is needed - preferences can change based on individual and/or situation.
Major Conclusions: Veterans value HIT and want to use it to manage their health conditions. Veterans value concepts of integration, synchronization, and standardization. Veterans want to expand new technology uses such as texting, FaceTime, etc. Veterans have concerns about security and delegation, particularly those with mental health conditions. Veterans want education to support their uptake of HIT.

IMPACT:
This partnered research addressed the priorities of the VA Blueprint for Excellence, QUERI and the Office of Informatics and Analytics. This project leveraged a timely opportunity to collaborate with operational efforts to support Veterans' sustained use of HIT resources. Products developed through participatory methods included: (1) Digital Health Matrix Decision Model of available and emerging VA HIT and contexts for use; (2) Data informing older Veterans' with co-morbid conditions preferences for using VA HIT; and (3) Visual modeling prototypes of patient-facing electronic interfaces. This research supports development of Veteran-centric digital health resources that are useful and easy to use.

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External Links for this Project

NIH Reporter

Grant Number: I21HX001209-01A1
Link: https://reporter.nih.gov/project-details/8604188

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PUBLICATIONS:

Journal Articles

1. Haun JN, Chavez M, Nazi KM, Antinori N. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach. Journal of medical Internet research. 2016 Oct 6; 18(10):e266. [view]
2. Haun JN, Chavez M, Nazi K, Antinori N, Melillo C, Cotner BA, Hathaway W, Cook A, Wilck N, Noonan A. Veterans' Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations. Journal of medical Internet research. 2017 Oct 23; 19(10):e359. [view]

Conference Presentations

1. Haun JN, Nazi KM, Chavez MA, Lind JD, Antinori N. A Veteran-centered participatory approach to designing and enhancing integrated digital health services. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA. [view]

DRA: Aging, Older Veterans' Health and Care
DRE: Prevention
Keywords: none
MeSH Terms: none