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Patient portals (PPs) are robust health IT programs that engage and empower patients in their care. Although PPs can benefit older adults who manage chronic conditions, their use of PPs have been largely overlooked and little training has been provided to them. Previously, our research team developed an older-adult-friendly Theory-based PP eLearning Program (T-PeP) and tested its impact on older adults with chronic conditions. As part of T-PeP, participants used discussion forums. The aim of this study was to explore older adults’ experiences with using PPs, perceived impact of PP on their health, and suggestions for improvement through analysis of discussion posts. A total of 205 posts were subjected to content analysis. Findings from 10 major themes explained older adults’ experiences with PPs and offered suggestions for vendors and healthcare organizations. As U.S. population is aging, older adults must be considered during the development and implementation of health IT programs.

Introduction - Cancer survivors may have physical, psychological, social, spiritual, and financial challenges that require coordinated, comprehensive care. Patient involvement programs that focus on education and health promotion help survivors to manage their symptoms and take better control of their total health. At the University of Maryland, a collaborative group developed the Cancer Survivorship Patient Engagement Toolkit (CaS-PET) which includes survivorship care plans, education on health topics, discussion boards, and ongoing communication between providers and patients using a patient portal. A study was performed to test the feasibility and preliminary impact of the CaS-PET program. Methods - After IRB approval, 30 cancer survivors at the University of Maryland Marlene and Stuart Greenebaum Comprehensive Cancer Center who were within 6 months of completion of active treatment were enrolled in a prospective pilot study of the CaS-PET that used a single group pre-post (3 month) design. The outcome measures included changes in quality of life, fear of recurrence, impact of cancer, dietary and exercise behaviors, and selected cancer symptoms. Participants’ demographic characteristics, internet/patient portal experience, and eHealth literacy was collected at baseline. Results - Among the 30 total participants, 15 (50%) were breast cancer survivors. Of the breast cancer participants, the median age was 57.2±13 years, 66.7% (n=10) were African American, and all were female. 13/15 (86%) participants completed the program and post questionnaires. After the CaS-PET program, participants had improved adherence to treatment (p=0.019), fruit and vegetable consumption (p=0.039), and trend to improved physical activity score (p=0.069). Tests related to psychosocial aspects of health did not show improvement. PrePostTest StatisticP valueAdherence to treatment25.223.2t=-2.7670.019Fruit and veg consumption9.712.4t=2.3110.039Physical Activity total MET5.16.7t=1.9950.069Global distress index0.90.9t=0.1890.853Fear of recurrence15.016.4t=0.8060.435 Discussion - The Cancer Survivorship Patient Engagement Toolkit (CaS-PET) was successfully administered to breast cancer survivors. Improvements in adherence, diet, and a trend towards improved physical activity were noted at the 3 month time point. While measured changes in fear of recurrence, impact of cancer, and symptom burden did not show significant changes, patients reported to investigators positive experiences from the program. Further longitudinal designed studies are needed with a larger sample and across different age groups. Citation Format: Paula Rosenblatt, Lindsey Hertsenberg, Hyojin Son, Mary McQuaige, Kenneth Miller, Eun Shim Nahm. Use of cancer survivorship patient engagement toolkit (CaS-PET) in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-11.

Cancer is a disease that predominantly affects older adults. The median age at diagnosis is 66 years and 62% of the 15.5 million American cancer survivors are age ≥65 years. Provision of supportive care after treatment is critical to this group due to their complex care needs; however, limited resources are available to them. As increasing numbers of older survivors adopt technology, digital health programs have significant potential to help them improve their health and communicate with their providers. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit program for older adults, CaS-PET Silver. The aim was to examine the preliminary impact of CaS-PET Silver on older survivors’ health outcomes. This was a 2-armed RCT with two observations (baseline, 8 weeks) on a sample of 60 survivors age ≥65 years (mean age, 70.1±3.8), who were treated with curative intent within 12 months from enrollment (02/2020-01/2022, COVID-19 pandemic). Outcomes included health-related quality of life (HRQoL), self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. The majority of participants were black (68.3%, n=41) and female (56.6%, n=34). At 8 weeks, CaS-PET Silver group showed significantly improved physical HRQoL (p < .001, ES=0.64) and symptom burden (p=.053, ES= -0.41). Self-efficacy (ES=0.56), mental HRQoL (ES=0.26), and communication (ES=0.40) showed a tendency to improve. Most participants reported benefits from the program on health management (mean, 19.41±2.6 [3–21]). Further research is needed with larger, diverse older cancer populations.

Objectives To evaluate an interactive electronic Cancer Survivorship Patient Engagement Toolkit (CaS-PET) using a single-group pre-/post-test design. Sample & setting 30 cancer survivors with a mean age of 56.5 years (SD = 13.6) were recruited from the University of Maryland Medical Center in Baltimore. Methods & variables CaS-PET was designed to deliver survivorship care plans (SCPs) with multifactorial support and comprised of SCPs, biweekly follow-up using patient portal e-messages, and online resources. Outcomes included health-related quality of life, symptom burden, impact of cancer, fear of recurrence, physical activities, dietary behavior, patient-provider communication, adherence to treatment, and e-health literacy. Results At three months, there was a significant improvement in quality of life, physical symptom burden, and total symptom burden. Implications for nursing Findings suggest an excellent potential for using CaS-PET for survivors who are in transition from treatment to survivorship.

BACKGROUND Intervention studies are used widely in nursing research to explore the efficacy of intervention programs for changing targeted health outcomes. However, the analyses of such studies have focused predominantly on their main intervention effects; most studies ignore the mechanisms underlying how the intervention programs work partly because of lack of application details of the longitudinal mediation analysis techniques. OBJECTIVES The aim of this study was to illustrate an application of parallel process latent growth curve modeling (PP-LGCM) to examine longitudinal moderated mediation effects. METHODS Longitudinal data from an online bone health intervention study were used to demonstrate the step-by-step application of PP-LGCM with Mplus statistical software. RESULTS With modification indices, we were able to achieve adequate model fit for PP-LGCM in our data. The mediation effects of self-efficacy on the intervention effects on exercise were nonsignificant for the entire sample. However, the conditional indirect effect showed the mediation effects were moderated by age group. DISCUSSION PP-LGCM provides an efficient way to analyze and explain the underlying mechanisms for the intervention effects in a trial, especially when the intervention program is guided by a theory.

The National Academy of Medicine's The Future of Nursing 2020–2030 recommends the expansion of the role of nurses throughout the continuum of health care in an effort to improve the health of the nation while decreasing costs. To accomplish this goal, nursing students and nurses must be well prepared to perform at their highest capacity to meet health care demands. Currently the U.S. health care delivery system is undergoing rapid changes that affect approaches to delivering care services. These changes call for education and practice reforms in nursing. This article introduces an innovative academic-practice partnership model (the University of Maryland Nursing [UMNursing] Care Coordination Implementation Collaborative), including its background, development, and blueprint for a large implementation project. The implementation model integrates nursing education and practice in areas of care co-ordination and population health, which have a significant impact on the Triple Aim of health. The project also uniquely integrates education, practice, and research, with the ultimate outcome of higher quality patient care.

Purpose The aim of this study was to test a modified version of the Technology Acceptance Model, which describes users' technology adoption, to examine the relations between patient portal use and potential influencing factors in adult patients who have used patient portals. The modified model posits that patient portal use can be explained by attitude and self-efficacy for using patient portals, perceived usefulness and ease of use, data privacy and security concerns, eHealth literacy, education level, and age. Design A cross-sectional anonymous online survey was conducted for adult patients who had used their patient portals in the past 12 months. Methods Participants were recruited from 20 settings selected in a large integrated health care system. Data from 743 patients were subject to structural equation modeling for model testing. Findings Sixty-eight percent were White and female, with a mean age of 53.1 years (SD = 15.34). Forty-seven percent used patient portals about monthly or more frequently. Scores for perceived usefulness and ease of use of patient portals were relatively high (as measured using the modified Perceived Health Web Site Usability Questionnaire; each item mean, 6.0-6.2; range, 1-7). The final model adequately fit the data (comparative fit index = .983, standardized root mean square residual = .064, root mean square error of approximation = .059). Patient portal self-efficacy and data privacy and security concerns had a direct impact on patient portal use. Perceived usefulness and ease of use, eHealth literacy, education level, and age indirectly influenced patient portal use. Conclusions This study contributes to expanding a theoretical understanding of adult patients' patient portal use in a real health care environment. Future studies need to include more diverse populations in various settings. Clinical relevance Knowledge gained from this study can be used by technology experts to make patient portals more user friendly and by administrators to implement patient portals more effectively.

The US healthcare system is moving into a new era of value-based care, which focuses on delivering safer and higher quality care while reducing costs. Health information exchange (HIE) has been a vital component in this process; however, there has been a lack of awareness and use of HIE among nurse leaders, clinicians, and researchers. The purpose of this article is to provide nurses and administrators with a brief overview of HIE and its impact on care delivery, as well as practical applications using specific case examples.

The passage of the Affordable Care Act shifted the focus of health care from individual, patient specific, episodic care, towards health management of groups of people with an emphasis on primary and preventive care. Population health management assists to attain and maintain health while improving quality and lowering costs. The recent Catalyst for Change report creates an urgent call for harnessing the power of nurses—in our communities, schools, businesses, homes and hospitals—to build capacity for population health. Informatics Nurse Specialists are prepared to bridge roles across practice, research, education, and policy to support this call. Each year, the AMIA Nursing Informatics Working Group convenes an expert panel to reflect on the “hot topics” of interest to nursing. Not surprisingly, the 2017 topic was on the current state and challenges of population health. The following summary reflects the panel’s perspectives and recommendations for action.

Older adults can benefit from using patient portals. Little is known whether the perceptions and use of patient portals differ among diverse older adult populations. The aim of this study was to assess the difference in perceived usability of patient portals, self-efficacy for using patient portals, and patient portal use between two adult samples aged 65 years or older. One sample was recruited from a health care system, including hospitals and clinics (n = 174), and the other sample was recruited from nationwide communities (n = 126). Conducting a secondary data analysis using two survey datasets, this study performed a series of linear and ordinal logistic regression analyses. The health care system sample had a higher mean number of chronic diseases and proportion of recent hospitalization than the community sample. The health care system sample showed higher perceived usability, self-efficacy, and usage frequency of patient portals compared to the community sample. eHealth literacy was a significant predictor of perceived usability and self-efficacy. Perceived usability was another significant predictor of self-efficacy. Self-efficacy and health condition variables significantly predicted the more frequent use of patient portals. Compared to the health care system sample, the relationship between perceived usability and use of patient portals was stronger and significant in the community sample. These findings suggest that approaches for promoting patient portal use should consider personal characteristics and health conditions of diverse older adult populations. Future research needs to focus on assessing the impact of using patient portals on older adults’ health care outcomes.

Introduction Adolescent obesity is one of the most serious global public health challenges. Social networking sites are currently popular among adolescents. Therefore, the obesity prevention program for Korean American adolescents was developed on the most popular social networking site, Facebook. The purpose of this study was to evaluate the usability of a culturally tailored Facebook-based obesity prevention program for Korean American adolescents (Healthy Teens). Method An explorative descriptive design of usability testing was used. Usability testing employing one-on-one observation, the think-aloud method, audio taping, screen activity capture, and surveys was performed. Twenty participants were recruited from two Korean language schools (mean age, 15.40 ± 1.50 years). Recruitment and user testing was performed between February and April 2014. Content analysis, using the inductive coding approach, was performed by three coders to analyze transcriptions. Descriptive statistics were used to analyze quantitative data including demographic characteristics, perceived usability, eHealth literacy, and health behaviors. Results Testing revealed several usability issues in content, appearance, and navigation. Participants' comments regarding content were positive. Although the Facebook platform provided limited flexibility with respect to building the site, participants described the program's appearance as appropriate. Most participants did not experience difficulty in navigating the program. Discussion Our preliminary findings indicated that participants perceived the Healthy Teens program as usable and useful. This program could be used as a robust platform for the delivery of health education to adolescents. Further research is required to assess the effects of Facebook-based programs on adolescent obesity prevention.

BACKGROUND Veterans are prone to bone-related illnesses due to multiple risk factors such as prior injuries. The aim of this study was to compare trends in osteoporosis preventive practices between veteran and nonveteran older adults. METHODS This was a secondary data analysis using selected baseline data and discussion postings from an online bone health trial including participants (N = 866) recruited from My HealtheVet (MHV) and SeniorNet (SN). Data were analyzed using descriptive statistics, parametric statistics, and content analysis. FINDINGS Overall, MHV participants were younger and included more men than SN participants. However, they reported higher rates of bone health issues, spent less time exercising, took fewer calcium and vitamin D supplements, and were less likely to discuss bone health with their care providers. More MHV participants discussed pain and disability as barriers to bone health behaviors and fear of deteriorating health as motivators. In addition, more MHV participants found that participating in the original study was helpful for changing health behaviors. CONCLUSION Overall, the findings suggest a disparity in bone health between veterans and nonveterans and a significant potential for using eHealth programs for veterans.

Introduction: The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods: A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results: The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion: The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples.

The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million older adults have at least one chronic illness. Although patient portals (PPs), a federally supported health information technology, have been shown to be effective in managing chronic illnesses, low PP adoption rates in older adults were addressed as a particular concern. Lack of support for older adults using PPs remains a critical gap in most implementation processes. Previously, our research team developed and pilot-tested 3-week Theory-based Patient portal eLearning Program (T-PeP) for older adults. The main aim of the study was to assess the impact of T-PeP on PP knowledge, selected health outcomes (self-efficacy for PP use and health decision-making and health communication) and PP use in older adults. A two-arm RCT was conducted with older adults (N=272) who have chronic conditions. Participants were recruited online and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. The average age of participants was 70.0 + 8.5 years and 78.3% (n=213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes, except PP use. At 4 months, the intervention effects decreased, but PP self-efficacy remained significant (p=.006) and PP use showed a significant increase in the intervention group (p=.029). Further studies are needed to test the long-term effects of T-PeP on health behaviors and clinical outcomes using more diverse samples.

Stroke is a significant health issue with devastating consequences among older adults in the United States. However, it can be prevented by improving stroke knowledge and managing risk factors. Many stroke education programs have been shown to be effective. Unfortunately, a minority of older adults, such as older Korean Americans, have not benefited from the programs because of language barriers.The purpose of this study was to examine the feasibility and preliminary impact of a primary stroke prevention program on stroke knowledge, healthy eating, and physical activity behaviors among Korean Americans.A randomized controlled pilot trial was conducted. A total of 73 persons were randomly assigned to either an intervention group (n = 37) or a control group (n = 36). The intervention program included in-person lectures and discussions. Sociodemographic data were analyzed using descriptive statistics. Analyses of covariance and logistic regression analysis were used to evaluate the effects of the intervention program.The mean age of participants was 71.49 ± 6.25 years, and most participants were female (74.0%) and married (65.8%). Upon intervention completion, the intervention group showed greater improvements than the control group in stroke knowledge and intake of sodium and total fats (F = 11.89, P = .001, ηp = 0.151; F = 4.04, P = .048, ηp = 0.057; and F = 4.51, P = .037,= ηp = 0.062, respectively). Step counts showed marginal effects (F = 3.27, P = .075, ηp = 0.049).This study demonstrated feasibility and effectiveness of the program to improve stroke knowledge and healthy behaviors in elderly Korean Americans.

Patient portals can be beneficial for older adults who manage their own health. However, there is a lack of research on older adults' experience using patient portals in the community. The aim of this study was to assess older adults' perceived usability of patient portals they currently use. This was a secondary data analysis using selected baseline data from an online trial that tested the effects of a 3-week Theory-Based Patient Portal eLearning Program, and included 272 older adults recruited online. Data were analyzed using descriptive statistics and content analysis. Most participants owned patient portal accounts (n = 194 [71.3%]). Self-efficacy for using patient portals was relatively low (mean, 27.1; range, 0-40), and perceived usability of patient portals was also low (mean, 28.7; range, 6-42). The most-favored features of patient portals were review of medical information and eMessaging. The main difficulties in using patient portals were associated with login/access and specific portal functions. Managing multiple patient portals was a particular challenge for many participants. Findings from this study indicate the importance of providing proper levels of training and technical support to older adults to maximize use and improve outcomes of patient portal implementation.

Patient portals (PPs), secure websites that allow patients to access their electronic health records and other health tools, can benefit older adults managing chronic conditions. However, studies have shown a lack of PP use in older adults. Little is known about the way they use PPs in community settings and specific challenges they encounter. The aim of this study was to examine the current state of PP use in older adults, employing baseline data (quantitative and qualitative) from an ongoing nationwide online trial. The dataset includes 272 older adults (mean age, 70.0 years [50-92]) with chronic conditions. Findings showed that the majority of participants (71.3%) were using one or more PPs, but in limited ways. Their comments revealed practical difficulties with managing PPs, perceived benefits, and suggestions for improvement. Further studies with different older adult groups (e.g., clinic patients) will help develop and disseminate more usable PPs for these individuals.

Aims The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment. Background Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient. Design A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities. Methods Eating performance was conceptualized using the single self-care ‘feeding’ item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance. Results Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance, agitation and depression, compromised eating performance was associated with severe cognitive impairment and low physical capability. Conclusion This study supported the association of eating performance with cognitive impairment and physical capability among long-term care residents with moderate-to-severe cognitive impairment. Targeted interventions should be implemented to reduce the impact of cognitive decline on eating performance and promote physical capability to optimize eating performance. Future work need to use validated multiple-item measures for eating performance and test the association of personal and environmental factors with eating performance among a larger heterogeneous group of long-term care residents to enhance understanding of the factors.

Background Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. Objective To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC). Methods A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, and intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Results Eleven intervention studies (five randomized controlled trials [RCTs]) were identified, and classified into four types: training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate (four studies were rated as strong, four moderate, and three weak in quality), with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. Linking evidence to action This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance.

This performance improvement (PI) project was conducted to recommend improvements for pain reassessment workflow and policies at a large military primary care clinic. The Joint Commission survey identified inconsistent pain reassessment practices at the facility in 2012. A review of the literature reveals that pain reassessment procedures can be affected by unclear organizational policies, poorly designed documentation procedures, and redundant or inefficient workflow practices. This PI project was designed to assess pain reassessment compliance rates, associated documentation, and clinic workflow, and to identify opportunities for improvement.Pain reassessment compliance was evaluated using an Electronic Medical Record (EMR) query for patients treated between February 1 and May 30, 2013, who received Toradol at a large military outpatient clinic (n = 151). In addition, observations of clinic workflow were conducted using tracer methodology as recommended by The Joint Commission to track a convenience sample of 12 patients moving through clinic care processes. Pain reassessment documentation and workflow procedures were then evaluated using the Situation Awareness (SA) framework, which is an approach used to evaluate operational implications of factors affecting staff decisions and performance (e.g., stress and workload, interface design, automation, complexity of workflow, staff abilities and training, goals and expectations).The EMR review revealed compliance rates greater than 90% for all pain reassessment requirements with the exception of the maximum 30-minute interval between initial and follow-up pain assessment required by clinic policy, which had a compliance rate of 38%. Pain reassessments were documented to occur at a mean time of 48.25 minutes after initial assessment. During the tracer, none of the 12 patient encounters was fully compliant with clinic policies. An analysis of clinic workflow using the SA framework revealed that the SA of clinic staff was impacted by a lack of standardized procedures and heavy reliance on staff memory.Recommendations for improvement included possible extension of the 30-minute time requirement, development of a template for pain reassessment documentation in the EMR, standardizing hand off and admission/discharge processes, and designing an electronic or manual dashboard to indicate pain reassessment times. Future PI projects in other military clinics would benefit from use of the SA perspective to review clinic policies, EMR documentation, and workflow analysis. Further analysis will be needed to evaluate the impact of these improvements.

PURPOSE:: The purpose of this study was to test a model delineating the factors known to influence fear of falling and exercise behavior among older adults. DESIGN AND METHODS:: This was a secondary data analysis using baseline data from the Bone Health study. A total of 866 individuals from two online communities participated in the study: 161 (18.6%) were from SeniorNet and 683 (78.9%) were from MyHealtheVet. More than half (63%) of the participants were male with a mean age of 62.8 (SD = 8.5) years. The majority was White (89%) and married (53%) and had some college education (87%). RESULTS:: Knowledge about osteoporosis and awareness one has a diagnosis of osteoporosis directly influenced fear of falling, and knowledge of osteoporosis directly and indirectly influenced exercise behavior. A diagnosis of osteoporosis indirectly influenced exercise behavior. Taken together, the hypothesized model explained 13% of the variance in exercise behavior. IMPLICATIONS:: Improving knowledge of osteoporosis and awareness of having a diagnosis of osteoporosis, decreasing fear of falling, and strengthening self-efficacy and outcome expectations for exercise may help improve exercise behavior among older adults. Language: en

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.

This secondary data analyses of a longitudinal study assessed whether self-efficacy for exercise (SEE) mediated online intervention effects on exercise among older adults and whether age (50−64 vs. ≥65 years) moderated the mediation. Data were from an online bone health intervention study. Eight hundred sixty-six older adults (≥50 years) were randomized to three arms: Bone Power (n = 301), Bone Power Plus (n = 302), or Control (n = 263). Parallel process latent growth curve modeling (LGCM) was used to jointly model growths in SEE and in exercise and to assess the mediating effect of SEE on the effect of intervention on exercise. SEE was a significant mediator in 50- to 64-year-old adults (0.061, 95 BCI: 0.011, 0.163) but not in the ≥65 age group (−0.004, 95% BCI: −0.047, 0.025). Promotion of SEE is critical to improve exercise among 50- to 64-year-olds.

Recently, there have been national efforts to use patient portals (PPs) to engage patients in their care. Through PPs, patient can access their health records and communicate with care providers. These functions can be beneficial for older adults who manage multiple chronic conditions. The current nationwide PP implementation, however, lacks strategies for facilitating PP use in older adults. As a first step to fill this gap, this study examined the prevalence of PP use among older adults, the demographic characteristics of older adult PP users, and self-efficacy for using PPs using three samples (two national, one local). Findings suggest that older adult online users are receptive to PPs and can use them like other age groups. Approaches to engage older adults in PP use may differ from those for younger adults, as they have additional support needs. Further research is needed to identify optimal approaches to support older adult populations.

American nurses (3.06 million) are at high risk for being overweight, as the majority are post-menopausal women (93.3% female; mean age 47). Studies have indicated that more than half of all nurses are either overweight or obese. This fact is of concern because nurses often lead major health promotion efforts. The aim of this study was to examine the feasibility of a novel participant-centered weight management program (PCWM) among nurses. The participant-centered (P-C) theoretical framework used originated from the field of usability engineering (i.e., user-centered design). Study methods included a single group pre-test/post-test design (baseline, eight weeks, three months) and an intervention consisting of face-to-face education sessions, technology-augmented exercise programs, and an eHealth portal. The results demonstrated a significant decrease in body weight, increased fruit and vegetable consumption, and increased exercise at eight weeks. In our discussion of this study, we note that although the intervention effects decreased at three months, these results are promising, considering that the intervention used was not regimented and relied only on nurses’ activation of their planned health behaviors. The major limitation of the study was the small sample size recruited from one large community hospital. Further research is needed to improve the sustainability of the program.

BACKGROUND Hip fracture is a serious injury for older adults, usually requiring surgical repair and extensive therapy. Informal caregivers can help older adults make a successful recovery by encouraging them to adhere to the therapy plans and improve their health behaviors. Few resources, however, are available for these caregivers to learn about how to assist their care receivers and cope with their unique caregiving situations. OBJECTIVE The study aims were to develop a comprehensive theory-based online hip fracture resource center (OHRC) for caregivers, Caring for Caregivers, and conducted a feasibility trial. METHODS The OHRC included self-learning modules, discussion boards, Ask the Experts, and a virtual library. The feasibility of the intervention was assessed by usage and usability. The feasibility of the future trial was tested using a one-group pre-post design on 36 caregiver-care receiver dyads recruited from six hospitals. The caregivers used the OHRC for 8 weeks. The impact of the intervention was assessed on both caregivers (primary) and care receivers (secondary). The data were analyzed by descriptive statistics, paired t tests, and content analyses. RESULTS On average, caregivers reviewed five modules and used the discussion board 3.1 times. The mean perceived usability score for the OHRC was 74.04 ± 7.26 (range, 12-84). Exposure to the OHRC significantly improved caregivers' knowledge about the care of hip fracture patients (t = 3.17, p = .004) and eHealth literacy (t = 2.43, p = .002). Changes in other caregiver outcomes (e.g., strain, coping, and social support) and care receiver outcomes (e.g., self-efficacy for exercise and osteoporosis medication adherence) were favorable but not significant. DISCUSSION The findings suggest that the OHRC was user-friendly and could be beneficial for caregivers. Additional larger-scale trials are needed to assess the effectiveness of the intervention on outcomes.

An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associated fractures. Although several interventions have been shown to be effective in preventing osteoporosis, their impact on bone health among older adults was limited. The aim of this study was, therefore, to examine the effects of a theory-based online bone health program (Bone Power program) for a large number of older adults. The 8-week program included learning modules, discussion boards, and other resources. Participants ( N = 866; M age = 62.5 years) were recruited online and randomized into a Bone Power or control group. At the end of the intervention, the Bone Power group showed significantly greater improvement over the control group in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise, and calcium intake and exercise behaviors. This study’s findings suggest that online health programs can be effective in improving older adults’ knowledge, beliefs, and health behaviors.

Hip fracture, a significant health issue for older adults, is an acute event in which older adults can recover their prefracture functional abilities. The recovery phase is often difficult for older adults, and the role of informal caregivers is particularly important. The aim of this qualitative study was to explore informal caregivers' experiences with providing care to older adults over the first 6-month trajectory of hip fracture recovery and their support needs. Participants ( N = 10) were interviewed twice at 0–2 and 5–6 months. Analyses of the verbatim transcripts revealed multiple shared themes. Some themes were consistent across phases, such as hip fracture as a turning point toward a frailer state, feeling tired, frustration with communication issues in health care delivery, and lack of information about caregiving-related activities. Certain themes were phase-specific. For instance, in the early phase, management of hospital bills and transitions between care settings were especially burdensome. The caregiving situation, however, was viewed as an opportunity to spend more time with their loved ones. Findings from this study revealed unmet support needs expressed by caregivers of older adult hip fracture patients. Ongoing research and clinical interventions are needed to establish effective methods to empower these caregivers.

Background: In this digital era, eHealth literacy is an essential skill set to leverage health information available online to promote health outcomes. South Korea has an advanced health information technology infrastructure, including widespread use of the internet and mobile phones. A few studies have explored eHealth literacy in South Korea using translated versions of the eHEALS; however, they were not fully validated. A unified reliable and valid assessment tool is critical to assess and enhance the eHealth literacy level across the population. Objective: The aim was to develop a Korean version of eHealth Literacy Scale (K-eHEALS) and evaluate its reliability and validity employing healthy young adults in Korea. Methods: The K-eHEALS was developed based on eHEALS, a widely used tool that measures eHealth literacy, and was validated using a sample of 500 young adults recruited from a pool of a Korean internet survey panel. Content validity was assessed using the content validity index (CVI) for individual items and for scale. Construct validity was examined using exploratory factor analysis and hypothesis testing. The Cronbach alpha coefficient was used to determine the internal consistency and the Pearson correlation coefficient was used to evaluable the stability of the measure (n=55). Results: Both individual and scale CVIs were acceptable (individual CVIs>0.67; scale CVI=0.83). Single factors accounting for 50.3% of the variance in the scales were extracted revealing the unidimensional latent structure of K-eHEALS. Hypothesis testing showed significant association between eHealth literacy and hours of internet use per day, supporting the construct validity. Items of the K-eHEALS were internally consistent (Cronbach alpha=.88) and stable over a 1-month period (r=.754, P

Heart failure (HF) is a major public health problem in the United States. Approximately 5 million Americans are living with HF, and each year, 550,000 more are newly diagnosed. With recent, rapidly advancing technologies, many studies have examined the effects of technology-based HF management programs. Most of these studies focused on telemonitoring devices, lacking an aspect to motivate individuals to manage their own illnesses. This exploratory study was conducted to (1) examine the readiness of patients with HF in using an eHealth program that includes both telemonitoring and motivational components (ie, Web learning modules, eCommunication) and (2) assess the specific needs of patients with HF that can be addressed by a future eHealth program. This was a single group descriptive study using a convenience sample. A total of 44 patients with HF (mean age, 72.8 years; range, 55-85 years) were recruited from the pool of enrollees of the Medicare Coordinated Care Demonstration project for HF management that used only a telemonitoring component. Although only 10 participants were users, among 34 nonusers, 17 reported availability of Web access, and 15 reported that they would use the Internet if access and training were available. Overall, confidence for using telemonitoring devices and Web-based health modules was high, with means of 27 (range, 3-30) and 7.6 (range, 1-10), respectively. Confidence for learning health information using Web modules, however, was lower with a mean of 41.5 (range, 8-80). The 2 most highly rated health information needs were research findings (n = 41, 93.2%) and medication (n = 39, 88.6%). Most participants would like to have e-mail communication with healthcare providers. The findings showed the participants' high readiness to use the proposed eHealth program if access and training were provided. This study used a small convenience sample. Further studies are needed with larger, diverse samples.

Web-based health information is particularly important for the increasing number of older adult online users. One strategy to deliver synthesized, evidence-based health information to these individuals is through Web-based learning modules. There is, however, a lack of research in the area of using Web-based learning for older adults. To assess the effects of Web-based health learning modules, older adults’ ability to use the modules must be assessed. This article described the development and testing of the psychometric properties of the Web-Based Learning Self-Efficacy Scale (WBLSES). Initially, the eight-item WBLSES was developed based on an in-depth review of the literature, prior findings, and expert consultation. Preliminary psychometric testing was conducted using a single group descriptive study (N = 33) and the WBLSES was then retested among a larger sample of 221 older adults. The findings supported the reliability of the WBLSES as evidenced by appropriate internal constancy and stability, and the validity through hypothesis testing and Rasch analysis. Further studies are needed using other Web learning programs and more diverse samples.

Background Stroke survivors are at significant risk for recurrent stroke and cardiovascular disease. Inadequately managed modifiable risk factors increase the threat of recurrent stroke, development of new comorbidities, and double the risk of premature mortality. The purpose of this study was to determine the prevalence of modifiable cardiovascular risk factors in stroke survivors who completed a research screening evaluation for entry into exercise rehabilitation studies. The sample collected between January 2001 and June 2005 evaluated 364 community-dwelling men and women aged 34 to 88 years living in Baltimore, Maryland. Methods Each participant’s risk profile was evaluated from data obtained during a medical history and physical examination and from laboratory analysis of a fasting blood sample. Current practice guidelines were used to define risk categories. Results Ninety-nine percent of participants had at least one suboptimally controlled risk factor. Ninety-one percent had two or more concurrent risk factors inadequately treated. Eighty percent of the participants had prehypertension or hypertension, 67% were overweight or obese, 60% had suboptimal low-density lipoprotein, 45% had impaired fasting glucose, 34% had low high-density lipoprotein, and 14% were current smokers, while reportedly receiving routine medical care. Conclusions These findings confirm that cardiovascular risk factors remain inadequately managed in stroke survivors, increasing the chance for repeat stroke and cardiovascular event. Systematic assessment of this vulnerable population is imperative at every healthcare encounter.

The purpose of this study was to test the reliability and validity of the short outcome expectations for exercise (SOEE) and short self-efficacy expectations for exercise (SSEE) scales in a sample of adults recruited into two exercise intervention studies for patients post stroke. A total of 157 individuals, 90 males (56%) and 67 females (43%) with an average age of 63.7 (SD=12.3) years participated in the study. There was evidence of internal consistency for both scales based on alpha coefficients and Rasch Model testing estimates of person and item separability, evidence of test re-test reliability with no change in scores over a 6-week period, and some support of reliability based on R2 estimates. There was evidence of validity of the measures based on confirmatory factor analysis using structural equation modeling and Rasch measurement model testing, and convergent validity testing. There was some evidence of convergent validity based on a statistically significant relationship between selfefficacy and outcome expectations, and both of these measures with physical health status. The study provided some preliminary evidence for the reliability and validity of the SSEE and SOEE when used with adult stroke patients, and suggested revisions for subsequent use of these measures are provided.

Introduction Facebook is the most popular online platform among adolescents and can be an effective medium to deliver health education. Although Korean American (KA) adolescents are at risk of obesity, a culturally tailored health education program is not available for them. Thus, our research team developed a health education program for KA adolescents on Facebook called “Healthy Teens.” The aim of this study was to discuss important lessons learned through the program development process. Method This program includes culturally tailored learning modules about healthy eating and physical activity. The program was developed on the basis of the social cognitive theory, and the online program was developed by applying Web usability principles for adolescents. Upon completion, the usability of the program was assessed using heuristic evaluation. Results The findings from the heuristic evaluation showed that the Healthy Teens program was usable for KA adolescents. Discussion The findings from this study will assist researchers who are planning to build similar Facebook-based health education programs.

Objectives The objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. Design A secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. Participants and Setting Participants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. Measurements Data at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care "feeding" item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single "chair sit-sitting balance" item in the Tinetti Gait and Balance scale, physical capability by Physical Capability Scale, depression by Cornell Scale for Depression in Dementia, and agitation by Cohen-Mansfield Agitation Inventory (short form). Results At baseline, almost one-third (32.2%) of the 199 residents needed help with eating. There was no significant change with regard to eating performance over time in both groups, and no significant treatment by time difference between groups in eating performance ( P = .195). Conclusion Current findings support a need to revise the FFC-CI to better address eating performance. Future work may benefit from a stronger focus on eating performance rather than the more commonly addressed functional tasks, such as bathing, dressing, and ambulation. In addition, the inclusion of a more heterogeneous group of LTC residents with regard to eating performance is needed to test the impact of the revised approach on eating performance.

Background: Stroke is the fourth leading cause of death, and nonfatal stroke is a leading cause of long-term functional disability in the United States. Stroke can be prevented by managing risk factors and improving stroke knowledge. Although many health education programs have been shown to be effective for stroke prevention, those programs may not reach minority populations with a language barrier, such as older Korean Americans (KAs). The purposes of this study were to develop an 8-week theory-based stroke prevention (TBSP) program for older KAs and test its preliminary impact on stroke knowledge, healthy eating, and physical activity behaviors among KAs. Methods: A two-group, pretest-posttest, randomized controlled trial was employed. Using a convenience sampling method, participants were recruited from two senior centers (n = 73, age ≥ 55). Data were collected at baseline and at 8 weeks. The TBSP program included face-to-face lectures and discussion sessions. Descriptive statistics were performed on the sample and variables. A general linear model and logistic regression analysis were used to test the main hypotheses. Results: The majority of participants (n = 54, 74.0%) were female (mean age, 71.49 ± 6.25 years), and 65.8% were married. Thirty-two participants (43.8%) completed greaterthan high school. More than half of participants (n = 40, 55.0%) were engaged in low levels of physical activity (< 600 MET-minutes/wk). Total fat intake was adequate (50.25 ± 22.10 g/day), and sodium intake was high (3861.80 ± 1891.19 mg/day). The intervention group showed greater improvement in stroke knowledge (F = 6.88, p = .011) and physical activity (OR = 11.79, 95% CI = 1.94 - 71.65) and a reduction in total fat intake (F = 8.93, p = .004). There were no significant differences between the two groups for sodium and cholesterol intake or self-efficacy and outcome expectations for physical activity and healthy eating. Conclusion: The findings demonstrated some improvement in stroke knowledge and healthy behaviors after the TBSP program. High sodium intake in this population needs further intervention. More studies are needed with larger, more diverse older KA samples to improve generalizability.