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Information and health literacy: could there be any impact on health decision-making among adults?—evidence from North America

• Review Article
• Published: 17 April 2024

Cite this article

• Lydia Ogbadu-Oladapo   ORCID: orcid.org/0000-0003-2973-9805 1 ,
• Kossi Bissadu   ORCID: orcid.org/0009-0001-9716-0822 1 ,
• Heejun Kim   ORCID: orcid.org/0000-0002-7213-1646 1 &
• Daniella LaShaun Smith   ORCID: orcid.org/0000-0002-9714-3168 1  

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In the era of data and information flood—where misinformation, disinformation, and mal-information are making the rounds—making the right decision can be challenging. Constant evaluation of scientific evidence about the direct and indirect impact of information and health literacy on health decision-making is critical for human well-being. This study aims to gather, assess, and summarize relevant and current research about the impacts of information and health literacy on health-related decision-making in North America.

One hundred twenty-three articles were retrieved, of which 56 were included in the final review. They were reviewed for study characteristics, conclusions, and recommendations. The appraisal revealed that low information and health literacy can impact health decision-making, but low health literacy directly impacts health decision-making more than low information literacy. Other factors influence health decision-making, such as neighborhood, age, numeracy, civil engagement, and health educational programs. However, health and information literacy were the most critical factors impacting health decision-making.

Information literacy and health literacy significantly influence health decision-making among adults. In today’s ever-evolving information landscape, health and information literacy have become indispensable tools for informed decision-making in healthcare, particularly among adults. Investing in health literacy and information literacy for adults, including providing educational programs, is crucial to promoting a healthy lifestyle, ensuring informed healthcare decisions, and safeguarding against misinformation.

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Data Availability

Our data repository can be accessed at https://docs.google.com/spreadsheets/d/1nunWLc-G2R1x5cCyocZfLNw02xE4yc5EWNLeT9e5C1U/edit#gid=1476125642 .

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Ogbadu-Oladapo, L., Bissadu, K., Kim, H. et al. Information and health literacy: could there be any impact on health decision-making among adults?—evidence from North America. J Public Health (Berl.) (2024). https://doi.org/10.1007/s10389-024-02260-9

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Exploring how members of the public access and use health research and information: a scoping review

• Celayne Heaton-Shrestha 1 ,
• Kristin Hanson 1 ,
• Sophia Quirke-McFarlane 2 ,
• Nancy Delaney 3 ,
• Tushna Vandrevala 1 &
• Lindsay Bearne   ORCID: orcid.org/0000-0002-2190-8590 1 , 4  

BMC Public Health volume  23 , Article number:  2179 ( 2023 ) Cite this article

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Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information.

This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information.

Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010–2022 on the public’s access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews.

The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public’s sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of ‘health information’ but a lack of reporting of the general public’s access to and use of health research. It found that ‘traditional’ sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people’s lived experiences, and the cultural knowledge required.

Conclusions

The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.

Peer Review reports

Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes, as knowledge ‘holds the potential to change practice and achieve positive clinical, population and other outcomes, ’ [ 1 ] (p.524). Minimally, ‘high quality information’ may be understood as information grounded in primary research, free from commercial sponsorship and other conflicts of interest [ 2 ]. Additional criteria such as conciseness, simplicity of design, and continued updating may be required by some authorities for research-based information to be considered ‘high quality information’ (e.g. [ 3 ]).

The science of how people access and use health information is not new (e.g. [ 4 ]). However, if the requirement of ‘high quality’ for health information is adopted, that is, that the information be ‘research’ or ‘research-based’, the existing literature presents a number of shortcomings. Firstly, the literature that has examined how research is accessed and used has tended to focus on practitioners and policymakers (e.g. in the emerging field of Research on Research use [ 5 ]), with relatively little attention paid to how members of the public access and use research. Secondly, while a rich literature exists on how the public access and use health information, it has tended to conflate all types of health information – including research evidence and information such as personal records, medication labels and physician’s personal web pages [ 6 ]. Consequently, little is known about how the public accesses and uses high quality health information, and there are no summaries or overviews of this topic.

In this light, a scoping review methodology was deemed appropriate as such reviews are intended to ‘map the literature and provide an overview of evidence, concepts, or studies in a particular field’ and the results may be used to inform priorities for future research on the topic of interest [ 7 ].

Accordingly, this review aimed to systematically search for and describe the research evidence on how members of the public access and use (high quality) health research or information (HRI) relating to human health and healthcare; the reasons for access and use of HRI and the factors that may shape how they access and use HRI. In order to approximate the notion of ‘high quality information’, the review adopted a narrower definition of ‘health information’ than in the broader literature, excluding personal records, product information, and information on establishments providing healthcare.

The review was informed by the Joanna Briggs Institute guidance for conducting scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews [ 8 , 9 ]. The search was conducted in three steps: an initial search of a select number of academic databases (CINAHL plus, MEDLINE and Web of Science) to identify and narrow the range of relevant search terms to inform the final search strategy; an expanded search of academic databases (CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS) with the identified search terms; and manual search of the reference lists of included systematic reviews and meta-analyses. Alongside, experts in the field were consulted to ensure all relevant studies had been included in the retrieved corpus.

This search strategy departed from the current JBI guidance on scoping reviews as neither grey literature nor manual searching of the reference lists of all included studies was conducted, due to resource constraints.

The protocol was registered with the Open Science Forum (registration https://doi.org/10.17605/OSF.IO/RXP39 ) on 16/02/2022.

Data sources

Search terms included subject headings, free text and wild-card terms located in the title or abstract for population of interest (members of the public e.g. general public, public, people, community, lay public, lay person, patient, carer), concept of interest (access to and use of human health research or information. e.g.: access*, utilisation/utilisation, us*, adopt*, uptake, engagement; AND research evidence, research findings, research publications, research articles, research outputs, scientific evidence, scientific findings, scientific articles, scientific publications, scientific knowledge, research, information) and context of interest (e.g. health, healthcare).

The search was limited to studies published between 01–01-2010 and 18–01-2022. This was informed by the rapid changes in communications technologies over the last decade and evidence that most studies on the use in healthcare of social media, a technology able to reach less traditional audiences [ 10 ], were published after 2010 [ 11 ] (Table 1 ). The full electronic search strategy is presented as Supplement 1 .

Study selection

Studies were eligible for inclusion in this review if: they investigated the access and use of HRI by members of the general public from any socio-cultural background, age, gender and ability, and national setting, following any research design, and they were published in the English language in peer-reviewed journals. The inclusion of English language only publications was due to the limited availability of resources for translation.

Access to HRI was defined as the process of finding and obtaining HRI or physically accessing HRI in varied formats. Studies which discussed how information is accessed conceptually only (e.g. National Institute of Health and Care Research (NIHR) [ 12 ]) were not included. HRI use or utilization was defined as what people did with the research or information they had accessed, including how they assessed, applied or adapted the research or information to their needs and context [ 13 ] rather than their intention or stated preference. Studies which discussed ‘access to health information’ where it was clear that by ‘health information’ was meant personal health records, information about physicians, hospitals or medication labelling or similar types of information (personal, product and institutional information) only were not included. Studies in which ‘health information’ included these last types of information as well as research evidence and data for each was presented separately, were included.

Collating, summarising and reporting the results

Records were exported to Proquest® RefWorks for deduplication and then exported to Rayyan (Rayyan https://www.rayyan.ai/ ). Independent (blind) screening of abstract/titles against eligibility criteria was completed by two reviewers [CHS, KH]. The two reviewers initially screened 25 records independently and then conferred to establish common understanding. Each reviewer screened 50% of remaining records and then checked 20% each other’s screening for accuracy. One reviewer [CHS] screened all full-texts against the eligibility criteria, and a second reviewer [KH] checked 5%. Any disagreements were resolved through discussion. A third reviewer was identified as arbitrator, though this was not needed [LB or TV].

A bespoke data extraction tool was developed and piloted on five included studies (See Additional file 1 ). Two reviewers [SQM, CHS] extracted data from included studies, and a third reviewer [ND] checked 10% of the extracted data for accuracy.

Data were extracted on: study characteristics (author/s, date, title, journal, keywords, study type, methodology); population characteristics; reasons/purpose for accessing/using HRI (general interest, specific condition); source of HRI; utilization of accessed HRI; condition/aspect of health or healthcare to which the HRI accessed relates; and factors facilitating access or barriers to accessing the HRI. Data for each category was summarised in table form, accompanied by a narrative.

Figure  1 presents a flow diagram for the scoping review process adapted according to the PRISMA extension for scoping reviews (PRISMA-ScR) statement [ 14 ].

PRISMAScR diagram

Study characteristics

The search produced 4410 records. Following deduplication and title and abstract screening the full text of 234 studies were screened and 130 studies were included in this review (Fig.  1 ).

Two studies investigated access to research by members of the public [ 15 , 16 ]. One hundred and twenty-eight studies investigated access to health information by members of the public (Supplement 2 ).

Eighty included studies (62%) applied a quantitative research methodology [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ], 33 studies (25%) followed a qualitative methodology [ 15 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 ], 13 studies (10%) were mixed- or multi-method studies [ 16 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 ], and four (3%) were reviews [ 138 , 139 , 140 , 141 ].

Fifty-nine included studies were conducted in North America (45%) [ 15 , 17 , 30 , 33 , 34 , 35 , 38 , 39 , 42 , 43 , 46 , 49 , 50 , 51 , 54 , 56 , 60 , 61 , 62 , 66 , 67 , 69 , 71 , 75 , 76 , 78 , 79 , 82 , 83 , 84 , 87 , 88 , 91 , 94 , 95 , 96 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 107 , 108 , 114 , 115 , 116 , 118 , 119 , 120 , 121 , 122 , 124 , 128 , 129 , 136 , 137 ], 18 in Europe (14%) [ 16 , 24 , 26 , 27 , 53 , 57 , 58 , 59 , 74 , 77 , 85 , 86 , 111 , 113 , 117 , 125 , 127 , 142 ], 18 in Asia (14%) [ 19 , 28 , 29 , 48 , 55 , 65 , 68 , 73 , 80 , 81 , 89 , 90 , 97 , 110 , 123 , 132 , 134 , 135 ], 11 in Africa (8%) [ 20 , 25 , 31 , 45 , 52 , 63 , 64 , 72 , 112 , 126 , 130 ], nine in the Middle East (7%) [ 18 , 22 , 23 , 32 , 47 , 93 , 109 , 143 , 144 ], five in Australasia (4%) [ 40 , 41 , 44 , 70 , 133 ] and two in South America (2%) [ 37 , 106 ]. Four studies spanned several continents (3%) [ 21 , 92 , 131 , 139 ] and another four studies did not state any specific geographical location (3%) [ 36 , 138 , 140 , 141 ].

The studies included people with specific health conditions ( n =33) [ 21 , 25 , 26 , 27 , 29 , 31 , 35 , 45 , 51 , 52 , 53 , 66 , 69 , 74 , 78 , 84 , 86 , 90 , 94 , 97 , 99 , 100 , 118 , 125 , 129 , 131 ], hearing or visual impairment ( n =4) [ 22 , 107 , 119 , 133 ], carers ( n = 11) [ 18 , 23 , 37 , 50 , 51 , 91 , 99 , 104 , 109 , 131 , 132 ], the elderly ( n =6) [ 44 , 67 , 72 , 85 , 87 , 134 ], youth or teens ( n =12) [ 32 , 35 , 64 , 67 , 82 , 94 , 119 , 129 , 130 , 135 , 137 , 140 ], minority populations ( n =22) (e.g. ethnic minorities [ 33 , 38 , 39 , 42 , 61 , 75 , 96 , 98 , 101 , 105 , 114 , 115 , 116 , 118 , 122 , 139 ], homeless people [ 60 , 62 ] or refugees [ 41 , 46 , 88 , 111 ], and criminalised individuals [ 102 ]. Twenty-four studies included other populations (e.g. African American breast cancer survivors [ 95 ], members of public libraries [ 143 ], women in Tanzania [ 126 ] a rural community [ 127 ], students in an ESOL class [ 17 , 28 , 34 , 41 , 47 , 60 , 62 , 67 , 70 , 80 , 83 , 93 , 95 , 106 , 110 , 112 , 113 , 117 , 120 , 123 , 124 , 126 , 127 , 145 ]. Eighteen studies were a sample of the general population [ 16 , 19 , 24 , 43 , 48 , 49 , 56 , 58 , 68 , 73 , 77 , 79 , 81 , 92 , 108 , 121 , 128 , 144 ] and sixteen studies did not identify the population [ 15 , 20 , 21 , 30 , 36 , 71 , 76 , 89 , 98 , 103 , 116 , 118 , 136 , 138 , 140 , 141 ]. Some study populations had several of the characteristics listed above.

Access to health research and information by members of the public

Sixty-one studies listed healthcare professionals (including GPs, nurses, allied health professionals, complementary and alternative therapists) as a source of HRI. Sixty studies mentioned informal sources (friends, work colleagues, families and neighbours); and 18 studies mentioned other types of professional advisors, such as pastors, educators, governmental officials or charity sector workers (Table 2 ).

Forty-five studies listed a type of setting (a place or event) as the source of HRI, including medical settings ( n  = 14), formal community settings such as town hall meetings ( n  = 20), formal educational settings ( n  = 5), other educational settings ( n  = 14) such as workshops/lectures, and settings such as bookshops or libraries ( n  = 12) (Table 2 ).

Finally, 83 studies reported on the tools used by members of the public to access HRI. This comprised: mass media ( n  = 51), printed information ( n  = 48) the internet ( n  = 38). Internet sources included social media ( n  = 27); various specialist governmental, non-governmental and personal websites ( n  = 25); and search engines ( n  = 19). Online communities of various types (platform unspecified) were mentioned as a way to access HRI in 13 studies. Other sources mentioned among included studies were scholarly sources such as academic journals, textbooks and encyclopaedias ( n  = 16), phone services and applications ( n  = 13), and marketing materials ( n  = 3) (Table 2 ).

Reasons for accessing and using health research and information

Fifty-six studies reported on reasons for seeking HRI by members of the public. The main reasons for seeking HRI were: (i) to find health-related information for other people and on different topics ( n  = 46); (ii) to navigate the healthcare system, such as preparing for meetings with healthcare professionals (HCPs) and advocating on one’s behalf, making one’s own health decisions, including whether to seek professional help, and sometimes to avoid going to an HCP, and to verify, clarify or add to information received from other sources; to manage one’s own health ( n  = 31); and (iii) to obtain psycho-social support by reading testimonials from other people, gain reassurance and comfort, and to gain a sense of control over the diagnosis, condition or treatment ( n  = 9) (Table 3 ).

Fourteen included studies reported the ways which the HRI accessed was used by members of the public (Table 4 ). Reasons for use included: to improve participants’ own health behaviours and/or ability to manage their health ( n  = 4); to support health-related decision making ( n  = 5); to facilitate or enhance conversations or encounters with HCPs ( n  = 4); to increase people’s own understanding of a health-related topic ( n  = 3); to assess the information from another source ( n  = 2); and to share with or educate others in the context of providing psychosocial support ( n  = 1).

Factors influencing access to and use of health research and information

Barriers to accessing and using health research or information.

Thirty studies reported barriers to accessing and using HRI. The main barriers related to: (i) the source characteristics ( n  = 24); (ii) the characteristics of the person accessing or using HRI ( n  = 12); the nature of the condition for which HRI was desired ( n  = 3). Other barriers such as a fear that seeking information could be distressing, inability to determine the quality of information appeared in seven studies (Table 5 ).

Factors that facilitate accessing and using health research and information

Six studies discussed factors that facilitated members of the public access and use of HRI. Six studies reported factors related to the source of information that facilitated access to HRI. These included ease of access [ 120 , 124 , 142 ], anonymity [ 125 , 142 ], cost [ 142 ], format and language in which HRI was presented [ 117 , 120 ], and quantity and complexity of contents [ 128 ]. Factors facilitating access were: reports that did not use technical terms and acronyms but ‘sound[ed] scientific’ [ 117 ]; on-demand availability of the channel [ 120 , 124 , 142 ]; information that was up-to-date and provided both an outline of the topic and detail [ 128 ].

Factors influencing choice of source of health research and information

Three studies reported the factors that influenced people’s choice of source of HRI. Two studies found that the health condition searched for, and how it was perceived (i.e. trivial or stigmatising) influenced choice of source [ 103 , 115 ]. One study reported that presenting health condition could influence choice [ 125 ]; one study noted that the healthcare provision available to study participants influenced choice of source [ 103 ]; and one study highlighted that patterns of access and use of HRI differed according to when in the patient journey this information was sought, and according to the purpose (for instance, the internet was not considered useful for making health decisions but it was useful for other health-related reasons) [ 115 ].

This scoping review was the first to be conducted with the aim to identify the extent and nature of the research literature on how members of the public access and use high quality health research and information.

The scoping review identified 130 studies that investigated how members of the public accessed HRI. Mass media was the most studied source of information, followed by printed information and the internet. The reasons for members of the public accessing and using HRI included to improve health behaviours, and/or ability to manage their health, to help with health-related decision making, facilitating or enhancing conversations or encounters with healthcare professionals, increasing people’s own understanding of a health-related topic; assessing the information from another source, and sharing with or educating others in the context of providing psychosocial support. The factors that constrained access and use of HRI, related to the source characteristics, the characteristics of the person accessing the HRI and the nature of the condition for which HRI was accessed. Six studies reported on the factors facilitating access and use of HRI, and three studies discussed factors that influenced the choice of one source rather than another.

Health information vs health research

The review identified a substantial literature on broader concept of ‘health information’ but limited reporting of the general public’s utilisation of health research.

Crucially, only two included studies investigated access of health research by members of the public, and none of the included studies explored the use of health research by members of the public. One case study conducted in the USA found that a library of brief podcasts on health research (duration 22 min each) was feasible to co-produce with local community partners and generated user views /engagement over 18 months [ 15 ]. However, this preliminary study, conducted in a single state in the USA, did not specify the number of study participants and their demographics, limiting learnings from the study, as well as the generalisability and transferability of its findings. Another mixed-methods study investigated the relationship between information sources and public trust in health research in two European countries (Italy, Slovakia) [ 16 ]. In this study, traditional media (e.g. television, newspapers) and digital media (e.g. blogs, social networks) were the most widely cited information channels, followed by personal interaction and exchanges (e.g. family, friends, experts, people in authority), echoing the overall results of this scoping review. At ten roundtable discussions participants ( n  = 192) reported obtaining credible health research from a source considered authoritative and competent (e.g. health professionals). The experts provided the information needed to help the individual understand and evaluate complex issues via direct interaction. Taken together, these two studies suggest that the public will engage with health research in diverse ways and that delivery by a source perceived as competent or authoritative may be important to engagement with health research, whatever the medium.

All other included studies centred on the broad concept of ‘health information’. This potentially obscures the interest among the general public in accessing research evidence. For example, 16 included studies reported ‘scholarly/academic sources’ as a source of HRI, potentially indicating direct access to health research by members of the public (Table 2 ). This is supported by a recent mixed-methods study conducted by the UK’s National Institute of Health and Care Research, which found a strong interest among the general public in being able to access research findings [ 12 ]. However, neither the NIHR study nor the majority of studied mentioning scholarly/academic sources provide demographic data or disaggregated demographic data for the participants accessing and using these sources. Furthermore, the two included studies that highlight the use of scholarly sources of HRI and also provide relevant participant data [ 121 , 122 ], suggest that such sources are more prevalent among more educationally privileged groups: in these two studies, up to 90–100% of study participants were college or university educated. It does not follow, however, that only more educated groups tend to access health research through scholarly or academic sources. Indeed, as studies such as Vandrevala et al. (forthcoming) have shown, information access and use is often a social act, with members of the public not only seeking information for themselves but others within their social network. The paucity of research on how members of the public access and use health research evidence, and the use of the umbrella term, ‘health information’, without explicit definition and distinguishing between the types of ‘health information’ sought, may underestimate the extent of access and use of research evidence, among the general public. The issue of paywalls excluding the general public from access to academic or scholarly sources such as journals was not raised in the retrieved literature.

Another issue highlighted by this review concerns the similarities and differences between how the general public and policymakers and practitioners use health research and HRI, respectively, though this will need further exploration. Like practitioners and policymakers, the general public’s uses included conceptual and instrumental uses of HRI [ 5 ]. In addition, the general public used HRI to obtain or provide psychosocial support, a use that was not noted in relation to research use by practitioners and policymakers.

A vast diversity of ways of accessing health research or information

Included studies reported a wide range sources to access HRI, with at least 84 different sources identified, which were classified into three broad categories: ‘other people’, ‘professional settings’ (medical, community or educational places), and ‘independent searches’ (that covered all those tools that people use to do their own ‘research’ to access the information that they need). The review found that, even as interest in the internet and social media as means to access or deliver HRI has increased (e.g. [ 146 , 147 ]), ‘traditional’ sources of information such as mass media or printed material are still relevant. For example, a 2016 survey conducted among Asian American groups in New York City ( n  = 1373), USA, found that the internet was among the least used sources of HRI, with print media being the most used source [ 46 ]. Similarly, a 2021 survey among cancer patients ( n  = 404) in Japan found the most widely used source of HRI to be newspapers, followed by healthcare professionals, and that the internet was used by a small proportion of the patients only [ 65 ]. These examples are not unique, and hint that diversification of means of delivering HRI to support self-care may be a more suitable approach for delivering HRI, though this conclusion is tentative and will need confirmation through a more systematic study and further research.

Communications technology has advanced rapidly in the past decade, notably through the increase in the number of internet platforms and the development of new functionalities so that, for instance, YouTube is no longer just a means to share video material but also features discussion boards. Instagram as a means to access HRI was mentioned in only one study [ 55 ], there was an absence of studies evaluating the role of Tiktok, a popular channel [ 148 ], and social media influencers as ways to deliver HRI (e.g. [ 149 ]), suggesting that this literature is now dated. Equally, podcasts were infrequently mentioned in the included studies, in spite of their growing appeal as a way to disseminate medical knowledge [ 150 ].

In addition, many studies lacked detail. For instance, studies reported ‘online chatrooms’ as a source of information without specifying the platform for the chatroom, whether social media or a specialist health organisation. Some sources of information such as social media were insufficiently distinguished in studies, for example Twitter and Instagram, which tend to favour one or the other format and may therefore appeal to different audiences. Generally, very few included studies considered or reported on the format of the HRI accessed.

Barriers and facilitators to independent searches vs other sources of health research or information

Included studies did not generally explore barriers and facilitators to the use of HRI, or, if they did, they did not report barriers to use separately from barriers to access. This section focuses therefore on barriers to and facilitators of access.

The studies included in this review described a wide range of factors that shaped how the public accessed HRI. These were classified into 16 different factors under four overarching categories that related to personal characteristics, source characteristics and nature of the health condition of interest or presenting and ‘other’ factors.

Relating these to the sources of HRI identified in this review (‘other people’, ‘professional settings’ and ‘independent searches’), included studies provided a detailed understanding of barriers to access and, in particular, barriers to access through independent searches, where major considerations related to how information is presented, namely: the format, the language used, the quantity of information and the level of detail provided. There was no consensus among studies, however, with some identifying as facilitators shorter pieces in simple, non-technical language while others indicated that accessible but ‘scientific-sounding’ (including some level of technical language) and more detailed information facilitated access to HRI.

Only one barrier was identified that related to ‘other people’ as sources of HRI, and that concerned the availability of the source. None of the studies specifically identified barriers relating to ‘professional settings’, though conceivably, features of the setting, including its physical features, may act as a barrier to accessing HRI. One example was provided by a study of people with autism which reported struggling with the physical environment of specialist clinics [ 151 ].

Studies provided a good understanding of the characteristics of the individual seeking information that may act as a barrier to accessing HRI, mainly their possession of specific technical skills (technological, linguistic, information retrieval) and time. However, again, these pertained mostly to independent searches rather than accessing HRI through other sources. No mention was made of the cultural knowledge and skills needed to navigate the professional settings or relationships through which HRI may be accessed, although it is known that lack of familiarity with healthcare systems and its norms can be a barrier to accessing these settings (e.g. [ 152 ]), and therefore, potentially, HRI.

Another factor shaping how people accessed HRI that was seldom investigated in included studies was the role of past experience with healthcare services, either an individual’s own lived experience of these services or that of other members of their community or social network. This was reported in one included study only [ 140 ], and in relation to a specific community (Lesbian, Gay and Bisexual adolescents). This absence is surprising, given the evidence that negative experiences with healthcare provision will impact health behaviours (e.g. [ 153 ]) and that negative experiences in the community will impact information seeking generally (e.g. [ 154 ]).

In a systematic review including 344 studies, Mirzaei et al. [ 6 ] identified a total of 1595 significant ‘predictors of health information seeking behaviours’, (defined as the variables affecting the actions of seeking out information) and classified these into 67 different categories. Although health information seeking behaviour and accessing and using HRI are not identical conceptually, there were parallels between the current scoping review findings and Mirzaei et al.’s [ 6 ] comprehensive typology. In addition, this scoping review built on Mirzaei et al.’s [ 6 ] findings: while Mirzaei et al. [ 6 ] had identified the role of previous exposure to a healthcare source of information as a predictor of health information seeking behaviour, this review identified that past lived experience with healthcare services generally (whether or not it was a source of information) in shaping how members of the public accessed HRI. Given the differences between this scoping review and Mirzaei et al. [ 6 ]’s systematic review, it is not possible to draw firm conclusions regarding influences on accessing different types of health information (Mirzaei et al.’s [ 6 ] definition is broader) or differences across groups (Mirzaei et al. [ 6 ] include the general public as well as healthcare practitioners and healthcare students). This will need further detailed exploration.

Limitations

Due to funding and time constraints this review only included peer-reviewed studies published in English language between 01/01/2010 and 18/01/2022. No grey literature searches or manual searching of the reference lists of included studies were conducted. However, we searched the reference lists of relevant systematic reviews and meta-analysis, and consulted experts in the field to ensure that very few, if any, relevant studies produced during this period had been overlooked. Studies published since January 2022, unpublished studies or studies in other languages, though, will not have been captured.

Limiting the review to English language studies may have influenced in the geographical bias of included literature, with a majority of studies conducted among North American populations. However, evidence indicates that the conclusions of most systematic reviews are not altered through the omission of non-English language studies, and the exclusion of non-English language publications aligns with recommendations from the Cochrane collaboration [ 155 ].

The conclusions from this review were hampered by poor reporting in some included studies particularly the lack of clear definitions for the term ‘health information’. As a result this review may have included studies with a broader definition of ‘health information’, though this is likely to apply in a very small number of cases only.

Implications

This scoping review found a lack of research on research use by members of the public. This absence may not reflect the extent to which the public uses research, given the subset of studies identifying scholarly sources as a means to access HRI by the general public in this review, and the fact that people will often access HRI on others’ behalf in their communities or social networks. This justifies more primary research in this area or a detailed review focusing on this subset, including contacting authors for more information on their study. Research on research access and use by the general public could also usefully explore the differences in access and use between the general public and practitioners and policymakers, for instance, through a systematic review including grey literature and increased number of databases consulted.

The review also identified the need for an update on the barriers in accessing HRI, following the observation that barriers (e.g. cost of internet access) have considerably decreased for some groups in the last decade. More specifically, it highlighted a need to enrich current knowledge of the facilitators of both HRI access and use and barriers to use of HRI, in relation to the following:

The factors shaping access to HRI through ‘other people’ and ‘professional settings’ , with specific attention to features of the setting and the presence or absence of cultural skills to navigate the professional settings where HRI is accessed;

A better understanding of the role of lived experience of individuals or communities with healthcare providers in shaping access to HRI;

A better understanding of person and setting characteristics that facilitate access to HRI

A better understanding generally of the factors shaping how the public uses HRI.

Finally, the literature was found to be dated in relation to the sources of HRI explored, underscoring the need for primary research to update our knowledge of the communications tools currently in use among different populations, and the formats that are now being adopted by social media networking platforms (e.g. Instagram in-feed, stories, and reels; YouTube Community Tab).

This scoping exercise, the first to adopt a narrow definition of health information in an attempt to understand how the public accesses and uses ‘high quality health and care information’, identified major patterns of access and use and also identified gaps in the existing research literature. Major patterns included: the use of a wide diversity of sources to access HRI, with traditional sources still relevant alongside newer sources; access and use for HRI a wide range of reasons, from the conceptual to the psychosocial, both for self and for others. Barriers to use related to how HRI is presented (e.g. language, quantity of information and level of detail) and its availability; the skill, knowledge and time of the person accessing the information, their physical condition and autonomy; and the perception of a health topic or the personal and social implications of searching a given topic. Gaps in the evidence included: a limited number of studies focussing on how members of the public accesses health research and how the public uses health research; the absence of newer (online) sources of HR/I, and the lack of exploration of the features and functionalities of online sources. The review also identified that there is a need for more detailed studies on the factors that shape how the public access HRI through other people and by visiting professional settings. Primary research investigating the factors that shape how the public uses health research and information is also needed, notably, by paying more attention to lived experience of healthcare provision and the cultural knowledge that is required by the public when attempting to access certain sources of health information.

Finally the review found that, given the challenges around reporting and the lack of precise definition of the term ‘information’, identifying how the public accesses and uses high quality information is not straightforward at present. More precise definitions of the term ‘information’, and studies based on these will be needed to find ways for policy-makers to better support self-care and improve health outcomes among the general public.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Healthcare professional or provider

Health information seeking behaviour

Health research or information

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Acknowledgements

The authors would like to acknowledge the funder for making this work possible and colleagues for their feedback on an early presentation of the review’s findings.

This review was funded by a research contract awarded by National Institute for Health and Care Research (NIHR Evidence). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funder has had no role in the design of the protocol nor any role in the conduct of the scoping review.

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LB, TV contributed to the study’s conception; LB, TV, CHS, KH, contributed to the design of the methodology; CHS, KH, SQM, ND contributed to the performance of the search, data extraction and analysis; the first draft of the manuscript and the tables were created by CHS and refined with input from LB, TV and KH. CHS prepared the final draft of the manuscript. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1:, additional file 2: supplementary table 1..

 Search strategy.

Additional file 3: Supplementary table 2.

 List of included studies, showing relevance to scoping review objective and evidence.

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Heaton-Shrestha, C., Hanson, K., Quirke-McFarlane, S. et al. Exploring how members of the public access and use health research and information: a scoping review. BMC Public Health 23 , 2179 (2023). https://doi.org/10.1186/s12889-023-16918-8

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DOI : https://doi.org/10.1186/s12889-023-16918-8

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A systematic literature review of health information systems for healthcare.

1. Introduction

2. material and method, 3. discussion, 3.1. the evolution of health information systems, 3.2. his structural deployment, 3.3. health information systems benefits, 3.4. information system and knowledge management in the healthcare arena, 3.4.1. information system, 3.4.2. knowledge management, 4. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Epizitone, A.; Moyane, S.P.; Agbehadji, I.E. A Systematic Literature Review of Health Information Systems for Healthcare. Healthcare 2023 , 11 , 959. https://doi.org/10.3390/healthcare11070959

Epizitone A, Moyane SP, Agbehadji IE. A Systematic Literature Review of Health Information Systems for Healthcare. Healthcare . 2023; 11(7):959. https://doi.org/10.3390/healthcare11070959

Epizitone, Ayogeboh, Smangele Pretty Moyane, and Israel Edem Agbehadji. 2023. "A Systematic Literature Review of Health Information Systems for Healthcare" Healthcare 11, no. 7: 959. https://doi.org/10.3390/healthcare11070959

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Prevalence of Health Misinformation on Social Media-Challenges and Mitigation Before, During, and Beyond the COVID-19 Pandemic: Scoping Literature Review

Affiliations.

• 1 School of Computing and Communications, The Open University, Milton Keynes, United Kingdom.
• 2 Faculty of Arts and Social Sciences, The Open University, Milton Keynes, United Kingdom.
• 3 School of Physical Sciences, The Open University, Milton Keynes, United Kingdom.
• PMID: 39159456
• DOI: 10.2196/38786

Background: This scoping review accompanies our research study "The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study." It surveys online health misinformation and is intended to provide an understanding of the communication context in which health professionals must operate.

Objective: Our objective was to illustrate the impact of social media in introducing additional sources of misinformation that impact health practitioners' ability to communicate effectively with their patients. In addition, we considered how the level of knowledge of practitioners mitigated the effect of misinformation and additional stress factors associated with dealing with outbreaks, such as the COVID-19 pandemic, that affect communication with patients.

Methods: This study used a 5-step scoping review methodology following Arksey and O'Malley's methodology to map relevant literature published in English between January 2012 and March 2024, focusing on health misinformation on social media platforms. We defined health misinformation as a false or misleading health-related claim that is not based on valid evidence or scientific knowledge. Electronic searches were performed on PubMed, Scopus, Web of Science, and Google Scholar. We included studies on the extent and impact of health misinformation in social media, mitigation strategies, and health practitioners' experiences of confronting health misinformation. Our independent reviewers identified relevant articles for data extraction.

Results: Our review synthesized findings from 70 sources on online health misinformation. It revealed a consensus regarding the significant problem of health misinformation disseminated on social network platforms. While users seek trustworthy sources of health information, they often lack adequate health and digital literacies, which is exacerbated by social and economic inequalities. Cultural contexts influence the reception of such misinformation, and health practitioners may be vulnerable, too. The effectiveness of online mitigation strategies like user correction and automatic detection are complicated by malicious actors and politicization. The role of health practitioners in this context is a challenging one. Although they are still best placed to combat health misinformation, this review identified stressors that create barriers to their abilities to do this well. Investment in health information management at local and global levels could enhance their capacity for effective communication with patients.

Conclusions: This scoping review underscores the significance of addressing online health misinformation, particularly in the postpandemic era. It highlights the necessity for a collaborative global interdisciplinary effort to ensure equitable access to accurate health information, thereby empowering health practitioners to effectively combat the impact of online health misinformation. Academic research will need to be disseminated into the public domain in a way that is accessible to the public. Without equipping populations with health and digital literacies, the prevalence of online health misinformation will continue to pose a threat to global public health efforts.

Keywords: COVID-19; antivaxxers; health misinformation; health professionals; intervention; online health communities; public health; social media; vaccine hesitancy.

©Dhouha Kbaier, Annemarie Kane, Mark McJury, Ian Kenny. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.08.2024.

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Meet Walter J. Koroshetz, M.D., Director of the National Institute of Neurological Disorders and Stroke

Dr. Walter J. Koroshetz, Director of the National Institute on Neurological Disorders and Stroke.

Dr. Walter J. Koroshetz has been fascinated by the brain and how it works from a young age. This curiosity, sparked by a chance encounter with a book on psychiatry, inspired a successful career in neurology and neuroscience. Now he leads the National Institute of Neurological Disorders and Stroke (NINDS), a driving force behind brain research in the United States. Dr. Koroshetz spoke with NIH MedlinePlus Magazine about his passion for the brain, his path to NINDS, and how The Brain Research Through Advancing Innovative Neurotechnologies ® Initiative , or the BRAIN Initiative®, is transforming how we understand the brain.

Tell us about your background and why you decided to study the brain.

I grew up in Brooklyn, New York, and became interested in the brain in eighth or ninth grade. I was curious about why people are so different. I went to the library one rainy day and picked up the biggest book I could see, which was a book on psychiatry. The first chapter was about how cells in the brain communicate through the movement of ions across the membranes that enclose nerve cells. This aspect of biology fascinated me, and I spent years working in membrane biology labs.

Also, my dad got very sick with Guillain-Barré syndrome (a rare and serious condition that affects the nerves causing paralysis). He was in the hospital for about six months. Luckily he made it out. I’m sure that also had something to do with my interest in the brain and nervous system.

You joined NINDS in 2007. How did you get here?

It was very serendipitous. I had been a neurologist and neuroscientist at the Massachusetts General Hospital (MGH) in Boston for 27 years. I was at a point in my career where I was being considered for chair of departments and was offered a couple of positions. I spoke with a friend and colleague who had left MGH to become a chair at another university. It turns out his wife was Story Landis, Ph.D., who was the Director of NINDS at the time. My friend said, “I have a better job for you!” And that was true. I came on as a Deputy Director at NINDS with Dr. Landis, and I’m glad I did. It wasn’t planned, it just happened. ( Editor’s note: Dr. Koroshetz became NINDS Director when Dr. Landis retired in 2014.)

The brain is a unique organ . It is both functional (it controls motor skills, breathing, and other bodily processes) and psychological (it’s responsible for our intellect, memory, personality, and mood). What’s something you wish more people understood about the brain?

There is nothing that we do or experience that doesn't involve our brain. If the brain is not working, behaviors are not going to be normal. Sometimes we are quick to blame the dysfunctional behavior on the person when there is a brain disorder. This can create a great deal of stigma and hinder needed treatment.

There are a lot of disorders where the brain circuits are severely affected. It’s important to understand that these are all disorders whether you can see something under a microscope or not.

"There is nothing that we do or experience that doesn't involve our brain...Sometimes we are quick to blame the dysfunctional behavior on the person when there is a brain disorder."

How does NINDS collaborate with other institutes that deal with the brain, like the National Institute of Mental Health (NIMH), and what sets NINDS apart?

Neuroscience itself is a huge area of focus here at NIH, and it’s funded by different institutes. The National Institute on Aging researches Alzheimer’s disease, and NINDS works with them on that and other neurodegenerative diseases. We also work with the National Institute on Drug Abuse (NIDA). Drugs such as opioids change the circuits in the brain, so addiction is really a brain problem, too. We closely collaborate with NIDA on the Helping to End Addiction Long-term® Initiative , or NIH HEAL Initiative®: We focus on pain, and they work on addiction.

Neurologists think of mental health as neurological disorder without a known cause. These are all brain disorders, but in neurology, we tend to focus on the pathology inside the brain—something you can see under a microscope. However, even in those cases the patient is always suffering from a dysfunctional circuit. In psychiatry, it’s been hard to identify the circuit trouble because there's nothing to see in the brain—it’s not anything you can look at under a microscope.

The problems you see in people who have neurological, mental, and substance misuse disorders happen because something is interrupting the circuit’s development or function. That’s why the BRAIN Initiative is so important. It’s run by multiple institutes but primarily NINDS and NIMH, and it’s focused on understanding how to map, monitor, and modulate (change or alter) circuits in the brain. The BRAIN Initiative is really merging the fields of neurology and psychiatry.

  Dr. Koroshetz (far left) joins other NIH institute directors at the 5th Annual HEAL Initiative Scientific Meeting.

The BRAIN Initiative is now in its 11th year, and you’ve been at NINDS since it started. What would you say are some of the most important findings or discoveries from that initiative?

The BRAIN Initiative was a great idea when the White House first announced it in 2013, but it has really defied all expectations. There have been so many amazing advances.

The biggest breakthrough was being able to barcode and sequence the RNA of individual brain cells. This allowed scientists to identify and categorize different types of cells very quickly and efficiently, which made it possible to create a library of all different cell types in animal and human brains. (A cell type is a way of categorizing the cell based on its specific features and functions in the body).

Next, BRAIN Initiative researchers began analyzing brain tissue of deceased individuals to find unique patterns of gene expression (how genes are turned on and off) in different cell types. This is an unbelievable advance and is being used now to study a host of brain diseases.

Once you know a cell’s type , you can look for changes in its current state . These snapshots tell us how the cell is functioning at a point in time, which can help us find changes associated with a specific disease. For example, looking at a population of dopamine neurons in the brain of someone with Parkinson’s disease and scientists can observe a range of states, or health statuses. You might see some that just died, some that are stressed or dysfunctional and may die soon, and others that are healthy and functional. Being able to see this all at once is a powerful tool for uncovering what's causing these cells to die.

Next, it turns out that you can also identify parts of the genome called “promoters” or “enhancers”, which regulate when, where, and how much a certain gene is expressed. By attaching engineered genes to these promoters and enhancers, we can make changes in specific cell types in a precise manner. In mice, scientists use this method to turn nerve cells on or off (make them fire or stop firing) and change sick cells into healthy ones. The challenge is figuring out how to effectively deliver these treatments to the human brain. The BRAIN Initiative is working on that, too. Together, all of this is going to change how we treat brain diseases.

NINDS is at the forefront of using new technologies to study the brain. What technology are you personally excited about and why?

It’s another tool that came out of the BRAIN Initiative : optogenetics. Scientists can add genes from algae into brain cells, which makes the cells produce proteins that react to light. By shining light on these cells, we can turn them on or off. This allows us to manipulate specific cells within the brain circuit of an animal that’s alert and active. Other genes make the cell light up when it’s active, so we can see which cells fire during a certain behavior.

Every time you do something, cells fire all over the brain because they are interconnected. Before the BRAIN Initiative , scientists used electrodes to study brain activity, but they could only monitor a few neurons during an activity. With these new technologies, we can record millions of neurons at a time.

Currently, these tools are only used in animal research. The next step is to move to using them to understand behaviors in humans.

How could these technologies be used to treat neurological disorders or improve overall health?

Lots of ways. For example, there are areas deep in the brain related to pain. If you stimulate those areas, you take the pain away. Researchers are already using electrical stimulation techniques to treat conditions like Parkinson's disease, depression, and chronic pain. They’re developing a process where you stimulate the brain to make symptoms, like muscle stiffness or tremor, stop. But this technique is not nearly as precise as what we can do with the technologies BRAIN Initiative researchers are currently using in mouse models.

"The real credit goes to the patients I’ve been privileged to care for...and the participants who were involved in the research."

Are there any other aspects of your work that you would like to highlight for people?

The real credit goes to the patients I’ve been privileged to care for throughout my career and the participants who were involved in the research. They’re the ones really doing the work, and they deserve the credit.

At NIH, most of the patient work happens in research studies with thousands of participants. And even with all the advances we have, for every person we save there are still thousands we don't have treatment for. We're still working for them, trying to go one by one. But I think the future is looking a lot brighter.

How do you unwind from work to give your brain a break?

I go to the park with my two-year-old grandchild and help him down the slide. It’s a lot of fun being a two-year-old again.

Brain Research Through Advancing Innovative Neurotechnologies®  Initiative, The BRAIN Initiative®, NIH HEAL Initiative, and Helping to End Addiction Long-term are registered trademarks of the U.S. Department of Health and Human Services.  

August 27, 2024

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Best Exercises for Health and Weight Loss

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What are the mental health benefits of exercise?

Other mental health benefits of exercise, reaping the mental health benefits of exercise is easier than you think, overcoming obstacles to exercise, getting started with exercise when you have a mental health issue.

• Easy ways to move more that don't involve the gym

The Mental Health Benefits of Exercise

You already know that exercise is good for your body. But did you know it can also boost your mood, improve your sleep, and help you deal with depression, anxiety, stress, and more?

Exercise is not just about aerobic capacity and muscle size. Sure, exercise can improve your physical health and your physique, trim your waistline, improve your sex life, and even add years to your life. But that’s not what motivates most people to stay active.

People who exercise regularly tend to do so because it gives them an enormous sense of well-being. They feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives. And it’s also a powerful medicine for many common mental health challenges.

Regular exercise can have a profoundly positive impact on depression, anxiety, and ADHD. It also relieves stress, improves memory, helps you sleep better, and boosts your overall mood. And you don’t have to be a fitness fanatic to reap the benefits. Research indicates that modest amounts of exercise can make a real difference. No matter your age or fitness level, you can learn to use exercise as a powerful tool to deal with mental health problems, improve your energy and outlook, and get more out of life.

Exercise and depression

Studies show that exercise can treat mild to moderate depression as effectively as antidepressant medication—but without the side-effects, of course. As one example, a recent study done by the Harvard T.H. Chan School of Public Health found that running for 15 minutes a day or walking for an hour reduces the risk of major depression by 26%. In addition to relieving depression symptoms , research also shows that maintaining an exercise schedule can prevent you from relapsing.

Exercise is a powerful depression fighter for several reasons. Most importantly, it promotes all kinds of changes in the brain, including neural growth, reduced inflammation, and new activity patterns that promote feelings of calm and well-being. It also releases endorphins, powerful chemicals in your brain that energize your spirits and make you feel good. Finally, exercise can also serve as a distraction, allowing you to find some quiet time to break out of the cycle of negative thoughts that feed depression.

Exercise and anxiety

Exercise is a natural and effective anti-anxiety treatment . It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins. Anything that gets you moving can help, but you’ll get a bigger benefit if you pay attention instead of zoning out.

Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. By adding this mindfulness element—really focusing on your body and how it feels as you exercise—you’ll not only improve your physical condition faster, but you may also be able to interrupt the flow of constant worries running through your head.

Exercise and stress

Ever noticed how your body feels when you’re under stress ? Your muscles may be tense, especially in your face, neck, and shoulders, leaving you with back or neck pain, or painful headaches. You may feel a tightness in your chest, a pounding pulse, or muscle cramps. You may also experience problems such as insomnia, heartburn, stomachache, diarrhea, or frequent urination. The worry and discomfort of all these physical symptoms can in turn lead to even more stress, creating a vicious cycle between your mind and body.

Exercising is an effective way to break this cycle. As well as releasing endorphins in the brain, physical activity helps to relax the muscles and relieve tension in the body. Since the body and mind are so closely linked, when your body feels better so, too, will your mind.

Exercise and ADHD

Exercising regularly is one of the easiest and most effective ways to reduce the symptoms of ADHD and improve concentration, motivation, memory, and mood. Physical activity immediately boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. In this way, exercise works in much the same way as ADHD medications such as Ritalin and Adderall.

Exercise and PTSD and trauma

Evidence suggests that by really focusing on your body and how it feels as you exercise, you can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response that characterizes PTSD or trauma. Instead of allowing your mind to wander, pay close attention to the physical sensations in your joints and muscles, even your insides as your body moves. Exercises that involve cross movement and that engage both arms and legs—such as walking (especially in sand), running, swimming, weight training, or dancing—are some of your best choices.

Outdoor activities like hiking, sailing, mountain biking, rock climbing, whitewater rafting, and skiing (downhill and cross-country) have also been shown to reduce the symptoms of PTSD.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Even if you’re not suffering from a mental health problem, regular physical activity can still offer a welcome boost to your mood, outlook, and mental well-being.

Exercise can help provide:

Sharper memory and thinking. The same endorphins that make you feel better also help you concentrate and feel mentally sharp for tasks at hand. Exercise also stimulates the growth of new brain cells and helps prevent age-related decline .

Higher self-esteem. Regular activity is an investment in your mind, body, and soul. When it becomes habit, it can foster your sense of self-worth and make you feel strong and powerful. You’ll feel better about your appearance and, by meeting even small exercise goals, you’ll feel a sense of achievement.

Better sleep. Even short bursts of exercise in the morning or afternoon can help regulate your sleep patterns . If you prefer to exercise at night, relaxing exercises such as yoga or gentle stretching can help promote sleep.

More energy. Increasing your heart rate several times a week will give you more get-up-and-go. Start off with just a few minutes of exercise per day, and increase your workout as you feel more energized.

Stronger resilience. When faced with mental or emotional challenges in life, exercise can help you build resilience and cope in a healthy way, instead of resorting to alcohol, drugs, or other negative behaviors that ultimately only make your symptoms worse. Regular exercise can also help boost your immune system and reduce the impact of stress.

You don’t need to devote hours out of your busy day to train at the gym, sweat buckets, or run mile after monotonous mile to reap all the physical and mental health benefits of exercise. Just 30-minutes of moderate exercise five times a week is enough. And even that can be broken down into two 15-minute or even three 10-minute exercise sessions if that’s easier.

Even a little bit of activity is better than nothing

If you don’t have time for 15 or 30 minutes of exercise, or if your body tells you to take a break after 5 or 10 minutes, for example, that’s okay, too. Start with 5- or 10-minute sessions and slowly increase your time. The more you exercise, the more energy you’ll have, so eventually you’ll feel ready for a little more. The key is to commit to some moderate physical activity—however little—on most days. As exercising becomes a habit, you can slowly add extra minutes or try different types of activities. If you keep at it, the benefits of exercise will begin to pay off.

You don’t have to suffer to get results

Research shows that moderate levels of exercise are best for most people . Moderate means:

• That you breathe a little heavier than normal, but are not out of breath. For example, you should be able to chat with your walking partner, but not easily sing a song.
• That your body feels warmer as you move, but not overheated or very sweaty.

Can’t find time to exercise during the week? Be a weekend warrior

A recent study in the United Kingdom found that people who squeeze their exercise routines into one or two sessions during the weekend experience almost as many health benefits as those who work out more often. So don’t let a busy schedule at work, home, or school be an excuse to avoid activity. Get moving whenever you can find the time—your mind and body will thank you!

Even when you know that exercise will help you feel better, taking that first step is still easier said than done. Obstacles to exercising are very real—particularly when you’re also struggling with a mental health issue.

Here are some common barriers and how you can get past them.

Feeling exhausted. When you’re tired, depressed, or stressed, it seems that working out will just make you feel worse. But the truth is that physical activity is a powerful energizer. Studies show that regular exercise can dramatically reduce fatigue and increase your energy levels. If you are really feeling tired, promise yourself a quick, 5-minute walk. Chances are, once you get moving you’ll have more energy and be able to walk for longer.

Feeling overwhelmed. When you’re stressed or depressed, the thought of adding another obligation to your busy daily schedule can seem overwhelming. Working out just doesn’t seem practical. If you have children, finding childcare while you exercise can also be a big hurdle. However, if you begin thinking of physical activity as a priority (a necessity for your mental well-being), you’ll soon find ways to fit small amounts of exercise into even the busiest schedule.

Feeling hopeless. Even if you’ve never exercised before, you can still find ways to comfortably get active. Start slow with easy, low-impact activities a few minutes each day, such as walking or dancing.

Feeling bad about yourself. Are you your own worst critic? It’s time to try a new way of thinking about your body. No matter your weight, age or fitness level, there are plenty of others in the same boat. Ask a friend to exercise with you. Accomplishing even the smallest fitness goals will help you gain body confidence and improve how you think about yourself.

Feeling pain. If you have a disability, severe weight problem, arthritis, or any injury or illness that limits your mobility, talk to your doctor about ways to safely exercise . You shouldn’t ignore pain, but rather do what you can, when you can. Divide your exercise into shorter, more frequent chunks of time if that helps, or try exercising in water to reduce joint or muscle discomfort.

Many of us find it hard enough to motivate ourselves to exercise at the best of times. But when you feel depressed, anxious, stressed or have another mental health problem, it can seem doubly difficult. This is especially true of depression and anxiety, which can leave you feeling trapped in a catch-22 situation. You know exercise will make you feel better, but depression has robbed you of the energy and motivation you need to work out, or your social anxiety means you can’t bear the thought of being seen at an exercise class or running through the park.

Start small. When you’re under the cloud of anxiety or depression and haven’t exercised for a long time, setting extravagant goals like completing a marathon or working out for an hour every morning will only leave you more despondent if you fall short. Better to set achievable goals and build up from there.

Schedule workouts when your energy is highest. Perhaps you have most energy first thing in the morning before work or school or at lunchtime before the mid-afternoon lull hits? Or maybe you do better exercising for longer at the weekends. If depression or anxiety has you feeling tired and unmotivated all day long, try dancing to some music or simply going for a walk. Even a short, 15-minute walk can help clear your mind, improve your mood, and boost your energy level. As you move and start to feel a little better, you’ll often boost your energy enough to exercise more vigorously—by walking further, breaking into a run, or adding a bike ride, for example.

Focus on activities you enjoy. Any activity that gets you moving counts. That could include throwing a Frisbee with a dog or friend, walking laps of a mall window shopping, or cycling to the grocery store. If you’ve never exercised before or don’t know what you might enjoy, try a few different things. Activities such as gardening or tackling a home improvement project can be great ways to start moving more when you have a mood disorder—as well as helping you become more active, they can also leave you with a sense of purpose and accomplishment.

Be comfortable. Wear clothing that’s comfortable and choose a setting that you find calming or energizing. That may be a quiet corner of your home, a scenic path, or your favorite city park.

Reward yourself. Part of the reward of completing an activity is how much better you’ll feel afterwards, but it always helps your motivation to promise yourself an extra treat for exercising. Reward yourself with a hot bubble bath after a workout, a delicious smoothie, or with an extra episode of your favorite TV show, for example.

Make exercise a social activity. Exercising with a friend or loved one, or even your kids, will not only make exercising more fun and enjoyable, it can also help motivate you to stick to a workout routine. You’ll also feel better than if you were exercising alone. In fact, when you’re suffering from a mood disorder such as depression, the companionship can be just as important as the exercise.

Easy ways to move more that don’t involve the gym

Don’t have a 30-minute block of time to dedicate to yoga or a bike ride? Don’t worry. Think about physical activity as a lifestyle rather than just a single task to check off your to-do list. Look at your daily routine and consider ways to sneak in activity here, there, and everywhere.

Move in and around your home. Clean the house, wash the car, tend to the yard and garden, mow the lawn with a push mower, sweep the sidewalk or patio with a broom.

Sneak activity in at work or on the go. Bike or walk to an appointment rather than drive, use stairs instead of elevators, briskly walk to the bus stop then get off one stop early, park at the back of the lot and walk into the store or office, or take a vigorous walk during your coffee break.

Get active with the family. Jog around the soccer field during your kid’s practice, make a neighborhood bike ride part of your weekend routine, play tag with your children in the yard, go canoeing at a lake, walk the dog in a new place.

Get creative with exercise ideas. Pick fruit at an orchard, boogie to music, go to the beach or take a hike, gently stretch while watching television, organize an office bowling team, take a class in martial arts, dance, or yoga.

Make exercise a fun part of your everyday life

You don’t have to spend hours in a gym or force yourself into long, monotonous workouts to experience the many benefits of exercise. These tips can help you find activities you enjoy and start to feel better, look better, and get more out of life.

More Information

• Greer, T. L., Trombello, J. M., Rethorst, C. D., Carmody, T. J., Jha, M. K., Liao, A., Grannemann, B. D., Chambliss, H. O., Church, T. S., & Trivedi, M. H. (2016). Improvements in psychosocial functioning and health-related quality of life following exercise augmentation in patients with treatment response but non-remitted major depressive disorder: Results from the TREAD study. Depression and Anxiety, 33(9), 870–881. Link
• Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. Link
• Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. Link
• Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Research, 249, 102–108. Link
• Kandola, A. A., Osborn, D. P. J., Stubbs, B., Choi, K. W., & Hayes, J. F. (2020). Individual and combined associations between cardiorespiratory fitness and grip strength with common mental disorders: A prospective cohort study in the UK Biobank. BMC Medicine, 18(1), 303. Link

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• v.25(9); 2018 Sep

The benefits of health information exchange: an updated systematic review

Nir menachemi.

1 Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA

2 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA

Saurabh Rahurkar

Christopher a harle, joshua r vest, associated data.

Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE.

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome.

Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects.

Conclusions

The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.

Introduction

Health information exchange (HIE), involves the electronic transfer of health information between health care organizations according to nationally recognized standards. 1 Recent initiatives such as the hospital readmission reduction program 2 as well as payment models including accountable care, 3 bundled payments, 4 and patient centered medical homes 5 have focused on coordination of care and data sharing for improved care quality. These models rely on HIE for success and subsequently for effective population health management by provider organizations. 6

Despite the theoretical benefits, previous reviews of the HIE literature concluded that only weak evidence exists that links HIE to reduced costs, use of health services, or quality of care. 7–9 The reviews also found that many of the early studies were limited in terms of settings studied, 7 , 8 outcomes examined, 7–9 and a focus on both first-generation systems and the infrequent use of study designs suited for making causal attributions. 7–9 Nevertheless, the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 and other federal policies have encouraged the continued adoption of HIE by providers. 10 The ensuing widespread adoption of HIE 11 has brought new innovations to the HIE landscape including the proliferation of new HIE organizations that differ from the community HIEs that first existed. For example, enterprise HIE systems and vendor-mediated HIEs are more commonplace today. 12

The purpose of the current study is to update a previous systematic review on the impact of HIE. First, we are interested in examining new evidence regarding how HIE may affect health care measures such as costs, use of services, and quality. Second, given the proliferation of new types of HIE organizations, we are interested in whether studies focused on community HIEs differ in their likelihood of reporting benefits when compared to studies focused on vendor-mediated or enterprise HIE systems. Lastly, we seek to determine the extent to which newly published studies have improved on the methodological shortcomings of earlier studies, by utilizing stronger research designs, focusing on a broader set of outcome measures, and/or examining more diverse populations and/or settings. The findings of our analysis will be beneficial to stakeholders interested in how HIE affects care; and to what degree the promised benefits of HIE are being realized. 13

Search Strategy

We replicated the search strategy used by Rahurkar et al. 7 which used a methodology consistent with the Preferred Reporting Items of Systematic Reviews and Meta Analyses guidelines. 14 Specifically, we searched the PubMed and Scopus databases from May 2014 to June 2017 (the period subsequent to the previous study) for any articles that evaluated the relationship between HIE and any resultant healthcare outcome measures. Similar to the previous study, we identified articles by searching for HIE-related and healthcare outcome related search terms together (See Supplementary materials , Appendix S1 ). We included only empirical peer-reviewed articles and thus excluded policy briefs, letters to the editor, governmental reports, commentaries, and other nonpeer-reviewed manuscripts.

The keyword search identified 1103 articles which we reviewed through the process shown in Supplementary Appendix S2 . Two reviewers first screened titles and abstracts of these articles to identify articles that evaluated HIE in the context of healthcare. Next, we reviewed the screened articles to select those that evaluated the relationship between HIE and specific healthcare outcomes (i.e., healthcare utilization, healthcare costs, quality of care). Finally, we used a snowballing technique whereby we searched the reference lists of included articles to identify potentially missed studies that should be considered. We repeated this process on each additional article until no additional articles worthy of inclusion could be identified. At each stage, we resolved conflicts in inclusion or exclusion by discussion and achieving consensus among the reviewers.

Research Dataset

We identified 24 articles for inclusion that were published between May 2014 and June 2017. These 24 articles included 63 discreet analyses, which were of interest given that a study may have evaluated more than one outcome measure. We identified a discreet analysis based on a distinct dependent variable that was examined in a given study (e.g., repeat imaging tests, repeat diagnostic tests, and healthcare costs). For example, Park and coauthors evaluated HIE’s impact on nine distinct analyses—total care costs, total drug costs, costs of four different types of tests, number of orders, number of outpatient visits, and length of hospital stay. For every article that was included, we extracted various information including type of study design used (cohort study, cross-sectional study, randomized controlled trial, quasi-experimental study), setting and population studied (primary care physicians, hospital, emergency department), and country of origin. Further, the dependent variables in each study were grouped into the following categories: health care services use (e.g., hospital or emergency department readmissions, redundant lab tests), health care costs (e.g., total care costs), disease surveillance (e.g., automatic reporting of diseases requiring public health notification), and quality-of-care measures (e.g., medication reconciliation, medication adherence).

Building on the gaps in literature that were identified in the prior systematic review, we extracted information, when possible, on whether or not a study measured actual usage of HIE in clinical care (Yes/No), the mechanism by which HIE information is accessed (Push/Pull), and the process by which patients consent to include their data in the HIE (Opt-in/Opt-out). We determined actual usage if a study observed HIE usage in each patient encounter or on the basis of HIE usage logs. We judged the mechanism of HIE as “Pull” if the clinician had to actively request or pull a patient’s information from the HIE. We judged the mechanism of HIE as “Push” if patient information from HIE was automatically provided without the clinician taking action. We determined the patient consent model to be “Opt-out” if all patients were enrolled for participation in HIE unless a given patient explicitly objected and was thus excluded. For each analysis in each included study, we also extracted information on the nature of the relationship between HIE and the dependent variable studied. We identified a relationship as beneficial if there was a statistically significant positive association for positive outcomes or a negative association for negative outcomes. The evidence in support of the identified relationship was considered “high-quality” if the study used a design that had strong internal validity, which included randomized controlled trials or quasi-experimental approaches.

Finally, we combined the information on the newly identified studies in the current systematic review with the studies identified in the previous systematic review by Rahurkar et al. This resulted in a sample of 51 studies (27 from previous review + 24 in the current review) consisting of 157 analyses (94 from previous review + 63 newly identified). For all studies in the final sample, we extracted information on the type of HIE investigated (community HIE, enterprise HIE, or vendor-mediated HIE). This enabled us to examine whether HIE type was related to the likelihood of finding a beneficial relationship across all 51 studies. Unfortunately, data regarding push/pull and opt in/out was not available from studies covered in the previous systematic review.

Analytical Approach

We descriptively analyzed each of the extracted variables to examine the nature of the published articles included in the current study. Next, we used Chi-square analysis or Fisher’s exact test, as appropriate, to investigate how each study characteristic was associated with reporting a beneficial impact from HIE. For example, with respect to setting, we examined whether studies conducted in emergency departments were more or less likely to report beneficial effects from HIE compared to studies in primary care or other settings. Given the nature of how analyses are nested within articles in our dataset, we specified a regression model that examined the relationship between finding a beneficial effect and the aforementioned study characteristics while adjusting for clustering at the article level. The results of this model appear in the Supplementary Appendix S3 and did not change the general conclusions we report below. Importantly, several cell sizes in the model were small given the sample size we have. Thus, we present the bivariate relationships in the results section. We conducted all analyses in STATA/MP version 15, and statistical significance was considered to be P  < .05.

The 24 articles that include 63 analyses identified by our search strategy are described in Table 1 . Also presented are the bivariate relationships between each extracted article characteristic and whether the analysis concluded a beneficial relationship with HIE. Among all analyses, 68.3% reported a beneficial effect from HIE; and 7.9% reported an unexpected adverse effect. The remaining analyses reported no effect.

Bivariate Relationships Between Various Study Characteristics and Finding a Beneficial Effect from HIE on the Outcome Studied ( n  = 24 articles that include n  = 63 analyses)

Overall, the majority of studies were from the United States and country of study location was not statistically associated with likelihood of finding benefits from HIE. We present the name of the HIE organizations represented in the included articles and their corresponding state in Table 2 . Overall, only 9 states were represented with any included study; and 25 out of 63 included analyses (39.7%) occurred in a handful of HIEs from the state of New York.

Name of the HIE Organizations Represented in the Literature (2014–2017) ( n  = 24 articles)

Whereas the majority of analyses used cohort designs, there were 13 analyses, contained within 7 studies, which used more rigorous randomized-controlled trials or quasi-experiments. There were no differences by study design in the likelihood of reporting a beneficial effect from HIE. Similarly, Pull vs Push HIE mechanisms was unrelated to finding HIE benefits. Lastly, the most common analyses focused on a measure of health care utilization ( n  = 25, 39.7%); and these analyses were less likely than others to conclude a beneficial effect from HIE (48% for utilization vs 77.8% for health care costs, 90% for quality of care, 80% for disease surveillance/public health; P  = .05).

Healthcare Utilization

The evidence base for this outcome consisted of 25 analyses, of which 12 (48%) found a beneficial effect from HIE. HIE was associated with improved performance on hospital and 30-day readmissions, 15–18 ICU and ED admissions, 19 , 20 repeated imaging, 18 , 20–23 therapeutic medical procedures, 24 and total number of orders. 25 One cohort study, based in Israel, reported that HIE was adversely related to the number of imaging tests ordered. 26

Healthcare Costs

The evidence base for this outcome consisted of 18 analyses, of which 14 (77.8%) found a beneficial effect from HIE. Specifically, HIE was associated with a reduction of total costs of care, 16 , 17 , 20 , 25 , 27–29 lab test costs, 25 , 30 imaging test costs, 18 , 25 , 27 , 30 and overall measures of return on investment. 28 , 29 One cohort study, conducted in the Veteran Health Administration, found that HIE was adversely associated with total unadjusted health care costs 1 year post HIE enrollment. 31

Healthcare Quality

The evidence base for this outcome consisted of 10 analyses, of which 9 (90%) found a beneficial effect from HIE. For example, HIE was associated with improved medication reconciliation, 32 immunization and health record completeness, 33 , 34 a reduction in care disparities, 35 and HIV-related quality of care measures. 35

Disease Surveillance and Public Health

The evidence base for this outcome consisted of 10 analyses, of which 8 (80%) found a beneficial effect from HIE. Specifically, HIE was linked with improved population level immunization rates, 33 the timeliness of reporting of reportable conditions, 34 identification of drug seeking behaviors, 21 and improved surveillance of high ED utilizing vulnerable patients. 36

Rigorous Studies

Seven of the 24 studies (including 13 of 63 analyses) utilized designs more suitable for generating high-quality evidence. We present a synthesis of these 7 studies in Table 3 . All 7 studies reported at least some beneficial effect from HIE (including 10 of 13 analyses); none reported adverse effects. Two of these studies focused on the emergency settings, 30 , 37 2 studies examined outpatient settings, 17 , 24 and 1 study each examine the inpatient, 32 community, 27 and HIV care setting, 35 respectively. Outcomes that improved with HIE included hospital admissions, 17 total costs of care, 17 , 24 , 27 , 30 , 37 improved medication reconciliation, 35 and HIV-related quality of care measures. 35

Overview of Experimental and Quasi-experimental Studies and Their Findings

In order to examine the relationship between HIE type and the likelihood of reporting benefits from HIE, we utilized the combined data set including the 51 individual articles described above. Twenty-seven of the 51 studies (52.9%) assessed community HIEs. Studies assessing a community HIE were more likely to report a benefit effect compared to studies that examined other types of HIEs (70.3% vs 54.2%, P  = .04).

Previous reviews of the HIE literature found that evidence for HIE came most frequently from studies with weak internal validity. Moreover, studies with greater internal validity were less likely to report benefits from HIE. 7 In contrast, our current review of the literature finds that a greater number of recent studies utilized study designs more suitable for determining causality; and invariably these studies reported benefits from HIE. This change may be due to several factors including the likelihood that HIE, like other information technologies, is subjected to a learning curve in implementation, usage, and system effectiveness. More recent studies may have evaluated more mature HIEs that have evolved to be more effective than earlier-generation systems previously studied. If so, this finding bodes well for HIEs ability to deliver on anticipated improvements in the delivery of care.

Our study also improves upon the previous reviews by examining the association of HIE type and its relationship with outcomes. Importantly, we found that studies that evaluated community HIEs were significantly more likely to find benefits than studies that focused on other types of HIEs. By design, the community HIE model may be better positioned to actually realize the impacts of information exchange on cost, quality, and utilization outcomes. Patients seek care from multiple organizations, and fragmentation of patient information and poor information sharing during transitions of care are underlying drivers of duplicate costs, readmissions, poor medication reconciliation, and repeat imaging. Community HIEs attempt to facilitate information exchange among the widest set of available providers within an area. As a result, community HIEs are positioned to provide access to the broadest range of patient information. In contrast, enterprise HIE or vendor-mediated HIEs have narrower exchange networks and, therefore, may not have access to the range of patient information necessary to address the challenges that result in poor outcomes. 38 At the same time, it is possible that the observed differences in benefits by HIE type is confounded by technology maturation, given that enterprise and vendor-mediated HIEs tend to be newer than community HIEs.

Compared to previous reviews, we currently found that, while the evidence base for HIE has improved in terms of the rigor of study designs, and types of HIEs studied, less gains were observed in the type of settings evaluated and especially the outcome measures studied. In terms of settings, HIE research continues to be dominated by the emergency department setting. The emergency care use case was among the earliest justifications for pursuing HIE, because a technology that allows providers to access information from other organizations on unfamiliar patients in a timely manner fits well with emergency care information needs. 39 Additionally, hospitals have been quicker to adopt interoperable health information technology than ambulatory care providers, so the opportunities for evaluation have been greater. 40 While the emergency department will continue to be an important use case for HIE, as reimbursement policies and organizational strategies attempt to move patients away from emergency department care, the impact of HIE in primary and specialty ambulatory care needs to be further examined. With respect to settings, we note that several studies examined the community level 22 , 27 , 34 or a long-term care setting, 15 neither of which were represented in a previous systematic review. 7 In terms of outcomes studied, utilization and cost-related outcomes remain the most frequently studied consequences of HIE. However, better access to patient information may also benefit patient health outcomes, such as through improved case management, care coordination, and clinical decision-making. Likewise, HIE may benefit organizational performance, such as through improved physician productivity. Thus, there is an opportunity for future studies that examine several other healthcare process and outcome measures.

Consistent with previous reviews of the literature, our study highlights a potential limitation pertaining to the generalizability of the current HIE literature. Specifically, a large number of existing studies emanate from a small number of organizations in a limited number of states. We found that HIEs operating in the state of New York are currently the most frequently studied. The preponderance of articles stemming from New York is likely due to the state’s substantial public and private investments aimed at fostering interoperable health information technology adoption along with the commitment to evaluate this state-level policy intervention. 41 In addition to state funding, several community’s served by HIEs in New York have qualities that favor HIE impact studies, including very large numbers of events, highly fragmented patient care patterns between emergency departments, and histories of innovative health care quality improvement. Recently, New York State made HIE participation a requirement for hospitals and urgent care providers. 42 Therefore, it is unclear if HIE efforts in states with less concerted efforts to support health information technology and quality improvement, will experience similar benefits. Critically, however, the ultimate objective is not to foster exchange within one community or one state, but to have information nationally accessible. We note that empirical evidence on the impact of HIE across state lines is scant.

Given the findings of our review, there is a need for continued policies to encourage widespread HIE activity. Encouragingly, at the federal level, Congress has declared “it a national objective to achieve widespread exchange of health information.” 10 Likewise, the Office of the National Coordinator for Health Information Technology has clearly defined behaviors that create unnecessary and artificial barriers to HIE as information blocking. 43 Nevertheless, challenges remain. Provider claims of information blocking behavior are not uncommon. 43 And, while adoption of interoperable health information technology is growing, the use of HIE by hospitals and individual providers is far from universal. 44 , 45

Limitations

Our study has the following limitations. First, our search strategy found only 24 articles that were included in our review which makes more complex statistical or meta-analyses difficult to perform. However, the narrative findings that we present are minimally sensitive to sample sizes. Also, it is possible that our search strategy missed some articles that should have been included. Along the same lines, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to structuring our review and recognize that other approaches exist which may have yielded different studies to be included. 46 Nevertheless, to minimize this risk, we used an iterative snowball technique to identify articles from bibliographic lists of included articles until no new articles were found. Additionally, because most of the included studies came from a select few states; and were limited in the settings and outcomes studied, we recognize that the generalizability of our findings may be limited. Lastly, we did not employ an expert panel in the selection of our search terms, nor did we submit an a priori protocol to a publically available repository such as PROSPERO. 47

Overall, our systematic review of the literature found that high quality evidence exists to link HIE with a reduction in healthcare utilization and costs. This represents progress in reaching the national goals of more accessible patient information in support of the triple aim of better quality, improved population health, and lower costs.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing interests

Contributors.

This work represents the original research of the authors. This work has not been previously published. NM conceptualized the study. NM and SR drafted the manuscript and conducted the analyses. All authors participated in interpretation of the data. CH and JV provided critical revisions to the manuscript. All authors approved the submission.

SUPPLEMENTARY MATERIAL

Supplementary material is available at Journal of the American Medical Informatics Association online.

Supplementary Material

Supplementary data.

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Call for Experts: Technical Advisory Group on health, migration and displacement

The WHO Health and Migration was established in 2020 and is now situated within the Healthier Populations Division.  All of the WHO Health and Migration’s work is framed by the following priorities identified in the  WHO Global Action Plan on promoting the health of refugees and migrants (GAP) :

• Priority 1. Promote the health of refugees and migrants through a mix of short-term and long-term public health interventions;
• Priority 2. Promote continuity and quality of essential health care, while developing, reinforcing and implementing occupational health and safety measures;
• Priority 3. Advocate the mainstreaming of refugee and migrant health into global, regional and country agendas and the promotion of: refugee-sensitive and migrant sensitive health policies and legal and social protection; the health and well-being of refugee and migrant women, children and adolescents; gender equality and empowerment of refugee and migrant women and girls; and partnerships and intersectoral, intercountry and interagency coordination and collaboration mechanisms;
• Priority 4. Enhance capacity to tackle the social determinants of health and to accelerate progress towards achieving the Sustainable Development Goals, including universal health coverage;
• Priority 5. Strengthen health monitoring and health information systems.
• Priority 6. Support measures to improve evidence-based health communication and to counter misperceptions about migrant and refugee health

WHO Health and Migration is forming an expert technical advisory group for the period 2024-2026 to support the implementation of the GAP on promoting the health of refugees and migrants and other related activities. The Technical Advisory Group (TAG) will play a key role in achieving the five core functions of WHO Health and Migration, which are aligned with the GAP and the WHO GPW14 objectives to promote, provide, and protect health. These functions particularly focus on reducing health inequities by addressing the social, economic, environmental, and other determinants of health, supporting countries in developing evidence-informed policies across all levels of government, and adapting public health measures to meet the health needs of populations such as migrants and displaced people.

During 2024-2026 the TAG will:

• Advise WHO Health and Migration on all technical areas, with a focus on implementing and monitoring the GAP, and implementing the  Global research agenda on health, migration and displacement  and associated Global Research Network on health, migration and displacement.
• Participate, according to area of expertise, in the development of further norms, standards, research products, and technical guidance on DHM priority areas such as health, migration and displacement in the context of: climate change, UHC/PHC, health financing, vaccination, communicable and non-communicable diseases, and health system strengthening.
• Provide technical advice on global, regional and national activities, high level events, and technical assistance initiatives, such as: the Global Consultation on the Health of Refugees and Migrants; the national health system reviews; the Global School on refugee and migrant health; the Global Evidence Series on Health and Migration (GEHM).

Functions of the Technical Advisory Group on health, migration and displacement

The technical advisory group is being formed to support the implementation of the GAP and other activities related to improving the health of migrants, refugees and other displaced populations carried out by WHO DHM, on the core thematic areas of:

• Providing global leadership and high-level advocacy on the health of migrants, refugees and other displaced populations;
• Providing technical assistance to countries and partners;
• Setting norms and standards and promoting research;
• Monitoring trends, documenting progress and developing tools.
• Multi-lateral, inter-regional collaboration and strategic partnerships.

The TAG will have thematic sub-groups focusing on priority areas. Over the next two years, it will support DHM’s work in technical assistance, research prioritization, implementation research, data, policy, and normative guidance in the areas of universal health coverage, healthier populations, and health emergencies, with a focus on topics such as:

• Migrant- and refugee-inclusive universal health coverage, primary health care, and health financing;
• Equitable access to and use of vaccines among migrants, refugees, and other displaced populations;
• The health of migrants, refugees, and displaced populations in the context of climate change; and
• Non-communicable diseases and communicable diseases, migration, and displacement.

Operations of the Technical Advisory Group on health, migration and displacement 

Members of the TAG will participate in monthly online advisory and/or working group meetings from 2024 to 2026. There will be one in-person meeting each year, with additional interim online meetings as needed. The working language of the group will be English.

Who can express interest?

The TAG will be multidisciplinary, with members who have a range of technical knowledge, skills and experience relevant to the field of health, migration and displacement, specializing in the following topics: universal health coverage, health emergencies, and social determinants of health. Particular expertise on the following topics relating to health, migration and displacement is also sought: health system strengthening, climate change; vaccination; non-communicable diseases; communicable diseases; UHC/PHC; health financing.

Approximately 30 members may be selected.  WHO welcomes expressions of interest from:

• academic experts,
• operational actors,
• individuals from policy and public health institutes across all WHO regions.

Experts will be invited to join the TAG based on:

• Contributions to the field of health, migration and forced displacement, in research, policy or practice;
• Active work history in the field of health, migration and displacement, in research, policy or practice, for at least 10 years, at the national, regional and/or international level;
• Technical expertise in at least one of DHM’s priority areas outlined above.

Applicants may have expertise in the following areas, among others: public health, medicine, sociology/medical anthropology, health systems, health promotion, health policy, political science, economics, health economics, epidemiology, legal and human rights, gender. 

Submitting your expression of interest

To register your interest in being considered for the TAG on health, migration and displacement, please submit the following documents by 24:00 Geneva time (midnight CET) 10 th September 202 4 to [email protected] using the subject line “Expression of interest for the Technical Advisory Group on health, migration and displacement:”

• A cover letter, indicating your motivation to apply and how you satisfy the selection criteria. Please note that, if selected, membership will be in a personal capacity; therefore, do not use the letterhead or other identification of your employer;
• Your curriculum vitae; and
• A signed and completed Declaration of Interests (DOI) form for WHO Experts, available at https://www.who.int/about/ethics/declarations-of-interest .

After submission, your expression of interest will be reviewed by WHO.  Due to an expected high volume of interest, only selected individuals will be informed. 

Important information about the selection processes and conditions of appointment

Members of WHO advisory groups (AGs) must be free of any real, potential or apparent conflicts of interest. To this end, applicants are required to complete the WHO Declaration of Interests for WHO Experts, and the selection as a member of a AG is, amongst other things, dependent on WHO determining that there is no conflict of interest or that any identified conflicts could be appropriately managed (in addition to WHO’s evaluation of an applicant’s experience, expertise and motivation and other criteria).

All AG members will serve in their individual expert capacity and shall not represent any governments, any commercial industries or entities, any research, academic or civil society organizations, or any other bodies, entities, institutions or organizations. They are expected to fully comply with the Code of Conduct for WHO Experts ( https://www.who.int/about/ethics/declarations-of-interest ). AG members will be expected to sign and return a completed confidentiality undertaking prior to the beginning of the first meeting.

At any point during the selection process, telephone interviews may be scheduled between an applicant and the WHO Secretariat to enable WHO to ask questions relating to the applicant’s experience and expertise and/or to assess whether the applicant meets the criteria for membership in the relevant AG.

The selection of members of the AGs will be made by WHO in its sole discretion, taking into account the following (non-exclusive) criteria: relevant technical expertise; experience in international and country policy work; communication skills; and ability to work constructively with people from different cultural backgrounds and orientations. The selection of AG members will also take account of the need for diverse perspectives from different regions, especially from low and middle-income countries, and for gender balance.

If selected by WHO, proposed members will be sent an invitation letter and a Memorandum of Agreement. Appointment as a member of an AG will be subject to the proposed member returning to WHO the countersigned copy of these two documents.

WHO reserves the right to accept or reject any expression of interest, to annul the open call process and reject all expressions of interest at any time without incurring any liability to the affected applicant or applicants and without any obligation to inform the affected applicant or applicants of the grounds for WHO's action. WHO may also decide, at any time, not to proceed with the establishment of the AG, disband an existing TAG or modify the work of the AG.

WHO shall not in any way be obliged to reveal, or discuss with any applicant, how an expression of interest was assessed, or to provide any other information relating to the evaluation/selection process or to state the reasons for not choosing a member.

WHO may publish the names and a short biography of the selected individuals on the WHO internet.

AG members will not be remunerated for their services in relation to the AG or otherwise. Travel and accommodation expenses of AG members to participate in AG meetings will be covered by WHO in accordance with its applicable policies, rules and procedures.

The appointment will be limited in time as indicated in the letter of appointment.

If you have any questions about this “Call for experts”, please write to [email protected] well before the applicable deadline, with the subject line: “Queries: Technical Advisory Group on health, migration and displacement.”