Evaluation for Circle of Health:
Information Infrastructure for Northwest Tribes
Phase I,
Pretest Baseline Report
November, 1999
DRAFT
by
John E. Bowes and
Fiona Clark§
School of
Communications
University
of Washington, Seattle
<jbowes@u.washington.edu>
I.
Introduction
T
|
his study evaluates implementation of a high-speed, Internet-based information infrastructure to address the lack of disease surveillance and epidemiological information in geographically remote Pacific Northwest tribal communities. The Northwest Portland Area Indian Health Board (NPAIHB) is working in partnership with 41 tribes, state health departments, and the Indian Health Service in building this new system. The project will connect eight tribal health programs to IHS/Washington State intranets and the Internet backbone, provide training, and evaluate the impact of this advanced connectivity on tribal health planning. Washington tribes will also participate in electronic communicable disease reporting systems. Internet access planning documents will be developed for the remaining 32 tribes. The NPAIHB will create listservs and websites for tribal collaboration on administrative issues and program delivery.
The
evaluation is a field experiment having a pretest/posttest design in two
phases. In phase one, four tribal health centers will be equipped with
high-speed Internet access to specialized health information and reporting
systems. Four other centers will be used as controls. In phase two, the
control group health centers will be equipped and also evaluated after a period
of six months' use. The result is
controlled comparison of project outcomes at roughly 6 and 12 months.
Evaluation criteria will involve use of information to manage community health,
to improve patient care and improved access to medical expertise. Techniques
used here are traditional personal interview surveys, collection of use data
from servers and some participant observation by field interviewers.
Figure 1 shows the original timeline of the study, an ideal that came up against the realities of deploying and organizing technology in remote, rural areas. The actual time taken for the initial deployment to four tribal health centers and took about 9 months.
Figure 1: Timeline showing relationship
of phase one and phase two surveys.
0 1 2 3 4 5 6 7 8 9 10 11 12
Mo.
Phase One 2nd Post-test
Phase 1 Phase
1
Four Phase 2 Villages Pretest Phase two 1st Post-test
Phase 2
Time Time Time
One Two Three
Field workers completed interviews for this report at the same time as health center systems were installed over a period of 3 months. It summarizes these results; the initial status of the four Phase 1 Villages Pretest, shown in the far left of Figure 1 above. Based on these findings, we will modify and better focus follow-up work in the Phase 1 Post-test and later treatments as part of a continuous scheme of project evaluation.
Phase One Respondents: Our test base is drawn from four Washington State tribes shown in figure two. They are groups of varied size, wealth, levels of community development and geographical situation.
Figure
2: Tribes
involved in the phase 1 pretest by percent, n = 59.
Tribes in Phase One
The Questionnaire and Its Structure: The questionnaire contained a mix of fixed response and open
questions where the respondent was free to respond in his/her own words. It was
administered by personnel who were both specifically trained for this study and
had experience in field work. They
were, however, not local residents or employees of the clinics where
they conducted interviews.
The strategy of designing questions was to get broad
coverage of respondent’s experience and work with information technologies and
how they used the information obtained. Because of time limitations, our effort
in this first, baseline study was to achieve breadth at some expense to the
depth or detail of information we learned. Later phases will focus more on
specific issues, though certain questions will be thematic, running throughout
the phases of the project. The phase
one baseline questionnaire can be found in Appendix A.
Thematic
Questions: Key is the respondents' use of information
and the degree to which new information technologies play a role. Of
importance, too, is the respondents' attitudes toward and confidence in the
information received through these new means in contrast to the traditional.
Usefulness, perceive accuracy, timeliness, usability and fit to local
circumstances are important criteria.
We are especially interested in the reliability and ease of using both
the on-line information and the network technology that delivers it.
The on-line environment offers new capabilities for
interaction. Email, collaborative on-line groups, specialized listservs
all promise a sense of virtual community that may lessen the isolation and
limited access of village health professionals to peer contact and expert
information. We will be especially interested in assessing the particular
social and professional opportunities possible with networked media. We wish to
see if there are distinct changes in orientation and use of these new media as
health workers gain experience in their use.
Focal
Questions in Later Phases: Some data need only be collected once or make little sense to assess
until Internet technologies have been in use. Basic demographic data of
respondents and their prior experience with on-line information resources will
be assessed in the pretests. An important part of posttest assessment is the
availability and quality of support personnel attendant to the on-line
experience. Respondent recommendations on training changes, software
alterations, use of information gathered on-line in daily work, social bonds
formed through on-line collaboration are key posttest elements. In short, we
have interest not only in the utility of this on-line environment, but
likelihood that its use will continue and grow in sophistication once the
formal evaluation is done.
As this report concerns our first phase, all present questions are ones needed to collect background data from respondents or to develop baselines to trends we believe are important over the course of the study. Items describing experience with specific products of our experimental Internet services will be done in later phases.
II.
Demographic and Job Profile of Health Center Respondents
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he health center workers we interviewed range across a variety of jobs and responsibilities shown in Figure 3. Physicians, nurses and related health care people constituted the highest number, followed by clerical workers and health center managers.
Figure
3:
Respondent health center jobs in percent, n=59.
In terms of personal characteristics, our respondents are, modally, younger middle aged (most commonly between 36 and 45 years); having a post-graduate, college or technical school degree; and mainly not supervisors or – at best – having responsibility for only a few (1-3) co-workers. At most, respondents worked with 4 other individuals. All worked with at least two others; the average being 3. Thus the clinic personnel we interviewed are by and large clerks, technicians and skilled heath professionals in a small office setting common to rural health clinics.
Figures
4 and 5: Showing
age and education of respondents, respectively, n=59
Figure
6: Supervisory
responsibility of respondents by numbers of employees supervised, n=59.
Supervisor Responsibility
As figure 7 shows, most employees (about 72%) have worked in their health center for four years or less. Some 38% have been on the job for a year or less. The average tenure for our interviewees is just short of two years (mean= 1.98 years at clinic). Overall, the
Figure
7: Respondent’s
time in present job in years, n=59.
Time in Present Job
impression is that our respondents are comparatively new to their posts and quite possibly to the communities they serve as well. Very few – only 4 – have been in the community for more than a decade.
III. Information and Record-Keeping, Health Data Systems
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e asked respondents to rate the importance of several common information technologies and record systems used in clinics for their adequacy and importance in their work. The results are shown in Figure 8. Most systems were evaluated as “good” and “important” with little variation shown from these upper middle category ratings. The comparatively low numbers of respondents who experienced videoconferencing shows in a high instability (standard error) for these values. Videoconferencing was not seen as important, perhaps not even realistic given the technologically minimalist setting of rural health clinics.
Figure
8: Showing
information and patient record system importance by type, n=59. Higher values
indicate greater levels (e.g. “vital” importance). Box indicates mean; line
length is + or – 2 standard error units (p < .04).
Information System Importance
Figure 9 shows “adequacy” of various clinic information systems. Highest rated was videoconferencing, which was experienced by only about half (N=24) of the respondents. Most information systems received intermediate ratings of adequacy, with least satisfaction toward medical reference and other library holdings at the clinic site. Medical data systems, while getting intermediate marks for adequacy, were in the lowest of this broad moderate adequacy group.
A ratio of importance to adequacy was computed and is shown in Figure 10. We want to see if high importance systems were also seen as most adequate, meaning that the ratio of “importance” to “adequacy” should be relatively constant if investment and refinement of systems (their adequacy) tracked their perceived importance. While variation here is not great, indicating a rough conformity of importance with adequacy, there are several suggestions here. First, patient record systems are the most imbalanced – they’re seen as important but not as adequately served as some other information needs.
Figure
9: Showing
information and patient record system adequacy by type. Higher values indicate
greater levels (e.g. “excellent”). Box indicates mean; line length is + or – 2
standard error units (p < .04).
Adequacy of Information System
The same seems to hold for medical reference and information systems, if to somewhat less a degree. These, then, should be points of attention in assessing the future impacts of computer information systems in the surveyed facilities. On the other hand, access to medical consultants and videoconferencing seem more in balance when relative importance and adequacy are considered.
Figure
10: Showing
ratios of importance to adequacy by type information source, N~59. Higher
values indicate greater levels of importance compared to adequacy of systems or
sources.
Ratio
of Importance to Adequacy
IV.
Use of the Internet and Related Information Gathering:
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ur respondents show a wide range of time spent in communication tasks, both traditional and computer-based. Average weekly time spent with traditional communications technologies was 15.44 hours, with significant groups spending little (1-5 hours) and considerable (over 30 hours) time with such tasks.
Not surprisingly, specific work-related communication activity, such as medical and health research, office paperwork and communication with colleagues, was more important than general news and information or social communication. In short, traditional workplace communication accorded high importance is specific, task-related, and confined to co-workers.
Figure
11: Showing
hours per week spent in communication activities, N=50.
Electronic or computer-based communication was not as balanced. A near majority spent five hours or less per week in this kind of activity. Average hours per week with electronic or computer communications was 10.27 hours. Only about 20% of respondents spent more than 20 hours per week. Importance levels accorded on line tasks were lower as well, save the use of computer databases and forms which had an elevated mean importance, followed at an intermediate level by email. Notably with database use, the high average traces to a few respondents whose job depends centrally on such systems. Other computer mediated tasks like on-line journals, listservs and teleconferences were low in importance.
Figure
12: Showing
importance of office communication activities by type. Greater values indicate
more importance. Box indicates mean; line length is + or – 2 standard error
units (p < .04).
Figure
13: Weekly
hours spent with electronic or computer-based communication, N=56.
Figure
14: Importance
of computer-centered, electronic communication by type. Greater values indicate
more importance. Box indicates mean; line length is + or – 2 standard error
units (p < .04).
The general impression is that phase one clinics engage in high levels of traditional communication. Newer, electronic forms have yet to attain these levels, with the exception of database use by a few whose work responsibilities center upon them. Email has growing importance for clinic personnel, but largely as a component balanced by much traditional communication activity.
V.
General Sources of Information:
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n this section, we looked at baseline attitudes towards several key classes of information: the Internet primarily; the Internet as a supplement; and books or journals as a preferred means. As shown in Figure 15, the prevailing sentiment is that the Internet is highly important to our respondents’ as an information source. There seemed only moderate support for the idea that the Internet was best as a supplement to other traditional sources. But there was strong disagreement with the statement that the Internet was overrated as an information source, coupled with strong support for the idea that it was important. In short, the Internet has come into its own as a primary information resource, not one that is of peripheral importance or of use only as a supplement.
As Figure 16 shows, patient records, diagnostic
information and research were the “most used” topics in doing one’s job.
Others, like grant information, clinic management and healthcare business news
were ranked lower by most. In short, information of direct use to patient care
was valued above that concerned with running a clinic or the healthcare
industry.
Figure 15: Agreement on value of
Internet v. traditional information sources. Low values indicate strong
agreement; high values indicate strong disagreement. Box shows mean;
line length indicates + or - 2 standard error units (p<.04.).
Figure
16: Ranking
“most use” topics of information in doing one’s job. Respondents selected their
top 3 topics from a list of nine. Lower rankings are shown in red. N~56.
Ranked Importance of Info Topics
VI.
Characteristics of Information Sources:
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he characteristics most prized in clinic information were credibility and timeliness. “Personalized” information and ease in finding related documents were least important. Most other characteristics were of moderate to high importance as indicated in Figure 17 and Table 1. Of least importance are data that were personalized or where related data were easy to find as with hyperlinked tables and detail.
Table
1: Needs
and concerns about computer-based information systems at work.
|
Characteristic/Rank |
Mean |
N |
|
Highest Importance |
|
|
|
Credibility:
Trust the competence and expertise of the source. |
2.95 |
52 |
|
Timeliness:
Information is up-to-date |
2.86 |
52 |
|
Moderate Importance |
|
|
|
Understandable: The information uses examples and is in language I understand. |
2.81 |
52 |
|
Organized or
searchable: I can find what I want easily. |
2.77 |
52 |
|
Help:
There’s back-up help I can count on if I don’t get what I need. |
2.68 |
52 |
|
Usable:
Information is easy to try-out, implement. |
2.67 |
52 |
|
Safety:
Information is low risk, cautious, tested. |
2.59 |
52 |
|
Lowest Importance |
|
|
|
Relational:
I can easily find related documents, other advice. |
2.48 |
52 |
|
Personalized:
The information speaks to my particular needs and community. |
2.45 |
52 |
Figure 17: Information characteristics
rated by importance to respondents. N~52. Red and yellow bars show “very” and
“somewhat” important responses, respectively. Green bar segments show
proportion of “not important” ratings.
Importance of Information Characteristics
Computer use attitudes show respondents generally favorable – highly so – to computer use in general (like using), use email readily with colleagues, but are less comfortable with on-line information seeking. There is a moderate level of concern with privacy and with reaching known, trusted sources.
Figure
18: Agreement
with attitude statements about computer use. Scales on items ranged from strongly
agree (red) to disagree strongly (purple). N~50.
Information Characteristic by Importance
Table
2: Computer
use attitudes mean ratings by statement.
|
Statement |
Mean |
N |
|
I like using computers
in my work and for finding information. |
1.44 |
45 |
|
It’s important for me to
reach colleagues and friends through email. |
1.98 |
52 |
|
I would feel better
about using computer-based information if my colleagues and coworkers used it
as well. |
2.33 |
55 |
|
My privacy may be at
risk using computer information systems. |
2.45 |
51 |
|
To trust information, I
usually have to get it from people or sources I know well. |
2.58 |
52 |
|
I’m usually comfortable
finding information on the Internet or from on-line health information
services. |
2.78 |
48 |
In all, our impression is of clinic personnel “liking” computers, but a bit wary of them in terms of privacy and trust-of-source concerns. “Comfort,” thus, is conditional with respondents liking computers more if colleagues used them as well.
VII. Uses of Information Technologies:
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ur clinic personnel are far from being new, novice users of computers and the Internet. A wide majority use computers and have Internet access at home and work. Despite their rural isolation, these respondents have higher computer use and Internet availability than is estimated for US population at large. It is a user profile typical for urban skilled professionals.
Figures
19, 20: Showing personal computer
use and place of use; n=59 and n=56, respectively.
Figures
21, 22: Showing web/Internet access
and place of access; n=56 and n=58, respectively.
As shown in Figure 23, the most used functions were word processing, accessing the Internet and email. Least used were on-line information services, spreadsheets and file transfer utilities. Using the computer to “train others” was intermediate. In all, this pattern is a typical profile where the most common uses of PCs nationally are for sending and creating written work.
Complaints in this activity seemed slight (Figure 24):
few saw computers as “isolating” or not fitting-in with their work activity
(only 9% believed this – see figure 24, right-hand bars). Rather more (38%)
complained that computers were “fragile.”
Getting assistance or building computer skills was seen most effectively
gained through classes, with self-instruction materials (manuals) or with the
help of an on-site technician. A
majority also believed that personal experience was moderately of use.
Figure
23: Mean
frequency of doing specific computing tasks. Lower values indicate more often (1=everyday);
higher values indicate less often (4=not at all). Box shows mean; line
length indicates + or - 2 standard error units (p<.04.).
Figure 24: Problems and assistance with
computers at work. Bars indicate agreement. N~56
We asked respondents to rate
their experience with computers on 8 adjective-opposite scales show in Figure
25 for a range of attributes. Most responses were midpoint in the scales,
indicating that most were equally poised between the extremes of, say, finding
computer “important” or “unimportant.” This is a common finding with
professionals (where unqualified extremes are rarely admitted). Despite a
consistent middle-of-the road response, anxiety and challenge were clear
deviations. Our respondents found computer use to be a force to contend with in
their workday.
Figure 25: Adjective scales reflecting respondents’ nominal
feelings about computer use. Lower values (~1.5) indicate strong feeling
characterized by left adjective (e.g. strongly contented); highest
values (~3.5) indicate strong feeling characterized by right adjective (e.g. strongly
frustrated). Intermediate values (~2.5) indicate that neither adjective
strongly relates to the use of personal computers by respondents. N~56.
But were there patterns of evaluation identifiable among our
respondents? To see if this were the case, we used a reductive procedure,
factor analysis. With this technique, if a respondent found computers “very
important,” would he or she also find them challenging or anxiety
arousing. In short, we looked for intercorrelations among the adjective
scales to identify central themes.
Table 3 shows the results. Questions are shown in the matrix by their loading or “belonging” on each of three key patterns identified in the analysis. Scales loading highly on a given pattern become the basis of describing this pattern as a “theme.” We clearly identified three, which we named: “satisfied & safe,” “challenged” and “anxious.”
What are the implications of the themes? Our analysis shows contrasting impressions: satisfaction with computer use may be mingled with some anxiety and a feeling of challenge. For trainers and those supervising clinic workers, they should expect challenge and satisfaction with computers in the workplace, but also anxiety in their use. In short, the core feelings about computer use that we identified show contrast and contradiction: satisfaction coexists with anxiety and a sense of challenge.
Table
3: Showing
rotated component matrix for feelings about computer use described in eight
adjective-opposite scales. Three factors resulted before extraction was halted.
Means were substituted for missing values. Boldface values indicate highest
loading scale on a given factor. N=59.
Rotated Component Matrix
Factors
|
Satisfied
& Safe |
Challenged |
Anxiety |
| Excited – calm |
.338 |
.759 |
.082 |
| Bored – challenged |
.303 |
-.773 |
.238 |
| Private – exposed |
.538 |
-.031 |
.328 |
| Content - frustrated |
.908 |
.027 |
-.117 |
| Active – passive |
.527 |
.618 |
.002 |
| Anxious - relaxed |
-.055 |
.059 |
.923 |
| Contented - unhappy |
.845 |
.295 |
-.016 |
| Important - unimportant |
.268 |
.715 |
.297 |
| Satisfied - unsatisfied |
.698 |
.452 |
-.031 |
Our final questions concerned use of
Internet browsers and the kinds of site preferred. The results shown in Figure
26 suggest specific, directed search in websites that are used to fulfill
specific goals. Aimless “websurfing” for entertainment is not strongly
favored. There seems little indication that respondents were either bored or
challenged by their browsing.
Figure 26: Web browsing preferences, key activity. Low values indicate left-hand
characteristic held strongly (e.g. challenged); high values indicate
right-hand characteristic held strongly (e.g. bored). Intermediate
values (~2.5) indicate neither characteristic held with strength.
N=43 N=45 N=40
VIII. Conclusions
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ur results consider central questions of traditional and computer-based information system use by rural health clinics. We developed a baseline picture of on-the-job information needs, use and attitudes. Later surveys, taken after new systems have been provided to rural clinics, will use these data to contrast effects of this newly-installed Internet technology.
Typical respondents are in their 30s, have advanced education to at least the level of a two-year college or technical school, and are at most responsible for supervising 2-3 other individuals. The workplace is a small office setting commonplace among rural health facilities.
The most important information systems are patient records and basic telecommunications capability (telephones). “Luxury” systems like video conferencing are seen as less important, likely due to the lack of experience with them. Only a handful of respondents had direct experience with this costly technology. Most information technologies were rated at middle levels of importance and adequacy. Patient records and medical reference were the most vital kind of information used at the clinics. They were the most disparate in terms of perceived importance weighed against the adequacy of what was presently available at the clinics.
Traditional communication activity varied widely among respondents, from a low of 5 hours or less to over 30 hours per week. Computer network-based information accounted for much less time – modally no more than 5 hours per week. Important traditional communication concerned patient records and office paperwork, meetings and mail. Importance and use of computer-based systems likewise centered on patient records, email and forms. Patient records and diagnostic information – extensions of older, formerly paper-based functions – were the most important functions served.
More general information such as management advice, heath care economics and other more general material pertinent to professional education was rated as moderately important. Use of computer technology for on-line journals, listserv discussions and videoconferences was accorded much lower levels of importance. Clearly, our clinic respondents use new information technologies, but the tendency is to value them for doing traditional patient-specific tasks.
On-line information must especially be credible and timely. And to a somewhat smaller degree, such information must be understandable, easily tried-out, safe to use and with back-up help available. There seemed little need to “personalize” the information or to use relational, hyperlink capabilities to easily bring in related information.
Respondents were familiar with computers and had access to the Internet, either at work, home or (often) at both places. Email and word processing dominates use – as it does customarily throughout the US population. Somewhat surprisingly, important management tools such as spreadsheets assumed comparatively low rates of use, perhaps due to their complexity. Respondents showed concern over accessing “trusted” sources and with privacy. To learn more about computers, classes were seen as most valuable followed by on-site help and good documentation, manuals. Personal experience was also valuable. In all, there were few negative attitudes toward computer use.
Use of web browsers followed other usage patterns: it was specific to job needs and favored known, trusted websites. There was little evidence of recreational “web surfing” at work.
We made a brief attempt to show underlying attitudes toward computers generally. Using a common reductive technique, factor analysis, we found three primary components or themes: satisfaction, challenge and anxiety. In short, computer use is rewarding for our respondents, but it may not be easy or comforting.
In all, there is little to suggest that our respondents are technologically backward or atypical of computer users in professional clinic settings. Workplace computer uses are not recreational or heuristic; they are specific, task-directed and show the same kinds of needs served with traditional paper-based information systems. Given these favorable signs, the Circle of Health Phase One technological improvements should both improve traditional clinic operations and promote new uses that are not presently appreciated or fully experienced.
IX. The Questionnaire
NPAIHB Evaluation Survey, Initial Wave - PRETEST 1
THIS INFORMATION FOR TRACKING
AND OFFICE USE ONLY. CONFIDENTIAL
Respondent #_________________1-3:001-999 Position_________________________6-7:01-99
Location_____________________4:0-9 Date
Given____________________8-13:mmddyy
NPAIHB
Staff________________5:0-9 Date Returned_________________14-19:mmddyy
Overview
Welcome to the Circle of Health: Information Infrastructure for Northwest Tribes project. The goal of this project is to provide electronic communication, collaboration and on-line research capabilities for tribes in order to facilitate disease surveillance and aid in the collection and analysis of epidemiology information. The grant is funded by the Telecommunications and Information Infrastructure Assistance Program (TIIAP), through the National Telecommunications and Information Administration (NTIA), an agency of the Department of Commerce. Their focus is to provide matching grants to non-profit organizations such as schools, libraries, hospitals, public safety entities, and state and local governments in order to improve the quality of, and the public's access to, education, health care, public safety, and other community-based services.
The Survey
This is one of two surveys you'll receive over the next year. Its purpose is to assess the impact of the "Circle of Health" computer network being brought to your facility and is a required component of the project. In completing this survey, we do not identify you by name directly, nor will we report any one person's answers in a way that can identify them. Your answers are strictly confidential and remain with our project. Only summaries of how all participants as a group respond will be reported together with a few examples of written answers (source concealed). There are no "right" or "wrong" answers to the questions we ask. You won't be "graded" or held accountable for negative or unfavorable replies. Your honest answers help us greatly in designing better information and delivery technologies.
The actual survey work and analysis is being done with the help of the University of Washington, School of Communication. However, the Northwest Portland Area Indian Health Board is responsible for the study and distributing the questionnaires. The survey is comprised of six sections of information:
Section I: Personal and Professional Information
Section II: Patient Record-Keeping, Local Health Tracking & Other Information
Section III: Communication and Other Informational Activities
Section IV: General Information Sources
Section V: Information Resource Characteristics
Section VI: Use of Information Technology
Remember that all answers are confidential. Should you have questions about this survey, please contact the Project Director, Esther L. Gartner, or Information Systems Specialist, Jim Fry, at (503) 228-4185.
Section I: Personal and Professional Information
We would like to ask some
questions about you and your position at the health facility.
Your Position:
q Tribal Health Director [20:1] q Site Manager [:5]
q Physician [:2] q Pharmacist [:6]
q Physical Therapist [:3] q Dentist [:7]
q Nurse [:4] q Records Clerk [:8]
q Other: ____________________________[21:0-9]
Your age:
q 18
to 25 years [21:1] q 46
to 55 years [:4]
q 26 to 35 years [:2] q 56 to 65 years [:5]
q 36 to 45 years [:3] q Over 65 years [:6]
Education:
q Elementary [22:1] q College (4 year) BA [:4]
q High School [:2] q Post-Grad (MS, MPH, etc) [:5]
q Community College or Technical School [:3] q MD, Ph.D. [:6]
How long you've been
in your present job:
q 1 year or less [23:1] q 11-20 years [:4]
q 2-4 years [:2] q Over 20 years [:5]
q 5-10 years [:3]
Number of people you
supervise at work:
q Not in supervisory job [24:1] q 4-10 people [:3]
q 1-3 people [:2] q More than 10 people [:4]
Number of people you
work with regularly:
q Work alone [25:1] q 4-10 people [:3]
q 1-3 people [:2] q More than 10 people [:4]
Finally, who do you
prefer to go to in your organization for information on:
PLEASE GIVE US THE INDIVIDUAL'S TITLE:
…your
job and responsibilities: [26-45]
…the
community and what's going on: [46-65]
…technology
and office equipment (e.g. computers): [66-85]
Section II: Patient record-keeping, local health tracking and other information
First, we want to know something about how
you presently handle information in your office.
Understanding this will help us evaluate
how new systems help (or don't help) your work.
Please
rate the following information categories that you encounter in your everyday
work. Circle the response
closest to how you feel. If a category isn't relevant to your work or is not needed, indicate this with the
"Not Apply" option. Circle the best answer.
Patient record systems - how
medical information about your patients is collected, stored and retrieved
on a daily basis at your clinic. [86:]
[87:]
|
\
- The
existing information system is (1)
excellent, (2) good, (3) fair, (4) poor, or (9) not apply
q
The importance of this information to my job is (1) vital, (2) important, (3) sometime
important, (4) not very important, or (9) does not apply
Community health statistics and related information - how
data about your clinic's service area is collected; how often it is reported
and its adequacy. Include data your clinic
collects and other data regularly
available to you from outside sources. [88:] [89:]
|
q
The existing information system is (1) excellent, (2) good, (3) fair, (4)
poor, or (9) not apply
q The importance of this information to my job is (1) vital, (2) important, (3) sometime important, (4) not very important, or (9) does not apply
Medical reference, library information at your
clinic or currently available through existing computer links there [don't
consider outside systems where you
have to travel or make special requests by phone to use]. [90:] [91:]
|
q
The existing information system is (1) excellent, (2) good, (3) fair, (4)
poor, or (9) not apply
q
The importance of this information to my job is (1) vital, (2) important, (3) sometime
important, (4) not very important, or (9) does not apply
Regularly available consultants, outside medical or diagnostic
expertise from larger medical centers. [92:] [93:]
|
q
The existing information system is (1) excellent, (2) good, (3) fair, (4)
poor, or (9) not apply
q The importance of this information to my job is (1) vital, (2) important, (3) sometime important, (4) not very important, or (9) does not apply
Adequacy of electronic or telephone communications at clinic. Rate the systems
presently used at your facility. Telephone
and paging systems[94:] [95:]
|
q
The existing information system is (1) excellent, (2) good, (3) fair, (4)
poor, or (9) not apply
q The importance of this system to my job is (1) very important, (2) important, (3) sometime important, (4) not very important, or (9) does not apply
Computer, internet and
data communication [96:] [97:]
q
The existing information system is (1) excellent, (2) good, (3) fair, (4)
poor, or (9) not apply
q
The importance of these information tools to my job is
(1) very important, (2) important, (3)
sometime important, (4) not very important, or (9) does not apply
Videoconferencing for
diagnostic or consultation use [98:] [99:]
q
The existing information system is (1)
excellent, (2) good, (3) fair, (4) poor, or (9) not apply
q The importance of this system to my job is (1) very important, (2) important, (3) sometime important, (4) not very important, or (9) does not apply
Section III: Communication and Informational Activities
Consider all the paperwork, face to face meetings and
research you do with traditional books and journals. About how many hours a
week, on average, do you spend performing all these activities (collectively)? Fill
in estimate of hours below:
______Hours per WEEK [100-101]
Please rate how you use traditional communication tools at
work. Circle the response closest to
how you feel. If a category isn't relevant to your work or is not needed,
indicate this with the "Does Not Apply" option. Circle the best answer.
q
Mail
(regular, postal, interoffice) [102]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q Paperwork (forms, contracts, time sheets, etc.) - reporting what you do [103]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q Medical or health research (Newsletters, Journals) [104]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q
Staff
conferences and meetings [104]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q
General news
and information (Newspapers, Magazines, Audio/Visual) [105]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q Professional communications with co-workers, memos, on the telephone [106]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q Social communications (not directly job related) [107]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
Are there major problems YOU have regularly with these traditional communication tools? Please describe below: [108]
Now consider your use of electronic data or computer-based communication systems. About how many hours a week on average do you spend in this kind of activity?
______Hours per WEEK [109-110]
q
Email
(electronic mail, messaging) [111]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q
Computer forms and Database (records use) [112]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q
Online journals, newsletters, internet information
[113]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q Listservs (email to several people at once),
computer-based teleconferences, internet
news groups [114]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
q
Teleconferences (more than 2 people conversing
together by phone), videoconferences [115]
(1)Very Important, (2)Somewhat Important, (3)Not Very Important or (9)Does Not Apply
Are there any major problems you have in using any of these computer or telephone-based communication tools? Or is there something NOT in the list above that is important? Please describe below: [116]
Section IV: General Information Sources
Indicate whether you agree strongly, agree somewhat, neither agree or disagree, disagree somewhat or disagree strongly with the following statements. Circle the answer closest to how you feel.
q
Too much is
made of the internet and technology. Getting information through regular
journals, books and libraries still is the best way. [117:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree
q
The Internet is
best as a supplement to traditional information resources. It's useful, but it
won't replace traditional resources. [118:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree
q
The Internet
opens up new kinds of information. It's an important, major way of getting
medical and health information today. [119:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree
Consider what you presently know about the Internet and medical information that can come to you through computer networks like the Internet. What kinds of information seem most of use to you in doing your job?
Put a "1" next to the most important category. Put a "2" and a "3" by your second and third most important choice.
___Major research and
medical news [121:]
___Business
information about health industry [122:]
___Healthcare
delivery news [123:]
___Financial information [124:]
___Grant information [125:]
___Organizational, clinic management [126:]
___Patient management, record-keeping and databases [127:]
___Area
health statistics [128:]
Section V: Information Resource Characteristics
Think about the
information you use everyday at work. Below are some characteristics used to
describe it. Let us know how important each is to you.
Circle the answer closest to your feelings about each characteristic.
Timeliness: Information is up-to-date [129:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Credibility: I trust the competence and expertise of the source [130:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Personalized: Information source speaks to my particular needs and community. [131:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Understandable: The information uses examples and is in language I understand. [132:]
(1)Very Important (2) Somewhat Important
(3) Not Very Important (9) Does Not Apply
Relational: I can find easily related documents, other advice. [133:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Usable: Information is easy to try out, implement. [134:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Safety: Information is low risk, cautious, tested. [135:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Organized or searchable: I can find what I want easily. [136:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Help: There's back-up help I can count on if I don't get what I need. [137:]
(1)Very Important (2) Somewhat Important (3) Not Very Important (9) Does Not Apply
Are there other things we should know about the quality of information
you use in your work? Tell us about them below: [138-139]
|
|
We'd like your reaction to the following general questions about information sources.
Indicate whether you agree strongly, agree somewhat, neither agree or disagree,
disagree somewhat or disagree strongly with the following statements. Circle your choice:
q
I like using
personal computers in my work and for finding information. [140:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or
Use
q
I am usually
comfortable finding information on the Internet or from on-line health
information services. [141:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or
Use
q It's important for me to reach colleagues and friends through email. [142:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or
Use
q
My privacy may
be at risk using computer information systems. [143:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or
Use
q
To trust information, I usually have to
get it from people or sources I know well. [144:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or
Use
q
I would feel
better about using computer-based information if my colleagues and coworkers
use it as well. [145:1-6]
Agree Agree Neither Disagree Disagree Don't
Strongly Somewhat Agree or Somewhat Strongly Know
Disagree or Use
Section VI: Use of Information Technology
We
wish to ask you a few questions on your use of information technology.
Do you use a personal computer . . .
? [146:] ____Yes [1] _____No [2]
___ at home ___
at work ___both home and work [147:1-3]
Do you have an Internet connection .
. . . ? [148:] ____Yes [1] _____No[2]
___ at home ___ at work ___both home and work [149:1-3]
Skip the following if no computer is used at all.
q How often do you use your computer . . . Circle best answer
For routine tasks like word processing [150:1-4,9]
Everyday Several
times Once a week Not at
Don't
a week or
less all know
For email [151:1-5]
Everyday Several
times Once a week Not at Don't
a week or
less all know
For spreadsheets, taxes or financial analysis [152:1-4,9]
Everyday Several
times Once a week Not at Don't
a week or less all know
For exploring the Internet [153:1-4,9]
Everyday Several
times Once a week Not at Don't
a week or less all know
For helping family members or friends [154:1-4,9]
Everyday Several
times Once a week Not at Don't
a week or less all know
For helping colleagues, co-workers [155:1-4,9]
Everyday Several
times Once a week Not at Don't
a week or less all know
For on-line information services, such as libraries and Medline [156:1-4,9]
Everyday Several
times Once a week Not at Don't
a week or
less all know
For transferring or downloading files [157:1-4,9]
Everyday Several times Once a week Not at Don't
a week or
less all know
q In using computers in your work . .
Are you able to answer most questions yourself from experience? [158:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
Can you answer most questions yourself with the instruction manuals? [159:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
Are there people there who can give you assistance? [160:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
Would you find classes or seminars on use helpful? [161:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
Computers are fragile, break easily. [162:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
Computers cut you off from people you work with. [163:1-3,9]
___Yes ___Sometimes ___No ___Don't
recall
Computers don't fit in with how we work around here. [164:1-3,9]
___Yes ___Sometimes ___No
___Don't recall
If you don't use computers, SKIP the following items.
|
When you use
computers, do you usually feel . . . .
Circle the best answer for you |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
FRUSTRATED |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[165:1-5] |
||||||||
|
|
UNSATISFIED |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[166:1-5] |
||||||||
|
|
UNHAPPY |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[167:1-5] |
||||||||
|
|
PASSIVE |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[168:1-5] |
||||||||
|
|
CALM |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly [169:1-5] |
||||||||
|
|
UNIMPORTANT |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[170:1-5] |
||||||||
|
|
RELAXED |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly [171:1-5] |
||||||||
|
|
EXPOSED |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
|
[172:1-5] |
||||||||
|
|
CHALLENGED |
|||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
[173:1-5]
q
Have you used the Internet Web? If yes, answer the following
. . .
If not, skip to the next section below.
|
When you use the Web, do you usually: |
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
have a specific |
|||||||
|
|
||||||||
|
Strongly Somewhat Neither Somewhat Strongly |
||||||||
[174:1-5]
|
Websites |
try new places and topics |
|
|
|
|
Strongly Somewhat Neither Somewhat Strongly |
|
[175:1-5]
|
|
feel bored |
|
|
|
|
Strongly Somewhat Neither Somewhat Strongly |
|
[176:1-5]
Any Comments you would like to add . . .
[177-179]
Thank
you for your help.
You
have successfully completed the survey.
Remember that all responses are kept strictly confidential.
After you have completed this survey,
please place it in the envelope provided and seal it to ensure your right to
privacy is protected. You can then
either hand it back to one of the Northwest Portland Area Indian Health Board,
Circle of Health project staff or mail it back to the following address:
Northwest
Portland Area Indian Health Board
520
SW Harrison
Suite
335
Portland,
OR 97201
Attn: Circle of Health Project Staff
Make sure the outside of the
envelope is marked "Confidential Material".
How can the Northwest
Portland Area Indian Health Board, Circle of Health project, reach you in case
we need to clarify one of your answers.
Phone Number: (
) _______________________________________[180-190]