My Health e vet for Communication & Social Marketing

1. My Healthevet for Communication & Social Marketing Keith McInnes & Allen Gifford

2. Collaboration QUERI HIV / Hepatitis Steve Asch Barbara Bokhour Jane Burgess Linda McCoy Jeff Solomon Public Health Strategic Healthcare Group (PHSHG) Jane Burgess David Ross Consumers Health Informatics Office / MHV Kim Nazi

3. Working in Area of Overlap MHV PHSHG QUERI

4. Overview • Objectives • Background • Methods • Patient focus group results • Provider focus group results • Summary • Future directions

5. Objectives • Assess veteran & provider attitudes about use of MHV to broadcast emails with public health messages; special interest in HIV screening • Evaluate patient and provider reactions to messages content • Refine message in preparation for broadcasting

6. Background • My Healthevet allows registrant to enter personal email address • Checkbox indicating interest in receiving health messages via email • Approximately 300,000 vets both provided email and indicated interest in email health messages

7. Methods • QUERI RRP funding • 4 total focus groups (2 with pts; 2 with providers) • First round focus groups (2) • Analysis & develop message content • Second round focus groups (2) • Analysis & refine message content

8. Patient Themes Lack of Clarity about MHV • about what My Healthevet is • type of registration gives which functions “I know about the [My Healthevet site], but I haven't done it. Are you telling me, in other words, if I sign up for this password and all that stuff, I can get my medical records via the Internet?”

9. Patient Themes Diffusion of Innovation? A: Oh, yeah, I use the Internet. But I also use the VA site, primarily for prescription refills. It's so convenient. B:Prescription refills are terrible, because you only get the prescription number. They don’t give you what it is. So you have to have a separate list to cross-reference. A: They’ve changed that now. They’ve got the name of the medication. B: No, they haven't. Not on mine, they don’t!

10. Patient Themes Trust: Provider instructions carry special weight “I would say if it came from the VA, just the VA site, I would have the tendency more than likely to delete that sort of thing, unless I was interested. But if it came from my healthcare provider saying ‘Your healthcare provider, your doctor has suggested that you be tested for X, Y, and Z,’ then that's a different story. But just to have a blanket email from the VA saying everybody should get tested -- I don’t think it will sit as well as a personal note saying, ‘Look, your doctor suggests you have this test.’"

11. Patient Themes Nuisance “…if you just send me to my open mail, I'll probably delete it, without opening it. Because I'm not looking for it. I'm going on line for something else. I'm doing other things. I don’t want to read about that. Don’t bother me. It's more of the same coming in that I probably delete a chunk, probably 20, 30 messages a day.”

12. Patient Themes Security / Confidentiality around HIV Content “I've given away computers …to people who never had one. [The new owner ] can get into your mainframe, as you folks may know. They can find stuff that you left in there. I'm not taking that chance, HIV. I'm very careful about what goes in my computer. I have a disk that I put everything on. I don’t let it go on my mainframe. But some stuff goes in there. You think I want to take a chance and let HIV go in there? And they accidentally find it? Hell, no!”

13. Patient Themes Alternatives to Email • Email: “Important message at MHV” • “Just tell me to go to My Healthevet website, log in and I get messages there. I'd rather see a message there than coming into [my personal email]” • Use of posters in clinics • Inserts with appointment reminder letters

14. Patient Themes Message Content Suggestions • Factual information about HIV • Story of Magic Johnson • Emphasize that all be tested • Appeal to altruism – help other vets • Cite authorities, such as CDC

15. Provider Themes Email about HIV would worry patients “… there is a small subset … who might think, "What happens in the military that puts us at higher risk for being exposed to HIV more than the rest of the population? Is it something the military performed experiments on us, unknown to us?"

16. Provider Themes Flood of Patient Inquiries to Message about HIV “I'm concerned …if they read something like this, they're going to be on the phone calling up. We can only handle so much.”

17. Provider Themes Workflow – Need to Address Demand for HIV Tests • Stand alone clinic • Designated staff person for education, pre- and post-test counseling “So up until now, in fact at this time, there is a disconnect with increasing numbers of performance measures… but without increasing support staff, infrastructure and time for providers, that makes us all feel very frustrated.”

18. Provider Themes Use Link to MHV • Similar to patient view “Make it a newsletter as opposed to [a personal email], …because you can do it with these things called ‘push pages’. [You get an email and it says] ‘Hi, your VA is sending you a weekly newsletter.’ • Hyperlink takes you to MHV newsletter

19. Provider Themes Content of Message • Treatable, chronic disease • Spread messages over several weeks starting with less sensitive conditions

20. Summary • Similarities between patients & providers • Email indicating mail at MHV; posters, fliers, US mail • Privacy / confidentiality concerns • Need to explain MHV to subjects • Wariness of electronic systems – happen fast & less control • Range of comfort / ability with computers

21. Future Directions? • Value of qualitative research • Diffusion of innovation • Social networks

22. THANK YOU