Tomorrow's leaders in health promotion are being educated at American University today.

 

CHAPTER 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

Summary and Significance

This study was a first-of-its-kind in this area. The goal of this study was to identify, gather data, and explore some of the key factors, issues, and relationships that are related to the adoption and use of computer-related technology and information systems in health promotion. Although this study was designed as an exploratory or preliminary investigation, there are nonetheless several interesting findings and worthwhile contributions to the body of science in the information systems field.

First, during the course of the study an instrument was developed that is specific for this population, the types of environment in which they work, and the duties they are called on to perform. The questionnaire exhibited adequate psychometric properties during its first full test in the field. The survey can serve as a beneficial tool for others who want to gather longitudinal data on this population or to modify it for other research purposes.

Second, the data presented in Chapter 4 provides some useful quantifiable benchmarking measures for several key computer-related variables including background, experience, attitude, habits, and use patterns for this population. The data can be beneficial for multiple constituencies in a variety of ways. For example, the data can be used by decision makers and others who would like to gain a clearer picture or understanding of the barriers, issues, and beliefs of the leaders and practitioners of health promotion that are related to computers and information systems. Practitioners can use the data to understand how others in their profession are reacting to computers and how they are using them. The data can help healthcare professionals understand how they can enhance their services to their clients, optimize their workflow and productivity, and how to prepare for a working environment that will become increasingly reliant on computers and information systems in all aspects of care (Anderson, 2001). The data can be of use for policy makers in their efforts to establish reasonable standards, regulations, and legislation that are appropriate for the Information Age. Policies that are based on quantifiable data can be effective in promoting and assisting in the development and deployment of current as well as the next generation of systems that will be designed to improve productivity, efficiency, safety, and quality of service as well as the greater good of society. The administration and faculties of higher education as well as career, professional, and training institutions may benefit from reviewing the data and conclusions of this study as a means of helping them to plan for and meet the needs of new students as well as those who are already working in the industry. Finally, researchers may find this data useful for comparison purposes, for exploring the data in greater depth, or in other ways that are beyond the scope of this exploratory study.

Third, it is clear from the data that on the whole, the respondents in this sample population were aware of, sufficiently knowledgeable about, and experienced with most of the basic computer skills, software applications, and many of the uses of IT that are commonplace in data and information-intensive industries. In short, the respondents were capable, equipped, adequately motivated to benefit fully from the power, performance enhancement, and potential that can come from the efficient use of modern, well-designed, intelligent, and universally accessible computers and IT systems. Further, this group of respondents shares many of same barriers and issues with their counterparts in other industries and healthcare domains, although the magnitude or intensity of feelings about those barriers were different in several ways. However, it is beyond the scope of this study and not possible to determine from this data the implications of the barriers on this population or what theoretical or practical approaches, techniques, or ways would be most effective or best for addressing them. It is worth noting that although the leaders and practitioners of health promotion that made up this sample were, in some areas, well behind their counterparts in some of the other data and information-intensive industries, they were nonetheless well ahead of some other types of healthcare professionals such as physicians in terms of the adoption, integration, and application of some technologies in their services and practices (Hanks, 2000; Mayo, 1999; Ferguson, 1997).

In summary, although the design and methodology that was used in this study prohibits generalizability of the conclusions beyond this sample population, the data does provide credible evidence about the current computer-related attitudes, habits, behaviors, and patterns of use of health promotion professionals. What is not evident from the data is why, given the proactive, empowering, and evidence-based nature and philosophy of health promotion, there is not a much greater insistence on, avocation for, and use of the modern sophisticated, intelligent, and powerful applications, computer, and IT systems in developing and delivering services and activities that can be highly beneficial for clients. Further, it is doubtful, given the organizational culture that dominates the healthcare industry, the current curricula that are in place, and the trends in educational and training institutions that there will be a dramatic change in this area in the foreseeable future. However, some of the theoretical and practical approaches that will be discussed in the next section could lead to a viable path for future development and growth in this vitally important area.

Conclusions and Implications

The ultimate goal of health promotion theories and programs is to achieve optimal health status and quality of life for individuals and populations in highly efficient and effective ways. Health promotion program planners and practitioners can choose from an array of theory and evidence-based interventions, management, education, and surveillance tools and techniques to accomplish this goal. There are numerous characteristics that are inherent in most computer-based and IT systems that make them ideal candidates for addressing the health problems that beset this country in a way that is consistent with the principles of health promotion.

Several practical and theoretical computer and IT-based systems and solutions were highlighted in the literature review. Unfortunately, the data from the survey indicate that too few of the basic computer and IT-based options have been universally adopted, and those that are rarely function optimally or are integrated into all aspects of care. Several conclusions that relate to this phenomenon can be drawn from the data that was collected for this study.

First, although the perceived worth of computers was generally rated highly, the wide-spread use or application of the best and most powerful technologies and tools is far from universal and rarely are they exploited to the fullest possible extent (Strecher, 2000; Street et al., 1997). Most studies in the literature have concluded that the level of perceived worth is a powerful factor in determining how quickly and fully individuals adopt technologies (Rogers, 1995; MacDougall & Brittain, 1994). The data in this study indicate that there is strong resistance among a small but strategically important number of professionals who are "late or reluctant adopters" of technology. Often they are individuals who oppose the adoption, proliferation, incursion, or greater use of existing or new technologies. It is possible to overcome or temper some of this resistance through techniques such as: mentoring and training programs, greater involvement in the development process of technologies and systems they will be expected to use, developing cultural change strategies in organizations that promote the adoption of strategically important technologies, and shielding them form situations when the technology is immature, user-unfriendly, or the benefit is not easily achievable, obvious, and immediate. Because trying to force unwanted technology on technology-averse people is generally counterproductive, offering them alternatives such as the ability to opt out, or to become gradually involved, or reassigning them to other duties is often a preferred strategy (Lorenzi, 1995). The techniques listed above should pay dividends in the form of higher ratings of perceived worth, greater and more frequent use of computers to provide health promotion programs and services to clients, and generally lower ratings for a variety of barriers.

Second, the three types and uses of software applications that were underutilized and underexploited in this study were the use of database software, the use of the Internet for research and servicing clients, and the use of communication tools such as e-mail with clients. The effective and widespread use of these applications is central to the theme of data and information-intensive and knowledge-based societies (Kurzweil, 2000; Donovan, 1998). Among the practical steps that can be taken to improve this situation are; earlier, improved, expanded, targeted, and in some cases mandated training options and technical support systems, development of incentives and motivational schemes, and establishing demonstration projects and special teams within organizations. Among the potential benefits of these steps, from the perspective of upper-level management, are higher ratings of perceived worth, greater productivity, and improved operational efficiency.

The conclusions related to the training of employees is the third area of this study that has enormous implications for this field. Individuals rarely learn the best and most efficient ways of doing things if they are left to learn on their own (Shortliffe, 1998). The large percentage of individuals who rated self-taught as their most important form of training indicates that a great deal of work can be done in this area. In order for organizations to maximize the efficiency and productivity of their employees, computer and IT systems-related training should be an integral part of the initial orientation process. Moreover, a strategically planned periodic and ongoing professional growth and enhancement process should be the norm in all data and information-intensive organizations. This retraining process should be especially targeted to, appropriate and beneficial for, and accommodating to "older" or technologically-averse employees.

Although training was not identified as one of the top barriers in this study, there is a substantial body of literature that states that the lack of purposeful training greatly undermines the productivity for all but a few employees (Hanks, 2000). Commensurate with the principles of effective learning, the training sessions should be topic-specific, tailored to the learning style of the user, and feature a mixture of multimedia techniques (Kieschnick et al., 1996). Unfortunately, many individuals in healthcare have not been exposed to technologically sophisticated organizations. Therefore, many of them do not even understand what is possible. An astute manager might develop mutually beneficial opportunities where cross-pollination can be fostered though frequent associations between willing health promotion professionals and seasoned IT professionals who are ready to listen, willing to learn from each other, and able to explore new horizons and become informed about how they might be able resolve common problems. These steps may pay great dividends including increased use of the computers and technologies in health promotion activities with clients.

Fourth, the advanced technologies are new for many professionals. From the data it is apparent that some technologies such the Internet are popular; however, many practitioners do not know how best to use it. For example, although e-mailing was a popular form of communication in this sample, relatively few of them are using it to connect with their clients. The use of database technologies is another area that is very new and unexploited in this domain. Further, almost all of the companies had Websites, but most of them were in existence for less than two years. In the future, people and organizations will learn to use them in ways that have been proven to be effective in other sectors of the economy.

Finally, it is logical to assume that professionals who have a health promotion orientation, are astute, well versed and immersed in technology, and willing to experiment may be the early adopters and evangelists of leading-edge technologies in healthcare for those who are healthy as well as the ill (Anderson, 2001; University of Wisconsin-Madison, 1998; Koop, 1995). Because they are well informed, they will be better able to make intelligent and informed decisions about whether to adopt some of the new technologies such as speech, wireless, agents that come on the market and see ways that they can be applied to make their jobs easier or used for the benefit those who are in their care.

Recommendations for Further Research

Several important areas for future research emerged during the course of this study. First, a great deal of benefit could be derived from a second study that seeks to replicate or extend the findings of this study with another sample, a larger group, or a slightly different methodological approach. Another useful project would be to repeat this study annually or at some designated period. This longitudinal data would allow for trend analysis as well as development of additional validity or data on the psychometric properties of the instrument.

Another interesting approach would be to explore these issues through qualitative methodologies. Focus groups, organizational analysis, case studies, and mixed-methodological approaches could lend support to this data through triangulating techniques.

Third, the data that has already been collected could be explored in greater depth and detail with more sophisticated statistical analysis techniques. Exploring the relationships among the different segments of the sample population may reveal additional useful findings.

A fourth area for additional study should involve use of a different survey methodology. For example, the survey could be put online or mailed to a random sample to ensure a more complete representation of whole profession.

Finally, important questions that were omitted from the initial pool of items could be included in modified or revised versions of this instrument. Each of these options could be important contributions to the body of science and help us understand how to best to advance in this vitally important area of study.

If the predictions of some of the visionaries are correct, then perhaps, in the near future, the following forecast by Anderson will come true for all of the healthcare supply chain "Modern healthcare is unimaginable without information technology" (Anderson, 2001 p. 21).

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Last Updated: December 10, 2001