Date of Award

12-2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Legacy Department

Industrial Engineering

Advisor

Joel S. Greenstein

Committee Member

Anand K. Gramopadhye

Committee Member

Richard Pak

Committee Member

DeWayne Moore

Abstract

Anecdotal information about a healthcare consumers' interaction with care providers and hospital facilities is becoming increasingly available to the public in the form of YouTube videos and as discussion posts on peer-support groups. This form of information can potentially jeopardize the utility of reports generated by Federal entities as it potentially diverts consumer attention from more reliable measures of quality. This dissertation investigates how a health consumer's choice of care is influenced by anecdotal information on the care process available on YouTube. This research then investigates the effect of information presentation methods such as narratives and active engagement with quality metrics to support the consumer's ability to comprehend public report information. An initial study investigated the characteristics of information healthcare consumers are searching for on a peer-support group. By analyzing the discussions available on the support community of a major ovarian cancer support group, the Ovarian Cancer National Alliance (OCNA), this study investigated the type of information that newly diagnosed ovarian cancer patients and their supporters seek. Using content analysis, 206 publicly available discussions exchanged on OCNA were analyzed by two researchers. Each discussion point was classified into one of the three broad themes that emerged: ovarian cancer-specific, treatment-related, or coping information. The discussion points were further analyzed using a multinomial logit model to predict the type of the desired information based on the role of the person looking for the information, the disease phase in which the information was sought, the emotional status of the information seeker, and the stage of the cancer. Treatment-related material was the most sought-after information by patients, while coping information was most sought by supporters. When forum posts were negative in tone, the information seekers were more likely to be looking for ovarian cancer-specific information than either treatment-related information or coping information. The second study investigated the effect of the role of the sequence in which such public report statistics and anecdotal information are viewed by health consumers during the sensemaking process. The study used the scenario of a patient looking for health facility-related information and employed a 2 (anecdotal information presented as videos supporting and contradicting public report information) * 2 (phase of introduction of anecdotal information: early, late) between-subjects experimental design. The results found that when the phase of introduction of anecdotal information changed from early to late, and when the anecdotal information contradicted the public reports, the probability of choosing the correct facility changed from 0.41 to 0.69. The probability of choosing the correct facility was reduced by more than half, changing from 0.85 to 0.41, when contradicting, rather than supporting, anecdotal information was presented before the public reports. Participants placed significant emphasis on this initial information and found it difficult to change their initial perceptions when presented with the more reliable public reports. The third study investigated ways to enhance consumer understanding by integrating standardized quality metrics with anecdotal information using user experience design methodologies. Two-hundred individuals participated in this study. This study employed a 2 (public report information presented in the standard way, presented within an anecdote) * 2 (engagement with each quality metric: none, active) between-subjects experimental design. The results of the study found that the probability of choosing the correct facility changes from 0.71 to 0.88 when information was presented within a narrative rather than with the standard public report format. A final study evaluated whether the influential nature of inaccurate anecdotal videos could be attenuated by presenting public report information within a narrative with active engagement. The study used the scenario of a patient looking for dialysis facility-related information and employed between-subjects experimental design - inaccurate anecdotal information was presented either early or late in the sensemaking process. Ninety-eight individuals participated in the study. The results found no significant differences in the choice of the dialysis facility and level of confidence in the choice. Given that narratives have the power to impact choice and comprehension, there exists a need to conduct further investigation to develop comprehensive guidelines for the presentation of narratives that support the use of public report information.

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