AHRQ-Funded Talking Touchscreen® Expanded for New Uses
An AHRQ-funded tool for patients with limited literacy, the Talking Touchscreen®, has been used in research studies in Chicago-area hospitals and as the basis for various other applications, including versions for Spanish-speaking patients, cancer patients, and diabetes patients. The Touchscreen has also been integrated into the Kaiser Permanente Los Angeles Medical Center (LAMC).
Talking Touchscreen, a multimedia health information technology tool, was developed as a user-friendly way of assessing patient-reported outcomes and as a tool to help end health disparities in underserved populations. It was developed in 2004 with AHRQ funding by researchers led by Elizabeth Hahn, Associate Professor, Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine. It was initially intended for patients with limited functional and health literacy, offering a means to assess health outcomes.
"We were doing all these studies and we realized we had developed a great tool for people to use in actual clinical practice," Hahn says. "Developing both the original and the Spanish-language versions provided evidence of the feasibility and validity of this new technology and the foundation for our further work in this area."
The original Touchscreen project was developed in English and intended for patients with limited literacy. The researchers sought to develop a tool that would be useful to all patients, regardless of their literacy level and computer skills. Patients are presented with questions and answers on a touch-sensitive screen, displayed in large type and offset with color to promote readability. The Touchscreen can also read the questions to the patient through a headset or speakers. The Spanish version is called La Pantalla Parlanchina. Questionnaires have been programmed to measure health-related quality of life and other patient-reported outcomes.
Now, two adaptations of the Touchscreen, the CancerHelp-Talking Touchscreen® and DiabetesHelp-Talking Touchscreen®, are the result of integrating the Touchscreen with the CancerHelp Institute's patient education programs. By combining these two technologies, limited literacy patients with a cancer or diabetes diagnosis receive information from the National Cancer Institute, AHRQ, or the National Institute of Diabetes and Digestive and Kidney Diseases on diagnoses, treatment, support, side effects, prevention, and screening. The goal is to improve the delivery of patient-centered health care to English- and Spanish-speaking patients.
Two CancerHelp-Talking Touchscreen kiosks have been installed at the John H. Stroger, Jr., Hospital of Cook County, Chicago's largest safety net hospital. Nearly 500 users viewed material on the kiosks in 2012, and more than half of the users were cancer patients or survivors, according to information provided by the CancerHelp Institute, which maintains the kiosks. Two DiabetesHelp-Talking Touchscreen kiosks have also been installed at Stroger Hospital.
"Our reports show that more than one person is often looking to learn at the same time," says Ed Miller, Director of Interactive Patient Education Programs for the CancerHelp Institute.
LAMC has integrated the kiosks into daily clinical practice in one inpatient unit, six adult outpatient clinics, and one pediatric transplant clinic, and another kiosk is located in the Kenmore apartments, which provide a "home away from home" for families so they can stay close by their hospitalized child at little or no cost. LAMC serves as a safety net hospital in a catchment area that includes a large number of people with low socioeconomic status, low literacy, and limited English-language skills.
Anne Fraser, Medical Librarian at LAMC, says that the "Listen and Learn" approach of the Touchscreen is a "user-friendly tool to enhance patient education activities for newly diagnosed cancer patients, and meets the Joint Commission's mandate for patient education." It is also used by unit-based teams to promote health education to ethnically diverse patients. Quality improvement researchers at LAMC studied how the kiosks were being used in various locations and also surveyed nursing staff to measure their impact. Implementing small changes, such as moving some kiosks to different areas and providing more information to clinical staff about how best to use them, led to an increase in patient use of the kiosks. Patients report that "anybody can walk up and touch the screen to access information in a friendly manner," says Hahn.
The Talking Touchscreen framework has also been built into an application called Health LiTT (available at http://www.healthlitt.org), a measure of health literacy that can be self-administered in either English or Spanish using sound, text, and images. It covers health- and insurance-related topics and informed consent. The Talking Touchscreen/La Pantalla Parlanchina and Health LiTT have also been incorporated into Assessment Center, a free online research management tool that helps researchers create study-specific Web sites for securely capturing participant data (available at http://www.assessmentcenter.net). By overcoming assessment barriers to self-administration of questionnaires, these tools enable new insight into previously undetected disease or treatment problems among low literacy patients, and also enable real-time reporting of health literacy scores.
The CancerHelp-Talking Touchscreen is available at http://www.cancerhelp.org.
Hahn EA, Choi SW, Griffith JW, Yost KJ, Baker DW. Health literacy assessment using talking touchscreen technology (Health LiTT): a new item response theory-based measure of health literacy. J Health Commun 2011;16(Suppl 3):150-62.
Hahn EA, Cella D, Dobrez D, Shiomoto G, Marcus E, Taylor SG, et al. The talking touchscreen: a new approach to outcomes assessment in low literacy. Psychooncology 2004;13:86-95.
Hahn EA, Cella D, Dobrez DG, Weiss BD, Du H, Lai JS, et al. The impact of literacy on health-related quality of life measurement and outcomes in cancer outpatients. Qual Life Res 2007;16:495-507.
RFA-HS-07-007. Ambulatory Safety and Quality: Enabling Patient-Centered Care Through Health Information Technology. Grant #017300.