https://doi.org/10.33698/NRF0204 Supriya Saini, Karobi Das, Manmeet Kaur, Sushma Kumari Saini
Abstract : Personal health records are records having important personal and medical information maintained in a paper or web based format in persons’ own language. This information helps in getting health services in an economical way by preventing repetition of routine medical tests and can give care providers more insight into health story of an individual.As nurses are the first person who gets in contact with community so this responsibility lies on their shoulders more than other health professionals. Keeping this in mind, study was undertaken with the objective to develop and operationalize Personal Health Record by involving family members at Dhanas village of U.T. Chandigarh. Out of approximately 500 families 108 were selected, based on literacy (above 8th class)and willingness to participate. In the end data of total 98 families were analyzed. From selected families the eligible respondents were taught about filling of personal health record. Seven follow ups for three months were done. During this period teaching sessions, demonstrations were given to correct and motivate participants to fill and maintain the records. The result shows that ability and acceptability of family members to fill and maintain health records for their families’ improved by follow up visits as people started taking interest in recording their health parameters age and education had no impact on completion of Personal Health Record. For Personal health records to be effectively used by people and to develop their interest in these records, proper guidelines, follow up and teaching sessions were very useful.
Keywords
Protocol, Personal health record, Family.
Correspondence at
Dr. Sushma Kumari Saini
Lecturer,
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
Personal Health Record (PHR) is a lifelong resource of health information needed by individuals to make health decisions. Documents commonly included in PHRs range from identification sheets and medications to X-ray reports and hospital summaries. Each one of these documents is a unique component of an individual’s PHR with his or her own health history.1It is a great tool to keep track of health.2 The term has been applied to both paper-based and computerized systems; current usage usually implies an electronic application used to collect and store health data.
PHR allows health care professionals to deliver safer, more effective care. A central factor stimulating the use of PHRs is the individuals’ increased desire to engage more actively with their personal health and collaborate more directly with their health care providers while discussing treatment options, negotiating costs, or prioritizing preventive actions. Another idea behind the PHR is that the more informed an individual is regarding his or her health; more likely he become interested in managing their own health.3
Nurses are in a prime position and direct care provider. So they can influence the use of PHRs among patients, friends, and family. People who are interested in PHRs, nurses should stress the importance of having a consistent, accessible record of one’s health in one location that can be updated by one’s self. This accessibility of health information can be essential during times of emergency or while planning health- related purchases such as buying insurance.1The types of Personal Health Records include: paper, electronic device, and web. Paper-based personal health records are those in which personal health information is recorded and stored in paper format. Printed laboratory reports, copies of clinic notes, and health histories created by the individual may be parts of a paper-based PHR. This method is low cost, reliable, and accessible without the need for a computer or any other hardware. It has been seen that paper records are extremely flexible and do have distinct advantages over rigid electronic systems.4
Personal health records have the ability to benefit the public health sector by providing health monitoring, outbreak monitoring, empowerment, linking to services, and research. PHR helps clients to play a large role in protecting and promoting the public’s health.5 Though PHR helps in keeping track of health information but the value of PHR to healthcare organizations is still unclear.6
Potential benefits of PHRs include lower chronic disease management costs, lower medication costs, and lower wellness program costs.7 PHR has the potential to lower communication barriers between patients and caregivers in the outpatient setting.8 A problem with paper based records adoption is that they can’t be filled properly if they are given without proper guidelines, clear language and are not need based. Personal health records development should be guided by ample patient-oriented research in future.4
PHR helps in assessing complete health information and in monitoring health and ensure that quality healthcare is being delivered. They have great importance in research and also act as a quality assurance tool. It also works as a legal document in cases where evidence of care is needed and most important thing is, it needs client’s permission first. People have control over his/her health information to be accessed, used, and disclosed. Nurses as being primary care giver to the community can play a major role in maintaining PHRs. As nurse can educate people about the benefits of maintaining health records such as self health monitoring, early detection of health problems and also can convince the people and encourage them to maintain PHRs. There are certain barriers which get in the way to adoption of personal health records. These are historic paternalistic model adopted by doctors and use of alternative sources of personal health information by clients but not accepted by caregivers.3
A study was conducted for seeing the importance of Integrated Personal Health Records as Transformative Tools for Consumer-Centric Care showed that Integrated Personal health records promote active, ongoing patient collaboration in care delivery and decision making.9 This study showed that maintaining health records by individuals themselves help them to realize need for health check-ups, and also motivate them to look after the early symptoms or danger signs of any disease. When people start maintaining their health records they become much more aware about the diseases, about the symptoms because now they themselves are responsible for recording their health issues. They will be more concerned about their disease, medication, doses, immunization, and other health check-ups.10
In developed countries people are much familiar with the concept of PHR but in developing countries technical advancement and education of people is not enough to implement it. Moreover the efforts from health care industry are not enough to motivate the general population for keepingtheir important health and personal information safe at their home.11
In India the health recording system at community level is not much developed. In the country there is very less substantial evidence on the use of health records among the rural population. Rural population has very limited access and knowledge regarding the importance of maintaining health records for their families. So need of study was felt to involve family members in maintaining health records. As the people are not having some set protocol about filling and maintaining health record, a need was felt to develop Personal Health Record Protocol (PHRP) and to operationalize it in the rural community .Many researches had been done in other countries to see the effectiveness of personal and family health records in promoting life, preventing diseases, early diagnosis, and self-health management of person and these studies shows a positive effect. In India the health recording system at community level is poorly developed. There is very less published evidence on the use of health records among the rural population. They have limited access and knowledge regarding the importance of maintaining health records. Dhanas village is rural area and the people are not much aware about importance of keeping or maintaining the health records. So need was felt to involve individuals in maintaining health records for their families effectively.
Objective
To develop and operationalize Family Health Record by involving family members.
Methodology
An operational research design was employed to conduct the research. On northwest corner of Chandigarh and 4 kilometers away from PGIMER Chandigarh, Dhanas complex is situated. It is a vast complex comprising of semi urban and rural areas and comes under Union Territory Chandigarh. General population of Dhanas Complex is approximately 3000 houses having 21,000 population. The rural area of Dhanas complex, Dhanas village was selected purposively to operationalize the protocol. All the families (approximately 500 families) of Dhanas village were selected by total enumeration technique. And the families having at least one literate member and above 18 years of age and also willing to participate in study were taken as sample.Total 108 families of Dhanas village,
U.T. Chandigarh were taken but the total sample size was 98 families as 6 refused to participate further and 4 migrated out of research setting.
The subject filled record of their each family member separately & total 441 health records were filled by 98 subjects.
The tool was prepared after reviewing the relevant literature. Content validity was established. The survey performa for research included date, serial number, house number, age, sex, education, occupation, and religion. Families who were meeting the inclusion criteria were asked for willingness of family members to fill the record, name of the willing individual from family who filled the record and phone no were also included in survey performa. To collect information regarding practices of keeping health records at home a semi structured interview schedule was also prepared. Personal health record performa separate for each individual of family with guidelines were given to help the respondent from family how and when to fill these performas. In each performa personal bio data of individual, personal health history, female health record, routine health check up record, short term illness record and long term illness record total six items were included so as to avail information regarding health of family members. These performas were provided in a plastic folder to prevent damage and to help in maintenance of the performas. A scoring sheet (check list) was prepared to assess the level of completion of personal health record performa and to assess the ability of individuals to maintain health records. Score for each item (component of health record) range from 0- Four marks were given for completely filled (76-100%) component, three marks were given when any of the component was partially filled (51-75%), two marks were given if any component was filled from 26- 50%, one mark given when any component was filled up to 25% and zero was given when it was not filled at all. The scoring sheet was prepared for seven follow up visits.
To assess the feasibility and practicability, a pilot study was conducted in similar kind of setting by randomly selecting five families. Findings of the pilot study showed that study was found feasible to conduct and sample was easily available. The tool was found appropriate and clear in terms of language; it was easy to understand by the respondents. Methodology was found appropriate for the study.
Total seven visits were conducted to gather the data for research. During first visit house to house survey was done. With the help of survey performa respondents (respondents) from families were identified and registered for the study. They were also interviewed to collect socio demographic data.After the selection of the families; written consent was taken from the respondents to participate in the study. The respondents were also interviewed regarding practices of health record keeping in their families by using semi structured interview schedule.The study respondents were educated about importance of keeping health record at home and with the prepared Personal health record per forma demonstrations were given to the respondents how they can keep their information at home by filling the proforma. Written guidelines (Hindi version) were also given to help them in filling and maintaining health record.
After one week of operationalization of protocol in the duration of next three months and one week, seven follow up visits were conducted to evaluate the ability and on that basis to see the acceptability of families to fill and maintain the health records. The ability of respondents to fill the records was checked with the help of checklist and teaching sessions were conducted to correct their mistakes. First four follow up visits were conducted every week in the first month of the study to educate and motivate the respondents to fill and maintain the records, fifth visit was conducted after a gap of two weeks and this gap was increased for next visits for three weeks and one month respectively. If on the time of follow up visit the respondents were not available or the house was found locked then on very next day the visit was done. The collected data was analyzed by using descriptive and inferential statistics and calculations were done with the help of SPSS -16 program.
Results:
Socio demographic profile of respondents of families
Mean age of the respondents as 28.8±8.28 years. Nearly half of respondents (48%) were in age group of 21-30 years, 93(94.9%) were females. Most of them were Hindus (73.46%), 55% were educated above metric, 96(97.96%) were not working and only 2(2.04%) respondents were never married.
Subjects were asked about the type of health records they were maintaining. It was seen that 40.8% use to keep records of medicine. For 59.2% delivery reports while for 77.6% immunization record of children in their family was available. Out of 30 individuals, who were hospitalized in last two months only 36.7% had their records. Out of 70 people only 7.1% were having their treatment and medication detailsfor short term illness. There were 29 people, who were suffering from any kind of chronic illness; only 13 of them have results of diagnostic tests and records of treatment. Out of 48 who get their routine health check up done only 52% got it recorded or having its documentation. As self medication, chemist prescription and treatment taken from faith healers is more in practice but 80.6% of the respondents said that they never keep record of these practices.
Table 1 summarized how the components of Personal health record were filled. In first follow up visit only one third of the subjects (32.9%) had almost completely filled the first component of health record i.e. personal bio data while 35.1% of the records were not filled at all. In second follow up visit the no. of filled records for the first component increased to 63.3% and the no. of not filled records decreased to 15.4%. There was a continuous increase in completion of this component from third to seventh visit and the number of records having almost completely filled bio data increased up to 92.5% in last follow up visit.
Personal health history was almost completely filled for only 2.9% individuals though the number of records having partially filled personal health history was 62.8%. During second follow up visit the number of filled records of personal health history increased to 63.7% and in seventh follow up visit it increased to 93.9%. Out of 51.2% of female records only 15.6% were filled almost completely during first follow up visit and this number increased to 35.8% in last follow up visit.37.9% records of Routine Health Check up were not filled at all by any of the respondent though the number of partially filled records was 60%. The no. of almost completely filled health records increased to 64.2% in second visit and till seventh visit the number increased to 90.5%. In short term illness record the no. of family members having short term illness varies in each follow up visit but the result shows that there was a continuous increase in status of completion of these records from 1.8% to 3.6 % in follow up visits. 28 family members suffering from long term illness and most of them(78.5%) were not had their illness records filled.
In table no. 2 Repeated Measure Anova shows the mean difference between scores of first and follow up visits. For personal bio data the mean difference between score of first and second visit is -22.4 with significant p value i.e. (<0.01) and for personal health history the mean difference is -28.9 with a significant p value (<0.01). For female record the mean difference between first and second visit was -11.2 with a significant p value<0.01. It shows that there was an increase in completion of personal health record components from first to seventh follow up visit. Routine Health Check up Record shows significant p value for first and follow up visits with mean difference of -31.7 for first and second follow up visit. The mean difference of scores of first and follow up visits for Short Term Illness Record shows very less difference in means of scores that means it was not completely filled for most of the family members. The p value was significant for first two visits but in later visits the difference was statistically not significant. It means statistically there was no improvement in completion of short term illness records in later follow up visit. For long Term Illness Record p value was not significant for first and second visit but significant from third to seventh visit that means there was increase in completion of long term illness record with follow up visits.
Table 1: Status of completion of Personal Health Records during follow up visits for all family members
N=441
| Status of completion | No. of Visits | ||||||
| 1st visit | 2nd visit | 3rd visit | 4th visit | 5th visit | 6th visit | 7th visit | |
| Personal | |||||||
| bio data | |||||||
| Not filled | 155(35.1) | 68(15.4) | 46(10.4) | 27(6.1) | 26(5.9) | 22(5) | 22(5) |
| 25%filled | 3 (0.7) | 4(0.9) | 3(0.7) | 5(1.1) | 3(0.7) | 4(0.9) | — |
| 26-50% filled | 4 (0.9) | 2(0.5) | 12(2.7) | 4(0.9) | 2(0.5) | 5(1.1) | 8(1.8) |
| 51-75% filled | 134(30.4) | 88(20) | 44(10) | 32(7.3) | 6(1.4) | 3(0.7) | 3(0.7) |
| 76-100% filled | 145(32.9) | 279(63.3) | 336(76.2) | 373(84.6) | 404(91.6) | 407(92.3) | 408(92.5) |
| Personal health | |||||||
| history | |||||||
| Not filled | 147(33.3) | 64(14.5) | 44(10) | 27(6.1) | 27(6.1) | 22(5) | 22(5) |
| 25%filled | 2(0.5) | 5(1.1) | 4(0.9) | 4(0.9) | 4(0.9) | 5(1.1) | 1(0.2) |
| 26-50% filled | 2(0.5) | 2(0.5) | 7(1.6) | 3(0.7) | 2(0.5) | 4(0.9) | 3(0.7) |
| 51-75% filled | 277(62.8) | 89(20.2) | 23(5.2) | 31(7) | 7(1.6) | 4(0.9) | 1(0.2) |
| 76-100% filled | 13(2.9) | 281(63.7) | 363(82.3) | 376(85.3) | 401(90.9) | 406(92.1) | 414(93.9) |
| Female record | |||||||
| Not filled | 68(15.4) | 31(7) | 22(5) | 18(4.1) | 18(4.1) | 16(3.6) | 16(3.6) |
| 25%filled | — | 1(0.2) | — | 1(0.2) | — | — | — |
| 26-50% filled | — | — | 1(0.2) | — | — | — | — |
| 51-75% filled | 89(20.2) | 36(8.2) | 45(10.2) | 49(11.1) | 50(11.3) | 52(11.8) | 52(11.8) |
| 76-100% filled | 69(15.6) | 158(35.8) | 158(35.8) | 158(35.8) | 158(35.8) | 158(35.8) | 158(35.8) |
| Not applicable | 215(48.8) | 215(48.8) | 215(48.8) | 215(48.8) | 215(48.8) | 215(48.8) | 215(48.8) |
| Routine health | |||||||
| check up record | |||||||
| Not filled | 167(37.9) | 75(17) | 29(6.6) | 29(6.6) | 29(6.6) | 29(6.6) | 29(6.6) |
| 25%filled | 1(0.2) | 1(0.2) | — | — | — | — | — |
| 26-50% filled | — | — | 4(0.9) | 1(0.2) | — | — | — |
| 51-75% filled | 264(59.9) | 73(16.6) | 1(0.2) | 4(0.9) | 5(1.1) | 4(0.9) | 4(0.9) |
| 76-100% filled | — | 283(64.2) | 398(90.3) | 398(90.2) | 398(90.2) | 399(90.5) | 399(90.5) |
| Not applicable | 9(2) | 9(2) | 9(2) | 9(2) | 9(2) | 9(2) | 9(2) |
| Short term | |||||||
| illness record | |||||||
| Not filled | 41(9.3) | 34(7.7) | 30(6.8) | 21(4.8) | 21(4.8) | 17(3.9) | 13(2.9) |
| 25%filled | 8(1.8) | 8(1.8) | 11(2.5) | 11(2.5) | 10(2.3) | 4(0.9) | 3(0.7) |
| 26-50% filled | 3(0.7) | 12(2.7) | 4(0.9) | 9(2) | 8(1.8) | 2(0.5) | 1(0.2) |
| 51-75% filled | — | 1(0.2) | — | — | — | — | — |
| 76-100% filled | 8(1.8) | 23(5.2) | 25(5.7) | 14(3.2) | 15(3.4) | 19(4.3) | 16(3.6) |
| Not applicable | 381(86.4) | 363(82.3) | 371(84.1) | 386(87.5) | 387(87.8) | 399(90.5) | 408(92.5) |
| Long term | |||||||
| illness record | |||||||
| Not filled | 22(5) | 16(3.6) | 13(2.9) | 11(2.5) | 11(2.5) | 11(2.5) | 11(2.5) |
| 25%filled | 6(1.4) | 10(2.3) | 3(0.7) | 2(0.5) | 1(0.2) | 1(0.2) | 1(0.2) |
| 26-50% filled | 2(0.5) | 3(0.7) | 8(1.8) | 2(0.5) | 1(0.2) | — | — |
| 51-75% filled | — | 1(0.2) | 5(1.1) | 12(2.7)’ | 3(0.7) | — | — |
| 76-100% filled | — | — | 1(0.2) | 3(0.7) | 14(3.2) | 18(4.1) | 18(4.1) |
| Not applicable | 411(93.2) | 411(93.2) | 411(93.2) | 411(93.2) | 411(93.2) | 411(93.2) | 411(93.2) |
*Value of parenthesis indicate percentage
Table 2: Repeated Measure Anova showing completion of personal health record
components in first and follow up visits
N=44
| Component of health record | First and Follow up visits | Mean difference between follow up visits score | Std. error of mean of score | P value |
| Personal Bio data | ||||
| 1 | ||||
| 2 | -22.4 | 1.33 | .01 | |
| 3 | -28.9 | 1.65 | .01 | |
| 4 | -34.4 | 1.83 | .01 | |
| 5 | -36.7 | 1.94 | .01 | |
| 6 | -37.3 | 1.95 | .01 | |
| 7 | -37.7 | 1.96 | .01 | |
| Personal health history | ||||
| 1 | ||||
| 2 | -22.4 | 1.13 | .01 | |
| 3 | -36.8 | 1.51 | .01 | |
| 4 | -40.7 | 1.55 | .01 | |
| 5 | -42.1 | 1.64 | .01 | |
| 6 | -43.1 | 1.65 | .01 | |
| 7 | – 44 | 1.68 | .01 | |
| Female record | ||||
| 1 | ||||
| 2 | -11.2 | .1.02 | .01 | |
| 3 | -12.8 | 1.11 | .01 | |
| 4 | -13.4 | .1.14 | .01 | |
| 5 | -13.5 | .1.14 | .01 | |
| 6 | -13.8 | .1.16 | .01 | |
| 7 | -13.9 | .1.16 | .01 | |
| Routine health checkup record | ||||
| 1 | ||||
| 2 | -31.7 | 1.29 | .01 | |
| 3 | -45.9 | 1.74 | .01 | |
| 4 | -46.1 | 1.74 | .01 | |
| 5 | -46.1 | 1.74 | .01 | |
| 6 | -46.2 | 1.74 | .01 | |
| 7 | -46.2 | 1.74 | .01 | |
| Short term illness record | ||||
| 1 | ||||
| 2 | -4.3 | 1.2 | .01 | |
| 3 | -4.0 | 1.2 | .03 | |
| 4 | -2.2 | 1 | .77 | |
| 5 | -2.3 | 1 | .69 | |
| 6 | -2.3 | 1.1 | .74 | |
| 7 | -1.6 | 1 | 1 | |
| Long term illness record | ||||
| 1 | ||||
| 2 | -.5 | .23 | .6 | |
| 3 | -.1.5 | .43 | .01 | |
| 4 | -2.4 | .61 | .01 | |
| 5 | -3.3 | .77 | .01 | |
| 6 | -3.5 | .83 | .01 | |
| 7 | -3.5 | .83 | .01 | |
Table 3 illustrates the completion of PHR in the first follow up visit according to the educational status of the respondents. About 40% of respondents who were educated above matriculation almost completely filled personal bio data, component of PHR followed as compared to 27% of up to matriculate respondents. Personal health history component was partially filled by 70% of respondents who were educated above matriculation level as compared to 54% of respondents educated up to matriculation. Female health records were almost completely filled by approximately one third or respondents in both the groups. Half of the respondents (54.2%) educated up to matriculation partially filled routine health check-up section of the PHR during first follow up visit. Same component was filled partially by 74% of respondents with above matriculation qualification. There were only few respondents who suffered from short term illness and maintained their short term illness record. For instance, 44.4% of respondents educated up to matriculation almost completely filled short term illness record during first follow up visit while this section was almost completely filled by only 11.1 respondents with above matriculation qualification. The long term illness records were not filled completely by any of the group at all and half of respondents with above matric qualification could partially filled this section of PHR. Though these differences were statistically not significant (p >0.05 as per chi square test).
Table 4 shows the completion of personal health records in last follow up visit associated with educational standards of the respondents. Majority (93.2%) of the respondents who were educated up to matriculation level almost completed personal bio data in health records during last follow up visit. Similarly, 92.6% of respondents educated above matriculation almost completely filled the same component.
Personal health history component of PHR was almost completely filled by majority (more than 94%) of respondents in both the groups. Female records were almost completely filled by 66% of respondents with up to matriculation qualification as compared to 74% with above matriculation qualification. Routine health check-up component was partially filled by 88.6% of respondents with up to matriculation qualification as compared to 94.4% with above matriculation qualification.
In last follow up visit short term illness component of PHR was applicable to only few respondents who suffered from this kind of illness. But none of respondent filled this component of record. Long term illnesses were also not applicable to majority ofthe respondents. Only few respondents who were suffering from long term illness. For instance, 50% of respondents with up to matriculation qualification partially filled this section of record as compared to 75% with above matriculation qualification. Though these differences were statistically not significant ( p >0.05 as per chi square test).
Table 3: Association of education with the completeness of health record (respondents) in First follow up visit
| Components of health record And Status of completeness | Educational Status | N=98 | |
|
Up to metric |
Above metric |
χ2 (df) p |
|
| (n=44) | (n=54) | ||
| Personal bio data | |||
| Not filled | 18(41.0) | 16(29.6) | 2.19 (2),0.3 |
| Up to 75% filled | 14(31.8) | 16(29.6) | |
| 76-100% filled | 12(27.2) | 22(40.7) | |
| Personal health history | |||
| Not filled | 18(41) | 15(27.8) | 2.7 (2),0.2 |
| Up to 75% filled | 24(54.5) | 38(70.4) | |
| 76-100% filled | 2(4.5) | 1(1.9) | |
| Female record | n= 41 | n=52 | |
| Not filled | 12(29.2) | 12(23.1) | 1.1 (2),0.7 |
| Up to 75% filled | 16(39.0) | 24(46.2) | |
| 76-100% filled | 13(31.7) | 16(30.7) | |
| Routine health check up | n=42 | n=54 | |
| Not filled | 19(45.2) | 16(29.6) | 4.9(2), 0.1 |
| Up to 75% filled | 23(54.2) | 38(70.4) | |
| Short term illness record | n=9 | n=9 | |
| Not filled | 5(55.6) | 5(55.6) | |
| Up to 75% filled | — | 3(33.3) | |
| 76-100% filled | 4(44.4) | 1(11.1) | |
| Long term illness record | n=2 | n=5 | |
| Not filled | 2(100) | 2(50) | |
| Up to 75% filled | — | 3(50) | |
It was seen that respondents who were aged above 30 years showed more interest in completion of personal bio data as 33% of this group partially filled the records whereas 29.5% of the respondents aged less than 30 years partially filled the records. Thirty eight percent of the respondents aged below 30 years almost completely filled the records whereas 30% of other group almost completely filled personal bio data in first follow up visit. Both groups of respondents showed equal interest in filling of personal health history component of PHR, as most of the respondents (66% of aged less than 30 years and 60% of aged more than 30 years) partially filled the records in first follow up visit.
Table 4: Association of education with the completeness of health record (respondents) in seventh visit
N=441
| Components of health record And Status of completeness | Education of Respondents | N=98 | |
| Up to Matriculation | Above Matriculation | χ2 (df) p | |
| (n=44) | (n=54) | ||
| Personal bio data
Not filled Up to 75% filled 76-100% filled |
1(2.3) 2(4.5) 41(93.2) |
3(5.6) 1(1.9) 50(92.6) |
1.21 (2)0.5 |
| Personal health history
Not filled Up to 75% filled 76-100% filled |
1(2.3) 1(2.3) 42(95.4) |
3(5.6) — 51(94.4) |
1.8 (2)0.3 |
| Female record
Not filled Up to 75% filled 76-100% filled |
n=41
1(2.3) 11(25) 29(66) |
n=52
4(7.4) 8(14.8) 40(74.1) |
3.2 (2)0.3 |
| Routine health check up
Not filled Up to 75% filled |
n=42
3(6.8) 39(88.6) |
n=55
3(5.6) 51(94.4) |
2.6 (2)0.2 |
| Short term illness record
Not filled |
n=2
2(100.0) |
n=1
1(100.0) |
|
| Long term illness record
Not filled Up to 75% filled |
n=2
1(50.0) 1(50.0) |
n=5
1(20.0) 4(80.0) |
1.3(2)0.5 |
Respondents below 30 years old participated more in completion of female health records as compared to respondents who were 30 years and above. 40.3%, Respondents who were below 30 years partially filled records where as 33.3% respondents of other age group partially filled the records. In completion of routine health check up records, 66.1% of respondents (<30 years) and 59.5% respondents (>30 years) partially filled the records during first follow up visit. Short term illness records werealmost completely filled by 20% and 37.5% respondents in both age groups respectively.There were few respondents among both age groups who had long term illness. For instance 66.7% (2 respondents) of respondents who were below 30 years and 25% (1) of subject who was above 30 years had partially filled the records. The p value was not significant for any component it means that age was not associated with completion of health records During seventh follow up visit it can be described as majority of respondents had almost completely filled personal bio data in personal health records. About 96.8% of respondents below 30 years and 86.5% of respondents who were 30 years and above have almost completely filled the records. About 98.4% respondents (<30 yrs) and 89.2% respondents (>30 yrs) had almost completely filled personal health history during last follow up visit. There were 80% respondents (<30 yrs) and 63.7% respondents(>30 yrs) almost completely filled the female health records. The p value was significant for female health record it showed association in age of the respondents with completion of the component.
Most of the respondents had almost completely filled routine health check up records during last follow up visit as figures from table shows that 96.6% of respondents (<30 yrs) and 89.2% of respondents (>30 yrs) completely filled the records. Short term illness records were not filled at all by any of the groups. Most of the respondents who had long term illness filled their records almost completely. In another words it can be said that respondents developed habit of maintaining health records during follow up visits.
Discussion
PHR is a tool that can be helpful in maintaining health and wellness as well as a tool to help with illness. It also can help in better management of health care. Having important health information – such as immunization records, lab results, and screening due dates in health record form makes it easy for an individual to update and share their records. Personal health records can improve persons’ engagement because when he/she will have information and tools to manage their health, they can be more engaged in their health and health care. It also helps in coordinating and combining information from multiple providers of health.
Personal health records are an important tool for encouraging family health management because it provides a system for tracking and updating health care information of young children, elderly parents, or spouses in family which can help caregivers to manage the patients’ care and coordinating with people to improve health care quality of family.12 Nurses, doctors and other health professionals working in community have an important role in helping and motivating the community to record their health information.
As most of the people are living in rural area and they do not maintain or even know about any kind of health records and their importance. Moreover, rural people do not have knowledge, awareness and habit of keeping health related records. So, to accomplish this purpose, this study was introduced to rural community i.e. Dhanas village U.T. Chandigarh with an objective to help the individuals from families in maintaining health records of their family members. The setting was also chosen because of convenience and familiarity of the area to the researcher.
As per planned research methodology all families residing in Dhanas village were taken for the study. The total enumeration sampling technique was used to choose the study sample. To develop protocol, an interview was conducted to observe the common practices among rural people formaintaining health related records. After knowing the practices of families, the protocol was developed by reviewing literature and opinions from experts of National Institute of Nursing Education and Department of Public Health of PGIMER, Chandigarh. Guidelines, teaching sessions and demonstrations were given to people to help them in filling personal health records by frequent follow up visits. A scoring check list was prepared to help the researcher to assess the level of completion of personal health record and to assess the ability of individuals to maintain health records.
In the current study, the results reveal that during initial visits only few respondents filled the records but gradually they developed habit of filling and maintaining personal health records in subsequent visits. Majority of individuals showed interest in filling and maintaining personal health records from first follow up visit. The planned teaching and supervisory sessions were significantly helpful in enhancement of the skills of the individuals in filling of PHR. In spite of motivation, education and subsequent follow up visits short term illness records were not completed by most of the respondents because many of them were not aware of importance of short term illness records. There were few individuals who had long term illness and most of them filled and maintained records almost completely up to last follow up visit. It shows that people were more worried about chronic illness and they regularly monitor and record the status of health.
The study results showed that there were no associations of higher education with completion of personal health records. Statistically no difference was found in respondents educated up to matriculation & above matriculation in terms of maintaining and filling records completely and accurately. The results also showed that the people who were below 30 years of age were maintaining health records more completely as compared to other group having respondents more than 30 years of age.There are certain benefits of maintaining health records like the individuals who maintain personal health records were having better knowledge of health care services. This was not concluded from present study because it was a new concept and introduced to the particular community for the first time. Though people started accepting it during follow up visits because regular motivation, teaching sessions and demonstrations were conducted for them but benefits cannot be concluded in the prospect of present study.
It is clear that with the help of regular teaching sessions, follow up visits, education and motivation the ability and acceptability of individuals can be enhanced. But this scenario is not same in all the studies.In addition these personal health records of all family members can help to increase the regular monitoring on health and compliance with the medical treatmentif any family member is on treatment. The study recommends that the nurse, doctors, and health care professionals should motivate family members about keeping and maintaining health records of their families. The nurses can also educate the families about importance of keeping health records and nwhen and what should be recorded in these health records.
The result shows that ability and acceptability of family members to fill and maintain health records for their families improved by follow up visits as people started taking interest in recording their health parameters. Results showed that age and education had no impact on completion of Personal Health Record. For Personal health records to be effectively used by people and to develop their interest in these records, proper guidelines, follow up and teaching sessions were very useful. Though this is a new concept but the acceptability and interest in filling health information and regularity in maintaining records results from continuous education and motivation. It may become a part of their regular practice later on. The results of the present research and their generalizability must be seen within the limitation of the time span of study (three months).
The study recommends that nurses, doctors and other health care professional can regularly motivate and teach family members with help of effective AV-aids and demonstrations how to manage and maintain health records of all family members at their homeand acceptability of this new concept to them.Studies can be conducted by using same protocol to see its effectiveness on anyaspect of individual’s health or any life style modification after using the personal health record and can be replicated in different setting with a large sample size for an extended period of time to generalize the findings.The study findings can help the nursing personnel’s and other health workers in community how they can educate and motivate the families for keeping health records.The protocol can be used to maintain health information of family members. Guidelines can be used as ready reference for management of health records at home.
References
- Piotrowski Personal Health Records and the Nurse Informaticist. [Online]. 2011 Aug 30 [cited on 2013 Jan 18]; Available from: URL: http://www.hhnmag.com/hhnmag/HHNDaily/HHN DailyDisplay.dhtml?id=3840005376
- Personal Health Record [online]. [cited on 2012 Jan 2 5 ] ; A v a i l a b l e f r o m : URL:http://en.wikipedia.org/wiki/Personal_health_ record
- Paul T, Joan A, Bates D, Overhage J, Sands Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. JAMIA [Serial Online] 2006 [cited on 2012 Mar 12]; 13;121–126. A vailable from:URL: http://www.pubmedcentral.nih.gov/articlerender.fc gi?tool=pmcentrez&artid=1447551
- American Health Information Management The value of personal health records. A joint position statement for consumers of healthcare. [Online]. Journal of AHIMA2009 Sep [cited on 2012 Jan 11]; 77 (9): 24. Available from: URL:http://www.ncbi.nlm.nih.gov/pmc/articles/P MC2781729/
- Cleveland My Chart.[Online]. 2011 Mar 12 [cited on 2012 Sep 15]. Available from: URL:http://health.clevelandclinic.org/
- Delbanco T, Sands Electrons in flight–e-mail between doctors and patients. N Engl J Med [Online] 2004 [cited on 2012 Oct 27]; 350(17):1705-7. A vailable from: URL:http://www.biomedcentral.com/pubmed/151 02994
- Angela Barbara, Mark L, Dolovich L, Brazil K, Russell ML. A Comparison of Self-report and Health Care Provider Data to Assess Surveillance Definitions of Influenza-like Illness in Outpatients. CPHA [Serial Online] 2007 [cited on 2012 May 13]; A v a i l a b l e f r o m : U R L : http://journal.cpha.ca/index.php/cjph/article/view/ 2745
- Dee M G, Hunter K, Hebda Personal health records. [Online]. 2010 [cited on 2012 Feb 17]. A v a i l a b l e f r o m : U R L : http://www.minoritynurse.com/improving-patient- care-personal-health-records
- Diabetes Health Record (DHR) Card. California Diabetes Program and the Diabetes Coalition of California [Online]. 2011 [cited on 2012 June 12]; A v a i l a b l e f r o m : URL:http://www.caldiabetes.org/content_display.c fm?contentID=19
- Importance of keeping a [Online]. 2011 [cited on 2013 Mar 12]; A vailable from: URL:http://cpaprotectplus.com/blog/2010/03/the- importance-of-having-a-personal-health Record
- Alex K. Self-reports of health care utilization compared to provider records. Stanford University School of Medicine [Online]. 2011 [cited on 2012 Dec 12]; 376-78. Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/11166528