Date of Award

Winter 2021

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctorate of Nursing Practice

Degree Name

Other

First Advisor

Pamela Kallmerten

Second Advisor

Mary Flanagan

Abstract

BACKGROUND: Shingles is considered one of the most significant vaccine-preventable diseases of older adults based on its morbidity and public health burden, which increase drastically with age. Adult vaccine awareness and promotion programs are undervalued in the U.S.; in particular, educational programs targeting older adults are needed. Older adults have increasing rates of adoption of health information technology (HIT) to seek guidance and support for their medical needs. Leveraging HIT in the form of clinical dashboards is an option for providing reliable, safe and cost-effective vaccine education to older adults at high risk of vaccine-preventable disease.

METHODS: The specific aims of this quality improvement project were to increase knowledge and uptake of recombinant zoster vaccine (Shingrix™) in older adults of a continuing retirement community (CCRC) through creation of a patient-facing clinical dashboard. The Four Pillars™ practice transformation program was used to guide implementation of the project including utilization of self-report surveys to determine baseline vaccination rates, perceptions of the dashboard and behavioral intention to receive future vaccination. The Patient Portal Acceptance Model (PPAM) was used as a theoretical framework to evaluate respondents’ perceptions of the dashboard across four domains: ease of use, usefulness, self-efficacy, and privacy/security.

RESULTS: Respondents reported high levels of education and computer literacy. The majority reported using the internet for over 20 years and over 10 hours per week and 77.8% had used the internet to search for healthcare information within the past year. Baseline Shingrix™ vaccination levels in the CCRC were higher than national average but not at goal rates, and the majority of respondents eligible for vaccination did not plan to receive it. Respondents rated the dashboard moderately high on perceived ease of use, low on concerns about privacy/security, high on ability to use independently (self-efficacy), and low on perceived usefulness.

DISCUSSION: The information provided by CCRC residents during development of this dashboard was valuable for elucidating motivators and barriers to HIT use in older adults, who largely view HIT as an adjunct to in-person interaction with a trusted provider. Improving older adults’ perceptions of HIT will be critical in the era of Covid-19, when many high-risk older adults are seeking alternatives to traditional provider visits. Respondents were willing and able to access and navigate the dashboard; however, shingles knowledge did not improve in this small sample. Improvements in the presentation of the material on the dashboard may improve perceptions of usefulness and comprehension of specialized clinical information.

CONCLUSION: CCRC residents were receptive to receiving vaccine information via electronic dashboard and expressed interest in using this format as a source of other healthcare information. There is ample opportunity to expand patient-facing dashboards in the CCRC setting to provide a wide array of healthcare education for this population.

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