Consumer Informatics and One Health: Shifting the Focus from the Individual to the Globe. Findings from the Yearbook 2023 Section on Education and Consumer Health Informatics

Summary

Objective: To summarise the state of the art during the year 2022 in consumer health informatics and education, with a special emphasis on “One Health”.

Methods: We conducted a systematic search of articles published in PubMed. We build queries to merge terms related to “consumer health informatics”, “one health”, and “digital”. We retrieved 94 potential articles for review. These articles were screened according to topic relevance and 12 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers were discussed in a consensus meeting. Three papers received the highest score from the expert panel, and these papers were selected to be representative papers on consumer informatics for exploring one health from consumer perspective in the year 2022.

Results: Bibliometrics analysis conducted on words found in abstracts of the 12 candidate papers revealed four clusters of articles, where clustering outcomes explained 96.91% of the dispersion. The first cluster composes three papers related to patient engagement in primary care practices, using digital-delivered diabetes prevention programmes, or exploring citizen involvement in co-designing environmental projects (such as air pollution exposure and health). The second cluster represents four papers related to digital health literacy and consumer behavior, such as digital vaccine literacy, and food labelling influences and whether displaying Nutri- and Eco-Score at food product level led to improved consumer choices. The third cluster consists of two papers exploring strategies to involve citizens in various science projects while analyzing the quality of citizen-collected data (e.g., mosquito bites or gastropod community dataset). The last cluster contains three papers related to the relationships between human behavior with their environment and their contribution to citizen science projects (e.g., biological water quality in the Netherlands distribution, composition, abundance of debris across sandy beaches in Australia and its regions, urbanization and reptile biodiversity across Florida).

Conclusion: Traditionally, consumer health informatics focuses on providing individuals with tools and resources to actively manage their own health. By incorporating a global health (or one health) perspective, our field is now at a crossroad, demanding us to think beyond the individual and challenging us to instill the thinking that our actions not only have consequences on the individual but also on the population and the environment. Perhaps this is also a reflective time for the consumer informatics field, to consider shifting the focus from the individual to one that is more aligned with one health, helping consumers gain awareness of how their actions impact on the individual, the population and the environment, and providing them with tools to work collectively to help decide how their actions may bring benefits (as well as harms) across these levels.

Keywords

Consumer health informatics - health literacy - digital literacy - citizen science projects - One Health

1 Introduction

Broadly speaking, consumer health informatics and global health are two interconnected fields that have significant relationships and influences on each other. “Consumer Health Informatics”, or CHI, is a term for the subfield of informatics that focuses on consumer and patient perspectives, simultaneously as users and beneficiaries of information systems that empower them to manage their own health [[1]]. By enabling individuals to access and understand health information, make informed decisions, and engage in self-care, consumer health informatics contributes to improving individual health outcomes globally. Global health initiatives aim to address health disparities and improve health outcomes worldwide, particularly in underserved communities.

‘One Health’ is an “integrated, unifying approach to balance and optimize the health of people, animals and the environment” [[2]]. It is particularly important to prevent, predict, detect, and respond to global health threats such as the COVID-19 pandemic [[2]]. Benis et al. [[3]] conceptualized the One Digital Health Steering Wheel framework. One Digital Health (ODH) aims to facilitate and improve collaboration among practitioners in One Health and Digital Health Communities. This collaboration allows both communities to benefit from efficient interactions over time and the delivery of near–real-time, data-driven contributions to systems medicine [[4]] and systems ecology [[5]]. It will also allow citizens to engage with their individual health and well-being.

One of the challenging key issues that ODH must face is collecting and managing critical indicators that are related to human, plant and veterinary health care, education, citizen engagement, environmental observation, agronomy, health care and the food industry. Ho [[6]] proposes for a dedicated global ODH framework—centred on fairness and equity—to be established to promote data-sharing across all the key knowledge domains of OH and to devise data-driven solutions to challenges in the human-animal-ecosystems interface. He identifies the data landscape in relation to (1) Human and population health; (2) Pathogens; (3) Animal and plant health; and (4) Ecosystems and biodiversity. His framework is based on a syndemic approach where data to be shared and aggregated could be molecular (e.g., genomic, serological, and metabolic data), observational (e.g., body temperature, weight, feed intake and nutriment quality according to front-of-package nutrition labelling [[7]]), agronomical (e.g., herd structure, breeding, sanitation), agricultural (or on land use or land cover, more generally), epidemiological, demographical, commercial, financial (median monthly or annually incomes), meteorological, pollutant data (air, soil and water), and so forth.

One Health and consumer health informatics intersect in promoting a holistic approach to health, leveraging data for disease surveillance and monitoring, incorporating animal and environmental health information, and utilizing data analysis techniques to enhance health education, awareness, and collaboration. By integrating consumer health informatics within the One Health framework, individuals can gain a broader understanding of health issues, including zoonotic diseases, environmental factors, and the impact of animal health on human health. By synergizing these two fields, we have great potential to strengthen our understanding of the interdependencies between human, animal, and environmental health, leading to improved health outcomes for all.

For this paper, our purpose was to identify significant papers published in 2022, illustrating how One Health and Consumer Health Informatics complement each other. To ensure we cover a broad spectrum of topics, we have not restricted to specific areas that are commonly associated with these two areas, such as disease surveillance and early detection, data integration and analysis, behavioural insights for behaviour change, enhanced health education, collaboration and communication, or policy development and resource allocation.

2 Methodology

2.1 Search Strategy

We used PubMed to conduct our search, capturing papers on consumer-using technologies and one health concern published in the year 2022. At the time we explored PubMed to find the candidate best papers, the basic query using MeSH terms (“One Health”[Mesh]) AND (“Consumer Health Informatics”[Mesh]) retrieved zero articles. Thus, we refined the choice of keywords according to the previous “one health” frameworks described above. The query we used is composed of four parts: the first is a classic set of filters (year of publication and publication types), the second is related to the section “consumer health informatics”, the third is a set of terms related to the components of “one health” and the sources of data, and the last one lists all the terms related to “digital”. The syntax “[All Fields]” was used wherever possible to ensure our search strategy was comprehensive. The final search query is listed below:

(2022/1/1:2022/12/31[DP] NOT “Epub ahead of print”) NOT Bibliography[pt] NOT Comment[pt] NOT Editorial[pt] NOT Letter[pt] NOT News[pt] NOT Case Reports[pt] NOT Published Erratum[pt] NOT Historical Article[pt] NOT Legal Case[pt] NOT legislation[pt] NOT (systematic review[pt] OR “review literature as topic”[MeSH Terms] OR “review”[All Fields])

AND

(“consumer health informatics”[MeSH Terms] OR “consumer health information”[MeSH Terms] OR “consumer behavior”[MeSH Terms] OR “consumer attitude”[All Fields] OR “consumer organizations”[MeSH Terms])

AND

(“syndemy”[All Fields] OR “global health”[All Fields] OR “planetary health”[All Fields] OR “human health”[All Fields] OR “population health”[All Fields] OR “pathogens”[All Fields] OR “animal health”[All Fields] OR “plant health”[All Fields] OR “ecosystems”[All Fields] OR “biodiversity”[All Fields] OR “molecular data”[All Fields] OR “observational data”[All Fields] OR “agronomical data”[All Fields] OR “agricultural data”[All Fields] OR “epidemiological data”[All Fields] OR “demographical data”[All Fields] OR “commercial data”[All Fields] OR “financial data”[All Fields] OR “meteorological data”[All Fields] OR “pollutant data”[All Fields])

AND

(“digital health”[All Fields] OR “ehealth”[All Fields] OR “e-health”[All Fields] OR “tele-health”[All Fields] OR “mhealth”[All Fields] OR “m-health”[All Fields] OR “mobile health”[All Fields] OR “telemedicine”[All Fields] OR “electronic patient-physician communication”[All Fields] OR “electronic medical record”[All Fields] “electronic health record”[All Fields] OR “personal health record”[All Fields] OR “electronic patient record”[All Fields] OR “electronic”[All Fields] OR “information technology”[All Fields] OR “communication technology”[All Fields] OR “mobile”[All Fields] OR “cell phone”[All Fields] OR “smart phone”[All Fields] OR “online”[All Fields] OR “online systems”[All Fields] OR “internet”[All Fields] OR “web”[All Fields] OR “website”[All Fields] OR “patient portal”[All Fields] OR “tele*”[All Fields] OR “digital*”[All Fields] OR “remote*”[All Fields] OR “video*”[All Fields] OR “virtual”[All Fields] OR “virtuality”[All Fields] OR “virtualization”[All Fields] OR “virtualized”[All Fields] OR “virtualizing”[All Fields] OR “virtuals”[All Fields])

2.2 Bibliometrics Analyses

To understand the state of the literature, we applied various bibliometrics tools onto the original set of articles returned from the search query. The “Bibliometrix” package from R [[8]] was used on the citation set of retrieved articles. We reported frequency of keywords. We illustrated the analysis of abstracts (measure of word frequency) by a word cloud drawing feature. We analysed keywords to uncover links between concepts through co-occurrences network. We also plotted a thematic map to analyse these clusters according to the quadrant in which they are placed [[9]].

• Themes in the upper-right quadrant are both well-developed and important for the structuring of a research field. They are known as the motor-themes of the specialty given that they present strong centrality and high density;

• Themes in the upper-left quadrant have well-developed internal ties but less-developed external ties and so are of only marginal importance to the field. These themes are very specialized and peripheral in character;

• Themes in the lower-left quadrant are both weakly-developed and marginal. The themes of this quadrant have low density and low centrality, mainly representing either emerging or disappearing themes;

• Themes in the lower-right quadrant are important for a research field but are not as well-developed. Each theme is represented as a sphere, its volume being proportional to the number of documents associated with the theme.

3 Results

3.1 State of the Literature

A descriptive analysis of 94 articles was conducted, reporting the frequency of keywords, and the frequency of words in titles and abstracts. 480 distinct bigrams in titles and 5,418 bigrams in abstracts were used. [Figure 1] lists the 50 most frequently cited bigrams in abstracts ranked from most frequently to least frequently reported. The top ten is composed of: health literacy (139 times), digital health (31 times), citizen science (28 times), eHealth literacy (26 times), mental health (23 times), added sugar (21 times), health care (20 times), breast cancer (17 times), health information (17 times), and public health (15 times).

Fig. 1 Occurrences of bigrams in abstracts of the first selection of 94 papers.

Regarding the conceptual structure of the set of 94 articles, [Figure 2] shows the co-occurrences of bigrams. Four blocks of co-occurrences have been identified. The biggest one is centred on “health literacy”. One is centered on “citizen science”. The remaining two identify “consumer behaviour” and “patient participation”.

Fig. 2 Co-occurrence network of the most frequent abstracts bigrams (original set of 94 papers)

Regarding thematic maps of keywords found in abstracts ([Figure 3]), clusters according to centrality (relevance degree) and density (development degree) are reported in each quadrant. The most common themes found across papers are related to “health literacy” and “community participation”. Niche themes revealed by this analysis are represented by “consumer behaviour and “food preferences”. The cluster “citizen science” is classified as an emerging theme.

Fig. 3 Thematic map of clusters of keywords (original set of 94 papers)

The analysis of these first metrics allows us to see that the terms at the intersection of “consumer health information” and “global health” are “health literacy”, “consumer/patient engagement” and “community participation”, “consumer behaviour” and “citizen science”. Whether we take the keywords or the terms of the abstracts, the respective analyses are consistent.

3.2 Best Paper Selection

To identify the 12 candidate papers, co-editors independently assessed the 94 retrieved papers using the Rayyan web tool [[10]], followed by a discussion. Elements that were considered in the screening decision include 1) the level of relevance regarding the 2022 Yearbook topic “global health and consumer health informatics”; 2) whether the study was focused only on patients and consumers; 3) the nature of the issues addressed; and 4) level of innovative approach and methodological design.

The 12 articles were then presented to a panel of international experts for full paper review and scoring according to the IMIA Yearbook best paper selection process. The final selection of best papers is completed after discussions at the annual IMIA Yearbook board meeting. We applied the same metrics to analyse the set of the 12 best papers selection. 59 distinct keywords were used, 71 distinct bigrams in titles and 891 words in abstracts. The top ten keywords are listed in [Table 1].

Table 1 List of the top ten keywords of the 12 selected articles

The co-occurrence network of abstracts bigrams is shown in [Figure 4]. Four clusters are described. The main two clusters are centred on “digital health” and “citizen science”. We also analysed the conceptual structure of the selection by means of a multiple correspondence analysis based on words of abstracts ([Table 2]). The result clustering explains (96.91%) of the dispersion ([Figure 5]). This clustering of best-candidate best papers was blinded to the reviewers.

• Cluster 1. Three papers have been grouped in this cluster and are related to patient engagement. The first [[11]] aimed to estimate the use of health IT in primary care practices. Authors explored domains of patient engagement, population health management (decision support and registries), and electronic information exchange. The second [[12]] aimed to develop and test a digital health acceptability model of factors influencing the intention of adults living in Ireland to use a digital-delivered diabetes prevention programme. The third [[13]] is centered on an innovative project related to environmental epidemiology in which citizens codesign with scientists a study to assess the link between air pollution exposure and health;

• Cluster 2. This second cluster consists of four papers centered on digital health literacy and consumer behavior. The first [[14]] study aimed to evaluate associations between information searching on public health, social measures, and university students' digital health literacy related to the SARS-CoV-2 and COVID-19 during the first wave of the pandemic in Portugal and associated university closures. Compared to those who never searched for information on environmental, economic and psychosocial issues, those who did are more likely to determine the relevance of content related to new coronavirus and COVID-19 on internet sources such as forums or social media. The second [[15]] study aimed to evaluate the quality of information and guidance on dietary sodium reduction available on consumer-facing websites. Consumers seeking information and guidance on dietary sodium reduction will find that most available websites provide accurate but limited information and insufficient guidance on how to lower sodium intake. The third [[16]] aimed to develop a tool measuring “Digital Vaccine Literacy” and assess its psychometric properties among a sample of French adults. The first subdimension (items 2 and 4) refers to understanding and trusting official information about vaccination provided by institutional websites. The second subdimension (items 1 and 5) refers to understanding and trusting information about vaccines as provided by social media. The fourth [[17]] explored the potential of several digital functionalities in an E-grocery environment to stimulate more healthy and pro-environmental food choices. They conducted a randomized control trial in a mock-up E-grocery. A representative sample of Belgian consumers (n = 1,000) selected food products for one meal for their daily household. Indices reflecting the nutritional quality (NQI) and environmental impact (EII) of selected food baskets were calculated. These findings suggest that displaying Nutri- and Eco-Score at the product level led to improved nutritional qualities of food choices, while the environmental impact was not reduced;

• Cluster 3. This cluster contains two papers exploring ways to involve citizens in science projects. The first [[18]] paper involved gaining insights into the connection between media coverage and the activation of citizens to participate in citizen science projects. As the factors triggering people to attract mosquito bites for science are still unknown, the authors analyzed the influence of mass media reports on mosquito submission numbers. They explored how effective a mass media approach turned out and thus provide insights for the targeted design of communication strategies for other citizen science projects. They found that an already heightened public and media awareness of mosquito-relevant topics combined with a direct call to action in a media report led to maximum participation. In the second study [[19]], investigators used a citizen science-based dataset to explore key drivers of variability in gastropod communities associated with canopy-forming brown macroalgae from North-Eastern (NE) Atlantic rocky shores. They considered that when protocols and training followed by non-scientific citizens, the quality of collected data can be equivalent to the ones collected by researchers. The authors concluded that this work sheds light on the value of a citizen science program resulting from consultation between professional and citizen volunteers as a useful and efficient tool to investigate large-scale processes;

• Cluster 4. This cluster is composed of three papers that link human behavior with their environment. The first study [[20]] assessed the quality of data from a citizen science project related to biological water quality assessment in the Netherlands. Authors compared data collected by volunteers in an unstructured way with those collected according to quality protocols by professionals employed at regional water authorities by focusing on (1) the spatial and temporal distribution of the samplings, (2) the investigated water types and patterns in both datasets with respect to (a) calculated water quality scores and (b) the sampled macroinvertebrate communities. Information gathered via citizen science on biological water quality in the Netherlands potentially adds to the information gathered by regional water authorities as volunteers collect data on other spatial and temporal scales. Volunteers however collect data in a different way and their inventory is less complete. The second study [[21]] provides a methodology for the systematic filtering of a continental citizen science database, towards improving data quality and subsequently, inferring patterns in distribution, composition, and abundance of debris across sandy beaches in Australia and its regions. Authors expect that, as citizen science techniques and databases progress, there is a need to improve their accuracy and reliability in gathering scientific knowledge, to further their inclusion within management and decision-making. The last paper [[22]] is completely different from the previous ones and reflects the links between human behaviour and animal health. The study is environment-focused and examines the association between urbanization and reptile biodiversity across Florida, a subtropical/tropical biodiversity hotspot. This study elucidates the potential of moderately urbanized areas to harbor native reptile species. Moderately urbanized areas have a combination of green space and built-up space enabling both native and non-native reptile species to co-exist, leading to a greater species richness in these periurban areas across subtropical and tropical Florida.

Fig. 4 Co-occurrence network of the most frequent abstracts bigrams (set of 12 selected best candidate papers)

Table 2 LFactorial analysis of the 12 selected candidate best papers groups according to four clusters based on the analysis of abstracts unigrams sorted by diminishing contribution.

Fig. 5 Factorial analysis of abstracts bigrams to clusterize the 12 selected best candidate papers

Finally, three papers were selected as best papers after discussions at a consensus meeting at the May 5^th 2023 IMIA Yearbook editorial meeting. They are listed in [Table 3]. See Appendix to read the description of the three studies and the main results. These three articles obtained the maximum score, collated from the independent scores of each member in the assessment panel, based on the innovative level of the study, its methodological quality, and its scientific scope in the field of “Consumer Health Informatics”.

Table 3 Best paper selection of articles for the Consumer Health Informatics and Education section of the IMIA Yearbook of Medical Informatics 2022.The articles are listed in alphabetical order of the first author's surname.

4 Conclusions

Making the link between “consumer health informatics” and “global heath” or “one health” is a promising approach that requires us to move beyond the usual boundaries of personal care towards preventive health on a much broader scale. The aim is to focus on behaviors that enable citizens and patients to take responsibility not only for themselves, but also for the population and the environment. The articles submitted and the best papers selected address three facets of this commitment, in the field of understanding the impact of vaccination, guiding food choices based on product labelling, and assessing environmental exposure, particularly air pollution. One health is an active approach that involves citizens and patients. At the crossroad of consumer health informatics, the aim of one health is to instill the thinking that actions not only have consequences on the individual, but also on the population and the environment. It is important to ensure actions at any level (individual, population, environment) do not bring harm (intentionally or unintentionally) to any of the other levels. Involving people in citizen research projects is not new, but it is gradually evolving in connection with the digital transformation of society. By harnessing the collective power of individuals and technology, we can create a more inclusive, data-driven, and participatory approach to improving health for the individual, population and the environment.

No conflict of interest has been declared by the author(s).

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Publication History

Article published online:
26 December 2023