USING HEALTH TECHNOLOGY TO ENGAGE AND EMPOWER YOUTH IN SELF-CARE MANAGEMENT
Methods: In a community-academic partnership and using a youth-participatory action research framework, HealthShack was developed with input from homeless youth, health professionals, and youth advocates. The project was piloted at a drop-in community center for disconnected youth. Former homeless youth served as “health ambassadors” by informing youth who accessed the center about the project. Youth who wanted to enroll in the project met privately with a nurse to create an electronic PHR and address their health needs. Descriptive surveys were administered with a convenience sample of 110 enrolled youth on demographics, health care access, and health records. Follow-up semi-structured interviews were also conducted with 40 youth about their experiences with HealthShack.
Results: Ninety percent of participants were 14 to 22 years old with 67% of the sample reporting being homeless or in unstable housing situations. Main reasons for wanting to enroll in HealthShack were having a place to store health records (69%), being able to talk with a nurse about health issues (29%), and finding health information on the HealthShack website; 94% reported that they felt comfortable talking with the HealthShack nurse about their health needs. Prior to enrollment in HealthShack, 48% reported that they did not have access to a doctor or nurse to address their health needs, 45% experienced foregone care, and 49% did not have health insurance or did not know their insurance status. The majority agreed or strongly agreed with the statement that having a PHR was important to their health and that a PHR would improve their ability to organize their health records (70% and 71% respectively). Qualitative data revealed that youth found HealthShack to be a useful portal to store important health information. This electronic PHR also permitted them to go back and find information such as insurance identification numbers and past appointments. The youth also reported nursing services as being a valuable aspect of the enrollment process; nurses connected them to health services and helped them obtain health insurance.
Conclusions: HealthShack is the first known electronic PHR designed for disconnected youth. Results indicate that this PHR is an important tool for disconnected youth to safely store and organize their health information. A key finding regarding acceptability of the project was having youth as peer educators about how to use this PHR and registered nurses as health coaches. An electronic PHR could serve as a conduit in addressing the health needs of disconnected youth, particularly if embedded within a community-based program that permits social connections with trained peers and health professionals.