- freely available
Int. J. Environ. Res. Public Health 2009, 6(6), 1818-1855; doi:10.3390/ijerph6061818
2. Methods and Data Sources
3. Results and Discussion
3.1. Opportunistic Versus Integrated into Clinical Process
3.2. Opportunistic Kiosks
Consumer health information, health education and promotion:
Early kiosk use:
Recent uses in health education:
Patient access to records:
3.3. Kiosks Built into Clinical Process
Patient registration and clinic organisation:
Remote consultation and patient monitoring:
3.5. Hardware Issues
3.6. Kiosk Locations
Opportunistic community sites:
Willingness of community sites to host a kiosk:
3.7. Kiosk Users
Social class and deprivation:
Ethnicity, literacy and language:
3.8. Which Kiosks Are Successful?
3.9. Examples of Success (Opportunistic Kiosks)
Michigan Health Kiosk:
Commercial kiosks in the UK:
Other widely available kiosks in UK:
Opportunistic non health installations:
3.10. Examples of Success (Integrated Kiosks)
3.11. Why Do Kiosks Fail?
3.12. Equity and the Digital Divide
3.13. How Current Trends May Influence Kiosks
3.14. Videofeeds from Existing Websites and Organisations
3.15. Kiosk in Community Development
3.16. Taking Kiosk Development Forward
- Show they are aware of successes and failures in kiosk use.
- Have a clear statement of how success for the new kiosk would be measured.
- Involve partnership between information, location, and system providers and a plan for how kiosk use will continue beyond the pilot stage.
- Have novel ideas for presentation and integration into location activities.
- Include some independent method for audit of information quality and assessment of cost effectiveness and equity.
- Schools in a region might work with national or local charities to develop kiosks with quizzes or ‘local magazines’ possibly re-using web-based materials where appropriate but adding a local and fun dimension to the interaction. Kiosks might be sited in locations targeted at older people. Author-schoolchildren would demonstrate the kiosks to older people and engage them with their use.
- As described above DIPEX might be ‘kiosked’, i.e. presented in a simpler format suitable for touchscreen access. A changing and random selection of nine people talking about a particular topic (e.g. cancer) might be presented in a cancer centre. Nursing or other staff would need to be involved and to encourage patients and their companions to use the kiosks. Success would be measured by patient and nursing opinions and level of use.
- Ethnic minority groups may work with PALS locally, Trusts, charities etc to produce audiovisual interviewing kiosks to collect signs and symptoms using spoken language, or to produce tailored information.
- Kiosks might be used to streamline registration and patient flow in a clinic.
- Kiosk enquiry service in hospital, with a human interface – i.e. telehelp where kiosks at entrance link to one enquiry desk and provide other information.
- Some pilot experiments combining patient interviewing such as provided by IMH together with patient assessment systems such as Wellbeing, and patient/consumer education.
3.17. Dos and Don’ts of Health Kiosks
- DO involve the staff or other ‘community’ where the kiosk is to be sited. Unless there is buy in at a local level and people are prepared to look after it and make its use effective it will not work. Locally people need to be clear what constitutes successful kiosk use. Can this be expressed as (e.g.) everyone or a proportion of visitors to that site using the kiosk, or can it be expressed by some change of behaviour, or some improved data collection or patient/public satisfaction, or by some cost saving from using the kiosk to replace some other resource?
- DON’T ‘parachute in’ a kiosk if local staff have not been involved in bidding for one. Nicholas et al. conclude ‘Kiosks appear to have had little impact on the work of health professionals and reception and managerial staff were found to be inconvenienced by their introduction. Little thought was given by staff to the upkeep of the kiosks when they were purchased. Replenishing paper, trying to fix paper jams, and staying at work late to wait for technicians all created much ill-feeling among practice managers and receptionists.... Locations where a health professional helped patients to use the kiosk had a higher number of users per hour.’
- If sited in a health service setting, DO integrate into clinical practice. Use it for booking in, or for a pre-consultation interview, or for a post-consultation information prescription. However, Nicholas noted from their studies ‘The ‘patient information prescription’ pads (an attempt to integrate kiosks in surgery routines) were virtually unused, and there was little evidence of doctors referring patients to the system or searching it with them. .... Nurses were more proactive than GPs, and evidence was found to suggest that they valued information as an important part of a patient’s consultation and recovery programme.’ This indicates that integration into clinical practice will not be easy unless clinical staff can see obvious advantages.
- If possible, for opportunistic kiosks, DO involve local schools or groups in tailoring the information so that they have ownership and they bring friends and relatives to come to see ‘their work .
- DON’T include a printer on a kiosk unless someone (as in a bank or an airport) is prepared for a high maintenance job in keeping it working. It will work, as in a bank, if the whole process is cost effective. If production of a booklet or a record or something to be used in the clinical process is the main outcome (see e.g. the U.S. breast screening project  then it may be worth it.
- DO make the kiosk interesting and highly visible. Particularly if you want opportunistic use the kiosk needs to be clearly visible and people should be curious as to what it does. Healthpoint when it was launched in the early 1990s was new and novel. NHS kiosk when it was launched in 2001 looked too ‘corporate’. (See new and novel interfaces)
- DON’T overestimate the need for privacy and do not hide the kiosk away. (Some of the NHS kiosks were in pharmacy back rooms only available by appointment).
- On the other hand, DON’T make it look too much like a children’s toy or locate it in a way that this perception is reinforced, otherwise its use may be dominated by toddlers and small children.
- DON’T think you are going to solve the digital divide just by providing kiosks. There are other ways of tackling this, for example, by the provision of Internet connected computers in libraries or opening up school computer labs for parents and grandparents, by aiming to bridge the generation gap through projects such as Liverpool scheme on mobile phones. On the other hand, kiosks may help ensure that at least some information is more widely accessible.
- DON’T try to replicate the Internet on a kiosk. Standing kiosk use is likely to be for a short period and more focused game or ‘page turning’ applications to capture interest for a short period are needed rather than offering ability to search a database or the web. Seated booth use may be longer.
- If the kiosk just provides opportunistic information DO make it clear that information on the kiosk will change frequently otherwise no-one will come to it for repeat use.
- DO talk to private sector suppliers
- DON’T forget that the TV and other mass media may be the most effective way of getting across a specific health promotion message. Doing so within the context of fiction and celebrity may be as effective as through health promotion video/film. For example, cervical cancer screening rates soared after a SOAP character contracted and died from cervical cancer . Celebrity cancers such as Kylie Minogue can raise awareness much more cost effectively than a 1000 kiosks [152,153]. However, kiosks can be used to personalise, tailor, and reinforce a mass media message.
- DO think about using kiosk with sound output and sound assisted input for groups who do not read English.
- Integrated kiosks: when information provision can be integrated with services, for example, in walk-in centres, outpatient areas, occupational health settings, etc and can focus on a particular task, such as signing in to a service, collection of data (including perhaps physical monitoring) or structured interview, in information prescription, planned education, or providing patient access to their records.
- Opportunistic kiosks: when they can be used in novel and entertaining ways to grab people’s attention and complement other media in health promotion amongst casual users, in both health service and community settings. The basic nature of an opportunistic ‘stand up’ kiosk should not be forgotten – people will use it for maybe two minutes (so there is little point in having deep nested information) and will probably only use it again if they think there is something new. Opportunistic kiosks should be obvious and in areas where there is a large flow of people. The need for privacy can be overstated and depends on the type of site.
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|Setting, (Number of kiosks, reference||Year publication, country, (type of access)||Comments|
|Scottish telepresence project (N = ?1) ||2008, Scotland, (R)||Newspaper article about teleconsultation where patient booth. Booth includes stethoscope, blood-pressure cuff and thermometer, works on a standard network & needs about 3.5 megabits per second.|
|Part of cluster RCT in 16 hospitals (so N = 8 intervention). ||2007 USA, (O).||Package of interventions to improve antibiotic use in acute respiratory infection: clinical lead, posters, brochures, interactive tailored video kiosk. Modest decrease in antibiotics: but no reporting of kiosk as component.|
|Kiosks in library, government office, and a McDonald’s in low-income urban locations in Seattle Mar to Oct 2005. (N = 3) ||2007 USA, (O)||Users entered child age, were shown selected info. McDonald’s most popular. 28% responded exit survey. 48% had less than high school education, 26% had never used the Internet.|
|Picker Institute study of patient feedback on two wards in hospitals in Slough. (N = 2) ||2007 UK, (R/O)||Two inpatient wards (surgery/urology and respiratory)|
|Kiosks in aboriginal areas. (N = 11)||2007 Australia, (O)||To improve health literacy in diabetes, alcohol use and child health for remote indigenous populations in Queensland.|
|Orthopaedic outpatients. (N = 1) ||2007 England, (R)||To collect ‘outcome scores’ Oswestry Disability Score from patients|
|Chicago emergency department ||2007 USA, (R)||To promote child safety. Received tailored report|
|Different sites in metropolitan St. Louis, Missouri, between June 2, 2003, and October 21, 2004. (four kiosks hosted at N = 40) ||2006 USA, (O)||Reflections of You kiosk. Tailored magazines about breast cancer and mammography. Questions on touch-screen used to generate and print each tailored magazine. 44/110 potential hosts 44 agreed. 7/day valid usages.|
|Outpatient clinic California (one kiosk, small patient numbers). ||2006, USA, (R)||Small scale patient education kiosk for management of uncomplicated urinary tract infections. When published162 women have accessed computer directed therapy.|
|Primary care waiting room USA. Tailored info. for parents (mean age 26). (N = 1) ||2005, USA, (R)||Household safety. Information tailored to child and parent.|
|Health centres and libraries in deprived areas of Leicester, Sheffield, Nottingham (England) (N = 3) ||2005 England, (O)||Written and spoken information on 10 topics in Chinese, Bengali, Gujarati, Urdu, and Mirpuri Punjabi. 2,456 users of 3 kiosks over 10 months.|
|Outpatient waiting areas. (N = 2) ||2005 UK, (R/O)||Patient feedback in outpatient setting (diabetes and orthopaedics clinics) in Edinburgh|
|Five diabetes clinics in Chicago||2005 USA, (R)||Aimed at low health literacy patients. Relatively less use of the computer among these participants|
|Emergency departments in USA (N = 1) [50–53]||2004–6 USA, (R)||Used to collect medication information about asthma and make recommendations. Could be used sitting or standing.|
|Hospital paediatric waiting room in New Mexico USA for Navajo parents (N = 1).||2005 USA, (R)||Aim to improve knowledge of fever management, dental care, sleep position, nutrition, and car seat use|
|Patient waiting area of multi-specialty clinics, USA (N = 2) [55,56]||2004–6 USA, (O)||Information about eye disease in Spanish and English. Two kiosks for 2.5 years, 1 for 1.5 years. 38,868 user sessions.|
|(1) kiosk in shopping centre; (2) kiosks in 18 community settings in New South Wales, Australia ||2004 Australia, (O)||(1)Three-quarters noticed kiosk and 21% used it.
(2)57064 user sessions, i.e. 19 user sessions on average/day
|Primary care waiting room near Edinburgh ||2004 Scotland (O)||Studied characteristics of users Vs non users in a postal survey of just under 200 patients|
|20 In Touch with Health kiosks sited in UK primary care ||2003 UK, (O)||Studied 20 kiosks over three years and half years. Novelty value for 4–5 months followed by decline|
|Kiosks sited in churches, senior centres, schools, shopping malls, grocery stores, hospitals (N = 100) ||2003 USA, (O)||Addition of Alzheimer ‘channel’ for Michigan Kiosk project. 100 kiosks sited in seniors centres, shopping malls etc.|
|In Touch and NHS kiosk compared with Surgery Door web site. England ||2003 UK, (O)||Comparison of log files (time spent etc) between web information and kiosk information|
|Nutrition education in food assistance programs among Hispanics in USA ||2002 USA, (R)||Bilingual Spanish-English. Comparative cost-effectiveness study Vs peer educators|
|Outpatient waiting room, diabetes eye examinations. [63,64]||2002, USA, (R)||Aimed at underserved populations|
|NHS Direct kiosks England ||2002 UK, (O)||Comparison of one month’s log data between 120 kiosks|
|Patient interviewing for anxiety and depression. ||2002 USA, (R)||Validation study of computerised HADS versus paper HADS (N = 1,304)|
|Country||Kiosk name||Max number approx||Dates||Sources|
|UK||Healthpoint||60||1989–1998|| (Jones, personal knowledge)|
|UK||NHS Kiosk||136||Sep 2000-c.2005|| (Bob Gann email)|
|UK||In Touch with Health||200||Approx 1997-Continuing|| emails from Kevin Snowball (In Touch with Health)|
|Aust||Health CHIPS||20||Main tranch of kiosks no longer supported, used in certain niche ‘markets’|| (email Trevor Hazell) [114,115]|
|UK||Wellpoint||268||2003-Continuing||Emails and phone calls Chris Dawson (Wellpoint)|
BT Street Kiosks
|Emails from Mark Worger, Business Development Officer StartHere|
|UK||Elephant kiosks||164||Current installations in Staffordshire and Suffolk Primary Care and, Cambridgeshire Hospital||Email Mark Worger on behalf of Annette Walker (Elephant Kiosks)|
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