PEOPLE-Centred (DIGITAL) Health

Who are we in the health system?  Are we patients? Consumers? Citizens, clients, Canadians?  No matter what you call us – we are people.  Unique individuals with unique interests and health care needs; and it is important that we are at the table when decisions about our care are being made. 

This is true no matter “who you are” in the system and no matter what particular care you may require or may not require yet.  As Valerie Billingham said in her session address at the 1998 Salzburg Global Seminar, Through the Patient’s Eyes,  “nothing about me without me.”[1]

We know that Canadians want to be engaged in their care.  They want to be seen and treated as active members of the health care team.  Canada Health Infoway’s (Infoway) annual survey results continue to show that Canadians who have access to digital health tools feel more informed about their care; feel more engaged in their care and feel more confident, not only about the care they are receiving but about their ability to manage their health conditions too.[2]  Providers also recognize the value of giving patients electronic access, noting an increase in patients’ level of engagement and sense of empowerment regarding their own health.[3]

There is an increasing range of digital health solutions in use across the country today, and while we continue to lag behind some of our international counterparts, it is exciting to see that the use of these tools has doubled in the past two years alone.[4] [5] Canadians report that they are able to connect with their health care team through virtual visits, by requesting prescription renewals online, by self-booking appointments, and can access and share their personal health information electronically.

As we continue to explore the future of our health system, we know the potential to improve the patient experience and health outcomes are significant.  The need to do this is paramount and should be guided by the peoples’ voices. WE need to be involved in designing, implementing, and evaluating this change.  OUR voices need to be heard.  As described by the European Patients’ Forum, “empowered patients are part of the healthcare system.   They make informed choices, have better relationships with their healthcare providers, are committed to adhering to treatment, take responsibility for their care and seek preventative measures to better manage their health.”[6]

At this year’s e-Health Conference, Infoway will be bringing ‘regular people’ to the event through paid scholarships and to participate in a panel presentation, “Hearing from Patients on What They Think of Digital Health,” which will take place on Tuesday, June 5 at 10:30 a.m. (Track: Patient Engagement Through Digital Health).

Throughout the conference there is a strong focus on this important topic:

  • Sunday Symposium (Sunday, June 4, 12:00 p.m. – 4:00 p.m.)
  • Advancing Frameworks for Patient Engagement (Monday, June 5, 4:00 p.m. – 5:30 p.m.)
  • Engaging Patients through Digital Health (Wednesday, June 7, 8:30 a.m. – 10:00 a.m.)
  • And more!

Plan to attend some of these promising sessions to learn how your colleagues in the industry are working together to include people in the future of digital health.

I invite you to also take some time to chat with our patient scholars and panelists during your time at the Conference.  Their stories and personal journeys are impactful and their perspectives, enlightening.

I look forward to continuing this discussion with you.  Feel free to connect with me on Twitter @Cassie482. See you at e-Health 2017!

Cassie Frazer has 20 years of health care experience working in numerous roles, including 12 years as a front-line Respiratory Therapist.  She has a Bachelor of Science from Queens University and a Masters in Heath Administration from the University of Toronto.  She was a co-founder of the Pan-Canadian Change Management Network, a leading contributor to the National Change Management Framework and is a certified health informatics professional. Cassie currently works for Canada Health Infoway as the Program Director for Consumer Health & Innovation.  Within the broad portfolio of digital health initiatives she manages, she is able to leverage her experience and interests in change management, health informatics and innovation.


[1]
Valerie Billingham. Through the Patient’s Eyes, Salzburg Seminar Session 356, 1998. Cited in N Engl J Med 366;9 nejm.org, March 1, 2012

[2] Canada Health Infoway. Connecting Patients for Better Health: 2016. Available at: https://www.infoway-inforoute.ca/en/component/edocman/resources/3152-connecting-patients-for-better-health-2016

[3] SRDC. Impacts of direct patient access to laboratory results – Final Report. August, 2015.  Available at:  https://www.infoway-inforoute.ca/en/component/edocman/2775-impacts-of-direct-patient-access-to-laboratory-results-final-report/download

[4] The Commonwealth Fund. Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. December 7, 2015.  Available at:  http://www.commonwealthfund.org/interactives-and-data/surveys/international-health-policy-surveys/2015/2015-international-survey

[5] Canada Health Infoway. Connecting Patients for Better Health: 2016.

[6] European Patients’ Forum – Patient Empowerment Campaign. May 2015.  Available at: http://www.eu-patient.eu/

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e-Health Annual Conference & Tradeshow 2017 | e-Health 2017 Toronto, ON

Empowering the Health Care Consumer

Brent Diverty is the Vice President, Programs for the Canadian Institute for Health Information (CIHI) and an e-Health 2017 Ambassador. In his role at CIHI, Brent oversees CIHI’s extensive data holdings, which span the continuum of health care services and also contain related financial, pharmaceutical and workforce data.  Connect with him on Twitter @BDiverty   

Studies confirm what many health leaders have long suspected; that engaged patients have better health outcomes.  So it probably comes as no surprise that the use of consumer digital solutions across the country has doubled in the past two years.  And that begs a rhetorical question: Where would Canada’s digital health community be without the voice of the consumer?

Participants at the #eHealth2017 Sunday Symposium June 4  will have a chance to hear the consumer voice firsthand when patients join digital health experts to discuss consumer empowerment, the current state of digital health solutions, patient centred data and the vision for the future. If you’re looking for one more reason to attend #eHealth2017, you’ll find it here.

The Symposium will kick off with a lunch and presentation from keynote speaker Lygeia Ricciardi, an industry expert in consumer engagement and digital health.  She’ll explore consumer choice, patient engagement and value for money.

Value for money, along with the patient experience and health outcomes, are key health system performance themes CIHI has identified as priorities in its strategic plan. I’m excited to see these reflected in the #eHealth2017 Symposium program – and I’m certain they will make for a lively discussion. 

Following Lygeia’s presentation, participants will have an opportunity to explore one of three tracks as eHealth 2017 co-hosts Infoway, Coach and CIHI each take a deeper look at empowering the healthcare consumer through data, digital solutions and a vision for engagement. 

Don’t miss the opportunity to participate.   Register today and join in the discussion.

I look forward to seeing you at #eHealth2017!

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e-Health Annual Conference & Tradeshow 2017 | e-Health 2017 Toronto, ON

Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study

Background: Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective: The aim was to illustrate uses and experiences with the secure e-recovery portal “ReConnect” as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions: Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans).
Journal of Medical Internet Research

A Content Analysis of Health and Safety Communications Among Internet-Based Sex Work Advertisements: Important Information for Public Health

Background: The capacity to advertise via the Internet continues to contribute to the shifting dynamics in adult commercial sex work. eHealth interventions have shown promise to promote Internet-based sex workers’ health and safety internationally, yet minimal attention has been paid in Canada to developing such interventions. Understanding the information communicated in Internet-based sex work advertisements is a critical step in knowledge development to inform such interventions. Objective: The purpose of this content analysis was to increase our understanding of the health and safety information within the Internet advertisements among women, men, and transgender sex workers and to describe how this information may be utilized to inform eHealth service development for this population. Methods: A total of 75 Internet-based sex worker advertisements (45 women, 24 men, and 6 transgender persons) were purposefully selected from 226 advertisements collected as part of a larger study in Western Canada. Content analysis was employed to guide data extraction about demographic characteristics, sexual services provided, service restrictions, health practices and concerns, safety and security, and business practices. Frequencies for each variable were calculated and further classified by gender. Thematic analysis was then undertaken to situate the communications within the social and commercialized contexts of the sex industry. Results: Four communications themes were identified: (1) demographic characteristics; (2) sexual services; (3) health; and (4) safety and security. White was the most common ethnicity (46/75, 61%) of advertisements. It was found that 20-29 years of age accounted for 32 of the 51 advertisements that provided age. Escort, the only legal business title, was the most common role title used (48/75, 64%). In total, 85% (64/75) of advertisements detailed lists of sexual services provided and 41% (31/75) of advertisements noted never offering uncovered services (ie, no condom). Gender and the type of Web-based platform mattered for information communicated. It was found that 35 of the 45 women’s advertisements were situated in personal websites and hosted details about nonsexual aspects of an appointment. Men and transworkers used Internet classified advertisement platforms with predetermined categories. Communications about sexually transmitted infections (STIs) occurred in only 16% (12/75) of advertisements with men accounting for 7. Women’s advertisements accounted for 26 of the 37 advertisements noting safety restrictions. Zero men or transpersons restricted alcohol or drug use. In total, 75% (56/75) of advertisements offered out-call services and the average minimal hourly rate ranged from Can $ 140/h to Can $ 200/h. Conclusions: The study findings contribute to understandings about the diverse platforms used in commercial sex advertisements, and how sex workers frame information for potential clients. This information affords health care providers and policy makers insights to how they might assist with promoting the health of Internet-based sex workers and their clients.
Journal of Medical Internet Research

Mobile Health: behoefte aan een goed communicatieplatform

Ronald Zondervan

Ronald Zondervan, Collaboration specialist in Healthcare bij Cisco, vertelt meer over deze actuele en toekomstige behoefte in de mobile healthcare markt. Bekijk zijn interview:

Of lees hieronder het interview:

Wat ziet u als de belangrijkste ontwikkelingen in mobile healthcare?

Wat je nu ziet in de markt, is dat er behoefte is aan een heel goed communicatieplatform om informatie met elkaar te kunnen delen en elkaar te kunnen bereiken.

Stel je voor: je wordt ziek, je gaat naar je huisarts, je gaat naar het ziekenhuis. Dan mag je niet zo lang meer blijven tegenwoordig, dus je gaat weer terug. En dan gaan heel veel mensen en organisaties zich met jou bemoeien.

Dat houdt in dat ze allemaal ketens zijn – de buurtzorg, de huisarts, de poli’s en dergelijke – en die moeten heel goed met elkaar kunnen communiceren om te zorgen dat je de juiste medicijnen krijgt, dat ze snappen wat er met je aan de hand is. Dus het communicatieplatform is echt een must.

En wat is uw rol of de rol van uw bedrijf daarin?

Wij leveren een volledig platform van communiceren om ervoor te zorgen dat we het bereikbaarheidsprobleem oplossen, dat we elkaar daarna makkelijk kunnen vinden en met elkaar kunnen samenwerken en data kunnen uitwisselen met elkaar.

Dus als iemand van de thuiszorg zou komen bij een patiënt en die zegt: “Hé, ik zie een paar medicijnen niet. Heeft de patiënt ze genomen of niet, hoe zit het?”, dat je in feite heel makkelijk met de huisarts, de zorgverzekeraar en dergelijke kunt communiceren om te zien hoe het zit.

Een technisch voorbeeld daarvan is een bot. Die praat met jou door middel van elektronica: een MedAssistant. Dan zeg je bijvoorbeeld “Dit is de patiënt, wat weten we van hem?” en dan krijg ik uit het medische ECD of EPD alle gegevens, inclusief de medische omgeving van die mevrouw en dan kan ik meteen zien: “Dit is goed, want de huisarts heeft dat medicijn weggehaald, dat hoeft niet meer”.

Wat verwacht u van de toekomst van mobile health?

De toekomst zal nog veel groter worden dan wat we nu al doen. Maar we zijn met elkaar al op de goede weg. Er zit alleen nog heel veel adoptie; gebruiksgemak bij de klant en de gebruiker zelf. Je zult zien dat video en dat soort mobiele omgevingen van alles naar alles een enorme vlucht gaat nemen.

Neem het voorbeeld van een dierbare die misschien MS heeft. Dan zou het toch fijn zijn – als het mijn vrouw betreft – dat ik gewoon vanaf thuis of mijn werk heel even kan kijken of het goed gaat, of ik iets moet gaan doen en al dat soort zaken. En dat dat hetzelfde platform is natuurlijk, waarbij ik als het niet goed zou gaan, meteen de buurtzorg, de thuiszorg, de poli kan informeren en dat we met elkaar kunnen communiceren.

Dus dat gaat een enorme vlucht nemen en dat is denk ik niet meer te stoppen.

Wat is de winst van een congres over mobile health?

Dat houdt in dat het heel goed is om met elkaar de meningen te delen, te netwerken, met potentiële klanten en partners te praten, om te zeggen: “wij hebben het platform dat ik net heb beschreven”… Maar bijvoorbeeld een hartmeter met een sensor die de data naar ons toestuurt, die maken wij niet zelf, maar die zou je dan hier weer kunnen vinden. Dus dan kun je partnerships ontwikkelen van mensen die de juiste componenten hebben, die in elkaar passen.

 

Mobile Healthcare: OuderenzorgTech 2017

Er is een transitie noodzakelijk om de ouderenzorg betaalbaar, bereikbaar en van hoge kwaliteit te houden. Nieuwe technologieën kunnen de samenwerking tussen de oudere/patiënt thuis en de eerste, tweede en derdelijns zorg optimaliseren. Tijdens OuderenzorgTech hoort u hier alles over.

 

Mobile Healthcare (waarvan OuderenzorgTech onderdeel is) vindt plaats op 23 november 2017. Mis deze editie niet en schrijf u nu (gratis) in!

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Mobile Healthcare Congres & iZone

Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin

Background: Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context. Objectives: The study aimed to (1) determine health professionals’ experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area. Methods: We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals’ knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected. Results: From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported “very” and “reasonably” experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of “entertaining,” “engaging,” and “fun” identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers. Conclusions: A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations. Journal of Medical Internet Research

Predicting an Exciting Year for Our Health Informatics Community

Let me start by stating that predictions are not my thing.  I did not accurately predict many Oscar winners this year and I usually finish close to the bottom in any office hockey/baseball pool in which I participate.  I do feel confident, however, in predicting an exciting year for our health informatics community.  Why, given my track record, am I feeling so bold?  Consider the following:

We have a Federal Health Minister who ‘gets it’.  Dr. Philpott, a physician who has been using an EMR for years, has been consistent in her message that digital health is transforming the health system and that there is tremendous potential to do more.  She understands the power of technology and the challenges of implementing the changes that will enable more widespread use of it and she is encouraging us, as a community, to continue our efforts to accelerate the pace of change. 

We have federal funding being allocated to healthcare.  By the time you read this blog, Minister Morneau will have tabled Budget 2017 in the House of Commons.  This year’s federal budget is expected to be good news for the health sector after what many would describe as lean years.  In addition to dollars allocated to health in the budget, Ottawa and the provinces/territories (except Manitoba) have reached bilateral funding agreements that will result in billions of dollars being transferred from the federal coffers. 

We have an increasing number of Canadians who are empowered to be more proactive members of their care teams.  This is significant.  According to Canada Health Infoway public opinion research, Canadians are increasingly aware of the benefits of digital health and want access to these services and solutions – and they are getting them. The availability of digital health services for Canadians, for example, has more than doubled between 2014 and 2016.  

We have a health informatics community that is dedicated to transforming the health system.   Canada’s health informatics community is thriving.  There is a renewed energy and a feeling that we are at a tipping point, poised to transform the health system at an unprecedented pace.   We understand the potential, we understand the challenges, and we are committed to working together as governments, industry, organizations, and patients, to make a difference. 

So, my prediction: eHealth 2017 will be the best conference experience you will have this year.  The enthusiasm, the progress, the discussion and celebration will leave you excited, energized and smarter! Looking forward to seeing you at #eHealth2017!

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e-Health Annual Conference & Tradeshow 2017 | e-Health 2017 Toronto, ON

Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

Background: Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs. Objective: The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician’s paternalism. Method: An email list–based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses. Results: The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=−.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=−.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=−.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=−.17, P=.01). Conclusions: Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians. Journal of Medical Internet Research

Comparison of Different Recruitment Methods for Sexual and Reproductive Health Research: Social Media–Based Versus Conventional Methods

Background: Prior research about the sexual and reproductive health of young women has relied mostly on self-reported survey studies. Thus, participant recruitment using Web-based methods can improve sexual and reproductive health research about cervical cancer prevention. In our prior study, we reported that Facebook is a promising way to reach young women for sexual and reproductive health research. However, it remains unknown whether Web-based or other conventional recruitment methods (ie, face-to-face or flyer distribution) yield comparable survey responses from similar participants. Objective: We conducted a survey to determine whether there was a difference in the sexual and reproductive health survey responses of young Japanese women based on recruitment methods: social media–based and conventional methods. Methods: From July 2012 to March 2013 (9 months), we invited women of ages 16-35 years in Kanagawa, Japan, to complete a Web-based questionnaire. They were recruited through either a social media–based (social networking site, SNS, group) or by conventional methods (conventional group). All participants enrolled were required to fill out and submit their responses through a Web-based questionnaire about their sexual and reproductive health for cervical cancer prevention. Results: Of the 243 participants, 52.3% (127/243) were recruited by SNS, whereas 47.7% (116/243) were recruited by conventional methods. We found no differences between recruitment methods in responses to behaviors and attitudes to sexual and reproductive health survey, although more participants from the conventional group (15%, 14/95) chose not to answer the age of first intercourse compared with those from the SNS group (5.2%, 6/116; P=.03). Conclusions: No differences were found between recruitment methods in the responses of young Japanese women to a Web–based sexual and reproductive health survey.
Journal of Medical Internet Research

Newsroom: Selfcare koppelt met Apple Health en Google Fit

eHealth en mHealth nieuws uit Nederland en het buitenland: alles over gezondheidsapps, wearables, persoonlijk gezondheidsdossier, fitness en wellness.

Het bericht Newsroom: Selfcare koppelt met Apple Health en Google Fit verscheen eerst op SmartHealth.

SmartHealth