Henk Boer

Evaluation of Internet-Based Technology for Supporting Self-Care: Problems Encountered by Patients and Caregivers When Using Self-Care Applications

Background Prior studies have shown that many patients are interested in Internet-based technology that enables them to control their own care. As a result, innovative eHealth services are evolving rapidly, including self-assessment tools and secure patient-caregiver email communication. It is interesting to explore how these technologies can be used for supporting self-care. Objective The aim of this study was to determine user-centered criteria for successful application of Internet-based technology used in primary care for supporting self-care. Methods We conducted scenario-based tests combined with in-depth interviews among 14 caregivers and 14 patients/consumers to describe the use of various self-care applications and the accompanying user problems. We focused on the user-friendliness of the applications, the quality of care provided by the applications, and the implementation of the applications in practice. Results Problems with the user-friendliness of the self-care applications concerned inadequate navigation structures and search options and lack of feedback features. Patients want to retrieve health information with as little effort as possible; however, the navigation and search functionalities of the applications appeared incapable of handling patients’ health complaints efficiently. Among caregivers, the lack of feedback and documentation possibilities caused inconvenience. Caregivers wanted to know how patients acted on their advice, but the applications did not offer an adequate feedback feature. Quality of care problems were mainly related to insufficient tailoring of information to patients’ needs and to efficiency problems. Patients expected personalized advice to control their state of health, but the applications failed to deliver this. Language (semantics) also appeared as an obstacle to providing appropriate and useful self-care advice. Caregivers doubted the reliability of the computer-generated information and the efficiency and effectiveness of secure email consultation. Legal or ethical issues with respect to possible misuse of email consultation also caused concerns. Implementation problems were mainly experienced by caregivers due to unclear policy on email consultation and the lack of training for email consultations. Conclusions Patients’ and caregivers’ expectations did not correspond with their experiences of the use of the Internet-based applications for self-care. Patients thought that the applications would support them in solving their health problems. Caregivers were more reserved about the applications because of medico-legal concerns about misuse. However, the applications failed to support self-care because eHealth is more than just a technological intervention. The design of the applications should include a way of thinking about how to deliver health care with the aid of technology. The most powerful application for self-care was secure email consultation, combined with a suitable triage mechanism to empower patients’ self-awareness. Future research should focus on the effectiveness of such Web-based triage mechanisms for medical complaints and on the development of interactive features to enhance patients’ self-care.

Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation

OBJECTIVEnTo identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).nnnMETHODSnWe used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.nnnRESULTSnIn total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups - the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors - were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.nnnCONCLUSIONnIn order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.

Health education to improve repeat participation in the Dutch breast cancer screening programme: evaluation of a leaflet tailored to previous participants

Participation in breast cancer screening programmes often declines in the course of the programme. The purpose of the present study was to examine whether health education could diminish the amount of drop-outs between two screening rounds. The health education was tailored to women who previously underwent mammography. Based on the Elaboration Likelihood Model two versions of the tailored leaflet were made: a simple version and a version with additional peripheral cues. In an experimental study among 2961 women the effects of the tailored leaflets on reparticipation were tested against a standard leaflet. Re-participation rates were high (> 90%) and did not differ between the 3 groups. No significant differences regarding beliefs about re-participating were found between the 3 groups. Results indicate that the tailored information leaflets did not enhance re-participation. Therefore, the required additional efforts and costs do not seem to be justified. The results of the study provide indications that less painful mammograms and friendly staff might improve re-participation.

Newspaper Coverage of Hazards and the Reactions of Readers

,For most hazardous events, information is likely to come neither from personal experience nor from other interpersonal sources but, rather, from the symbolic environment of the mass media. In several studies a direct link between mass media reporting of hazards and the perception and reaction of the public is presumed. Combs and Slovicl for example, correlated the frequency with which 41 causes of death were reported in two newspapers with people’s estimates of the frequency of these same causes of death. Moderately high positive correlations were found even when the actual frequency of death associated with these causes was held constant. In 1981 Mazur2 formulated his Coverage-Attitude Hypothesis in which was stated that ‘the rise in reaction against a scientific technology appears to coincide with a rise in quantity of media coverage, suggesting that media attention tends to elicit a conservative public bias’. In an analysis of mass media coverage of Three

Patient use and compliance with medical advice delivered by a web-based triage system in primary care

We studied a web-based triage system which was accessible to the general public in the Netherlands. In a retrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided. Over a period of 15 months, 13,133 different people began using the web-based triage system and 3812 patients went right through the triage process to the end. The most frequent complaints were common cold symptoms, such as cough and a sore throat (22%), itch problems (13%), urinary complaints (12%), diarrhoea (10%), headache (8%) and lower back pain (8%). Most commonly, the system generated the advice to contact a doctor (85%) and in 15% of the cases the system provided fully automated, problem-tailored, self-care advice. A total of 192 patients participated in a prospective study and completed an online survey immediately after the delivery of advice. A follow-up questionnaire on actual compliance was completed by 35 patients. Among these, 20 (57%) had actually complied with the advice provided by the system. A regression analysis revealed that intention to comply was strongly related to actual compliance. In turn, intention to comply was strongly related to attitude towards the advice (P < 0.001). Web-based triage can contribute to a more efficient primary care system, because it facilitates the gatekeeper function.

Knowledge about HIV/AIDS and policy knowledge in a South African state hospital

Sub-Saharan Africa is the epicentre of the HIV/AIDS epidemic. With about 5.6 million people living with HIV/AIDS (PLWHA) in 2004 South Africa has the largest number of PLWHA in a single country. It is expected that in the coming years the number of PLWHA will increase in South Africa. Medical staff involved in the hospital care of HIV/AIDS patients in South Africa especially nurses and doctors are confronted with a number of problems. Due to the presumed dangers of HIV infection during patient care medical staff may experience stress when caring for HIV/AIDS patients. Adequate knowledge about HIV/AIDS is an important means to reduce stress and could result in better care and improve information to the general public. (excerpt)

EFFECTS OF A THEORY-BASED AUDIO HIV/AIDS INTERVENTION FOR ILLITERATE RURAL FEMALES IN AMHARA, ETHIOPIA

In Ethiopia the level of illiteracy in rural areas is very high. In this study, we investigated the effects of an audio HIV/AIDS prevention intervention targeted at rural illiterate females. In the intervention we used social-oriented presentation formats, such as discussion between similar females and role-play. In a pretest and posttest experimental study with an intervention group (n = 210) and control group (n = 210), we investigated the effects on HIV/AIDS knowledge and social cognitions. The intervention led to significant and relevant increases in HIV/AIDS knowledge, self-efficacy, perceived vulnerability to HIV/AIDS infection, response efficacy of condoms and condom use intention. In the intervention group, self-efficacy at posttest was the main determinant of condom use intention, with also a significant contribution of vulnerability. We conclude that audio HIV/AIDS prevention interventions can play an important role in empowering rural illiterate females in the prevention of HIV/AIDS.

HIV-prevention knowledge among illiterate and low-literate women in rural Amhara, Ethiopia

More than 85% of Ethiopias population lives in rural areas and literacy levels in the country are relatively low. Despite this, little is known about levels of knowledge in regard to HIV/AIDS and condom use among illiterate and low-literate rural individuals. We conducted a cross-sectional study among 200 illiterate to semi-literate women, ages 13 to 24, from two rural communities in the Amhara region of northwestern Ethiopia. Nearly all the women had heard about HIV and AIDS. Among the illiterate individuals (n = 54), 24% did not know that HIV was the cause of AIDS and 48% did not know that HIV could be transmitted by sexual intercourse without a condom with an HIV-infected person. Among the same group, 59% did not know what a condom is. Literacy had a strong positive association with knowledge of HIV transmission and condoms. Thus, due to a generally higher level of literacy (grade 5-8 attainment), very young women (ages 13-20) had better knowledge of HIV transmission and condoms than did women ages 21-24 who by comparison were less literate. Given poor knowledge of HIV transmission and condoms among illiterate and low-literate women in Amhara, targeted HIV-prevention interventions are needed in this region.

Reaching the hearts and minds of illiterate women in the Amhara highland of Ethiopia: development and pre-testing of oral HIV/AIDS prevention messages.

In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact.

An Extension of the Coverage-Attitude Hypothesis: Coverage of Technological and Environmental Hazards in Dutch Newspapers and Readers’ Reactions

Most people depend on the mass media for information about technological and environmental hazards. In this paper we discuss the Coverage-Attitude Hypothesis which supposes a relationship between the amount of mass media coverage of technological and environmental hazards and the reactions of the public to these hazards.