Laurence Alpay

E-health applications and services for patient empowerment: Directions for best practices in the Netherlands

OBJECTIVE E-health may enable the empowerment process for patients, particularly the chronically ill. However, e-health is not always designed with the requirements of patient empowerment in mind. Drawing on evidence-based e-health studies, we propose directions for best practices to develop e-health that promotes patient empowerment. METHODS The concept of patient empowerment in the Dutch setting is discussed first. The prerequisites for patient empowerment are then described and translated into empowerment areas relevant to e-health. MATERIALS We reviewed Dutch e-health studies that provide insights into what works, and what does not, in e-health. RESULTS On the basis of the lessons learned from the studies, we propose directions for best practices to develop e-health that promotes patient empowerment. These directions cover various aspects, such as the design and implementation of e-health, its information content and usability, awareness, and acceptance. The studies also indicate the difficulty of establishing that e-health is really dedicated to patient empowerment. CONCLUSIONS Despite the body of knowledge about patient empowerment, as well as the technological visibility of e-health, evidence for best practices in general and for patient empowerment in particular is scarce. We call for a more systematic evaluation of e-health for patient empowerment and more reliable evidence. Beyond the organizational and technical issues involved in e-health, there is also a need to demonstrate its practical benefits to patients. The Netherlands is active in developing sustainable e-health. National initiatives are now in place to support the processes with the aim of establishing the required evidence-based best practices.

Validity and usability of low-cost accelerometers for internet-based self-monitoring of physical activity in patients with chronic obstructive pulmonary disease

Background The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life. Objective Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients’ preferences with regards to the presentation of and feedback on monitored physical activity. Methods To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device Results The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices. Conclusions The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients.

Easing Internet access of health information for elderly users

Elderly users are increasingly becoming active consumers of Internet technologies. Developing websites dedicated to this user group presents several design issues (such as that of ‘design for all’, participatory design, patient empowerment and cognitive usability assessment methods). SeniorGezond is a health information resource currently under development. It aims to support elderly users in their search and access of appropriate information in the area of fall incidences. The current development of SeniorGezond provides a useful illustration on how design issues can be addressed and applied in a practical setting.

Current Challenge in Consumer Health Informatics: Bridging the Gap between Access to Information and Information Understanding

The number of health-related websites has proliferated over the past few years. Health information consumers confront a myriad of health related resources on the internet that have varying levels of quality and are not always easy to comprehend. There is thus a need to help health information consumers to bridge the gap between access to information and information understanding–-i.e. to help consumers understand health related web-based resources so that they can act upon it. At the same time health information consumers are becoming not only more involved in their own health care but also more information technology minded. One way to address this issue is to provide consumers with tailored information that is contextualized and personalized e.g. directly relevant and easily comprehensible to the persons own health situation. This paper presents a current trend in Consumer Health Informatics which focuses on theory-based design and development of contextualized and personalized tools to allow the evolving consumer with varying backgrounds and interests to use online health information efficiently. The proposed approach uses a theoretical framework of communication in order to support the consumers capacity to understand health-related web-based resources.

Determinants influencing the implementation of home-based stroke rehabilitation: a systematic review

Abstract Purpose: Home-based rehabilitation is a promising alternative to regular center-based stroke rehabilitation. The objective of this study was to identify what is currently known about determinants that influence the implementation of home-based stroke rehabilitation (HBSR) in clinical practice. Methods: A systematic review of determinants of HBSR was conducted, using a framework for innovation (including determinants related to the innovation, the user, the organization, and the socio-political context). Reviews, meta-analyses, and qualitative studies were included. Studies were selected if they concerned: home-based rehabilitation of stroke patient’s (motor) function, changes in in-person service delivery (> 24 h to 12 months post-stroke) and determinants of implementation. Results: A total of 88 studies were identified, of which 7 studies met the inclusion criteria. Identified determinants of implementation of HBSR were: intervention effectiveness, the exact nature of the medical condition, satisfaction with services, coordination of services, inter-professional collaborations, availability of appropriate training equipment, and costs. However, none of the studies had the primary aim to identify determinants of implementation. Conclusion: A more complete and detailed overview of existing determinants of HBSR is needed to assist professionals and organizations in decision-making on HBSR implementation and development of suitable strategies for implementation. Implications for Rehabilitation Committed professionals and a smooth transfer to the home-environment are essential elements for home-based rehabilitation or early supported discharge. The determinants related to the client include age, needs, stability and severity of the stroke as well as the living conditions. Clients and care givers should be involved in the recovery process including the decision for early discharge and home-based rehabilitation. It is necessary that essential therapy equipment be provided and that the travel times and costs of therapists are reimbursed.

Empowering citizens in assessing health related websites: a driving factor for healthcare governance

Information and access to information are critical issues in healthcare governance. Increasingly citizens are searching for health information on the Internet. The Internet can act as an enabler to empower citizens in their health management. However, one of the problems that citizens face is that of evaluating (health) information. User guidance tools available to citizens are often difficult to apply and can vary greatly in their contents and presentation. Filtering tools and accreditation labels, although sparse, and not always familiar to the citizens, are found to offer more advantages than user guidance tools. The development of filtering tools and accreditation labels needs to be sustained and prioritised in order to ensure that citizens are well equipped to assess health information on the Internet, and empowered with accurate health information. This has great implications for healthcare governance, specifically with regards to increasing public participation, achieving equality of information and of access to information, and integrating Internet-;based information facilities to other healthcare services.