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The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation

BACKGROUND: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. Howev...

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Autores principales: Kerr, Cicely, Murray, Elizabeth, Noble, Lorraine, Morris, Richard, Bottomley, Christian, Stevenson, Fiona, Patterson, David, Peacock, Richard, Turner, Indra, Jackson, Keith, Nazareth, Irwin
Formato: Texto
Lenguaje:English
Publicado: Gunther Eysenbach 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056534/
https://www.ncbi.nlm.nih.gov/pubmed/21156471
http://dx.doi.org/10.2196/jmir.1438
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author Kerr, Cicely
Murray, Elizabeth
Noble, Lorraine
Morris, Richard
Bottomley, Christian
Stevenson, Fiona
Patterson, David
Peacock, Richard
Turner, Indra
Jackson, Keith
Nazareth, Irwin
author_facet Kerr, Cicely
Murray, Elizabeth
Noble, Lorraine
Morris, Richard
Bottomley, Christian
Stevenson, Fiona
Patterson, David
Peacock, Richard
Turner, Indra
Jackson, Keith
Nazareth, Irwin
author_sort Kerr, Cicely
collection PubMed
description BACKGROUND: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide. OBJECTIVE: To explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD). METHODS: Quantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services. RESULTS: Only 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention. CONCLUSIONS: The availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge.
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spelling pubmed-30565342011-03-15 The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation Kerr, Cicely Murray, Elizabeth Noble, Lorraine Morris, Richard Bottomley, Christian Stevenson, Fiona Patterson, David Peacock, Richard Turner, Indra Jackson, Keith Nazareth, Irwin J Med Internet Res Original Paper BACKGROUND: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide. OBJECTIVE: To explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD). METHODS: Quantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services. RESULTS: Only 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention. CONCLUSIONS: The availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge. Gunther Eysenbach 2010-12-02 /pmc/articles/PMC3056534/ /pubmed/21156471 http://dx.doi.org/10.2196/jmir.1438 Text en ©Cicely Kerr, Elizabeth Murray, Lorraine Noble, Richard Morris, Christian Bottomley, Fiona Stevenson, David Patterson, Richard Peacock, Indra Turner, Keith Jackson, Irwin Nazareth. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.12.2010   http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Kerr, Cicely
Murray, Elizabeth
Noble, Lorraine
Morris, Richard
Bottomley, Christian
Stevenson, Fiona
Patterson, David
Peacock, Richard
Turner, Indra
Jackson, Keith
Nazareth, Irwin
The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title_full The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title_fullStr The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title_full_unstemmed The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title_short The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation
title_sort potential of web-based interventions for heart disease self-management: a mixed methods investigation
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056534/
https://www.ncbi.nlm.nih.gov/pubmed/21156471
http://dx.doi.org/10.2196/jmir.1438
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