Aspects of uptake, use and effectiveness of eHealth interventions for self-management support and patient-provider communication
Year: 2015
Type: dissertation
Abstract: The prevalence and burden of chronic diseases, including cancer, are escalating worldwide. New models of care are needed to meet this challenge. eHealth has a great potential to support patients self-management and communication with health care providers. However, a number of barriers to achieve the full benefits of eHealth have been reported. The aim of this dissertation was to address gaps related to the uptake, use and effectiveness of eHealth interventions.\nThis study used a multi-method approach, employing both qualitative and quantitative methods including interviews with nurses, secondary analyses of longitudinal data and a randomized controlled trial with patient reported outcomes. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used as the conceptual framework in this dissertation.\nThe study shows that a Web-based self-management system can be an important contributor in providing health care for breast cancer patients in terms of reducing symptom distress, anxiety and depression scores. A secure e-mail component alone contributed to reduced depression scores, which indicates that secure e-mail is an important part of multi-component systems and can also effectively be offered as a stand-alone service. This is promising, as depression is highly prevalent and debilitating among cancer patients. An e-mail service is much easier to develop and to implement widely than more complex multi-component solutions. Despite the concerns identified in the literature regarding health care providers being flooded by messages, only modest use was observed in these studies, indicating e-mail as manageable to integrate in routine care.\nFurther, this study revealed that different user characteristics are associated with different use patterns of Web-based self-management support systems. Secure e-mail and self-management advice were highly accessed components among patients with low levels of social support combined with high illness burden, suggesting that patients with these characteristics may find such tools particularly useful. This information is important in order to target Web-based support systems to different patient groups.\nFinally, the results suggest that, from nurses’ perspectives, integration of an interactive tailored assessment tool in clinical practice offers many benefits for communication and enhancement of patient-centered care. However, to reap these benefits, use of such tools must receive equal priority to other routines and require sufficient time and competence.\nIn summary, through materials from three different studies and use of multiple methods, this dissertation adds to the knowledge about the uptake, use and effectiveness of eHealth interventions in real life settings. The results and knowledge gained are important to the design of support systems that are better tailored to the individual and the context of use.
Author: Elin Børøsund
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2287801088