Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial

Abstract

Background There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions.Objective This study was designed as an evaluation of the usage and effects of the “Internet Doctor” website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change.Methods Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use.Results The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline in intentions to consult the doctor between baseline and follow-up was predicted by age (beta = .10, P= .003), believing before accessing the website that consultation was necessary for recovery (beta = .19, P < .001), poor understanding of illness (beta = .11, P = .004), emotional reactions to illness (beta = .15, P <.001), and use of the Diagnostic section of the Internet Doctor website (beta = .09, P = .007).Conclusions Our findings provide initial evidence that tailored web-based advice could help patients self-manage minor symptoms to a greater extent. These findings constitute a sound foundation and rationale for future research. In particular, our study provides the evidence required to justify carrying out much larger trials in representative population samples comparing tailored web-based advice with routine care, to obtain a definitive evaluation of the impact on self-management and health service use.

Internet-based randomized controlled trials: a systematic review

“…In trials of a web-based intervention, participants in the control group can be given access to a standard website while participants in the intervention group can be given access to a more comprehensive interactive website. 29 Only 11 of the included 50 trials attempted to blind participants, one of which evaluated the success of blinding by measuring participants' belief about treatment allocation.…”

Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 1: State of the Art

“…All of the included studies, except that of Yardley et al [66], focused on long-term conditions or issues.…”

“…All included studies, except 1 [66], focused on long-term conditions or issues that must take into account fluctuation in condition intensity and variations in how they influence the patient’s life.…”

“…A total of 3 self-management studies (4 articles) [66,67,73,74] and 3 monitoring studies [54,55,57] mainly used computer-tailored feedback to the patients. None of these studies focused on health care costs, even if these interventions may be the most promising ones to save both time and money for the health care system, compared with monitoring and self-management, where the physician or the nurse is the main communication partner.…”

Development of StopAdvisor

“…Team members' expertise in website development came from the experience of leading and participating in the development of a number of interactive web-based interventions [13,[26][27][28][29][30][31]. This produced principles of how to maximise engagement, for example by optimising the aesthetics, credibility and interactivity of the site [32] and employing a hybrid architecture combining tunnelled exposure to key messages and choice of content from a menu [33].Website content was guided by an assessment of the balance between (1) maintaining motivation to stop and maximising self-regulatory capacity and (2) avoiding burdening users in a way that would deter them from making further use of the website.…”