How Can Research Keep Up With eHealth? Ten Strategies for Increasing the Timeliness and Usefulness of eHealth Research

Abstract

BackgroundeHealth interventions appear and change so quickly that they challenge the way we conduct research. By the time a randomized trial of a new intervention is published, technological improvements and clinical discoveries may make the intervention dated and unappealing. This and the spate of health-related apps and websites may lead consumers, patients, and caregivers to use interventions that lack evidence of efficacy.ObjectiveThis paper aims to offer strategies for increasing the speed and usefulness of eHealth research.MethodsThe paper describes two types of strategies based on the authors’ own research and the research literature: those that improve the efficiency of eHealth research, and those that improve its quality.ResultsEfficiency strategies include: (1) think small: conduct small studies that can target discrete but significant questions and thereby speed knowledge acquisition; (2) use efficient designs: use such methods as fractional-factorial and quasi-experimental designs and surrogate endpoints, and experimentally modify and evaluate interventions and delivery systems already in use; (3) study universals: focus on timeless behavioral, psychological, and cognitive principles and systems; (4) anticipate the next big thing: listen to voices outside normal practice and connect different perspectives for new insights; (5) improve information delivery systems: researchers should apply their communications expertise to enhance inter-researcher communication, which could synergistically accelerate progress and capitalize upon the availability of “big data”; and (6) develop models, including mediators and moderators: valid models are remarkably generative, and tests of moderation and mediation should elucidate boundary conditions of effects and treatment mechanisms. Quality strategies include: (1) continuous quality improvement: researchers need to borrow engineering practices such as the continuous enhancement of interventions to incorporate clinical and technological progress; (2) help consumers identify quality: consumers, clinicians, and others all need to easily identify quality, suggesting the need to efficiently and publicly index intervention quality; (3) reduce the costs of care: concern with health care costs can drive intervention adoption and use and lead to novel intervention effects (eg, reduced falls in the elderly); and (4) deeply understand users: a rigorous evaluation of the consumer’s needs is a key starting point for intervention development.ConclusionsThe challenges of distinguishing and distributing scientifically validated interventions are formidable. The strategies described are meant to spur discussion and further thinking, which are important, given the potential of eHealth interventions to help patients and families.

Internet-based support programs to alleviate psychosocial and physical symptoms in cancer patients: A literature analysis

“…Internet-based technologies appear at a much greater pace than research can keep up with. A way to resolve this challenge is to examine the efficacy of generic program components and/or underlying principles that are more timeless than the programs themselves as has been proposed previously [44]. Successful implementation into routine cancer care represents another challenge but is crucial to reach the full potential of internet-based support programs.…”

Physical Activity in Ankylosing Spondylitis: evaluation and analysis of an eHealth tool

“…The availability of self-assessment technology is increasing and as eHealth accessibility is improving, prevention, treatment and health maintenance is becoming personalised and patient tailored 11. Studies show that there has been an upward trend in using the internet for health-related purposes12 and that small studies with a direct focus improve the efficacy and accuracy of clinical support for long-term conditions 13…”

A patient perspective on eHealth in primary care

“…The traditional randomized controlled trial (RCT) approach does not fit in the way technological interventions are rapidly being updated and improved. 47 Furthermore, its effectiveness can only be proven when eHealth is fully integrated into daily care routines, and the preferred way to implement it might change between care organizations. In the eLabEL project a living lab approach is used, which we still see as being an appropriate approach for developing and studying eHealth interventions.…”

“…45,46 To date, the adoption of eHealth by patients has been low. 44,[47][48][49] We think that there is often a suboptimal fit between the needs of patients and the eHealth solutions. …”