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

Abstract

BackgroundExisting 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.ObjectiveTo explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD).MethodsQuantitative 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.ResultsOnly 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.ConclusionsThe 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.

Online Health Information Tool Effectiveness for Older Patients: A Systematic Review of the Literature

“…In two studies, satisfaction with OHITs was equal to that of face-to-face interventions (Nguyen et al, 2008(Nguyen et al, , 2013. Older patients who were more experienced with using the Internet were more likely to become either moderate or heavy OHIT users (Kerr et al, 2010). Because of technological issues, one study found OHIT usage to be sub-optimal (Nguyen et al, 2008).…”

“…Ten articles reported on a sample or subsample with a mean age between 65 and 70 years (Bond et al, 2007(Bond et al, , 2010Kerr et al, 2010;Mewton et al, 2013;Neafsey et al, 2011;Nguyen et al, 2008Nguyen et al, , 2013Ruland et al, 2013;Westlake et al, 2007;Zou et al, 2012), 14 articles used a sample or subsample with a mean age between 70 and 75 years (Berman et al, 2013;Hill-Kayser et al, 2011;Homenko et al, 2010;McKinstry et al, 2013;Nahm et al, 2008;Shea et al, 2006Shea et al, , 2009Sheeran et al, 2011;Trief et al, 2007Trief et al, , 2009Trief et al, , 2013Weinstock et al, 2011), and one article used a sample with a mean age of 79 years (Finkelstein et al, 2011). Four articles discussed OHITs based on a single function: three of which were concerned with information provision Sheeran et al, 2011) …”

“…This OHIT was compared with an intervention that consisted of face-to-face consultations, paper diaries, reinforcement telephone calls, printed educational modules and face-to-face group sessions. A third article described an OHIT that provided interactive information, behavior change support, and both peer and expert support components for heart disease patients (Kerr et al, 2010). The fourth study evaluated an OHIT that consisted of a symptom-monitoring component, a tailored self-management component, an information component, and a communication component for corresponding with other patients and nurses (Ruland et al, 2013).…”

Guided Internet-based Psycho-educational Intervention Using Cognitive Behavioral Therapy and Self-management for Individuals with Chronic Pain: A Feasibility Study

“…The rate of accrual to this study was low, although larger health care and epidemiological studies that used the Internet to recruit participants have reported enrollment rates of 0.2%-16.9% (Glasgow et al, 2010;Koo & Skinner, 2005;Stopponi et al, 2009). The ICPI study click-through rate was slightly higher than that of other health care advertisements online (Webtrends, 2011); however, the cost per recruited subject as a result of this advertising was significantly higher than other research that recruited in the same manner, reporting their cost at $5.14 per participant (Bull, Vallejos, Levine, & Ortiz, 2008).…”

“…The ICPI was well received by participants and demonstrated positive outcomes in this preliminary study. Further research with more participants is feasible and While research has established the effectiveness of these therapies, delivered via traditional face-toface methods, for those with chronic pain (Broderick et al, 2014;Hoffman, Papas, Chatkoff, & Kerns, 2007;LeFort, Gray-Donald, Rowat, & Jeans, 1998;McCracken, MacKichan, & Eccleston, 2007;Nicholas et al, 2010;Reid et al, 2008;Sveinsdottir, Eriksen, & Reme, 2012), early studies documenting delivery of these therapies online involved individuals with depression, anxiety, other social and mood disorders (Andersson, 2006;Andersson, Bergstrom, Carlbring, & Lindefors, 2005;, and other chronic diseases (Ghahari, Packer, & Passmore, 2009;Kerr et al, 2010;Lorig, Ritter, Laurent, & Plant, 2006). The effect of an Internet-based chronic pain psycho-educational intervention that included selfmanagement and CBT had not been studied in depth prior to initiation of this project.…”