Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

Abstract

BackgroundParticipatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults.ObjectiveTo review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s).MethodsA systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles.ResultsMost interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions.ConclusionsThere is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

Chronic disease and use of online health information and online health services

“…The results are similar to recent studies, [28,31,41] prompting the improvement of OHS. It is nonetheless important to keep in mind that these expected yet intriguing results indicate that the possibility of over-diagnosis is high.…”

“…[24,25] Use of OHS is indeed considered as significant means for self-management because it facilitates treatment and follow ups and prevents unnecessary health complications. [26,27] Recent evidence indicates though that CD patients are not likely to use OHS, lowering thereof, the odds for effective self-management of CD, [28][29][30][31] raising concerns regarding the level of ignoring or misunderstanding specific needs among CD patients [28] higher risk of hospital admission and even higher mortality rates [32] and may lower the use of preventive online and offline health services [28,29] and the likelihood for an effective self-management of health. [33,34] H2: A CD condition will increase access to OHS.…”

Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews (Preprint)

“…After removing duplicates and initial screening of titles and abstracts, 42 papers were retrieved for detailed evaluation. [24,25,26] which were part of another main study [6,27,28], leading to a total of 20 unique reviews [3,6,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. The overall process of review selection was …”

Social media and senior citizen advocacy: an inclusive tool to resist ageism?

“…It is, therefore, important to recognize for whom these technologies are designed, and for whom these are not. Importantly, economic and regional barriers to social media use still exist, particularly for lowincome rural older adults (Chou, Lai, and Liu 2010;Doyle and Goldingay 2012;Stellefson et al 2013). These systemic barriers perpetuate difficulties because the less one participates on the web, the less one is able to participate in the development process of websites (Baker et al 2013).…”