Why Are Health Care Interventions Delivered Over the Internet? A Systematic Review of the Published Literature

Abstract

Background As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions.Objective The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research.Methods We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized.Results We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery.Conclusions One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery?

Effectiveness of telemedicine: A systematic review of reviews

“…One review found that a societal perspective on costs has not yet been developed for home telehealth [71] and another highlighted the need to consider not only costs to health services of interventions, but also costs to service users and their social networks [72].…”

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

“…The Internet provides patients, families and health care professionals with unparalleled opportunities to learn, inform and communicate with one another, receive meaningful social support, fulfill the rising demand for expedient access to evidence-based health information and achieve greater involvement in health care decisionmaking (84,85). Using the Internet to deliver health interventions dramatically reduces geographical constraints, provides opportunities for access regardless of language spoken and travel constraints (financial constraints or those due to physical disability), and provides 24 h access to information that can help patients feel less isolated and more in control of managing their chronic condition (86). Therapeutic Internet interventions are treatments based on effective face-to-face interventions (eg, psychoeducational and CBT) that are transformed for delivery via the Internet with the goal of improved health outcomes (symptom reduction [pain and pain-related disability; anxiety and depression] and improved HRQL).…”

Internet-based guided self-help for posttraumatic stress disorder (PTSD): Randomized controlled trial

“…In response, there has been a growing interest in using the internet as a platform for the delivery of psychological therapy (Amstadter, Broman-Fulks et al 2009). Using the internet to deliver evidence-based treatment has the capacity to reduce the cost of effectively delivering evidence-based therapy (Hedman, Andersson et al 2011) and has the potential to overcome many other barriers that currently limit the availability and uptake of treatment (Griffiths, Lindenmeyer et al 2006).…”