NorthPoint Domain

Simple, Interactive e-Health Programs Best

Patients cite user-friendliness as key

According to a study published in the Journal of Medical Internet Research, healthcare technology will diffuse if it is simple to use and has applicable components for interactivity.

E-health technology is advancing rapidly, and it provides a powerful new medium for self-care. Its use is still rather low, and attrition is a problem. The authors of the current study therefore wanted to explore the factors that influence utilization of a web-based application. They chose to focus on type 2 diabetes because its incidence is rising quickly; it is estimated that 439 million adults worldwide will have the condition by 2030. DiabetesCoach was developed to encourage patients to play a more active role in their care. It features a place to document personal data, email health professionals, monitor metabolic values such as weight and blood glucose level, educate oneself on diabetes, keep a calendar, and complete self-tests in support of healthy lifestyle changes. The authors recruited 50 patients from their institution in the Netherlands who had type 2 diabetes, were motivated to perform self-care, and had access and skill with the Internet. Enrollees were 43 to 80 years old (mean age 61), had a high or medium level of education, were treated with diet and medication such as metformin, and were mostly male (37) and Dutch (40).

Participants used DiabetesCoach over a two-year period, and the study authors analyzed their activity via a combination of log files, semi-structured interviews, usability tests, and a survey. Patients cited three main reasons for using the program: increased possibilities for self-care, more continuously received feedback from the nurse, and improved access to care (mostly due to email). Their usage declined over time, and patients reported it having to do with a ceiling effect, in that they no longer needed it because their checkups had decreased and they were doing well, or a lack of user-friendliness, in that they wanted more interactive features like email reminders and appointment scheduling functionality.

The authors conclude that more research in this area is critical, and that future healthcare e-technology programs can be successful by “avoiding selective enrollment, making use of participatory design methods, and developing push factors for persistence.”

Source: Nijland N, van Gemert-Pijnen JEWC, Kelders SM, et al. 2011. Factors influencing the use of a web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study. Journal of Medical Internet Research 13(3):e71.