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The potential of internet interventions for heart disease self-management: a mixed methods investigation

Kerr, C; Murray, E; Noble, LMM; Morris, R; Bottomley, C; Stevenson, F; Patterson, D; ... Nazareth, I; + view all (2010) The potential of internet interventions for heart disease self-management: a mixed methods investigation. Journal of Medical Internet Research , 12 (4) 10.2196/jmir.1438.

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Abstract

Background: Existing initiatives to support patient self-management of heart disease do not appear to be reaching those most in need. Providing self-care 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. Objective: To explore the effectiveness of a web-based intervention in decreasing inequalities of access to self-management support in patients with coronary heart disease (CHD). Methods: Quantitative 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 centres in diverse socioeconomic and ethnic areas of North London, UK. Patients without home internet access were supported in using the intervention at public internet services. Results: Only 10.6% of eligible patients participated (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 ago. 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 experience 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 those without home internet access. The use of the intervention by participants with little or no internet experience was limited by lack of confidence with computers and discomfort asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention. Conclusions: The 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.

Type: Article
Title: The potential of internet interventions for heart disease self-management: a mixed methods investigation
DOI: 10.2196/jmir.1438
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/402750
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