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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Promoting health through tailored web-based patient education modalities
Tantalizing Insights for Frontline Practice Re-design
The Future of Web-based Patient Education
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Laura Anderko, Milwaukee, USA Associate Dean and Professor, Unviersity of Wisconsin-Milwaukee
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The “time crunch” experienced by providers in primary care clinics combined with the increasing complexity of need for patients, presents incredible challenges for improving health behaviors and ultimately, health outcomes. The importance of technology and specifically, the appeal of web-based platforms to improve knowledge are inescapable. Woolf et al. present findings from an impressive effort to integrate web-based patient education methods into six family practices that spanned 9 months. The authors examine the pursuit of health behaviors of patients referred to a Web site that provides tailored health advice, a library of national and local resources, and printouts for clinicians. This study links patient’s readiness to change with internet informational resources, with the intent of changing personal health behaviors for four separate health issues: alcohol consumption, diet, physical activity, and smoking. As we know, behaviors leading to each of these health conditions are not limited to a lack of knowledge in the individual, but rather, a complex, interplay of a wide range of socio- behavioral aspects as well. Findings from this study reinforce the need to design interventions that specifically consider the complexity of behavior change and need for human interaction to improve health outcomes (e.g., more than 50% requested physician assistance with health behaviors) within primary care settings. The authors acknowledge that, “The larger question is whether information alone is sufficient to help patients sustain long term behavior” and study findings underscore the need to create a more comprehensive approach to improving patient health behaviors that may include web sites as a component of an integrated strategy for behavior change. This study takes an important first step in designing and implementing a web-based patient education program into a network of family practices: a difficult task at best! In an Institute of Medicine report entitled "Promoting Health" (2000), research recommendations stressed the need to explore the psychosocial and bio-behavioral mechanisms that influence health to better understand and tailor intervention efforts. This study advances our knowledge in the area of tailoring health messages and information, providing us with an innovative strategy that can be used in addition to socio-behavioral interventions. Future research can and should build on the foundation created by Woolf et al. with an eye towards a more ecological approach which emphasizes intervention at multiple levels of influence (e.g., individual, interpersonal, institutional, community). Competing interests: None declared |
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Larry A Green, Denver, Co, USA Family Physician
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It is stunning how much Woolf et al and their partners accomplished in 16 months with a small grant! They were obviously able to innovate to a level that confirmed practical feasibility and inspire an entire portfolio of additional questions--that really seem timely and pertinent to the creation of the nation's "medical home" that pediatricians, internists, and family physicians are simultaneously recommending. Made obvious by this work is the inadequacy of old-fashioned financing arrangements for primary care that are limited to fee for service and require the presence of a physician. The transformed model of primary care with its patient-centered approach, asynchronous care, and teamwork aligns with what was demonstrated in this study. It also merits a full-throated cry for payment revisions, akin to those articulated a decade ago for primary care by the Institute of Medicine. Such financing reform is now obviously necessary and is likely to blend capitation payments, with premium payments for particular services and capacities, and incentives to be the best. Let the momentum keep building. Somewhere out there is a "tipping point." Woolf et al and their compatriots across the world are moving us closer to a high-performance primary care system of which we can and will be proud. Competing interests: I am the director of Prescription for Health, the program that funded this research. |
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Sara Kim, Seattle, Washington, USA Associate Professor, Department of Family Medicine, University of Washington
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The article by Woolf et al. examines the effectiveness of a Web site specifically designed to help patients with their behavior change in four target areas: diet, physical activity, smoking, and alcohol consumption. I highly recommend reading the online supplementary material, which includes more detailed description about the Web site and analyses of data comparing the intervention and control groups in specific behavior change areas. Creating a Web site that lends personal meanings to users is critical to sustaining their motivation and engagement. However, many sites developed for educational or informational purposes lack design elements that match the intended goals and objectives of developers. Careful thoughts have gone into designing the My Healthy Living Web site featured in this article. The development of the site was informed by a theoretical framework in behavioral change for optimizing a patient’s interaction with the Web content. Also integrated in the development process were inputs from multiple stakeholders, such as practices, communities, experts, beta testers, and national organizations. The content and feedback of the Web site were customized based on patients’ responses to questions. These individualized features help increase the patient’s motivation to stay engaged with and make return visits to the site. Direct input from patients who used the site was also solicited to understand both facilitating and inhibiting factors in implementing a patient’s behavior change plans. As acknowledged by the authors, the answer to whether a customized patient education Web site promotes healthy behaviors remains elusive for two reasons. First, the low number of participants in this study compromised the statistical power of the study’s findings as well as the generalizability to a wider population. The study population is of moderate to high socioeconomic status and is highly proficient in the Internet use. Their approach to using the Web site may not be a representative predictor in estimating the general population’s use of a site, such as My Healthy Living. Second, this study falls short of generating a significant knowledge base pertaining to specific Web design features that positively affect behavioral changes. The authors describe the reasons for not tracking an individual patient’s use of the Web site. Maximizing the Web’s capability to track and compile usage data may have helped further explore whether the patterns of engagement with the site differed between the patients whose behaviors worsened or improved. Woolf et al. lay down an important groundwork for further inquiry in our on-going attempt to understand the unique contribution of customized Web sites in patient education. Future studies could examine whether a uniform Web design template can be effectively applied to promoting a wide spectrum of healthy behaviors across dieting habits, physical activity, smoking cessation, and alcohol consumption. References Doupi, P; van der Lei, J. Towards personalized Internet health information: the STEPPS architecture. Medical Informatics and The Internet in Medicine; 27 (3) 1 Sep 2002, pp.139-151. Dutta-Bergman, Mohan J. The impact of completeness and Web use motivation on the credibility of e-health information Journal of Communication; 54 (2) Jun 2004, pp.253-269. Oenema A, Tan F, Brug J. Short-term efficacy of a web-based computer- tailored nutrition intervention: main effects and mediators. Ann Behav Med. 2005 Feb;29(1):54-63. Shelton, Brett E; Turns, Jennifer; Wagner, Tracey S. Technology adoption as process: a case of integrating an information-intensive website into a patient education helpline. Behaviour and Information Technology; 21 (3) 1 May 2002, pp.209-222. Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web -based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction. 2005 May;100(5):682-8. Yi, M Y; Hwang, Y. Predicting the use of web-based information systems: self-efficacy, enjoyment, learning goal orientation, and the technology acceptance model. International Journal of Human-Computer Studies. Vol. 59, no. 4, pp. 431-449. Oct. 2003. Competing interests: None declared |
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