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Expanding the Reach and Impact of
Consumer e-Health Tools

June 2006

Office of Disease Prevention and Health Promotion logo

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Appendix 3. Chapter 3 Literature Review Summary (Part 7)

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Table Reference Number/Authors/
Text Section
Sample Health Topic Area/
Locus of Use/
Description of the Tool Overview Measures Outcomes
Single Group Designs
70. Radvan D, Wiggers J, Hazell T. HEALTH C.H.I.P.S.: opportunistic community use of computerized health information programs. Health Education Research 2004;19:581-90. [Overview, Access] Study 1: 386 people age 18-83, mean age 42.9; 70.2% female. Study 2: 55.3% male, age range of users from <12 to >60 with the greatest proportion (31.4%) of users children under age 12 Health information: community-based touch screen computer in free-standing kiosks HEALTH CHIPS (Computerized Health Information Programs): health education modules (smoking, blood pressure, cervical cancer) available on a touch-screen computer kiosk. Modules include information, personal risk assessment with tailored feedback, and quizzes. Modules also include text, photos, diagrams, animations, sound, and video. 1. Intercept: a kiosk loaded with three modules (blood pressure, cervical cancer, and smoking) was in a shopping center for 7 months. Then, trained interviewers approached subjects every 15 minutes for intercept-interviews. Utilization study: kiosks established at 17 venues over 12 months with 17 modules on many health topics. Program database collected usage data. 1. Intercept: exposure, attention, and use; usefulness and information; barriers to use 2. Utilization 1. Intercept: a total of 99.7% of participants were in the vicinity of the kiosk (exposure); 77.4% of these noticed it, and 20.8% of these used it. Program acceptability was high. Most common barriers to use were time constraints, disinterest, kiosk already in use, not comfortable using kiosk in public. 2. Utilization: there were 57,064 uses in 2,943 days (19.4 uses per kiosk per day). Most used the following topics: sexual health, smoking, and drunk driving. Most often submodules used were quizzes and self-assessments. Also had a comparison of use across different community settings.
71. Reeves, PM. Coping in cyberspace: the impact of Internet use on the ability of HIV-positive individuals to deal with their illness. Journal of Health Communication 2000;5(Suppl):47-59. [Acceptability] 10 adults with HIV; 60% male, 80% Caucasian, all at least with some college HIV: home computer with Internet NA Semi-structured interviews about Internet use and coping History of Internet use, how they use the Internet, and coping strategies Internet use promotes empowerment, augments social support, and facilitates helping others.
72. Rozmovits L, Ziebland S. What do patients with prostate or breast cancer want from an Internet site? A qualitative study of information needs. Patient Education and Counseling 2004;53:57-64. [Availability, Appropriateness] 28 adults with breast or prostate cancer for focus groups; 8 adults with breast or prostate cancer for individual interviews Cancer: home computer with Internet DIPEx Web site: presents video, audio, and written clips from interview studies with people about their experiences of health and illness. Modules available for breast and prostate cancer; hypertension; and cancer of the testis, cervix, and bowel. Interviews and focus groups with members of the target audience Information needs, sources of information, review of Web site content Cancer patients have information needs that change over time, and some information needs are unmet. Sample seems aware of issues with getting information from the Internet. Interviewees liked DIPEx site, but site could be improved to provide other needed information, such as financial help and benefits, practical advice, non-Internet resources.
73. Ryan R, Kobb R, Hilsen P. Making the right connection: matching patients to technology. Telemedicine Journal and e-Health 2003;9:81-8. [Overview, Access, Acceptability] 911 veterans with chronic medical or mental health problems Patient-provider interaction: home with traditional telehealth technology; Web-based messaging devices; disease management tool; cameras, PC with Internet for supervised chat rooms See technology column. Developed an algorithm to match patients to technology based on education, vision, manual dexterity, willingness to use technology, and compliance to medical regimen. Satisfaction, ease of use, self-reported functional status (physical function, bodily pain, general health, vitality, mental health, and role function) 94% satisfied with their primary technology device at 12 months; 93% found the technology easy to understand, 95% easy to use, 87% device generally reliable; 90% felt the Community Care Coordination Service program helped educate them about their chronic disease, 88% helped them manage their health better; 82% improved communication with providers, 95% would recommend participation to other veterans. Initial medication compliance at 63%, increased to over 93% during the study. Self-reported functional status either improved or remained unchanged for all but one parameter (physical function).
74. Shaw BR, McTavish F, Hawkins R, Gustafson DH, Pingree S. Experiences of women with breast cancer: exchanging social support over the CHESS computer network. Journal of Health Communication 2000;5:135-59. [Acceptability] 12 women participating in the Comprehensive Health Enhancement Support System (CHESS). Mean age 51, all at least high school educated, one-half college educated Cancer: home computer connected to central server CHESS: contains 11 tools that provide information, decisionmaking, and support services. Women with breast cancer who used CHESS were interviewed to examine the experience of giving and receiving support in a computer-mediated environment. How they used CHESS, how do CHESS support groups compare with other support groups, how could CHESS work better Some findings include: equalized participation important; no social cues to bias. Could not see others’ reactions, so not discouraged from venting painful feelings. Online support can compensate when participants do not feel good about appearance, do not feel well enough to go out. Asynchronous nature had pros and cons (could use any time, might not get response in timely manner). Other advantages: do not have to travel, good for those who are geographically isolated. In CHESS, groups are size-limited, so people can create more intimate ties. Even with size limitations, still get an abundance of messages, membership requires a serious time commitment. Motivations: CHESS groups provide support especially when family members do not understand the stresses of living with breast cancer, may change over time—start out needing support/information then become a provider of support/information. Benefits: realizing that others have similar problems—helps to feel less isolated; reducing uncertainty; knowing what to expect from noxious treatments, altruism, and showing caring to others in group help take focus from preoccupation with self to others; social comparison (“maybe what you have isn’t so bad compared to someone else”).
75. Shaw LH, Gant LM. In defense of the Internet: the relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support. Cyberpsychology and Behavior 2002;5:157-71. [Acceptability] 40 undergraduate students Social support: home computer with Internet Web site with chat rooms, requiring login name and password to enter Participants engaged in five structured chats with an anonymous partner from the study. Depression, loneliness, social support, self-esteem Scores on depression and loneliness scales decreased, and scores on social support and self-esteem scales increased, indicating positive effects over time.
76. Tang PC, Black W, Buchanan J, Young CY, Hooper D, Lane SR. PAMFOnline: integrating ehealth with an electronic medical record system. Proceedings of the American Medical Informatics Association Symposium 2003:649-53. [Acceptability, Applicability] 914 adults recruited from the Palo Alto Medical Foundation; gender equally split, mean age 52 Patient-provider interaction/electronic medical record: home computer with Internet PAMFOnline provides access to summary data from medical records: users can view test results, make appointments, refill prescriptions, update demographics, view doctor-approved health information, get advice from doctors and nurses. All services were available free, except messaging service, which required a nominal subscription fee. Surveyed users of PAMFOnline, conducted focus groups to determine who would be the most likely users. Satisfaction Survey findings: 73% satisfied with existing functionality. Majority of users ranked viewing lab test results as most important benefit. Online messaging with clinicians also rated highly, even though this was available only with an extra charge. Patients wanted more of the medical record available to them, especially old lab results.
77. Weis R, Stamm K, Smith C, Nilan M, Clark F, Weis J, et al. Communities of care and caring: the case of Journal of Health Psychology 2003;8:135-48. [Acceptability] 943 adults; 76% female, mean age 43.7 Multiple sclerosis (MS): home computer with Internet a Web site designed for patients with MS. Site provides information (community news, humor, ask-an-expert, personal stories, tips, library, newsletter, diary, and MS news) and support (chat rooms, discussion groups, instant messaging, e-mail, and postcards). Users of MSWatch were surveyed. Perceived usefulness of information and support functions Information functions showed greater perceived usefulness than support features. Only between 10% and 30% of users found the support features useful. Usefulness of the Web site was greater for those in the early stages of the disease and then again in the third year of the disease. Use of support features did not relate to disease progression. Those using the Web site to answer general questions rated the information as useful, while those who were referred to the site by other MS patients found the support features useful. Women rated the information function of greater importance than males. Adults with children rated both support and information functions higher than those without children. Younger people rated the support functions more highly than older people did. The highest rating of the site overall came from those who found it useful for information and support.
78. Wilkie D, Huang H, Berry D, Schwartz A, Lin Y, Ko N, et al. Cancer symptom control: feasibility of a tailored, interactive computerized program for patients. Family and Community Health 2001;24:48-62. [Acceptability] 41 outpatients with cancer; age 18 or older; all participants were white except for one Asian; 26% had never used computer Pain management: clinic-based computer program with touch screen SymptomReport is a software program that asks questions about pain and fatigue. SymptomConsult provides tailored management strategies. Two groups of patients: all used SymptomReport, saw doctor, then randomly interacted with SymptomConsult or computer games; 4 weeks later completed SymptomReport again. Completion time, acceptability Mean completion time for SymptomReport was less than 40 minutes, for SymptomConsult 20 minutes. High acceptability scores for SymptomReport; some felt SymptomConsult was not targeted to their needs or provided no new information. Some reported they had increased understanding, awareness, and medical compliance.
79. Wilkie D, Judge M, Berry D, Dell J, Zong S, Gilespie R. Usability of a computerized PAINReportIt in the general public with pain and people with cancer pain. Journal of Pain and Symptom Management 2003;25:213-24. [Acceptability] 213 patients with pain. Outpatients: N=10, all white, 40% male and 60% female; Inpatients N=106, 46% male and 64% female, 86% white and 14% people of color; general public N=97, 58% male and 42% female, 73% white and 27% people of color Pain management: clinic-based computer program with touch screen PAINReportIt is a computerized version of the McGill Pain Questionnaire. Three different groups of participants interacted with PAINReportIt. Completion time, completeness of pain data, acceptability Mean completion time 15.8 minutes. All gave responses to at least 3/4 domains (location, intensity, quality, pattern). High acceptability overall, with highest acceptability among participants of color.
80. Woodruff SI, Edward CC, Conway TL, Elliott SP. Pilot test of an Internet virtual world chat room for rural teen smokers. Journal of Adolescent Health 2001;29:239-43. [Acceptability] 18 high-risk youth recruited from 6 small alternative schools; mean age 15, 66% male; 55% Caucasian, 28% Hispanic, 17% other Smoking cessation: school computer with Internet Breathing Room: Internet-based virtual “world” in which young smokers interact with a trained cessation facilitator and with each other; primarily offered chat, also created billboards to address teens’ reasons to quit smoking and coping strategies. Also had access to links, shopping, and other features. Participants interacted with facilitator and other teens in chat room for seven 1-hour sessions. Acceptability, attitudes about quitting, quitting, intentions Participated in an average of 5.3 out of 7 sessions, 95% would recommend this to another teen smoker. Positive but not significant changes in “abstinence in the past week” from pretest to posttest. 39% called themselves former smokers at posttest, maintained at 1-month followup. Reduction in number of cigarettes smoked, intention to quit greater, attitudes toward quitting more positive.
81. Zarcadoolas C, Blanco M, Boyer JF. Unweaving the Web: an exploratory study of low-literate adults’ navigation skills on the World Wide Web. Journal of Health Communication 2002;7:309-24. [Availability] 24 adults with low-literacy, low incomes; 17 Hispanic, 3 African American, 2 Asian, 2 white; recruited from literacy or computer classes at community-based organizations; 10 reported owning computers, 15 had used the Internet before. Health information: lab computer with Internet Specific Web sites on the World Wide Web Participants were asked to assess the content and information available on specific Web sites as well as perform specific tasks. Methods used included observation, contextual inquiry, and a think-aloud protocol. Satisfaction, navigation 23/24 excited to use Internet. 23/24 thought they would use Internet more in next few years. Navigation difficulties: scrolling, using back arrow, typing/spelling to enter Web address, using graphic links. 11/24 thought people should not trust everything on Web, 9/24 thought they should trust everything, 4/24 not sure. None could identify how to determine what to trust.
82. Zimmerman DE, Akerelrea CA, Buller DB, Hau B, Leblanc M. Integrating usability testing into the development of a 5 a day nutrition Website for at-risk populations in the American Southwest. Journal of Health Psychology 2003;8:119-34. [Appropriateness] Study 1: 43 adults; mean age 42.8, 32% income <$15,000, 61% Hispanic/Latino, 15% Native American, 24% Caucasian; 91% had computer experience. Study 2: 35 participants; mean age 43.7, 74% women, 25% income <$15,000, 47% Hispanic/Latino, 26% Native American, 27% other (8 white, 1 Asian); 66% with more than 1 year computer experience, 34% with less than 1 year experience. Study 3: 31 adults; mean age 43, 60% female; 35% income <$15,000, 42% Hispanic/Latino, 35% Native Americans, 23% Caucasians Nutrition: lab computer with Internet “5 a Day, the Rio Grande Way”: a nutrition education Web site for multicultural adults living in southern Colorado and northern New Mexico Study 1: card-sorting task used to identify how target population categorized nutrition concepts. Study 2: talk aloud protocol and observation as users interacted with a prototype Web site. Study 3: same protocol as study 2, but with a larger and near-final version of the Web site Categorization of nutritional concepts; satisfaction and ease of use Card-sort task results were used to create the site map for the Web site. Study 2 found that most users (86%) were satisfied with the Web site, 85% found it easy to use. Observation showed some areas of difficulty including: assumption of user content knowledge that was lacking, text type too small, unclear titles, participants reluctant to use page links, some difficulty initially locating information, need for additional visuals. Study 3 found that 83% found site interesting, 74% useful, 55% easy to read. Observation showed problems with navigation and locating information. Of the study participants, about 33% had never used computers, and they had difficulty with the hand-eye coordination required for navigating the site, recognizing navigational aids, and understanding the Web site organization and structure. Mouse skills were difficult for users with physical impairments. Only 23% completed all 12 tasks in the protocol. This version was less well-received than previous prototype. Those with more computer experience reported that the site was easier to use.

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