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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 5)

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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
46. Barnes MD, Penrod C, Neiger BB, Merrill RM, Thackeray R, Eggett DL, et al. Measuring the relevance of evaluation criteria among health information seekers on the Internet. Journal of Health Psychology 2003;8:71-82. [Appropriateness] 578 adults who were employees of Idaho National Engineering and Environmental Labs who were enrolled in the Occupational Medicine Health Promotion Program; 57% male, 84% attended at least some college Health information: lab computer with Internet Three publicly available Web sites about cold and flu information Participants first ranked 12 criteria in importance for evaluating health information. Then they used those criteria to evaluate three preselected Web sites that had been chosen on the basis of low, medium, and high quality. Ranking of the criteria, rating of the Web sites Participants ranked criteria related to credibility of information and reliability of source as most important with design and aesthetics seen as least important. When rating actual Web sites, six criteria proved to be significant predictors of quality: content, design and aesthetics, currency of information, intended audience, contact addresses, and user support. Those younger than age 50 were better able to select the high-quality site.
47. Beebe TJ, Asche SE, Harrison PA, Quinlan KB. Heightened vulnerability and increased risk-taking among adolescent chat room users: results from a statewide school survey. Journal of Adolescent Health 2004;35:116-23. [Applicability] 40,376 ninth grade students who had Internet at home, of which 19,511 reported accessing chat rooms Social support: home computer with Internet World Wide Web Data from the Minnesota Student Survey were analyzed to determine demographic, psychological, environmental, and behavioral differences between chat room users versus nonusers. Psychological, environmental, and behavioral factors; Internet activities Chat room use was consistently, positively, and significantly associated with adverse psychological and environmental facts and engagement in risk behaviors among ninth grade boys and girls. Other Internet activities, such as use of e-mail or games, did not show a consistent pattern of positive associations with these factors. Cannot infer causality: possible that teens who need support are trying to attain it via the chat rooms.
48. Birru MS, Monaco VM, Lonelyss C, Drew H, Njie V, Bierria T, et al. Internet usage by low-literacy adults seeking health information: an observational analysis. Journal of Medical Internet Research 2004;6:e25. [Appropriateness] Eight adults with low literacy; mean age 41.5; seven African American, one Asian Health information: lab computer with Internet World Wide Web All participants had a computer skills session. Then participants were asked to use Internet and Google to research information on three health-related questions, using a think-aloud protocol. Then they were asked to navigate a specific Web site. Search engine usage, ability to answer questions, information accessed, attitudes Most found generating search terms challenging, difficulty remembering to space between words, some difficulty with spelling; generally retained navigational skills learned in skills session; difficulty generating independent queries and answering specific questions. Participants at times able to locate answers, but could not put into their own words, thus suggesting comprehension difficulties. Average reading level of sites accessed was 10th grade. Seven of eight accessed sponsored sites. All were at least moderately comfortable with their searching experience. Seven of eight felt it was easy to locate trustworthy information. All were enthusiastic about improving skills and using computers.
49. Block G, Miller M, Harnack L, Kayman S, Mandel S, Cristofar S. An interactive CD-ROM for nutrition screening and counseling. American Journal of Public Health 2000;90:781-5. [Acceptability] 281 adults Nutrition: clinic-based computer with CD-ROM Interactive program designed to assess fat and fiber intake; compare to recommendations; and provide tailored information to intake, stage of change, and lifestyle habits Users interacted with the program, then completed questionnaire; followup phone calls made 2 to 4 weeks later. Satisfaction, new learning, goal setting, and attainment Large majority found the program easy to use, would recommend it to a friend, thought it could be longer; 78% reported learning something new. 60% had selected a personal goal. Of those who could be reached for followup, 50% tried to reach their goal.
50. Bowen DJ, Ludwig A, Bush N, Meischke J, Wooldridge JA, Robbins R. Early experience with a Web-based intervention to inform risk of breast cancer. Journal of Health Psychology 2003;8:175-86. [Acceptability] Study 1: Utilization: 268 women; 88% white, 56% college degree. Study 2: Interviews with nonusers: 83 women Cancer: home computer with Internet WIRES: a multicomponent Web site that includes information tailored to personal risk, exercise, eating habits, mammogram history, and age. Components include information, interactive features (“make a commitment” quizzes), contact with study staff, discussion forums. This study included an analysis of usage by those who actually used the Web site along with identification of predictors or usage, and interviews with nonusers. Quality of life, healthcare coverage, risk factors for breast cancer, perceived risk, usage patterns Usage: by week 3, only 21.5% of users had logged into the Web site. After a cue at 3 weeks, usage increased to 37.2%. By 3 months, 47.6% had logged into the Web site. An additional cue at 3 months increased usage by 3.4%. By 6 months, usage was 58.7%. Average length of visit was 30 minutes. Most frequently used pages were home page, personal risk information, exercise and healthy eating pages, then pages on breast cancer, risk factors, and Tamoxifen use. Main reason for not logging in was being too busy. Most difficult part of getting online was finding time. Women with higher incomes and employed full time were less likely to use Web site. Women with higher mental health scores were more likely to use the Web site. Those with lower perceptions of their general current health were less likely to use the Web site. Those with higher perceptions of risk were more likely to use Web site.
51. Cimino JJ, Li J, Mendonca EA, Sengupta S, Patel VL, Kushniruk AW. An evaluation of patient access to their electronic medical records via the WWW. Proceedings of the American Medical Informatics Association Symposium 2000:151-5. [Acceptability] Eight adults recruited from private practices of internists at NY Presbyterian Hospital. Only five were actual users; the others did not participate after consent. Patient-provider interaction: home computer with Internet PatCIS gives patients access to their electronic medical record, allowing them to add data, review online health information, and apply their own clinical data to guideline programs that offer health advice. System supports security functions and records user activities. User functions: data entry data review, education, advice, comments, and help. Review of system usage logs—sessions were analyzed by the success of the login, number of functions used during the sessions, duration of the sessions, and whether the user logged out. User logs Logged in 243 times, 33 logins failed due to incorrect password or code, 14 sessions had OK login but no other activity. No illegal logins. 196 logins used one or more functions. Log out used 122 times, not 74 times. Most frequently used function: checking lab data 140 times (71%), reports 40 times. Data entry functions: vitals entered 31 times, diabetes information 14 times. Educational functions (links) used 35 times, advice functions 6 times. No adverse reports received from physicians.
52. Colvin J, Chenoweth L, Bold M, Harding C. Caregivers of older adults: advantages and disadvantages of Internet-based social support. Family Relations 2004;53:49-57. [Acceptability] 63 caregivers recruited from 15 Web sites; 89% women, mean age 54.9 years; 59% not employed outside the home; spent 88 hours/week caregiving; 12.6 hours on Internet Social support for caregivers: home computer with Internet Web sites offering social networks Surveyed caregivers of older adults who used Internet support groups. Advantages and disadvantages of online social support Advantages cited: anonymity and nonjudgmental atmosphere; asynchrony; able to personalize use of computer-mediated communication (can lurk if desired and delete content); allows expansion of network. Disadvantages: absence of physical presence, social cues; desire for more intimacy; desire to give/receive tangible support; anonymity (not being sure if people are really who they say they are); technical problems; loss of anonymity so they screen what they say; online cliques. Disadvantages cited by small numbers, 24% did not cite any, five left blank.
53. Czaja SJ, Rubert, MP. Telecommunications technology as an aid to family caregivers of persons with dementia. Psychosomatic Medicine 2002;64:469-76. [Acceptability] 44 caregivers of family members with dementia: 21 Cuban American, 23 white; 34 female; mean age 67.5; 62% with income <30,000; 41% high school or less Social support for caregivers: home computer-integrated telephone system CTIS is an information-network that uses computer-telephone technology. It uses screen phones and allows both text and voice messages. Phone system allows users to conference call, join phone support group, leave/send messages to family and care providers; provides caregiver resources, respite functions for patients. Participants used telephone system for 6 months, then completed survey. Usability, satisfaction Generally, participants liked the system and found it easy to use. System use averaged 49 calls/caregiver. Most used function was calling family members. 80% participated in the discussion group. 82% of those liked participating in the discussion groups, and 86% found participation valuable. Several caregivers could participate who could not get to face-to-face support groups.
54. Davis JJ. Disenfranchising the disabled: the inaccessibility of Internet-based health information. Journal of Health Communication 2002;7:355-67. [Access] NA Health information: lab computer with Internet Web sites about health and illness 500 Web sites representing common illnesses/conditions were evaluated for accessibility for visually impaired users who use automated screen readers. Accessibility Only 19% of sites were found to be accessible. 64.7% failed because of inability to satisfy a single Priority 1 criteria as specified by the Web Accessibility Initiative of the World Wide Web Consortium. Most failed to provide text descriptions of graphic elements or provided inadequate descriptions.
55. Epstein YM, Rosenberg HS, Grant TV, Hemenway N. Use of the Internet as the only outlet for talking about infertility. Fertility and Sterility 2002;78:507-14. [Applicability] 589 adults; 99.1% female, >85% at least some college education Infertility: home computer with Internet Web site for the International Council on Infertility Information Dissemination Survey was completed by visitors to the Web site. Researchers then compared two groups: those whose only support was online (OO) and those with additional support (AO). Diagnostic and treatment information; medication usage; current treatment status; Internet activity; perceived consequences of Internet activity; self-assessment of ways of dealing with infertility; current social and emotional well-being; depression Greater proportion of OO than AO are not college educated, have no health insurance coverage for infertility, and have a lower household income. OOs spend more hours/day on the Internet for any activity and infertility-related activity; 1/5 of each group are lurkers. Both groups report that their participation has had important cognitive, behavioral, and relationship consequences (switching to a specialist, learning how to deal with doctors, decreasing communication about infertility with partner [OO more than AO]). OOs are more depressed, consider infertility more stressful, report poorer coping strategies for dealing with infertility, worry more, are less satisfied with important relationships, perceive that they receive less support. Lower income predicted greater depression. Time spent on Internet did not predict depression.
56. Erwin BA, Turk DL, Heimberg RG, Fresco DM, Hantula DA. The Internet. Home to a severe population of individuals with social anxiety disorder? Journal of Anxiety Disorders 2004;18:629-46. [Applicability] 434 participants recruited from Internet sites on social anxiety; 291 women, 140 men, 3 no response; also 229 who sought face-to-face treatment and 36 controls without psychological distress Anxiety: home computer with Internet World Wide Web Surveyed Internet users with social anxiety disorders, those who sought face-to-face treatment, and controls. Internet use, clinical and impairment variables Internet survey respondents reported greater severity of and impairment due to social anxiety disorder than treatment-seeking sample. They reported positive (more social support, developing increased confidence) and negative effects of Internet use (fewer face-to-face social bonds, more comfortable interacting on Internet than in person).
57. Escoffery C, McCormick L, Bateman K. Development and process evaluation of a Web-based smoking cessation program for college smokers: innovative tool for education. Patient Education and Counseling 2004;53:217-25. [Acceptability] 35 college students from one campus; 20 women, 15 men Smoking cessation: home computer with Internet Kick It!: a four-session program of smoking cessation information, support (ask an expert, message boards, personal stories). Information tailored by stage of change. Each available for 2 weeks. Users interacted with site, then completed surveys or were interviewed. Process information, quit rate 14.3% (5) participants quit at end of intervention; at 6-month followup, 25.7% quit. Quit rates of this program were as good as and better than other reports of face-to-face and online interventions. Users rated reading the text, taking quizzes, and using the links as the top activities. Limited use of ask-the-expert and message boards. Participants found the program somewhat useful, interesting, valuable, and personally relevant. Many found it easy to use. Log files and usage self-report showed 82.4% agreement, with some users reporting attending one more session than logs indicated. Interviews also yielded mostly positive feedback.
58. Eysenbach G, Kohler C. How do consumers search for and appraise health information on the World Wide Web? Qualitative study using focus groups, usability tests, and in-depth interviews. British Medical Journal 2002;324:573-7. [Availability, Appropriateness] 21 adults in focus groups (5 men, 16 women; mean age 37); 17 adults in usability study and interviews (6 men, 11 women; mean age 38) Health information: lab computer with Internet World Wide Web Focus groups, usability study in which participants used the Internet to find answers to specific researcher-generated health questions and individual interviews Self-report and performance of how they search for health information and determine its credibility Users reported that Web sites from official authorities, with professional layout, understandable and professional writing, and citation of scientific references, were the most often mentioned criteria. Observation showed all users started with search engine, most used suboptimal search strategy; usually chose one of first displayed results. Users could answer all but 7 of the 136 total questions, but quality of answers was not assessed. Also, users did not attend to the source of the information while searching.
59. Fallows D. Search engine users: Internet searchers are confident, satisfied and trusting—but they are also unaware and naive. Pew Internet & American Life Project, 2005. Available online at
. [Availability]
1,399 adult Internet users Health information: home computer with Internet NA Survey of Internet users Search engine use and satisfaction 84% of Internet users have used search engines, 92% who use search engines are confident, and 87% report successful search experiences most of the time.

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