University of Wollongong Research Online University of Wollongong Thesis Collection 1954-2016 University of Wollongong Thesis Collections 2013 Identifying design features of online patient education for chronic disease management Naffisah Mohd Hassan University of Wollongong Follow this and additional works at: https://ro.uow.edu.au/theses University of Wollongong Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorise you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part of this work may be reproduced by any process, nor may any other exclusive right be exercised, without the permission of the author. 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Recommended Citation Hassan, Naffisah Mohd, Identifying designeatur f es of online patient education for chronic disease management, Doctor of Philosophy thesis, School of Information Systems and Technology, University of Wollongong, 2013. https://ro.uow.edu.au/theses/4130 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Identifying Design Features of Online Patient Education for Chronic Disease Management A thesis in partial fulfilment of the requirements for the award of the degree DOCTOR OF PHILOSOPHY From UNIVERSITY OF WOLLONGONG By NAFFISAH MOHD HASSAN BBA (Hons). M.Sc. (IT) School of Information Systems and Technology Faculty of Engineering and Information Sciences 2013 i Certification I, Naffisah Mohd Hassan, declare that this thesis, submitted in partial fulfilment of the requirements for the award of Doctor of Philosophy, is wholly my own work unless otherwise referenced or acknowledged. It was completed at the University of Wollongong, within the School of Information System and Technology, Faculty of Engineering and Information Sciences. The document has not been submitted for qualifications at any other academic institution. Naffisah Mohd Hassan 21st August 2013 ii Abstract Although Online Patient Education (OPE) is becoming increasingly common in many countries, research on the design features of the sites and the perceived benefits of OPE remains sparse. Specifically, this study extends upon extant research, proposing a model in which the design features OPE influence the users’ perceptions regarding the benefits of OPE. This study formulates hypotheses regarding the effect of: (1) the OPE design features on the perceived benefits derived from health outcomes; and (2) the OPE design features on the perceived benefits derived from social outcomes. This study was undertaken in three phases. First, a conceptual phase was conducted in order to investigate and analyse the existing literature on the key dimension of OPE design features; and also on the key dimensions of the perceived benefits of OPE. The conceptual phase resulted in the development of a research model and relevant hypotheses. Second, in the exploratory phase, two separate questionnaire surveys were formulated and distributed. The exploratory phase enabled the development and testing of all instruments that were subsequently used in the study. The result of the exploratory phase was the production of a reliable and valid set of instruments to be used within the final phase – the confirmatory phase. In the confirmatory phase, an online survey was conducted in order to test the research model and the proposed hypotheses. This phase provided a broader understanding of the OPE design features and their effect on the perceived benefits of OPE, as well as on the significance of the patients’ stages of change. The results of this study indicate that: (1) a positive effect exists between the OPE design features and the perceived benefits derived from the health outcomes; (2) there is a positive effect existing between OPE design features and perceived benefits derived from social outcomes; (3) there is a significant difference in patients’ perceptions of the way that content features are presented, according to the patients’ stages of change; and (4) there is a significant difference in the patients’ perceptions of interpretability features, according to the patients’ stage of change. However, the results of this study show no significant difference for fourteen of the hypothesized relationships. These included: (1) a significant difference in patients’ perceptions iii toward the perceived benefits derived from health outcomes, according to the patients’ stages of change; and (2) a significant difference in patients’ perceptions of the benefits derived from social outcomes, according to the patients’ stages of change. These results also suggest that SOC has no significant effect on the OPE design features and the perceived benefits derived from health and social outcomes. Whilst preceding studies on design features have focused upon online health information and online health interventions, this study is the first to investigate OPE design features and their relation to the perceived benefits of OPE, as influenced by the patients’ stages of change. Specifically, this research was conducted within the research field of OPE for chronic diseases. The main contribution of this study is in the form of a conceptual framework that includes OPE design feature-dimensions and two dimensions of OPE perceived- benefits from the perspectives of both health professionals and patients/carers. This study also explains the effect of OPE design features and the perceived benefits of OPE whilst taking each patient’s stage of change into consideration. Finally, this study contributes to extant theory by using the two-factor theory and the persuasive system development (PSD) model. In doing so, this study may have important implications for developing Websites that are intended for use within health promotion research and practice, with attention focused upon the final Transtheoretical Model (TTM) theory. This study entailed several methodological improvements suggested within previous studies; these included: (1) the use of new instrument items to measure the OPE design features construct; (2) the use of a new two-dimensional perceived-benefits construct, according to health outcomes and social outcomes (respectively); and (3) the assessment of the content validity and reliability of instrument-items prior to the actual data collection. This study provides healthcare providers and system developers with a better understanding of the OPE design features and the perceived benefits of OPE, as drawn from the health professionals and patients/carers that used the system. This study also provides healthcare providers and system developers with an explanation of the different perceptions held toward OPE design features and the benefits of OPE, according to the patients’ stages of change. iv Publications from this Thesis Hassan, N. M., Win K. T. and Hyland, P., 'Benefits of Online Patient Education (OPE) for Chronic Disease' Paper presented at the Fourth International Conference on Internet Technologies and Applications (ITA11), UK: Glyndŵr University, 2011 (Conference Proceeding) Hassan, N. M., Win, K. T., & Hyland, P. (2013). Online Health Information for Chronic Disease: Diabetes in Pervasive Health Knowledge Management (pp. 245-270). Springer New York (Book Chapter) Hassan, N. M., Win, K. T., & Hyland, P. (2013, January). Exploring Design Features and Benefits of Online Patient Education (OPE) Sites for Chronic Diseases. Proceeding in Health Information and Computer in System Sciences (HICSS), 2013 46th Hawaii International Conference on (pp. 2454-2463). IEEE. (Conference Proceeding) v Acknowledgement The ink of the scholar is more holy than the blood of the martyr. Prophet Muhammad (PBUH) Undertaking this PhD has truly been a life changing experience that would not have been possible without the support and guidance received from many. Foremost, I am indebted to my supervisor, Dr. Khin Than Win for her guidance and support throughout my PhD journey. She has taught me a wide variety of research skills: identifying important journals, crafting ideas, and analysing and interpreting results. I truly feel that I have learned an invaluable amount from such a brilliant scholar. Moreover, Dr. Khin Than Win, I promise you that I shall disseminate your teachings. Next, I would like to express my sincere gratitude to my co-supervisor, Associate Professor Dr. Peter Hyland for his continuous support throughout my PhD journey – for his motivation, enthusiasm and vast amount of knowledge. He taught me to ask interesting questions, and showed me what quality really was. I could not have imagined having a better mentor for my PhD. I would like to acknowledge