Aspects of uptake, use and effectiveness of eHealth interventions for self-management support and patient-provider communication Elin Børøsund, RN, MSc Faculty of Medicine, University of Oslo Center for Shared Decision Making and Collaborative Care Research, Department of Medicine, Oslo University Hospital 2014 © Elin Børøsund, 2015 Series of dissertations submitted to the Faculty of Medicine, University of Oslo No. 1951 ISBN 978-82-8264-975-9 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission. Cover: Hanne Baadsgaard Utigard. Printed in Norway: AIT Oslo AS. Produced in co-operation with Akademika Publishing. The thesis is produced by Akademika Publishing merely in connection with the thesis defence. Kindly direct all inquiries regarding the thesis to the copyright holder or the unit which grants the doctorate. Table of Contents ACKNOWLEDGEMENTS ................................................................................................................................... III SUMMARY ....................................................................................................................................................... V ABBREVIATIONS ............................................................................................................................................ VIII LIST OF PAPERS ............................................................................................................................................... IX 1. INTRODUCTION ............................................................................................................................................ 1 1.1 SPECIFIC AIMS ................................................................................................................................................... 2 2. BACKGROUND .............................................................................................................................................. 4 2.1 ELECTRONIC SYMPTOM ASSESSMENT AND COMMUNICATION TOOLS ............................................................................. 5 2.2 WEB-BASED SELF-MANAGEMENT SUPPORT ............................................................................................................. 6 2.3 UPTAKE OF EHEALTH INTERVENTIONS IN ROUTINE CARE............................................................................................. 8 2.3.1 Barriers to technology adoption and maintenance .............................................................................. 9 2.3.2 Facilitators and incentives for technology adoption and maintenance .............................................. 10 2.4 USER CHARACTERISTICS AND USE PATTERN OF EHEALTH INTERVENTIONS ..................................................................... 11 2.4.1 User characteristics and use patterns of Web-based self-management support ............................... 12 2.5 CONTRIBUTORS TO EFFECTIVENESS OF WEB-BASED SELF-MANAGEMENT SUPPORT ........................................................ 13 2.5.1 Components and relations to effectiveness ........................................................................................ 13 2.5.2 Dose of use and relations to effectiveness .......................................................................................... 15 2.6 THEORETICAL FRAMEWORK ................................................................................................................................ 16 2.61 The RE-AIM framework ........................................................................................................................ 16 2.6.2 Additional theories and models .......................................................................................................... 18 2.7 SUMMARY...................................................................................................................................................... 18 3. METHODS ................................................................................................................................................... 21 3.1 INTERVENTIONS STUDIED ................................................................................................................................... 23 3.1.1 Choice ................................................................................................................................................. 23 3.1.2 WebChoice 1.0 .................................................................................................................................... 25 3.1.3 WebChoice 2.0 .................................................................................................................................... 27 3.2 OVERVIEW OF THE STUDIES IN THE THESIS ............................................................................................................. 29 3.3 STUDY I ......................................................................................................................................................... 30 3.3.1 Design ................................................................................................................................................. 30 3.3.2 Participants ......................................................................................................................................... 31 3.3.3 Procedure for data collection.............................................................................................................. 31 3.3.4 Analyses .............................................................................................................................................. 32 3.4 STUDY II ........................................................................................................................................................ 34 3.4.1 Design ................................................................................................................................................. 34 3.4.2 Participants ......................................................................................................................................... 34 i 3.4.3 Procedure for data collection.............................................................................................................. 34 3.4.4 Self-report assessments ...................................................................................................................... 35 3.4.5 Analyses .............................................................................................................................................. 36 3.5 STUDY III ....................................................................................................................................................... 37 3.5.1 Design ................................................................................................................................................. 37 3.5.2 Study sites ........................................................................................................................................... 38 3.5.3 Participants and sample ..................................................................................................................... 38 3.5.4 Study procedures ................................................................................................................................ 39 3.5.5 Procedure for data collection.............................................................................................................. 41 3.5.6 Self-report assessments ...................................................................................................................... 42 3.5.7 Support and surveillance .................................................................................................................... 43 3.5.8 Analyses .............................................................................................................................................. 44 3.6 ETHICAL ASPECTS ............................................................................................................................................. 45 3.7 SECURITY ....................................................................................................................................................... 46 4. RESULTS ..................................................................................................................................................... 47 4.1 STUDY I ......................................................................................................................................................... 47 4.2 STUDY II ........................................................................................................................................................ 48 4.3. STUDY III ...................................................................................................................................................... 49 5. DISCUSSION ................................................................................................................................................ 51 5.1 MAIN RESULTS ................................................................................................................................................ 51 5.1.1 Reach .................................................................................................................................................