J. Med. Internet Res. - Factors influencing the use of a Web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study.

Tópicos

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Resumo

CKGROUND: The take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups.OBJECTIVE: The aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes.METHODS: A mixed-methods research design was used for a process analysis of the actual usage of the Web application over a 2-year period and to identify user profiles. Research instruments included log files, interviews, usability tests, and a survey.RESULTS: The DiabetesCoach was predominantly used for interactive features like online monitoring, personal data, and patient-nurse email contact. It was the continuous, personal feedback that particularly appealed to the patients; they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. Despite the positive outcomes, usage of the Web application was hindered by low enrollment and nonusage attrition. The main barrier to enrollment had to do with a lack of access to the Internet (146/226, 65%). Although 68% (34/50) of the enrollees were continuous users, of whom 32% (16/50) could be defined as hardcore users (highly active), the remaining 32% (16/50) did not continue using the Web application for the full duration of the study period. Barriers to long-term use were primarily due to poor user-friendliness of the Web application (the absence of "push" factors or reminders) and selection of the "wrong" users; the well-regulated patients were not the ones who could benefit the most from system use because of a ceiling effect. Patients with a greater need for care seemed to be more engaged in long-term use; highly active users were significantly more often medication users than low/inactive users (P = .005) and had a longer diabetes duration (P = .03).CONCLUSION: Innovations in health care will diffuse more rapidly when technology is employed that is simple to use and has applicable components for interactivity. This would foresee the patients' need for continuous and personalized feedback, in particular for patients with a greater need for care. From this study several factors appear to influence increased use of eHealth technologies: (1) avoiding selective enrollment, (2) making use of participatory design methods, and (3) developing push factors for persistence. Further research should focus on the causal relationship between using the system's features and actual usage, as such a view would provide important evidence on how specific technology features can engage and captivate users.

Resumo Limpo

ckground takeup ehealth applic general still rather low user attrit often high limit inform avail use ehealth technolog among specif patient groupsobject aim studi explor factor influenc initi longterm use webbas applic diabetescoach support selfcar patient type diabetesmethod mixedmethod research design use process analysi actual usag web applic year period identifi user profil research instrument includ log file interview usabl test surveyresult diabetescoach predomin use interact featur like onlin monitor person data patientnurs email contact continu person feedback particular appeal patient felt close monitor nurs encourag play activ role selfmanag diseas despit posit outcom usag web applic hinder low enrol nonusag attrit main barrier enrol lack access internet although enrolle continu user defin hardcor user high activ remain continu use web applic full durat studi period barrier longterm use primarili due poor userfriendli web applic absenc push factor remind select wrong user wellregul patient one benefit system use ceil effect patient greater need care seem engag longterm use high activ user signific often medic user lowinact user p longer diabet durat p conclus innov health care will diffus rapid technolog employ simpl use applic compon interact forese patient need continu person feedback particular patient greater need care studi sever factor appear influenc increas use ehealth technolog avoid select enrol make use participatori design method develop push factor persist research focus causal relationship use system featur actual usag view provid import evid specif technolog featur can engag captiv user

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