J. Med. Internet Res. - Usage of a generic web-based self-management intervention for breast cancer survivors: substudy analysis of the BREATH trial.

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Resumo

CKGROUND: Generic fully automated Web-based self-management interventions are upcoming, for example, for the growing number of breast cancer survivors. It is hypothesized that the use of these interventions is more individualized and that users apply a large amount of self-tailoring. However, technical usage evaluations of these types of interventions are scarce and practical guidelines are lacking.OBJECTIVE: To gain insight into meaningful usage parameters to evaluate the use of generic fully automated Web-based interventions by assessing how breast cancer survivors use a generic self-management website. Final aim is to propose practical recommendations for researchers and information and communication technology (ICT) professionals who aim to design and evaluate the use of similar Web-based interventions.METHODS: The BREAst cancer ehealTH (BREATH) intervention is a generic unguided fully automated website with stepwise weekly access and a fixed 4-month structure containing 104 intervention ingredients (ie, texts, tasks, tests, videos). By monitoring https-server requests, technical usage statistics were recorded for the intervention group of the randomized controlled trial. Observed usage was analyzed by measures of frequency, duration, and activity. Intervention adherence was defined as continuous usage, or the proportion of participants who started using the intervention and continued to log in during all four phases. By comparing observed to minimal intended usage (frequency and activity), different user groups were defined.RESULTS: Usage statistics for 4 months were collected from 70 breast cancer survivors (mean age 50.9 years). Frequency of logins/person ranged from 0 to 45, total duration/person from 0 to 2324 minutes (38.7 hours), and activity from opening none to all intervention ingredients. 31 participants continued logging in to all four phases resulting in an intervention adherence rate of 44.3% (95% CI 33.2-55.9). Nine nonusers (13%), 30 low users (43%), and 31 high users (44%) were defined. Low and high users differed significantly on frequency (P<.001), total duration (P<.001), session duration (P=.009), and activity (P<.001). High users logged in an average of 21 times, had a mean session duration of 33 minutes, and opened on average 91% of all ingredients. Signing the self-help contract (P<.001), reporting usefulness of ingredients (P=.003), overall satisfaction (P=.028), and user friendliness evaluation (P=.003) were higher in high users. User groups did not differ on age, education, and baseline distress.CONCLUSIONS: By reporting the usage of a self-management website for breast cancer survivors, the present study gained first insight into the design of usage evaluations of generic fully automated Web-based interventions. It is recommended to (1) incorporate usage statistics that reflect the amount of self-tailoring applied by users, (2) combine technical usage statistics with self-reported usefulness, and (3) use qualitative measures. Also, (4) a pilot usage evaluation should be a fixed step in the development process of novel Web-based interventions, and (5) it is essential for researchers to gain insight into the rationale of recorded and nonrecorded usage statistics.TRIAL REGISTRATION: Netherlands Trial Register (NTR): 2935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2935 (Archived by WebCite at http://www.webcitation.org/6IkX1ADEV).

Resumo Limpo

ckground generic fulli autom webbas selfmanag intervent upcom exampl grow number breast cancer survivor hypothes use intervent individu user appli larg amount selftailor howev technic usag evalu type intervent scarc practic guidelin lackingobject gain insight meaning usag paramet evalu use generic fulli autom webbas intervent assess breast cancer survivor use generic selfmanag websit final aim propos practic recommend research inform communic technolog ict profession aim design evalu use similar webbas interventionsmethod breast cancer ehealth breath intervent generic unguid fulli autom websit stepwis week access fix month structur contain intervent ingredi ie text task test video monitor httpsserver request technic usag statist record intervent group random control trial observ usag analyz measur frequenc durat activ intervent adher defin continu usag proport particip start use intervent continu log four phase compar observ minim intend usag frequenc activ differ user group definedresult usag statist month collect breast cancer survivor mean age year frequenc loginsperson rang total durationperson minut hour activ open none intervent ingredi particip continu log four phase result intervent adher rate ci nine nonus low user high user defin low high user differ signific frequenc p total durat p session durat p activ p high user log averag time mean session durat minut open averag ingredi sign selfhelp contract p report use ingredi p overal satisfact p user friendli evalu p higher high user user group differ age educ baselin distressconclus report usag selfmanag websit breast cancer survivor present studi gain first insight design usag evalu generic fulli autom webbas intervent recommend incorpor usag statist reflect amount selftailor appli user combin technic usag statist selfreport use use qualit measur also pilot usag evalu fix step develop process novel webbas intervent essenti research gain insight rational record nonrecord usag statisticstri registr netherland trial regist ntr httpwwwtrialregisternltrialregadminrctviewasptc archiv webcit httpwwwwebcitationorgikxadev

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