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Cited by 54Mobile Health and mHealth ApplicationsHealth Literacy and Information AccessibilityCardiac Health and Mental Health

The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation

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Kerr, Cicely, Murray, Elizabeth, Noble, Lorraine, Morris, Richard, Bottomley, Christian, Stevenson, Fiona, Patterson, David, Peacock, Richard +3 more·2010·Journal of Medical Internet Research
DOI 10.2196/jmir.1438PMC PMC3056534
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Abstract

BACKGROUND: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide. OBJECTIVE: To explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD). METHODS: Quantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services. RESULTS: Only 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention. CONCLUSIONS: The availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge.

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Authors
Kerr, C., Murray, E., Noble, L., Morris, R., Bottomley, C., Stevenson, F., Patterson, D., Peacock, R., Turner, I., Jackson, K., & Nazareth, I.
Affiliations
  • University College London (GB)
  • London School of Hygiene & Tropical Medicine (GB)
  • Whittington Hospital (GB)
Corresponding author
Murray, Elizabeth
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2010-12-02
Volume
12
Issue
4
Pages
e56
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.1438
PMC
PMC3056534
OpenAlex
W2169523372
Cited by
54
References
35
Citations by year
2026: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 8 · 2014: 7 · 2013: 11 · 2012: 1
FWCI
6.82
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
Funders
  • University of Wisconsin-Madison
  • National Institute for Health and Care Research
  • Bupa Foundation (BUPAF/33a/05)
  • University College London
  • Rural Development Administration
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
online intervention, coronary artery disease, digital divide, health disparities, internet access, public internet access, intervention use, socioeconomic disparities, patient participation, primary care, health information needs, technology adoption barriers, online health information seeking, self-efficacy, social support
MeSH terms
Adult, Age Factors, Aged, Coronary Disease, Counseling, Female, Humans, London, Male, Middle Aged, Patient Acceptance of Health Care, Patient Education as Topic, Surveys and Questionnaires, Self Care, Health Behavior, Patient Satisfaction, Disease Management, Internet

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