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Montali L, Zulato E, Frigerio A, Frangi E, Camussi E. Mirroring, monitoring, modelling, belonging, and distancing: Psychosocial processes in an online support group of breast cancer patients. J Community Psychol 2022; 50:992-1007. [PMID: 34428308 PMCID: PMC9290070 DOI: 10.1002/jcop.22696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Breast cancer patients are primary users of Internet Health Forums, virtual self-help communities where they find and share information, preoccupations, and support. Previous literature has mainly focused on analysing the contents and the outcomes of breast cancer forums' participation. In light of the Community of Practice theoretical model, our research investigated the psychosocial processes that build and shape patients' experience and participation in the forum. We conducted 16 semi-structured email interviews with breast cancer patients recruited within a well-established online community. Thematic analysis identified five processes-mirroring, monitoring, modelling, belonging, and distancing-that marked three phases of users' experience: initiation, participation, detachment. An interactive dynamic characterised the identified processes: the disease's experience was shaped by and, in turn, it crafted this virtual community. These community processes contributed to participants' empowerment at practical, informative, and emotional levels through the development of a shared repertoire of resources, stories, and ways of dealing with patients' recurring problems.
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Affiliation(s)
- Lorenzo Montali
- Department of PsychologyUniversity of Milano‐BicoccaMilanoItaly
| | - Edoardo Zulato
- Department of PsychologyUniversity of Milano‐BicoccaMilanoItaly
| | | | - Elisa Frangi
- Department of PsychologyUniversity of Milano‐BicoccaMilanoItaly
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Abstract
This prospective, randomized, controlled trial for parents of overweight and obese 3- to 7-year-olds was performed to assess the feasibility of a program promoting healthy eating and lifestyle by targeting parents as agents of change. The intervention was composed of 6-in-person group sessions and a customized website over 12 months. The control group received customary care. The primary outcome was feasibility of the intervention to promote healthy behavior change measured by attendance. The secondary outcome was effectiveness assessed by attaining reduced body mass index (BMI) z scores, healthy behavior changes and increased parent self-efficacy. Seventy-three child-parent dyads were enrolled; 14 parents never attended any sessions. Participation in follow-up assessments did not meet the hypothesized level. Ultimate BMI z scores did not differ between control and intervention groups. Parenting skills did not improve in the intervention group. This intervention to achieve healthy lifestyle changes in children via their parents as "change agents" was unsuccessful.
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Affiliation(s)
- Ellen R Wald
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda J Ewing
- 2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jens C Eickhoff
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Kim E, Scheufele DA, Han JY, Shah D. Opinion Leaders in Online Cancer Support Groups: An Investigation of Their Antecedents and Consequences. Health Commun 2017; 32:142-151. [PMID: 27192376 PMCID: PMC5266618 DOI: 10.1080/10410236.2015.1110005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With a focus on the nature and dynamic process of social interactions among breast cancer patients, this study argues that the notion of opinion leaders can be another crucial factor in explaining positive psychosocial health outcomes within computer-mediated social support (CMSS) groups. This study investigates the relationship between opinion leaders and their psychosocial health benefits by considering two overarching questions: (a) Who are the opinion leaders? (b) What role do these opinion leaders play in explaining health outcomes? The data analyzed in this study resulted from merging human-coded content analysis of discussion group messages, action log data analysis of interactive health system usage, and longitudinal survey data. Surveys were administered to 221 women with breast cancer; participants were provided free access to and training for the CMSS groups developed by the Comprehensive Health Support System (CHESS) project. The findings suggest that opinion leaders obtained psychosocial health benefits, such as higher levels of cancer information competence, breast cancer knowledge, and better problem-focused coping strategies. Those who had a higher baseline level of breast cancer knowledge and optimism in coping with challenges in their life were more likely to act as opinion leaders. Implications for research and improving psychosocial interventions for people with health concerns are discussed.
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Affiliation(s)
- Eunkyung Kim
- a School of Journalism and Mass Communication , University of Wisconsin-Madison
| | - Dietram A Scheufele
- b Department of Life Sciences Communication , University of Wisconsin-Madison, Morgridge Institute for Research
| | - Jeong Yeob Han
- c Department of Advertising and Public Relations , Henry W. Grady College of Journalism and Mass Communication
| | - Dhavan Shah
- d School of Journalism and Mass Communication , Center for Health Enhancement System Studies (CHESS), University of Wisconsin-Madison
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Abstract
AbstractThe vital signs of chronically ill patients are monitored daily. The record flags when a specific vital sign is stable or when it trends into dangerous territory. Patients also self-assess their current state of well-being, i.e. whether they are feeling worse than usual, neither unwell nor very well compared to usual, or are feeling better than usual. This paper examines whether past vital sign data can be used to forecast how well a patient is going to feel the next day. Reliable forecasting of a chronically sick patient’s likely state of health would be useful in regulating the care provided by a community nurse, scheduling care when the patient needs it most. The hypothesis is that the vital signs indicate a trend before a person feels unwell and, therefore, are lead indicators of a patient going to feel unwell. Time series and classification or regression tree methods are used to simplify the process of observing multiple measurements such as body temperature, heart rate, etc., by selecting the vital sign measures, which best forecast well-being. We use machine learning techniques to automatically find the best combination of these vital sign measurements and their rules that forecast the wellness of individual patients. The machine learning models provide rules that can be used to monitor the future wellness of a patient and regulate their care plans.
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Affiliation(s)
| | - Chris Okugami
- 1Digital Productivity Flagship, CSIRO, Sydney, Australia
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Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision Aids for Benign Prostatic Hyperplasia: Applicability across Race and Education. Med Decis Making 2016; 24:359-66. [PMID: 15271274 DOI: 10.1177/0272989x04267010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Method. Decision aids have not been widely tested in diverse audiences. The authors conducted interviews in a 2 2 race by education design with participants who were 50 years old (n = 188). The decision aid was a benign prostatic hyperplasia videotape. Results. There was an increase in knowledge equal in all groups, with baseline knowledge higher in whites. The decision stage increased in all groups and was equivalent in the marginal-illiterate subgroup (n = 0.15). Conclusion. Contrary to expectations, results show no difference by race or college education in knowledge gain or increase in reported readiness to decide. The video appeared to produce change across race and education. The end decision stage was high, especially in less educated men. Results suggest that decision aids may be effective without tailoring, as suggested previously to enhance health communication in diverse audiences. Research should test findings in representative samples and in clinical encounters and identify types of knowledge absorbed from decision aids and whether the shift to decision reflects data/ knowledge or shared decision-making message.
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Affiliation(s)
- David R Rovner
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing 48823, USA
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6
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Abstract
The overall objectives of this project were to evaluate whether psychosocial outcomes in employed family caregivers of people with chronic disease, who participate in online support, differ from nonactive participants and whether psychosocial outcomes differ based on the format of online group support. A randomized longitudinal design comparing two types of online support groups and nonactive participants, on the basis of three principal measures, was utilized. Eighty-six self-reported family caregivers of people with chronic disease, who spoke English and had Internet access, took part in the study. Subjects were randomly assigned to professionally facilitated/psychoeducational or moderated/peer-directed online support groups for a period of 12 weeks. The setting was a password-protected Web page housed on a university server. Independent variables were type of online support groups and level of participation; the dependent variables were depressive symptoms, caregiver burden, and caregiver quality of life. There were significant differences in depressive symptoms and quality of life among nonactive participants and either of the two intervention groups, but not between the two intervention groups. Results suggest that professionally facilitated/psychoeducational and moderated/peer-directed online support groups help reduce depressive symptoms and improve quality of life for those who actively participate and that both types of online support groups provided similar benefits. Men and minorities should be targeted in future caregiver research.
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Porter LS, Pollak KI, Farrell D, Cooper M, Arnold RM, Jeffreys AS, Tulsky JA. Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers. Support Care Cancer 2015; 23:2907-16. [PMID: 25701437 DOI: 10.1007/s00520-015-2656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/08/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers. METHODS The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study. RESULTS The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %. CONCLUSIONS This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.
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Hightow-Weidman LB, Muessig KE, Pike EC, LeGrand S, Baltierra N, Rucker AJ, Wilson P. HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention. Health Educ Behav 2015; 42:493-9. [PMID: 25588932 DOI: 10.1177/1090198114562043] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships. METHODS To assess the feasibility, acceptability, and preliminary outcomes, a 1-month pilot trial of HMP among 15 YBMSM/TW was conducted. RESULTS Retention was 100%. Mean age was 26 years, 60% were HIV-infected, 87% earned <$21,000, and 67% were uninsured. Despite the small sample size and limited intervention length, statistically significant improvements were seen in social support (p = .012), social isolation (p = .050), and depressive symptoms (p = .045). CONCLUSION The HMP pilot trial demonstrated feasibility and acceptability. Given the burden of the epidemic among YBMSM/TW, there is an imperative to develop, test, and scale up culturally appropriate interventions to both prevent HIV acquisition and limit onward transmission.
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Affiliation(s)
| | | | - Emily C Pike
- University of North Carolina at Chapel Hill, NC, USA
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9
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Abstract
OBJECTIVES People who grow up with a family member who has a substance use disorder (SUD) are at risk for serious problems, and yet support for family members focuses mainly on the individual with the SUD. Technology may offer a way to make support widely available to family members of those with SUDs. This small randomized trial examined an online system of resources called CHESS (Comprehensive Health Enhancement Support System) for adult children of alcoholics (ACOAs), a population at greater risk for SUDs, depression, and other difficulties than adults whose parents were not alcoholics. METHODS The study randomized 23 self-identified ACOAs to 3 interventions for 8 weeks. The goal was to increase participants' treatment compliance and psychological health. The interventions were therapy only, CHESS only, and CHESS plus therapy. We used 2 measures: compliance with treatment, gauged by attendance in group therapy for the 2 groups assigned to therapy, and aspects of psychological health or distress, measured by a survey with items from 7 scales. RESULTS The CHESS-plus-therapy group had an attendance rate in group therapy of 81.5% compared to 42.8% for the therapy-only group. The CHESS-only intervention had the largest effect size on 5 of the 7 measures of psychological health or distress. In 4 of the 5 cases, the effect size was large; in 1 case, it was moderate. CONCLUSIONS The findings of this pilot study are based on a small sample, but they suggest the need for more research and the potentially important role of technology in behavioral health treatment.
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Abstract
There is substantial epidemiological evidence that widespread adoption of specific behavior changes can significantly improve population health. Yet, health communication efforts, while well intentioned, have often failed to engage people to change behavior within the complex contexts of their lives. `E-health communication', health promotion efforts that are mediated by computers and other digital technologies, may have great potential to promote desired behavior changes through unique features such as mass customization, interactivity and convenience. There is growing initial evidence that e-health communication can improve behavioral outcomes. However, we have much to learn about whether the technical promise of e-health communication will be effective within the social reality of how diverse people communicate and change in the modern world. This article examines current evidence concerning e-health communication and evaluates opportunities for e-health applications.
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Abstract
This article describes how 121 women newly diagnosed with breast cancer used a computer mediated discussion group to cope with their diagnosis. These data are part of a larger data set from a randomized clinical trial assessing the impact of a computer-based system called CHESS (the Comprehensive Health Enhancement Support System) on health outcomes. The larger study found significant improvement in health outcomes for those in the experimental group (those receiving CHESS), especially for women of color. Since discussion group is by far the most heavily used service of CHESS, one might conclude that these benefits (both overall and greater for women of color) should be attributed to amount of discussion group use. This study looks at how women of color and Caucasian women used the CHESS discussion group over the period of the study. Content analysis of messages in the discussion group showed that women of color used the discussion group differently from Caucasian women-they used it less frequently but their messages were more focused on breast cancer, suggesting they used discussion group more instrumentally.
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Klemm P. Effects of online support group format (moderated vs peer-led) on depressive symptoms and extent of participation in women with breast cancer. Comput Inform Nurs 2012; 30:9-18. [PMID: 22240564 DOI: 10.1097/NCN.0b013e3182343efa] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purposes of this study were to evaluate the effects of different formats of online group support (moderated vs peer-led) on depressive symptoms and extent of participation in women with breast cancer. A randomized longitudinal design was used to address the study aims. The setting was a secure password-protected Web page. Fifty women with breast cancer, at least 21 years old, who had Internet access participated. Subjects were randomly assigned to moderated or peer-led groups, given a password, and instructed to complete the study questionnaires at baseline and again at 6, 12, and 16 weeks. The independent variables were types of online support (moderated or peer-led), and the dependent variables were depressive symptoms and extent of participation. There were no significant differences in depressive symptoms by group or by extent of group participation. Moderated groups read and posted significantly more messages than did peer-led groups. This study adds to the research base on different group formats for online support and the extent of participation and nonparticipation (lurking) in online groups. It provides a springboard for additional studies that include ethnic minorities, people with different types of cancer, and men.
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Hong Y, Peña-Purcell NC, Ory MG. Outcomes of online support and resources for cancer survivors: a systematic literature review. Patient Educ Couns 2012; 86:288-96. [PMID: 21798685 DOI: 10.1016/j.pec.2011.06.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/20/2011] [Accepted: 06/22/2011] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study aims to review systematically the available literature on health outcomes of online cancer support and resources. METHODS We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010. RESULTS A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes. CONCLUSION Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions. PRACTICE IMPLICATIONS Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes.
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Affiliation(s)
- Yan Hong
- Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, USA.
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14
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Abstract
E-health is seen as an important technological tool in achieving self-management; however, there is little evidence of how effective e-health is for self-management. Example tools remain experimental and there is limited knowledge yet about the design, use, and effects of this class of tools. By way of introducing a new view on the development of e-health tools dedicated to self-management we aim to contribute to the discussion for further research in this area. Our assumption is that patient empowerment is an important mechanism of e-health self-management and we suggest incorporating it within the development of self-management tools. Important components of empowerment selected from literature are: communication, education and health literacy, information, self-care, decision aids and contact with fellow patients. All components require skills of both patients and the physicians. In this discussion paper we propose how the required skills can be used to specify effective self-management tools.
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Affiliation(s)
| | - Paul van der Boog
- Leiden University Medical Centre (LUMC), The Netherlands TNO, The Netherlands
| | - Adrie Dumaij
- TU Delft, Centre for Innovation and Public Sector Efficiency (IPSE) Studies, The Netherlands
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Baker TB, Hawkins R, Pingree S, Roberts LJ, McDowell HE, Shaw BR, Serlin R, Dillenburg L, Swoboda CM, Han JY, Stewart JA, Carmack-Taylor CL, Salner A, Schlam TR, McTavish F, Gustafson DH. Optimizing eHealth breast cancer interventions: which types of eHealth services are effective? Transl Behav Med 2011; 1:134-145. [PMID: 21709810 PMCID: PMC3119549 DOI: 10.1007/s13142-010-0004-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.
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Affiliation(s)
- Timothy B Baker
- />Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, 53711 WI USA
- />UW-Center for Tobacco Research and Intervention, 1930 Monroe Street, Suite 200, Madison, WI 53711 USA
| | - Robert Hawkins
- />School of Journalism and Mass Communication, University of Wisconsin, Madison, WI USA
| | - Suzanne Pingree
- />Department of Life Sciences Communication, University of Wisconsin, Madison, WI USA
| | - Linda J Roberts
- />School of Human Ecology, University of Wisconsin, Madison, WI USA
| | - Helene E McDowell
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | - Bret R Shaw
- />Department of Life Sciences Communication, University of Wisconsin, Madison, WI USA
| | - Ron Serlin
- />Department of Educational Psychology, University of Wisconsin, Madison, WI USA
| | - Lisa Dillenburg
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | | | | | | | | | - Andrew Salner
- />Department of Radiation Oncology, Hartford Hospital, Hartford, CT USA
| | - Tanya R Schlam
- />Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, 53711 WI USA
| | - Fiona McTavish
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | - David H Gustafson
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
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Wen KY, McTavish F, Kreps G, Wise M, Gustafson D. From Diagnosis to Death: A Case Study of Coping With Breast Cancer as Seen Through Online Discussion Group Messages. J Comput Mediat Commun 2011; 16:331-361. [PMID: 23055657 PMCID: PMC3466054 DOI: 10.1111/j.1083-6101.2011.01542.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To understand the underlying psychosocial reactions against the unfolding of medical events that announce the disease progression, the objective of this analysis was to identify the patterns of online discussion group message themes in relation to the medical timeline of one woman's breast cancer trajectory. 202 messages posted by Darlene (our studied case) were analyzed by 2 independent coders using a grounded theory approach. The findings suggest that the pattern of messages was clearly correlated with distress-inducing events. The most frequent interaction theme was about building friendship with peers through communication of encouragement, validation, appreciation, and life sharing. Narratives of medical progression were constantly updated to identify similarities with peers. Family issues were increasingly raised at the end of life.
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Welch JL, Siek KA, Connelly KH, Astroth KS, McManus MS, Scott L, Heo S, Kraus MA. Merging health literacy with computer technology: self-managing diet and fluid intake among adult hemodialysis patients. Patient Educ Couns 2010; 79:192-198. [PMID: 19796911 PMCID: PMC2856795 DOI: 10.1016/j.pec.2009.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 08/20/2009] [Accepted: 08/27/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The Dietary Intake Monitoring Application (DIMA) is an electronic dietary self-monitor developed for use on a personal digital assistant (PDA). This paper describes how computer, information, numerical, and visual literacy were considered in development of DIMA. METHODS An iterative, participatory design approach was used. Forty individuals receiving hemodialysis at an urban inner-city facility, primarily middle-aged and African American, were recruited. RESULTS Computer literacy was considered by assessing abilities to complete traditional/nontraditional PDA tasks. Information literacy was enhanced by including a Universal-Product-Code (UPC) scanner, picture icons for food with no UPC code, voice recorder, and culturally sensitive food icons. Numerical literacy was enhanced by designing DIMA to compute real-time totals that allowed individuals to see their consumption relative to their dietary prescription. Visual literacy was considered by designing the graphical interface to convey intake data over a 24-h period that could be accurately interpreted by patients. Pictorial icons for feedback graphs used objects understood by patients. PRACTICE IMPLICATIONS Preliminary data indicate the application is extremely helpful for individuals as they self-monitor their intake. If desired, DIMA could also be used for dietary counseling.
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Affiliation(s)
- Janet L Welch
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA.
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18
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Han JY, Wise M, Kim E, Pingree R, Hawkins RP, Pingree S, McTavish F, Gustafson DH. Factors Associated with Use of Interactive Cancer Communication System: An Application of the Comprehensive Model of Information Seeking. J Comput Mediat Commun 2010; 15:367-388. [PMID: 21760702 PMCID: PMC3133670 DOI: 10.1111/j.1083-6101.2010.01508.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In order to provide insights about cancer patients' online information seeking behaviors, the present study analyzes individuals' transaction log data and reports on how demographics, disease-related factors, and psychosocial needs predict patterns of service use within a particular Interactive Cancer Communication System (ICCS). Study sample included 294 recently diagnosed breast cancer patients. Data included pretest survey scores of demographic, disease-related, and psychosocial factors and automatically collected ICCS use data over the 4-month intervention. Statistical analyses correlated pre-test survey scores with subsequent, specific types of ICCS service usage. Patterns of online cancer information seeking differed according to the patients' characteristics, suggesting that lower income, less educated women and those lacking in information-seeking competence use the computer and online services to the same or a greater degree if those services are made available to them. Results of this study can inform more effective resource development for future eHealth applications.
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Mayer DK, Ratichek S, Berhe H, Stewart S, McTavish F, Gustafson D, Parsons SK. Development of a health-related website for parents of children receiving hematopoietic stem cell transplant: HSCT-CHESS. J Cancer Surviv 2010; 4:67-73. [PMID: 19967409 DOI: 10.1007/s11764-009-0108-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 11/08/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Parents of pediatric hematopoietic stem cell transplant (HSCT) play a pivotal role in the care of their child during and after transplant. In addition to the child's comforter, parents also serve as care coordinators and conduits of communication between various health care providers, family and community members. The stress on the parent and family is enormous during this process, which for many is compounded by geographic dislocation to accompany their child during the rigorous treatment and recovery process. For many parents, their own recovery spans months to years. METHODS Parental activation, a process of becoming informed to participate in decisions, collaborate with health care providers, and manage care provided the conceptual framework to develop an eHealth approach for this population. HSCT-CHESS was developed, based on previous success with an existing eHealth system of integrated services, the Comprehensive Health Enhancement Support System (CHESS). CHESS(TM) is designed to help individuals and families cope with a health crisis or medical concern. The iterative user-centered development process for HSCT-CHESS included parents of HSCT recipients, representatives from an HSCT Advocacy Group, and members of the clinical, research, development and design teams. This rigorous process, including online focus groups and surveys, utilization of a parental user group, and an editorial and development process are described. CONCLUSION As the population of cancer survivors and caregivers increase and as the oncology workforce becomes more stretched; developing eHealth applications may be an approach to address many of caregivers unmet needs. The purpose in describing this process is to help others when considering such an endeavor. HSCT-CHESS is now being tested in a randomized controlled trial versus standard care to evaluate its impact on the quality of life of both the parent and child HSCT recipient.
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Samoocha D, Bruinvels DJ, Anema JR, Steenbeek R, van der Beek AJ. Empowerment of disability benefit claimants through an interactive website: design of a randomized controlled trial. BMC Med Inform Decis Mak 2009; 9:23. [PMID: 19426557 DOI: 10.1186/1472-6947-9-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 05/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals claiming a disability benefit after long-term sickness absence, have to undergo medical disability assessments. These assessments, often carried out by specialized physicians, can be complicated by wrong expectations or defensive attitudes of disability benefit claimants. It is hypothesized that empowerment of these claimants will enhance the physician-patient relationship by shifting claimants from a passive role to a more active and constructive role during disability assessments. Furthermore, empowerment of claimants may lead to a more realistic expectation and acceptance of the assessment outcome among claimants and may lead to a more accurate assessment by the physician. METHODS/DESIGN In a two-armed randomized controlled trial (RCT), 230 claimants will be randomized to either the intervention or control group. For the intervention group, an interactive website was designed http://www.wiagesprek.nl using an Intervention Mapping procedure. This website was tested during a pilot study among 51 claimants. The final version of the website consists of five interactive modules, in which claimants will be prepared and empowered step-by-step, prior to their upcoming disability assessment. Other website components are a forum, a personal health record, a personal diary, and information on disability assessment procedures, return to work, and coping with disease and work disability. Subjects from the control group will be directed to a website with commonly available information only. Approximately two weeks prior to their disability assessment, disability claimants will be recruited through the Dutch Workers Insurance Authority (UWV). Outcomes will be assessed at five occasions: directly after recruitment (baseline), prior to disability assessment, directly after disability assessment as well as 6 and 16 weeks after the assessment. The study's primary outcome is empowerment, measured with the Vrijbaan questionnaire. Secondary outcomes include claimants' satisfaction, perceived justice, coping strategy, and knowledge. A process evaluation will also be conducted. DISCUSSION This study evaluates the effectiveness of an interactive website aimed at empowerment of disability claimants. It is hypothesized that by increasing empowerment, the physician-patient relationship may be enhanced and claimants' satisfaction and perceived justice can be improved. Results are expected in 2010. TRIAL REGISTRATION NTR-1414.
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Abstract
PURPOSE To describe the evolution of "The Women to Women Conceptual Model for Adaptation to Chronic Illness." DESIGN A three-phase, computer-based research intervention to provide support and health information to chronically ill middle-aged women living in rural areas of the intermountain West. EVOLUTION OF A CONCEPTUAL MODEL: The path of the conceptualization of the WTW project was traced from a single concept to its present explanatory, multiconcept model consisting of three major adaptation constructs (environmental stimuli, psychosocial response, illness management) with related middle-range theoretical concepts (focal, contextual, and residual stimuli, psychosocial adaptation, chronic illness self-management, and quality of life) including empirical indicators and measures for each. CLINICAL RELEVANCE As the computer-based intervention is maturing, we are demonstrating its efficacy in helping rural women to better manage chronic illness. At the completion of this study, the intervention should be adequately tested so that it could be adapted for use by advanced practice nurses especially those working with people in isolated rural areas.
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Affiliation(s)
- Clarann Weinert
- College of Nursing, Montana State University, Bozeman, MT 59717, USA.
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Shaw BR, Jeong Yeob Han, Hawkins RP, McTavish FM, Gustafson DH. Communicating about self and others within an online support group for women with breast cancer and subsequent outcomes. J Health Psychol 2009; 13:930-9. [PMID: 18809644 DOI: 10.1177/1359105308095067] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Research suggests communicating too much about one's self within an online support group may amplify breast cancer patients' focus on their own problems and exacerbate negative emotions while focusing on others may have the opposite effects. This study explored how pronoun usage within an online support group was associated with subsequent mental health outcomes. There were 286 patients recruited into the study who filled out the pre-test and 231 completed post-tests four months later with survey measures including breast cancer-related concerns and negative emotions. Messages were analyzed using a program counting first person and relational pronouns. A positive relationship was found between use of first person pronouns and negative emotions.
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Affiliation(s)
- Bret R Shaw
- University of Wisconsin -Madison & Center for Excellence in Cancer Communication Research, Department of Life Sciences Communication, USA.
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Ndiaye K, Krieger JR, Warren JR, Hecht ML, Okuyemi K. Health Disparities and Discrimination: Three Perspectives. J Health Dispar Res Pract 2008; 2:51-71. [PMID: 20694161 PMCID: PMC2916656 DOI: 10.1901/jaba.2008.2-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article presents three perspectives on health discrimination and disparities, organized around different conceptualizations of the way "space" perpetuates health disparities. The first two perspectives are grounded in conceptualizing space in a physical sense by exploring the manifestation of discrimination as a problem both among and within nations. The third perspective juxtaposes geographical space with cyberspace. The internet, with its ability to blur sense of place, social demarcations, and behavior is often considered a panacea that can eliminate the health disparities. The internet, however, may not be fulfilling its promise as an equal source of health information for all and disparities related to international and rural geography remain problematic. Solutions are proposed for reducing health disparities based on The Principle of Cultural Grounding (Hecht & Krieger, 2006; Hecht & Miller-Day, in press).
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Affiliation(s)
- Khadidiatou Ndiaye
- The Pennsylvania State University, Communication Arts and Sciences, 234 Sparks Building University, PA 16802, 814-865-0945
| | - Janice R. Krieger
- The Ohio State University, The School of Communication, 3058 Derby Hall 154 North Oval Mall, Columbus, OH 43210-1339, 614-292-4040
| | - Jennifer R. Warren
- The University of Minnesota, Program in Health Disparities Research, Medical School, MMC 451, A420, Mayo Memorial Bldg, 420 Delaware Str., SE, Minneapolis, MN 55455
| | - Michael L. Hecht
- The Pennsylvania State University, Communication Arts and Sciences, 234 Sparks Building University, PA 16802, 814-865-0945
| | - Kola Okuyemi
- The University of Minnesota, Program in Health Disparities Research, Medical School, MMC 451, G254, Mayo Memorial Bldg, 420 Delaware Str., SE, Minneapolis, MN 55455, 612-625-2698
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Weinert C, Cudney S, Hill WG. Rural women, technology, and self-management of chronic illness. Can J Nurs Res 2008; 40:114-134. [PMID: 18947095 PMCID: PMC2700733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.
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Dubenske LL, Chih MY, Dinauer S, Gustafson DH, Cleary JF. Development and implementation of a clinician reporting system for advanced stage cancer: initial lessons learned. J Am Med Inform Assoc 2008; 15:679-86. [PMID: 18579837 DOI: 10.1197/jamia.m2532] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Innovative approaches can strengthen patient-caregiver-clinician information exchange and more effectively address the physical and psychosocial challenges of advanced disease. This study reports initial findings from implementation of the Clinician Report (CR)-a patient and caregiver status report tool accessible by the oncology clinic team. DESIGN The CR tracks and communicates essential information from cancer patients and caregivers to the oncology team. The CR conveys patient symptoms, emotional strain, and key concerns. MEASUREMENTS Authors used a model developed to explain acceptance, implementation, and sustainability of Interactive Health Communication Systems (IHCS) to evaluate implementation of the new CR system. The study carried out qualitative analyses of interviews with clinicians regarding their experience utilizing the Clinician Report. RESULTS Primary CR benefits included enhancement of patients' clinic visit experiences, greater caregiver involvement, and facilitation of earlier interventions. Challenges included CR functional issues, users' desire for greater depth of information, user privacy concerns, and limited patient use. These findings are discussed using parameters of the implementation model. Limitations of this study include its small clinician sample size, which represented only a portion of existing organizational settings in which CR systems might be implemented. CONCLUSION Though in its early implementation stages, the CR demonstrates the potential to positively impact care delivery in the cancer clinic setting, particularly by facilitating earlier interventions and improving patient-caregiver-clinician communication both during and between clinic visits.
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Affiliation(s)
- Lori L Dubenske
- Center for Health Enhancement Systems Studies, University of Wisconsin, Madison, Wisconsin, USA.
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Shaw BR, Dubenske LL, Han JY, Cofta-Woerpel L, Bush N, Gustafson DH, McTavish F. Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of the Cognitive-Social Health Information Processing (C-SHIP) model. J Health Commun 2008; 13:389-408. [PMID: 18569368 PMCID: PMC3632214 DOI: 10.1080/10810730802063546] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer health care providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access, and training for how to use an interactive cancer communication system, pretest survey scores indicating patients' psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors, with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies, and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared with to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.
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Affiliation(s)
- Bret R Shaw
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, Wisconsin, USA.
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Patten CA, Rock E, Meis TM, Decker PA, Colligan RC, Pingree S, Dornelas EA, Offord KP, Boberg EW, Gustafson DH. Frequency and type of use of a home-based, Internet intervention for adolescent smoking cessation. J Adolesc Health 2007; 41:437-43. [PMID: 17950163 PMCID: PMC2063436 DOI: 10.1016/j.jadohealth.2007.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/06/2007] [Accepted: 05/16/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE The Internet offers a potential medium for delivering smoking cessation treatment to adolescents. However, few Internet-based cessation programs for adolescents have been evaluated. We describe adolescent use of a home-based Internet intervention to stop smoking (Stomp Out Smokes [SOS]) and explore baseline characteristics associated with SOS use. METHODS Participants were 70 adolescent smokers aged 12-18 years (50% female, 90% Caucasian) randomized to receive the SOS intervention for 24 weeks as part of a larger clinical trial. SOS comprised 40 components, of which eight were primarily interactive (e.g., discussion support group, ask an expert, quit plan) and 32 were primarily informational (e.g., managing withdrawal, medications to stop smoking). SOS use data were captured electronically, including total logins to the site, and type of SOS components used defined by page hits on the interactive and information components. RESULTS A total of 7,708 SOS website pages (6825 interactive and 883 informational) were accessed over the 24 weeks. The highest proportion of page hits was for the discussion support group (35%) and quit plan (30%). Interactive pages were significantly more likely to be used than informational pages (median 65 vs. 6, p < .001). Males accessed fewer interactive pages compared with females (p = .04). No other baseline characteristics were univariately associated with total logins or use of informational or interactive pages. CONCLUSIONS Adolescent smokers most often used a discussion support group and other interactive Internet-based cessation components. Future studies designed to increase adolescent use, and efficacy of, Internet-based cessation programs are warranted.
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Affiliation(s)
- Christi A. Patten
- Mayo Clinic College of Medicine, Department of Psychiatry & Psychology, 200 First Street SW, Rochester MN, 55905, Mayo Clinic College of Medicine, Behavioral Health Research Program, 200 First Street SW, Rochester MN, 55905
| | - Emily Rock
- Mayo Clinic College of Medicine, Behavioral Health Research Program, 200 First Street SW, Rochester MN, 55905
| | - Tracy M. Meis
- University of Wisconsin, Madison, Center for Health Enhancement Systems Studies, 610 Walnut Street, Madison WI 53705
| | - Paul A. Decker
- Mayo Clinic College of Medicine, Division of Biostatistics, 200 First Street SW, Rochester MN, 55905
| | - Robert C. Colligan
- Mayo Clinic College of Medicine, Department of Psychiatry & Psychology, 200 First Street SW, Rochester MN, 55905
| | - Suzanne Pingree
- University of Wisconsin, Madison, Center for Health Enhancement Systems Studies, 610 Walnut Street, Madison WI 53705
| | - Ellen A. Dornelas
- Hartford Hospital, Division of Cardiology, 80 Seymour Street, Hartford CT 06105
| | - Kenneth P. Offord
- Mayo Clinic College of Medicine, Division of Biostatistics, 200 First Street SW, Rochester MN, 55905
| | - Eric W. Boberg
- Northwestern University Feinberg School of Medicine, Department of Medicine, 251 East Huron Street, Chicago IL 60611
| | - David H. Gustafson
- University of Wisconsin, Madison, Center for Health Enhancement Systems Studies, 610 Walnut Street, Madison WI 53705
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Shaw B, Han JY, Kim E, Gustafson D, Hawkins R, Cleary J, McTavish F, Pingree S, Eliason P, Lumpkins C. Effects of prayer and religious expression within computer support groups on women with breast cancer. Psychooncology 2007; 16:676-87. [PMID: 17131348 DOI: 10.1002/pon.1129] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research indicates that two common ways breast cancer patients or women with breast cancer cope with their diagnosis and subsequent treatments are participating in computer support groups and turning to religion. This study is the first we are aware of to examine how prayer and religious expression within computer support groups can contribute to improved psychosocial outcomes for this population. Surveys were administered before group access and then 4 months later. Message transcripts were analyzed using a word counting program that noted the percentage of words related to religious expression. Finally, messages were qualitatively reviewed to better understand results generated from the word counting program. As hypothesized, writing a higher percentage of religion words was associated with lower levels of negative emotions and higher levels of health self-efficacy and functional well-being, after controlling for patients' levels of religious beliefs. Given the proposed mechanisms for how these benefits occurred and a review of the support group transcripts, it appeared that several different religious coping methods were used such as putting trust in God about the course of their illness, believing in an afterlife and therefore being less afraid of death, finding blessings in their lives and appraising their cancer experience in a more constructive religious light.
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Affiliation(s)
- Bret Shaw
- The Centre of Excellence in Cancer Communication Research, University of Wisconsin-Madison, USA.
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Abstract
The application of information technology (IT) to issues of healthcare delivery has had a long and tortuous history in the United States. Within the field of eHealth, vanguard applications of advanced computing techniques, such as applications in artificial intelligence or expert systems, have languished in spite of a track record of scholarly publication and decisional accuracy. The problem is one of purpose, of asking the right questions for the science to solve. Historically, many computer science pioneers have been tempted to ask "what can the computer do?" New advances in eHealth are prompting developers to ask "what can people do?" How can eHealth take part in national goals for healthcare reform to empower relationships between healthcare professionals and patients, healthcare teams and families, and hospitals and communities to improve health equitably throughout the population? To do this, eHealth researchers must combine best evidence from the user sciences (human factors engineering, human-computer interaction, psychology, and usability) with best evidence in medicine to create transformational improvements in the quality of care that medicine offers. These improvements should follow recommendations from the Institute of Medicine to create a healthcare system that is (1) safe, (2) effective (evidence based), (3) patient centered, and (4) timely. Relying on the eHealth researcher's intuitive grasp of systems issues, improvements should be made with considerations of users and beneficiaries at the individual (patient-physician), group (family-staff), community, and broad environmental levels.
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Affiliation(s)
- Bradford W Hesse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7365, USA.
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Patten CA, Croghan IT, Meis TM, Decker PA, Pingree S, Colligan RC, Dornelas EA, Offord KP, Boberg EW, Baumberger RK, Hurt RD, Gustafson DH. Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation. Patient Educ Couns 2006; 64:249-58. [PMID: 16616449 DOI: 10.1016/j.pec.2006.03.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 01/31/2006] [Accepted: 03/01/2006] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Evaluation of novel treatment delivery methods, such as the Internet are notably absent from the adolescent smoking treatment literature. METHODS Adolescent smokers ages 11-18 years were randomized to a clinic-based, brief office intervention (BOI; N=69) consisting of four individual counseling sessions; or to Stomp Out Smokes (SOS), an Internet, home-based intervention (N=70). Adolescents in SOS had access to the SOS site for 24 weeks. RESULTS The 30-day, point-prevalence smoking abstinence rates for BOI and SOS were 12% versus 6% at week 24 and 13% versus 6% at week 36, with no significant treatment differences. Among participants who continued to smoke, SOS was associated with a significantly greater reduction in average number of days smoked than BOI (P=0.006). The BOI was found to be feasible with high session attendance rates. SOS participants accessed the site a mean+/-S.D. of 6.8+/-7.1 days. SOS use dropped to less than one-third of participants by week 3. CONCLUSION Additional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components. PRACTICE IMPLICATIONS Augmenting the SOS type of intervention with more structured, personal and proactive patient-education components delivered in-person or by telephone or electronic mail is recommended.
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Affiliation(s)
- Christi A Patten
- Mayo Clinic College of Medicine, Department of Psychiatry & Psychology, Rochester, MN 55905, USA.
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Shaw BR, Hawkins R, Arora N, McTavish F, Pingree S, Gustafson DH. An exploratory study of predictors of participation in a computer support group for women with breast cancer. Comput Inform Nurs 2006; 24:18-27. [PMID: 16436908 DOI: 10.1097/00024665-200601000-00007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined what characteristics predict participation in online support groups for women with breast cancer when users are provided free training, computer hardware, and Internet service removing lack of access as a barrier to use. The only significant difference between active and inactive participants was that active users were more likely at pretest to consider themselves active participants in their healthcare. Among active participants, being white and having a higher energy level predicted higher volumes of writing. There were also trends toward the following characteristics predictive of a higher volume of words written, including having a more positive relationship with their doctors, fewer breast cancer concerns, higher perceived health competence, and greater social/family well-being. Implications for improving psychosocial interventions for women with breast cancer are discussed, and future research objectives are suggested.
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Affiliation(s)
- Bret R Shaw
- Center of Excellence in Cancer Communications Research, University of Wisconsin-Madison, Madison, WI, USA.
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Abstract
AIMS AND OBJECTIVES This study describes and compares the information patients want with the information they receive and examines whether this varies between patients. BACKGROUND Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view. DESIGN Descriptive, survey design with questionnaires. METHODS The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests). RESULTS Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas. CONCLUSIONS Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs. RELEVANCE TO CLINICAL PRACTICE More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems.
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Shaw BR, Hawkins R, McTavish F, Pingree S, Gustafson DH. Effects of insightful disclosure within computer mediated support groups on women with breast cancer. Health Commun 2006; 19:133-42. [PMID: 16548704 DOI: 10.1207/s15327027hc1902_5] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Written expression about emotionally traumatic events is associated with physical and mental health benefits, and this study examines how insightful disclosure within a computer-mediated support group for women with breast cancer affects breast cancer-related concerns, emotional well-being, and self-reported physical well-being. Using a word counting program that notes the percentage of words related to various linguistic dimensions, this research specifically examined the effects of insightful disclosure written within these groups. Surveys were administered just before group access and then 2 months and 5 months later. Insightful disclosure improved emotional well-being and reduced negative mood but did not influence breast cancer-related concerns or self-reported physical well-being. Despite the common and frequent use of computer-mediated social support (CMSS) groups for people coping with health concerns, very little research to date has quantitatively tested the effects of participating in CMSS groups, and this is among the first published studies to quantitatively link any specific activity within a CMSS group to any specific outcomes. Implications for improving psychosocial interventions for people with health concerns are discussed, and future research objectives are suggested.
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Affiliation(s)
- Bret R Shaw
- Center of Excellence in Cancer Communications Research, University of Wisconsin-Madison, Madison, WI 53726, USA.
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Abstract
BACKGROUND Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based, information packages for patients that combine health information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain. OBJECTIVES To assess the effects of IHCAs for people with chronic disease. SEARCH STRATEGY We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature; and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search time period commenced at 1990, where possible, and ran until 31 December 2003. SELECTION CRITERIA Randomised controlled trials (RCTs) of IHCAs for adults and children with chronic disease. DATA COLLECTION AND ANALYSIS One reviewer screened abstracts for relevance. Two reviewers screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios for binary outcomes; heterogeneity was assessed using the I(2 )statistic. MAIN RESULTS We identified 24 RCTs involving 3739 participants which were included in the review.IHCAs had a significant positive effect on knowledge (SMD 0.46; 95% confidence interval (CI) 0.22 to 0.69), social support (SMD 0.35; 95% CI 0.18 to 0.52) and clinical outcomes (SMD 0.18; 95% CI 0.01 to 0.35). Results suggest it is more likely than not that IHCAs have a positive effect on self-efficacy (a person's belief in their capacity to carry out a specific action) (SMD 0.24; 95% CI 0.00 to 0.48). IHCAs had a significant positive effect on continuous behavioural outcomes (SMD 0.20; 95% CI 0.01 to 0.40). Binary behavioural outcomes also showed a positive effect for IHCAs, although this result was not statistically significant (OR 1.66; 95% CI 0.71 to 3.87). It was not possible to determine the effects of IHCAs on emotional or economic outcomes. AUTHORS' CONCLUSIONS IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users. There is a need for more high quality studies with large sample sizes to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.
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Affiliation(s)
- E Murray
- RF&UCMS at University College London, Primary Care and Population Sciences, Level 2 Holborn Union Building, Archway Campus, London, UK N19 5LW.
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Bouwman LI, Hiddink GJ, Koelen MA, Korthals M, van't Veer P, van Woerkum C. Personalized nutrition communication through ICT application: how to overcome the gap between potential effectiveness and reality. Eur J Clin Nutr 2005; 59 Suppl 1:S108-15; discussion S116. [PMID: 16052178 DOI: 10.1038/sj.ejcn.1602182] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The potential effectiveness of personalized nutrition communication through the Internet is promising in terms of addressing personal relevance, flexibility, interactive options and amount of people that can be reached. However, little research on the contribution to behaviour change has been done. The MyFood program at Wageningen University aims at providing insight into strategies to implement personalized nutrition communication through interactive tools. In this article we present the framework for research on social acceptance of personalized nutrition communication through interactive computer technology as part of the MyFood program.
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Affiliation(s)
- L I Bouwman
- Communication Sciences, Wageningen University, Wageningen, The Netherlands.
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Abstract
The demands placed on cancer caregivers are well documented. Support for informal caregivers has been shown to increase hope and decrease psychosocial morbidity. The Internet is a readily available means of support for cancer caregivers, however little research on online support for informal caregivers of cancer patients exists. Descriptive statistics and qualitative analysis were used to evaluate messages posted over a 2-month period on an online cancer caregiver listserv. Three major themes emerged from the data: hope, emotional roller coaster, and physical/emotional/psychological responses. Supportive and hopeful statements prevailed among online participants in the current study. However, subjects also described the emotional roller coaster associated with caregiving. Emotional/physical/psychological responses included anger, weakness, exhaustion, grief, and sadness. Outcome research is needed to help evaluate the efficacy of online support for caregivers. Findings in this study can help nurses focus on some problems common to caregivers of cancer patients and plan appropriate interventions and research.
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Affiliation(s)
- Paula Klemm
- Department of Nursing, University of Delaware College of Health and Nursing Sciences, Newark, DE 19701, USA.
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Safran C, Pompilio-Weitzner G, Emery KD, Hampers L. A Medicaid eHealth program: an analysis of benefits to users and nonusers. AMIA Annu Symp Proc 2005; 2005:659-63. [PMID: 16779122 PMCID: PMC1560881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To describe parental use of an Internet-based educational and emotional support system, in a regional NICU program. METHODS Baby CareLink was installed in NICUs in 4 Denver area hospitals in 2003. Parents were offered access from hospital terminals and from any other Internet access point. Data on use of the program was collected by the computer system. Discharge status was verified by Colorado's Department of Public Assistance. RESULTS Of the 388 families admitted to Denver area NICUs with Baby CareLink during the study period, 135 (34.8%) were identified as Medicaid families (needing public assistance). After exclusions, data for 81 Medicaid and 154 non-Medicaid families were available for analysis. Medicaid families who accessed 3 or more Baby CareLink web pages per day took their infants home 17.5 days sooner than families who used Baby CareLink less often (p=0.03). Among the non-Medicaid families, more frequent users of Baby CareLink took their infants home 14.3 days sooner (p=0.04). CONCLUSIONS Internet portals will be used by both Medicaid and non-Medicaid parents with children in NICUs to meet educational needs. More frequent use of Baby CareLink was associated with significantly shorter length of stay. Self-help tools for parents may free nursing resource for families with greater needs.
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Abstract
BACKGROUND Chronic kidney disease (CKD) affects up to 19.2 million Americans, and untreated kidney disease can progress to kidney failure. Patient education is an important part of slowing disease progression, but the ability of health professionals to provide this education is limited by time constraints. To date, there have been no systematic evaluations of CKD eHealth Web sites. METHODS Seven nonproprietary and 4 proprietary Web sites geared toward educating patients with CKD were identified by using the Internet to search for the terms "chronic kidney disease," "kidney disease," and "chronic renal failure." Web sites were evaluated according to (1) compliance with the principles of the Health on the Net (HON) Foundation Code of Conduct and (2) reading grade level. RESULTS Nonproprietary sites were in compliance with an average of 5.2 principles, with a range of 3 to 8. Average compliance of proprietary Web sites with the HON Code of Conduct principles was 3.12, with a range of 2 to 4 (P = 0.021). Of nonproprietary Web sites, average reading grade level assessed by the Fry Readability Scale was greater than grade 14, with a range from grade 11 through graduate school. Of proprietary sites, average readability was grade 11, with a range from grades 7 through 16 (P = 0.575). CONCLUSION The Internet has the potential to be a very powerful educational tool for patients with CKD. However, many easily accessed CKD public health Web sites do not comply with accepted standards for health Web sites and are written using language beyond the general public's reading comprehension.
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Affiliation(s)
- Jonathan B Jaffery
- Department of Medicine, Section of Nephrology, University of Wisconsin-Madison, Madison, WI, USA.
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Murray E, Burns J, See TS, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004274.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor-patient relationship. OBJECTIVE We conducted the present study to understand the association between one's interest in using the Internet for general and quality-oriented health information and attitudes about one's communications with health care provider(s). DESIGN Cross-sectional survey. SETTING Four community-based primary care practices in Rhode Island. MEASUREMENTS A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a patient's perceptions of the degree to which their doctors over the previous year have: (1) given them information and (2) engaged them in the decision-making process. RESULTS A total of 300 patients completed the survey. Among patients without Internet access, interest in using the Internet for health related activities was less among patients who felt that their doctor gave less information: Odds ratio 0.83 (95% CI, 0.70-0.98) and greater among patients who felt that their doctor engaged them more in decision making: Odds ratio 1.3 (95% CI, 1.1-1.6). Among patients with Internet access, we found no relationship between interest in using the Internet for health related activities and measures of patient-physician communication or patient-physician decision making. CONCLUSIONS Interest in using the Internet for health information is greater for those who (1) felt their doctors provided less information and (2) felt their doctors engaged them more in the decision-making process, but this is true only for those without access to the Internet.
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Affiliation(s)
- Christopher N Sciamanna
- Department of Community Health, Brown Medical School, The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Coro Building, One Hoppin Street, Suite 500, Providence, RI 02903, USA.
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Abstract
SchoolhealthLink, a Web-based information service for Missouri school nurses, is a promising resource to reach school nurses isolated from traditional professional networks. It also may serve as an important adjunct to stay abreast of the latest health information. Using a strategy to identify the health information needs of school nurses and to test the site early in its development, this pilot study found school nurses reported SchoolhealthLink was an easy-to-use method to find high-quality, up-to-date information relevant to school nursing practice, was better than existing methods to access information, and could change the way they practiced. In order to continue to build SchoolhealthLink, a partnership with Barnes College of Nursing and the Missouri Association of School Nurses has been established to work together to continue to add health information resources useful to school nursing practice.
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Affiliation(s)
- Jean A Bachman
- Barnes College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
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Abstract
The purpose of this study was to describe patient satisfaction with outpatient psychiatric care in two community care clinics in Finland. Data were collected using a structured questionnaire from 300 outpatients between February and March 2000. A total of 171 patients returned completed questionnaires (response rate 57%). The data analysis was based on descriptive statistics, chi-square test, the Mann-Whitney U-test and the Kruskal-Wallis test. Item homogeneity was analysed using Cronbach alpha coefficient. The results showed that patient satisfaction was highest in areas pertaining to staff and care discussions, and lowest in areas pertaining to information. Patients who considered the wait for treatment to be too long were more dissatisfied with staff, their chance of influencing their own care, and the help they received, compared with patients who considered the wait to be reasonable in length. We can conclude that although patients are quite satisfied with their outpatient treatment in general, the patient information process is not at a satisfactory level at outpatient psychiatric clinics. In the future, more emphasis should be put on developing more innovative methods to increase psychiatric patients' knowledge level regarding their own illness and treatment.
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Affiliation(s)
- U Siponen
- Mental Health Centre (A3), Turku, Finland.
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Boberg EW, Gustafson DH, Hawkins RP, Offord KP, Koch C, Wen KY, Kreutz K, Salner A. Assessing the unmet information, support and care delivery needs of men with prostate cancer. Patient Educ Couns 2003; 49:233-242. [PMID: 12642195 DOI: 10.1016/s0738-3991(02)00183-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study identified the key Unmet Needs of men with localized prostate cancer. A series of Nominal Groups were used to identify needs, from which a 135-item survey was developed to assess both the Importance and Unmet Need of each item. An Importance-Weighted Unmet Need score was calculated for each item, incorporating both the Importance and the degree to which the need was unmet. Surveys (n=500) were distributed in four geographically distinct areas, with a response rate of 46%. Respondents were 90% Caucasian, 80% married, with a mean age of 66 years, and mean education of 14 years. Care delivery needs were most important and least unmet, while Support needs were least important and most unmet. However, when degree to which needs were unmet was weighted by Importance, information needs had the highest Importance-Weighted Unmet Need scores. The greatest Unmet Needs for information were in knowledge of recurrence issues and in side effects of the illness and its treatment.
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Affiliation(s)
- Eric W Boberg
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 1119 WARF, 610 Walnut Street, Madison, WI 53705, USA
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Sciamanna CN, Clark MA, Houston TK, Diaz JA. Unmet needs of primary care patients in using the Internet for health-related activities. J Med Internet Res 2002; 4:E19. [PMID: 12554550 PMCID: PMC1761942 DOI: 10.2196/jmir.4.3.e19] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Accepted: 11/05/2002] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Millions of people use the Internet as a source for health information yet little is understood about the use of the Internet for other health-related activities. OBJECTIVE We conducted the present study to understand, among primary care patients, the interest in and experience with using the Internet for a variety of health-related activities. METHODS Cross-sectional survey in the setting of 4 community-based primary care practices in Rhode Island. A single self-administered questionnaire included the following: 14 items measuring interest in using the Internet for a variety of health-related purposes, demographics, self-reported health status, and self-reported health care quality. RESULTS The survey was completed by 300 patients, 109 without access to the Internet and 191 with access to the Internet. Experiences with and attitudes about each of the health-related activities on the Internet varied widely across each activity. Regardless of access, patients were most interested in using the Internet for finding information about diseases and medications. However, patients with Internet access were more interested, compared to those without access, in each of the health-related activities on the Internet. Among patients with access to the Internet, the largest gap between interest and experience (the opportunity gap) was in using the Internet to investigate the quality of their care (eg, "find out if your health care provider was giving you all of the tests and treatments that you are due to have?") and administrative functions (eg, "schedule an appointment with your doctor?"). CONCLUSIONS Much opportunity remains for developing health-related Internet Web sites to address the unmet needs of primary care patients.
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Affiliation(s)
- Christopher N Sciamanna
- Department of Community Health, Brown Medical School, The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Providence, RI 02903, USA.
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Abstract
The question of how public funds for research should be allocated has led to participatory priority-setting in prosperous democracies like Taiwan, Republic of China. Useful criteria for research priorities are scientific merit, social benefit and feasibility. Taking a health needs approach and using these criteria, nearly 200 nurses from service and education in a national forum participated in describing research priorities. Through the group method of idea-writing, for clinical nursing, of high priority were assessing quality, care of the elderly, and preventing infectious disease. For nursing education, research addressing advanced role preparation and bridging nursing education and practice were priorities. For nursing management, research of highest priority pertained to economic evaluation, personnel administration, and effectiveness. These suggestions from the deliberation of a committed group of nurses can help shape future national decisions about research funding and training.
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Affiliation(s)
- T J Yin
- Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
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Abstract
Information technology is rapidly changing the world in which we live and ever-cheaper technology will ensure that this change continues at a rapid pace; this Government plans to have Internet access in every home within 5 years. Additionally, preregistration curricula are including technological training — and therefore IT competence — among learning outcomes in preparation for the inevitable changes in healthcare delivery.
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Affiliation(s)
- A While
- Florence Nightingale School of Nursing and Midwifery, King's College London
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