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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2010

Open Access 01-12-2010 | Research article

Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision

Authors: Lucy Yardley, Leanne G Morrison, Panayiota Andreou, Judith Joseph, Paul Little

Published in: BMC Medical Informatics and Decision Making | Issue 1/2010

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Abstract

Background

It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms.

Methods

In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis.

Results

Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed.

Conclusions

Educational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they seek.
Literature
1.
Pagliari C: Design and evaluation in eHealth: challenges and implications for an interdisciplinary field. J Med Internet Res. 2007, 9: e15-10.2196/jmir.9.2.e15.CrossRefPubMedPubMedCentral
2.
Farzanfar R, Finkelstein J, Friedman RH: Testing the usability of two automated home-based patient-management systems. J Med Syst. 2004, 28: 143-153. 10.1023/B:JOMS.0000023297.50379.3c.CrossRefPubMed
3.
Lin H-X, Choong Y-Y, Salvendy G: A proposed index of usability: a method for comparing the relative usability of different software systems. Behav Inf Technol. 1997, 16: 267-278. 10.1080/014492997119833.CrossRef
4.
Hinchliffe A, Mummery WK: Applying usability testing techniques to improve a health promotion website. Health Promot J Aust. 2008, 19: 29-35.
5.
Cotton D, Gresty K: Reflecting on the think-aloud method for evaluating e-learning. Br J Educ Technol. 2006, 37: 45-54. 10.1111/j.1467-8535.2005.00521.x.CrossRef
6.
van den Haak MJ, de Jong MDT, Schellens PJ: Evaluation of an informational web site: three variants of the think-aloud method compared. Tech Commun. 2007, 54: 58-71.
7.
Fleisher L, Buzaglo J, Collins M, Millard J, Miller SM, Egleston BL, Solarino N, Trinastic J, Cegala DJ, Benson AB, Schulman KA, Weinfurt KP, Sulmasy D, Diefenbach MA, Meropol NJ: Using health communication best practices to develop a web-based provider-patient communication aid: the CONNECT study. Patient Educ Couns. 2008, 71: 378-387. 10.1016/j.pec.2008.02.017.CrossRefPubMedPubMedCentral
8.
Kaufman DR, Patel VL, Hilliman C, Morin PC, Pevzner J, Weinstock RS, Goland R, Shea S, Starren J: Usability in the real world: assessing medical information technologies in patients' homes. J Biomed Inform. 2003, 36: 45-60. 10.1016/S1532-0464(03)00056-X.CrossRefPubMed
9.
Rotondi AJ, Sinkule J, Haas GL, Spring MB, Litschge CM, Newhill CE, Ganguli R, Anderson CM: Designing websites for persons with cognitive deficits: design and usability of a psychoeducational intervention for persons with severe mental illness. Psychol Serv. 2007, 4: 202-224. 10.1037/1541-1559.4.3.202.CrossRefPubMedPubMedCentral
10.
Dorfman C, Williams R, Kassan E, Red S, Dawson D, Tuong W, Parker E, Ohene-Frempong J, Davis K, Krist A, Woolf S, Schwartz M, Fishman M, Cole C, Taylor K: The development of a web- and a print-based decision aid for prostate cancer screening. BMC Med Inform Decis Mak. 2010, 10: 12-10.1186/1472-6947-10-12.CrossRefPubMedPubMedCentral
11.
Faulkner L: Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput. 2003, 35: 379-383.CrossRefPubMed
12.
Sillence E, Briggs P, Harris PR, Fishwick L: How do patients evaluate and make sense of online health information?. Soc Sci Med. 2007, 64: 1853-1862. 10.1016/j.socscimed.2007.01.012.CrossRefPubMed
13.
Hardey M: Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise. Sociol Health Illn. 1999, 21: 820-835. 10.1111/1467-9566.00185.CrossRef
14.
Rogers A, Mead N: More than technology and access: primary care patients' views on the use and non-use of health information in the Internet age. Health Soc Care Community. 2004, 12: 102-110. 10.1111/j.0966-0410.2004.00473.x.CrossRefPubMed
15.
Kerr C, Murray E, Stevenson F, Gore C, Nazareth I: Internet interventions for long-term conditions: patient and caregiver quality criteria. J Med Internet Res. 2006, 8: e13-10.2196/jmir.8.3.e13.CrossRefPubMedPubMedCentral
16.
Stevenson FA, Kerr C, Murray E, Nazareth I: Information from the Internet and the doctor-patient relationship: the patient perspective -- a qualitative study. BMC Fam Pract. 2007, 8: 10.1186/1471-2296-8-47.
17.
Atack L, Luke R, Chien E: Evaluation of patient satisfaction with tailored online patient education information. Comput Inform Nurs. 2008, 26: 258-264. 10.1097/01.NCN.0000304838.52207.90.CrossRefPubMed
18.
Armstrong N, Powell J: Preliminary test of an Internet-based diabetes self-management tool. J Telemed Telecare. 2008, 14: 114-116. 10.1258/jtt.2008.003002.CrossRefPubMed
19.
Armstrong N, Hearnshaw H, Powell J, Dale J: Stakeholder Perspectives on the Development of a Virtual Clinic for Diabetes Care: Qualitative Study. J Med Internet Res. 2007, 9: e23-10.2196/jmir.9.3.e23.CrossRefPubMedPubMedCentral
20.
Kerr C, Murray E, Burns J, Turner I, Westwood MA, Macadam C, Nazareth I, Patterson D: Applying user-generated quality criteria to develop an Internet intervention for patients with heart disease. J Telemed Telecare. 2008, 14: 124-127. 10.1258/jtt.2008.003006.CrossRefPubMed
21.
Hartmann CW, Sciamanna CN, Blanch DC, Mui S, Lawless H, Manocchia M, Rosen RK, Pietropaoli A: A website to improve asthma care by suggesting patient questions for physicians: qualitative analysis of user experiences. J Med Internet Res. 2007, 9: e3-10.2196/jmir.9.1.e3.CrossRefPubMedPubMedCentral
22.
Linke S, McCambridge J, Khadjesari Z, Wallace P, Murray E: Development of a psychologically enhanced interactive online intervention for hazardous drinking. Alcohol Alcohol. 2008, 43: 669-674.CrossRefPubMedPubMedCentral
23.
Steele R, Mummery KW, Dwyer T: Development and process evaluation of an Internet-based physical activity behaviour change program. Patient Educ Couns. 2007, 67: 127-136. 10.1016/j.pec.2007.02.013.CrossRefPubMed
24.
Neuhauser L, Kreps GL: Rethinking communication in the e-health era. J Health Psychol. 2003, 8: 7-23. 10.1177/1359105303008001426.CrossRefPubMed
25.
Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. Br Med J. 2000, 321: 694-696. 10.1136/bmj.321.7262.694.CrossRef
26.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J. 2008, 337: a1655-10.1136/bmj.a1655.CrossRef
27.
Dixon-Woods M: Writing wrongs? An analysis of published discourses about the use of patient information leaflets. Soc Sci Med. 2001, 52: 1417-1432. 10.1016/S0277-9536(00)00247-1.CrossRefPubMed
28.
Korp P: Health on the Internet: implications for health promotion. Health Educ Res. 2006, 21: 78-86. 10.1093/her/cyh043.CrossRefPubMed
29.
Little P, Somerville J, Williamson I, Warner G, Moore M, Wiles R, George S, Smith A, Peveler R: Randomised controlled trial of self management leaflets and booklets for minor illness provided by post. Br Med J. 2001, 322: 1214-1217. 10.1136/bmj.322.7296.1214.CrossRef
30.
Macfarlane JT, Holmes WF, Macfarlane RM: Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care. Br J Gen Pract. 1997, 47: 719-722.PubMedPubMedCentral
31.
Lord SR, Tiedemann A, Chapman K, Munro B, Murray SM, Sherrington C: The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc. 2005, 53: 1296-1304. 10.1111/j.1532-5415.2005.53425.x.CrossRefPubMed
32.
Williams P, Huntington P, Nicholas D: Health information on the Internet: a qualitative study of NHS Direct Online users. Aslib Proc. 2003, 55: 304-312. 10.1108/00012530310498879.CrossRef
33.
Umefjord G, Hamberg K, Malker H, Petersson G: The use of an Internet-based Ask the Doctor Service involving family physicians: evaluation by a web survey. Fam Pract. 2006, 23: 159-166. 10.1093/fampra/cmi117.CrossRefPubMed
34.
Kreuter M, Farrell D, Olevitch L, Brennan L: Tailoring Health Messages: Customizing Communication with Computer Technology. 2000, London: Erlbaum
35.
Leventhal HA, Brissette I, Leventhal EA: The common-sense model of self-regulation of health and illness. The Self-Regulation of Health and Illness Behaviour. Edited by: Cameron LD, Leventhal H. 2003, London: Routledge, 42-65.
36.
Bandura A: Self-Efficacy: The Exercise of Control. 1997, New York: W.H.Freeman
37.
38.
Smith SK, Trevena L, Nutbeam D, Barratt A, McCaffery KJ: Information needs and preferences of low and high literacy consumers for decisions about colorectal cancer screening: utilizing a linguistic model. Health Expect. 2008, 11: 123-136. 10.1111/j.1369-7625.2008.00489.x.CrossRefPubMed
39.
Boyatzis RE: Transforming Qualitative Information: Thematic Analysis and Code Development. 1998, London: Sage
40.
Joffe H, Yardley L: Content and thematic analysis. Research Methods for Clinical and Health Psychology. Edited by: Marks D, Yardley L. 2004, London: Sage, 56-68.
41.
Chamberlain K, Camic P, Yardley L: Qualitative analysis of experience: grounded theory and case studies. Research methods for clinical and health psychology. Edited by: Marks DF, Yardley L. 2004, London: Sage, 69-89.
42.
Charmaz K, Henwood K: Grounded theory. The Sage Handbook of Qualitative Research in Psychology. Edited by: Willig C, Stainton-Rogers W. 2008, London: Sage, 240-260.CrossRef
43.
Andreou P: Developing a theory based web intervention for respiratory tract infections. PhD thesis. 2009, University of Southampton, School of Medicine
44.
Yardley L: Demonstrating validity in qualitative psychology. Qualitative Psychology. Edited by: Smith JA. 2008, London: Sage, 2
45.
Lambert SD, Loiselle CG: Health information-seeking behaviour. Qual Health Res. 2007, 17: 1006-1019. 10.1177/1049732307305199.CrossRefPubMed
46.
Say R, Murtagh M, Thomson R: Patients' preferences for involvement in medical decision making: a narrative review. Patient Educ Couns. 2006, 60: 102-114. 10.1016/j.pec.2005.02.003.CrossRefPubMed
47.
Cotten SR, Gupta SS: Characteristics of online and offline health information seekers and factors that discriminate between them. Soc Sci Med. 2004, 59: 1795-1806. 10.1016/j.socscimed.2004.02.020.CrossRefPubMed
48.
Henwood F, Wyatt S, Hart A, Smith J: 'Ignorance is bliss sometimes': constraints on the emergence of the 'informed patient' in the changing landscapes of health information. Sociol Health Illn. 2003, 25: 589-607. 10.1111/1467-9566.00360.CrossRefPubMed
49.
O'Cathain A, Goode J, Luff D, Strangleman T, Hanlon G, Greatbatch D: Does NHS Direct empower patients?. Soc Sci Med. 2005, 61: 1761-1771. 10.1016/j.socscimed.2005.03.028.CrossRefPubMed
50.
Nutbeam D: The evolving concept of health literacy. Soc Sci Med. 2008, 67: 2072-2078. 10.1016/j.socscimed.2008.09.050.CrossRefPubMed
51.
McMillan SJ, Macias W: Strengthening the safety net for online seniors: factors influencing differences in health information seeking among older internet users. J Health Commun. 2008, 13: 778-792. 10.1080/10810730802487448.CrossRefPubMed
52.
Yardley L, Nyman S: Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. Health Promot Int. 2007, 22: 122-128. 10.1093/heapro/dam007.CrossRefPubMed
53.
Nijland N, van Gemert-Pijnen J, Boer H, Steehouder FMl, Seydel RE: Evaluation of Internet-based technology for supporting self-care: problems encountered by patients and caregivers when using self-care applications. J Med Internet Res. 2008, 10: e13-10.2196/jmir.957.CrossRefPubMedPubMedCentral
Metadata
Title
Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision
Authors
Lucy Yardley
Leanne G Morrison
Panayiota Andreou
Judith Joseph
Paul Little
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2010
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-10-52

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