Campbell Robert J, Nolfi David A
Rangos School of Health Sciences, Department of Health Management Systems, Duquesne University, Pittsburgh, PA 15282, USA.
J Med Internet Res. 2005 Jun 30;7(2):e19. doi: 10.2196/jmir.7.2.e19.
Much has been written about the Internet's potential to revolutionize health care delivery. As younger populations increasingly utilize Internet-based health care information, it will be essential to ensure that the elderly become adept at using this medium for health care purposes, especially those from minority, low income, and limited educational backgrounds.
This paper presents the results of a program designed to teach elderly adults to use the Internet to access health care information. The objective was to examine whether the training led to changes in participant's perceptions of their health, perceptions of their interactions with health care providers, health information-seeking behaviors, and self-care activities.
Participants attended a 5-week training course held in public libraries and senior community centers within the greater Pittsburgh and Allegheny County region. Classes within each seminar lasted 2 hours and consisted of lecture and hands-on training. Baseline surveys were administered prior to the course, 5-week follow-up surveys were administered immediately after the course, and final surveys were mailed 1 year later. Instruments included the Multidimensional Health Locus of Control (MHLC) Scale, which measures three domains of locus of control (internal, external, and chance); the Krantz Health Opinion Survey (HOS); and the Lau, Hartman, and Ware Health Value Survey. Two additional questionnaires included multiple choice and qualitative questions designed to measure participants' Internet utilization and levels of health care participation. The Health Participation Survey was administered with the baseline survey. The Internet Use Survey was administered at the 1-year mark and contained several items from the Health Participation Survey, which allowed comparison between baseline and 1-year responses.
Of the60 elderly adults who began the training course, 42 (mean age 72) completed the entire 5-week training program and the 5-week follow-up questionnaire administered immediately after the program, and 27 completed the 1-year follow-up survey. Statistically significant differences were found between baseline and 5-week follow-up results for MHLC chance subscores in males (P = .02) and females (P = .05), as well as total HOS information seeking scores (P = .05). However, these statistically significant findings disappeared when all 60 original participants were included using a "last observation carried forward" imputation. No statistically significant changes were found between baseline and 5-week follow-up surveys for MHLC external (P = .44) and internal (P = .97) locus of control scores in both genders, or for the HOS behavioral involvement subscale (P = .65).
We failed to show robust before-after effects for most of the outcomes measured. Elderly adults may be willing to use the Internet as a source for general health information; however, when making decisions about their health care, our participants seemed to adhere to a physician-centered model of care. Demographic and situational variables may play a large role in determining which seniors will use the Internet for making behavioral decisions about their health care and in which scenarios they will do so.
关于互联网变革医疗服务的潜力，已有诸多论述。随着年轻人群越来越多地利用基于互联网的医疗信息，确保老年人，尤其是来自少数族裔、低收入和教育程度有限背景的老年人，能够熟练运用这一媒介实现医疗目的，将至关重要。
本文介绍了一项旨在教导老年人使用互联网获取医疗信息的项目成果。目的是检验该培训是否会导致参与者对自身健康的认知、对与医疗服务提供者互动的认知、健康信息寻求行为以及自我护理活动发生变化。
参与者参加了在匹兹堡和阿勒格尼县大区的公共图书馆和老年社区中心举办的为期5周的培训课程。每个研讨班的课程时长为2小时，包括讲座和实践培训。在课程开始前进行基线调查，课程结束后立即进行5周随访调查，1年后邮寄最终调查问卷。所使用的工具包括多维健康控制点（MHLC）量表，该量表测量控制点的三个维度（内控、外控和机遇）；克兰茨健康意见调查（HOS）；以及刘、哈特曼和韦尔健康价值调查。另外两份问卷包括多项选择题和定性问题，旨在测量参与者的互联网使用情况和医疗参与水平。健康参与调查与基线调查同时进行。互联网使用调查在1年时进行，包含了健康参与调查中的几个项目，以便比较基线和1年时的回答。
在开始培训课程的60名老年人中，42人（平均年龄72岁）完成了整个5周的培训项目以及项目结束后立即进行的5周随访问卷，27人完成了1年随访调查。在男性（P = 0.02）和女性（P = 0.05）的MHLC机遇子分数以及总HOS信息寻求分数（P = 0.05）方面，基线和5周随访结果之间发现了统计学上的显著差异。然而，当使用“末次观察结转”插补法将所有60名原始参与者纳入分析时，这些统计学上的显著发现消失了。在两性的MHLC外控（P = 0.44）和内控（P = 0.97）控制点分数方面，以及HOS行为参与子量表（P = 0.65）方面，基线和5周随访调查之间未发现统计学上的显著变化。
对于所测量的大多数结果，我们未能显示出明显的前后效应。老年人可能愿意将互联网作为一般健康信息的来源；然而，在做出关于自身医疗保健的决策时，我们的参与者似乎坚持以医生为中心的护理模式。人口统计学和情境变量可能在决定哪些老年人会使用互联网做出关于其医疗保健的行为决策以及在哪些情况下会这样做方面发挥很大作用。
