Armstrong Natalie, Hearnshaw Hilary, Powell John, Dale Jeremy
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
J Med Internet Res. 2007 Aug 9;9(3):e23. doi: 10.2196/jmir.9.3.e23.
The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based "virtual clinic," which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users.
The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management.
Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized.
Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described.
Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study.
互联网的发展为医疗保健服务创造了新机遇，包括将其用作辅助慢性病自我管理的工具。我们研究了利益相关者对基于互联网的“虚拟诊所”的反应，该虚拟诊所可让糖尿病患者与医疗服务提供者沟通、查找有关自身病情的信息，并与其他用户分享信息及获得支持。
本研究旨在呈现与各类利益相关者群体进行详细咨询的结果，以确定他们认为基于互联网的辅助糖尿病自我管理干预措施应具备的理想、重要且可行的特征。
对12名使用胰岛素泵的1型糖尿病患者进行了3次焦点小组访谈。参与者通过当地糖尿病诊所招募。对同一家诊所的5名医疗保健专业人员（2名医生、2名护士、1名营养师）以及1名胰岛素泵公司代表进行了一对一访谈。我们通过电子邮件收集了患者对用于其他慢性病（哮喘、癫痫、肌痛性脑脊髓炎、心理健康问题）的基于互联网系统的重要且有用功能的共识。组织了一次研讨会，以收集关于利用信息技术改善糖尿病青少年护理的专家共识。
利益相关者群体确定了基于互联网的虚拟诊所的以下重要特征：基于个人需求而非仅提供一般信息；具备与同龄人交流并向其学习的功能；提供糖尿病最新进展和新闻信息；快速且易于使用。本文结合相关文献综述对这些特征进行了讨论。描述了一个体现这些原则且基于自我效能理论的糖尿病虚拟诊所的开发情况。
在复杂干预措施的早期开发阶段，利益相关者的参与至关重要。利益相关者对虚拟诊所系统应提供的内容有清晰且相关的看法，并且这些看法能够相对轻松地被收集和综合。这项工作促成了一个能够满足用户需求的系统的设计，该系统目前正在一项试点研究中进行评估。
