Nordqvist Cecilia, Hanberger Lena, Timpka Toomas, Nordfeldt Sam
Department of Medical and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
J Med Internet Res. 2009 Apr 6;11(2):e12. doi: 10.2196/jmir.1152.
The Internet, created and maintained in part by third-party apomediation, has become a dynamic resource for living with a chronic disease. Modern management of type 1 diabetes requires continuous support and problem-based learning, but few pediatric clinics offer Web 2.0 resources to patients as part of routine diabetes care.
To explore pediatric practitioners' attitudes towards the introduction of a local Web portal for providing young type 1 diabetes patients with interactive pedagogic devices, social networking tools, and locally produced self-care and treatment information. Opportunities and barriers related to the introduction of such systems into clinical practice were sought.
Twenty clinicians (seven doctors, nine nurses, two dieticians, and two social welfare officers) from two pediatric diabetes teams participated in the user-centered design of a local Web 2.0 portal. After completion of the design, individual semi-structured interviews were performed and data were analyzed using phenomenological methods.
The practitioners reported a range of positive attitudes towards the introduction of a local Web 2.0 portal to their clinical practice. Most interviewees were satisfied with how the portal turned out, and a sense of community emerged during the design process and development of the portal's contents. A complementary role was suggested for the portal within the context of health practice culture, where patients and their parents would be able to learn about the disease before, between, and after scheduled contacts with their health care team. Although some professionals expected that email communication with patients and online patient information would save time during routine care, others emphasized the importance of also maintaining face-to-face communication. Online peer-to-peer communication was regarded as a valuable function; however, most clinicians did not expect that the portal would be used extensively for social networking amongst their patients. There were no major differences in attitudes between different professions or clinics, but some differences appeared in relation to work tasks.
Experienced clinical practitioners working in diabetes teams exhibited positive attitudes towards a Web 2.0 portal tailored for young patients with type 1 diabetes and their parents. The portal included provision of third-party information, as well as practical and social means of support. The practitioners' early and active participation provides a possible explanation for these positive attitudes. The findings encourage close collaboration with all user groups when implementing Web 2.0 systems for the care of young patients with chronic diseases, particularly type 1 diabetes. The study also highlights the need for efforts to educate clinical practitioners in the use of Web publishing, social networking, and other Web 2.0 resources. Investigations of attitudes towards implementing similar systems in the care of adults with chronic diseases are warranted.
互联网部分由第三方中介创建和维护，已成为慢性病患者生活的动态资源。1型糖尿病的现代管理需要持续支持和基于问题的学习，但很少有儿科诊所将Web 2.0资源作为常规糖尿病护理的一部分提供给患者。
探讨儿科医生对引入本地门户网站的态度，该门户网站为1型糖尿病青少年患者提供交互式教学设备、社交网络工具以及本地制作的自我护理和治疗信息。寻找将此类系统引入临床实践的机会和障碍。
来自两个儿科糖尿病团队的20名临床医生（7名医生、9名护士、2名营养师和2名社会福利官员）参与了本地Web 2.0门户网站的以用户为中心的设计。设计完成后，进行了个人半结构化访谈，并使用现象学方法对数据进行了分析。
医生们对将本地Web 2.0门户网站引入他们的临床实践表现出一系列积极态度。大多数受访者对门户网站的最终效果感到满意，并且在门户网站内容的设计过程和开发过程中形成了一种社区感。有人建议该门户网站在健康实践文化背景下发挥补充作用，患者及其父母可以在与医疗团队定期接触之前、期间和之后了解该疾病。虽然一些专业人员预计与患者的电子邮件通信和在线患者信息将在常规护理中节省时间，但其他人强调保持面对面沟通的重要性。在线点对点通信被视为一项有价值的功能；然而，大多数临床医生预计该门户网站不会被患者广泛用于社交网络。不同专业或诊所之间的态度没有重大差异，但在工作任务方面存在一些差异。
在糖尿病团队工作的经验丰富的临床医生对为1型糖尿病青少年患者及其父母量身定制的Web 2.0门户网站表现出积极态度。该门户网站包括提供第三方信息以及实际和社会支持手段。医生的早期积极参与为这些积极态度提供了一种可能的解释。研究结果鼓励在为慢性病青少年患者，特别是1型糖尿病患者实施Web 2.0系统时，与所有用户群体密切合作。该研究还强调了努力对临床医生进行Web发布、社交网络和其他Web 2.0资源使用教育的必要性。有必要对在慢性病成年患者护理中实施类似系统的态度进行调查。
