Nijland Nicol, van Gemert-Pijnen Julia E W C, Kelders Saskia M, Brandenburg Bart J, Seydel Erwin R
Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, Netherlands.
J Med Internet Res. 2011 Sep 30;13(3):e71. doi: 10.2196/jmir.1603.
The take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups.
The aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes.
A mixed-methods research design was used for a process analysis of the actual usage of the Web application over a 2-year period and to identify user profiles. Research instruments included log files, interviews, usability tests, and a survey.
The DiabetesCoach was predominantly used for interactive features like online monitoring, personal data, and patient-nurse email contact. It was the continuous, personal feedback that particularly appealed to the patients; they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. Despite the positive outcomes, usage of the Web application was hindered by low enrollment and nonusage attrition. The main barrier to enrollment had to do with a lack of access to the Internet (146/226, 65%). Although 68% (34/50) of the enrollees were continuous users, of whom 32% (16/50) could be defined as hardcore users (highly active), the remaining 32% (16/50) did not continue using the Web application for the full duration of the study period. Barriers to long-term use were primarily due to poor user-friendliness of the Web application (the absence of "push" factors or reminders) and selection of the "wrong" users; the well-regulated patients were not the ones who could benefit the most from system use because of a ceiling effect. Patients with a greater need for care seemed to be more engaged in long-term use; highly active users were significantly more often medication users than low/inactive users (P = .005) and had a longer diabetes duration (P = .03).
Innovations in health care will diffuse more rapidly when technology is employed that is simple to use and has applicable components for interactivity. This would foresee the patients' need for continuous and personalized feedback, in particular for patients with a greater need for care. From this study several factors appear to influence increased use of eHealth technologies: (1) avoiding selective enrollment, (2) making use of participatory design methods, and (3) developing push factors for persistence. Further research should focus on the causal relationship between using the system's features and actual usage, as such a view would provide important evidence on how specific technology features can engage and captivate users.
总体而言，电子健康应用的使用率仍然较低，用户流失率往往较高。关于特定患者群体中电子健康技术的使用情况，仅有有限的信息。
本研究旨在探讨影响基于网络的应用程序（糖尿病教练）初始和长期使用的因素，该应用程序用于支持2型糖尿病患者的自我护理。
采用混合方法研究设计，对该网络应用程序在2年期间的实际使用情况进行过程分析，并确定用户特征。研究工具包括日志文件、访谈、可用性测试和一项调查。
糖尿病教练主要用于在线监测、个人数据和患者与护士电子邮件联系等交互功能。持续的个人反馈尤其吸引患者；他们感觉护士对他们的监测更密切，并鼓励他们在疾病自我管理中发挥更积极的作用。尽管取得了积极成果，但网络应用程序的使用受到低注册率和未使用流失的阻碍。注册的主要障碍与无法访问互联网有关（146/226，65%）。尽管68%（34/50）的注册用户是持续用户，其中32%（16/50）可被定义为核心用户（高度活跃），但其余32%（16/50）在研究期间未持续使用该网络应用程序。长期使用的障碍主要是由于网络应用程序用户友好性差（缺乏“推动”因素或提醒）以及选择了“错误”的用户；病情控制良好的患者并非因天花板效应而能从系统使用中获益最多的人群。护理需求较大的患者似乎更愿意长期使用；高度活跃的用户使用药物的频率明显高于低活跃/不活跃用户（P = 0.005），且糖尿病病程更长（P = 0.03）。
当采用易于使用且具有交互性适用组件的技术时，医疗保健领域的创新将传播得更快。这将预见患者对持续和个性化反馈的需求，特别是对于护理需求较大的患者。从本研究来看，有几个因素似乎会影响电子健康技术使用的增加：（1）避免选择性注册，（2）采用参与式设计方法，（3）开发促进持续使用的推动因素。进一步的研究应关注使用系统功能与实际使用之间的因果关系，因为这样的观点将为特定技术功能如何吸引和留住用户提供重要证据。
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