Camerini Luca, Schulz Peter Johannes
Institute of Communication and Health, Faculty of Communication Sciences, Università della Svizzera italiana, Lugano, Switzerland.
J Med Internet Res. 2012 Jul 18;14(4):e105. doi: 10.2196/jmir.1953.
The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented. However, there is a need to understand not only whether eHealth interventions work, but also what kind of functions and mechanisms enhance their effectiveness. The present investigation contributes to tackling these challenges by investigating the role played by functional interactivity on patients' knowledge, empowerment, and health outcomes.
To test whether health knowledge and empowerment mediate a possible relationship between the availability of interactive features on an eHealth application and individuals' health outcomes. We present an empirical, model-driven evaluation of the effects of functional interactivity implemented in an eHealth application, based on a brief theoretical review of the constructs of interactivity, health knowledge, empowerment, and health outcomes. We merged these constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with fibromyalgia syndrome (FMS).
This study used a pretest-posttest experimental design. We recruited 165 patients and randomly assigned them to three study groups, corresponding to different levels of functional interactivity. Eligibility to participate in the study required that patients (1) be fluent in Italian, (2) have access to the Internet, (3) report confidence in how to use a computer, and (4) have received a diagnosis of FMS from a doctor. We used structural equation modeling techniques to analyze changes between the pretest and the posttest results.
The main finding was that functional interactivity had no impact on empowerment dimensions, nor direct observable effects on knowledge. However, knowledge positively affected health outcomes (b = -.12, P = .02), as did the empowerment dimensions of meaning (b = -.49, P < .001) and impact (b = -.25, P < .001).
The theoretical model was partially confirmed, but only as far as the effects of knowledge and empowerment were concerned. The differential effect of interactive functions was by far weaker than expected. The strong impact of knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by eHealth applications.
电子健康干预措施在覆盖面和效果方面的有效性现已得到充分证明。然而，不仅需要了解电子健康干预措施是否有效，还需要了解何种功能和机制能提高其有效性。本研究通过调查功能交互性在患者知识、赋权和健康结果方面所起的作用，为应对这些挑战做出了贡献。
测试健康知识和赋权是否介导电子健康应用程序上交互功能的可用性与个体健康结果之间的可能关系。基于对交互性、健康知识、赋权和健康结果等构念的简要理论回顾，我们对电子健康应用程序中实现的功能交互性的效果进行了实证的、模型驱动的评估。我们将这些构念整合到一个交互性效果的理论模型中，并在一个针对纤维肌痛综合征（FMS）患者的电子健康应用程序上进行了测试。
本研究采用前测-后测实验设计。我们招募了165名患者，并将他们随机分配到三个研究组，对应不同水平的功能交互性。参与研究的资格要求患者（1）意大利语流利，（2）能上网，（3）对如何使用计算机有信心，以及（4）已由医生确诊为FMS。我们使用结构方程建模技术分析前测和后测结果之间的变化。
主要发现是功能交互性对赋权维度没有影响，对知识也没有直接的可观察到的影响。然而，知识对健康结果有积极影响（b = -0.12，P = 0.02），意义维度的赋权（b = -0.49，P < 0.001）和影响维度的赋权（b = -0.25，P < 0.001）也有同样的效果。
理论模型得到了部分证实，但仅就知识和赋权的效果而言。交互功能的差异效应远低于预期。知识和赋权对健康结果的强烈影响表明，电子健康应用程序应针对并增强这些构念。
