Børøsund Elin, Cvancarova Milada, Ekstedt Mirjam, Moore Shirley M, Ruland Cornelia M
Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo 0424, Norway.
J Med Internet Res. 2013 Mar 1;15(3):e34. doi: 10.2196/jmir.2285.
Frequently eHealth applications are not used as intended and they have high attrition rates; therefore, a better understanding of patients' need for support is warranted. Specifically, more research is needed to identify which system components target different patient groups and under what conditions.
To explore user characteristics associated with the use of different system components of a Web-based illness management support system for cancer patients (WebChoice).
For this secondary post hoc analysis of a large randomized controlled trial (RCT), in which WebChoice was tested among 325 breast cancer and prostate cancer patients who were followed with repeated measures for 1 year, usage patterns of 162 cancer patients in the intervention arm with access to WebChoice were extracted from the user log. Logistic regression was performed to identify patterns of associations between system use and patient characteristics. Latent class analyses (LCA) were performed to identify associations among the use of different system components and levels of social support, symptom distress, depression, self-efficacy, and health-related quality of life.
Approximately two-thirds (103/162, 63.6%) of the patients logged on to WebChoice more than once, and were defined as users. A high level of computer experience (odds ratio [OR] 3.77, 95% CI 1.20-11.91) and not having other illnesses in addition to cancer (OR 2.10, 95% CI 1.02-4.34) increased the overall probability of using WebChoice. LCA showed that both men with prostate cancer and women with breast cancer who had low scores on social support accompanied with high levels of symptom distress and high levels of depression were more likely to use the e-message component. For men with prostate cancer, these variables were also associated with high use of the self-management advice component. We found important differences between men with prostate cancer and women with breast cancer when associations between WebChoice use and each user characteristic were analyzed separately. High use of all components was associated with low levels of social support among women with breast cancer, but not among men with prostate cancer. High use of e-messages, advice, and the discussion forum were associated with high levels of depression among women with breast cancer, but not among men with prostate cancer. For men with prostate cancer (but not women with breast cancer), high use of symptom assessments, advice, and the discussion forum were associated with high levels of symptom distress. However, it is unclear whether these findings can be attributed to differences related to diagnosis, gender, or both.
This study provides evidence that different user characteristics are associated with different use patterns. Such information is crucial to target Web-based support systems to different patient groups. LCA is a useful technique to identify subgroups of users. In our study, e-messages and self-management advice were highly used components for patients who had low levels of social support and high illness burden, suggesting that patients with these characteristics may find such tools particularly useful.
ClinicalTrials.gov NCT00710658; http://clinicaltrials.gov/ct2/show/NCT00710658 (Archived by WebCite at http://www.webcitation.org/6EmEWZiwz).
电子健康应用程序常常未按预期使用，且流失率很高；因此，有必要更好地了解患者对支持的需求。具体而言，需要更多研究来确定哪些系统组件针对不同患者群体以及在何种条件下适用。
探讨与基于网络的癌症患者疾病管理支持系统（WebChoice）不同系统组件使用相关的用户特征。
对于这项大型随机对照试验（RCT）的二次事后分析，在325名乳腺癌和前列腺癌患者中对WebChoice进行了测试，并对其进行了为期1年的重复测量跟踪，从用户日志中提取了干预组中162名有权使用WebChoice的癌症患者的使用模式。进行逻辑回归以确定系统使用与患者特征之间的关联模式。进行潜在类别分析（LCA）以确定不同系统组件的使用与社会支持水平、症状困扰、抑郁、自我效能感以及健康相关生活质量之间的关联。
约三分之二（103/162，63.6%）的患者多次登录WebChoice，被定义为用户。高水平的计算机经验（优势比[OR] 3.77，95%置信区间1.20 - 11.91）以及除癌症外没有其他疾病（OR 2.10，95%置信区间1.02 - 4.34）增加了使用WebChoice的总体概率。LCA显示，社会支持得分低、症状困扰水平高且抑郁水平高的前列腺癌男性和乳腺癌女性更有可能使用电子信息组件。对于前列腺癌男性，这些变量也与自我管理建议组件的高使用率相关。当分别分析WebChoice使用与每个用户特征之间的关联时，我们发现前列腺癌男性和乳腺癌女性之间存在重要差异。乳腺癌女性中所有组件的高使用率与低社会支持水平相关，但前列腺癌男性并非如此。乳腺癌女性中电子信息、建议和讨论论坛的高使用率与高抑郁水平相关，但前列腺癌男性并非如此。对于前列腺癌男性（而非乳腺癌女性），症状评估、建议和讨论论坛的高使用率与高症状困扰水平相关。然而，尚不清楚这些发现是否可归因于与诊断、性别或两者相关的差异。
本研究提供了证据表明不同的用户特征与不同的使用模式相关。此类信息对于将基于网络的支持系统针对不同患者群体至关重要。LCA是识别用户亚组的有用技术。在我们的研究中，电子信息和自我管理建议是社会支持水平低且疾病负担高的患者高度使用的组件，这表明具有这些特征的患者可能会发现此类工具特别有用。
ClinicalTrials.gov NCT00710658；http://clinicaltrials.gov/ct2/show/NCT00710658（由WebCite存档于http://www.webcitation.org/6EmEWZiwz）。
