Lygidakis Charilaos, Wallace Paul, Tersar Costanza, Marcatto Francesco, Ferrante Donatella, Della Vedova Roberto, Scafuri Francesca, Scafato Emanuele, Struzzo Pierluigi
Centro Studi e Ricerche in Medicina Generale (CSeRMEG), Monza, Italy.
JMIR Res Protoc. 2016 Mar 4;5(1):e36. doi: 10.2196/resprot.5232.
Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app.
We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module.
The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences.
Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance.
The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact.
Clinicaltrials.gov NCT 01638338; https://clinicaltrials.gov/ct2/show/NCT01638338 (Archived by WebCite at http://www.webcitation.org/6f0JLZMtq).
在初级卫生保健中实施的简短干预措施在减少过度饮酒方面是有效的；在线行为改变技术干预可能会有所帮助。医生可以通过帮助患者访问选定的网站（这一过程称为“便利访问”）来积极鼓励使用此类干预措施。尽管治疗工作联盟在面对面心理治疗取得积极成果方面发挥着重要作用，并且已证明其在网上发展是可行的，但关于其对简短干预措施影响的研究却很少。增强患者对医生认可网站的认知可能有助于在患者与应用程序之间建立有效的联盟。
在一项非劣效性随机对照试验中，作为实验性在线干预措施的一部分，我们描述了一种数字介导的个人医生形象的实施情况，以增强患者对一个戒酒网站的参与度。我们还报告了用户对该模块的反馈。
创建了“下载你的医生”模块，以模拟为在意大利弗留利-威尼斯-朱利亚地区进行的EFAR-FVG试验开发的戒酒网站的个人医生形象。该模块旨在增强治疗联盟，从而改善干预组（便利访问网站）的效果。参与的全科医生和家庭医生可以定制信息和视觉元素，并上传个人照片、签名和视频记录。为了评估医生的认知和态度，在试验开始3个月后进行了半结构化访谈。参与的患者在招募后12个月被邀请回答一份简短的在线问卷，以调查他们对在线体验的评价。
近四分之三（23/32，72%）接受访谈的医生选择使用提供的功能来定制与患者互动的内容，并认可在线工具的易用性。大多数医生（21/32，57%）至少定制了介绍性照片和视频。未定制内容的医生使用该工具的障碍包括时间限制、隐私担忧、使用工具困难以及认为该方法无用。超过一半（341/620，5" />
