van der Meij Eva, Huirne Judith Af, Ten Cate A Dorien, Stockmann Hein Bac, Scholten Piet C, Davids Paul Hp, Bonjer H Jaap, Anema Johannes R
Amsterdam Public Health Research Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands.
Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands.
J Med Internet Res. 2018 Jan 2;20(1):e1. doi: 10.2196/jmir.8338.
Electronic health (eHealth) interventions have proven effective, but implementation in clinical practice is difficult. More research focusing on the implementation process of eHealth interventions is necessary.
The objective of this study was to describe the process evaluation of a perioperative eHealth intervention, aiming to enhance recovery after laparoscopic abdominal surgery.
A process evaluation was carried out alongside a multicenter randomized controlled trial. Patients aged between 18 and 75 years who were scheduled for a laparoscopic cholecystectomy, hernia inguinal surgery, or laparoscopic adnexal surgery were included. The eHealth intervention comprised a website and mobile phone app with the possibility to develop a personalized convalescence plan, a section with information about the surgical procedure and the recovery period, the possibility to ask questions via an electronic consultation (eConsult), and an activity tracker. The process evaluation was carried out using the model of Linnan and Steckler, measuring components such as reach, dose delivered, dose received, fidelity, and participants' attitudes. Implementation scores were calculated based on the average of the four components. Quantitative data were collected by means of an electronic questionnaire, a logistic database, a weblog, and medical files. Qualitative data were collected by conducting interviews with a subsample of the study participants.
A total of 344 of the 863 eligible patients were included in the study, which accounted for a reach of 39.9%, and 173 participants were randomized to the intervention group. The implementation scores of the different functions of the intervention ranged between 60% and 65%. The website, mobile phone app, and activity tracker were rated 7.3 to 7.6 on a scale of 1 to 10. Almost all participants who were interviewed about the eConsult function rated it as being of additional value if combined with the usual care but not as a replacement for usual care.
Although participants were overall satisfied with the intervention, the implementation scores of the different functions of the intervention were fair. More research is needed to evaluate the barriers and facilitators for implementation of this perioperative eHealth intervention in normal practice outside study setting.
Netherlands Trial Registry NTR4699; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699 (Archived by WebCite at http://www.webcitation.org/6vr02V4KK).
电子健康（eHealth）干预已被证明是有效的，但在临床实践中的实施却很困难。需要更多聚焦于eHealth干预实施过程的研究。
本研究的目的是描述一项围手术期eHealth干预的过程评估，旨在促进腹腔镜腹部手术后的恢复。
在一项多中心随机对照试验的同时进行了过程评估。纳入年龄在18至75岁之间、计划进行腹腔镜胆囊切除术、腹股沟疝修补术或腹腔镜附件手术的患者。eHealth干预包括一个网站和一个手机应用程序，可制定个性化康复计划、一个包含手术过程和恢复期信息的板块、通过电子咨询（eConsult）提问的功能以及一个活动追踪器。过程评估采用Linnan和Steckler模型，测量诸如覆盖范围、提供的剂量、接受的剂量、保真度和参与者态度等要素。实施得分基于这四个要素的平均值计算得出。定量数据通过电子问卷、逻辑数据库、网络日志和医疗档案收集。定性数据通过对研究参与者的一个子样本进行访谈收集。
863名符合条件的患者中共有344名被纳入研究，覆盖范围为39.9%，173名参与者被随机分配到干预组。干预不同功能的实施得分在60%至65%之间。网站、手机应用程序和活动追踪器在1至10分的评分中得分为7.3至7.6。几乎所有接受关于eConsult功能访谈的参与者都认为，如果与常规护理相结合，它具有额外价值，但不能替代常规护理。
尽管参与者总体上对干预感到满意，但干预不同功能的实施得分一般。需要更多研究来评估在研究环境之外的正常实践中实施这种围手术期eHealth干预的障碍和促进因素。
荷兰试验注册中心NTR4699；http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699（由WebCite存档于http://www.webcitation.org/6vr02V4KK）
