Engelen Marscha, van Gaal Betsie, Vermeulen Hester, Zuidema Rixt, Bredie Sebastian, van Dulmen Sandra
IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.
School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands.
JMIR Hum Factors. 2022 Jul 1;9(3):e34925. doi: 10.2196/34925.
Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low.
This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not.
A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study.
This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). Patients with CVD with higher self-management and quality of life scores were less likely to use the program, whereas patients with RA with higher self-management and quality of life scores were more likely to use the program. Interviews with 10 nonusers, 10 low users, and 18 high users were analyzed to provide insight into the relationship between mechanisms and outcome. Program use was encouraged by an easy-to-use, clear, and transparent design and by recommendations from professionals and email reminders. A total of 5 BCTs were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior, delayed feedback, providing information on peer behavior, and modeling.
This realistic evaluation showed that certain patient, disease, and program characteristics (age, education, diagnosis, program design, type of reminder, and BCTs) are associated with the use of web-based self-management support programs. These results represent the first step in improving the tailoring of web-based self-management support programs. Future research on the interaction between patient and program characteristics should be conducted to improve the tailoring of participants to program components.
自我管理可以提高自我效能感和生活质量，并改善疾病预后。有效的自我管理还可能有助于减轻医疗保健系统的压力。然而，患者在应对疾病以及培养管理疾病后果和相关变化的技能方面需要支持。基于网络的自我管理支持项目已帮助患有心血管疾病（CVD）和类风湿关节炎（RA）的患者，但项目使用率较低。
本研究旨在确定决定患者是否使用基于网络的自我管理支持项目的患者、疾病和项目特征。
采用现实评估方法，全面概述背景（患者和疾病特征）、机制（项目特征）和结果（项目使用情况）。研究纳入了成年CVD患者（n = 101）和RA患者（n = 77）的二手数据。使用逻辑回归分析来分析背景（性别、年龄、教育程度、就业状况、生活状况、自我管理[使用患者激活量表 - 13进行测量]、生活质量[使用兰德36项健康调查进行测量]、互动效能[使用患者与医生互动中的5项感知效能进行测量]、诊断、身体合并症以及确诊后的时间）与结果（项目使用情况）之间的关系。通过定性访谈研究分析机制（项目设计、实施策略和行为改变技术[BCTs]）与结果之间的关系。
本研究纳入了68名基于网络的自我管理支持项目未使用者和111名使用者，其中56.4%（101/179）被诊断为CVD，43.6%（78/179）被诊断为RA。年龄较小和教育程度较低与项目使用有关。在项目使用与诊断以及4个生活质量子量表（社会功能、身体角色限制、活力和身体疼痛）之间发现了交互作用。自我管理和生活质量得分较高的CVD患者使用该项目的可能性较小，而自我管理和生活质量得分较高的RA患者使用该项目的可能性较大。对10名未使用者、10名低使用者和18名高使用者进行了访谈分析，以深入了解机制与结果之间的关系。易于使用、清晰透明的设计以及专业人员的推荐和电子邮件提醒促进了项目的使用。共确定了5种BCTs作为促进项目使用的潜在机制：量身定制的信息、自我报告行为、延迟反馈、提供同伴行为信息以及示范。
这项现实评估表明，某些患者、疾病和项目特征（年龄、教育程度、诊断、项目设计、提醒类型和BCTs）与基于网络的自我管理支持项目的使用有关。这些结果代表了改进基于网络的自我管理支持项目量身定制的第一步。未来应开展关于患者与项目特征之间相互作用的研究，以改善参与者与项目组成部分的匹配度。
