Interactive Health Communication Applications for people with chronic disease

 

Abstract

Background

Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based, information packages for patients that combine health information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain.

Objectives

To assess the effects of IHCAs for people with chronic disease.

Search methods

We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature; and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search time period commenced at 1990, where possible, and ran until 31 December 2003.

Selection criteria

Randomised controlled trials (RCTs) of IHCAs for adults and children with chronic disease.

Data collection and analysis

One review author screened abstracts for relevance. Two review authors screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios for binary outcomes; heterogeneity was assessed using the I² statistic.

Main results

We identified 24 RCTs involving 3739 participants which were included in the review.

IHCAs had a significant positive effect on knowledge (SMD 0.46; 95% confidence interval (CI) 0.22 to 0.69), social support (SMD 0.35; 95% CI 0.18 to 0.52) and clinical outcomes (SMD 0.18; 95% CI 0.01 to 0.35). Results suggest it is more likely than not that IHCAs have a positive effect on self-efficacy (a person's belief in their capacity to carry out a specific action) (SMD 0.24; 95% CI 0.00 to 0.48). IHCAs had a significant positive effect on continuous behavioural outcomes (SMD 0.20; 95% CI 0.01 to 0.40). Binary behavioural outcomes also showed a positive effect for IHCAs, although this result was not statistically significant (OR 1.66; 95% CI 0.71 to 3.87). It was not possible to determine the effects of IHCAs on emotional or economic outcomes.

Authors' conclusions

IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users. There is a need for more high quality studies with large sample sizes to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.

 

Plain language summary

Computer-based programmes ('Interactive Health Communication Applications') for people with chronic disease

People with chronic disease have multiple needs, including information about their illness and the various treatment options; social support; support with making decisions; and help with achieving behaviour change, for example, changes in diet or exercise. Computer-based programmes which combine health information with online peer support, decision support, or help with behaviour change may be one way of meeting these needs, and of helping people to achieve better health. This review sought to find out how such computer programmes, known as Interactive Health Communication Applications (IHCAs), might affect people with chronic disease. The review authors found that IHCAs improved users' knowledge, social support, health behaviours and clinical outcomes. It is also more likely than not that IHCAs improve users' self-efficacy (a person's belief in their capacity to carry out a specific action). It was not possible to determine whether IHCAs had any effect on emotional and economic outcomes. The included studies involved different IHCAs, with different characteristics, for a wide range of chronic diseases. There was variability in several of the outcomes, and the results should therefore be treated with some caution. There is a need for more large, high quality studies to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.

 

摘要

背景

給慢性疾病患者的互動式健康溝通軟體

互動式健康溝通軟體 (IHCAs) 使用電腦 (通常是透過網路), 提供資訊給病人之外,至少還提供社會支持,協助如何作決策或協助如何改變行為.這在醫療照護方面算是一種創新，但其健康效益尚未被確認.

目標

評估IHCAs對慢性病人的效果.

搜尋策略

我們設計的搜尋策略包含四部份:第一,我們搜尋電子文獻資料庫,以查詢所有發表文獻; 第二,我們搜尋灰文獻; 第三,我們在適當的資料庫中搜尋進行中和剛完成的臨床試驗試驗資料.最後,連絡納入試驗的作者和相關參考文獻列表. IHCAs需要比較先進的應用科技,故搜尋區間為1990年到2003年12月31日.

選擇標準

對有慢性疾病的成年人和孩童使用IHCAs的隨機對照試驗

資料收集與分析

一個檢閱者檢查所有摘要確定是否相關.兩個檢閱者檢閱所有可能試驗以確定符合條件可以納入,品質夠水準,然後擷取資料.連絡納入的臨床試驗作者以取得遺失資料.試驗結果用隨機效果模式合併分析,連續變數的統計量為標準化平均值差,二元變項的統計量為odds ratio;用I2統計量評估異質性.

主要結論

我們找到24個隨機對照試驗,包含3739位受試者. IHCAs對連續變項之行為結果變數有顯著正向效果:增加知識 (SMD 0.46; 95% confidence interval (CI) 0.22 to 0.69), 社會支持 (SMD 0.35; 95% CI 0.18 to 0.52), 臨床結果 (SMD 0.18; 95% CI 0.01 to 0.35). 本結果顯示IHCAs對個人效能 (對自己有能力進行某項行為的信心) 有正向效果 (SMD 0.24; 95% CI 0.00 to 0.48). IHCAs對持續性行為有顯著正向效果 (SMD 0.20; 95% CI 0.01 to 0.40). 對二元行為結果變數,則顯示沒有統計顯著的正向效果 (OR 1.66; 95% CI 0.71 to 3.87). 無法判斷IHCAs對情感和經濟結果變數的影響.

作者結論

IHCAs似乎對使用者有很大的正向效果, IHCAs使用者,和非使用者相比,傾向有比較多的知識,覺得得到比較多社會支持,行為與臨床結果有進步.需要更多高品質,大樣本的研究以確認這些先期發現.以確定什麼是使用IHCAs最好的方式,且了解IHCAs如何影響不同慢性病族群.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

慢性病病人有很多需要,需要疾病資訊,各種治療選擇資訊,社會支持資訊,協助決策資訊,改變行為的知識,例如飲食運動行為的改變.電腦程式結合健康資訊和線上同儕支持,決策支援或改變行為的協助,電腦程式語言是滿足病人需要的方式之一,希望幫助病人改善健康.本回顧希望找出電腦程式 (又稱互動式健康溝通軟體) 如何影響慢性病人.檢閱者發現IHCAs可改進使用者的知識,社會支援,健康行為和臨床結果. IHCAs對個人效果 (對自己有能力進行某項行為的信心) 有正向效果.無法判斷IHCAs對情感和經濟結果的影響. 納入的研究包含不同ICHAs,不同特質,不同慢性疾病.結果變數有一些變異性,故解釋結果時應小心.需要更大樣本,更高品質的試驗,以確定這些先期發現.更希望能進一步確定什麼IHCAs最好的呈現方式,和IHCAs如何影響不同慢性病族群.