Patient Readiness to Use Internet Health Resources (Missouri)

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Summary:

The use of the Internet to find health information has increased with the proliferation of online and mobile tools and interventions designed to assist a user in lifestyle changes and chronic disease self-management. However, these tools are only helpful if patients are ready to use them, meaning that they have both the aptitude and readiness to utilize the resources. The ability to assess this in potential users may help developers and researchers design and investigate the utility of these tools.

This project developed the Patient Readiness to Engage in Health Information Technology Scale (PRE-HIT). The tool allows the examination of preferences for use of Web-based health resources among ambulatory patients who have chronic diseases such as diabetes, hypertension, and heart disease. In addition to evaluating computer skills and media literacy, PRE-HIT examines factors such as motivation, information needs, and privacy concerns. The final tool contains 28 questions covering eight subscales: 1) health information need; 2) computer/Internet experience; 3) computer anxiety; 4) preferred mode of interaction; 5) relationship with doctor; 6) cell phone expertise; 7) Internet privacy; and 8) ‘no news is good news.’ PRE-HIT was designed to identify those likely to enroll in and use electronic health resources, in particular patient portals.

The specific aims of this project were to:

  • Develop a measure of the readiness (aptitude and desire) of patients with chronic conditions attending primary care clinics to use Web-based health resources for health information exchange (PRE-HIT). 
  • Determine how the frequency and type of use of Web-based health resources are associated with improvements in clinical measures for patients with type 2 diabetes. 

Following a review of existing tools, focus groups and key informant interviews were conducted to better understand issues related to the use of technology. As a result, a tool with 53 questions was developed. This was validated with 200 patients who were 18 years and older and had at least one chronic condition. At 3 months, a quarter of the patients re-used the tool to assess its re-test reliability. The tool was further refined to create the final instrument, which underwent validation with 234 patients. A predictive validity test was conducted by directly observing search behaviors of 14 patients with diabetes. 

PRE-HIT was found to be a valid instrument for measuring how likely a patient with a chronic condition would be to use Web-based health resources. PRE-HIT scores were significantly associated with those who chose to use a patient portal and those who declined. There was no difference between users and non-users of the portal regarding health behaviors and status such as smoking, being overweight, and hazardous alcohol consumption. The instrument performed less well when assessing the search ability of patients with diabetes, possibly because this sub-study considered only the computer ability component of the eight PRE-HIT subscales.

Following development of new Internet and technology-based interventions there is frequently a need to enroll patients to test these tools. However, there is the recurring question of who to enroll, how to know if a participant is capable of using the technology, and how likely s/he is to use it. The PRE-HIT instrument can help researchers choose appropriate test participants. It can also assess a user’s readiness to use the technology and can therefore assist researchers’ statistical analyses of these tools.

Patient Readiness to Use Internet Health Resources - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 017948
  • Project Period: 
    March 2009 – February 2014
  • AHRQ Funding Amount: 
    $723,592
  • PDF Version: 
    (PDF, 259.97 KB)

Summary: As the burden of chronic disease increases, new approaches are needed to adequately care for people with chronic conditions. The Chronic Care Model suggests processes and systems that can help optimize the care of patients with chronic disease. It emphasizes patient self-activation because activated patients are prepared to take a collaborative, if not central, role in managing their own health. Online health resources could potentially provide a sustainable and patient-centered format for delivering the education, communication, and self-management resources needed to optimize patient activation.

This project is funded as a Career and Dissertation Award (K08), a funding mechanism used by AHRQ’s Health IT Portfolio to support the next generation of health-IT focused researchers. This particular project examines patient readiness, in terms of both aptitude and desire, to use Web-based health resources such as patient education, self-management tools, online prescription refills, requests, medication reconciliation, and secure messaging. The study looks at the relationship between motivation for behavioral change and the use of online health resources and interactive online communication between the patient and the health care team. The project team developed the Patient Readiness to Engage in Health Information Technology Scale (PRE-HIT), which it is using to examine the preferences for use of Web-based health resources among ambulatory patients with chronic disease. In doing so, this project will inform systems and policies that seek to use the online environment as part of a comprehensive disease- management strategy.

Specific Aims:

  • Develop a measure of the readiness (aptitude and desire) of patients with chronic conditions attending primary care clinics to use Web-based health resources for health information exchange. (PRE-HIT). (Achieved)
  • Determine how the frequency and type of use of Web-based health resources are associated with improvements in clinical measures for patients with type 2 diabetes. (Ongoing)

2012 Activities: The focus of activity was on finalizing PRE-HIT, which included 28 items clustered into eight factors, and completing the data extraction from a patient portal to compare usage data with the readiness scale. Data extraction is informing the patient validation of the instrument because usage data can be correlated with scores from the final scale.

Throughout the year, the study team encountered some technical glitches with the patient portal and heard from patients that the system was not working properly. As a result, Dr. Koopman suspended further large-scale recruitment to the study until the technical issues could be addressed. Meanwhile, the study team focused on writing a development paper that included a literature review, factor analysis, and qualitative research conducted to date. The paper has been submitted for publication. A focus of 2013 will be looking for new validation settings so that the study team can demonstrate predictive validity across different settings.

Preliminary Impact and Findings: Focus group findings indicated that promoters of online health resource use included speed, convenience, and the ability to look up information before a visit with a physician. Primary barriers to online health resource use included Internet security and privacy concerns. Some general conclusions drawn from the results are that the use of online information among patients with chronic conditions is an accessory to their relationship with their physician; that patients with less-established relationships may rely on the Internet more heavily; and that patients are using the Internet to enhance care by becoming more informed consumers, confirming the Chronic Care Model. These results were used to inform development of the scale to measure patient readiness to use Internet health resources.

Target Population: Adults, Chronic Care*, Diabetes

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations

Patient Readiness to Use Internet Health Resources - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 017948
  • Project Period: 
    March 2009 - February 2014
  • AHRQ Funding Amount: 
    $723,592
  • PDF Version: 
    (PDF, 185.78 KB)

Summary: As the burden of chronic disease increases in the United States and throughout the world, new approaches are needed to adequately care for people with chronic conditions. The Chronic Care Model suggests processes and systems that can help optimize the care of patients with chronic disease. It emphasizes patient self-activation because activated patients are prepared to take a collaborative, if not central, role in managing their own health. Online health resources could potentially provide a sustainable and patient-centered format for delivering the education, communication, and self-management resources needed to optimize patient activation. However, Web-based resources for chronically ill patients are only valuable if patients have the computer skills and motivation to use them.

This project examines patient readiness, in terms of both aptitude and desire, to use Web-based health resources such as patient education, self-management tools, online prescription refills, requests, medication reconciliation, and secure messaging. The study looks at the relationship between motivation for behavioral change and the use of online health resources and interactive online communication between the patient and the health care team. To help examine the question of patient readiness, the project team is developing a practical measure of the readiness of ambulatory patients with chronic conditions to use Web-based health resources. This examination of preferences for use of Web-based health resources among ambulatory patients with chronic disease will inform projects, systems, and policies that seek to use the online environment as part of a comprehensive disease management strategy.

Specific Aims:

  • Develop a measure of the readiness (aptitude and desire) of patients with chronic conditions attending primary care clinics to use Web-based health resources for health information exchange. This measure will be called the Electronic Health Information Exchange Readiness Scale (E-HIERS). (Achieved)
  • Determine how the frequency and type of use of Web-based health resources are associated with improvements in clinical measures for patients with type 2 diabetes. (Ongoing)

2011 Activities: Activities focused on study participant recruitment, data extraction from the patient portal (called IQ Health), factor analysis, and readiness scale development. Dr. Koopman began with an exploratory analysis on items and then looked at those items pre- and post-test. The feasibility testing for the scale included 50 items and the final scale included 28 items. Data extraction began and is informing the patient validation of the instrument because usage data can be correlated with scores from the final scale. Recruitment of participants was on target. The institutional review board has granted approval for the remaining study activities.

Preliminary Impact and Findings: Dr. Koopman developed a manuscript to be submitted based on the focus group findings from 2010, which indicated that promoters of online health resource use included speed, convenience, and the ability to look up information before a visit with a physician. Primary barriers to online health resource use included Internet security and privacy concerns. Some general conclusions drawn from the results are that the use of online information among patients with chronic conditions is an accessory to their relationship with their physician, that patients with less-established relationships may rely on the Internet more heavily, and that patients are using the Internet to enhance care by becoming more informed consumers, confirming the Chronic Care Model. These results were used to inform development of the scale to measure patient readiness to use Internet health resources.

Target Population: Adults, Chronic Care*, Diabetes

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Patient Readiness to Use Internet Health Resources - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 017948
  • Project Period: 
    March 2009 – February 2014
  • AHRQ Funding Amount: 
    $723,592
  • PDF Version: 
    (PDF, 318.4 KB)


Target Population: Adults, Chronic Care*, Diabetes

Summary: As the burden of chronic disease increases in the United States and throughout the world, new approaches are needed to adequately care for people with chronic conditions. The Chronic Care Model suggests processes and systems that can help optimize the care of patients with chronic disease. It emphasizes patient self-activation because activated patients are prepared to take a collaborative, if not central, role in managing their own health. Online health resources could potentially provide a sustainable and patient-centered format for delivering the education, communication, and self-management resources needed to optimize patient activation. However, Web-based resources for chronically ill patients are only valuable if patients have the computer skills and motivation to use them.

This project examines patient readiness, in terms of both aptitude and desire, to use Web-based health resources such as patient education, self-management tools, online prescription refills, requests, medication reconciliation, and secure messaging. The study looks at the relationship between motivation for behavioral change and the use of online health resources and interactive online communication between the patient and the health care team. To help examine the question of patient readiness, the project team is developing a practical measure of the readiness of ambulatory patients with chronic conditions to use Web-based health resources. The first aim of the study is to test the measure’s predictive validity against logs of actual use of Web-based health resources by such patients, and directly observe their use of these Web resources. The second aim is to examine how use of an interactive online patient portal is associated with improvements in clinical measures for patients with type 2 diabetes.

This examination of preferences for use of Web-based health resources among ambulatory patients with chronic disease will inform projects, systems, and policies that seek to use the online environment as part of a comprehensive disease management strategy.

Specific Aims:
  • To develop a measure of the readiness (aptitude and desire) of patients with chronic conditions attending primary care clinics to use Web-based health resources for health information exchange. This measure will be called the Electronic Health Information Exchange Readiness Scale (E-HIERS). (Ongoing)
  • To determine how the frequency and type of use of Web-based health resources are associated with improvements in clinical measures for patients with type 2 diabetes. (Upcoming)

In addition to the specific research project aims, Dr. Koopman, as part of her Mentored Clinical Scientist Research Career Development Award, has an overarching goal to improve the quality and safety of patient care for those with chronic conditions. This will be attained via the following short-term career goals: 1) to acquire expertise in scale development, such as the E-HIERS Scale; 2) to develop an understanding of the intersection of information and learning in health applications, focusing on both the human and technological dimensions; 3) to gain scientific and career guidance from local collaborators, advisors, and consultants; and 4) to acquire skills in leadership and management from professional development seminars and a longitudinal self-improvement plan developed in collaboration with a mentor.

2010 Activities: Activities primarily included the analysis of the focus group findings, using qualitative software to analyze responses, to inform development of the scale to measure patient readiness to use Internet health resources. The complete scale development, which is scheduled over a period of 2 to 3 years, has also been informed by a comprehensive literature review of validated items from previously published scales, all of which were examined in terms of risk perception, motivation, anxiety, and trust. Quantitative and qualitative evaluations will help to validate the scale. Feasibility testing of the scale began in November 2010, during which the questionnaire was administered in conjunction with a cognitive interview to help determine if any of the questions were confusing or misinterpreted. The questionnaire is divided into various sections related to computer use, familiarity with the Internet, e-mail use, and communication with their health care provider. The questions are grouped thematically but are aligned with themes found in the focus groups. Once feasibility testing is complete, the scale will be revised as necessary and administered to 200 participants.

Grantee’s Most Recent Self-Reported Quarterly Status (as of December 2010): The research team made significant progress this year. The recruitment goal of 15 participants in the feasibility testing phase is well within reach. Dr. Koopman reports that all project milestones were met on time and spending is roughly on target.

Preliminary Impact and Findings: Dr. Koopman is developing a manuscript based on the focus group findings, which indicated that promoters of online health resource use included speed, convenience, and the ability to look up information before a visit with a physician. Primary barriers to online health resource use included Internet security and privacy concerns. Some general conclusions drawn from the results are that the use of online information among patients with chronic conditions is an accessory to their relationship with their physician, that patients with less-established relationships may rely on the Internet more heavily, and that patients are using the Internet to enhance care by becoming more informed consumers, confirming the Chronic Care Model. These results were used to inform development of the scale to measure patient readiness to use Internet health resources.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Patient Readiness to Use Internet Health Resources - Final Report

Citation:
Koopman RJ. Patient Readiness to Use Internet Health Resources - Final Report. (Prepared by the University of Missouri - Columbia under Grant No. K08 HS017948). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 444.98 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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