Patient Readiness to Use Internet Health Resources

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.