| Date post: | 01-Jul-2015 |
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Nicol Nijland, PhD, University of Twente
Bart Brandenburg, MD, Medicinfo
Lisette van Gemert-Pijnen, PhD, University of Twente
Medicine 2.0’10, 29-30 Nov, Maastricht, the Netherlands
Factors influencing the long-term useof a web-based disease management program for self-care
support of patients with diabetes type 2
Research focus
The Diabetescoach
onlinesupport
10-08-2010 01-01-2007
The “Who”
(0)0Diet & insulin
(0)0Diet, tablets & insulin
(86)37Diet & tablets
(9)4Diet(5)2No treatmentDiabetes treatment (n = 43)(33)14>7 years
(38)163-6 years(29)120-2 yearDiabetes duration (n = 42)(0)0Poor
(28)12Fair
(58)25Good
(14)6Very good(0)0ExcellentHealth status (n = 43)(37)16High
(51)22Medium(12)5Low Education (n = 43)(%)nCharacteristics
Statement 1: Motivate the unmotivated
eHealth technologies (eHts) will have most effect on unmotivated & unhealthy care consumers
We need to find ways to reach people who need eHtsthe most; those with the greatest need for care
The “What”
35,2%
26,2%
23,2%
7,5%
5,3%
2,5%
1,7%Printing feature
Personal li festyle coach
Calendar
Online education
E-mail contact
Personal data
Online monitoring
Mai
n fe
atur
es o
f the
web
app
licat
ion
Total hits (n = 6289)
Email message content
(5.2)(7.7)(6.2)Otherj
(6.2)(4.6)(5.6)Current eventsi
(4.1)(10.8)(6.2)Lifestyle supporth
(10.9)(2.3)(7.4)Use of DiabetesCoach functionalitiesg
(5.2)(14.6)(9.0)Physical symptomsf
(16.1)(9.2)(13.0)Medication usee
(10.9)(21.5)(15.2)DiabetesCoach remarksd
(32.6)(29.2)(30.7)Affective communicationc
(39.9)(19.2)(31.3)Administrative communicationb
(33.2)(32.3)(32.2)Measurementsa
(%)(%)(%)Content categories
StatementsStatementsStatements
(n = 193)(n = 130)(n = 323)
Nurses’ messagesPatients’ messagesTotal messages
Top 3
Patients’ messages
My blood sugar has been a bit higher these days. Do you think we should do something?
At least I am relieved that it has nothing to do with my diabetes!
I would like to reschedule our appointment
monitoring
affective
administrative
Nurses’ messages
Unfortunately, I will not be present at the practice next week.
Weight and blood pressure look great! Keep going on!
How are you? Take care
monitoring
affective
administrative
Statement 2: Dialogue support
Technology use (adherence) will be enhanced through dialogue support
More research is needed on which type of dialogue support
works best for whom…
- patients with short-term vs. long-term care needs
- purpose of the communication: task-focused vs. affective
Long-term use
0
10
20
30
40
50
60
07/0
7
08/0
7
09/0
7
10/0
7
11/0
7
12/0
7
01/0
8
02/0
8
03/0
8
04/0
8
05/0
8
06/0
8
07/0
8
08/0
8
09/0
8
10/0
8
11/0
8
12/0
8
01/0
9
02/0
9
03/0
9
04/0
9
05/0
9
06/0
9
Mea
n nu
mbe
r of h
its
Practice 1 (n=19) Practice 2 (n=24) Practice 3 (n=7) Average practices (n=50)
Barriers to long-term use:
§ Lack of push factors
§ Usability problems
§ Ceiling effect
Statement 3: Fixed vs. free use
The effects of technology use will be stronger…
….on patients who log-in every month (fixed use)
….than on patients who log on only once in a while (free use)
Highly activeFreq. log-ins: 45-191
Low activeFreq. log-ins: 10-96
InactiveFreq. log-ins: 0-56
Usage profiles
Hardcore users vs. nonusage dropouts
DiabetesCoach Enrollees(n = 50)
Continuous users
68%Discontinued users
32%
Low active users
38%
Dropouts 32%
Hardcore users 30%
Statement 4: Methods
Most attrition measures perform survival analysis, like Kaplan Meier (cut-off measure). However, such measures could not be used in our study because they only provide insights into…
the drop in usage and not in the pattern of usage
Cut-off measures are not adequate with free-to-use technologies
