Abstract
BackgroundChronic diseases contribute to 71% of deaths worldwide every year, and an estimated 15 million people between the ages of 30 and 69 years die mainly because of cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Web-based educational interventions may facilitate disease management. These are also considered to be a flexible and low-cost method to deliver tailored information to patients. Previous studies concluded that the implementation of different features and the degree of adherence to the intervention are key factors in determining the success of the intervention. However, limited research has been conducted to understand the acceptability of specific features and user adherence to self-guided web interventions.ObjectiveThis systematic review aims to understand how web-based intervention features are evaluated, to investigate their acceptability, and to describe how adherence to web-based self-guided interventions is defined and measured.MethodsStudies published on self-guided web-based educational interventions for people (≥14 years old) with chronic health conditions published between January 2005 and June 2020 were reviewed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement protocol. The search was performed using the PubMed, Cochrane Library, and EMBASE (Excerpta Medica dataBASE) databases; the reference lists of the selected articles were also reviewed. The comparison of the interventions and analysis of the features were based on the published content from the selected articles.ResultsA total of 20 studies were included. Seven principal features were identified, with goal setting, self-monitoring, and feedback being the most frequently used. The acceptability of the features was measured based on the comments collected from users, their association with clinical outcomes, or device adherence. The use of quizzes was positively reported by participants. Self-monitoring, goal setting, feedback, and discussion forums yielded mixed results. The negative acceptability was related to the choice of the discussion topic, lack of face-to-face contact, and technical issues. This review shows that the evaluation of adherence to educational interventions was inconsistent among the studies, limiting comparisons. A clear definition of adherence to an intervention is lacking.ConclusionsAlthough limited information was available, it appears that features related to interaction and personalization are important for improving clinical outcomes and users’ experience. When designing web-based interventions, the selection of features should be based on the targeted population’s needs, the balance between positive and negative impacts of having human involvement in the intervention, and the reduction of technical barriers. There is a lack of consensus on the method of evaluating adherence to an intervention. Both investigations of the acceptability features and adherence should be considered when designing and evaluating web-based interventions. A proof-of-concept or pilot study would be useful for establishing the required level of engagement needed to define adherence.
Highlights
BackgroundChronic diseases contribute to 71% of deaths worldwide every year, which corresponds to 41 million deaths per year
This review shows that the evaluation of adherence to educational interventions was inconsistent among the studies, limiting comparisons
These web-based interventions can be in a guided format by including features such as electronic counseling (e-counseling) and long-distance monitoring by health care professionals (HCPs) [10] or can be self-guided, defined in this paper as an absence of individual or face-to-face contact between health care professional Medical Subject Headings (MeSH) (HCP) and the users
Summary
BackgroundChronic diseases contribute to 71% of deaths worldwide every year, which corresponds to 41 million deaths per year. The use of information and communication technology for health-related purposes has the potential to mitigate these consequences by offering numerous benefits for disease management, such as facilitating access to health information and helping to increase the understanding of the disease [7] It is considered a flexible, low-cost method for patients to obtain information in comparison with face-to-face education sessions [8]. Previous studies have investigated the integration of various features (eg, reminders and opportunities for social support) and the design of these web-based interventions They concluded that the implementation of specific features and degree of adherence to the intervention are key factors in determining their success [11,12]. Limited research has been conducted to understand the acceptability of specific features and user adherence to self-guided web interventions
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