Online Self-management Support Research Articles

A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing.

Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed "chapters"), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial.

A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT.

Relatives caring for people with severe mental health problems find information and emotional support hard to access. Online support for self-management offers a potential solution. The objective was to determine the clinical effectiveness and cost-effectiveness of an online supported self-management tool for relatives: the Relatives' Education And Coping Toolkit (REACT). This was a primarily online (UK), single-blind, randomised controlled trial, comparing REACT plus a resource directory and treatment as usual with the resource directory and treatment as usual only, by measuring user distress and other well-being measures at baseline and at 12 and 24 weeks. A total of 800 relatives of people with severe mental health problems across the UK took part; relatives who were aged ≥ 16 years, were experiencing high levels of distress, had access to the internet and were actively seeking help were recruited. REACT comprised 12 psychoeducation modules, peer support through a group forum, confidential messaging and a comprehensive resource directory of national support. Trained relatives moderated the forum and responded to messages. The main outcome was the level of participants' distress, as measured by the General Health Questionnaire-28 items. Various online and offline strategies, including social media, directed potential participants to the website. Participants were randomised to one of two arms: REACT plus the resource directory (n = 399) or the resource directory only (n = 401). Retention at 24 weeks was 75% (REACT arm, n = 292; resource directory-only arm, n = 307). The mean scores for the General Health Questionnaire-28 items reduced substantially across both arms over 24 weeks, from 40.2 (standard deviation 14.3) to 30.5 (standard deviation 15.6), with no significant difference between arms (mean difference -1.39, 95% confidence interval -3.60 to 0.83; p = 0.22). At 12 weeks, the General Health Questionnaire-28 items scores were lower in the REACT arm than in the resource directory-only arm (-2.08, 95% confidence interval -4.14 to -0.03; p = 0.027), but this finding is likely to be of limited clinical significance. Accounting for missing data, which were associated with higher distress in the REACT arm (0.33, 95% confidence interval -0.27 to 0.93; p = 0.279), in a longitudinal model, there was no significant difference between arms over 24 weeks (-0.56, 95% confidence interval -2.34 to 1.22; p = 0.51). REACT cost £142.95 per participant to design and deliver (£62.27 for delivery only), compared with £0.84 for the resource directory only. A health economic analysis of NHS, health and Personal Social Services outcomes found that REACT has higher costs (£286.77), slightly better General Health Questionnaire-28 items scores (incremental General Health Questionnaire-28 items score adjusted for baseline, age and gender: -1.152, 95% confidence interval -3.370 to 1.065) and slightly lower quality-adjusted life-year gains than the resource directory only; none of these differences was statistically significant. The median time spent online was 50.8 minutes (interquartile range 12.4-172.1 minutes) for REACT, with no significant association with outcome. Participants reported finding REACT a safe, confidential environment (96%) and reported feeling supported by the forum (89%) and the REACT supporters (86%). No serious adverse events were reported. The sample comprised predominantly white British females, 25% of participants were lost to follow-up and dropout in the REACT arm was not random. An online self-management support toolkit with a moderated group forum is acceptable to relatives and, compared with face-to-face programmes, offers inexpensive, safe delivery of National Institute for Health and Care Excellence-recommended support to engage relatives as peers in care delivery. However, currently, REACT plus the resource directory is no more effective at reducing relatives' distress than the resource directory only. Further research in improving the effectiveness of online carer support interventions is required. Current Controlled Trials ISRCTN72019945. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 32. See the NIHR Journals Library website for further project information.

Online Self-Management Support for Family Caregivers Dealing With Behavior Changes in Relatives With Dementia (Part 2): Randomized Controlled Trial.

BackgroundOnline contacts with a health professional have the potential to support family caregivers of people with dementia.ObjectiveThe goal of the research was to study the effects of an online self-management support intervention in helping family caregivers deal with behavior changes of a relative with dementia. The intervention—involving among others personal email contacts with a dementia nurse—was compared with online interventions without these email contacts.MethodsA randomized controlled trial was conducted with 81 family caregivers of people with dementia who live at home. Participants were randomly assigned to a (1) major self-management support intervention consisting of personal email contacts with a specialist dementia nurse, online videos, and e-bulletins; (2) medium intervention consisting only of online videos and e-bulletins; or (3) minor intervention consisting of only the e-bulletins. The primary outcome was family caregivers’ self-efficacy in dealing with behavior changes of the relative with dementia. Secondary outcomes were family caregivers’ reports of behavior problems in the people with dementia and the quality of the relationship between the family caregiver and the person with dementia. Measurements were performed at the baseline and at 6 (T1) and 12 weeks (T2) after the baseline. A mixed-model analysis was conducted to compare the outcomes of the 3 intervention arms.ResultsFamily caregivers participating in the major intervention involving email contacts showed no statistically significant differences in self-efficacy after the intervention compared with the minor intervention involving only e-bulletins (difference –0.02, P=.99). In the adjusted analysis, the medium intervention (involving videos and e-bulletins) showed a negative trend over time (difference –4.21, P=.09) and at T1 (difference –4.71, P=.07) compared with the minor intervention involving only e-bulletins. No statistical differences were found between the intervention arms in terms of the reported behavior problems and the quality of the relationship between the family caregiver and the person with dementia.ConclusionsThe expectation that an online self-management support intervention involving email contacts would lead to positive effects and be more effective than online interventions without personal email contacts was not borne out. One explanation might be related to the fact that not all family caregivers who were assigned to that intervention actually made use of the opportunity for personal email contact. The online videos were also not always viewed. To obtain more definite conclusions, future research involving extra efforts to reach higher use rates is required.Trial RegistrationNetherlands Trial Registry NTR6237; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6237 (Archived by WebCite at http://www.webcitation.org/6v0S4fxTC)International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8365

Mining Twitter to Inform the Design of Online Interventions for Hispanic Alzheimer's Disease and Related Dementias Caregivers.

Hispanics are about 1.5 times as likely as non-Hispanic Whites to experience Alzheimer's disease and related dementias (AD/ADRD). Eight percent of AD/ADRD caregivers are Hispanics. The purpose of this article is to provide a methodological case study of using data mining methods and the Twitter platform to inform online self-management and social support intervention design and evaluation for Hispanic AD/ADRD caregivers. It will enable other researchers to replicate the methods for their phenomena of interest. We extracted an analytic corpus of 317,658 English and Spanish tweets, applied content mining (topic models) and network structure analysis (macro-, meso-, and micro-levels) methods, and created visualizations of results. The topic models showed differences in content between English and Spanish tweet corpora and between years analyzed. Our methods detected significant structural changes between years including increases in network size and subgroups, decrease in proportion of isolates, and increase in proportion of triads of the balanced communication type. Each analysis revealed key lessons that informed the design and/or evaluation of online self-management and social support interventions for Hispanic AD/ADRD caregivers. These lessons are relevant to others wishing to use Twitter to characterize a particular phenomenon or as an intervention platform.

Process Evaluation of Nurse-Led Online Self-Management Support for Family Caregivers to Deal With Behavior Changes of a Relative With Dementia (Part 1): Mixed Methods Study.

BackgroundCoping with behavioral changes is a daily challenge for family caregivers in all phases of dementia, and assistance is needed for it. An online self-management support intervention was therefore developed and conducted involving the following elements: (1) email contact with a specialized dementia nurse, (2) online videos, and (3) e-bulletins containing information about behavior changes and how to manage them.ObjectiveThe aim of this study was to understand (1) family caregivers’ actual use of various elements of the online self-management support, (2) family caregivers’ evaluation and satisfaction with the various elements, and (3) nurses’ usage and evaluations of the online support through the tailored email contacts.MethodsA mixed methods design was used in this process evaluation, combining quantitative and qualitative methods including analyses of dementia nurses’ registration forms, the number of clicks on online videos and e-bulletins, evaluation questions answered by family caregivers in a survey questionnaire, semistructured interviews with family caregivers and nurses, and analysis of the content of the email contacts.ResultsThe actual use of various elements of the online self-management support by family caregivers varied: 78% (21/27) of family caregivers had an email contact with the specialist nurse, 80% (43/54) of family caregivers clicked on an online video, and 37% (30/81) clicked on an e-bulletin. Family caregivers showed positive evaluations and satisfaction. The tailor-made approach in the personal email contacts in particular was valued by the family caregivers. Nurses’ evaluations about providing self-management support online were mixed as it was a relatively new task for them.ConclusionsAn important insight is that not all participants made optimum use of the various elements of the intervention. Nurses also said that the email contacts were more often used to express feelings about coping with behavioral changes. More research is needed to investigate the reasons why people accept, adopt, and adhere to online interventions to reduce cases where they are not used and to back them up appropriately with tailored (online) information and advice for their personal situations.

1301-P: An Analysis of Correlative Factors of HbA1c Achieving Rate in Follow-Up Cohort of Internet plus Diabetes Shared Care Clinic

Objectives: Our study aimed to investigate the correlative factors of HbA1c achieving rate in diabetic patients followed-up in Internet plus Diabetes Shared Care Clinic (IDSCC) in General Hospital. Methods: Patients who were regularly followed-up in IDSCC were enrolled in the study from Oct. 2016. Up to Dec. 2018, demographic data of patients, HbA1c of each follow-up, diabetic medication and education power during online and offline follow-ups were recorded. Patients were divided into two groups according to whether HbA1c achieve target (<7%) or not at the last follow-up. Logistic regression analysis was performed to analyze covariates of HbA1c at last follow-up, including age, diabetic duration (<5 years, 5-10 years, 10-15 years, >15 years), gender, baseline HbA1c, insulin usage, self-monitoring of pre-meal and postprandial glucose (none, <=1 pair per week, >1 pair per week), intensity of offline support and exposure of online support. Results: 515 patients were enrolled. Shorter diabetic duration (OR=2.64, p=0.005), no usage of insulin (OR=3.83, p<0.0001), achieving HbA1c target at first visit (OR=7.94, p<0.0001) and higher exposure of online support (OR=1.84, p=0.009) were positively correlated to better HbA1c achieving rate. Conclusions: Higher online self-management support (over 41.9 min/quarter) could bring better HbA1c achieving rate for diabetic patients in IDSCC. Disclosure A. Li: None. X. Yuan: None. L. Lin: None. D. Lu: None. D. Zhang: None. Y. Sun: None. J. Li: None. L. Jing: None. Y. Wang: Employee; Self; iHealth Labs Inc. X. Guo: None. J. Zhang: None.

The role of support and sustainability elements in the adoption of an online self-management support system for chronic illnesses.

The direct cost of treating chronic disease in Canada has risen to an average of 58% of healthcare spending. Thus, more attention is being directed to technologically supported health self-management and lifestyle change, to help patients mitigate and manage their own conditions. This study investigates how support elements (decision support and education) and sustainability elements (rewards systems), can help to motivate patients to adopt proposed technologies. A proposed model was tested using data collected from two potential user groups: 198 online and 83 in-person, using an identical survey. Although the system was built and ready to use at the time this study was conducted, in order to keep the experience of both groups identical, a video simulation (of the system) was used to familiarize both groups of users with the system. The study reveals that: individual perceptions on usability, ease of use, and hedonic motivation were influenced by the proposed support elements. Support elements enhance user perceptions of usability and ease of use, while sustainability elements positively affect user motivations, thus encouraging their decisions to adopt and use the technology. The study implies that, for better success at helping patients to self-manage their health, special attention should be paid to support and sustainability elements.

Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators.

Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9; 95% CI -2.55, 114.25; P = 0.06). Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.

The systematic development of a complex intervention: HealthMap, an online self-management support program for people with HIV

BackgroundDespite persistent calls for HIV care to adopt a chronic care approach, few HIV treatment services have been able to establish service arrangements that prioritise self-management. To prevent cardiovascular and other chronic disease outcomes, the HealthMap program aims to enhance routine HIV care with opportunities for self-management support. This paper outlines the systematic process that was used to design and develop the HealthMap program, prior to its evaluation in a cluster-randomised trial.MethodsProgram development, planning and evaluation was informed by the PRECEDE-PROCOEDE Model and an Intervention Mapping approach and involved four steps: (1) a multifaceted needs assessment; (2) the identification of intervention priorities; (3) exploration and identification of the antecedents and reinforcing factors required to initiate and sustain desired change of risk behaviours; and finally (4) the development of intervention goals, strategies and methods and integrating them into a comprehensive description of the intervention components.ResultsThe logic model incorporated the program’s guiding principles, program elements, hypothesised causal processes, and intended program outcomes. Grounding the development of HealthMap on a clear conceptual base, informed by the research literature and stakeholder’s perspectives, has ensured that the HealthMap program is targeted, relevant, provides transparency, and enables effective program evaluation.ConclusionsThe use of a systematic process for intervention development facilitated the development of an intervention that is patient centred, accessible, and focuses on the key determinants of health-related outcomes for people with HIV in Australia. The techniques used here may offer a useful methodology for those involved in the development and implementation of complex interventions.

Using an educational video vs. in-person education to measure patient perceptions of an online self-management support system for chronic illness

The study is about comparing the users’ perception and understanding of an online healthcare support system in two different situations and groups: Internet-panel group and In-person group. In the first group (Internet-panel), the participants were a group of patients, suffering from at least one type of chronic disease, who were chosen remotely from Canada and the United States. In the second group (In-person), participants were a group of outpatients in St. Michael’s Hospital in Toronto, Canada, who were suffering from at least one type of chronic disease. A short video clip was produced and used to educate the Internet-panel about the functionality and features of an online self-management support system for chronic illnesses (the system). After watching the video, participants were given a survey to test their perceptions of the system. For the In-person group, a nurse educated the patients about the functionalities of the system and later they answered to an identical survey. The UTAUT2, a pre-validated model of technology adoption, was used in the form of a Structured Equation Model to test the participants’ perceptions in both groups of the study. A PLS statistical method was used for data analysis. The results of the two groups were compared; it showed that using a short video to introduce and educate patients with the different aspects and features of a highly complex technology, is as effective as time-consuming in-person education. The key is to develop relatable scenarios of using the technology and to focus on the structure of the video and the material that is conveyed to audience through the video.

Accessibility of online self-management support websites for people with osteoarthritis: A text content analysis.

This study assessed accessibility of online self-management support webpages for people with osteoarthritis by considering readability of text and inclusion of images and videos. Eight key search terms developed and agreed with patient and public involvement representatives were entered into the Google search engine. Webpages from the first page of Google search results were identified. Readability of webpage text was assessed using two standardised readability indexes, and the number of images and videos included on each webpage was recorded. Forty-nine webpages met the inclusion criteria and were assessed. Only five of the webpages met the recommended reading level for health education literature. Almost half (44.9%) of webpages did not include any informative images to support written information. A minority of the webpages (6.12%) included relevant videos. Information provided on health webpages aiming to support patients to self-manage osteoarthritis may not be read, understood or used effectively by many people accessing it. Recommendations include using accessible language in health information, supplementing written information with visual resources and reviewing content and readability in collaboration with patient and public involvement representatives.

Online Self-Management Support for Family Caregivers to Help Them Manage Behavior Changes in Their Relative With Dementia: Study Protocol for a Randomized Controlled Trial and a Process Evaluation.

BackgroundOnline interventions are potentially effective ways to support family caregivers in the management of behavior changes in their relative with dementia.ObjectiveThe objective of this paper is to present the design of a study evaluating and comparing 3 intervention arms for online self-management support.MethodsA randomized controlled trial (RCT) will be conducted with a total of 81 family caregivers of community-dwelling people with dementia in the Netherlands. Family caregivers will be randomly allocated to one of the following intervention arms: (1) a major self-management support intervention consisting of personal email contacts with a nurse specialized in dementia care, online videos, and electronic bulletins (e-bulletins); (2) a medium self-management support intervention consisting of only online videos and e-bulletins; and (3) a minor self-management support intervention with only e-bulletins. The primary outcome is the self-efficacy of the family caregiver. The secondary outcomes are the behavior problems of the person with dementia as reported by the family caregiver, and positive and negative aspects of the relationship. Background characteristics (eg, type of family relationship) will also be assessed. All data for the RCT will be collected via online questionnaires, administered before the intervention (T0), after 6 weeks (T1), and after 12 weeks (T2). Alongside the RCT, a process evaluation will be conducted, based on a number of evaluation questions and semi-open interviews with family caregivers.ResultsData collection will be completed in August 2017. Study results will be reported in early 2018.ConclusionsThe study will shed more light on the effect of online self-management support interventions and insights will be gained into whether a major intervention, consisting of personal email contacts with specialized nurses, videos, and e-bulletins, has more effect than smaller online interventions. This is relevant in an age with increasing numbers of people with dementia, growing pressure on family caregivers, more and more people using the Internet, and increasing healthcare costs.Trial RegistrationNederlands Trial Registry (NTR): NTR6237; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6237 (Archived by WebCite at http://www.webcitation.org/6v0S4fxTC)

130. ALLIED HEALTH PROFESSIONAL AND NURSE INTERNSHIPS SCHEME: EVALUATION OF YEAR 1 COHORT 2016

Background: The Allied Health Professional (AHP) and Nurse Internships Scheme 2015–18 is open to final year students or recent graduates who are predicted to receive a 2:1 or first degree in Occupational Therapy, Physiotherapy, Podiatry, or Nursing. Building on similar schemes it is a successful model of a collaborative project working with our wide consortium of researchers at the Universities of Southampton, Oxford, Salford, Leeds and the West of England. The aim of the scheme is to identify and introduce graduate AHPs and nurses to musculoskeletal (MSK) research. Methods: In 2016, 6 (4 female) graduates from Allied Health and Nursing participated in the scheme. Over an intensive 8 week period the interns contributed to the conduction of research in projects focused on key public health priorities for people with MSK conditions. Projects included both qualitative and quantitative methodology, including an investigation into online self-management support websites for patients and an assessment of footwear choices in knee osteoarthritis. The interns presented their research findings and development journey at a dissemination day held at the University of Leeds. The placements were evaluated through reflective logs and progress reports completed by the interns, supervisors and mentors. The interns completed additional evaluation questionnaires before and after their placements. Evidence of impact of the internships scheme was collated. Results: All of the interns stated their career aspirations and expectations changed over the 8 week period and all reported they now plan a future career in research. One intern quoted “In relation to my career plans, my expectations have completely changed. The scheme has provided me with the skills, knowledge and contacts I need to build my profile and apply for future research opportunities”. Supervisors and mentors reported all of the interns completed required research tasks and met or exceeded initial agreed learning outcomes. Further evidence of impact included two press releases and an article reporting on progress of the first cohort. All 6 interns wrote two blogs (pre- and post-internship) - published on the Arthritis Research UK website and have submitted a conference abstract and a journal article. Further conference and journal submissions are anticipated from all 6 interns alongside the work supporting grant applications. This scheme’s Twitter site has to date gained over 100 followers. Conclusion: Evaluation from the interns has demonstrated how valuable the scheme is in introducing newly qualified AHPs and nurses to a network of rheumatology researchers and linking their clinical roles with the latest research; benefiting patients with MSK conditions with the latest evidence-based care. All interns intend to remain involved in research, providing mentorship for future cohorts, sharing their experiences and promoting the scheme. We thank our consortium for their expertise and dedicated time with our interns.

Preferences and needs of patients with a rheumatic disease regarding the structure and content of online self-management support

ObjectiveAim of this study was to investigate preferences and needs regarding the structure and content of a person-centered online self-management support intervention for patients with a rheumatic disease. MethodsA four step procedure, consisting of online focus group interviews, consensus meetings with patient representatives, card sorting task and hierarchical cluster analysis was used to identify the preferences and needs. ResultsPreferences concerning the structure involved 1) suitability to individual needs and questions, 2) fit to the life stage 3) creating the opportunity to share experiences, be in contact with others, 4) have an expert patient as trainer, 5) allow for doing the training at one’s own pace and 6) offer a brief intervention. Hierarchical cluster analysis of 55 content needs comprised eleven clusters: 1) treatment knowledge, 2) societal procedures, 3) physical activity, 4) psychological distress, 5) self-efficacy, 6) provider, 7) fluctuations, 8) dealing with rheumatic disease, 9) communication, 10) intimate relationship, and 11) having children. ConclusionA comprehensive assessment of preferences and needs in patients with a rheumatic disease is expected to contribute to motivation, adherence to and outcome of self-management-support programs. Practice implicationsThe overview of preferences and needs can be used to build an online-line self-management intervention.

EHealth and quality in health care: implementation time.

The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future.