Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients.

OBJECTIVES: To evaluate the effectiveness of an Internet-based patient education intervention, which was designed upon principles of personalization and participatory design. METHODS: Fifteen months after the first release of the website, 209 fibromyalgia patients recruited through health professionals completed an online questionnaire to assess patients' use of the website, health knowledge, self-management behavior, and health outcomes. These constructs were combined into an a-priory model that was tested using a structural equation modeling approach. RESULTS: Results show that the usage of certain tools of the website - designed and personalized involving the end users - impacts patients' health knowledge, which in turn impacts self-management. Improvements in self-management ultimately lower the impact of Fibromyalgia Syndrome leading to better health outcomes. CONCLUSION: This study empirically confirmed that the adoption of a participatory approach to the design of eHealth interventions and the use of personalized contents enhance the overall effectiveness of systems. PRACTICE IMPLICATIONS: More time and effort should be invested in involving patients in the preliminary phases of the development of Internet-based patient education interventions and in the definition of models that can guide the systems' evaluation beyond technology-related variables such as usability, accessibility or adoption.

The impact of presentation style on the retention of online health information: a randomized-controlled experiment.

The Internet plays an increasingly important role in health education, providing laypeople with information about health-related topics that range from disease-specific contexts to general health promotion. Compared to traditional health education, the Internet allows the use of multimedia applications that offer promise to enhance individuals' health knowledge and literacy. This study aims at testing the effect of multimedia presentation of health information on learning. Relying on an experimental design, it investigates how retention of information differs for text-only presentation, image-only presentation, and multimedia (text and image) presentation of online health information. Two hundred and forty students were randomly assigned to four groups each exposed to a different website version. Three groups were exposed to the same information using text only, image only, or text and image presentation. A fourth group received unrelated information (control group). Retention was assessed by the means of a recognition test. To examine a possible interaction between website version and recognition test, half of the students received a recognition test in text form and half of them received a recognition test in imagery form. In line with assumptions from Dual Coding Theory, students exposed to the multimedia (text and image) presentation recognized significantly more information than students exposed to the text-only presentation. This did not hold for students exposed to the image-only presentation. The impact of presentation style on retention scores was moderated by the way retention was assessed for image-only presentation, but not for text-only or multimedia presentation. Possible explanations and implications for the design of online health education interventions are discussed.

Differential effects of health knowledge and health empowerment over patients' self-management and health outcomes: a cross-sectional evaluation.

OBJECTIVE: The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients' self-management and health outcomes. METHODS: This study relies on a cross-sectional design involving a total of 209 Fibromyalgia patients. Structural Equation Modeling techniques were employed to analyze the model relationships. RESULTS: Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes. CONCLUSION: Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change. PRACTICE IMPLICATIONS: Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs.

Effects of functional interactivity on patients' knowledge, empowerment, and health outcomes: an experimental model-driven evaluation of a web-based intervention.

BACKGROUND: The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented. However, there is a need to understand not only whether eHealth interventions work, but also what kind of functions and mechanisms enhance their effectiveness. The present investigation contributes to tackling these challenges by investigating the role played by functional interactivity on patients' knowledge, empowerment, and health outcomes. OBJECTIVES: To test whether health knowledge and empowerment mediate a possible relationship between the availability of interactive features on an eHealth application and individuals' health outcomes. We present an empirical, model-driven evaluation of the effects of functional interactivity implemented in an eHealth application, based on a brief theoretical review of the constructs of interactivity, health knowledge, empowerment, and health outcomes. We merged these constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with fibromyalgia syndrome (FMS). METHODS: This study used a pretest-posttest experimental design. We recruited 165 patients and randomly assigned them to three study groups, corresponding to different levels of functional interactivity. Eligibility to participate in the study required that patients (1) be fluent in Italian, (2) have access to the Internet, (3) report confidence in how to use a computer, and (4) have received a diagnosis of FMS from a doctor. We used structural equation modeling techniques to analyze changes between the pretest and the posttest results. RESULTS: The main finding was that functional interactivity had no impact on empowerment dimensions, nor direct observable effects on knowledge. However, knowledge positively affected health outcomes (b = -.12, P = .02), as did the empowerment dimensions of meaning (b = -.49, P < .001) and impact (b = -.25, P < .001). CONCLUSION: The theoretical model was partially confirmed, but only as far as the effects of knowledge and empowerment were concerned. The differential effect of interactive functions was by far weaker than expected. The strong impact of knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by eHealth applications.

Defining and measuring health literacy: how can we profit from other literacy domains?

When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement exists about which dimensions to include in the concept. To contribute to the development of a consistent and parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.