Nicol Nijland*, University of Twente, Enschede, Netherlands Julia Van Gemert-pijnen, University of Twente, Enschede, Netherlands Bart Brandenburg*, Medicinfo, Tilburg, Netherlands Erwin Seydel, University of Twente, Enschede, Netherlands Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Panel Presentation Building: MECC Room: Auditorium 2 Date: 2010-11-29 01:30 PM – 02:30 PM Last modified: 2010-09-21

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Background: The take-up of eHealth applications in general is still rather low and only limited information is available on the level of technology usage among specific patient groups.
Objective: The aim of this study was to explore the factors that influence the use -initial and long-term- of a web-based disease management program for supporting the self-care of patients with diabetes type II.
Methods: Using a mixed-methods research design with log files, usability tests, interviews and a survey, we assessed the actual use of the web application over a 2-year period along with the motivation to use the web application and the barriers that hindered this, and the patients’ demographics and health-related characteristics.
Results: 14% (50/350) of the patients who were approached enrolled in the Diabetes Coach project. The main impediment to enrollment had to do with a lack of access to the Internet or a PC (65%, 146/226). Valued by participating patients as a useful supplement to regular care, the Diabetes Coach was predominantly used for online monitoring, personal data and patient-nurse e-mail contact. It was the continuous, personal feedback that particularly appealed to the patients: they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. The extent to which the web application was used fluctuated during the 2-year study period. Among the Diabetes Coach enrollees, 68% (34/50) were continuous users, of which 32% (16/34) could be defined as hardcore users (highly active). The remaining 32% (16/50) did not continue using the web application for the full duration of the study period. Inactivity was not the result of a negative assessment of the web application. Barriers to long-term use were primarily due to the absence of “push” factors (reminders), interface issues and enrollment by the “wrong” users. It turned out that health-related characteristics were related to the use of the web application; highly active users were significantly more often medication users than low/inactive users (P = .007). The highly active users were also more inclined to engage in online monitoring (P = .042).
Conclusion: This study found that successful diabetes management support systems should integrate several functions to meet the needs of patients. Technology is most useful when it is easy-to-use, integrated into the existing infrastructure (not stand-alone), with interoperable and interactive features that provide highly personal feedback and provide challenging content, especially for patients with high rates of behavioral risk factors and multiple chronic conditions. To increase our understanding of the relationship between system features and the usage of eHealth, future research should focus on how to put “persuasion” into technology.