Elizabeth Murray*, University College London, London, United Kingdom Track: Research Presentation Topic: co-Creation in health Presentation Type: Oral presentation Submission Type: Single Presentation Building: MECC Room: Auditorium 2 Date: 2010-11-29 10:00 AM – 10:30 AM Last modified: 2010-09-27 Free Full Paper

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The potential advantages of using mobile technologies, such as the internet and mobile phones, to deliver self-care and behaviour change programmes are well understood. The combination of an ageing population, increasing prevalence of long-term conditions and more effective medical interventions is placing a financial strain on all health care systems. Web-delivered interventions have the potential to combine the tailored approach of individual or face-to-face interventions, while maintaining the scalability of public health interventions with very low marginal costs per additional user. From a patient perspective, interventions delivered over the web can be highly attractive, as they can be convenient, easily accessible, and can maintain anonymity / privacy. Recognition of this potential led to a large amount of research into the effectiveness of computer-based or web-delivered programmes for self-management of long term conditions and behaviour change. There is no doubt that some of this early enthusiasm has been justified – a number of systematic reviews have demonstrated an overall positive effect of such interventions when compared to no intervention.

However, many questions remain unanswered, and there is still a long way to go before the claimed potential of such interventions can be fully achieved. Most of the systematic reviews have found an overall positive effect on outcomes of interest (health behaviours, clinical outcomes), but the effect size tends to be small, and not all interventions are successful. Work is needed to determine why some interventions work and others do not. This includes considering the “active ingredients” or mechanism of action of these complex interventions, and the context in which they are used. Are there certain demographic, psychological or clinical factors which promote or inhibit success? Are some behaviours or some clinical problems more amenable to change by computer-based interventions? Equally problematic is the issue of implementation, and integration of such programmes into routine clinical practice. Many e-health projects come to an end after the conclusion of the research and fail to become part of mainstream clinical care.

In this talk I shall clarify these and other questions which need addressing before e-health can have a significant impact on patients health and health care. I shall explore current research into these issues, and highlight theoretical frameworks, such as Normalisation Process Theory, which illuminate many of the observed problems. I shall conclude with reference to a research agenda for the e-health research community.