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"Why Didn't it Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma.
J Med Internet Res. 2015 Dec 15; 17(12):e283.JM

Abstract

BACKGROUND

Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors.

OBJECTIVE

The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma.

METHODS

A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy.

RESULTS

A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once.

CONCLUSIONS

Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A).

Authors+Show Affiliations

Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. annie.lau@mq.edu.au.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26678294

Citation

Lau, Annie Y S., et al. ""Why Didn't It Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults With Asthma." Journal of Medical Internet Research, vol. 17, no. 12, 2015, pp. e283.
Lau AY, Arguel A, Dennis S, et al. "Why Didn't it Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma. J Med Internet Res. 2015;17(12):e283.
Lau, A. Y., Arguel, A., Dennis, S., Liaw, S. T., & Coiera, E. (2015). "Why Didn't it Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma. Journal of Medical Internet Research, 17(12), e283. https://doi.org/10.2196/jmir.4734
Lau AY, et al. "Why Didn't It Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults With Asthma. J Med Internet Res. 2015 Dec 15;17(12):e283. PubMed PMID: 26678294.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Why Didn't it Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma. AU - Lau,Annie Y S, AU - Arguel,Amaël, AU - Dennis,Sarah, AU - Liaw,Siaw-Teng, AU - Coiera,Enrico, Y1 - 2015/12/15/ PY - 2015/05/21/received PY - 2015/11/09/accepted PY - 2015/10/21/revised PY - 2015/12/19/entrez PY - 2015/12/19/pubmed PY - 2016/8/26/medline KW - Internet KW - adult KW - asthma KW - eHealth KW - intervention KW - personal health record KW - personally controlled health management system KW - self-management SP - e283 EP - e283 JF - Journal of medical Internet research JO - J Med Internet Res VL - 17 IS - 12 N2 - BACKGROUND: Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors. OBJECTIVE: The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma. METHODS: A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy. RESULTS: A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once. CONCLUSIONS: Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A). SN - 1438-8871 UR - https://www.unboundmedicine.com/medline/citation/26678294/"Why_Didn't_it_Work"_Lessons_From_a_Randomized_Controlled_Trial_of_a_Web_based_Personally_Controlled_Health_Management_System_for_Adults_with_Asthma_ L2 - https://www.jmir.org/2015/12/e283/ DB - PRIME DP - Unbound Medicine ER -