eHealth recruitment challenges

Little is known about effective eHealth recruitment methods. This paper presents recruitment challenges associated with enrolling African-American girls aged 8–10 years in an eHealth obesity prevention program, their effect on the recruitment plan, and potential implications for eHealth research.Although the initial recruitment strategy was literature-informed, it failed to enroll the desired number of girls within a reasonable time period. Therefore, the recruitment strategy was reformulated to incorporate principles of social marketing and traditional marketing techniques. The resulting plan included both targeted, highly specific strategies (e.g., selected churches), and more broad-based approaches (e.g., media exposure, mass mailings, radio advertisements).The revised plan enabled recruitment goals to be attained. Media appeared to be particularly effective at reaching the intended audience. Future research should identify the most effective recruitment strategies for reaching potential eHealth audiences.     

Worksite e-mail health promotion trial: Early lessons

In preparation for an electronic mail (e-mail) and web-based health promotion intervention across multiple worksites, secure, regulatory-compliant, user-friendly e-mail and Internet applications were used to recruit potential participants across worksites, to enroll participants, and to collect baseline health assessment data. Specific hardware and software information technology environments were required of the 19 participating worksites. Sequential e-mails introduced the study and invited participation. Twenty-four percent of all employees (1106 of approximately 4600) provided consent. E-mail delivered a web link for the baseline study assessment, and reminder e-mails were sent to prompt completion. Of those who consented, 888 (80%) completed baseline health and behavior data surveys. An HTML-native web survey software was more stable across computing environments. Using e-mail and web assessment, this research recruited, enrolled, and collected data from more than 850 participants. Technical and operational challenges emerged at each step. Solutions and recommendations are discussed. Overall, this experience suggests that the use of e-mail and web software can facilitate recruitment, enrollment, and data acquisition through direct contact with study participants. This experience yields a series of lessons learned for using e-mail and the Internet to support multi-site trials.     

Tailored program evaluation: Past, present, future

This paper discusses measurement issues related to the evaluation of computer-tailored health behavior change programs. As the first generation of commercially available tailored products is utilized in health promotion programming, programmers and researchers are becoming aware of the unique challenges that the evaluation of these programs presents. A project is presented that used an online tailored health behavior assessment (HBA) in a worksite setting. Process and outcome evaluation methods are described and include the challenges faced, and strategies proposed and implemented, for meeting them. Implications for future research in tailored program development, implementation, and evaluation are also discussed.     

The lifestyle paradox: adverse effects of Internet use on self-rated health status

How individuals subjectively rate their health status stands in close relationship with both actual health status and mortality. Previous research has shown that Internet use in general, and online health information seeking in particular, increases self-rated health status. However, this relationship may not always hold true: Albrecht and Devlieger’s [(1999). The disability paradox: high quality of life against all odds. Social Science & Medicine, 48(8), 977–988] disability paradox captures that those with severe health conditions may still perceive their health as very good. This paper introduces the lifestyle paradox as another exception to the generally positive relationship: those without health conditions may still perceive their health as inferior based on general and health-related Internet use. This paper corroborates the lifestyle paradox empirically using quantitative data from the Oxford Internet Surveys connected to the national census through spatial microsimulation, and 43 qualitative interviews conducted with a subsample of the participants from the quantitative strand. A theoretical explanation for this phenomenon is provided based on the concepts of agenda setting and reference groups: the online realm may make lifestyle topics more salient, and provides a variety of opportunities for comparing oneself to others, thereby influencing how people evaluate their own health. Through describing, verifying and explaining the lifestyle paradox, this paper contributes theoretical and empirical insights into the relationship between Internet use and self-rated health status, and thereby adds to the scientific debate around tangible outcomes of Internet use.     

What encourages community health workers to use mobile technologies for health interventions? Emerging lessons from rural Rwanda

This article explores the determinants of using mobile phone technologies for public health (mHealth) through a quantitative study with community health workers (CHWs) in rural Rwanda. A total of 72 CHWs from two districts in Rwanda who were using the mHealth tool, RapidSMS, were surveyed in June 2014. Using a socio‐technical approach, user, programme and technical characteristics were tested and deemed influential in determining use. Technical characteristics (reminders and alerts) were by far the strongest predicting factors of use. The user characteristic, age, had no influence on utilization, while supports though training and supervision (programme characteristics) revealed mixed findings. These findings illustrate the uniqueness of each context and reiterate the need to consider social and technical factors when implementing mHealth projects.     

Multidisciplinary eHealth survey evaluation methods

This paper describes the development process of an evaluation framework for describing and comparing web survey tools. We believe that this approach will help shape the design, development, deployment, and evaluation of population-based health interventions. A conceptual framework for describing and evaluating web survey systems will enable the developers of health interventions to identify, select, and use the most appropriate and relevant survey tools. The primary contributors included survey methodologists, computer scientists, informaticians, technical communications specialists, educators, evaluators, clinical practitioners, and health services researchers, who together developed a comprehensive ontology to describe the electronic survey domain. This paper will describe the survey ontology development process and detail lessons learned in the creation of the web survey system evaluation framework.     

Stakeholder driven indicators for eHealth performance management

The goal of the present article is to compile a corpus of indicators of eHealth development evaluation that would essentially reflect stakeholder approaches and complement technical indicators of assessment of an eHealth system. Consequently, the assessment of the development of an eHealth system would reflect stakeholder approaches and become an innovative solution in attempting to improve productivity of IT projects in the field of health care. The compiled minimum set of indicators will be designed to monitor implementation of the national eHealth information system. To ensure reliability of the quality research, the respondents were grouped in accordance to the geographical distribution and diversity of the levels and types of the represented jobs and institutions. The applied analysis implies several managerial insights on the hierarchy of eHealth indicators. These insights may be helpful in recommending priority activities in implementation of an eHealth data system on the national or international level. The research is practically useful as it is the first to deal with the topic in Lithuania and its theoretical and practical aspect are particularly relevant in implementation of an eHealth data system in Lithuania. The eHealth assessment indicators presented in the article may be practically useful in two aspects: (1) as key implementation guidelines facilitating the general course of eHealth system development and (2) as a means to evaluate eHealth outcomes.     

Does self-help increase rates of help seeking for student mental health problems by minimizing stigma as a barrier?

Objective: This study examined whether self-help (books, websites, mobile apps) increases help seeking for mental health problems among college students by minimizing stigma as a barrier. Participants and Methods: A survey was conducted with 200 college students reporting elevated distress from February to April 2017. Results: Intentions to use self-help were low, but a significant portion of students unwilling to see mental health professionals intended to use self-help. Greater self-stigma related to lower intentions to seek professional help, but was unrelated to seeking self-help. Similarly, students who only used self-help in the past reported higher self-stigma than those who sought professional treatment in the past. Although stigma was not a barrier for self-help, alternate barriers were identified. Conclusions: Offering self-help may increase rates of students receiving help for mental health problems, possibly by offering an alternative for students unwilling to seek in-person therapy due to stigma concerns.     

Challenges in telemedicine equivalence studies

As the number of telemedicine programs continues to grow, the accuracy of diagnosis over interactive televideo is a central concern. Although investigators have begun to address diagnostic equivalency in telehealth clinics, few published studies reflect strong research design. The two presented telehealth programs completed randomized controlled trials in real-world clinical settings that addressed some of the methodologic shortcomings of prior studies. Diagnostic equivalency studies were completed across five telehealth specialty clinics: physical therapy, speech therapy, ambulatory pediatrics, child psychiatry, and developmental disabilities services. The two research teams encountered similar decision points in designing and implementing the equivalency protocols. This article addresses methodologic issues in choosing design, participants, technology, and evaluation measures. Although the paper focuses on interactive televideo, the issues raised are pertinent across telehealth technologies.     

A framework for evaluating eHealth research

Health care is in the midst of a consumer-oriented technology explosion. Individuals of all ages and backgrounds have discovered eHealth. But the challenges of implementing and evaluating eHealth are just beginning to surface, and, as technology changes, new challenges emerge. Evaluation is critical to the future of eHealth. This article addresses four dimensions of eHealth evaluation: (1) design and methodology issues; (2) challenges related to the technology itself; (3) environmental issues that are not specific to eHealth but pose special problems for eHealth researchers; and (4) logistic or administrative concerns of the evaluation methodology selected. We suggest that these four dimensions must be integrated to provide a holistic framework for designing and implementing eHealth research projects, as well as for understanding the totality of the eHealth intervention. The framework must be flexible enough to adapt to a variety of end users, regardless of whether the end user is a healthcare organization, a for-profit business, a community organization, or an individual. The framework is depicted as a puzzle with four interlocking pieces.