Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision

BackgroundIt is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms.MethodsIn Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis.ResultsStudy 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed.ConclusionsEducational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they seek.

[1]  Peter Williams,et al.  Health information on the Internet: a qualitative study of NHS Direct Online users , 2003, Aslib Proc..

[2]  Lucy Yardley,et al.  Qualitative analysis of experience: grounded theory and case studies , 2003 .

[3]  Gary L. Kreps,et al.  Rethinking Communication in the E-health Era , 2003, Journal of health psychology.

[4]  Gavriel Salvendy,et al.  A proposed index of usability: A method for comparing the relative usability of different software systems , 1997, Behav. Inf. Technol..

[5]  R. Thomson,et al.  Patients' preference for involvement in medical decision making: a narrative review. , 2006, Patient education and counseling.

[6]  Richard E. Boyatzis,et al.  Transforming Qualitative Information: Thematic Analysis and Code Development , 1998 .

[7]  E. Murray,et al.  Applying user-generated quality criteria to develop an Internet intervention for patients with heart disease , 2008, Journal of telemedicine and telecare.

[8]  E. Seydel,et al.  Evaluation of Internet-Based Technology for Supporting Self-Care: Problems Encountered by Patients and Caregivers When Using Self-Care Applications , 2008, Journal of medical Internet research.

[9]  Michael B. Spring,et al.  Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness. , 2007, Psychological services.

[10]  M. Hardey.  Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise , 1999 .

[11]  J. Powell,et al.  Stakeholder Perspectives on the Development of a Virtual Clinic for Diabetes Care: Qualitative Study , 2007, Journal of medical Internet research.

[12]  P. Sandercock,et al.  Framework for design and evaluation of complex interventions to improve health , 2000, BMJ : British Medical Journal.

[13]  Joseph Finkelstein,et al.  Testing the Usability of Two Automated Home-Based Patient-Management Systems , 2004, Journal of Medical Systems.

[14]  E. Murray,et al.  Information from the Internet and the doctor-patient relationship: the patient perspective – a qualitative study , 2007, BMC family practice.

[15]  L. Yardley,et al.  Research Methods for Clinical and Health Psychology , 2003 .

[16]  Katarina Hamberg,et al.  The use of an Internet-based Ask the Doctor Service involving family physicians: evaluation by a web survey. , 2006, Family practice.

[17]  Lucy Yardley,et al.  Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. , 2007, Health promotion international.

[18]  Lyndal Trevena,et al.  Information needs and preferences of low and high literacy consumers for decisions about colorectal cancer screening: utilizing a linguistic model , 2008, Health expectations : an international journal of public participation in health care and health policy.

[19]  S. Wyatt,et al.  'Ignorance is bliss sometimes': constraints on the emergence of the 'informed patient' in the changing landscapes of health information. , 2003, Sociology of health & illness.

[20]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[21]  Howard Leventhal,et al.  The self-regulation of health and illness behaviour. , 2003 .

[22]  Karen A. Gresty,et al.  Reflecting on the think-aloud method for evaluating e-learning , 2006, Br. J. Educ. Technol..

[23]  Sally J. McMillan,et al.  Strengthening the Safety Net for Online Seniors: Factors Influencing Differences in Health Information Seeking Among Older Internet Users , 2008, Journal of health communication.

[24]  Nicola Mead,et al.  More than technology and access: primary care patients' views on the use and non-use of health information in the Internet age. , 2004, Health & social care in the community.

[25]  J. Powell,et al.  Preliminary test of an Internet-based diabetes self-management tool , 2008, Journal of telemedicine and telecare.

[26]  D. Nutbeam.  The evolving concept of health literacy. , 2008, Social science & medicine.

[27]  Claudia Pagliari,et al.  Design and Evaluation in eHealth: Challenges and Implications for an Interdisciplinary Field , 2007, Journal of medical Internet research.

[28]  C. Hartmann,et al.  A Website to Improve Asthma Care by Suggesting Patient Questions for Physicians: Qualitative Analysis of User Experiences , 2007, Journal of medical Internet research.

[29]  Trudy Dwyer,et al.  Development and process evaluation of an internet-based physical activity behaviour change program. , 2007, Patient education and counseling.

[30]  S. Lambert,et al.  Health Information—Seeking Behavior , 2007, Qualitative health research.

[31]  Vimla L. Patel,et al.  Usability in the real world: assessing medical information technologies in patients' homes , 2003, J. Biomed. Informatics.

[32]  Peter R. Harris,et al.  How do patients evaluate and make use of online health information? , 2007, Social science & medicine.

[33]  Lucy Yardley,et al.  Content and thematic analysis , 2003 .

[34]  M Dixon-Woods,et al.  Writing wrongs? An analysis of published discourses about the use of patient information leaflets. , 2001, Social science & medicine.

[35]  S. Cotten,et al.  Characteristics of online and offline health information seekers and factors that discriminate between them. , 2004, Social science & medicine.

[36]  R. Wiles,et al.  Primary care Randomised controlled trial of self management leaflets and booklets for minor illness provided by post , 2022 .

[37]  Alicia O'Cathain,et al.  Does NHS Direct empower patients? , 2005, Social science & medicine.

[38]  M. Petticrew,et al.  Developing and evaluating complex interventions: the new Medical Research Council guidance , 2008, BMJ : British Medical Journal.

[39]  David L. Dawson,et al.  The development of a web- and a print-based decision aid for prostate cancer screening , 2010, BMC Medical Informatics Decis. Mak..

[40]  P. Korp,et al.  Health on the Internet: implications for health promotion. , 2006, Health education research.

[41]  E. Murray,et al.  Internet Interventions for Long-Term Conditions: Patient and Caregiver Quality Criteria , 2006, Journal of medical Internet research.

[42]  L. Atack,et al.  Evaluation of Patient Satisfaction With Tailored Online Patient Education Information , 2008, Computers, informatics, nursing : CIN.

[43]  Laura R. Olevitch,et al.  Tailoring Health Messages: Customizing Communication With Computer Technology , 1999 .

[44]  L. Faulkner.  Beyond the five-user assumption: Benefits of increased sample sizes in usability testing , 2003, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[45]  E. Murray,et al.  Development of a Psychologically Enhanced Interactive Online Intervention for Hazardous Drinking , 2008, Alcohol and alcoholism.

[46]  Brian G Danaher,et al.  The Information Architecture of Behavior Change Websites , 2005, Journal of medical Internet research.

[47]  Linda Fleisher,et al.  Using health communication best practices to develop a web-based provider-patient communication aid: the CONNECT study. , 2008, Patient education and counseling.

[48]  Howard Leventhal,et al.  The common-sense model of self-regulation of health and illness. , 2003 .

[49]  J T Macfarlane,et al.  Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

[50]  S. Kvale,et al.  The SAGE handbook of qualitative research in psychology , 2008 .

[51]  Peter Jan Schellens,et al.  Evaluation of an Informational Web Site: Three Variants of the Think-aloud Method Compared , 2007 .

[52]  Catherine Sherrington,et al.  The Effect of an Individualized Fall Prevention Program on Fall Risk and Falls in Older People: A Randomized, Controlled Trial , 2005, Journal of the American Geriatrics Society.

[53]  W Kerry Mummery,et al.  Applying usability testing techniques to improve a health promotion website. , 2008, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[54]  Lucy Yardley,et al.  Demonstrating validity in qualitative psychology , 2007 .