The WWW of the World Wide Web: Who, What, and Why?

Background: While still in its infancy, Internet-based diabetes management shows great promise for growth. However, the following aspects must be considered: what are the key metrics for the evaluation of a diabetes management site? how should these sites grow in the future and what services should they offer? Objectives: To examine the needs of the patient and the health care professional in an Internet-based diabetes management solution and how these needs are translated into services offered. Methods: An evaluation framework was constructed based on a literature review that identified the requirements for an Internet-based diabetes management solution. The requirements were grouped into 5 categories: Monitoring, Information, Personalization, Communication, and Technology. Two of the market leaders (myDiabetes and LifeMasters) were selected and were evaluated with the framework. The Web sites were evaluated independently by 5 raters using the evaluation framework. All evaluations were performed from November 1, 2001 through December 15, 2001. Results: The agreement level between raters ranged from 60% to 100%. The multi-rater reliability (kappa) was 0.75 for myDiabetes and 0.65 for LifeMasters, indicating substantial agreement. The results of the evaluations indicate that LifeMasters is a more-complete solution than myDiabetes in all dimensions except Information, where both sites were equivalent. LifeMasters satisfied 32 evaluation criteria while myDiabetes satisfied 24 evaluation criteria, out of a possible 40 in the framework. Conclusions: The framework is based on the recognition that the management of diabetes via the Internet is based on several integrated dimensions: Monitoring, Information, Personalization, Communication, and Technology. A successful diabetes management system should efficiently integrate all dimensions. The evaluation found that LifeMasters is successful in integrating the health care professional in the management of diabetes and that MyDiabetes is quite effective in providing a communication channel for community creation (however, communication with the health care professional is lacking). (J Med Internet Res 2002;4(1):e1) doi:10.2196/jmir.4.1.e1

[1]  W. Hawkins,et al.  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[2]  J. Seeley,et al.  The diabetes network internet-based physical activity intervention: a randomized pilot study. , 2001, Diabetes care.

[3]  I. Blackburn,et al.  A meta-analysis of the effects of cognitive therapy in depressed patients. , 1998, Journal of affective disorders.

[4]  P. Impicciatore,et al.  Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home , 1997, BMJ.

[5]  M. Seligman,et al.  Prevention of depressive symptoms in school children. , 1994, Behaviour research and therapy.

[6]  J. Carlin,et al.  Bias, prevalence and kappa. , 1993, Journal of clinical epidemiology.

[7]  D. A. Tong,et al.  Requests for medical advice from patients and families to health care providers who publish on the World Wide Web. , 1997, Archives of internal medicine.

[8]  Jeremy C Wyatt,et al.  Survey of Doctors' Experience of Patients Using the Internet , 2002, Journal of medical Internet research.

[9]  Robert Mittman,et al.  Health e-People: The Online Consumer Experience , 2000 .

[10]  W. Willett,et al.  Misinterpretation and misuse of the kappa statistic. , 1987, American journal of epidemiology.

[11]  Ivar Jacobson,et al.  Software Reuse: Architecture, Process And Organization For Business Success , 1998, Proceedings. Technology of Object-Oriented Languages. TOOLS 26 (Cat. No.98EX176).

[12]  Steven Wilson,et al.  Impact of the Internet on Primary Care Staff in Glasgow , 1999, Journal of medical Internet research.

[13]  J K Aronson,et al.  Autopathography: the patient's tale , 2000, BMJ : British Medical Journal.

[14]  George Hripcsak,et al.  Generic data modeling for home telemonitoring of chronically ill patients , 2000, AMIA.

[15]  Trevor Jackson.  Website of the week: Bioterrorism , 2001 .

[16]  Kathleen M Griffiths,et al.  Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores , 2002, Journal of medical Internet research.

[17]  R Dobson.  Internet sites may encourage suicide , 1999, BMJ.

[18]  B. Gerber,et al.  The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda , 2001, Journal of medical Internet research.

[19]  M. Hagland.  Managing diseases by managing IT. , 1998, Health management technology.

[20]  M. Seligman,et al.  The prevention of depression and anxiety. , 1999 .

[21]  J. D. Brown.  The relative importance of persons, items, subtests and languages to TOEFL test variance , 1999 .

[22]  J. Licciardone,et al.  Use of the Internet as a Resource for Consumer Health Information: Results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II) , 2001, Journal of medical Internet research.

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

[24]  S. Siegel,et al.  Nonparametric Statistics for the Behavioral Sciences , 2022, The SAGE Encyclopedia of Research Design.

[25]  P. Riis,et al.  [Information to the patients]. , 1972, Ugeskrift for laeger.

[26]  A. Boulton,et al.  Why bother educating the multi-disciplinary team and the patient--the example of prevention of lower extremity amputation in diabetes. , 1995, Patient education and counseling.

[27]  P. Cuijpers,et al.  Bibliotherapy in unipolar depression: a meta-analysis. , 1997, Journal of behavior therapy and experimental psychiatry.

[28]  Jean Carletta,et al.  Assessing Agreement on Classification Tasks: The Kappa Statistic , 1996, CL.

[29]  Lee Rainie,et al.  The online health care revolution: how the web helps americans take better care of themselves , 2000 .

[30]  Yasuo Haruki,et al.  Internet Medical Usage in Japan: Current Situation and Issues , 2001, Journal of medical Internet research.

[31]  Ware J.E.Jr.,et al.  THE MOS 36- ITEM SHORT FORM HEALTH SURVEY (SF- 36) CONCEPTUAL FRAMEWORK AND ITEM SELECTION , 1992 .

[32]  G Gillespie.  Deploying an I.T. cure for chronic diseases. , 2000, Health data management.

[33]  P. Hjortdahl,et al.  Internett og lege-pasient-forholdet - fra "takk" til "hvorfor?" , 1999 .

[34]  L. Sobell,et al.  Rediscovering Fire : Small Interventions , Large Effects , 2001 .

[35]  R. Blendon,et al.  Health information, the Internet, and the digital divide. , 2000, Health affairs.

[36]  Manuel Barrera,et al.  Social Support, Self-Management, and Quality of Life Among Participants in an Internet-Based Diabetes Support Program: A Multi-Dimensional Investigation , 1999, Cyberpsychology Behav. Soc. Netw..

[37]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[38]  R. Smith.  Almost no evidence exists that the internet harms health. , 2001, BMJ.

[39]  A. Korten,et al.  Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults. , 2002, Addiction.

[40]  G Eysenbach,et al.  Information in practice Towards quality management of medical information on the internet : evaluation , labelling , and filtering of information , 1998 .

[41]  R Roberts,et al.  Verifying quality and safety in health informatics services , 2001, BMJ : British Medical Journal.

[42]  P. Duncan-Jones,et al.  Detecting anxiety and depression in general medical settings. , 1988, BMJ.

[43]  P. Whatling.  Having non-medical readers of papers on internet will enhance peer review , 1999, BMJ.

[44]  D. Ford,et al.  Screening the public for depression through the Internet. , 2001, Psychiatric services.

[45]  H. Christensen,et al.  Quality of web based information on treatment of depression: cross sectional survey , 2000, BMJ : British Medical Journal.

[46]  M. Kunik,et al.  One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease , 2001, Psychological Medicine.

[47]  I. Miller,et al.  Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. , 2001, Journal of affective disorders.

[48]  J. Greist,et al.  Computer-administered cognitive-behavioral therapy for depression. , 1990, The American journal of psychiatry.

[49]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[50]  Russell E. Glasgow,et al.  Who Participates in Internet-Based Self-Management Programs? A Study Among Novice Computer Users in a Primary Care Setting , 2000, The Diabetes educator.

[51]  R. Glasgow,et al.  Feasibility and Use of an Internet Support Service for Diabetes Self-Management , 1998, The Diabetes educator.

[52]  Jürgen Baumert,et al.  Modeling longitudinal and multilevel data: Practical issues, applied approaches, and specific examples. , 2000 .

[53]  D Johnston,et al.  Implications of the results of community intervention trials. , 1998, Annual review of public health.

[54]  D H Gustafson,et al.  Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health. , 1999, American journal of preventive medicine.

[55]  G. Eysenbach,et al.  Cybermedicine. Interview by Clare Thompson. , 1999, BMJ.

[56]  G Eysenbach,et al.  Online prescriptions of pharmaceuticals: Where is the evidence for harm or for benefit? A call for papers - and for reflection , 2001, Journal of medical Internet research.

[57]  P. Kimmel,et al.  Poison on line--acute renal failure caused by oil of wormwood purchased through the Internet. , 1997, The New England journal of medicine.

[58]  O. Dearlove,et al.  Internet is useful for information on rare conditions , 1997, BMJ.

[59]  J. Piette,et al.  Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs Health Care System: a randomized controlled trial. , 2001, Diabetes care.

[60]  Robert Varnam,et al.  “That's very nice, but will it get me pregnant?” , 2001, BMJ : British Medical Journal.

[61]  Christian Köhler,et al.  Does the internet harm health? Database of adverse events related to the internet has been set up. , 2002, BMJ.

[62]  John Uebersax,et al.  Statistical Modeling of Expert Ratings on Medical Treatment Appropriateness , 1993 .

[63]  Robert P. Hawkins,et al.  Will the disadvantaged ride the information highway? Hopeful answers from a computer‐based health crisis system , 1996 .

[64]  On-Line with the Friends of Bill W: Social Support and the Net , 2000 .

[65]  P. Reeves.  Coping in Cyberspace: The Impact of Internet Use on the Ability of HIV-Positive Individuals to Deal with Their Illness , 2000, Journal of health communication.

[66]  H. Sandvik.  Health information and interaction on the internet: a survey of female urinary incontinence , 1999, BMJ.

[67]  Theodoros N. Arvanitis,et al.  Use of the Internet by Patients Before and After Cardiac Surgery: An Interdisciplinary Telephone Survey , 2001, Journal of medical Internet research.

[68]  Ivar Jacobson,et al.  The Unified Software Development Process , 1999 .

[69]  A. Jacobson,et al.  What attracts patients with diabetes to an internet support group? A 21‐month longitudinal website study , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[70]  J. Licciardone,et al.  Factors Associated with Intended Use of a Web Site Among Family Practice Patients , 2001, Journal of medical Internet research.