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A digital intervention for respiratory tract infections (Internet Dr): process evaluation to understand how to support self-care for minor ailments

A digital intervention for respiratory tract infections (Internet Dr): process evaluation to understand how to support self-care for minor ailments
A digital intervention for respiratory tract infections (Internet Dr): process evaluation to understand how to support self-care for minor ailments
Background: Approximately 57 million physician appointments annually in the United Kingdom are for minor ailments. These illnesses could be self-cared for, which would potentially lower patients’ anxiety, increase their confidence, and be more convenient. In a randomized controlled trial of the Internet Dr digital intervention, patients with access to the intervention had fewer consultations for respiratory tract infections (RTIs). Having established intervention efficacy, further examination of trial data is required to understand how the intervention works. Objective: This paper reports a process evaluation of Internet Dr usage by the intervention group. The evaluation aims to demonstrate how meaningful usage metrics (ie, interactions that are specific and relevant to the intervention) can be derived from the theoretical principles underlying the intervention, then applied to examine whether these interactions are effective in supporting self-care for RTIs, for whom, and at what time. Methods: The Internet Dr trial recorded patients’ characteristics and usage data over 24 weeks. At follow-up, users reported whether their levels of enablement to cope with their illness changed over the trial period. The Medical Research Council process evaluation guidance and checklists from the framework for Analyzing and Measuring Usage and Engagement Data were applied to structure research questions examining associations between usage and enablement. Results: Viewing pages containing advice on caring for RTIs were identified as a meaningful metric for measuring intervention usage. Almost half of the users (616/1491, 42.31%) viewed at least one advice page, with most people (478/616, 77.6%) accessing them when they initially enrolled in the study. Users who viewed an advice page reported increased enablement to cope with their illness as a result of having participated in the study compared with users who did not (mean 2.12, SD 2.92 vs mean 1.65, SD 3.10; mean difference 0.469, 95% CI 0.082-0.856). The target population was users who had visited their general practitioners for an RTI in the year before the trial, and analyses revealed that this group was more likely to access advice pages (odds ratio 1.35, 95% CI 1.159-1.571; P<.001). Conclusions: The process evaluation identifies viewing advice pages as associated with increased enablement to self-care, even when accessed in the absence of a RTI, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was effective at reaching the target population of users who had previously consulted their general practitioners. However, attrition before reaching advice pages was high, highlighting the necessity of prioritizing access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated and have wider implications for minor ailment interventions.
Evaluation studies, Illness behavior, Internet, Mobile phone, Respiratory tract infection, Self-care
Miller, Sascha
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940
Weal, Mark
e8fd30a6-c060-41c5-b388-ca52c81032a4
Milton, Alexander MC
0f19539b-e9ec-4f41-a2e5-a4af9a3d05c4
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef
Miller, Sascha
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940
Weal, Mark
e8fd30a6-c060-41c5-b388-ca52c81032a4
Milton, Alexander MC
0f19539b-e9ec-4f41-a2e5-a4af9a3d05c4
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef

Miller, Sascha, Yardley, Lucy, Smith, Peter W.F., Weal, Mark, Milton, Alexander MC, Stuart, Beth, Little, Paul and Morrison, Leanne (2022) A digital intervention for respiratory tract infections (Internet Dr): process evaluation to understand how to support self-care for minor ailments. JMIR Formative Research, 6 (1), [e24239]. (doi:10.2196/24239).

Record type: Article

Abstract

Background: Approximately 57 million physician appointments annually in the United Kingdom are for minor ailments. These illnesses could be self-cared for, which would potentially lower patients’ anxiety, increase their confidence, and be more convenient. In a randomized controlled trial of the Internet Dr digital intervention, patients with access to the intervention had fewer consultations for respiratory tract infections (RTIs). Having established intervention efficacy, further examination of trial data is required to understand how the intervention works. Objective: This paper reports a process evaluation of Internet Dr usage by the intervention group. The evaluation aims to demonstrate how meaningful usage metrics (ie, interactions that are specific and relevant to the intervention) can be derived from the theoretical principles underlying the intervention, then applied to examine whether these interactions are effective in supporting self-care for RTIs, for whom, and at what time. Methods: The Internet Dr trial recorded patients’ characteristics and usage data over 24 weeks. At follow-up, users reported whether their levels of enablement to cope with their illness changed over the trial period. The Medical Research Council process evaluation guidance and checklists from the framework for Analyzing and Measuring Usage and Engagement Data were applied to structure research questions examining associations between usage and enablement. Results: Viewing pages containing advice on caring for RTIs were identified as a meaningful metric for measuring intervention usage. Almost half of the users (616/1491, 42.31%) viewed at least one advice page, with most people (478/616, 77.6%) accessing them when they initially enrolled in the study. Users who viewed an advice page reported increased enablement to cope with their illness as a result of having participated in the study compared with users who did not (mean 2.12, SD 2.92 vs mean 1.65, SD 3.10; mean difference 0.469, 95% CI 0.082-0.856). The target population was users who had visited their general practitioners for an RTI in the year before the trial, and analyses revealed that this group was more likely to access advice pages (odds ratio 1.35, 95% CI 1.159-1.571; P<.001). Conclusions: The process evaluation identifies viewing advice pages as associated with increased enablement to self-care, even when accessed in the absence of a RTI, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was effective at reaching the target population of users who had previously consulted their general practitioners. However, attrition before reaching advice pages was high, highlighting the necessity of prioritizing access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated and have wider implications for minor ailment interventions.

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Accepted/In Press date: 2 August 2021
Published date: 19 January 2022
Additional Information: Acknowledgments We would like to thank the Economic and Social Research Council for funding this paper (award 1692136—Understanding digital intervention engagement: Making sense of large-scale usage data). Internet Dr development and randomized controlled trials were funded by the National Institute for Health Research (NIHR) Program Grants for Applied Research (grant RP-PG-0407-10098). The Internet Dr website was developed using LifeGuide, which was partly funded by the NIHR Biomedical Research Centre, Southampton. LY is an NIHR Senior Investigator of the National Health Service, the NIHR, or the Department of Health. LY is affiliated with the NIHR Health Protection Research Unit in behavioral science and evaluation of interventions at the University of Bristol in partnership with Public Health England.
Keywords: Evaluation studies, Illness behavior, Internet, Mobile phone, Respiratory tract infection, Self-care

Identifiers

Local EPrints ID: 454564
URI: http://eprints.soton.ac.uk/id/eprint/454564
PURE UUID: c0494f0b-90fd-4edf-ae3f-48896911c5cf
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for Peter W.F. Smith: ORCID iD orcid.org/0000-0003-4423-5410
ORCID for Mark Weal: ORCID iD orcid.org/0000-0001-6251-8786
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Leanne Morrison: ORCID iD orcid.org/0000-0002-9961-551X

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Date deposited: 16 Feb 2022 17:36
Last modified: 28 Apr 2022 02:03

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Contributors

Author: Sascha Miller
Author: Lucy Yardley ORCID iD
Author: Mark Weal ORCID iD
Author: Alexander MC Milton
Author: Beth Stuart ORCID iD
Author: Paul Little
Author: Leanne Morrison ORCID iD

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