Interactive Health Communication Applications for people with chronic disease
Abstract
Background
Interactive Health Communication Applications (IHCAs) are computer‐based, usually web‐based health information packages for patients that combine information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain.
Objectives
To assess the effects of IHCAs for people with chronic disease.
Search methods
We designed a four‐part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search commenced at 1990 where possible.
Selection criteria
Randomised controlled trials (RCTs) of Interactive Health Communication Applications for adults and children with chronic disease.
Data collection and analysis
One reviewer screened abstracts. Two reviewers screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using a random effects model and standardised mean differences (SMDs) were calculated to provide net effect sizes.
Main results
We screened 24,757 unique citations and retrieved 958 papers for further assessment, yielding 28 RCTs involving 4042 participants. One of these had an inadequate method of concealment of allocation, and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta‐analyses. Results in the abstract are from the meta‐analyses excluding data from this study.
IHCAs were found to have a positive effect on knowledge (SMD 0.49; 95% confidence interval (CI) 0.14 to 0.84) and on social support (SMD 0.47; 95% CI 0.28 to 0.66). IHCAs were found to have no effect on self‐efficacy (SMD 0.15; 95% CI ‐0.13 to 0.43) or behavioural outcomes (SMD ‐0.09; 95% CI ‐0.49 to 0.32). IHCAs had a negative effect on clinical outcomes (SMD ‐0.32; 95% CI ‐0.63 to ‐0.02).
Authors' conclusions
The number and range of IHCAs is increasing rapidly; however there is a shortage of high quality evaluative data. Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful. However, consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present. Further research is needed to determine the reason for this negative effect on clinical outcomes, whether an optimal IHCA can achieve behaviour change and improved health outcomes, and if so, what are the essential features of such an IHCA, and the extent to which they differ according to patient group or condition.
PICOs
Plain language summary
Interactive Health Communication Applications for people with chronic disease have benefits and harms.
People with chronic disease have multiple needs, including information about their illness and the various treatment options; social support; support with making decisions; and help with achieving behaviour change, for example changes in diet or exercise. Computer‐based programmes which combine information with on‐line peer support, decision support, or help with behaviour change may be one way of meeting these needs, and helping people achieve better health. This review sought to determine the effects of such computer programmes, known as Interactive Health Communication Applications (IHCAs), for people with chronic disease. The reviewers found that IHCAs improved users' knowledge and perceived social support. IHCAs had no effect on users' self‐efficacy or health behaviours, and users of IHCAs had worse clinical outcomes than non‐users.
