Evaluation of influenza prevention in the workplace using a personally controlled health record: randomized controlled trial.
BACKGROUND
Personally controlled health records (PCHRs) are accessible over the Internet and allow individuals to maintain and manage a secure copy of their medical data. These records provide a new opportunity to provide customized health recommendations to individuals based on their record content. Health promotion programs using PCHRs can potentially be used in a variety of settings and target a large range of health issues.


OBJECTIVE
The aim was to assess the value of a PCHR in an employee health promotion program for improving knowledge, beliefs, and behavior around influenza prevention.


METHODS
We evaluated a PCHR-based employee health promotion program using a randomized controlled trial design. Employees at Hewlett Packard work sites who reported reliable Internet access and email use at least once every 2 days were recruited for participation. PCHRs were provided to all participants for survey administration, and tailored, targeted health messages on influenza illness and prevention were delivered to participants in the intervention group. Participants in the control group received messages addressing cardiovascular health and sun protection. The main outcome measure was improvement in knowledge, beliefs, and behavior around influenza prevention. Secondary outcomes were influenza vaccine rates among household members, the impact of cardiovascular health and sun protection messages on the control group, and the usability and utility of the PCHR-based program for employees.


RESULTS
The intervention did not have a statistically significant effect on the influenza knowledge elements we assessed but did impact certain beliefs surrounding influenza. Participants in the intervention group were more likely to believe that the influenza vaccine was effective (OR = 5.6; 95% CI = 1.7-18.5), that there were actions they could take to prevent the flu (OR = 3.2; 95% CI = 1.1-9.2), and that the influenza vaccine was unlikely to cause a severe reaction (OR = 4.4; 95% CI = 1.3-15.3). Immunization rates did not differ between the intervention and control groups. However, participants in the intervention group were more likely to stay home during an infectious respiratory illness compared with participants in the control group (39% [16/41] vs 14% [5/35], respectively; P = .02). The program also succeeded in improving recognition of the signs of heart attack and stroke among participants in the control group. Overall, 78% of participants rated the PCHR as "extremely/very" easy to use, and 73% responded that they would be "extremely/very" likely to participate again in a PCHR-based health promotion system such as this one.


CONCLUSIONS
With a small sample size, this study identified a modest impact of a PCHR-based employee health program on influenza prevention and control. Employees found the PCHR acceptable and easy to use, suggesting that it should be explored as a common medium for health promotion in the workplace.


BACKGROUND
ClinicalTrials.gov NCT00142077.
Bourgeois
Florence T
FT
Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. florence.bourgeois@childrens.harvard.edu
Simons
William W
WW
Olson
Karen
K
Brownstein
John S
JS
Mandl
Kenneth D
KD
D000328:Adult; D003194:Computer-Assisted Instruction; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D020407:Internet / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D009786:Occupational Health Services / Q000458:organization & administration; D033283:Patient Access to Records / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D014481:United States; D017132:Workplace