title: The potential of Web-based interventions for heart disease self-management: a mixed methods investigation.
abstract: BACKGROUND
  Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide.
  
  
  OBJECTIVE
  To explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD).
  
  
  METHODS
  Quantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services.
  
  
  RESULTS
  Only 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention.
  
  
  CONCLUSIONS
  The availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge.
authors.affiliation: E-Health Unit, Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Cicely
authors.initials: C
authors.lastname: Kerr
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: Lorraine
authors.initials: L
authors.lastname: Noble
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.forename: Fiona
authors.initials: F
authors.lastname: Stevenson
authors.forename: David
authors.initials: D
authors.lastname: Patterson
authors.forename: Richard
authors.initials: R
authors.lastname: Peacock
authors.forename: Indra
authors.initials: I
authors.lastname: Turner
authors.forename: Keith
authors.initials: K
authors.lastname: Jackson
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000517:prevention & control / Q000534:rehabilitation*; D003376:Counseling / Q000379:methods; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires