title: Development and evaluation of an internet and personal health record training program for low-income patients with HIV or hepatitis C.
abstract: BACKGROUND
  Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services.
  
  
  OBJECTIVE
  To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience.
  
  
  METHODS
  Preevaluation and postevaluation using quantitative surveys, semistructured interviews, focus groups, and ethnographic observation.
  
  
  METHODS
  Fourteen low-income Veterans receiving care at Veterans Affairs medical centers for human immunodeficiency virus or hepatitis C.
  
  
  METHODS
  Internet and PHR use, self-efficacy, patient activation, disease knowledge, predictors of medication adherence.
  
  
  RESULTS
  At follow-up one (FU1), mean number of internet for health features used increased from 1.57 to 4.07 (P<0.001) as did number of PHR features, from 0.36 to 2.00 (P<0.001). Mean self-efficacy increased at FU1, from 7.12 to 8.60, (P=0.009) and was maintained at follow-up two (FU2). Patient activation increased only at FU2, from 3.42 to 3.61 (P=0.03). Disease specific knowledge showed borderline increase at FU1, from 67.9% to 72.2% (P=0.05), whereas there were no changes in predictors of medication adherence. Qualitative findings underscored the interest in using internet and PHRs and their contribution to increased engagement in care. Training cost per participant was $287.
  
  
  CONCLUSIONS
  Group training of vulnerable patients represents a cost-effective method to increase internet and PHR skills, and improve patient confidence in finding health-related information, making online health-related transactions, and interacting with health care providers.
authors: VA QUERI Program and Center for Health Quality, Outcomes, and Economic Research, ENRM VA Medical Center, Bedford, MA 01730, USA. keith.mcinnes@va.gov
authors: D Keith
authors: DK
authors: McInnes
authors: Jeffrey L
authors: JL
authors: Solomon
authors: Stephanie L
authors: SL
authors: Shimada
authors: Beth A
authors: BA
authors: Petrakis
authors: Barbara G
authors: BG
authors: Bokhour
authors: Steven M
authors: SM
authors: Asch
authors: Kim M
authors: KM
authors: Nazi
authors: Thomas K
authors: TK
authors: Houston
authors: Allen L
authors: AL
authors: Gifford
mesh_terms: D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D015658:HIV Infections / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006526:Hepatitis C / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D011203:Poverty; D016730:Program Development; D015397:Program Evaluation; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans; D035862:Vulnerable Populations