title: Which bundles of features in a Web-based personally controlled health management system are associated with consumer help-seeking behaviors for physical and emotional well-being?
abstract: BACKGROUND
  Personally controlled health management systems (PCHMS), which include a personal health record (PHR), health management tools, and consumer resources, represent the next stage in consumer eHealth systems. It is still unclear, however, what features contribute to an engaging and efficacious PCHMS.
  
  
  OBJECTIVE
  To identify features in a Web-based PCHMS that are associated with consumer utilization of primary care and counselling services, and help-seeking rates for physical and emotional well-being concerns.
  
  
  METHODS
  A one-group pre/posttest online prospective study was conducted on a university campus to measure use of a PCHMS for physical and emotional well-being needs during a university academic semester (July to November 2011). The PCHMS integrated an untethered personal health record (PHR) with well-being journeys, social forums, polls, diaries, and online messaging links with a health service provider, where journeys provide information for consumer participants to engage with clinicians and health services in an actionable way. 1985 students and staff aged 18 and above with access to the Internet were recruited online. Logistic regression, the Pearson product-moment correlation coefficient, and chi-square analyses were used to associate participants' help-seeking behaviors and health service utilization with PCHMS usage among the 709 participants eligible for analysis.
  
  
  RESULTS
  A dose-response association was detected between the number of times a user logged into the PCHMS and the number of visits to a health care professional (P=.01), to the university counselling service (P=.03), and help-seeking rates (formal or informal) for emotional well-being matters (P=.03). No significant association was detected between participant pre-study characteristics or well-being ratings at different PCHMS login frequencies. Health service utilization was strongly correlated with use of a bundle of features including: online appointment booking (primary care: OR 1.74, 95% CI 1.01-3.00; counselling: OR 6.04, 95% CI 2.30-15.85), personal health record (health care professional: OR 2.82, 95% CI 1.63-4.89), the poll (health care professional: OR 1.47, 95% CI 1.02-2.12), and diary (counselling: OR 4.92, 95% CI 1.40-17.35). Help-seeking for physical well-being matters was only correlated with use of the personal health record (OR 1.73, 95% CI 1.18-2.53). Help-seeking for emotional well-being concerns (including visits to the university counselling service) was correlated with a bundle comprising the poll (formal or informal help-seeking: OR 1.03, 95% CI 1.00-1.05), diary (counselling: OR 4.92, 95% CI 1.40-17.35), and online appointment booking (counselling: OR 6.04, 95% CI 2.30-15.85).
  
  
  CONCLUSIONS
  Frequent usage of a PCHMS was significantly associated with increased consumer health service utilization and help-seeking rates for emotional health matters in a university sample. Different bundles of PCHMS features were associated with physical and emotional well-being matters. PCHMS appears to be a promising mechanism to engage consumers in help-seeking or health service utilization for physical and emotional well-being matters.
authors: Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia. a.lau@unsw.edu.au
authors: Annie Y S
authors: AY
authors: Lau
authors: Judith
authors: J
authors: Proudfoot
authors: Annie
authors: A
authors: Andrews
authors: Siaw-Teng
authors: ST
authors: Liaw
authors: Jacinta
authors: J
authors: Crimmins
authors: Amaël
authors: A
authors: Arguel
authors: Enrico
authors: E
authors: Coiera
mesh_terms: D000293:Adolescent; D000328:Adult; D057286:Electronic Health Records; D004644:Emotions; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D020407:Internet; D008297:Male; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Web-based intervention; consumer; eHealth; emotional well-being; health service; help-seeking; personal health record; physical well-being; preventative health; university
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