title: The effect of online chronic disease personas on activation: within-subjects and between-groups analyses.
abstract: BACKGROUND
  Although self-management of chronic disease is important, engaging patients and increasing activation for self-care using online tools has proven difficult. Designing more tailored interventions through the application of condition-specific personas may be a way to increase engagement and patient activation. Personas are developed from extensive interviews with patients about their shared values and assumptions about their health. The resulting personas tailor the knowledge and skills necessary for self-care and guide selection of the self-management tools for a particular audience.
  
  
  OBJECTIVE
  Pre-post changes in self-reported levels of activation for self-management were analyzed for 11 chronic health personas developed for 4 prevalent chronic diseases.
  
  
  METHODS
  Personas were created from 20 to 25 hour-long nondirected interviews with consumers with a common, chronic disease (eg, diabetes). The interviews were transcribed and coded for behaviors, feelings, and beliefs using the principles of grounded theory. A second group of 398 adults with self-reported chronic disease were recruited for online testing of the personas and their impact on activation. The activation variables, based on an integrated theory of health behavior, were knowledge of a given health issue, perceived self-management skills, confidence in improving health, and intention to take action in managing health. Pre-post changes in activation were analyzed with a mixed design with 1 within-subjects factor (pre-post) and 1 between-group factor (persona) using a general linear model with repeated measures.
  
  
  RESULTS
  Sixteen pre-post changes for 4 measures of activation were analyzed. All but 2 of the within-subjects effects were statistically significant and all changes were in the direction of increased activation scores at posttest. Five significant differences between personas were observed, showing which personas performed better. Of low activation participants, 50% or more shifted to high activation across the 4 measures with minimal changes (≤5%) in the reverse direction.
  
  
  CONCLUSIONS
  The majority of participants using a persona-tailored learning path reported high levels of satisfaction with their online user experience and increased levels of activation about their own health. In the body of work on patient activation, the current study adds to understanding of both short-term impact and the content of a brief, online intervention for engagement of specific groups in self-management.
authors.affiliation: Healthwise, Boise, ID, United States. cserio@healthwise.org.
authors.forename: Catherine Devany
authors.identifier: http://orcid.org/0000-0002-0758-4032
authors.initials: CD
authors.lastname: Serio
authors.forename: Jason
authors.identifier: http://orcid.org/0000-0002-2612-7259
authors.initials: J
authors.lastname: Hessing
authors.forename: Becky
authors.identifier: http://orcid.org/0000-0001-5872-0762
authors.initials: B
authors.lastname: Reed
authors.forename: Christopher
authors.identifier: http://orcid.org/0000-0003-3837-5062
authors.initials: C
authors.lastname: Hess
authors.forename: Janet
authors.identifier: http://orcid.org/0000-0001-7574-0837
authors.initials: J
authors.lastname: Reis
keywords: Internet; chronic disease; patient-centered care; self-management