title: Usage and users of online self-management programs for adult patients with atopic dermatitis and food allergy: an explorative study.
abstract: BACKGROUND
  Two online self-management programs for patients with atopic dermatitis (AD) or food allergy (FA) were developed with the aim of helping patients cope with their condition, follow the prescribed treatment regimen, and deal with the consequences of their illness in daily life. Both programs consist of several modules containing information, personal stories by fellow patients, videos, and exercises with feedback. Health care professionals can refer their patients to the programs. However, the use of the program in daily practice is unknown.
  
  
  OBJECTIVE
  The aim of this study was to explore the use and characteristics of users of the online self-management programs "Living with eczema," and "Living with food allergy," and to investigate factors related to the use of the trainings.
  
  
  METHODS
  A cross-sectional design was carried out in which the outcome parameters were the number of log-ins by patients, the number of hits on the system's core features, disease severity, quality of life, and domains of self-management. Descriptive statistics were used to summarize sample characteristics and to describe number of log-ins and hits per module and per functionality. Correlation and regression analyses were used to explore the relation between the number of log-ins and patient characteristics.
  
  
  RESULTS
  Since the start, 299 adult patients have been referred to the online AD program; 173 logged in for at least one occasion. Data from 75 AD patients were available for analyses. Mean number of log-ins was 3.1 (range 1-11). Linear regression with the number of log-ins as dependent variable showed that age and quality of life contributed most to the model, with betas of .35 ( P=.002) and .26 (P=.05), respectively, and an R(2) of .23. Two hundred fourteen adult FA patients were referred to the online FA training, 124 logged in for at least one occasion and data from 45 patients were available for analysis. Mean number of log-ins was 3.0 (range 1-11). Linear regression with the number of log-ins as dependent variable revealed that adding the self-management domain "social integration and support" to the model led to an R(2) of .13. The modules with information about the disease, diagnosis, and treatment were most visited. Most hits were on the information parts of the modules (55-58%), followed by exercises (30-32%).
  
  
  CONCLUSIONS
  The online self-management programs "Living with eczema" and "Living with food allergy" were used by patients in addition to the usual face-to-face care. Almost 60% of all referred patients logged in, with an average of three log-ins. All modules seemed to be relevant, but there is room for improvement in the use of the training. Age, quality of life, and lower social integration and support were related to the use of the training, but only part of the variance in use could be explained by these variables.
authors.affiliation: University Medical Centre Utrecht, department of Dermatology/Allergology, Utrecht, Netherlands. h.vanosmedendorp@umcutrecht.nl.
authors.forename: Harmieke
authors.identifier: http://orcid.org/http://orcid.org/0000-0003-3300-2101
authors.initials: H
authors.lastname: van Os-Medendorp
authors.forename: Ilse
authors.identifier: http://orcid.org/0000-0003-1059-2022
authors.initials: I
authors.lastname: van Leent-de Wit
authors.forename: Marjolein
authors.identifier: http://orcid.org/0000-0002-1249-6993
authors.initials: M
authors.lastname: de Bruin-Weller
authors.forename: André
authors.identifier: http://orcid.org/0000-0002-1056-3179
authors.initials: A
authors.lastname: Knulst
keywords: Internet; atopic dermatitis; food allergy; self-management