title: Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application.
abstract: BACKGROUND
  Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app.
  
  
  OBJECTIVE
  We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module.
  
  
  METHODS
  The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences.
  
  
  RESULTS
  Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance.
  
  
  CONCLUSIONS
  The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT 01638338; https://clinicaltrials.gov/ct2/show/NCT01638338 (Archived by WebCite at http://www.webcitation.org/6f0JLZMtq).
authors.affiliation: Centro Studi e Ricerche in Medicina Generale (CSeRMEG), Monza, Italy. lygidakis@gmail.com.
authors.forename: Charilaos
authors.identifier: http://orcid.org/0000-0003-2571-6286
authors.initials: C
authors.lastname: Lygidakis
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0003-4292-3092
authors.initials: P
authors.lastname: Wallace
authors.forename: Costanza
authors.identifier: http://orcid.org/0000-0003-1435-3328
authors.initials: C
authors.lastname: Tersar
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0003-0675-0876
authors.initials: F
authors.lastname: Marcatto
authors.forename: Donatella
authors.identifier: http://orcid.org/0000-0002-4304-5087
authors.initials: D
authors.lastname: Ferrante
authors.forename: Roberto
authors.identifier: http://orcid.org/0000-0001-5109-6143
authors.initials: R
authors.lastname: Della Vedova
authors.forename: Francesca
authors.identifier: http://orcid.org/0000-0002-3280-6901
authors.initials: F
authors.lastname: Scafuri
authors.forename: Emanuele
authors.identifier: http://orcid.org/0000-0001-5663-6751
authors.initials: E
authors.lastname: Scafato
authors.forename: Pierluigi
authors.identifier: http://orcid.org/0000-0003-0570-3103
authors.initials: P
authors.lastname: Struzzo
keywords: Internet; alcohol drinking; behavior and behavior mechanisms; family physicians; multimedia; physician-patient relations; primary health care; research design