title: How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis.
abstract: Mental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals' needs.
  
  
  
  This study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care.
  
  
  
  A total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the "Fit between Individual, Task, and Technology" framework.
  
  
  
  Survey respondents had a mean age of 64.0 (SD 12.0) years, 85.1% (97/114) were male, 72.4% (84/116) were white, and 63.1% (70/111) had an annual household income of < US $50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6% (50/112) used health-related technology 1 to 3 times per month and 21.4% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9%, 90/114), communicate with providers (71.1%, 81/114), and track medications (64.9%, 74/114). Five major themes emerged that describe how eHealth technology influences veterans with PTSD and comorbid CMCs: (1) interactions with social support, (2) condition management, (3) access to and communication with providers, (4) information access, and (5) coordination of care.
  
  
  
  The "Fit between Individual, Task, and Technology" model provided a useful framework to examine the clinical tasks that arose for veterans and their resourceful adoption of eHealth tools. This study suggests that veterans who use the Web are eager to incorporate eHealth technology into their care and self-management activities. Findings illustrate a number of ways in which the VA and eHealth technology developers can refine existing applications, develop new resources, and better promote tools that address challenges experienced by veterans with PTSD and comorbid CMCs.
authors: Clinical Informatics Service, VA Pacific Island Health Care System, Honolulu, HI, United States. Julia.Whealin@va.gov.
authors: Julia M
authors: 0000-0002-2876-6783
authors: JM
authors: Whealin
authors: Emily C
authors: 0000-0001-9171-0283
authors: EC
authors: Jenchura
authors: Ava C
authors: 0000-0003-1777-219X
authors: AC
authors: Wong
authors: Donna M
authors: 0000-0001-8904-2810
authors: DM
authors: Zulman
mesh_terms: D015897:Comorbidity; D019468:Disease Management; D005260:Female; D057220:Health Literacy / Q000379:methods*; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: computer literacy; electronic mail; self-care; social media; stress disorders, post-traumatic; telemedicine