title: An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign.
abstract: The recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines.
  
  
  
  The objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality.
  
  
  
  At 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users.
  
  
  
  Over 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project's Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ≤.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562% (95% CI 456%-4870%) for the app and 620% (95% CI 176%-1777%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9% (95% CI 0.0%-1.8%) for the app and 1.4% (95% CI 0.7%-2.1%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5% (397/500).
  
  
  
  Despite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted.
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Donatella
authors.identifier: 0000-0002-2677-0551
authors.initials: D
authors.lastname: Panatto
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Alexander
authors.identifier: 0000-0001-9608-8892
authors.initials: A
authors.lastname: Domnich
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Roberto
authors.identifier: 0000-0002-1012-6913
authors.initials: R
authors.lastname: Gasparini
authors.affiliation: Department of Health Sciences, University of Florence, Florence, Italy.
authors.forename: Paolo
authors.identifier: 0000-0003-2875-3744
authors.initials: P
authors.lastname: Bonanni
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Giancarlo
authors.identifier: 0000-0002-8463-8487
authors.initials: G
authors.lastname: Icardi
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Daniela
authors.identifier: 0000-0002-9707-5214
authors.initials: D
authors.lastname: Amicizia
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Lucia
authors.identifier: 0000-0002-8708-2955
authors.initials: L
authors.lastname: Arata
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Stefano
authors.identifier: 0000-0002-8358-4798
authors.initials: S
authors.lastname: Carozzo
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Alessio
authors.identifier: 0000-0001-6289-9144
authors.initials: A
authors.lastname: Signori
authors.affiliation: Department of Health Sciences, University of Florence, Florence, Italy.
authors.forename: Angela
authors.identifier: 0000-0002-6013-8779
authors.initials: A
authors.lastname: Bechini
authors.affiliation: Department of Health Sciences, University of Florence, Florence, Italy.
authors.forename: Sara
authors.identifier: 0000-0002-9695-7549
authors.initials: S
authors.lastname: Boccalini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data*; D011008:Pneumococcal Infections / Q000628:therapy*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult
keywords: eHealth; invasive pneumococcal disease; mHealth; mobile app; pneumococcus