A website has been developed to aid asthma patients' self-care and allow their health care providers to monitor their condition. The site includes an electronic asthma diary, a discussion forum, and access to summaries of peer-reviewed journal articles concerning asthma. Site statistics, a web survey, a mail survey, and interviews were used to assess the level of usage of the web site, and obtain feedback from users. Positive feedback on use was received, but usage levels were generally low, and declined without marketing by the site's sponsor. Participants were divided on their use, some preferring the diary, others the articles and discussion forum. Problems arose with convenience for patients to submit daily diary entries, and with willingness to accept feedback that included changes in medication dosage. Health care practitioners lacked computer skills and had difficulty with time constraints when attempting to use the site.

Background: Asthma is an illness requiring much self-management by patients. A web site (Danish version: www.linkmedica.dk and UK version: www.linkmedica.co.uk) provided a means for asthma patients to submit information on medication use and symptoms. It was developed to provide patients with assistance in the self-management process, and to allow health care providers to monitor their patients' condition. The site contains an electronic diary, in which patients submit daily a variety of indictors and symptoms experienced in relation to their asthma. The purpose of this study was to investigate how patients and health care professionals used the system, to evaluate their perceptions about it, and gain more understanding about its impact on their daily lives.

Methods: Researchers collected data in 2002 and 2003 using four sources: usage statistics from the web site; an on-line survey of patient users (n=85); a mail survey of health care providers (n=131); and interviews of patients (n=10) and health care providers (n=5), recruited from survey participants. Descriptive statistics from the first three sources were provided, as well as sample responses to interview questions from the fourth.

Finding: Fluctuations in registered asthma diary users occurred, with increases possibly related to advertising of the web site. The online survey indicated most participants were asthma patients, some were mothers with asthmatic children, and the remainder health care providers. Web survey respondents found the site quality to be either good or very good. The final survey, distributed to all health care providers who registered at the web site, yielded mostly physician respondents and some nurses. Approximately one third of these practitioners stated they did not use the asthma management site with their patients and about one third used it only sometimes. Analysis of the interviews yielded a variety of themes among participants based on their perspective of the system. Those patients who used the web site to maintain their health by seeking information to control their condition generally focused on the diary component. Others did not routinely search for material about their illness, preferring to access this based on need and subsequently used only the message board and articles. Some participants focused more on using the diary component at certain times and message boards and articles at other times (for example mothers of asthmatic children). The health care practitioners perceived that the web site was useful to their patients. However, usage and satisfaction were in some cases limited by lack of experience with the Internet among physicians, and a lack of routine access to the Internet among patients. Patients reported they did not submit their information on a daily basis, often entering one week's worth of data at a time, despite knowing this would impede positive impact of the diary. Some patients questioned the automated advice generated by the web site's response system, and thinking the recommended dosage was incorrect, did not follow the advice provided. General practitioners had problems instructing their patients on use of the system as well as using it themselves.

Conclusions: In order for web-based self-care interventions to be successful the interface must meet the needs of the users. Profiles of site users should be determined in advance in order to design the web interface to best suit needs, whether treatment-based or information-based. Feedback messages should provide information about health status and not recommend change in dosages. Another web site that provides a tool for managing chronic illness, in particular diabetes is https://www.diabetease.com/. Recommendations were also made for use of other, easier to integrate technology such as cell phones, which may be more readily used and accessed by both patients and providers.

Reference: Anhøj J, Nielsen L "Quantitative and Qualitative Usage Data of an Internet-based Asthma Monitoring Tool" Journal of Medical Internet Research 2004;6(3):e23

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