From face to face, to web based.
The shift over the past twenty years from a paternalistic model of health care to one of equal relationships between clinicians and patients has resulted in greater patient autonomy and empowerment.
Recent years have seen a further shift from traditional face-to-face consultations to greater technology driven interventions or e-therapies. This has been evidenced by a 12-fold increase in Medline citations for “web-based therapies” from 1996-2003 (Wantland, Portillo, Holzemer, Slaughter & McGhee, 2004). Such technologies are now being embraced across disease states and populations to allow patients more freedom in when, where and how health information is delivered. Such a shift appears to be driven by the explosion of the internet and web-based platforms, both of which allow patients to search for information and engage in a time and place that is suitable for the individual. Technologies therefore need to evolve in such a way as to engage a patient and maintain the relationship with them throughout the course of the intervention.
With the explosion of SMS, iphones, ipads, e-books, widgets and apps, healthcare needs to evolve to meet demand. Whether this is by developing evidence-based technology driven treatment programmes, delivering adherence messages through SMS or electronic monitoring of behaviour, consumers now demand this and there is a race to meet these needs. Many providers of healthcare are doing so, but the question is how successfully and is their investment and investment well spent?
Internet interventions or e-therapies have been shown to be able to deliver effective intervention programmes for a number of psychological conditions (Griffiths & Christensen, 2006; MacKinnon, Griffiths & Christensen, 2008). These interventions are delivered on a large scale by a technology platform that appears to be creating outcomes that may be as effective as face-to-face consultations”. This is advantageous when a cost effective, high volume intervention is required. In addition to this, the demand for e-therapies are increasing and there is evidence that web-based interventions are often preferentially sought for their anonymity, their capacity to be used privately at home and for their lack of face-to-face contact. As such e-therapies may increase the likelihood of contact with individuals who might not otherwise seek care (Ruggiero, Resnick, Acierno, Coffey, Carpenter, Ruscio, et al., 2006).
Similar results have been created with our AsthmaAim trial. Through the use of our health psychology strategy, we have been able to develop a SMS programme that not only increases adherence to preventer medication, but results in sustained change even after the intervention has finished; a major challenge in Asthma.
Whilst we have seen success in these areas, many programmes and providers are not as successful. At present, several areas are becoming saturated with programmes following the perception that a web-based platform is a must regardless of disease state or patient population. This is not always the case as the programme needs to consider a number of factors to be successful – one being catering for a consumer need. Once the need is identified, the programme then needs to be positioned in such a way as to reach the target audience, engage them in the programme, encourage their persistence in the programme and deliver the appropriate messaging to produce behaviour change. There are many programmes in circulation that produce no change in target behaviours, or even put consumers off using the technology thereby negatively tainting the consumer’s perspective of the product. Engagement is and persistence with the programme is also a huge issue. There are some programmes in circulation where only 0.5% of the programme participants complete the programme with the majority failing to have a desirable level of exposure to content and thereby not producing the desired outcomes.
Not unlike adherence to pharmaceuticals, adherence to these programmes can also be poor. “For real world effectiveness outside the clinical setting, success demands an understanding of the “patient specific” barriers, an effective engagement strategy that connects, and behaviour changing interventions that patients want to be a part of.” Combining these factors will ensure the success of your venture.
Liesje Donkin MSc (Hons), PGDipHlthPsych, PGDipArts(Dist), PGDipClinPsych
Atlantis Healthcare Health Psychologist
