E-HealthCardiac patients’ experiences with a telerehabilitation web portal: Implications for eHealth literacy
Introduction
Cardiovascular diseases are often associated with decreased quality of life, loss of memory, increased fatigue, onset of depression, and anxiety [1,2]. Successful recovery from cardiac events requires not only short-term alterations in physical activity but may also require long-term lifestyle changes for both patients and families [3]. Today, the Internet is a source of enormous amounts of health and disease information [4]. If online health information from web portals, websites, and blogs is to be used as an effective tool in cardiac telerehabilitation, patients need to know how to use the Internet and how to seek out reliable health information. They need to be able to understand and assess health information, to understand the technologies, and be able to make informed health decisions. This package of skills can be defined as ‘eHealth Literacy’, which is the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to address or solve a health problem [5].
A study [6] has estimated that only 12% of adults have the required health literacy to manage their own disease. Other studies [5,6] have found that low health literacy was associated with limited knowledge about cardiac diseases and that low health literacy was a risk factor for low self-care behavior, re-hospitalizations, and all-cause mortality [6,7]. However, low health literacy was found not to be significantly associated with decreased use of online cardiac rehabilitation systems [7], thus making online patient education and counseling important in increasing cardiac patients’ awareness of their disease and its symptoms. While research on eHealth literacy in cardiac patients is limited, some studies [8,9] have shown that web-based learning and online cardiac rehabilitation may help patients make informed health decisions and to become more involved in their own health care, thus making eHealth programs potentially efficient tools in the management of health. Furthermore, positive attitudes have been observed among cardiac patients following the use of an online patient education program, while an increase in eHealth literacy was associated with increased self-care behavior [10]. Studies [9,11] have found that age plays an important role in the kind and extent of Internet use for health information, while no significant associations have been found between gender and eHealth literacy [7]. Low education level and socio-economic status seem to have a negative influence on eHealth literacy and on the use of online health information services [9,11]. The aim of this study was two-fold: firstly, to explore how cardiac patients experience the use and content of a telerehabilitation tool in a specific web portal, called ‘Active Heart’, and secondly, to study how the patients’ use of the Active Heart portal affected their eHealth literacy skills.
Active Heart was developed during a user-driven process that included cardiac patients, their relatives, health care professionals, researchers, and representatives from companies. The portal was developed through the Teledi@log project [12] as an interactive cardiac telerehabilitation tool aimed at educating and helping patients during their rehabilitation. Active Heart content contains texts, videos, and pictures communicating a range of information about cardiac disease, treatment, adverse effects, and advice to relatives. The content offers suggestions for lifestyle changes, such as detailed information on diet, alcohol and smoking consumption, exercise suggestions, and motivational texts describing how to adopt new habits as a tool to initiate and maintain lifestyle changes. There are 80 videos of cardiac patients presenting their stories and experiences of rehabilitation. The videos last from 1 to 2 min. A screen dump of the Active Heart front page is shown in Fig. 1 and shows the range of topics covered: food, medicine, sleep, pain, smoking, training, contacts to healthcare professionals, etc. The portal also provides information for both patient and relatives on how to take action and whom to contact if adverse events occurred during rehabilitation.
Section snippets
Recruitment of patients
Patients for this study were recruited from the ward of the Department of Cardiothoracic Surgery, Aalborg University Hospital, and from the ward of the Department of Cardiology at the North Denmark Regional Hospital in Denmark. The study was performed between September 2014 and February 2015. The Active Heart web portal was part of a telerehabilitation program, and the patients were recruited for the research study prior to discharge from hospital.
Inclusion criteria for the study were:
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Patients
Baseline characteristics
A total of 109 patients were included in this study, of which 49 patients completed the questionnaires before and after the trial period of three months, yielding a response rate at 45%. Thirteen patients never began to use the web portal and therefore did not answer any of the questionnaires, and 47 patients had one or more missing data and were excluded from the analysis. Baseline characteristics and patients’ use of devices are shown in Table 2.
Furthermore, data (not presented) show that
Discussion
This study had two objectives: to explore how cardiac patients experience the contents of the Active Heart web portal as a telerehabilitation tool and to study how interaction with Active Heart has affected the patients’ eHealth literacy skills. The results show that the cardiac patients had a positive impression of Active Heart. During the trial, patients changed their understanding of how they best could obtain and assess health information (see Table 3), and how they could improve their
Author contributions
C. Melholt and K. Jønsson analyzed the results and drafted the manuscript. H. Spindler, J. Hansen, J. J. Andreasen, G. Nielsen, A. Noergaard and B. Dinesen designed the study, commented on the analysis, and provided feedback to the manuscript. A. Noergaard, A. Tracey, C. Thorup, and R. Kringelholt collected data and commented on the analysis. All authors approved the final manuscript before submission.
Funding
The research was funded by Eir Research and Business Park, The European Regional Development Fund, and the following partners in the project: KMD; IBM; Tunstall Healthcare; Oscar Film; SOS International; Department of Cardiology, North Denmark Regional Hospital, Hjoerring; Department of Cardiothoracic Surgery, Aalborg University Hospital; Center for Clinical Research, North Denmark Regional Hospital;Health Centers in Hjoerring and Frederikshavn Municipalities; Department of Psychology and
Conflicts of interest
The authors have no conflicts of interest to declare.
Acknowledgements
The authors would like to thank all cardiac patients for participating in this study. Further, we wish to thank Aalborg University Hospital and North Denmark Regional Hospital for their cooperation and support. For information on the Teledi@log project, please see http://www.teledialog.dk/en/home/.
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