Kingshuk Pal*, eHealth Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom Charlotte Dack*, eHealth Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom Jamie Ross*, eHealth Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom Fiona Stevenson, eHealth Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom Elizabeth Murray*, eHealth Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom Track: Research Presentation Topic: Web 2.0 approaches for behaviour change, public health and biosurveillance Presentation Type: Oral presentation Submission Type: Single Presentation Building: Mermaid Room: Room 4 - Queenshithe Date: 2013-09-23 04:00 PM – 06:00 PM Last modified: 2013-09-25

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Background
Diabetes is one of the commonest chronic medical conditions in the UK, affecting approximately 1.9 million adults. Structured patient-education programmes can reduce the risk of developing diabetes related complications fourfold. In 2007 only 11% of people with Type 2 diabetes reported that they had been offered structured education. One way of improving access to education and self-management training is through internet-based interventions. Around 90% of people with diabetes have type 2 diabetes, many of whom will not require insulin, so might benefit from low-intensity internet-based self-management training. However, internet interventions often struggle to ensure sufficient uptake and adherence. It is therefore essential that these interventions engage patients effectively and strike a balance between providing the education and training that patients need, with an interface and components that makes patients want to use them.

Objective
The purpose of this work was to explore what patients would want from such interventions and what health-professionals thought were needed in such interventions. One feature of such interventions might be providing access to online medical records. There is a commitment from the UK government to allow patients online access to their medical records by 2015 and we wanted to explore the issues that might arise around this.

Methods
Patients: We recruited adults with Type 2 diabetes who responded to advertisements for the research project in print (Diabetes UK Balance magazine) and online. Purposive sampling was used to recruit a maximum variety sample in terms of gender, age, ethnicity, length of time of diagnosis, treatment regimen, educational attainment, internet use, presence or absence of diabetes related complications and previous experience of self-management programmes. Recruitment continued until we reached theoretical saturation.
Health Professionals: GPs, practice nurses and community specialist diabetes nurses were recruited through the research networks represented in our team. Hospital consultants and hospital specialist diabetes nurses were recruited through the Diabetes Research Networks and contacts. Recruitment continued until we reached theoretical saturation.
Participants in both categories were interviewed in focus-groups or semi-structured interviews. Interviews were recorded and transcribed verbatim. Data was coded and analysed by a multi-disciplinary group in parallel with data collection. Individual researchers read and coded the data independently and emerging codes and themes were discussed in a multi-disciplinary team to reach a consensus. Coded data were organised and analysed using thematic analysis.

Results
Patients were clear on what they wanted. They wanted an intervention that was easy to use and attractive with a consistent format. It was important that the tone of the intervention was positive supportive and fun. In terms of content, patients wanted as much information as possible, interactive content and quizzes, links to other relevant sites, personal stories and tools to track self-monitoring data. They also wanted access to expert opinions. Content that was not localised or relevant to their situation was a strong deterrent to use. Factors that that might increase engagement were trustworthiness, tailored content, a strong online community and email or text alerts. Health professionals had similar views about the basic features of the website, but were more focused on motivation to change and wanted evidence of effectiveness of the intervention. Their main concerns were around workload implications (e.g. being overwhelmed by self-management data) and there were some concerns about the implications of patients having full access to their electronic medical records.

Conclusions
There was significant overlap between what patients and health professionals wanted from such an intervention: both sets felt that ease of use, multimedia features and a positive tone were important. Patients and professionals agreed that giving patients access to a summary of their medical records would be a very valuable tool.
There were some areas where they felt differently: patients felt quite strongly that the intervention should to be fun to use, whereas health professionals felt that it was very important for the intervention to motivate change. Patients liked the idea of being able to access their notes, whereas health professionals were more ambivalent and were worried about causing anxiety, increased workload and litigation.