A web-compatible instrument for measuring self-reported disease activity in arthritis.

OBJECTIVE: To describe a Web-based computer health assessment survey for patients with rheumatoid arthritis (RA) and to evaluate the survey in comparison with current paper versions. METHODS: Utilizing data from a study on RA, we compared results from 43 patients attending a university-based clinic who were each given a paper and a demonstration computer version of a patient self-assessment questionnaire including multiple-choice questions from a multi-dimensional Health Assessment Questionnaire (HAQ); visual analog scales (VAS) for pain, fatigue, and global disease severity; and a tender and swollen joint count reporting tool. Patients were given optional followup surveys to determine their opinion of the computer program. RESULTS: High correlations (intraclass correlation coefficient > 0.9) were seen across methods for the 10-item HAQ and psychological distress scores and the VAS scores for pain and global disease severity. Moderate correlation was observed for the self-efficacy scores, the VAS scores for fatigue, and tender joint counts. The data also revealed a small shift in the mean scores for the HAQ and self-efficacy questions, with patients reporting slightly higher scores on the computer instrument. Overall, patient opinions of the uniquely designed joint count tool were good, with 71% of responding patients answering favorably. CONCLUSION: Web-based computer versions of patient self-assessment surveys in RA are comparable to paper versions, and their use in clinics or over the Internet could dramatically facilitate the ability of physicians to monitor patients' health.

Design and pilot evaluation of an internet smoking cessation program.

Relatively little is known about how to use the Internet to promote health behavioral change. This article describes a multiple-contact Internet smoking cessation program with an 8-week web-based course, online tools for self-monitoring of behaviors, and computer-tailored e-mail messages timed to enrollees' quit efforts. In a pilot study in 49 smokers, we found that enrollees returned to the website a median of 2 times and completed an average of 2 of 8 educational modules. In follow-up, respondents (n = 26) rated e-mail and web components of the intervention as equally valuable (5.9 vs. 5.5 of 10, p = 0.44). While site had potentially important effects on smoking behaviors (34% of enrollees either quit smoking or had a 50% reduction in cigarette use), we were not able hold the interest of the majority of enrollees over the intervention period. Problems with the design of the site are discussed.

IMPACT4: a framework for rapid, modular construction of web-based patient decision support systems and preference measurement tools.

To support the rapid creation of software systems that provide patients with decision support and measure patients' preferences, we have develop a framework called iMPACT4. The framework, which combines XML and Flash, has rich client-side state navigation control capabilities, reusable components, cross-platform compatibility, and facilitated access for persons with disabilities. It has many of the advanced navigation capabilities of complex server controlled web software while retaining an architecture that allows automated generation of web sites similar to our previous software system iMPACT3.

The Internet as a research tool: worth the price of admission?

The Internet is a rich multimodal communication environment where researchers can often recruit large numbers of participants for survey studies at low cost; however, there are many unanswered questions about the use of this technology in medical research. An important question is whether the results obtained in such surveys are generalizable to other populations. In this article, we describe different approaches for recruitment of participants on the Internet and how specific approaches may limit generalizability. Another issue clouding use of the Web in research is the essential anonymity of participants. We discuss the risk and benefits of anonymous surveys and technical methods that minimize the risks while preserving anonymity and confidentiality. A related problem may be accidental or deliberate enrollment of unqualified individuals in studies. Researchers can use survey design and statistical methods described herein to partially address threats to validity arising from such individuals; however, in some situations, confirmation of eligibility, by manual review of medical records, may be necessary.