Summary Table 6. Specific Findings for Populations of Interest

Author, Year, Design, NPopulation descriptionConditionInteractive Computer Technology (ICT)Findings
African Americans
Artinian, 2003106
RCT, N= 18
65 % Black (11 pts)
35% White (6 pts)
Congestive heart failurevideo cassette (Med - Monitor) that sat in a cradle connected to a telephone lineMajority (56%) loved it
Lifestyle change seen in 67%
BP more stable by remembering meds; need less nitroglycerine
Improved self care behaviors and QOL
Some technical difficulties reported
Brennen, 2001157
RCT, N= 140
12% African American
86% Caucasian
CABGComputerized, internet-based information and support system that provides extension and enhancement of traditional nursing servicesFor one week snapshot: Group 1 used the HeartCare system a total of 451 times, an average of 64 accesses per day
Gerbert, 200395
RCT, N=52
48% African American; 12%Latino; low incomeSmoking & AlcoholismBrief motivational video risk assessment with tailored adviceConvenience (right amount of time;5.7 / 7); privacy(5.95/ 7 pts); confidential (5.9/7pts); honest (6.94/7 pts); ease of use (6.8 /7 pts); satisfaction (5.7 /7pts)
71% would feel more comfortable with a “real” doctor.
Guendelman, 2002128
RCT, N= 134
Gp 1:
79% African American
8% Caucasian
Gp 2:
74% African American
12% Caucasian
AsthmaInteractive communication device with question and response tasks. Questions provided by the nurse to the patient for their responesReduction in the number of urgent calls (p= 0.05), ED visits (p= 0.21), hospitalizations, (0.96)
Reduction in limitation of activity (p=0.03)
Decrease in the number of people having trouble sleeping, (p= 0.83)
Reduction in number of subjects that missed school
Joseph, 2007130
RCT, N= 314
>98% students were African AmericanAsthmaWeb based program focusing on controller medication adherence, rescue inhaler availability,
smoking cessation/reduction.
Decrease in symptom days, symptom nights, school days missed/30 days,
Decreased days of restricted activity
Decrease in days having to change plans
Decreased Hospitalizations (p= 0.01) and ED visits/12 months, p= (0.08)
Positive behavior in medication adherence (p= 0.09) and rescue inhaler activity (p=0.01)
Trend towards better quality of life
La Porta, 2007a153
Survey, N= 2485
11% African American
75% Caucasian
6% Hispanic
Cancer and SmokingCancer Information Service and LiveHelp provide cancer patients and family members with real time information and advice73% reported their knowledge had increased after using the service
95% said they were very satisfied or satisfied
88% said service met or exceeded expectations
67% said they felt more confident in their ability to seek cancer information following the service
60% of those who used the service for themselves (not a family member) and were dx w/cancer, felt more confident in their ability to actively participate in treatment decisions
Of those actively smoking at time of using service, at survey completion: 14% had quit, 35% had cut back, 45% plan to quit or cut back in future
La Porta, 2007b158
Survey, N= 2485
11% African American
75% Caucasian
6% Hispanic
Cancer and SmokingCancer Information Service (CIS)and LiveHelp provide cancer patients and family members with real time information and adviceLive help group was more likely to gain cancer-related knowledge compared to CIS telephone group (P<0.001)
61% in Live help grp and 59% in CIS grp were very satisfied, 39% in Live help and 35% in CIS grp were satisfied
38% in Live Help and 29% in CIS said the system exceeded expections,
56% in Live Help and 59% in CIS said system met expectations
Meigs, 2003159
RCT, N= 598
Grp 1 vs Grp 2
Black: 19.2% vs 18.9%
White: 71% vs 71.1%
Other: 9.8% vs 10.0%
Type 2 Diabetesweb based decision support tool, displaying interactive patient specific clinical data,
treatment advice, and links to other web based care resources
Positive change seen in all glycemic control outcomes except Mean HbA1c (% Hb)
Positive change seen in all cholesterol control outcomes
Positive change seen in all BP control outcomes except the Mean systolic BP (mmHg)
Increase in the number of subjects having at least one eye examination by an eye care professional and one foot exam in the last 12 months
Nguyen, 2005*113
Between group, N= 23
6% African-American (1)
13% White (13)
6% Native American (1)
6% Other (1)
Chronic Obstructive
Pulmonary disease
web site to help individuals with COPD by logging onto website at least 3 times/week, 2 weekly chat sessions, online bulletin board and email support, individualized exercise plansNo significant differences in physiologic outcomes.
Piette, 1997*47
Prospective study, N= 65
9.2% Black
61.5% White
18.5% Hispanic
10.8% Asian/Pacific Islander
DiabetesAVM system using specialised computer technology to telephone patients, communicate messages, and collect informationAVM system with multiple phone line with half time nurse will cost 10% of the human calling system
Program cost for second year is 2% of human calling system (assuming progam paid for itself in first yr)
Almost all of the subjects reported that AVM was useful and would like to receive AVM.
Almost all had no difficulty responding to the system
37.5% – 85.6% listened to 2 + preventive messages
72.2–90.9 % thought AVM would make them more satisfied with VA care
Sciamanna, 2004*86
Cohort, N= 150
4.1% Black (6)
83.1% White (123)
11.4% Hispanic (17)
1.4% Other (2)
chronic illnesscomputer assessment on smoking and physical activity with tailored printed feedback12% of patients asked for help using computer;
81.1% patients felt computer easy to use
Satisfaction with provider visit significantly related to having a chronic conditon, being a nonsmoker, and having a provider who reviewed the report with the patient
Sciamanna, 2005102
Quasi experimental, N= 121
6.6% Black
86.8% White
2.5% American Indian
3.3% Hispanic
5% Other
osteoarthritis of the kneecomputer assessment on OA, satisfaction with care;
computer personalized feedback about OA quality of care and treatment recommendations
website ratings-23.1% excellent, 52.9% very good, 24% good;
97.5 % said website was easy to use
Majority thought that Website could help get better care,
help understand and manage osteoarthritis and help talk to doctor
Shaw, 2007*53
RCT, N= 231
35.9% African American (83)
62.3% Caucasian (144)
1.7% Other minorities
Metastatic Breast CancerCHESS: Web-based information, discussion group, ask an expert, and interactive services (tailored action plan, decision aids, health trackingPositive change in information competence
Use of all four components of ICT
Use over 4 months by category
Mean use discussion 506.2 min
Mean use information 35.5 min
Mean use ask an expert 28 min
Mean interactive service 27.9 min
Taylor, 2006107
RCT, N= 114
UC vs Exp

40% vs 42% African American
60% vs 49% Caucasian
0% vs 5% Hispanic
0% vs 5% Asian
Obstructive sleep apneaOSAS library with customized information; Daily questions on sleep and CPAP use, responses monitored and categorized into low/medium/high risk, sleep specialist call patient after 3 days of high-risk responses83% found HealthBuddy very easy to use;
2 out of 3 reported it a positive experience;
83% had no difficulty using it;
75% wer likely or very likely to continue using it.
69% satisfied with Health Buddy,
71% satisfied with communication with clinicians;
Mean hours of CPAP use (hrs): Usual care 4.22, Exp 4.29, p=.87
CPAP mean proportion (hrs):UC 50.1%, exp 46.9%, p=.61;
Functional status, Usual care 2.27, exp group 2.03, p=.76
Winzelberg, 2002141
RCT, N= 72
4% African American
80% Caucasian
4% Asian
6% Hispanic/Latina
6% Other
Breast cancer12 week, structured, web based support group moderated by a mental health professionalGroup experience evaluation (% reporting a lot or a great deal)
getting support and encouragement: 65
helping others: 56
learning that problems are not unique: 56
develop new friendships: 63
get advice: 55
express true feelings: 65
model self after group participants: 30
confront difficult probs. and fears: 44
discuss sexual concerns: 44
Rural
Estabrooks, 2005146
RCT, N= 422
Urban as well as ruralType 2 DiabetesComputer CD-ROM with Goal setting, Tailored action plan, assessments of dietary intake and physical activity, hard copy of pts personal action planDecreased fat consumtion
increased veggie and fruit consumption
Increased moderate/vigorous activity
Ferrer-Roca, 200460
Case series, N= 172
(Gp 1 (DM): 12
Gp 2 (website review only): 160)
Rural IslandersDiabetesWebsite with patient and doctor interfaces for inputting data and sending adviceOut of those who entered the trial to test the system
86% would recommend the site
Majority (71%) thought the system was easy
33% did not find the system useful and efficient
50% had difficulties in accessing the system
Ambiguous results on HIT satisfaction

Out of those who reveiwed the website
40% would recommend the site
Majority (92%) thought the system was easy
12%did not find the system useful and efficient
88% had difficulties in accessing the system
Gustafson, 1998*36
Cohort, N=38
28[76%] of 27 potentially eligible urban vs. 10 [71%] of 14 ruralBreast CancerCHESS: computerized information and problem-solving, Q & A, ask an expert, health profile, peer discussion group, personal stories, decision aidsUse over 10 weeks:
Mean 6.8 uses/week/subject
100% used discussion group, ask an expert, Q & A, health profile
71% of uses for social support,
16% of uses for information
Gustafson, 200174
RCT, N = 295
Urban, small city and rural areasBreat cancerComputer based patient support system providing information, decision-making and emotional supportIncreased participation and level of comfort
Increased confidence in doctors
Increased information competence
Decreased unmet information need (5 month Follow up)
Increased partici[ation and behavioral involvement
Better quality of life
Hill, 2006156
RCT, N= 120
Ranch, Farm or Small town
(Rural- lived 25 miles outside an urbanized area (a city of 12,500 or more),having to travel almost 57 miles one way)
Diabetes, Rheumatoid conditions, heart disease, cancer, multiple sclerosisOnline, asynchronous, peer-led support group and health teaching units using WebCTTrend toward increasing self esteem, (p=0.016)
Increase in feeling of empowerment, (p=0.016)
Increased seld efficacy (p=0.107)
Decreased feelings of depression, loneliness and stress (p= 0.342, 0.206, 0.343 respt)
High levels of social support, (p=0.038)
Kaufman, 2003*75
usability cognitive walkthrough and field observation,
N= 14 NYC, 11 upstate (but really 2 case studies)
rural upstate NY and hispanic NYCDiabetes Mellitusvideoconferencing, BP & BG uploading and review, education, emailUsability issues
system barriers- problematic widgets, small fonts, bad spacing, complext tasks, screen transitions, system stability
Cognitive/Skill barriers-mouse-keyboard skill, mental model, literacy, numeracy.
Also anxiety, self-efficacy, motivation
Shaw, 2007*53
RCT, N= 231
Detroit cohort: unknown.
Wisconsin cohort: rural.
Metastatic Breast CancerCHESS: Web-based information, discussion group, ask an expert, and interactive services (tailored action plan, decision aids, health trackingPositive change in information competence
Use of all four components of ICT
Use over 4 months by category
Mean use discussion 506.2 min
Mean use information 35.5 min
Mean use ask an expert 28 min
Mean interactive service 27.9 min
Smith, 200054
RCT, N= 30
Rural-at least 25 miles away from 6 major cities of MontanaDiabetesweb based computer intervention on general health and info on diabetes with Conversation area, mailbox, health chat area and resource rackTime spent using the HIT decreasing over study period
Psychosocial adjustment to illness scale lower in the computer group as compared to the non computer group
Raw mean scores of quality of life and support lower in the computer group
Woodruff, 2001151
pre post cohort study, N= 26
Rural alternative schoolsSmokingchat room, facilitated by tobacco counselor, using Active World38.9% self reported not smoking
Underserved
Finkelstein, 199633
Qualitative Study, N=41
Reside in low-income inner city area, 2/3 had never used a computer, almost 50% had never used a computer or an ATM, >50% born outside US and English was their 2nd language, age range was on older side (most >40 yrs, and 1/3 >50 yrs),Asthma/underservedSymptom diary and spirometry testNot complicated at all, very easy to use
Lober, 2006*82
N=38
Low-income elderly and disabled, mean age 69 years (range 49–92 years), 82% Female, 18% Male, many had chronic diseasesMany chronic illnessesPersonal health records with areas for communication with health professionalEmpowering patients to keep track of PHR, reassurance that if a natural disaster hits, their PHR will remain intact since they are not paper-form
  • 93% of providers found the Personal Health Information System useful when treating patients
McDaniel, 200299
Cohort, N=110
35% did NOT have HS diplomaSmokingInteractive smoking cessation softwareTechnology malfunctions; software errors;
60.2 / 70pts; minority participants more satisfied
Sciamanna 2004*86
Cohort
N= 150
Public health clinics
1 provider at 10 clinic sites;
63.3% had some chronic illnesscomputer assessment on smoking and physical activity with tailored printed feedback12% of patients asked for help using computer;
81.1% patients felt computer easy to use
Satisfaction with provider visit significantly related to having a chronic conditon, being a nonsmoker, and having a provider who reviewed the report with the patient
Elderly
Barnason, 2003119
RCT w/ repeated measures, N= 35
Age range 65 –85 yearsCoronary Artery diseaseHealth buddy:small device attached to patient's telephone. Provides asssessment, strategies, education, and positive reinforcementSignificantly higher self efficacy scores, adjusted physical functioning mean scores, adjusted general health functioning mean scores, mental health functioning and validity functioning in intervention group,
Significant time effect [F(1,29)=11.25, P <.002] on the role emotional functioning and pain subscale [F(1,29)=11.25, P <.002]
Fewer subjects reported the use of salt when cooking and eating at 4 weeks, 6 weeks, and 3 months postoperatively.
Significantly higher exercise adherence (t = 3.09, P < .01) and stress control
Baranson, 2006120
randomized, experitmental two-group repeated measures design,
N= 50
Average age- 73.3 yearsCoronary Artery diseaseHealth Buddy-12 weeks of a desktop telehealth device with daily interventions with recovery assessment, strategies to manage problems, education and positive reinforcementImprovement seen in physical and mental health outcomes at 6 wks and 3 months after bypass
(Physical- F=9.42, p<0.01; Mental- F= 7.97, p< 0.01)
Decreased number of emergency room visits in the intervention grp (p= 0.15)
More number of non routine provider visits in the intervention grp (Mean =2.8) as compared to the conrol (mean=2.61)
Nursing visit average higher in the experimental group as compared to control group
Feil, 200069
Qualitative Study, N=160
Ages 40–75 yearsType 2 DiabetesD-Net intervention: peer social support and personalized dietary interventionComputer was initial barrier to program participants
Gustafson, 1998*36
Cohort, N=38
Mean age- 71.8, SD 6.06Breast CancerCHESS: computerized information and problem-solving, Q & A, ask an expert, health profile, peer discussion group, personal stories, decision aidsUse over 10 weeks:
Mean 6.8 uses/week/subject
100% used discussion group, ask an expert, Q & A, health profile
71% of uses for social support,
16% of uses for information
Holbrook, 2007162
Randomised trial (no control), N= 98
≥ 65 yearsNot specifiedDecision board, decision booklet with audiotape, or interactive computer program with either pie graphs or pictogramsHigher post intervention scores on the Atrial Fibrillation Information Questionnaire (p<0.01)
96% of participants felt that the information in the decision aids helped them make their treatment decision
Mean difference scores by format and graphic presentation similar in corresponding groups
Jones, 199938
RCT, N= 525
>60 examined as variableCancerPersonalized computer based information i.e. Cancer information tailored by data in EHR vs not tailored vs printed bookletsNS change depression and cancer adjustment scores;
84% improved anxiety scores, especially PINF (tailores),
especially but also BKLT (booklets); subgroups examined
Physician assessed ‘above avg knowledge’ 35% GINF(non tailored), 25% PINF, 20% BKLT. [note that in general, docs assessed pt knowledge below average]
12 min (1–44) 1st use; 71% no repeat use: 20/169 PINF, 4/155 GINF 80% would prefer 10 min w/ professional (71% PINF, 80% GINF, 90% BKLT); overall 40% satisfied; satisfaction with information higher in PINF
Kaufman, 2003*75
usability cognitive walkthrough and field observation,
N= 14 NYC, 11 upstate (but really 2 case studies)
Age-69.6±6 (NYC); 73.7±8 upstateDiabetes Mellitusvideoconferencing, BP & BG uploading and review, education, emailUsability issues
system barriers- problematic widgets, small fonts, bad spacing, complext tasks, screen transitions, system stability
Cognitive/Skill barriers-mouse-keyboard skill, mental model, literacy, numeracy.
Also anxiety, self-efficacy, motivation
Kressig, 200298
Cohort, N=34
≥60 yearsPhysical activity for elderlycomputer system for exercise promotion (questionnaire with tailored recommendations)Most problems had to do with survey issues, not computer. 22% questions were mouse related. Ease of use 4.6/5 pts; 21.45/24pts on acceptability of recommendation.
Lee, 200762
Quasi-experimental, N= 274
Elderly examined as subgroupType 2 DMWeb-based system for managing patients' care of their diabetesSignificant reduction in fasting blood glucose levels (p= 0.001), total cholesterol levels p=0.012 and HbA1c % (p=0.001)
Subjects in “College or University” logged into system more often than those in “Illiterate” or “Elementary school/Junior high school” (P=0.007 and P=0.012, respectively)
Subjects in the age category of <29 years logged than those in 50–59, 60–69, and 70–79 (P=0.011, P=0.000, P=0.000, respectively)
Those in the age category of 40–49 years logged more often than those in the age category of 60–69 and 70–79 (P=0.012 and P=0.040, respectively)
Lober, 2006*82
N=38
Low-income elderly and disabled, mean age 69 years (range 49–92 years), 82% Female, 18% Male, many had chronic diseasesMany chronic illnessesPersonal health records with areas for communication with health professionalEmpowering patients to keep track of PHR, reassurance that if a natural disaster hits, their PHR will remain intact since they are not paper-form
  • 93% of providers found the Personal Health Information System useful when treating patients
Nguyen, 200345
Non randomized trial, N= 16
Mean age = 69.1 (grp 2)
range- 55–82
Dyspnoeanurse facilitated and peer supported internet based dyspnoea self management programFEV1/FVC: 41 +/- 7%; Improvements noted for Dyspnoea (effect size=0.86)
Endurance exercie 0.27 for the overall sample
Improvement in self efficacy for managing dyspnoea = 0.94
First month registered most logins (330) compared to 104 in the final month
Nguyen, 2005*113
Between groups, N= 23
Age- 69.1 +/- 7.0 (55–82)Chronic Obstructive
Pulmonary disease
web site to help individuals with COPD by logging onto website at least 3 times/week, 2 weekly chat sessions, online bulletin board and email support, individualized exercise plansNo significant differences in physiologic outcomes.
Piette, 1997*47
Prospective study, N= 65
9.2% Black
61.5% White
18.5% Hispanic
10.8% Asian/Pacific Islander
DiabetesAVM system using specialised computer technology to telephone patients, communicate messages, and collect informationAVM system with multiple phone line with half time nurse will cost 10% of the human calling system
Program cost for second year is 2% of human calling system (assuming progam paid for itself in first yr)
Almost all of the subjects reported that AVM was useful
and would like to receive AVM.
Almost all had no difficulty responding to the system
37.5% – 85.6% listened to 2 + preventive messages
72.2–90.9 % thought AVM would make them more satisfied with VA care
*

Study appears in more than one category on this table

From: Summary Tables

Cover of Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically III, and Underserved
Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically III, and Underserved.
Evidence Reports/Technology Assessments, No. 175.
Jimison H, Gorman P, Woods S, et al.

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