Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 26, 2018
Open Peer Review Period: Jun 29, 2018 - Aug 24, 2018
Date Accepted: Dec 9, 2018
(closed for review but you can still tweet)
The impact of superfast broadband, tailored booklets for households, and discussions with GPs on personal eHealth Readiness: A cluster factorial quasi-randomised control trial
ABSTRACT
Background:
eHealth may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011 the British Government supported implementation of ‘superfast’ broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess impact of structural change and person based interventions.
Objective:
We assessed the impact of three interventions on personal eHealth Readiness; (i) implementation of Superfast; (ii) tailored booklets to households providing information to help improve personal skills in eHealth; and (iii) discussions with general practices to encourage greater internet use in health service provision.
Methods:
This was a cluster quasi-randomised factorial controlled trial. Implementation of Superfast was monitored and households were classified as having early or late availability. An algorithm selected 78 from 16385 eligible postcodes to minimise possibility of overlap between general practices and ensure balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the eight (2X2X2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0-10) and four components (personal, provision, support, economic) from baseline (Aug 2013) to 18-month follow-up between the eight arms, to assess the impact of interventions. We compared standard deviations of scores to assess changes in eHealth inequalities.
Results:
eHealth Readiness improved over 18 months from 4.36/10 to 4.59/10 (t(235)=4.18 p<.001, CI=0.13-0.35) resulting from increases in personal and provision components of the score (t(255)=3.191 p=.002, t(258)=3.410 p=.001). However, there were no significant differences between the three interventions, either singly or in combination on an intention to treat analysis. There were increases in proportion of internet users (78% to 82%) and mobile use (50.5% to 64.8%). There was no change in eHealth inequality.
Conclusions:
People in Cornwall became more ready to adopt eHealth services, increasing in both their personal ability to use eHealth and their methods of access. The roll out of Superfast may have contributed to this and we are certain that our other two interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of carrying out a randomised controlled trial to assess impact of infrastructure change and variations on our method may be of use to others. Clinical Trial: NCT02355808
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.