JMIR Publications

ABSTRACT

Background:

Value is one of the central concepts in healthcare, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways.

Objective:

To identify contextual factors that determined similarities and differences in the value of an eHealth intervention between two contexts. Also, to reflect on and contribute to the discussion about the specification, assessment and relativity of the ‘value’ concept in the evaluation of eHealth interventions.

Methods:

The study concerned a six-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating value of eHealth interventions was designed as monetary and non-monetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using Mini-mental state examination, Clock drawing test, and EuroQoL-5D-5L. Semi-structured interviews were conducted with patients and healthcare professionals. Monetary data was collected from the healthcare and technology providers.

Results:

Value of an eHealth intervention applied to similar types of populations but in different contexts differed. In Sweden, patients improved cognitive performance (MMSE mean=0.85, SD=1.62, P=.0007), reduced anxiety (EuroQoL-5D-5L, mean=0.16, SD=0.54, P=.046), perceived their health better (EuroQoL-5D-5L VAS scale, mean=2.6, SD=9.7, P=.035), and both patients and healthcare professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for healthcare professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, healthcare professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, the clinical efficacy and quality of life improvements have not been observed. Six factors influencing value of eHealth intervention in a particular context have been identified: (1) service delivery design of the intervention (process of delivery), (2) organizational set-up of the intervention (i.e. organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (e.g. how physically active they were in their daily life and if they were living alone or with a family), (6) local preferences on the quality of patient care.

Conclusions:

Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behaviour changes. To obtain a holistic view of the value created, it needs to be operationalized in monetary and non-monetary outcomes, categorizing these into the benefits and sacrifices.