JMIR Publications

ABSTRACT

Background:

For over a decade, digital health has held promise for enabling broader access to health information, education and services for the general population at lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of e-health technologies (eHT). In this context, community-based health promotion (CBHP) represents an interesting and efficient conceptual framework, which could help increase adoption of digital health solutions and ease their evaluation.

Objective:

To understand how the local implementation of the promotion of an e-health tool aimed at preventing psychological distress and suicide, StopBlues, varied according to local contexts and if this implementation was related to the use of the tool.

Methods:

A cluster randomized controlled trial was conducted notably to evaluate the effectiveness of the promotion with before and after observation (NCT03565562). Data issued from questionnaires, observations and institutional sources were collected in the 22 localities where StopBlues was implemented. A Multiple Correspondence Analysis (MCA) was performed to assess the relations between context, type of implementation and use of the tool.

Results:

Three distinct promotion patterns emerged according to the localities’ profile, that were associated with the utilization rates of SB. From highest to lowest utilization rates, they are listed as follows: The urban privileged localities investing in health that implemented a digital with high-intensity promotion, demonstrated a greater capacity to take ownership of the project and thoroughly analyze its ins and outs. The urban but less well-off localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion. The rural localities with little experience in addressing health issues that implemented a low-intensity promotion, could not overcome the challenges associated with their local context.

Conclusions:

These findings suggest the substantial influence of local context on the reception of digital tools. The urban and SES profiles of the localities along with their investment and pre-existing experience in health appear to be critical for shaping the promotion implementation eHealth tools, in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. Clinical Trial: NCT03565562. Registered on June 11, 2018.