Sample PICOT Paper

Web-based Intervention Term Paper

Introduction to Web-based Intervention

A web –based intervention refers to a primarily self-directed intervention program implemented by using a prescriptive online program which is maneuvered by a website and utilized by the users who seek health-related help (Barak, Klein, & Proudfoot, 2009). This intervention endeavors to bring about positive change and improvement of knowledge, understanding, and consciousness by providing comprehensive health-related material and utilization of the collaborative web-based technologies. The internet provides a new method of healthcare interventions hence web-based interventions are commonly used for the provision of healthcare services at the consumers’ doorsteps (Barak, Klein & Proudfoot, 2009).

The interventions are beneficial for a number of reasons such as easy accessibility, privacy and comfort of accessibility at any preferred time (Balhara & Verma, 2014). Furthermore, they assist in overcoming the distance barriers and may theoretically be offered to increased numbers of individuals. The services are effective and economical as demonstrated by the fact they can be accessed by a greater number of end users (Elliott, Carey & Bolles, 2008). There are three sub-types of web-based interventions including web-based education interventions, self-guided web –based therapeutic interventions, and human-supported web-based therapeutic interventions.

The web –based education interventions are programs that are particularly designed for health and mental health end users to allow them access information about a certain problem such as the diagnosis of a disorder, its signs and symptoms, its causes, effects and treatment (Barak, Klein, & Proudfoot, 2009). These interventions differ with regards to usage and the number of the multimedia formats and the interactive online events offered yet most of them are fairly static websites. The self-guided and the human-supported web-based interventions have been considered for creation of positive intellectual, behavioral, and emotive changes (Kelders et al., 2011). The contents are framed in a detailed manner and communicated in both modularized and highly organized set-up. The contents are learnt through theory and commonly modeled on efficient face to face prevention and treatment programs but distributed through the internet (Spek et al., 2006).

The inception and integration of the internet into the clinical practice as a medium for sharing information has led to numerous opportunities for inventive medical interventions for people with chronic diseases and health care providers (Kelders et al., 2011). The internet-based interventions have various advantages over the traditional methods of healthcare delivery (Cuijpers, van Straten & Anderson, 2008). Some of the advantages include saving therapist’s time, reduction of the waiting lists, enabling patients to work at their pace and elimination of the need of scheduling appointments with therapist (Marks et al., 2007). Moreover, the internet-delivered interventions can be programmed for the enhancement of the motivation of the patients. This can be realized by the presentation of diverse audiovisual information with voices that give instructions in whatever gender, accent, age, language and probably game format as preferred by the consumer. It may also provide a rapid and automatic patient progress report and self-ratings (Cuijpers, van Straten & Anderson, 2008).

Due to the many advantages of web-based interventions and its associated benefits, this paper reviews and proposes a web-based educational intervention. This is aimed at ensuring better healthcare outcomes at reduced healthcare costs. The paper gives a description of the proposed intervention by use of the PICOT with the existing evidence followed by a discussion of how the proposed web-based educational intervention can be achieved when implemented.

Proposed Internet-Telephone Intervention

In this type of intervention internet based intervention is used along with telephone to enhance self-care education. Hence the patients can access the internet during their own leisure time in their post-hospital discharge time. In addition to the use of the internet, an individual can have a telephone conversation with the nurse for any extra of unanswered questions. This is paramount in ensuring that an increased number of patients receive healthcare education.

According to Lustria et al. (2013), the web based interventions have a considerable significance in enhancing health promotion behaviors and improvement of the healthcare outcome in several health conditions and the patient populations. The researchers conducted a meta-analysis on the impacts of tailored against non-tailored web-based interventions on the healthcare behaviors. The results obtained indicate that the web-based interventions improve the healthcare outcomes as compared to the control conditions. Webb et al. (2010) assessed the efficiency of the internet based interventions. Moreover, the researchers note that the usage of internet based intervention together with telephone follow-up enable provision of the post-operative recovery information that can easily be accessed by individual patients at any time.

At the completion of the internet based interventions, Cote et al. (2011) and Webb et al. (2010) showed that the patients had reduced number of questions and decreased time for interaction with the healthcare providers. Hence the combination of the internet based intervention and phone is crucial in reduction of the nursing workload, allowing the patients easy access to information any time and the provision of unprecedented accessibility to information. This ultimately results to significant improvement of the health outcomes thus leading to decrease hospital readmission and disease complication (Cote et al., 2011)

PICOT

The proposed web- based intervention is based upon the following question; does web- based intervention promote management of disease and well-being among patients compared to absence of web-based intervention in disease management after being released from the hospital for a month? Hence, the PICOT question is illustrated as shown;

P: Patients seeking healthcare information

I: Web-based intervention

C: No web-based intervention.

O:  Improved disease management

T: One month of post-hospital delivery time.

The key words used include internet, telephone, web-based intervention, and health information technology.

Description of the Proposed Web-based Intervention

In this intervention, patient education will comprise of the design of the webpage where the patients will be requested to complete the patient learning needs questionnaire before they receive education. The patient’s perceived learning needs will be evaluated by use of the patient learning needs scale (PLNS). The topics to be included on the PLNS include disease complications, signs and symptoms, causes, effects, disease management, and prevention. The PLNS is necessary in guiding the discussion topics and becoming focused on the education being delivered. This is expected to enhance the probability for retention of information as well as its application. This will enable the patient to use their time efficiently.

The patients will have an option of clicking on several topics to acquire additional information about that is related to self-care disease management. Hence, the patients will be allowed accessibility to the self-care education through the internet following their discharge from hospital. The telephone part will entail a telephone call by the nurse after one week of discharge from hospital. The patients’ queries will be responded to during the telephone conversation. The nurse may review the information the patient may have accessed over the internet depending on the individual’s learning needs. In case of unwillingness of the patient to have the telephone call, he or she can still access the information through the internet.

Factors to be Considered

Age. The information displayed on the website will designed to reflect the patient’s learning needs.  For instance, the internet telephone education intervention for the adult population will be different for the young population. The website will be created with information being broken into short sections with a clear language and numbering of the major points. Moreover, the medical jargons will be reduced for avoidance of the necessary and enhance information retention.

Socio-economic status of individuals. The socio economic status of the individuals will be considered before the implementation of the internet-telephone intervention. For instance, majority of the older population may not have access to the internet. Hence, the patients may be notified of other ways of internet access such as the using the community centers’ computers.

Reflection on the Web-based Intervention from a HIT Perspective

            The change program proposal is basically created for the healthcare users including the patients and nurses to get access to information about particular disorders. The kind of information that can be accessed include the causes, effects, diagnosis and treatment of the condition. This is expected to result to increased knowledge, understanding, and awareness of the healthcare. In this program, the patients will be provided with self-assessment tests where the patients will get a universal and automated feedback. Moreover, the consumers will be allowed accessibility to the chat room for receipt of feedback on healthcare inquiries.

Potential benefits. Health information technology (HIT) entails exchange of healthcare information in an electronic setting. The increased usage of HIT in health is aimed at improvement of the healthcare quality hence preventing medical errors and reduction of healthcare costs (U.S. Department of Health & Human Services, 2015).  Moreover, there are enhanced administrative efficiencies, reduced paperwork and expanded accessibility to affordable and cost effective healthcare. The possible benefits of the proposed web-based educational interventions include enhanced accessibility to healthcare information and its cost-effectiveness.

The website-based educational program will be interactive where the users enters their personal information which enables the website to tailor the healthcare services to that particular user as well as other users interacting with the others through the website. The patients will therefore exchange healthcare information with other patients using the website.

In addition to improvement in healthcare knowledge, the significant outcomes of the web-based educational intervention include cognitive, emotional, and behavioral outcomes. The cognitive outcomes in healthcare will include enhanced understanding of certain healthy behaviors as well as improved self-efficacy among patients. Some of the behavioral outcomes of the web-based intervention comprise dietary changes, cessation of smoking, safe and effective management of alcohol consumption. The program also targets to achieve emotional outcomes including improvement in management of depression, shame, guilt and anger. This is expected to lead to improved well-being of the individual users.

Challenges. Despite the potential benefits of the web-based interventions will face difficulties in terms of its equity, efficacy and implementation. There are chances for web-based health inequalities in healthcare whereby those who are accessible to the internet benefit from the enhanced services while those who lack internet access become disadvantaged. Moreover, getting access to the information through the web-based information program is not adequate for improvement of the healthcare of individuals. The end users will have the task of reading the information displayed on the website, understanding it, making it logical and having it applied to their individual circumstances.

Furthermore, accessibility to the website resources may be influenced by several factors such as the health literacy levels of the users, internal and external factors that may hinder the end users from applying their information. This calls for comprehensive orientation of the users to what the website is all about and how certain information may be accessed in every day’s life of a patient. The web-based educational intervention is expected to be used autonomously by the end users and during consultations with the healthcare providers. It is a very unique resource for both the patients and individuals who are healthy and interested in healthcare information.  The intervention is also significant to the healthcare providers and other healthcare educators who work for the enhancement of health literacy abilities.

Throughout the development of the proposal I gained significant information about the active role of a patient in enhancement of healthcare literacy. The proposal has given me insight into what entails the web based education intervention and how it can be structured for improved patient education about certain health diseases. I learnt that if the patients can have access to information in relation to their diseases such as causes, effects, signs and symptoms, diagnosis and prevention, positive results are expected. For example, there will be reduced healthcare costs, improved patients’ outcomes and reduction in the number of hospitalizations.

Conclusion

Web-based education intervention is majorly a self-directed internet-based intervention program whereby the users search for health related information from the website. The proposed web-based educational program is expected to result to improved knowledge and understanding of the disease condition. The internet is advantageous in provision of healthcare information services at the end users doorstep. The proposed web-based educational intervention is specifically meant for allowing the users and other healthcare providers’ access information on diagnosis, signs and symptoms, causes, effects, treatment and prevention of diseases.

The introduction and adoption of internet usage in the clinical practice is relevant in sharing of information which leads to many opportunities for inventive medical interventions for individuals with chronic diseases as well as the healthcare professionals. The proposed web-based intervention is aimed at finding out whether internet-telephone based intervention is significant in promoting disease management and the well-being of individuals. The proposed web-based educational intervention will be composed of a webpage where the users will be required to complete the patient’s learning needs prior to receiving of the health related education. Several topics will be included based on the patient’s learning needs; disease complication, cause, effects, signs and symptoms, treatment and prevention.

The patients will be able to access information related to their condition even when discharged from the hospital. They will also have a telephone call with the nurse after being discharged from the hospital for more clarification of the contents on the website. There will be constant consultations by the nurses and healthcare providers through the website portal. The telephone is included in the web-based intervention for easier comprehension and follow-up of the website contents. Several factors will be considered in designing the educational intervention program such age and socio-economic factors of the website users. The proposed web based intervention is expected to improve quality of patient care because of enhanced patient knowledge and understanding of the healthcare concepts.

 References

Balhara, Y.P.S., Verma, R. (2014). A review of web based interventions focusing on alcohol use. Annals of Medical & Health Sciences Research, 4(4), 472-480.

Barak, A., Klein, B., & Proudfoot, J.G. (2009). Defining internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4-17.

Cote, J., Ramirez-Garcia, P., Rouleau, G., Saulnier, D., Gueheneuc, Y-G., Hernandez, A., &  Godin, G. (2010). Real–time support for managing antiretroviral therapy. Computers,  Informatics, Nursing, 29(1), 43–51.

Cuijpers, P., van Straten, A., &Andersson, G. (2008). Internet-administered cognitive behavior therapy for health problems: A systematic review. Journal of Behavioral Medicine, 31(2), 169-177.

Elliott, J.C., Carey, K.B., & Bolles, J.R. (2008). Computer-based interventions for college drinking: A qualitative review. Addiction Behavior, 33, 994–1005.

Kelders, S.M., Van Gemert-Pijnen, J.E., Werkman, A., Nijland, N., & Seydel, E.R. (2011). Effectiveness of a web-based intervention aimed at healthy dietary and physical activity behavior: A randomized controlled trial about users and usage. Journal of Medical Internet Results, 13(2), 32-43.

Lustria, M.L.A., Noar, S.M., Cortese, J., Van, S.S.K., Glueckauf, R.L., & Lee, J. (2013). A Meta-analysis of web-delivered tailored health behavior change interventions. Journal of Health Communication, 18 (9), 1039-1069.

Marks, I.M., Cavanagh, K.,& Gega, L.(2007). Maudsleymonographs no. 45. Hands-on help:         Computer-aided psycho-therapy. Hove: Psychology Press

Spek, V., Cuipers, P., Nyklicek, I., Riper, H., Keyzer, J., &Pop, V. (2006). Internet-based cognitive behavior therapy for symptoms of depression and anxiety: A meta-analysis. Psychology Medicine, 37; 319-328.

U.S. Department of Health & Human Services. (2015). Health information technology.     Retrieved, 7^th April, 2015 from       http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/

Webb, T.L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of  Medical Internet Research, 12 (1), 4-15.