@Article{info:doi/10.2196/jmir.4.1.e4,
author="Powell, John
and Clarke, Aileen",
title="The WWW of the World Wide Web: Who, What, and Why?",
journal="J Med Internet Res",
year="2002",
month="Feb",
day="18",
volume="4",
number="1",
pages="e4",
doi="10.2196/jmir.4.1.e4",
url="http://www.jmir.org/2002/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/11956036"
}


@Article{info:doi/10.2196/jmir.4.1.e3,
author="Christensen, Helen
and Griffiths, M. Kathleen
and Korten, Ailsa",
title="Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores",
journal="J Med Internet Res",
year="2002",
month="Feb",
day="15",
volume="4",
number="1",
pages="e3",
keywords="Internet",
keywords="depression",
keywords="primary prevention",
keywords="program evaluation",
abstract="Background: Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face, via self-help books (bibliotherapy), and through computer administration. The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners. We have developed a free Internet-based cognitive behavior therapy intervention (MoodGYM, http://moodgym.anu.edu.au) designed to treat and prevent depression in young people, available to all Internet users, and targeted to those who may have no formal contact with professional help services. Objective: To document site usage, visitor characteristics, and changes in depression and anxiety symptoms among users of MoodGYM, a Web site delivering a cognitive-behavioral-based preventive intervention to the general public. Methods: All visitors to the MoodGYM site over about 6 months were investigated, including 2909 registrants of whom 1503 had completed at least one online assessment. Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately. The main outcome measures were (1) site-usage measures including number of sessions, hits and average time on the server, and number of page views; (2) visitor characteristics including age, gender, and initial Goldberg self-report anxiety and depression scores; and (3) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions. Results: Over the first almost-6-month period of operation, the server recorded 817284 hits and 17646 separate sessions. Approximately 20\% of sessions lasted more than 16 minutes. Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population-based surveys and those characterizing a sample of University students. For the Web-based population, both anxiety and depression scores decreased significantly as individuals progressed through the modules. Conclusions: Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public. However, randomized controlled trials are required to establish the effectiveness of these interventions. ",
doi="10.2196/jmir.4.1.e3",
url="http://www.jmir.org/2002/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/11956035"
}


@Article{info:doi/10.2196/jmir.4.1.e5,
author="Potts, W. Henry W.
and Wyatt, C. Jeremy",
title="Survey of Doctors' Experience of Patients Using the Internet",
journal="J Med Internet Res",
year="2002",
month="Mar",
day="31",
volume="4",
number="1",
pages="e5",
keywords="Internet",
keywords="information quality",
keywords="attitude to computers",
keywords="questionnaires",
keywords="patient education",
abstract="Background: There have been many studies showing the variable quality of Internet health information and it has often been assumed that patients will blindly follow this and frequently come to harm. There have also been reports of problems for doctors and health services following patient Internet use, but their frequency has not been quantified. However, there have been no large, rigorous surveys of the perceptions of Internet-aware doctors about the actual benefits and harms to their patients of using the Internet. Objective: To describe Internet-literate doctors' experiences of their patients' use of the Internet and resulting benefits and problems. Methods: Online survey to a group of 800 Web-using doctors (members of a UK medical Internet service provider, Medix) in September and October 2001. Results: Responses were received from 748 (94\%) doctors, including 375 general practitioners (50\%). Respondents estimated that 1\%-2\% of their patients used the Internet for health information in the past month with no regional variation. Over two thirds of the doctors considered Internet health information to be usually (20\%) or sometimes (48\%) reliable; this was higher in those recently qualified. Twice as many reported patients experiencing benefits (85\%; 95\% confidence interval, 80\%-90\%) than problems (44\%; 95\% confidence interval, 37\%-50\%) from the Internet. Patients gaining actual physical benefits from Internet use were reported by 40\% of respondents, while 8\% reported physical harm. Patients' overall experiences with the Internet were judged excellent 1\%, good 29\%, neutral 62\%, poor 9\%, or bad <1\%. Turning to the impact of patient Internet use on the doctors themselves, 13\% reported no problems, 38\% 1 problem, and 49\% 2 or more problems. Conversely, 20\% reported no benefits for themselves, 49\% 1 benefit, and 21\% 2 or more benefits. Conclusions: These doctors reported patient benefits from Internet use much more often than harms, but there were more problems than benefits for the doctors themselves. Reported estimates of patient Internet usage rates were low. Overall, this survey suggests that patients are deriving considerable benefits from using the Internet and that some of the claimed risks seem to have been exaggerated. ",
doi="10.2196/jmir.4.1.e5",
url="http://www.jmir.org/2002/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/11956037"
}


@Article{info:doi/10.2196/jmir.4.1.e2,
author="Craigie, Mark
and Loader, Brian
and Burrows, Roger
and Muncer, Steven",
title="Reliability of Health Information on the Internet: An Examination of Experts' Ratings",
journal="J Med Internet Res",
year="2002",
month="Jan",
day="17",
volume="4",
number="1",
pages="e2",
keywords="Newsgroup",
keywords="Internet",
keywords="rating information",
keywords="reliability",
keywords="reproducibility of results",
keywords="statistics",
keywords="quality control",
abstract="Background: The use of medical experts in rating the content of health-related sites on the Internet has flourished in recent years. In this research, it has been common practice to use a single medical expert to rate the content of the Web sites. In many cases, the expert has rated the Internet health information as poor, and even potentially dangerous. However, one problem with this approach is that there is no guarantee that other medical experts will rate the sites in a similar manner. Objectives: The aim was to assess the reliability of medical experts' judgments of threads in an Internet newsgroup related to a common disease. A secondary aim was to show the limitations of commonly-used statistics for measuring reliability (eg, kappa). Method: The participants in this study were 5 medical doctors, who worked in a specialist unit dedicated to the treatment of the disease. They each rated the information contained in newsgroup threads using a 6-point scale designed by the experts themselves. Their ratings were analyzed for reliability using a number of statistics: Cohen's kappa, gamma, Kendall's W, and Cronbach's alpha. Results: Reliability was absent for ratings of questions, and low for ratings of responses. The various measures of reliability used gave conflicting results. No measure produced high reliability. Conclusions: The medical experts showed a low agreement when rating the postings from the newsgroup. Hence, it is important to test inter-rater reliability in research assessing the accuracy and quality of health-related information on the Internet. A discussion of the different measures of agreement that could be used reveals that the choice of statistic can be problematic. It is therefore important to consider the assumptions underlying a measure of reliability before using it. Often, more than one measure will be needed for ``triangulation'' purposes. ",
doi="10.2196/jmir.4.1.e2",
url="http://www.jmir.org/2002/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/11956034"
}


@Article{info:doi/10.2196/jmir.4.1.e1,
author="Mazzi, P. Christian
and Kidd, Michael",
title="A Framework for the Evaluation of Internet-based Diabetes Management",
journal="J Med Internet Res",
year="2002",
month="Jan",
day="10",
volume="4",
number="1",
pages="e1",
keywords="Diabetes",
keywords="Internet",
keywords="evaluation",
keywords="therapy",
keywords="chronic disease management",
abstract="Background: While still in its infancy, Internet-based diabetes management shows great promise for growth. However, the following aspects must be considered: what are the key metrics for the evaluation of a diabetes management site? how should these sites grow in the future and what services should they offer? Objectives: To examine the needs of the patient and the health care professional in an Internet-based diabetes management solution and how these needs are translated into services offered. Methods: An evaluation framework was constructed based on a literature review that identified the requirements for an Internet-based diabetes management solution. The requirements were grouped into 5 categories: Monitoring, Information, Personalization, Communication, and Technology. Two of the market leaders (myDiabetes and LifeMasters) were selected and were evaluated with the framework. The Web sites were evaluated independently by 5 raters using the evaluation framework. All evaluations were performed from November 1, 2001 through December 15, 2001. Results: The agreement level between raters ranged from 60\% to 100\%. The multi-rater reliability (kappa) was 0.75 for myDiabetes and 0.65 for LifeMasters, indicating substantial agreement. The results of the evaluations indicate that LifeMasters is a more-complete solution than myDiabetes in all dimensions except Information, where both sites were equivalent. LifeMasters satisfied 32 evaluation criteria while myDiabetes satisfied 24 evaluation criteria, out of a possible 40 in the framework. Conclusions: The framework is based on the recognition that the management of diabetes via the Internet is based on several integrated dimensions: Monitoring, Information, Personalization, Communication, and Technology. A successful diabetes management system should efficiently integrate all dimensions. The evaluation found that LifeMasters is successful in integrating the health care professional in the management of diabetes and that MyDiabetes is quite effective in providing a communication channel for community creation (however, communication with the health care professional is lacking). ",
doi="10.2196/jmir.4.1.e1",
url="http://www.jmir.org/2002/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/11956033"
}