%0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 8 %N 1 %P e3 %T Using Sequential Email Messages to Promote Health Behaviors: Evidence of Feasibility and Reach in a Worksite Sample %A Franklin,Patricia D %A Rosenbaum,Paula F %A Carey,Michael P %A Roizen,Michael F %+ Department of Orthopedics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA, +1 508 856 2202, Patricia.franklin@umassmed.edu %K Health promotion %K employee wellness %K information technology in health care %D 2006 %7 30.3.2006 %9 Original Paper %J J Med Internet Res %G English %X Background: US adults report suboptimal physical activity and fruit and vegetable intake. Innovative strategies to promote healthy behaviors are needed. Employee health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. Email and Web-based worksite programs have the potential to reach a broad adult population and to provide a cost-effective approach to employee wellness programming. Objective: To assess the feasibility of using sequential email messages to promote physical activity and increase fruit and vegetable intake among employed adults. Methods: Employees at one worksite of a large insurance company in New York State were invited to participate. Interested workers provided written consent. After completing a baseline survey, participants received daily emails, Monday through Friday, for 26 weeks. The emails provided (a) succinct strategies to encourage physical activity or increase fruit and vegetable intake and (b) links to detailed Web-based information and tools. Program reach was assessed by the number of emails opened, measures of sustained participation over 6 months, and the number of health-related Web-links clicked. Results: Of 960 employees, 388 (40%) consented to participate; of these, 345 (89%) completed the baseline health survey. After 6 months, 70% of the 345 participants had opened 50% or more of the daily emails. In addition, 75% of participants continued to open at least one email a week through week 26 of the study. Email opening rates did not vary by gender, age, income, education, ethnicity, or baseline health behavior. Conclusions: The rate of enrollment and sustained participation document the feasibility, broad reach, employee acceptance, and potential value of using electronic communications for health promotion in the workplace. %R 10.2196/jmir.8.1.e3 %U http://www.jmir.org/2006/1/e3/ %U https://doi.org/10.2196/jmir.8.1.e3 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 8 %N 1 %P e1 %T A Case Analysis of INFOMED: The Cuban National Health Care Telecommunications Network and Portal %A Séror,Ann C %+ Department of Management, Faculté des Sciences de l’Administration, Université Laval, Pavillon Palasis-Prince, Cité Universitaire, Québec, QC G1K 7P4, Canada, +1 418 525 5102, ann.seror@mng.ulaval.ca %K Case analysis %K Cuban national health care system %K INFOMED %K ideology %K virtual infrastructure %K health care markets %K globalization %D 2006 %7 27.1.2006 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet and telecommunications technologies contribute to national health care system infrastructures and extend global health care services markets. The Cuban national health care system offers a model to show how a national information portal can contribute to system integration, including research, education, and service delivery as well as international trade in products and services. Objective: The objectives of this paper are (1) to present the context of the Cuban national health care system since the revolution in 1959, (2) to identify virtual institutional infrastructures of the system associated with the Cuban National Health Care Telecommunications Network and Portal (INFOMED), and (3) to show how they contribute to Cuban trade in international health care service markets. Methods: Qualitative case research methods were used to identify the integrated virtual infrastructure of INFOMED and to show how it reflects socialist ideology. Virtual institutional infrastructures include electronic medical and information services and the structure of national networks linking such services. Results: Analysis of INFOMED infrastructures shows integration of health care information, research, and education as well as the interface between Cuban national information networks and the global Internet. System control mechanisms include horizontal integration and coordination through virtual institutions linked through INFOMED, and vertical control through the Ministry of Public Health and the government hierarchy. Telecommunications technology serves as a foundation for a dual market structure differentiating domestic services from international trade. Conclusions: INFOMED is a model of interest for integrating health care information, research, education, and services. The virtual infrastructures linked through INFOMED support the diffusion of Cuban health care products and services in global markets. Transferability of this model is contingent upon ideology and interpretation of values such as individual intellectual property and confidentiality of individual health information. Future research should focus on examination of these issues and their consequences for global markets in health care. %R 10.2196/jmir.8.1.e1 %U http://www.jmir.org/2006/1/e1/ %U https://doi.org/10.2196/jmir.8.1.e1 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 8 %N 1 %P e4 %T What Is eHealth (6): Perspectives on the Evolution of eHealth Research %A Ahern,David K %A Kreslake,Jennifer M %A Phalen,Judith M %+ Health e-Technologies Initiative, Brigham and Women’s Hospital, 1249 Boylston Street, Third Floor, Boston, MA 02215, USA, +1 617-525-6167, dahern@partners.org %K Health services research %K outcome and process assessments (health care) %K behavioral medicine %K health behavior %K information dissemination %K telemedicine %D 2006 %7 31.3.2006 %9 Original Paper %J J Med Internet Res %G English %X Background: The field of eHealth holds promise for supporting and enabling health behavior change and the prevention and management of chronic disease. Objective: In order to establish areas of congruence and controversy among contributors to the early development, evaluation, and dissemination of eHealth applications, as well as the desire to inform an evaluation research funding agenda, 38 semistructured, qualitative interviews were conducted among stakeholders in eHealth between May 2002 and September 2003. Methods: Participants were asked about their perspectives on the credibility, value, and future potential of information technology for health behavior change and chronic disease management. Interviews were coded and analyzed for emergent themes using qualitative methods. Results: Consistent themes were identified across stakeholder groups, with slight differences in emphasis. These topics included the following: (1) consensus and standardization—most stakeholders expressed a strong desire for a more coordinated, rigorous effort to define and integrate the field; (2) evaluation methods and challenges—demonstrating outcomes is required to establish eHealth quality and efficacy, but stakeholders were not satisfied with the sensitivity, validity, and reliability of existing outcome measures; (3) quality, value, and future potential—the intersection between eHealth’s potential cost-effectiveness, efficiency, and improved clinical status among users generated a high degree of interest; and (4) health disparities—many stakeholders contended that traditionally underserved populations will particularly benefit from eHealth applications, although others argued that the underserved are also disadvantaged in terms of access to technology. Conclusions: Recommendations included the need for improvement and formalization of development and evaluation standards across private and public sectors, additional research on the technology needs and preferences of traditionally underserved populations, and long-term epidemiologic studies of the impact of eHealth on outcomes and cost-effectiveness. %R 10.2196/jmir.8.1.e4 %U http://www.jmir.org/2006/1/e4/ %U https://doi.org/10.2196/jmir.8.1.e4 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 8 %N 1 %P e2 %T Physicians’ Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices %A Brooks,Robert G %A Menachemi,Nir %+ Florida State University, Division of Health Affairs, College of Medicine, 1115 W. Call Street, Tallahassee, Florida 32306-4300, USA, +1 850 644 3845, Robert.Brooks@med.fsu.edu. %+ Florida State University College of Medicine, Tallahassee, Florida, %K Email %K electronic records %K health information technology %K electronic communication %D 2006 %7 24.3.2006 %9 Original Paper %J J Med Internet Res %G English %X Background: With the public’s increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, email use by physicians for clinical care has been slow. Objective: To examine the factors associated with physician-patient email, and report on the physicians’ adherence to recognized guidelines for email communication. Methods: Cross-sectional survey (March–May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics. Results: The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used email to communicate with patients. Only 120 (2.9%) used email with patients frequently. In univariate analysis, email use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to email use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for email communication. Conclusions: This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of email communication, and little adherence to recognized guidelines for email correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of email communication, and to remove fiscal and legal barriers to its adoption. %R 10.2196/jmir.8.1.e2 %U http://www.jmir.org/2006/1/e2/ %U https://doi.org/10.2196/jmir.8.1.e2