Patterns of Usage of Internet Resources by Persons with Post-Coronary Arterial Bypass Graft (CABG)...
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Patterns of Usage of Internet Resources by Persons with Post-Coronary Arterial Bypass Graft (CABG) Kamisha Hamilton, Michelle Rogers, Anita Ground, RN, David H. Gustafson, PhD, Dr. Patricia Flatley Brennan, RN, PhD, FAAN University of Wisconsin, Madison, WI, USA [email protected] Abstract The purpose of this study is to describe the patterns of usage of defined Internet resources by persons following coronary arterial bypass graft surgery. Two different methods of measuring usage were primarily employed: counts of accesses and persistence of activity during the study. Duration of accesses was also considered in describing system usage. The patterns of usage were visually inspected and categorized according to the three different measurement methods. Four patterns were identified. We illustrate three of the four patterns by describing usage by three participants. This study is shown to be relevant to clinical care by demonstrating the possible impact patterns of the Internet in clinically patient-focused interventional studies. The HeartCare System Designed to help with in- hospital discharge planning, post-hospital self-monitoring, and home management necessary for recovery among patients who have undergone CABG surgery Fifty four participants received the system in their homes for an 180 day study HeartCare Components : Information Resource: Nearly 500 total webpages (either Description of the Participants Gender: 81.5% Male 18.5% Female Race: 87% Caucasian 13% African-American Mean Age: 62.9; Range: 38 – 82 Years Materials and Methods The 4-S Framework is used as a guideline for characterizing computer network use Four perspectives of computer network use: system level, service level, session level and subject level. Aspects of subject level use include number, timing, nature, and reasons of accesses Quantitative information on system use such as the date and time when accesses occurred, duration of access, and services accessed (e.g. information, forum, email) was documented Users were grouped according to Subject and Session Level Use System use ranged widely across participants; usage ranged from no usage by one participant to over 400 system accesses during the 180 day period Low – system use through the first 90 days on 10 or fewer occasions Moderate – system use through the first 90 days on more than 10 occasions Intermittent – system use with large intervals between accesses High – typically daily access Participant A African-American male, 58 years old with an inactive lifestlye, 11 years of education Married, with one dependent and an annual income less than $20,000 No computer or Internet experience, no access to a computer with Internet capability 14 total accesses to the system; stopped at Day 19 Used email function during two sessions; forum during 9 sessions Mean access length: 14 minutes, with longest session being 48 minutes Viewed 12 different web pages over 4 different sessions Low User Participant B Caucasian male, 72 years old with an inactive lifestyle, 7 years of education Widowed, with two dependents and an annual income less than $20,000 42 total accesses to the system; stopped at Day 90 No computer or Internet experience, no access to a computer with Internet capability Used email almost every access to the system; no accesses to the forum or webpages Mean access length: 6.17 minutes, with longest session being 115 minutes. Over 85% of accesses were under one minute Moderate User Participant C African-American male, 79 years old with a fairly inactive lifestyle, 14 years of education Married, with one dependent and an annual income between $40,000 and $50,000 Has computer experience, no experience with the Internet, but has had access to a computer with Internet capability 102 total accesses to the system; stopped at Day 156 Did not use either email or forum in the entire study period, rather, exclusively viewed webpages Mean length: 23.69 minutes; maximum duration: 167.33 minutes Accessed 32 different webpages, viewing the “FAQ feeling tired” page most often Discussion The nature of the HeartCare resource allowed users to personalize their use behavior Users on the whole accessed the system most heavily in the first week, thus it is likely that HeartCare aids most significantly in the early stages of recovery Email and forum use decreased throughout the study, suggesting that as recovery progresses, the need for electronic communication decreases The social aspects of computer-mediated communication may have an effect on how participants used the HeartCare system Multiple measures of use are required to effectively characterize user behavior Studying how patients use an Internet system is critical in designing future The HeartCare study is supported by a grant from the National Library of Medicine and the National Institute of Nursing Research, NLM/NINR Grant RO1-LM06249. Acknowledgements: UW-Madison GERS (Graduate Engineering Research Scholars) Program and the Department of Industrial Engineering for funding for the Medinfo2001 Conference. Additional thanks to Dr. Patricia F. Brennan for encouragement and funding support. System and Service Use by Time Period Average time spent on system per user per day 0 20 40 60 80 100 120 140 160 180 Day ofStudy TotalA ccess Length (m in P articipantExperience 57.4 37 31.5 42.6 63 68.5 0 20 40 60 80 100 Experience w ith Computers Access to Internet Experience Using Internet Percent No Y es 0 10 20 30 40 50 60 1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103 109 115 121 127 133 139 145 151 157 163 169 175 D ay ofStudy TotalA ccess Length (m in) 0 20 40 60 80 100 120 140 1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103 109 115 121 127 133 139 145 151 157 163 169 175 D ay ofStudy TotalA ccess Length (m in) D ays Total A ccess A verage Session Length (m in) Forum A ccess Em ail A ccess Active U sers 1-7 396 21.42 170 179 50 8-30 663 18.27 176 340 48 31-90 818 23.47 133 438 39 91-180 736 19.03 90 444 28 ParticipantA verage A ccess 0 10 20 30 40 50 60 D ay ofStudy A verage Tim e (m in)
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Transcript of Patterns of Usage of Internet Resources by Persons with Post-Coronary Arterial Bypass Graft (CABG)...
Patterns of Usage of Internet Resources by Persons with Post-Coronary Arterial Bypass Graft (CABG)
Kamisha Hamilton, Michelle Rogers, Anita Ground, RN, David H. Gustafson, PhD, Dr. Patricia Flatley Brennan, RN, PhD, FAANUniversity of Wisconsin, Madison, WI, USA
AbstractThe purpose of this study is to describe the patterns of usage of defined Internet resources by persons following coronary arterial bypass graft surgery. Two different methods of measuring usage were primarily employed: counts of accesses and persistence of activity during the study. Duration of accesses was also considered in describing system usage. The patterns of usage were visually inspected and categorized according to the three different measurement methods. Four patterns were identified. We illustrate three of the four patterns by describing usage by three participants. This study is shown to be relevant to clinical care by demonstrating the possible impact patterns of the Internet in clinically patient-focused interventional studies.
The HeartCare System
Designed to help with in-hospital discharge planning, post-hospital self-monitoring, and home management necessary for recovery among patients who have undergone CABG surgery
Fifty four participants received the system in their homes for an 180 day study
HeartCare Components: Information Resource:
Nearly 500 total webpages (either designed by the research team or on existing health information websites)
Email to nurse and other participants Online Forum for group discussion between patients
Patients accessed HeartCare via a WebTVTM device (with modem access to
the Internet) on a 19” television screen
Description of the Participants
Gender: 81.5% Male 18.5% Female Race: 87% Caucasian 13% African-American Mean Age: 62.9; Range: 38 – 82 Years
Materials and Methods
The 4-S Framework is used as a guideline for characterizing computer network use
Four perspectives of computer network use: system level, service level, session level and subject level. Aspects of subject level use include number, timing, nature, and reasons of accesses
Quantitative information on system use such as the date and time when accesses occurred, duration of access, and services accessed (e.g. information,
forum, email) was documented
Users were grouped according to frequency and endurance of accesses
Subject and Session Level Use
System use ranged widely across participants; usage ranged from no usage by one participant to over 400 system accesses during the 180 day period
Low – system use through the first 90 days on 10 or fewer occasions
Moderate – system use through the first 90 days on more than 10 occasions
Intermittent – system use with large intervals between accesses
High – typically daily access
Participant A African-American male, 58 years old with an inactive lifestlye, 11 years of
education Married, with one dependent and an annual
income less than $20,000 No computer or Internet experience, no
access to a computer with Internet capability 14 total accesses to the system; stopped at
Day 19 Used email function during two sessions;
forum during 9 sessions Mean access length: 14 minutes, with longest session being 48 minutes Viewed 12 different web pages over 4 different sessions Low User
Participant B Caucasian male, 72 years old with an inactive lifestyle, 7 years of education Widowed, with two dependents and an annual income less than $20,000 42 total accesses to the system; stopped at Day 90 No computer or Internet experience, no
access to a computer with Internet capability Used email almost every access to the
system; no accesses to the forum or webpages
Mean access length: 6.17 minutes, with longest session being 115 minutes.
Over 85% of accesses were under one minute
Moderate User
Participant C African-American male, 79 years old with a
fairly inactive lifestyle, 14 years of education Married, with one dependent and an annual
income between $40,000 and $50,000 Has computer experience, no experience with the Internet, but has had access to a computer with Internet capability 102 total accesses to the system; stopped at Day 156 Did not use either email or forum in the entire study period, rather, exclusively viewed webpages Mean length: 23.69 minutes; maximum
duration: 167.33 minutes Accessed 32 different webpages, viewing the “FAQ feeling tired” page most often
Intermittent User
Discussion
The nature of the HeartCare resource allowed users to personalize their use behavior
Users on the whole accessed the system most heavily in the first week, thus it is likely that HeartCare aids most
significantly in the early stages of recovery
Email and forum use decreased throughout the study, suggesting that as recovery progresses, the need for
electronic communication decreases
The social aspects of computer-mediated communication may have an effect on how participants used the HeartCare system
Multiple measures of use are required to effectively characterize user behavior
Studying how patients use an Internet system is critical in designing future similar patient-centered home management
systems
The HeartCare study is supported by a grant from the National Library of Medicine and the National Institute of Nursing Research, NLM/NINR Grant RO1-LM06249.
Acknowledgements: UW-Madison GERS (Graduate Engineering Research Scholars) Program and the Department of Industrial Engineering for funding for the Medinfo2001 Conference. Additional thanks to Dr. Patricia F. Brennan for encouragement and funding support.
System and Service Use by Time Period
Average time spent on system per user per day
0
20
40
60
80
100
120
140
160
180
Day of Study
To
tal
Access L
en
gth
(m
in)
Participant Experience
57.437 31.5
42.663 68.5
0
20
40
60
80
100
Experience w ithComputers
Access to Internet Experience UsingInternet
Perc
ent No
Yes
0
10
20
30
40
50
60
1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103
109
115
121
127
133
139
145
151
157
163
169
175
Day of Study
To
tal A
cces
s L
eng
th (
min
)
0
20
40
60
80
100
120
140
1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103
109
115
121
127
133
139
145
151
157
163
169
175
Day of Study
To
tal A
cces
s L
eng
th (
min
)
Days TotalAccess
Average SessionLength (min)
ForumAccess
EmailAccess
ActiveUsers
1-7 396 21.42 170 179 508-30 663 18.27 176 340 48
31-90 818 23.47 133 438 3991-180 736 19.03 90 444 28
Participant Average Access
0
10
20
30
40
50
60
Day of Study
Ave
rag
e T
ime
(min
)
![Marissa Balme RN, BSN. Background Number of coronary artery bypass graft surgeries (CABG) performed in 2006: 448,000 (American Heart Association [AHA],](https://static.fdocuments.us/doc/165x107/56649e1a5503460f94b0781f/marissa-balme-rn-bsn-background-number-of-coronary-artery-bypass-graft-surgeries.jpg)
