A questionnaire and measure of ‘e-health readiness’

and ‘e-health inequalities’

for use in intervention studiesRay Jones

Professor Health InformaticsPlymouth University

What is the impact of……

What is the impact of……Superfast Cornwall?

Is it going to mean the young and connected will start doing ever more things on the Internet leaving the old and disconnected ever further behind and disadvantaged?

How do we measure digital inequality?Binary: have or haven’t

Typically•Number with home Internet•Number used Internet in last 3 months

How do we measure digital inequality?Binary: have or haven’t

Or perhaps•Have been able to do X on Internet (access+skill)

Can assess inequality by looking at spread

Other more sophisticated ways..

Other more sophisticated ways..

Mr Gini

Lorenz curve

Gini coefficient

e-health readiness: ability to use Internet for health

e-health inequality: spread (SD) of distribution of e-health readiness

e-health readiness: ability to use Internet for health

e-health inequality: spread (SD) of distribution of e-health readiness

Interventions are ‘good’ if they improve e-health readiness and at least do not increase e-health inequality, preferably decrease it:

e-health readiness: ability to use Internet for health

e-health inequality: spread (SD) of distribution of e-health readiness

Interventions are ‘good’ if they improve e-health readiness but at least do not increase e-health inequality, preferably decrease it:

Why? (i) fairness, (ii) efficiency of health services

Things you know about• Differences in use of Internet: about 80% of people had used

Internet in last 3 months

• Differences by age (personal skill and interest)

• Differences by urban/rural (physical availability)

• Some people have support to help, others don’t

• Some people will consider Internet expensive

E-health inequalities you may not have thought about

• 35% of GPs in Southend had a website compared to 94% in Harrogate

• Many US practices use pre-consultation computer-interviews but these are rarely used in the UK.

• Most UK renal patients have access to their renal medical record online but few if any stroke patients have such facility.

• Use of a globally available online cognitive behavioural therapy site for depression, varied 30-fold by postcode area across UK

Plymouth E-health Readiness Questionnaire (PERQ)

• 3 stage process of piloting • Self-completed questionnaire• Used in population survey to check validity• Produces an e-health readiness score (0-9)• From four subscores:

– Provision– Personal– Support– Economic

Distribution of e-health readiness (PERQ) scores on possible scale 0-9 showing Internet-users and non-Internet-users

Assumed changes Difference in readiness score for sub group

Paired t-test on sub group

Overall mean (SD) readiness

Paired t-test on whole population

Baseline: 344 respondents 4.24 (1.73)

20 people who previously used computer at home and at work got mobile access and became aware of GP services including patient access to records.

From 4.9 to 6.2 for these 20

t=12.6 P<0.001

4.32 (1.79)

t=4.34 P<0.001

20 non-Internet-users are supported in getting online. They have not looked at the GP website but have found other health information online

From 1.8 to 5.0 for these 20

t=18.6 p<0.001

4.44 (1.61)

t=4.48 p<0.001

• If you would like to use PERQ and its scoring system, or would like to collaborate on its further development, please get in touch

• Ray.jones@plymouth.ac.uk