A study by Nijland and coworkers noted that prior studies have shown that many patients are interested in Internet-based technology that enables them to control their own care. As a result, innovative eHealth services are evolving rapidly, including self-assessment and patient-caregiver e-mail communication. The aim of the study by the Netherlands investigators was to determine user-centered criteria for successful application of Internet-based technology used in primary care for supporting self-care. Scenario-based tests were combined with in-depth interviews among 14 caregivers and 14 patients/consumers to describe the use of various self-care applications and the accompanying user problems. The focus was on the user-friendliness of the applications, the quality of care provided by the applications, and the implementation of the applications in practice. Results showed that problems with the user-friendliness of the self-care applications concerned inadequate navigation structures and search options, and lack of feedback features. Patients wanted to retrieve health information with as little effort as possible; however, the navigation and search functionalities of the applications appeared incapable of handling patients' health complaints efficiently. Among caregivers, the lack of feedback and documentation possibilities caused inconvenience. Caregivers wanted to know how patients acted on their advice, but the applications failed to offer an adequate feedback feature. Quality of care problems was mainly related to insufficient tailoring of information to patients' needs and to efficiency problems. Patients expected personalized advice to control their state of health, but the applications failed to deliver this. Language also appeared as an obstacle to providing appropriate and useful self-care advice. Caregivers doubted the reliability of the computer-generated information and the efficiency and effectiveness of secure email consultation. Legal or ethical issues with respect to possible misuse of e-mail consultation also caused concerns. Caregivers due to unclear policy on email consultation and the lack of training for e-mail consultations mainly experienced implementation problems.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that patient and caregiver expectations did not correspond with their experiences of the use of the Internet-based applications for self-care. Patients thought that the applications would support them in solving their health problems. Caregivers were more reserved about the applications because of medico-legal concerns about misuse. However, the applications failed to support self-care because eHealth is more than just a technological intervention. The design of the applications should include a way of thinking about how to deliver health care with the aid of technology. The most powerful application for self-care was secure e-mail consultation, combined with a suitable triage mechanism to empower patients' self-awareness. It is hard to believe that any useful information could come out of this study. Patients must acquire and perform self-management skills before they can use the Internet to gain feedback on their needs and performance. This precondition must be the foundation for any future uses of the Internet by either patients or health care providers. Other research has indicated that the Internet can then become a useful tool to enhance communication between patients and health care providers when patients can successfully perform self-management or self-care skills.

N Nijland et al. Evaluation of internet-based technology for supporting self-care: problems encountered by patients and caregivers when using self-care applications. Journal of Medical Internet Research, 2008;10:e13.