via Journal of Medical Internet Research
(J
Med Internet Res 2010;12(2):e23) Patient
empowerment; Internet; eHealthABSTRACT
Background: Patient empowerment is growing
in popularity and application. Due to the increasing possibilities of
the Internet and eHealth, many initiatives that are aimed at empowering
patients are delivered online.
Objective: Our objective was to evaluate
whether Web-based interventions are effective in increasing patient
empowerment compared with usual care or face-to-face interventions.
Methods: We performed a systematic
review by searching the MEDLINE, EMBASE, and PsycINFO databases from
January 1985 to January 2009 for relevant citations. From the 7096
unique citations retrieved from the search strategy, we included 14
randomized controlled trials (RCTs) that met all inclusion criteria.
Pairs of review authors assessed the methodological quality of the
obtained studies using the Downs and Black checklist. A meta-analysis
was performed on studies that measured comparable outcomes. The GRADE
approach was used to determine the level of evidence for each outcome.
Results: In comparison with usual care
or no care, Web-based interventions had a significant positive effect
on empowerment measured with the Diabetes Empowerment Scale (2 studies,
standardized mean difference [SMD] = 0.61, 95% confidence interval [CI]
0.29 - 0.94]), on self-efficacy measured with disease-specific
self-efficacy scales (9 studies, SMD = 0.23, 95% CI 0.12 - 0.33), and on
mastery measured with the Pearlin Mastery Scale (1 study, mean
difference [MD] = 2.95, 95% CI 1.66 - 4.24). No effects were found for
self-efficacy measured with general self-efficacy scales (3 studies, SMD
= 0.05, 95% CI -0.25 to 0.35) or for self-esteem measured with the
Rosenberg Self-Esteem Scale (1 study, MD = -0.38, 95% CI -2.45 to 1.69).
Furthermore, when comparing Web-based interventions with face-to-face
deliveries of the same interventions, no significant (beneficial or
harmful) effects were found for mastery (1 study, MD = 1.20, 95% CI
-1.73 to 4.13) and self-esteem (1 study, MD = -0.10, 95% CI -0.45 to
0.25).
Conclusions: Web-based
interventions showed positive effects on empowerment measured with the
Diabetes Empowerment Scale, disease-specific self-efficacy scales and
the Pearlin Mastery Scale. Because of the low quality of evidence we
found, the results should be interpreted with caution. The clinical
relevance of the findings can be questioned because the significant
effects we found were, in general, small.
doi:10.2196/jmir.1286