Background:

Interactive Health Communication Applications (IHCA) are computer-based, usually web-based, information packages for patients that also contain at least one of peer support; decision support; or behaviour change. The combination of information with peer support, decision support or behaviour change is likely to promote users ability to internalise, interpret and apply relevant information. Hence, IHCA have the potential to promote informed decision-making, improved health behaviours, self-care, peer information exchange and emotional support, and improved health outcomes.

Objectives:

The objectives were to determine the effects of IHCA for people with chronic disease on patients, health outcomes and health service utilisation.

Methods:

We searched MEDLINE, EMBASE, CINAHL, PsycINFO, CCCTR, DARE, NHSEED, Dissertation abstracts, ASLIB index to theses, SIGLE for grey literature, research registers (January 1990 - December 2003)and reference lists of articles. We also contacted researchers in the field.

Inclusion criteria were: all methodologies; all participants of all ages with chronic disease, and all IHCA (except decision aids and computerised cognitive behavioural therapy as these are already subjects of systematic reviews, and packages aimed solely at professionals). Simple information packages were excluded as they do not fulfill the definition of an IHCA.

Patient outcomes were: cognitive (knowledge and understanding); affective (e.g self-efficacy, anxiety, depression); social support; and behaviour change (e.g diet, exercise, self-monitoring). Clinical outcomes were disease specific, and economic outcomes examined costs and resource utilisation. Data in each outcome category were divided into 4 time periods: immediate (2 weeks or less); short term (over 2 weeks to 3 months); medium term (over 3 months to 9 months); and long term (over 9 months). Meta-analyses were performed on data extracted from reports of RCTs, whille non-RCT studies were used to address additional outcomes and inform the findings.

Results:

20,821 abstracts were screened, yielding 878 candidate studies. Of these, 124 papers were included in the review, and 35 reported 29 separate RCTs. Meta-analyses showed that IHCA were better than control in improving cognitive outcomes and social support. The findings for affective changes, behaviour change and clinical outcomes were more mixed, and it was hard to draw definite conclusions. There was insufficient economic data to perform any analyses. Non-RCT papers provided theoretical frameworks for the mechanism of action of IHCA, and for developing IHCA. They addressed the issue of equity, suggesting that all sections of the population, including the elderly, ethnic minorities and people of low educational attainment can benefit from IHCA. Social support was highly valued.

Conclusions:

IHCA can improve cognitive and social support outcomes in patients with chronic disease. These results support continued cautious investment in IHCA, as long as it is coupled with a rigorous research programme to determine their effects on behaviour change, clinical outcomes, and cost-effectiveness.