Transcript Patterns of Usage of Internet Resources by Persons with

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]
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.
Abstract
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
Participant Experience
42.6
Percent
63
68.5
60
60
Days
1-7
8-30
31-90
91-180
100
80
System and Service Use by Time Period
Forum
Access
170
176
133
90
Email
Access
179
340
438
444
Active
Users
50
48
39
28
40
30
20
Yes
40
57.4
10
20
37
31.5
Access to Internet
Experience Using
Internet
0
97
10
3
10
9
11
5
12
1
12
7
13
3
13
9
14
5
15
1
15
7
16
3
16
9
17
5
91
85
79
73
67
61
55
49
43
37
31
25
19
13
7
0
1
Experience w ith
Computers
Day of Study
Subject and Session Level Use
Participant Average Access
Discussion
 The nature of the HeartCare resource allowed users to
personalize their use behavior
60
 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
50
160
40
 Email and forum use decreased throughout the study,
suggesting that as recovery progresses, the need for electronic
communication decreases
30
 The social aspects of computer-mediated communication may
have an effect on how participants used the HeartCare system
20
10
 Multiple measures of use are required to effectively characterize
user behavior
0
140
120
100
80
60
40
20
Day of Study
Average time spent on system per user per day
 Studying how patients use an Internet system is critical in
designing future similar patient-centered home management
systems
97
10
3
10
9
11
5
12
1
12
7
13
3
13
9
14
5
15
1
15
7
16
3
16
9
17
5
91
85
79
73
67
61
55
49
43
37
31
25
19
13
7
97
10
3
10
9
11
5
12
1
12
7
13
3
13
9
14
5
15
1
15
7
16
3
16
9
17
5
91
85
79
73
67
61
55
49
43
37
31
25
19
13
7
0
1
Average Time (min)
180
1
 Fifty four participants received the system
in their homes for an 180 day study
Participant C
Day of Study
120
100
80
60
40
20
97
10
3
10
9
11
5
12
1
12
7
13
3
13
9
14
5
15
1
15
7
16
3
16
9
17
5
91
85
79
73
67
61
55
49
43
37
31
0
25
High – typically daily access
140
19

Intermittent – system use with large intervals between
accesses
Total Access Length (min)
 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

Moderate – system use through the first 90 days on
more than 10 occasions
 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
13
 Users were grouped according to frequency and
endurance of accesses

Low – system use through the first 90 days on 10 or
fewer occasions
Participant B
7
 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

System use ranged widely across participants; usage
ranged from no usage by one participant to over 400
system accesses during the 180 day period
1
 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

Total Access Length (min)
Materials and Methods
 Patients accessed HeartCare via a
WebTVTM device (with modem access to the
Internet) on a 19” television screen
Average Session
Length (min)
21.42
18.27
23.47
19.03
No
The HeartCare System
 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
Total
Access
396
663
818
736
50
Total Access Length (min)
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 patientfocused interventional studies.
 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 A
Day of Study
 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