Year

2013

Degree Name

Doctor of Philosophy

Department

School of Nursing, Midwifery and Indigenous Health

Abstract

This doctoral thesis has been prepared in Type 2 - Journal Article Style, and addresses the development and piloting of an online asthma self-management education tool for use by older adults, consists of a literature review and five empirical papers. The Introduction provides the background to the research, which was part of a larger project funded by an Australian Research Council (ARC) Linkage Grant in partnership with Asthma Foundation NSW.

The burden of asthma mortality and morbidity currently lies with older adults and is likely to increase as the population ages, placing further pressure on the primary healthcare system. However, active self-management can improve symptom control, leading to fewer attacks and resulting in quality of life gains.

A user-centred design process was utilised to develop an intervention that met the needs of older adults. The first step in this process was the development of a paperbased survey. Data from the survey pilot is presented exploring the impact of various demographic variables on Internet use. While a surprising number of respondents were online (62%), this was more likely if they had a higher income (> $40,000) or had completed tertiary education. Data from the main survey, completed by 4,060 people was explored in relation to health information sources used by older adults. The Internet was found to be the third most frequently used source of health information after doctors (96%) and pharmacists (60%) suggesting that the Internet has a role in providing education in the self-management of asthma.

The literature review, aimed to identify the “active ingredients” present in online interventions targeting older adults with chronic diseases, using Ritterband’s model of Internet Interventions. However, the diversity of interventions coupled with differences in reporting methods made it difficult to identify the “active ingredients”. As such, the candidate proposed the iSMURF (Internet Self-Management Reporting Uniform Framework) as a means of standardising the information reported. iSMURF consists of six domains: website design, support, study design, website use, user characteristics and reporting outcomes.

Data from both the paper-based survey and the focus groups is bought together to identify the types of asthma information older adults were interested in learning about and the types of technology with which they were happy to engage. It was found that the main topics of interest included the identification and avoidance of triggers, dealing with attacks, and the latest information about asthma. Despite huge advancements in interactive web-technologies such as blogs and forums, older adults expressed little interest in using such technology to learn about asthma. These findings informed the development of AsthmaWise.

User-centred testing was undertaken and is reported, this included usability testing using a sample of end users (older adults with asthma), a cognitive walk through by an independent researcher, and assessment of content readability. The issues identified through the usability testing were reported to the developer and AsthmaWise was subsequently refined. Finally, the piloting of the refined version of AsthmaWise over a three month period is reported. Matched data were obtained from 51 participants and showed significant improvements in asthma knowledge, asthma control, and asthma quality of life. Results from this pilot study suggest that this online asthma self-management education program is acceptable to older Australians with asthma.

This doctoral thesis provides a number of contributions to the literature. Primarily it shows that online asthma self-management education is acceptable to older adults and can result in improved self-reported outcomes. No evidence has been found to indicate that previous online asthma education programs have targeted older adults. Secondly, the thesis proposes the Internet Self-Management Reporting Uniform Framework (iSMURF) as a standardised reporting framework, which can be utilised in the future by researchers reporting Internet interventions targeting chronic diseases, enabling comparisons between studies.

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