iHealth: supporting health by technology
This thesis is about how people support their health through the use of technology. It focuses on web-based information and communication technology (ICT). Many factors play a role in the interaction between people, technology and context. In five studies we have investigated a few of them. The central research question concerns the values eHealth technologies add to what people need for health in terms of information, communication and transformation. We have used a mixed-methods design to improve data collection and understanding of the issues concerned. The introduction depicts the context of pervasive and revolutionary ICTs in contemporary society. This influences how people perceive their health, the organization of health care and medical research. In the first chapter we examine the extent to which a so-called 'brain machine' affects relaxation among health professionals at risk for burn-out. Chapters 2-4 concern the Dutch government-funded health portal kiesBeter.nl. After a historical report of the policy context of New Public Management (accountability) and the transformation of the health care system (transparency) the portal is analyzed with regard to its original objectives. The next study analyses aspects of the portal's usability as perceived by patients with long-term conditions, followed by a study on the effect of a decision aid on the decision-making process of patients. Chapter 5 presents a study on the risks for patient safety and quality of care associated with eHealth technologies. The last study is an intellectual contribution to the international academic discourse on the impact of eHealth interventions in global health care. The studies have lead to a constructive perspective on 'iHealth' which is further elaborated in the 'Discussion'part. iHealth is the term introduced to denote persuasive health technologies in context, which implies that information and users are central to the development of technology. eHealth is a transitory concept in the progression towards fully integrated information and communication technologies in care: eHealth inside. Outcomes have been used to foster the extension of a 'holistic' framework to increase the uptake and impact of eHealth technologies. It is operationalized in a 'roadmap' that enables evidence-based design, implementation and evaluation of eHealth interventions.