How digital interventions support self-care of minor ailments: A process evaluation of the Internet Dr intervention for colds and flu

Background: Around 57 million doctor appointments annually in the UK are for minor ailments that could be self-cared for by patients. As well as taking up healthcare resources, patients experience increased anxiety, lowered confidence and inconvenience. The ‘Internet Dr’ is a digital intervention developed to support patients to self-care for respiratory tract infections. In a randomised controlled trial, patients with access to the intervention had fewer visits to their doctor for respiratory tract infections. Having established intervention efficacy, further examination of the data collected in the trial is required to understand how the intervention was successful. Objective: This paper reports a process evaluation of the ‘Internet Dr’ intervention. The evaluation identifies meaningful usage metrics (ie, types of interaction that are specific and relevant to the intervention). These metrics are used to examine which parts of the intervention are effective in supporting self-care for respiratory tract infections, who used them and at what time. Methods: The ‘Internet Dr’ trial recorded patients’ characteristics and usage data over 24 weeks. At follow-up users reported changes in their levels of enablement to cope with their illness over the trial period. An evaluation plan to examine this data was developed using Medical Research Council guidance and the framework for Analysing and Measuring Usage and Engagement Data. Results: Viewing pages containing advice on caring for respiratory tract infections was identified as a meaningful metric for measuring usage of the intervention. Almost half the users (n=616, 42.32%) viewed at least one advice page, with most people (n=478, 77.60%) accessing them when they initially enrolled in the study. Users who viewed an advice page (M=2.12) reported increased enablement to cope with their illness as a result of having participated in the study (MD =.469, 95% CI [.082, .856]), compared to users who did not view advice pages (M=1.65). Users who had visited their GP for a respiratory tract infection in the year prior to the trial were a target population, and analyses revealed that this group were more likely to access advice pages (Wald's x2=14.915, P=<.001). Conclusions: The process evaluation identifies viewing advice pages as associated to increased enablement to self-care, even when accessed in the absence of a respiratory tract infection, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was also effective at reaching the target population of users who consulted their GP previously. However, attrition prior to advice pages was high, highlighting the necessity of prioritising access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated, and have wider implications for minor ailment interventions. Clinical Trial: ISRCTN91518452