Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application

Charilaos Lygidakis, Paul Wallace, Costanza Tersar, Francesco Marcatto, Donatella Ferrante, Roberto Della Vedova, Francesca Scafuri, Emanuele Scafato, Pierluigi Struzzo, Charilaos Lygidakis, Paul Wallace, Costanza Tersar, Francesco Marcatto, Donatella Ferrante, Roberto Della Vedova, Francesca Scafuri, Emanuele Scafato, Pierluigi Struzzo

Abstract

Background: Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app.

Objective: We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module.

Methods: The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences.

Results: Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance.

Conclusions: The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact.

Trial registration: Clinicaltrials.gov Keywords: Internet; alcohol drinking; behavior and behavior mechanisms; family physicians; multimedia; physician-patient relations; primary health care; research design.

Conflict of interest statement

Conflicts of Interest: CL is the cofounder and Chief Executive Officer at Lumos Medica Srl, which provides software solutions for clinical trials.

PW has intellectual property rights for the Downyourdrink website, is Chief Medical Advisor to the UK charity Drinkaware, and has provided private consultancy on the topic of screening and brief interventions to several agencies.

Figures

Figure 1
Figure 1
The GP/FP customization page (adapted in English).
Figure 2
Figure 2
The screening page with the personalized speech bubble (adapted in English).
Figure 3
Figure 3
The personalized welcome page (adapted in English).
Figure 4
Figure 4
The GP/FP can provide customized comments on the different patient inputs (adapted in English).

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