Achieving Health Equity with e-Healthystrides©: Patient Perspectives of a Consumer Health Information Technology Application

Abstract

Objective: We describe the implementa­tion, clinical outcomes and participant perspectives for e-Healthystrides©.Setting: Three independent ambulatory clinics and an historic African American (AA) church.Participants: Adults with diagnosed diabe­tes mellitus type 2.Interventions: e-Healthystrides© health coach facilitated interventionPrimary outcome: Acquisition of three new self-management behaviors.Secondary outcomes: Blood pressure, blood glucose, A1c, attrition rate and par­ticipant perspectives of e-Healthystrides©Methods: A convergent parallel mixed method design was used in both pilot stud­ies.Results: Two hundred and sixty-four par­ticipants, aged ~62±16 years, enrolled. At­trition at 52 weeks varied 50%-90% by site. Low engagement users were defined mainly by anxiety with putting health information online. The primary outcome was achieved in 36% of our participants, with the top 3 self-management behaviors acquired be­ing: reducing risk (24.5%); healthy eating (23.7%); and monitoring (16.4%). Problem solving had the lowest rate of achievement (.91%). Blood pressure improved signifi­cantly at all sites at 12 weeks and at clinics A,B,C at 52 weeks. Blood glucose im­proved at 12 weeks: clinic A (P=.0001), B (P=.003), C (P=.001) and D (P=.03); but, at 52 weeks, only clinics A (P=<.0001) and B (P=.0001). Participants felt empowered by features of e-Healthystrides©. Engage­ment with health coaches and peers was highly valued.Conclusions: e-Healthystrides© is effec­tive for self-management behavior change. Participants showed the best success with healthy coping, healthy eating, and moni­toring behaviors. They felt empowered by access to health information and valued interaction with coaches and peers. Our findings support strong relational/social network strategy with a role for coaches as guides (apomediaries) who facilitate skill acquisition using technology. Ethn Dis. 2019;29(Suppl 2):393-404; doi:10.18865/ed.29.S2.393.