Access to fracture risk assessment by FRAX and linked National Osteoporosis Guideline Group (NOGG) guidance in the UK—an analysis of anonymous website activity

McCloskey, Eugène; Johansson, Helena; Harvey, Nicholas C.; Compston, Juliet; Kanis, John А.

doi:10.1007/s00198-016-3696-2

Cited by 18 publications

(19 citation statements)

References 21 publications

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“…Indeed, Google Analytics has already been used in health research as part of process evaluation [19-21]. For example, this tool has been used to assess the usage of a website about sexual health [19], an internet-delivered genetics education resource developed for nurses [21], and a Web-based tool to encourage the proper use of antibiotics [16], as well as websites related to osteoporosis and fractures [22], smoking cessation [23], and knowledge translation [24]. These studies have presented various indicators available from Google Analytics to show overall user engagement with their platforms.…”

Section: Introductionmentioning

confidence: 99%

A Process Evaluation of a Web-Based Mental Health Portal (WalkAlong) Using Google Analytics

et al. 2018

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BackgroundDespite the increasing amount of research on Web-based mental health interventions with proven efficacy, high attrition rates decrease their effectiveness. Continued process evaluations should be performed to maximize the target population’s engagement. Google Analytics has been used to evaluate various health-related Web-based programs and may also be useful for Web-based mental health programs.ObjectiveThe objective of our study was to evaluate WalkAlong.ca, a youth-oriented mental health web-portal, using Google Analytics to inform the improvement strategy for the platform and to demonstrate the use of Google Analytics as a tool for process evaluation of Web-based mental health interventions.MethodsGoogle Analytics was used to monitor user activity during WalkAlong’s first year of operation (Nov 13, 2013-Nov 13, 2014). Selected Google Analytic variables were overall website engagement including pages visited per session, utilization rate of specific features, and user access mode and location.ResultsThe results included data from 3076 users viewing 29,299 pages. Users spent less average time on Mindsteps (0 minute 35 seconds) and self-exercises (1 minute 08 seconds), which are important self-help tools, compared with that on the Screener tool (3 minutes 4 seconds). Of all visitors, 82.3% (4378/5318) were desktop users, followed by 12.7 % (677/5318) mobile phone and 5.0% (263/5318) tablet users. Both direct traffic (access via URL) and referrals by email had more than 7 pages viewed per session and longer than average time of 6 minutes per session. The majority of users (67%) accessed the platform from Canada.ConclusionsEngagement and feature utilization rates are higher among people who receive personal invitations to visit the site. Low utilization rates with specific features offer a starting place for further exploration of users in order to identify the root cause. The data provided by Google Analytics, although informative, can be supplemented by other evaluation methods (ie, qualitative methods) in order to better determine the modifications required to improve user engagement. Google Analytics can play a vital role in highlighting the preferences of those using Web-based mental health tools.

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Section: Introductionmentioning

confidence: 99%

A Process Evaluation of a Web-Based Mental Health Portal (WalkAlong) Using Google Analytics

et al. 2018

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“…Over the period of this study, 228 countries or dependencies worldwide had documented access and interacted with the FRAX tool website. As previously reported, the country with the most frequent access to the FRAX tool website is the USA [ 14 ]. Over the reporting period, around 4.3 million usage sessions were conducted from the USA, followed by the UK (1.3 million) and Canada (0.3 million) (Table 2 ).…”

Section: Resultsmentioning

confidence: 96%

Temporal changes in access to FRAX® in Thailand between 2010 and 2018

et al. 2019

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Summary The usage of FRAX® tool in Thailand and other countries was explored using Google Analytics data. Over the period 2010–2018, Thailand ranked 35th in the world for FRAX usage (the US is ranked first). Incorporation of FRAX into a national osteoporosis guideline in Thailand appears to have increased its usage. Purpose To document access to the web-based FRAX® tool and specifically its access in Thailand between 2010 and 2018. Methods A descriptive retrospective study using data from Google Analytics that provides numerical and geographical information on internet access to the FRAX tool website worldwide. Result In Thailand, Bangkok is the highest ranked site for FRAX access with more than 20,000 usage sessions since 2010 (3.6 usage session per 1000 population) followed by Khon Kaen and Chiang Mai. It has been accessed from within 76 out of 77 provinces (98.7%). There was a steady increase in access to FRAX from within Thailand of approximately 1000 usage sessions per year between 2010 and 2016. After the FRAX fracture risk calculation was included in the national guideline for osteoporosis management published in late 2016, the rate of increase in access was four-fold higher compared with the previous period. In world ranking, the USA is the country with the most frequent access to the FRAX tool, whereas Thailand was ranked 35th in the world. There were weak but significant correlations between the absolute number of FRAX sessions and population size ( r = 0.165, p = 0.011) and land area ( r = 0.375, p < 0.001). Conclusion Access to the FRAX tool website is increasing in Thailand. The incorporation of FRAX into national guidelines, in parallel to the adoption of osteoporosis fracture prevention into national policy, has had a rapid and significant impact on its use. Electronic supplementary material The online version of this article (10.1007/s11657-019-0613-2) contains supplementary material, which is available to authorized users.

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“…Over the 1-month period of April, there were approximately 123,000 fewer FRAX sessions than might have been expected. Bearing in mind that the session number underestimates the actual number of FRAX calculations by about 30% [20], then somewhere in the region of 175,000 patients were likely excluded from fracture risk assessment. If the measures adopted to address COVID-19 continue to impede osteoporosis care, then over a 3-month period more than 0.5 million patients would be excluded from assessment and a substantial proportion of those from necessary treatment.…”

Section: Discussionmentioning

confidence: 99%

Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures

et al. 2020

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Summary The COVID-19 pandemic, and its management, is markedly impacting the management of osteoporosis as judged by access to online FRAX fracture risk assessments. Globally, access was 58% lower in April than in February 2020. Strategies to improve osteoporosis care, with greater use of fracture risk assessments, offer a partial solution. Introduction The COVID-19 pandemic is having a significant detrimental impact on the management of chronic diseases including osteoporosis. We have quantified the global impact by examining changes in the usage of online FRAX fracture risk assessments before and after the declaration of the pandemic (11 March 2020). Methods The study comprised a retrospective analysis using GoogleAnalytics data on daily sessions on the FRAX® website (www.sheffield.ac.uk/FRAX) from November 2019 to April 2020 (main analysis period February–April 2020), and the geographical source of that activity. Results Over February–April 2020, the FRAX website recorded 460,495 sessions from 184 countries, with 210,656 sessions in February alone. In March and April, the number of sessions fell by 23.1% and 58.3% respectively, a pattern not observed over the same period in 2019. There were smaller reductions in Asia than elsewhere, partly related to earlier and less-marked nadirs in some countries (China, Taiwan, Hong Kong, South Korea and Vietnam). In Europe, the majority of countries (24/31, 77.4%) reduced usage by at least 50% in April. Seven countries showed smaller reductions (range − 2.85 to − 44.1%) including Poland, Slovakia, Czech Republic, Germany, Norway, Sweden and Finland. There was no significant relationship between the reduction in FRAX usage and measures of disease burden such as COVID-attributed deaths per million of the population. Conclusion This study documents a marked global impact of the COVID-19 pandemic on the management of osteoporosis as reflected by FRAX online fracture risk assessments. The analysis suggests that impact may relate to the societal and healthcare measures taken to ameliorate the pandemic.

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Access to fracture risk assessment by FRAX and linked National Osteoporosis Guideline Group (NOGG) guidance in the UK—an analysis of anonymous website activity

Cited by 18 publications

References 21 publications

A Process Evaluation of a Web-Based Mental Health Portal (WalkAlong) Using Google Analytics

A Process Evaluation of a Web-Based Mental Health Portal (WalkAlong) Using Google Analytics

Temporal changes in access to FRAX® in Thailand between 2010 and 2018

Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures

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