Web Health Monitoring Survey: A New Approach to Enhance the Effectiveness of Telemedicine Systems

Abstract

BackgroundAging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research.ObjectiveThe objective of our study was to propose new metrics to control the quality of data, along with the well-known indicators of survey methodology. Web questionnaires administered daily to a group of patients for an extended length of time are a Web health monitoring survey (WHMS) in a telemedicine system.MethodsWe calculated indicators based on paradata collected during a WHMS study involving 12 patients, who signed in to the website daily for 2 months.ResultsThe patients’ involvement was very high: the patients’ response rate ranged between 1.00 and 0.82, with an outlier of 0.65. Item nonresponse rate was very low, ranging between 0.0% and 7.4%. We propose adherence to the chosen time to connect to the website as a measure of involvement and cooperation by the patients: the difference from the median time ranged between 11 and 24 minutes, demonstrating very good cooperation and involvement from all patients. To measure habituation to the questionnaire, we also compared nonresponse rates to the items between the first and the second month of the study, and found no significant difference. We computed the time to complete the questionnaire both as a measure of possible burden for patient, and to detect the risk of automatic responses. Neither of these hypothesis was confirmed, and differences in time to completion seemed to depend on health conditions. Focus groups with patients confirmed their appreciation for this “new” active role in a telemonitoring system.ConclusionsThe main and innovative aspect of our proposal is the use of a Web questionnaire to virtually recreate a checkup visit, integrating subjective (patient’s information) with objective data (biometric information). Our results, although preliminary and if need of further study, appear promising in proposing more effective telemedicine systems. Survey methodology could have an effective role in this growing field of research and applications.

Questionnaire Breakoff and Item Nonresponse in Web-Based Questionnaires: Multilevel Analysis of Person-Level and Item Design Factors in a Birth Cohort

“…The proportion of item nonresponse was low in our study, ranging from 1.3% to 2.9%. Another study that administered daily Web-based questionnaires also described low rates of item nonresponse, ranging from 0% to 7.4% [25]. In our study, online recruitment, older age, and lower educational levels were positively associated with item nonresponse.…”

Paradata analyses to inform population-based survey capture of pregnancy outcomes: EN-INDEPTH study

“…Not surprisingly, it has already found use in other health and medical areas. For example, similar to our study, paradata were previously used in telemedicine research to estimate time spent to complete a questionnaire [ 20 ] and to examine completion and impact of push notifications on data completion in behaviour risk assessment [ 21 ]. Other applications in health include examining the role of paradata in non-response adjustment process [ 22 ], underreporting errors and finding suggestions for methodological improvement for future surveys [ 23 ] and examining response time at the level of individual questions [ 24 ].…”