TY - JOUR AU - Abbott-Garner, Philip AU - Richardson, Janet AU - Jones, Ray B PY - 2019 DA - 2019/03/11 TI -超高速宽带的影响，为家庭量身定制的小册子，以及与全科医生就个人电子健康准备的讨论:聚类阶乘准随机对照试验JO - J Med Internet Res SP - e11386 VL - 21 IS - 3kw -电子健康KW -随机对照试验KW -数字鸿沟KW -宽带实现KW -电子健康就绪KW -电子健康不平等KW -定制小册子KW -集群试验AB -背景:电子健康(eHealth)可以改善健康结果，但许多人仍然被数字排除在外。个人使用互联网促进健康的意愿可能因缺乏互联网基础设施、个人技能、社会支持、服务提供和成本而受到限制。减少这些障碍的干预措施的影响是未知的。从2011年起，英国政府支持在康沃尔郡农村地区实施“超高速”宽带(superfast)。这为评估区域、实践和家庭各级干预措施的影响提供了机会。目的:本研究旨在评估3项干预措施对个人电子健康准备的影响:(1)Superfast在区域层面的实施，(2)与全科医生进行实践层面的讨论，以鼓励在医疗服务提供中更多地使用互联网，以及(3)家庭层面的定制小册子，提供帮助提高个人电子健康技能的信息。方法:这是一项聚类准随机因子对照试验。对Superfast的实施进行了监控，并将邮编分类为早可用或晚可用。算法从16385个符合条件的邮政编码中选择78个，以尽量减少一般做法之间的重叠可能性，并确保城乡地区的平衡; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities. Results: eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t255=3.191; P=.002 and t258=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality. Conclusions: People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others. Trial Registration: ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x) SN - 1438-8871 UR - //www.mybigtv.com/2019/3/e11386/ UR - https://doi.org/10.2196/11386 UR - http://www.ncbi.nlm.nih.gov/pubmed/30855234 DO - 10.2196/11386 ID - info:doi/10.2196/11386 ER -