Abstract
Web-based self-care resources have a number of potential benefits for military service members (SMs) and their families such as convenience, anonymity, and immediate 24/7 access to useful information. There is limited data available, however, regarding SM and military healthcare provider use of online self-care resources. Our goal with this study was to conduct a preliminary survey assessment of self-care Web site awareness, general attitudes about use, and usage behaviors of Web-based self-care resources among SMs and military healthcare providers. Results show that the majority of SMs and providers use the Internet often, use Internet self-care resources, and are willing to use additional Web-based resources and capabilities. SMs and providers also indicated a preference for Web-based self-care resources as adjunct tools to face-to-face/in-person care. Data from this preliminary study are useful for informing additional research and best practices for integrating Web-based self-care for the military community.
Introduction
Online self-care resources have many potential benefits for military service members (SMs) and their families. Some of these potential benefits include 24/7 availability of resources, access to resources when distant from a Military Treatment Facility (MTF), directories of available services, self-assessments, and searchable health and medical information. Further, because online self-care resources can be accessed anonymously in a person's private home, they can help to overcome the barrier of perceived stigma associated with the seeking of mental healthcare. Hoge et al. 1 reported that a significant amount of SMs who screened positive for mental health issues also reported that seeking face-to-face mental healthcare would be “embarrassing” or render them “weak.” A study of SMs who recently returned from deployment, however, indicated that a third of those unwilling to participate in traditional therapy would be open to utilizing at least one technology-based approach to mental healthcare. 2
Limited data are available, however, on the attitudes and usage of Web-based healthcare resources among SMs and providers in the military healthcare system. The goal of this study was to conduct a preliminary assessment of attitudes, awareness, and usage behaviors regarding online self-care resources among SMs and military healthcare providers.
Methods
SM volunteers were recruited at a personnel administrative processing center on a large military installation. Providers, who were located at various clinics at a large MTF, were sent surveys via interoffice mail and asked to return them in anonymous envelopes. Human Use Review Committee approval was obtained at the military installation where data were collected, and this study was designated as exempt research not requiring a formal informed consent procedure. All potential participants were provided with an information statement that informed them of the intent of the study.
Data were collected by self-report questionnaires designed specifically for this study. The surveys included items designed to assess three main content areas: (1) Internet usage and purpose, (2) attitudes about the value and utility of Web-based resources, and (3) comfort/willingness to use Web-based self-care resources. Because this study was exploratory, responses were examined on an item-by-item basis within these domains.
Results
Demographics
Forty-eight SMs volunteered and were included in the study sample. The mean age of the SMs was 30.5 (standard deviation, SD=8.2). Forty-five were active duty SMs and three SMs did not report their duty status. The majority (83.3%) were Enlisted Soldiers, with the remaining 16.7% comprised of Commissioned Officers. The remaining demographics are shown in Table 1.
Service Member Demographics (n=48)
GED, general equivalency diploma; AA, associate degree.
Disclosure Statement
No competing financial interests exist.
Of the 105 provider surveys that were distributed, only 27 providers (9 women and 18 men) returned surveys. Provider disciplines included 13 (48.1%) medical doctors (MD) or doctors of osteopathic medicine, 6 (22.2%) nurse practitioners or physician assistants, 6 psychologists (22.2%), 1 social worker (3.7%), and 1 mental health counselor (3.7%).
SM and Provider Internet Use
SMs reported a mean number hours per week of personal Internet use (nonwork related) of 16.2 (SD=12.6). Forty-six SMs (95.8%) indicated that they access the Internet for personal or work purposes by home computer, 33.3% use shared/public computers, and 35.4% use a mobile device (phone/personal digital assistant [PDA]) to access the Internet. Three SMs rated their proficiency and level of comfort with Internet as “beginner” (6.3%), 25% as “somewhat experienced” (n=12), 35.4% as “experienced” (n=17), and 34% as “very experienced” (n=16). The majority of SMs indicated capability at home to chat/instant message (95.8%), e-mail (100%), use a Web cam (85.4%), and to use streaming video (93.8%). Two-thirds (66.7%) had the capability at home to conduct video-conferencing.
Providers reported 15.2 h per week (SD=14.4) on average for work-related Internet use and 8.2 h per week for personal Internet use (SD=6.8). Twenty-six percent (n=7) indicated that they use a phone or PDA to access the Internet and 11.1% (n=3) use a virtual private network from home. None of the providers rated their level of comfort/proficiency with the Internet as “beginner,” 33.3% indicated “somewhat experienced,” 48.1% as “experienced,” and 18.5% indicated “very experienced.”
SM and Provider Self-Care Web Use and Purpose
SMs indicated that they are more likely to use self-care Web sites for medical/physical health concerns compared to mental/psychological health concerns (see Table 2). The majority of providers reported that they had used self-care Web sites as part of providing care and more than half reported encouraging a patient to visit self-care Web sites. Providers reported that the following Web sites were useful in their work with patients: (1)
Service Member Web-Based Self-Care Behaviors and Attitudes (n=48)
Provider Web-Based Self-Care Behaviors and Attitudes (n=27)
Attitudes About and Willingness To Use Internet-Based Self-Care Resources
The most frequent reported reasons SMs used self-care Web sites were (1) instant access to health information, (2) deciding when to see a healthcare provider for a medical/physical health reason, and (3) deciding when to see a healthcare provider for a mental/psychological health reason. Although SMs reported being more likely to use Internet-based self-care resources for a medical/physical concern versus a mental/psychological health concern, there was not a difference in online resource use to help decide when to see a healthcare provider. Results also show that although SMs appear to value Internet-based resources, they view seeing a healthcare provider face-to-face/in-person as more credible. Details regarding SM responses are shown in Table 2.
As can be seen in Table 3, provider attitudes about the value and utility of Internet-based resources were generally positive. The majority of providers endorsed that Web-based self-care resources are valuable as an adjunct to providing care in-person and that Web-based resources expand patient access to healthcare/self-care. Over 70% (n=19) endorsed that online resources have been very helpful in informing and educating patients about health concerns. Most providers also reported a willingness to use Internet-based resources and that they were open to learning more about online self-care programs.
Discussion and Conclusions
The goal of this study was to collect preliminary data to assess attitudes and awareness of online self-care resources among SMs and military healthcare providers. Results show that the majority of SMs and providers are currently using Internet self-care resources and are willing to use additional Internet-based resources. Interestingly, SMs and providers both indicated that although self-care Internet resources are useful, they perceive them as useful only as adjunct tools to face-to-face/in-person care. Also, nearly all of the SMs surveyed indicated that they have Web cam capabilities at home. Although the current study is limited by a small sample size, low survey response rate by providers, and the use of preliminary surveys not previously validated, these data provide useful information that help to identify capabilities, understand user preferences, and inform future research and program development.
Web-based self-care resources can be an important adjunct to traditional healthcare delivery. More research is needed, however, on the effectiveness of Web-based programs in the military and how personal technology devices such as smartphones can be used to deliver care. 3 The National Center for Telehealth and Technology (T2) is currently conducting a comprehensive survey study that is examining the use, availability, and need for personal technologies of SMs and their families. Results of this programmatic line of research will help to identify ways to best leverage technology for care, improve access to care, and increase awareness of Web-based self-care programs to meet the healthcare needs of the military community.
Footnotes
Acknowledgments
The authors wish to thank Jennifer L. Alford, Ph.D., Robert P. Ciulla, Ph.D., Greg A. Gahm, Ph.D., and Mark A. Reger, Ph.D., for their assistance with this research.
Disclaimer
The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.