Eine stetig wachsende Zahl von Nutzern sucht im Internet nach Gesundheitsinformationen. Hierzu steht ihnen eine Vielzahl ganz unterschiedlicher Anbieter zur Verfügung, die bei divergierenden Interessen gesundheitsrelevante Angebote im Internet vorhalten. Abgesehen von der Informationsflut, mit der die Nutzer bei der Suche überhäuft werden, erhalten sie auch falsche, irreführende, veraltete und sogar gesundheitsgefährdende Informationen. In den letzten zehn Jahren haben verschiedene Wissenschaftler die Anforderungen an ein ideales Gesundheitsinformationssystem ermittelt. Im Rahmen des in diesem Beitrag beschriebenen Projekts wurde ein Gesundheitsinformationssystem als Prototyp zur anamnesebezogenen, internetbasierten Patienteninformation entwickelt und anhand einer Studie evaluiert. Dabei wird die Untersuchung auf deutschsprachige Erwachsene mit Kopfschmerzen eingegrenzt. Insgesamt wird die Hypothese überprüft, dass eine angeleitete, anamnesebezogene Internetsuche für den Patienten bessere Ergebnisse liefert, als dies durch die herkömmliche Nutzung von Gesundheitsportalen oder Suchmaschinen erreicht werden kann. Zur Evaluation wurde eine kontrollierte Zweigruppenstudie mit insgesamt 140 Teilnehmern in zwei Studienabschnitten durchgeführt. Dabei wurde im ersten Abschnitt festgestellt, dass bei einfach strukturierten Krankheitsfällen das Informationssystem gleichgute Ergebnisse liefert wie die herkömmliche Suche. Im zweiten Abschnitt konnte allerdings festgestellt werden, dass bei komplexen Kopfschmerzfällen mit Hilfe des Prototyps signifikant (P=0,031) bessere Diagnosen gestellt werden konnten als ohne. Medizinische Expertensysteme in Kombination mit einer Meta-Suche nach maßgeschneiderten qualitätsgesicherten Informationen erweisen sich als probate Möglichkeit, den Ansprüchen an eine geeignete Versorgung mit Gesundheitsinformationen gerecht zu werden. / A steadily increasing number of users search for health information online. Therefore, a multitude of totally different providers with diverging interests offer information. Apart from the information overload the users are flooded with, they may access false, misleading or even life threatening information. In the last 10 years scientists have determined the requirements of an ideal health information system. In the study described in this paper a prototype health information system providing anamnesis related internet-based consumer health information is evaluated. In total, the hypothesis that a computer-aided anamnesis-related internet search provides better results than the use of conventional search engines or health portals is evaluated. For evaluation a randomised controlled study with 140 participants has been conducted in two study sections. In the first section it was found, that for a less complex diagnosis the prototype information system did equally well as the conventional information retrieval. In the second study section it was found, that dealing with complex headache cases participants using the prototype determined significantly better (P=0.031) diagnoses than the control group did without prototype support. It has been shown, that medical expert systems in combination with a meta-search for tailored quality controlled information represents a feasible strategy to provide reliable health information.

Abstract Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency towards the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through the use of mobile technologies (mHealth) has grown exponentially in recent years. However, only a fraction of these solutions takes into consideration the views of relevant stakeholders like healthcare professionals or even patients. The use of behavioral change models (BCM) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. This doctoral thesis is framed in Consumer Health Informatics within the field of Medical Informatics and Information Systems. The focus of this work was to discover factors for the design of mHealth solutions for chronic patients; to do so, negotiations between medical knowledge, BCM and gamification were explored through an embedded case study research methodology. The data obtained was thematically analyzed to create the Model for Motivational Mobile-health Design for Chronic conditions (3MD). The 3MD model guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are: 1) Condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; 2) Motivation related, which are factors that address how to influence behaviors in an engaging manner; and 3) Technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. 3MD also provides a series of high level illustrative design questions for designers to use and consider during the design process. The work on this thesis addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients. / Tiivistelmä Krooniset sairaudet ovat maailman yleisin kuolinsyy. Akuutissa hoidossa ja diagnostiikassa on tapahtunut merkittäviä parannuksia, ja aikaisemmin kuolemaan johtaneista sairauksista on tullut kroonisia ja ihmisten on opittava hallitsemaan niitä itse. Mobiiliteknologiat tarjoavat mahdollisuuksia sairauksien itsehallintaan, koska teknologiaa on yleisesti saatavilla ja se on kustannustehokasta. Terveyspalvelujen tarjoaminen mobiiliteknologian avulla on lisääntynyt huomattavasti viime vuosina. Kuitenkin vain murto-osa näistä ratkaisuista ottaa huomioon sidosryhmien, kuten terveydenhuollon ammattilaisten ja jopa potilaiden, näkemykset. Käyttäytymismuutosmallit ovat osoittautuneet tärkeiksi kehitettäessä onnistuneita terveysratkaisuja, mutta potilaiden osallistaminen kehittämiseen on yhä vaikeaa. Pelillistäminen on mobiilien terveysratkaisujen suunnittelutrendi, ja pelielementeillä pyritään vaikuttamaan ihmisten käyttäytymiseen ja sitoutumiseen. Mobiilien terveyssovellusten suunnittelijoilla ei ole selkeää näkemystä siitä, mitkä sovellustekijät vaikuttavat merkittävimmin kroonisissa sairauksissa sairastavien potilaiden käyttäytymisen muutokseen. Tämä väitöskirja tarkastelee kuluttajille suunnattua terveysteknologiaa, joka hyödyntää lääketieteellistä informatiikkaa ja tietojärjestelmätieteitä. Työn tavoitteena oli selvittää kroonisia sairauksia sairastaville potilaille tarkoitettujen mobiilien terveyssovellusten suunnitteluun liittyviä tekijöitä. Tämän vuoksi lääketieteen tietämyksen, käyttäytymismuutoksien mallien ja pelillistämisen yhdistämistä tutkittiin sulautetun tapaustutkimuksen avulla. Saatuja tietoja temaattisesti analysoimalla luotiin kroonisia sairauksia varten motivoivan mobiilin terveyssovelluksen suunnittelumalli (3MD = Model for Motivational Mobile-health Design). 3MD-malli ohjaa sairauksien hallintaan tarkoitettujen pelillistettyjen ja käyttäytymismuutoksiin tähtäävien mobiilien terveyssovellusten suunnittelua. Mallin pääkomponentit ovat: 1) Sairautta kuvaavat tekijät, jotka kuvaavat tekijöitä, jotka on mukautettava ja sovitettava kullekin krooniselle sairaudelle. 2) Motivaatioon liittyvät tekijät, jotka vaikuttavat innostavasti käyttäytymiseen. 3) Teknologiaan perustuvat tekijät, jotka liittyvät suoraan mobiiliteknologian teknisiin ominaisuuksiin. 3MD tarjoaa myös havainnollisia suunnittelukysymyksiä, joita suunnittelijat voivat käyttää ja pohtia suunnitteluprosessin aikana. Tämä väitöskirja käsittelee yleisesti tunnistettua puutetta tutkimuksessa ja suunnittelukäytännössä ja esittelee ainutlaatuisen mallin, josta voi olla hyötyä uusien ratkaisujen luomisessa ja kroonisia sairauksia sairastavien potilaiden auttamisessa.

This study investigates, within the current health care situation, the interrelationship of the user, resources and tool in the design of a prototype WELLNESS database-driven web site. A shift has taken place in health care, in which the base of conventional medicine has broadened to integrate other systems, practices and worldviews. These include complementary and alternative medicine, health promotion, disease prevention and wellness. Emphasis is placed on the need to take personal responsibility for one's own health and wellness. The global burden of chronic disease, reaching epidemic proportions, is increasingly linked to risk factors resulting from personal lifestyle choices. The growing evidence of the user's need to make personal, informed, lifestyle choices and their reliance on the Web for health information, required investigation. WELLNESS, a specific orientation to health and wellness, formed the framework within which the user and resources were defined and the tool designed. The user was profiled as the WELLNESS health information seeker, hereby contributing significantly to an understanding of the user in this new context. The user profile informed the establishment of resource selection criteria and tool design. The identification of WELLNESS content selection criteria, within a five-dimensional model, was required to ensure quality, relevant and credible resources. The tool is comprised of the WELLNESS thesaurus and WELLNESS database-driven web site. The WELLNESS thesaurus was constructed based on a combination of relevant thesauri. It will be used as an indexing tool. An investigation of existing health information web sites highlighted the importance of designing a specific WELLNESS database-driven web site. A database host was identified against which the original study's conceptual schema was assessed. A low-fidelity prototype web site was designed as the interface between the WELLNESS health information seeker and the database of WELLNESS health information resources. This study has epidemiological, philosophical, epistemological, sociological and psychological relevance. The provision of access to WELLNESS health information resources, made available in the WELLNESS database-driven web site, for personal, informed lifestyle choice by the WELLNESS health information seeker could potentially contribute to the reduction of the global burden of chronic disease. / Information Science / D.Litt. et Phil. (Information Science)

This study investigates, within the current health care situation, the interrelationship of the user, resources and tool in the design of a prototype WELLNESS database-driven web site. A shift has taken place in health care, in which the base of conventional medicine has broadened to integrate other systems, practices and worldviews. These include complementary and alternative medicine, health promotion, disease prevention and wellness. Emphasis is placed on the need to take personal responsibility for one's own health and wellness. The global burden of chronic disease, reaching epidemic proportions, is increasingly linked to risk factors resulting from personal lifestyle choices. The growing evidence of the user's need to make personal, informed, lifestyle choices and their reliance on the Web for health information, required investigation. WELLNESS, a specific orientation to health and wellness, formed the framework within which the user and resources were defined and the tool designed. The user was profiled as the WELLNESS health information seeker, hereby contributing significantly to an understanding of the user in this new context. The user profile informed the establishment of resource selection criteria and tool design. The identification of WELLNESS content selection criteria, within a five-dimensional model, was required to ensure quality, relevant and credible resources. The tool is comprised of the WELLNESS thesaurus and WELLNESS database-driven web site. The WELLNESS thesaurus was constructed based on a combination of relevant thesauri. It will be used as an indexing tool. An investigation of existing health information web sites highlighted the importance of designing a specific WELLNESS database-driven web site. A database host was identified against which the original study's conceptual schema was assessed. A low-fidelity prototype web site was designed as the interface between the WELLNESS health information seeker and the database of WELLNESS health information resources. This study has epidemiological, philosophical, epistemological, sociological and psychological relevance. The provision of access to WELLNESS health information resources, made available in the WELLNESS database-driven web site, for personal, informed lifestyle choice by the WELLNESS health information seeker could potentially contribute to the reduction of the global burden of chronic disease. / Information Science / D.Litt. et Phil. (Information Science)

Eine stetig wachsende Zahl von Nutzern sucht im Internet nach Gesundheitsinformationen. Hierzu steht ihnen eine Vielzahl ganz unterschiedlicher Anbieter zur Verfügung, die bei divergierenden Interessen gesundheitsrelevante Angebote im Internet vorhalten. Abgesehen von der Informationsflut, mit der die Nutzer bei der Suche überhäuft werden, erhalten sie auch falsche, irreführende, veraltete und sogar gesundheitsgefährdende Informationen. In den letzten zehn Jahren haben verschiedene Wissenschaftler die Anforderungen an ein ideales Gesundheitsinformationssystem ermittelt. Im Rahmen des in diesem Beitrag beschriebenen Projekts wurde ein Gesundheitsinformationssystem als Prototyp zur anamnesebezogenen, internetbasierten Patienteninformation entwickelt und anhand einer Studie evaluiert. Dabei wird die Untersuchung auf deutschsprachige Erwachsene mit Kopfschmerzen eingegrenzt. Insgesamt wird die Hypothese überprüft, dass eine angeleitete, anamnesebezogene Internetsuche für den Patienten bessere Ergebnisse liefert, als dies durch die herkömmliche Nutzung von Gesundheitsportalen oder Suchmaschinen erreicht werden kann. Zur Evaluation wurde eine kontrollierte Zweigruppenstudie mit insgesamt 140 Teilnehmern in zwei Studienabschnitten durchgeführt. Dabei wurde im ersten Abschnitt festgestellt, dass bei einfach strukturierten Krankheitsfällen das Informationssystem gleichgute Ergebnisse liefert wie die herkömmliche Suche. Im zweiten Abschnitt konnte allerdings festgestellt werden, dass bei komplexen Kopfschmerzfällen mit Hilfe des Prototyps signifikant (P=0,031) bessere Diagnosen gestellt werden konnten als ohne. Medizinische Expertensysteme in Kombination mit einer Meta-Suche nach maßgeschneiderten qualitätsgesicherten Informationen erweisen sich als probate Möglichkeit, den Ansprüchen an eine geeignete Versorgung mit Gesundheitsinformationen gerecht zu werden. / A steadily increasing number of users search for health information online. Therefore, a multitude of totally different providers with diverging interests offer information. Apart from the information overload the users are flooded with, they may access false, misleading or even life threatening information. In the last 10 years scientists have determined the requirements of an ideal health information system. In the study described in this paper a prototype health information system providing anamnesis related internet-based consumer health information is evaluated. In total, the hypothesis that a computer-aided anamnesis-related internet search provides better results than the use of conventional search engines or health portals is evaluated. For evaluation a randomised controlled study with 140 participants has been conducted in two study sections. In the first section it was found, that for a less complex diagnosis the prototype information system did equally well as the conventional information retrieval. In the second study section it was found, that dealing with complex headache cases participants using the prototype determined significantly better (P=0.031) diagnoses than the control group did without prototype support. It has been shown, that medical expert systems in combination with a meta-search for tailored quality controlled information represents a feasible strategy to provide reliable health information.