PhD project

WebChoice 2.0

Aspects of uptake, use and effectiveness of eHealth interventions for self-management support and patient-provider communication

Project period



The South-East Regional Health Authority of Norway (grant number: 2009051)


The prevalence and burden of chronic diseases, including cancer, are escalating worldwide. New models of care are needed to meet this challenge. eHealth has a great potential to support patients self-management and communication with health care providers. However, a number of barriers to achieve the full benefits of eHealth have been reported.


The aim of this dissertation was to address gaps related to the uptake, use and effectiveness of eHealth interventions.

  • Study I - Uptake: Explore nurses’ experiences of benefits of and barriers to maintaining the use of an interactive tailored patient assessment tool, called Choice, in cancer care one year after implementation.
  • Study II - Use: Explore user characteristics and use patterns associated with the use of different components of a web-based self-management support system, called WebChoice, for patients with cancer.
  • Studie III - Effectiveness:Test and compare, in a randomized controlled trial (RCT), the effects of (a) a stand-alone secure e-mail service, (b) the secure e-mail service with additional features of WebChoice, a multi component system, and (c) usual care on: symptom distress, anxiety, depression and self-efficacy.


This study used a multi-method approach, employing both qualitative and quantitative methods including interviews with nurses, secondary analyses of longitudinal data and a randomized controlled trial with patient reported outcomes. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used as the conceptual framework in this dissertation.

  • Study I had a qualitative design, in which 20 nurses participated in focus group discussions about their experiences of using Choice in regular care. Analyses were performed using content analysis.
  • Study II used secondary analysis of user characteristics and user patterns of 162 patients with breast or prostate cancer who had 12 months access to WebChoice in a previous RCT. Analyses were performed using logistic regression and latent class analysis.
  • Study III entailed a three-group randomized controlled trial in which 167 breast cancer patients recruited from three hospitals in Norway and were randomized to a nurse-administered secure e-mail service, or to the Web-based self-management support system WebChoice (which included the secure e-mail service) or to usual care. Analyses of primary and secondary study outcomes were performed using linear mixed models.


The study shows that a Web-based self-management system can be an important contributor in providing health care for breast cancer patients in terms of reducing symptom distress, anxiety and depression scores. A secure e-mail component alone contributed to reduced depression scores, which indicates that secure e-mail is an important part of multi-component systems and can also effectively be offered as a stand-alone service. This is promising, as depression is highly prevalent and debilitating among cancer patients. An e-mail service is much easier to develop and to implement widely than more complex multi-component solutions. Despite the concerns identified in the literature regarding health care providers being flooded by messages, only modest use was observed in these studies, indicating e-mail as manageable to integrate in routine care.

Further, this study revealed that different user characteristics are associated with different use patterns of Web-based self-management support systems. Secure e-mail and self-management advice were highly accessed components among patients with low levels of social support combined with high illness burden, suggesting that patients with these characteristics may find such tools particularly useful. This information is important in order to target Web-based support systems to different patient groups.

Finally, the results suggest that, from nurses’ perspectives, integration of an interactive tailored assessment tool in clinical practice offers many benefits for communication and enhancement of patient-centered care. However, to reap these benefits, use of such tools must receive equal priority to other routines and require sufficient time and competence.


Børøsund E, Cvancarova M. Moore SM, Ekstedt M, Ruland CM (2014) Comparing Effects in Regular Practice of E-Communication and Web-Based Self-Management Support Among Breast Cancer Patients: Preliminary Results From a Randomized Controlled Trial. J Med Internet Res 16(12); e295

Børøsund E, Ruland CM, Moore SM, Ekstedt M (2014). Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation. International Journal of Medical Informatics 83 (7), e23-e34

Børøsund E, Cvancarova M, Ekstedt M, Moore SM, Ruland CM (2013).How user characteristics affect use patterns in web-based illness management support for patients with breast and prostate cancer. J Med Internet Res. 15(3); e34.

Børøsund E, Ruland CM, Moore SM, Ekstedt M (2013).Patient-centered care challenges nurses’ professional role. Experiences of using an interactive tailored patient assessment tool in clinical practice. The 10th Nordic Conference on Advances in Health Care Sciences Research, November 13-14, Lund, Sweden.

Børøsund E, Cvancarova M, Ruland CM (2013). Using latent class analysis to explore how user characteristics affect patterns of use of a Web-Based Illness Management Support System. 34th Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine, March 20-23, San Francisco, CA.

Børøsund E, Moore SM, Ruland CM (2012). Relationships Between Patient Characteristics and the Use of an Internet-based Self-management Support System. 33rd Annual Meeting, Society of behavioral Medicine, April 11-14, 2012 New Orleans, LA. Abstract # D120, Annals of Behavioral Medicine, Vol 43, supplement 1, 2012.



  • University Hospital of North Norway (Thumbnail)
    University Hospital of North Norway
  • Sørlandet Hospital Kristiansand (Thumbnail)
    Sørlandet Hospital Kristiansand
  • Hospital in Vestfold (Thumbnail)
    Hospital in Vestfold
  • The Norwegian Health Economics Administration (HELFO) (Thumbnail)
    The Norwegian Health Economics Administration (HELFO)