Week 5: An e-Health solution for people with alcohol problems

In this final blog post I decided to study the efficacy of Information and Communication Technologies (ICT) based interventions in the prevention of relapse among alcohol abused people. I wanted to find out if computers and mobiles are considerable options to prevent relapse. In this text I refer to Gustafson et al:s article “An e-Health solution for people with alcohol problems” 2011.

I am interested in how addictive behaviors are treated in patients’ homes. In my eyes addictive behaviors are a tabu in the society and therefore I believe that ICT-solutions can be a good option in addition to face-to-face- methods.

Gustafson et al. (pg. 328) refers to Cunningham et al:s (1999) research that demonstrated that computer-based interventions increases people’s acknowledgement of drug use comapared to face-to-face interviews. Computer-based solutions also reduce problem drinking (Murray et al. 2007, see Gustafson et al. gpg. 328).

Gustafson et al. (pg. 328) states that smartphones have not been a part of the treatment for so long and that results from studies about the use of smartphones in the treatment are not yet widely available. Some results however demonstartes positive results; Over 93% of alcohol-dependent people responded to calls and the comliance can be high (Searles et al. 2002, see Gustafson et al. pg 329).

There is an umbrella name for computer-based e-health systems; CHESS. The programs included in this center are designed to meet different target groups. The progrmas are available in smartphones, usually in both audio and text formats. A smartphone-based system for the prevention of relapse is called A-CHESS. This system focuses on three important constructs in the self-determination theory; coping competence, social support, autonomous motivation. The program encourages patients to work for the goals and adhere to the program. It also offers a GPS services and the possibility to locate the patient. The locationing is to initiate rescue services if a patient is around any places that can pose a risk for relapse.  (Gustafson et al. pg 329) This sounds to me a bit like getting too much into a patient’s privacy, but on the other hand, if the patient is highly motivated to the treatment, then I suppose this could work. I think that A-CHESS recognizes the autonomy of a patient. It is possible for the patients to select resources that they need at the moment and the system communicates information respectfully.

There are still  a lot to do to improve the ICT-based interventions. It is important to remember that the use of smartphones in health care is fairly unevaluated and thus might pose some complications that we aren’t fully aware of yet. (Gustafson pg. 334)




David H. Gustafson, Ph.D.; Michael G. Boyle, M.A.; Bret R. Shaw, Ph.D.; Andrew Isham, M.S.; Fiona McTavish, M.S.; Stephanie Richards; Christopher Schubert; Michael Levy, Ph.D.; and Kim Johnson, M.S. 2011, An e-Health solution for people with alcohol problems. Alcohol Research & Health. Vol. 33 Issue 4, p327-337. 9p. 1 Chart.



week 4

Week 4: eHealth today – introducing Terveyskylä

This time I’m going to introduce the web site Terveyskylä.fi.

Terveyskylä is an online site developed by health care professionals and users (patients). The aim for this site is to provide information, treatment and support for patients and their relatives as well as health care professionals. The site is good for getting information about own health status and to follow own personal health. The main purpose is not to cure people but to provide them with information needed for preventing diseases and being able to independently maintain a stable health. So far there are own web places for 13 different diseases/dysfunctions, for example asthma and rheumatism.

Terveyskylä is coordinated by HUS and the online service is a project where all the Finnish health care districts are involved. The service provides high standard information because it is developed by professionals and the information is always up to date and is based on results of academic research. Some of the pages provide only directive instructions and therefore the content in Terveyskylä can’t replace diagnosis made by a doctor or other health care professionals.

HUS patients can also register to “Omapolku” service where they can follow the progression of their treatment and get additional information on how to proceed. In Omapolku patients can also register the weekly activities prescribed by the responsible health care professional. People can sign in to Omapolku via personal online bancing account.

At first glance the site seemed very confusing with a lot of textboxes and information everywhere but I think that the idea behind Terveyskylä is good. However, there are still a lot to do in order to make the service better. In the future it will for exxample be possible to contact health care professionals online through Terveyskylä. The information available for each disease is also very concise. Yes, it is trustworthy but with a quick check I could find the same information from other reliable sources sources as well.

I like the idea that users are free to contribute to the development of Terveyskylä by sending their own ideas to the website. It gives the users a feeling of empowerment. Terveyskylä also works for equality by providing people an audiotape for all the written information.



week 3

Week 3; Ethics

The topic of this week is ethics in health care. I find this topic really interesting but also very complicated. The amount of stakeholders in the field of health care is big which means lot of different aspects, opinions and values to consider.

This time I want to reflect on a patient’s autonomy. It is one of the six ethical aspects in eHealth that Miesperä et al. (2013) found in their litterature review. To me autonomy is something that should be an obvious factor in health care. In Miesperä et al:s article they discussed the importance of autonomy especially in assistive technology among elderly people. They mention that some people might feel that their private life is threatened if they are monitored 24/7. In the article they also talk about the eventual risks that comes along with assistive technology; elderly people might become too dependent on the technology and uncapable to make own desicions and live an independent life and analyze risk factors etc in their own house.  I have an example from my personal life that illustrates this example. My grandmother is very old but still lives alone in her appartent and refuses to receive much help from home services etc. She doesn’t really trust the system and thinks that having for example her fallings monitored would not make a big difference and in the worst case she would just be taken away from her home to a service house. She rather relys on the help of relatives.

Refering to van Limburg (2013)the values in eHealth can be difficult to analyze because different stakeholders value different things. For example factors like cost, social interaction and the chosen treatment are valued differently depending on who is asked.  In for example home assistance for elderly people the quality of help depends a lot on the economic factors and what the most valuable aspects are. The helath care professionals that come to visit my grandmother don’t have a lot of time to stay at her place before they have to rush to the next place. I think that balancing between cost and time/quality is an everyday struggle in health care.


Miesperä, Anne, Ahonen, Sanna-Mari & Reponen, Jarmo. 2013. Ethical Quality in eHealth: A challenge with many facets.

van Limburg, Maarten. eHealth Business Modeling. 2013. In: J.E.W.C. van Gemert-Pijnen, O. Peters & H.C. Ossebaard. Improving eHealth.


week 2

week 2; Are the eHealth strategies realistic?

All the new implementations in eHealth comes with many issues that we need to take a serious look at. This post targets only a few of them and there are so many more facors to discuss.

In The eHealth and eSocial Strategy 2020 Räty et al. discuss the implementation of a nation-wide eHealth strategy. They mention the online platform of patient data that is available for health care professionals. and patients. Patient’s have the right to decide to what extent their data is stored there and the freedom to choose how, when and to what extent they want to take advantage of it all. This is empowerment, one of the factors that according to Eysenbach’s article defines eHealth. I believe that empowerment is something realistic to achieve. No doubt that having personal information circulating online comes along with safety issues. However, I want to believe that patients’ rights are something valuable and empowerment something people respect.

European Commission’s article mentions effective data protection as a vital factor for building trust as well as a key driver for a successfull cross-boarder development of eHealth. I believe that this safety issue might be one major reason why people don’t run straight into new interventions.

The idea of Human-Centered Design (HCD) approach is good and sure gives better results in many cases than technology -driven approach does (Niljand & Verhoeven 2013). The question is how good the implementation of stakeholders’ feedback in the actual product development is? Niljand and Verhoeven are talking about collecting data from users to evaluate the target group and be able to expand it. I’m sceptic about the effectiveness of this kind of methods. Many times the ones willing to participate in these kind of surveys are the ones already actively involved in the particular field of research. How is it possible to include passive users in these studies? By asking them to participate in a context outside eHealth?



European Commission. Page 9. eHealth Action Plan 2012-2020 – Innovative healthcare for the 21st century, Brussels, 6.12.2012 COM(2012) 736 final.

Eysenbach, G. 2001. What is e-health? Available: http://www.jmir.org/2001/2/e20/

Niljand, Nicol & Verhoeven, Fenne. 2013, Human-Centered Design in eHealth. In J.E.W.C. van Gemert-Pijnen; O. Peters; H.C. Ossebaard, Improving eHealth. 

Räty, Laura; Huovinen, Susanna & Haatainen, Tuula. INFORMATION TO SUPPORT WELL-BEING AND SERVICE RENEWAL eHEALTH AND eSOCIAL STRATEGY  2020, Ministry of social affairs and health, local and regional government Finland.