Patterns of Usage of Internet Resources by Persons with Post-Coronary Arterial Bypass Graft (CABG) Kamisha Hamilton, Michelle Rogers, Anita Ground, RN, David H. Gustafson, PhD, Dr. Patricia Flatley Brennan, RN, PhD, FAAN University of Wisconsin, Madison, WI, USA Abstract The purpose of this study is to describe the patterns of usage of defined Internet resources by persons following coronary arterial bypass graft surgery. Two different methods of measuring usage were primarily employed: counts of accesses and persistence of activity during the study. Duration of accesses was also considered in describing system usage. The patterns of usage were visually inspected and categorized according to the three different measurement methods. Four patterns were identified. We illustrate three of the four patterns by describing usage by three participants. This study is shown to be relevant to clinical care by demonstrating the possible impact patterns of the Internet in clinically patient- focused interventional studies. The HeartCare System  Designed to help with in-hospital discharge planning, post-hospital self-monitoring, and home management necessary for recovery among patients who have undergone CABG surgery  Fifty four participants received the system in their homes for an 180 day study  HeartCare Components:  Information Resource: Nearly 500 total webpages (either designed by the research team or on existing health information websites)  to nurse and other participants  Online Forum for group discussion between patients  Patients accessed HeartCare via a WebTV TM device (with modem access to the Internet) on a 19” television screen Description of the Participants  Gender: 81.5% Male 18.5% Female  Race: 87% Caucasian 13% African-American  Mean Age: 62.9; Range: 38 – 82 Years Materials and Methods  The 4-S Framework is used as a guideline for characterizing computer network use  Four perspectives of computer network use: system level, service level, session level and subject level.  Aspects of subject level use include number, timing, nature, and reasons of accesses  Quantitative information on system use such as the date and time when accesses occurred, duration of access, and services accessed (e.g. information, forum, ) was documented  Users were grouped according to frequency and endurance of accesses Subject and Session Level Use  System use ranged widely across participants; usage ranged from no usage by one participant to over 400 system accesses during the 180 day period  Low – system use through the first 90 days on 10 or fewer occasions  Moderate – system use through the first 90 days on more than 10 occasions  Intermittent – system use with large intervals between accesses  High – typically daily access Participant A  African-American male, 58 years old with an inactive lifestlye, 11 years of education  Married, with one dependent and an annual income less than $20,000  No computer or Internet experience, no access to a computer with Internet capability  14 total accesses to the system; stopped at Day 19  Used function during two sessions; forum during 9 sessions  Mean access length: 14 minutes, with longest session being 48 minutes  Viewed 12 different web pages over 4 different sessions  Low User Participant B  Caucasian male, 72 years old with an inactive lifestyle, 7 years of education  Widowed, with two dependents and an annual income less than $20,000  42 total accesses to the system; stopped at Day 90  No computer or Internet experience, no access to a computer with Internet capability  Used almost every access to the system; no accesses to the forum or webpages  Mean access length: 6.17 minutes, with longest session being 115 minutes.  Over 85% of accesses were under one minute  Moderate User Participant C  African-American male, 79 years old with a fairly inactive lifestyle, 14 years of education  Married, with one dependent and an annual income between $40,000 and $50,000  Has computer experience, no experience with the Internet, but has had access to a computer with Internet capability  102 total accesses to the system; stopped at Day 156  Did not use either or forum in the entire study period, rather, exclusively viewed webpages  Mean length: minutes; maximum duration: minutes  Accessed 32 different webpages, viewing the “FAQ feeling tired” page most often  Intermittent User Discussion  The nature of the HeartCare resource allowed users to personalize their use behavior  Users on the whole accessed the system most heavily in the first week, thus it is likely that HeartCare aids most significantly in the early stages of recovery  and forum use decreased throughout the study, suggesting that as recovery progresses, the need for electronic communication decreases  The social aspects of computer-mediated communication may have an effect on how participants used the HeartCare system  Multiple measures of use are required to effectively characterize user behavior  Studying how patients use an Internet system is critical in designing future similar patient-centered home management systems The HeartCare study is supported by a grant from the National Library of Medicine and the National Institute of Nursing Research, NLM/NINR Grant RO1-LM Acknowledgements: UW-Madison GERS (Graduate Engineering Research Scholars) Program and the Department of Industrial Engineering for funding for the Medinfo2001 Conference. Additional thanks to Dr. Patricia F. Brennan for encouragement and funding support. System and Service Use by Time Period Average time spent on system per user per day