In the paper “Internet Interventions for Long-Term Conditions: Patient and Caregiver Quality Criteria,” [
The authors attempt to put forward “quality criteria” for Internet interventions based on 10 focus groups with a total of 40 participants. They were given time to examine the sites and then provide feedback. However, it appears that the list of “Internet interventions” were mostly patient education web sites and not what most in the field of Internet intervention research would consider Internet interventions [
Perhaps it is the term “Internet intervention” that is problematic, as one could regard an interactive patient education web site to be an intervention. “Internet intervention” could be considered an umbrella term that encompasses various types of web programs, including behaviorally-based and empirically validated web-based treatment programs as well as patient education sites. However, currently, it is our belief that the term “Internet intervention” is not typically used as a generic phrase, but as the specific expression for what is described above. At present, the lack of formal terms to define these various web sites and web programs may be confusing to those not familiar with this area. However, with the significant use of the Internet for health purposes [
Interestingly, in the introduction to the paper, the authors describe and cite Internet intervention research that fits the more specific definition above. In fact, two of the authors wrote a paper for the Cochrane review in 2005 evaluating this literature [
In this paper, the authors also inquired about and reported what “good Internet interventions” should contain or be (i.e., “A good Internet intervention will provide information about the following…”). These global statements are also flawed and misleading. First, they are again based on participants’ viewing of patient education web sites (and not real Internet interventions). Second, it is unclear how the authors determined which criterion were important. Was there a threshold for determining that a criterion was worthy of follow-up examination in the respondent validation survey (e.g., 50% of participants mentioned it)? Third, it is difficult, and sometimes meaningless, to try to generalize across interventions/disorders. Interventions can (and should) be significantly different from program to program given the focused disorder. For example, we would not expect a program targeting diabetes to contain the same ingredients as a program targeting insomnia. Fourth, to say “a good Internet intervention will provide information about ‘medication’ or ‘available treatments in the UK and elsewhere’” is much too general a statement to be made. Instead, offering some of the bulleted items as issues for consideration would be more appropriate. Some useful, though-provoking information was obtained by the focus group members, and researchers, clinicians, and developers in the field of Internet interventions could learn from this contribution. However, the provision of the information as currently presented is at times misleading and the conclusions drawn are inaccurate.
This paper does raise the important point that there is a need for an authoritative body to provide information about, and possibly rate the quality of, Internet interventions. This should include not only patient and caregiver criteria, but empirically validated outcome studies demonstrating effectiveness. We hope the current paper and subsequent discussion will help provide the impetus to push this critical agenda forward. Similarly, there is an obvious need to better define what Internet interventions are and how to differentiate among various kinds of health-focused web sites. As we move forward in this young field, we must clarify how we communicate about these interventions to ensure productive exchanges and sound science behind our work.