Published on in Vol 8, No 3 (2006):

Internet Interventions or Patient Education Web Sites? – Author's Reply

Internet Interventions or Patient Education Web Sites? – Author's Reply

Internet Interventions or Patient Education Web Sites? – Author's Reply


1Department of Primary Care and Population Sciences, London, United Kingdom

2The Hepatitis C Trust, London, United Kingdom

Corresponding Author:

Cicely Kerr, MSc

E-health Unit, Department of Primary Care and Population Sciences

University College London

Archway Campus

Highgate Hill

London, N19 5LW

United Kingdom

Phone: +44 20 7288 3474

Fax:+44 20 7281 8004


Related ArticlesComment on: Ritterband LM, Thorndike F. Internet interventions or patient education websites? J Med Internet Res. 2006;8(3) p. e18
Comment on: Kerr C, Murray E, Stevenson F, Gore C, Nazareth I. Internet interventions for long-term conditions: Patient and caregiver quality criteria. J Med Internet Res. 2006;8(3) p. e13
J Med Internet Res 2006;8(3):e19


We agree with Ritterband and Thorndike that the terminology and definitions in this field are confusing, and should be clarified and standardized. We would be happy to work with them and others on such a project.

However, they are mistaken in their belief that the interventions used in our study were mostly patient education websites [1]. The interventions were carefully selected to fulfil the criteria for Interactive Health Communication Applications (IHCAs); namely that they were computer-based programs that combined health information with at least one interactive component, such as decision support, behavior change support or peer support. For example, contains interactive self-assessment tools, as a support for behavior change, as well as online peer support, in the form of both personal stories and online chat groups. Similarly, contains interactive tools and online peer support, in the form of an e-mail "buddy" arrangement.

This definition of an IHCA was provided in the paper, as were the criteria for choice of IHCA used in this study. As IHCA is a somewhat clumsy term, we preferred to use the more intuitive term “Internet interventions” to refer to web-based IHCAs.

The other major point raised by Ritterband and Thorndike refers to our chosen methodology. It is the nature of qualitative research to work in-depth with small samples. We believe the combination of a qualitative research design allowing participating patients and caregivers to generate and define criteria, followed by a further validation exercise allowing them to check we have identified important criteria, is a particular methodological strength [2-3]. We did not set out to produce a list of generic criteria and in our analysis we were alert to the likelihood that patients and caregivers managing different chronic conditions would have different quality criteria. Instead, however, it was striking how similar needs and quality criteria were across groups.

This is the basis for the generic quality criteria described in the paper and we question Ritterband and Thorndike’s assertion that an intervention for people with diabetes would self-evidently be completely different to one for insomnia. Our work concentrates on people with long-term conditions. Lorig has proposed that people with long-term conditions face three tasks (medical management, emotional management and role management) irrespective of the type of condition. These tasks require specific skills, such as problem solving, decision-making, finding and utilizing resources, forming partnerships with health professionals and taking action. Lorig postulates that enhancing self-efficacy, (i.e. a person’s belief in their capacity to carry out a specific action) is key to enhancing self-care skills [4]. Based on this theory, interventions designed to enhance self-care skills in people with long-term conditions should target these skills and aim to enhance self-efficacy. The specific content of an intervention will differ according to the condition targeted, but the theoretical basis, and hence the core components (e.g. tailored information, decision-support, action planning, emotional support) may well be similar.

  1. Kerr C, Murray E, Stevenson F, Gore C, Nazareth I. Internet interventions for long-term conditions: patient and caregiver quality criteria. J Med Internet Res 2006;8(3):e13 [FREE Full text] [Medline] [CrossRef]
  2. Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ 2000 Jan 1;320(7226):50-52 [FREE Full text] [Medline] [CrossRef]
  3. Mays N, Pope C. Rigour and qualitative research. BMJ 1995 Jul 8;311(6997):109-112 [FREE Full text] [Medline]
  4. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003 Aug;26(1):1-7. [Medline] [CrossRef]

Edited by G Eysenbach; This is a non–peer-reviewed article. submitted 07.08.06; published 29.09.06


© Cicely Kerr, Elizabeth Murray, Fiona Stevenson, Charles Gore, Irwin Nazareth.Originally published in the Journal of Medical Internet Research (, 29.09.2006. Except where otherwise noted, articles published in the Journal of Medical Internet Research are distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, including full bibliographic details and the URL (see "please cite as" above), and this statement is included.