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 [
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 [
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 [