Article

Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions

Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
Journal of Medical Internet Research (Impact Factor: 4.67). 03/2011; 13(1):e30. DOI: 10.2196/jmir.1602
Source: PubMed

ABSTRACT The effectiveness of and adherence to eHealth interventions is enhanced by human support. However, human support has largely not been manualized and has usually not been guided by clear models. The objective of this paper is to develop a clear theoretical model, based on relevant empirical literature, that can guide research into human support components of eHealth interventions. A review of the literature revealed little relevant information from clinical sciences. Applicable literature was drawn primarily from organizational psychology, motivation theory, and computer-mediated communication (CMC) research. We have developed a model, referred to as "Supportive Accountability." We argue that human support increases adherence through accountability to a coach who is seen as trustworthy, benevolent, and having expertise. Accountability should involve clear, process-oriented expectations that the patient is involved in determining. Reciprocity in the relationship, through which the patient derives clear benefits, should be explicit. The effect of accountability may be moderated by patient motivation. The more intrinsically motivated patients are, the less support they likely require. The process of support is also mediated by the communications medium (eg, telephone, instant messaging, email). Different communications media each have their own potential benefits and disadvantages. We discuss the specific components of accountability, motivation, and CMC medium in detail. The proposed model is a first step toward understanding how human support enhances adherence to eHealth interventions. Each component of the proposed model is a testable hypothesis. As we develop viable human support models, these should be manualized to facilitate dissemination.

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Available from: David C. Mohr, Aug 05, 2015
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    • "MedLink has been designed to address each of the components in Figure 1. Communication with the physician was guided by our Supportive Accountability model [15], which indicates that patients are more likely to engage in behaviors if they know that a provider is receiving information about that behavior, and that they are likely to discuss that information at some point in the future. MedLink design was also informed by Wagner's Chronic Care Model, which has received considerable empirical support [16]. "
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    • "Supportive accountability is a theoretical model that argues that adherence and engagement is promoted through human support through three aspects: the bond between the user and supporting individual, sense of accountability, and the user's perception of the supporting individual as possessing legitimacy and expertise[8]. This sense of accountability can be strengthened through several aspects including social presence, expectations, and performance monitoring. "
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    • "The myPace technology was developed out of research into the methods and strategies dietitians routinely use in their practice and, therefore, built to match practical dietetic experience. The technology was also designed to embody the key facets of the SAF [7]. The concepts advocated in this framework overlapped, broadly, with the kinds of approaches and strategies dietitians used in their routine practice and, importantly, identified human support as a significant contributor in e-health interventions. "
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