There has been relatively little research on the role that web-based support for self-management might play in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. It is well known that patients already self-care for the vast majority of minor symptoms, making their own decisions about whether and how to manage symptoms themselves (eg, using over-the-counter remedies) or whether to seek medical advice [1
]. Nevertheless, over half the population in the United Kingdom consult their doctor each year for a minor symptom, and acute respiratory symptoms (eg, cough, sore throat) are the most common cause of consultation [2
]. Only a tiny minority of the general public use the Internet for routine health care activities such as contacting their own doctor [4
There are compelling reasons for finding ways to use the Internet to support patients to self-manage minor symptoms. Most people say that they would find it convenient and empowering to be given enough information to be able to self-manage without seeing their doctor [5
]. Policy makers and clinicians are concerned that unnecessary consultations are an inefficient use of scarce health care resources [8
]. However, there are also significant barriers to using the Internet for self-care. Both patients and doctors are concerned about the quality of information provided, and whether patients have the necessary skills and confidence to evaluate and manage their symptoms [3
Prior to the advent of mass Internet access, patient education about self-management of minor symptoms was attempted by means of booklets and other media with some degree of success [13
], although effects on consultation rates were typically very modest. A plausible advantage of using the Internet as a means of providing advice about self-management is that it can be tailored to symptoms, and should therefore be, and be perceived as, more personally relevant and hence accurate [17
]. Qualitative evaluations of websites that provide tailored information for self-diagnosis and self-management of symptoms [18
] suggest that they are seen as a useful complement to medical advice, but that it can be difficult to provide patients with advice that is sufficiently personalized, accessible, and detailed to replace consultation. However, the assumption that tailoring advice to the individual’s symptoms will improve patient satisfaction and outcomes has not yet been experimentally tested in the context of web-based advice for self-management of common symptoms.
Previous studies of providing information on self-management of symptoms have been largely pragmatic, focusing simply on whether providing educational materials leads to better outcomes than routine care. For example, an observational study of providing a student population with online digital triage advice on whether they needed to seek medical care for minor symptoms was able to demonstrate satisfactory uptake and excellent concordance between the online advice and clinical diagnoses [20
]. However, if Internet-delivered care is to become a widely accepted and well-integrated part of efficient routine health care, then we need to understand better how and why it might be welcomed and used effectively [14
]. Theory-based psychological explanations of how people decide whether they can self-manage symptoms may help us to understand how interventions can be designed to better support self-care.
According to the Social Cognitive Theory, performance of any behavior is typically predicted by confidence that one can carry out the behavior successfully (self-efficacy) and beliefs about the likely consequences (“outcome expectancies”) [21
]. Thus, advice on how to self-manage symptoms and evidence that the advice has worked for others should improve confidence in the ability to self-care, while reassurance that symptoms are not indicative of serious illness requiring medical care should reduce beliefs that consultation is necessary for recovery. In addition, the Common Sense Model of Self-regulation of health and illness [24
] highlights perceptions of illness that are likely to affect self-management of symptoms, such as whether the symptoms cause emotional reactions or are not well understood [25
]; providing information about these aspects of symptoms may provide reassurance and reduce the need to consult the doctor. Finally, the Theory of Planned Behavior [26
] proposes that the effects of beliefs on behavior are mediated by conscious intentions. A small observational study confirmed that intention to comply with the advice provided by a web-based system providing tailored advice for common symptoms was a strong predictor of reported compliance with the advice 3 months later [27
This study forms part of a program of research into how theory and evidence can be used to design an intervention that will help patients to self-manage minor respiratory symptoms without seeking medical help. In accordance with best practice in the development of complex interventions [28
], it was designed as an exploratory or phase 2 randomized controlled trial (RCT) that would provide an initial evaluation of the usage and effects of the “Internet Doctor” website. The first aim of the study was to evaluate the effects of using the Internet Doctor webpages on the target outcomes for the main trial, namely patient “enablement” [29
] (ie, perceived ability to self-manage health and illness) and use of health services (ie, contacting the doctor or other health care services). The control condition was a webpage consisting of advice previously shown to be effective in reducing consultations and improving patient confidence to self-care [9
]. This design provides a direct test of whether tailored, theory-based advice is more effective than the best existing information and advice. The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in consultation intentions and in relevant beliefs and illness perceptions in the intervention and control groups, and levels of satisfaction with the website advice. The third aim was to examine whether outcomes were predicted, as expected, by beliefs about self-care and illness perceptions, and use of our theory-based advice. This was addressed by analyzing usage of the Internet Doctor webpages and predictors of change in consultation intentions.