Why are health care interventions delivered over the internet? A systematic review of the published literature

Background: As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions. Objective: The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research. Methods: We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized. Results: We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery. Conclusions: One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery? © Griffiths, Frances, Lindenmeyer, Antje, Powell, John, Thorogood, Margaret.

Submission for the degree of Doctor of Philosophy by published work at Aston University

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From postgraduate student to published writer:discourse variation and development in TESOL

This thesis is part of a project whose overall aim is to assist participants on an MSc TESOL course who wish to begin to publish articles in the field to do so. The project, which is undertaken within a naturalistic paradigm, has two intimately related and mutually constitutive strands: one descriptive, one interventionist. The descriptive strand consists of an analytical model of the TESOL article genre, and it is instantiated in this thesis. The interventionist strand consists of a series of pedagogic interactions and materials intended to assist project participants formulate a text suitable for publication within the target genre, and it is reported on in this thesis. I begin the thesis by looking in detail at the research approach which characterises the project. I then attempt to explain the situational context of the work and to position it within the context of other research in the areas of discourse community membership, academic genres, genre learning and academic enculturation. Having thus contextualised the work, I next attempt a detailed exploration of the problems of postgraduate students in TESOL when first attempting to write in the TESOL article genre: this exploration is undertaken from both a linguistic and a pedagogic perspective. Then in subsequent chapters, both a linguistic and a pedagogic response to these problems are proposed: the first consisting of an analytical model of the target genre, the second consisting of a series of pedagogic interactions and materials. The relationships between the two lines of response are also examined in some detail. Then in the final part of the thesis, I report feedback from the interventionist strand and attempt to conduct an evaluation of the whole project to date. Criteria for evaluation are proposed and examined in some detail in the context of the research approach of the project. The concluding chapter is a brief discussion of future directions for this work.