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【研究紹介】Development of a user-centered health information service system for depressive symptom management

国際看護学研究室　So woo Lee

Aim
　　A user-centered,Web-based depressive symptoms management system might be particularly useful in Korea,where those who seek mental health care face stigmatism and where personal computers and the Internethave reached saturation levels. The purpose of this article is to describe the development process of aWeb-based system for depressive symptom management through user-centered design principles.

Figure 1. User-centered model for research design.

Research design and Methods
　　Our designprocess included four distinct phases: a needs assessment, analysis, design/development/testing, and the applicationrelease. The final revised website was released with the URL address, “http://www.baejy.com/smiles/”.

Results
　In the 3 years since the site was made available publicly, it is notable that 161 604 Koreans have accessed thiswebsite, either for educational purposes or for managing their depressive symptoms (table 1, table 2).　A Web-based depressivesymptommanagement system with a high degree of usability was developed.This website can be used to assessdepressive symptoms and to serve as an intervention strategy to improve mental health.n

DISCUSSION AND CONCLUSIONS

　　This study has reported the development and implementation of a Web-based intervention to manage depressive symptoms. One outcome of this work was a user-centered design for increasing the effective participation of the general population, including those with low computer skills, in Internet-mediated, health-care programs. With the application of user-centered design principles, this site was designed to be culturally sensitive to its target population, thereby forming healthier assessments and presenting more accurate findings. This intervention is especially important as it is the first interactive website to assess the level of depression and to provide comprehensive information about depressive symptom management in Korea. Furthermore, most educational materials, such as books and videotapes, are limited in their scope for direct intervention and suffer from the potential stigmatization of the users when they are trying to access the content.
    Although no Web-based depression management system can completely replace the richness of the interaction between health providers and patients, the capacity to assess and report back information about mental health might empower the self-management or utilization of external resources. The growth of the Internet and online health seekers will continue to accelerate in Korea. These findings suggest that future, Internet-based, mental health interventions have a real potential to help Koreans who are suffering, or who are at risk of, depressive symptoms, particularly because of the stigma related to psychiatric therapy in Korea. In the 3 years since the site was made available publicly, 161 604 Koreans have used this website, either for educational purposes or to help manage their depressive symptoms.
    This Web intervention could be employed for the assessment of depressive symptoms and as an intervention strategy for not only depressed people, but also for various other groups, such as community mental health practitioners. For example, this system enables nurses to screen those people with depressive symptoms among the general population as a primary prevention mechanism against depression. In addition, the Web users who access the site and are assessed with high levels of depression are offered counseling services by the principal author, who is a psychiatric nursing professor and practitioner, via the discussion board or email features. If clients’ depression levels remain severe and unimproved after counseling, they are referred then to psychiatric institutions for further treatment.
    Not only does this scheme provide information and intervention to end users, it also offers links to appropriate institutions for further medical assistance, thereby aiding health-care practitioners in supplying proper mental health care to the public.
    However, it is important to note that this intervention does not promise a total cure for depression, but acts as a medium to assess the severity of the depressive symptoms and to provide alternative, self-help, evidence-based interventions for its end users, that is, the general population.

The Internet site created by this research will continue to run in Korea as an open website for anyone who wants to make use of it. The second phase of this project includes an evaluation of the program. The principal investigator is planning to examine the effects of this program in changing depression scores in 2009. Greater efforts are required to explore these emerging technologies as we seek to reduce the burden of depression and to promote mental health.

Co-researchers;
Jeongyee Bae, RN, PhD¹ ,Seth Wolpin, RN, PhD²,Eunjung Kim, RN, PhD²,Sookhee Yoon, RN, PhD¹ ,and Kyungeh An, RN, PhD⁴Department of Nursing, Inje University, Busan, Korea, ²School of Nursing, University of Washington, Seattle,Washington,⁴School of Nursing, University of Texas Medical Branch, Galveston, Texas, USA

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