With the aging population and changing lifestyles, the prevalence of chronic diseases such as diabetes, heart diseases and chronic lung diseases is increasing [1]. This results in greater demands for health care services and improvements in effectiveness and efficiency, and thereby in a rapid increase in costs of health care. Given these developments, it is becoming more challenging to deliver health care according to these increasing demands and an efficient health care organization is needed [2].
A promising solution to this problem that is advocated by European governments and industries might be eHealth [2], [3]. eHealth is the use of information and communication technologies (ICT) to support health and the health care system [4], also referred to as telehealth or telemedicine [5]. It includes a wide range of initiatives and applications, e.g. electronic health records, electronic consultations with care givers, monitoring from a distance and online contact with other patients [6].
The expectations of eHealth are high. It has been mentioned as a solution for the shortage of health care professionals as eHealth has the potential to increase self-management and empowerment of patients, for example by giving patients insight into their own health condition, enabling them to make informed choices and engaging them in self-care activities, and thereby diminishing the need for face to face contact with the health care professionals [7]. eHealth is also expected to improve the quality of care, increasing patient safety and improve continuity of care [2]. The European Commission has unveiled an Action Plan on eHealth in 2012, which aims to improve healthcare for the benefit of patients, give patients more control of their care and bring down costs [8].
However, the benefits of eHealth have not been fully proven yet, which leads to significant discussion around this topic. Evidence on the effectiveness of eHealth is limited and heterogeneous. Interventions that are performed around eHealth differ widely in population, type of intervention and outcomes measured [9], [10], [11].
A group in which eHealth could have a beneficial effect is patients with a chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD). Self-management could play an important role in controlling chronic lung diseases (i.e. prevention of further health deterioration and acute attacks of dyspnea) [12], and therefore the utilization of eHealth is of great interest [11]. Although inconclusive, literature suggests that eHealth (e.g. health care at a distance, home telemonitoring, telephone support) has the capacity to reduce exacerbations and rates of hospitalization and has a positive effect on the quality of life in chronic lung disease patients [13], [14], [15].
While the interest in eHealth is growing, the implementation of eHealth is no common practice yet [5]. Initiatives for eHealth applications are mainly regional and collaboration between regions is necessary to reach national coverage [16]. In the Netherlands, upscaling the implementation of eHealth by joint actions is highly advocated by the national government [17]. The National Implementation Agenda (NIA) has been developed as a collaboration of care givers, care takers and health insurances in 2011. Their activities are focused on creating more awareness of the possibilities of eHealth, increasing the use of eHealth applications and promoting further research and development around eHealth [18]. In concordance with NIA, an action plan for eHealth implementation research has been developed to accelerate implementation and wide application of eHealth innovations in daily health care [19].
A crucial factor for successful implementation of eHealth is a positive attitude toward eHealth of its intended users, e.g. the patients. Currently, there is no clear understanding of what patients know about eHealth and what their attitude about its use is. This study is conducted to gain insight into the level of knowledge and experience of patients with chronic lung diseases with eHealth applications as well as their general attitude toward the use of these applications in the daily care for their lung disease. Understanding these aspects may be helpful to further implement eHealth applications and to target eHealth interventions more specifically to subgroups of chronic lung disease patients given their knowledge, former experiences and attitudes toward eHealth.