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Developing Websites for eHealth Interventions

Posted on October 22, 2014

Yelena Wu (bio) and Ric Steele (bio) provide tips for successful online program implementation and address common problems.


Q: I have developed an intervention that I'd like to implement online. How do I find and hire web developers for this project?
A: There are several options that one can pursue when moving an intervention into an online format, such as on the web. Often, cost will make some options more attractive and feasible than others. We therefore recommend that eHealth developers first gather a list of resources available, including direct funding (e.g., from grants), institutional supports (e.g., information technology and design departments), and other local resources (e.g., university departments focused on web development). In our own experience, using a combination of resources was useful. For example, we obtained grant funding from a local health foundation and then worked with our institution's information technology staff to develop the web platform. A next step is to find programmers or web developers who could be good collaborators for the project. These collaborators could be freelancers, those working with a larger company, or those within a university, hospital, or technology department. It can often be more cost effective to work with individuals within your particular setting (e.g., within the university if you are a researcher in an academic setting) and/or to include student workers as collaborators. However, cost-effectiveness of various options should also be balanced with the web developer's prior experience with similar projects and information one can gather on their past work (e.g., from references).

There are several organizations and services that can facilitate the dissemination of new online products. For example, 3C Institute's Centervention is a web-based product that helps disseminate evidence-based programs with online provider training, real-time progress monitoring, fidelity monitoring, and outcomes tracking. Similarly, the University of Virginia's Research Infrastructure Containing E-Interventions (RICE) [licensed to BeHealth Solutions, LLC as BeStudy Manager™] is a web-based tool that enables the delivery of eHealth interventions alongside essential research tools, such as administering study questionnaires.
Q: What are some common challenges I might encounter during the web development process and how can I address them?
A: The web development process is lengthy, and more time than one expects. This process can include regular and frequent contact with web developers and ongoing pilot testing to ensure the usability of the eHealth intervention. Typically, web developers will take the lead on making changes to the eHealth intervention, so there can be a lag time between when problems are identified, fixed, and then testing can resume. In our experience, establishing up-front with web developers an estimated timetable and preferred methods and frequency of contact can facilitate productive interactions for all parties.
Q: How do I find financial support for server time, technical support, and website maintenance once the grant period is over?
A: Depending on the mechanism, a sustainability plan (or marketing plan) may be necessary to obtain the initial funds to develop the website. For example, without a strong marketing/commercialization plan, SBIR/STTR applications to the NIH will likely go unfunded. Similarly, private investment in the development of an eHealth application is likely to require a solid business plan for sustainability. Many universities and academic medical centers will have an Office of Technology Transfer or an Office of Research Commercialization. In addition to assisting with the identification of initial funding for the project, these offices are frequently equipped to assist with marketing and/or business plans as well as with legal aspects of the project (e.g., ownership, royalties, licensing).

Even if not required by the initial funding source, a solid business and marketing plan is key to the successful development of an eHealth application. Without this, even the best eHealth applications will fall into disrepair after the initial build. Thus, it is imperative to consider long-term financing very early in the development process. This often means commercialization of the product (i.e., sale of licenses, individual use fees, subscriptions). Alternatively, some developers might consider transferring ownership of the product to an organization that can provide the needed support (e.g., an online Continuing Education group). Arrangements can be made that will allow the researcher to continue to have access to the technology (for further research and development) while ongoing support is covered by the business entity, who generally realizes a profit from the administration of the product.
Q: How can I keep my eHealth intervention current amid evolving technologies?
A: In many regards, the methods of keeping eHealth interventions current are the same as those used to keep behavioral interventions current. Following their initial development and testing, many behavioral health interventions are further investigated to determine the ideal/optimal dose, setting, or intensity. For example, behavioral or cognitive behavioral interventions for anxiety, depression, and anger are frequently tested against "shorter" or "longer" versions (dose), with updated materials (intensity), or in new populations. Similarly, an eHealth intervention that is part of an active research agenda may continue to be developed over the course of the researcher's career. In a very real sense, any intervention (eHealth or not) should remain "in development" to remain current.

However, because of the rapid evolution of eTechnologies (new platforms, new devices), a current intervention that does not "make the jump" to a new or emerging operating system or device may lose market share or fade into oblivion. One of the technology companies that we work with recommends an initial build on one platform (e.g., Appleâ„¢ or Androidâ„¢), followed soon by translation of the intervention to additional platforms. With more initial capital (sometimes significantly more capital), developers may be in a position to market a product on multiple platforms simultaneously. This usually is associated with greater risk (more up-front costs with no guarantee of success). The topic of subsequent builds of an intervention and expansion of the intervention to new platforms should be discussed among the research team, particularly if the team is contracting with a technology company for the technical build.




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