© Borgis - New Medicine 3/2010, s. 99-101
*Erzsébet Mák1, Márta Veresné Bálint1, Erzsébet Pálfi1, Istvánné Németh1, Adrienn Lichthammer1, Ferenc Fehér1, Balázs Gaál2, István Szabolcs1
Improving the quality of life of the population through the Internet by surveying demand for use of diet planning software
1Semmelweis University, Faculty of Health Sciences,
Dean: Dr. Judit Mészáros, PhD
Department of Dietetics and Nutrition Sciences
Head of Department: Dr. István Szabolcs, DSc
2Pannon University Information Systems Professorship
Dean: Dr. Kozmann György, associate professor
Objective.A preliminary survey of demand among non-infectious chronic patients for the development of diet planning software employing artificial intelligence was carried out. We would like this specialist system not only to serve the theoretical development of this scientific domain, but satisfy actual market demand in relation to the population's quality of life and health care services.
Material and method. In the framework of the applied research a cross-sectional survey was performed at specific intervals in the 2006-2009 period among non-infectious chronic patients (n=359) at clinics providing care for the participants. The questionnaire developed by us examined sociodemographic data, the software's method of use, required information content, proof of authenticity, duration of time available for use and the approximate amount payable for use of the program. Data were processed in the framework of descriptive statistics using frequency, mean value and dispersion calculation. The significance level of statistical procedures required for verification of the hypotheses was set at 5% in all cases.
Results. Hypotheses were analysed by sex, age, disease group and method of use. The majority of respondents were women; 221 women and 138 men gave replies. By age distribution the average age of men was 44.85 yrs (dispersion: 18.67); and that of women 42.13 yrs (dispersion: 16.54). Sex, age and selected method of use did not significantly influence use of the advisory system. However, the type of work and even more so the type of disease had a substantial influence on usage.
Conclusions. We obtained information that is useful from the point of view of health science, and for the development of IT software. We identified areas in the care of patients suffering from various civilization diseases that require greater emphasis to ensure their satisfaction. This way it is possible to create a system that is harmonized with the needs of those using the health care software.
Due to the rapid development of hardware and programming computers have become capable of solving tasks that could previously be coped with only by the human brain. There is x-ray image analysing and therapeutic advice software, and systems that monitor physiological parameters and signal the need for intervention, such as the intelligent toilet that solves this task by analysing faeces and urine.
Specialist systems can replace or assist specialists in analysing and solving large-scale and complex problems by relying on a knowledge base specific to a professional area, using artificial intelligence and taking into consideration the problem-solving process of human specialists. These can be used with the highest efficiency in fields where initial data can be described objectively, and a quick solution is expected for the task, but specialists are lacking in number. In health care such a field is dietetics, and as part of that individual diet planning. (1). A proper diet can be useful in preventing diseases, stopping or delaying the deterioration of one's condition, so it has a direct impact on the improvement of the quality of life of patients. Nowadays, complex dietetics advice is performed in the most comprehensive manner by dietetics specialists, but to some extent tasks are carried out by physicians, district nurses, qualified nurses and assistants as well. This is a necessity, because the number of dietitians employed is low compared to the number of patients. In Hungary there were 150 patients per single dietitian in 2002, 130 in 2005, 171 in 2007 and 143 in 2008. (2-4). The aforementioned rather saddening facts clearly indicate that the potential for individual advice is limited. The Internet provides an opportunity to remedy this situation.
According to the survey of EUROSTAT in 25 member states of the EU 52% of households had Internet access in the first quarter of 2006, as opposed to 48% in the corresponding period of 2005. According to this survey 47% of EU citizens use the Internet at least once a week (5).
In Hungary the vast majority of the population obtains information related to dietary advice through the Internet. Among the users of lifestyle portals 53 and 46% visit the two most popular sites (www.mindmegette.hu and www.hazipatika.com), respectively, but visitation of these sites is nearly 20% among all Internet users. Internet use by persons over 60 is increasing, and the majority of new users who access the Internet at least once a month are pensioners (6). In the USA the percentage of those searching for medical information on the Internet at least once a month has reached 25%. It is a fact to be accepted already now: such information will be used by patients for self-diagnosis and also self-treatment (7).
Laymen take their symptoms seriously or lightly depending on the degree to which they affect their everyday lives. They tend to normalize certain symptoms, and rationalize those according to their age, work or bad habits. (8). The self-treatment mechanism starts in parallel with or prior to turning to a physician. Under this we mean factors that provide patients with information about symptoms, diseases and therapy. Information sources can be: the direct surroundings, civil organizations advising laymen, and devices of mass communication: physicians' columns in magazines, medical advertisements on television, and sites on the Internet. (9).
The objective is to develop a diet planning dietetics system that could provide guidelines for a social group that is searching for help for the treatment of symptoms or a disease, or improvement of the quality of life on the Internet, outside the formal health care system. In order to ensure the satisfaction of users a questionnaire survey was carried out among those suffering from civilization diseases and stress-induced ailments, so we can develop the software in the form of use they desire the most.
Material and method
Applied research was used to survey the expectations of the software's target group. A cross-sectional survey was performed at clinics treating those concerned at specific dates from 2006 to 2009. Among those suffering from civilization diseases we were primarily interested in the needs of those who are at the top of morbidity and mortality statistics in Hungary, and influence the quality of life of individuals the most: the obese, cardiovascular patients, diabetics, cancer patients, those suffering from food allergies and coeliac disease. However, due to the lack of accurate data and lists we were unable to carry out sampling in a representative manner, so the results should be regarded as indicative. In spite of the above the information is rather useful, because we know about no such survey of data to date.
In the study it was a criterion for recruitment that the person in question visit the clinic and be at least 18 years of age. Each person was listed under the disease relevant to the specialized clinic, because at that point of time it was that condition that urged him/her to contact the health care system. Newly diagnosed patients were excluded from the study. This was done because the first shock reaction can have a great influence on the replies.
In addition to demographic data the questionnaire we developed focused on 6 criteria: method of use, required information content, proof of authenticity, duration of time available for use, duration acceptable for waiting for a reply, and the approximate amount payable for use of the program. Therefore in total 15 open and closed questions were used. The questionnaires were filled in individually and anonymously, subject to the permission of the heads of ambulatory clinics in question.
In the framework of descriptive statistics, frequency, mean value and dispersion calculations were performed. The statistical procedures necessary for verification of the hypotheses included generation of reliability domain, χ2-test, and double sample t-test. The significance level was set in advance at 5%. Data processing was done using SPSS for Windows version 15.00 and Microsoft Excel computer programs.
During the survey 359 questionnaires, filled in properly, were returned to the ambulatories. The majority of respondents were women: replies were received from 221 women and 138 men. According to the statistical calculations of age distribution the average age of men was 44.85 yrs (dispersion: 18.67); and that of women 42.13 yrs (dispersion: 16.54). For both sexes the youngest person examined was 18 years of age, the oldest male was 90 and the oldest female was 84, when they visited the cardiological clinic. The majority of persons examined are intellectual workers (n=209) or had performed such work in the past. It was surprising that nearly as many women (n=59) perform/performed physical work as men (n=56), and the proportion of women who were students (n=22) was higher than that of men (n=13).
According to our first hypothesis sex does not significantly influence demand for use of the software. This was verified by the results of the double sample t-test, because the only significant difference was observable in time spent on filling in (p=0.047), and it could be seen that women are willing to spend more time on filling in the detailed nutrition history than men. In spite of the above, we regarded the hypothesis set up by us as verified, because a substantial difference was observable in only one of the six issues.
According to our second hypothesis age significantly influences demand for use of the software. For this hypothesis test, and for ones to follow, statistical tests were carried out with χ2-test after cross-table analysis. It can be stated that age influences demand for form of use of the software to a lesser degree than envisaged. Only two of the six parameters inspected – selected form (p=0.001) and time for filling in (p=0.044) – showed significant differences when calculating with average age figures of disease groups. Such connections could not be verified in the four other cases.
On the basis of our third hypothesis we expected to receive proof that the type of work performed does not significantly influence demand for use of the software. This hypothesis was verified, because only time spent on and the type of work showed no significant difference, but there was a difference concerning the required form (p=0.024), willingness to pay (p=0.023) and authenticity (p=0.002).
According to the fourth hypothesis disease groups show a significant difference in demand for use of the software. This hypothesis showed significant differences in most of the criteria inspected. Only the time spent on filling in (p=0.418) did not show any significant difference. A significant difference is observable in the required form (p=0.000), depth of information (p=0.002), willingness to pay (p=0.021), authenticity (p=0.049) and period of waiting for the result (p=0.001).
According to the fifth hypothesis the form of use selected shows a difference in demand for use of the software. The supposition seemed to be logical that the followers of various forms of use (Web, CD, through specialists) think differently about the needs for information content and proof of authenticity, would spend different amounts on use, and would allocate different durations for data input and waiting for the result. This hypothesis, however, was not verified, because a significant difference was observed only in the duration of waiting for the reply (p=0.011).
On the basis of the output the following conclusions can be made: The majority of the patients, in total 186, would select the Internet for use of the program, and 155 persons would like to use the most detailed version that comprises all of the previous potentialities, that is a detailed menu plan, recipes and preparation instructions, in addition to the enumeration of current bad nutrition practice. The payment willingness of those asked was higher than previously anticipated, because we expected non-payers to be in the majority, but 186 persons would give a symbolic contribution. A nearly identical number selected that they would believe it, if it was in operation (n=132) or proof was provided by the operator (n=136). Those selecting "other” (n=28) gave replies as follows: acquaintance, family member, friend, physician, and a variety of combinations of these (physician+media; acquaintance+operator, etc.). What surprised us is the 132 persons who would believe without any proof, and would probably follow the recommendations of the dietetics advising system just because the system is in operation. It is quite evident that these are the patients who can be misled the easiest by professionally untrained charlatans presenting themselves as healers, and who are quickly won over by various trends that come and go, and obviously damage the prestige of the dietetics profession. Only 20% of those asked would be willing to spend more than 40 minutes on filling in the history, but greater patience was observed on the basis of the replies received, because 152 persons indicated a longer duration. In respect of the last two parameters we expected the opposite result.
Significant differences were observable in respect of many issues. This leads us to the conclusion that the advisory system can be recommended in general to everyone, but it is necessary to give an opportunity for use of the software to those having unique needs, particularly in light of differences in sex and disease groups. In practice this means that several types of input and output points should be created to ensure use of the system by everyone according to their individual needs. This does not make developing the work easier; on the contrary, as a consequence of the resulting combination possibilities and challenges it makes it more difficult.
1. Gaal B, Vassanyi I, Gy. Kozman: A novel artificial intelligence method for weekly dietary menu planning. Methods Inf Med 5/2005; pp.: 44-55. 2. Henter I, Kubányi J, Barna Lajosné: A kórházban dolgozó dietetikusok munkakörülményeinek változása 2002 és 2008 között, Új Diéta, 2008. 6. pp.14. /I. Henter, J. Kubányi, Mrs. L. Barna: Changes in the labour conditions of dietitians working in hospital between 2002-2008. Új Diéta, 2008. 6. pp.14./ 3. Henter I, Mák E: Egy felmérés tanulsága. Új Diéta, 2, 14, 2003. /I. Henter, E. Mák: Conclusions of a survey. Új Diéta, 2, 14, 2003./ 4. Henter I, Mák E: Egy felmérés tanulsága (folytatás). Új Diéta, 3, 14-15, 2003. /I. Henter, E. Mák: Conclusions of a survey (continuation). Új Diéta, 3, 14-15, 2003./ 5. http://epp.eurostat.ec.europa.eu/portal/page/portal/product_results/search_results?mo=containsall&ms=internet+statistics&saa 2009. december 18. 11.58. 6. NRC: Vertikális portálok és látogatóik. URL: http://www.nrc.hu/kutatas/piackutatasprezentaciok?page=details&oldal=1&news_id=469&parentID=930 (2008. április 8.) /NRC: Vertical portals and their visitors. URL: http://www.nrc.hu/kutatas/piackutatasprezentaciok?page=details&oldal=1&news_id=469&parentI D=930 (18 April 2008.)/ 7. Watson R: Jövő-dosszié. Mit jósol a jelen a következő öt évtizedre? HVG Kiadó, Budapest, 2008. /R. Watson: Future dossier. What is the forecast of the present for the next five decades? HVG Kiadó, Budapest, 2008./ 8. Szántó Zs, Susánszky É: Lakossági öngyógyítási stratégiák, in Lage Artis Medicinae 2000; 1(10), pp.: 74-81. /Zs. Szántó, É. Susánszky: Self-treatment strategies of the public, in Lage Artis Medicinae 2000; 1(10), pp.: 74-81./ 9. László K, Susánszky É: Az öngyógyítástól a kórházig, in Szántó Zs., Susánszky É.: Orvosi szociológia, Semmelweis Kiadó 2002; pp.:127-139. /K. László, É. Susánszky: From self-treatment to the hospital, in Szántó Zs., Susánszky É.: Medical sociology, Semmelweis Kiadó 2002; pp.:127-139./