Background: Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of “superfast” broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels. Objective: This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth. Methods: This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities. Results: eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001 ci="0.13" to resulting from increases in personal and provision components of the score p=".002" t258="3.410;" however there were no significant differences between interventions either singly or combination using intention-to-treat analysis. proportion internet users did not significantly increase mobile use was greater change ehealth inequality. conclusions: people cornwall became more ready adopt services increasing both their ability methods access. implementation superfast may have contributed this we are certain that our other not. increased readiness cause a larger digital divide. study illustrates complexity conducting randomized controlled trial assess impact at regional practice household levels. method be others. registration: clinicaltrials.gov nct00102401 https: by webcite http:>
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