Interactive Computer-based Interventions Research Articles

Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

Digital health promotion in sexual health clinics: results of a feasibility trial of the Men’s Safer Sex website

004.2 A pilot randomised controlled trial of an interactive computer-based intervention for sexual health in adolescents and young adults

Introduction Interactive computer-based interventions (ICBI) are potentially scalable tools for use in real-world settings to promote sexual health and prevent sexually transmitted infections (STIs) and unintended pregnancies. We assessed the feasibility and acceptability of an ICBI for sexual health and the effectiveness of the intervention in reducing unprotected sex and biomarker outcomes of STIs and unintended pregnancy. Methods This pilot randomised controlled trial enrolled STD Clinic patients, 14–24 years old, reporting unprotected vaginal sex during the last 2 months. The ICBI included personalised sexual health feedback from a physician avatar; instructive video modules advocating sexual health; and identification of one behaviour to change. At 3-month follow-up participants reported on interim sexual and pregnancy histories and underwent repeat urine testing. Intervention impact on unprotected vaginal sex, number of sexual partners, incident STIs and unintended pregnancy was assessed. Results Of 272 participants, 242 (89%) completed the study, of which 65% were female. At 3-month follow-up, when compared to controls, the intervention group reported a 33% lower rate of vaginal sex without condoms [IRR = 0.67, 95% CI: 0.44–1.01]; 20% fewer partners [IRR = 0.80, 95% CI: 0.61–1.05]; 48% fewer STIs [IRR = 0.52, 95% CI: 0.24–1.13]. Intervention females reported less frequent vaginal sex without birth control [IRR = 0.78, 95% CI: 0.46–1.32]; half as many unintended pregnancies [IRR = 0.51, 95% CI: 0.16–1.6]. In exploratory analyses, intervention females reported fewer partners [IRR = 0.71, 95% CI: 0.50–1.00] and a significantly lower rate of vaginal sex without condoms [IRR = 0.50, 95% CI: 0.30–0.85]. Conclusion The intervention was acceptable to both males and females, and at 3-month follow-up, there was a non-significant but substantial trend towards effectiveness for all outcomes. Among females, in exploratory analysis, the reduction in vaginal sex without condoms was statistically significant. Disclosure of interest statement Test kits for STI testing were provided by GenProbe.

What are the effects of interactive computer-based interventions in overweight or obese people for weight loss?

What are the effects of interactive computer-based interventions in overweight or obese people for weight loss?

What are the effects of interactive computer-based interventions for weight maintenance in overweight or obese people who have previously lost weight on a weight loss program?

What are the effects of interactive computer-based interventions for weight maintenance in overweight or obese people who have previously lost weight on a weight loss program?

Using Health Information Technology to Prevent and Treat Diabetes

Using Health Information Technology to Prevent and Treat Diabetes

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.

The World Health Organization (WHO) estimates that the number of obese or overweight individuals worldwide will increase to 1.5 billion by 2015. Chronic diseases associated with overweight or obesity include diabetes, heart disease, hypertension and stroke. To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. We searched several electronic databases, including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO, through 25 May 2011. We also searched clinical trials registries to identify studies. We scanned reference lists of included studies and relevant systematic reviews. Studies were included if they were randomized controlled trials or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. We excluded trials if the duration of the intervention was less than four weeks or the loss to follow-up was greater than 20% overall. Two authors independently extracted study data and assessed risk of bias. Where interventions, control conditions, outcomes and time frames were similar between studies, we combined study data using meta-analysis. We included 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants. Treatment duration was between four weeks and 30 months. At six months, computer-based interventions led to greater weight loss than minimal interventions (mean difference (MD) -1.5 kg; 95% confidence interval (CI) -2.1 to -0.9; two trials) but less weight loss than in-person treatment (MD 2.1 kg; 95% CI 0.8 to 3.4; one trial). At six months, computer-based interventions were superior to a minimal control intervention in limiting weight regain (MD -0.7 kg; 95% CI -1.2 to -0.2; two trials), but not superior to infrequent in-person treatment (MD 0.5 kg; 95% -0.5 to 1.6; two trials). We did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials. Three weight loss studies estimated the costs of computer-based interventions compared to usual care, however two of the studies were 11 and 28 years old, and recent advances in technology render these estimates unlikely to be applicable to current or future interventions, while the third study was conducted in active duty military personnel, and it is unclear whether the costs are relevant to other settings. One weight loss study reported the cost-effectiveness ratio for a weekly in-person weight loss intervention relative to a computer-based intervention as USD 7177 (EUR 5678) per life year gained (80% CI USD 3055 to USD 60,291 (EUR 2417 to EUR 47,702)). It is unclear whether this could be extrapolated to other studies. No data were identified on adverse events, morbidity, complications or health-related quality of life. Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

Computer-based interventions for sexual health promotion: systematic review and meta-analyses

This systematic review was conducted to determine the effects of self-help interactive computer-based interventions (ICBIs) for sexual health promotion. We searched 40 databases for randomized controlled trials (RCTs) of computer-based interventions, defining 'interactive' as programmes that require contributions from users to produce personally relevant material. We conducted searches and analysed data using Cochrane Collaboration methods. Results of RCTs were pooled using a random-effects model with standardized mean differences for continuous outcomes and odds ratios (ORs) for binary outcomes, with heterogeneity assessed using the I(2) statistic. We identified 15 RCTs of ICBIs (3917 participants). Comparing ICBIs to minimal interventions, there were significant effects on sexual health knowledge (standardized mean difference [SMD] 0.72, 95% confidence interval [CI] 0.27-1.18); safer sex self-efficacy (SMD 0.17, 95% CI 0.05-0.29); safer-sex intentions (SMD 0.16, 95% CI 0.02-0.30); and sexual behaviour (OR 1.75, 95% CI 1.18-2.59). ICBIs had a greater impact on sexual health knowledge than face-to-face interventions did (SMD 0.36, 95% CI 0.13-0.58). ICBIs are effective tools for learning about sexual health, and show promising effects on self-efficacy, intention and sexual behaviour. More data are needed to analyse biological outcomes and cost-effectiveness.

Nursing professionalsʼ experiences of the facilitators and barriers to the use of telehealth applications: - a systematic review of qualitative evidence

Nursing professionalsʼ experiences of the facilitators and barriers to the use of telehealth applications: - a systematic review of qualitative evidence

Cochrane Review: Interactive computer‐based interventions for sexual health promotion

AbstractBackgroundSexual health promotion is a major public health challenge; there is huge potential for health promotion via technology such as the Internet.ObjectivesTo determine effects of interactive computer‐based interventions (ICBI) for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes.Search strategyWe searched more than thirty databases for randomised controlled trials (RCTs) on ICBI and sexual health, including CENTRAL, DARE, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsycINFO. We also searched reference lists of published studies and contacted authors. All databases were searched from start date to November 2007, with no language restriction.Selection criteriaRCTs of interactive computer‐based interventions for sexual health promotion, involving participants of any age, gender, sexual orientation, ethnicity or nationality. 'Interactive' was defined as packages that require contributions from users to produce tailored material and feedback that is personally relevant.Data collection and analysisTwo review authors screened abstracts, applied eligibility and quality criteria and extracted data. Results of RCTs were pooled using a random‐effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. We assessed heterogeneity using the I2 statistic. Separate meta‐analyses were conducted by type of comparator: 1) minimal intervention such as usual practice or leaflet, 2) face‐to‐face intervention or 3) a different design of ICBI; and by type of outcome (cognitive, behavioural, biological outcomes).Main resultsWe identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta‐analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self‐efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer‐sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta‐analysis of biological outcomes and analysis of cost‐effectiveness.In comparison with face‐to‐face sexual health interventions, meta‐analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face‐to‐face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome.No studies measured potential harms (apart from reporting any deterioration in measured outcomes).Authors' conclusionsICBI are effective tools for learning about sexual health, and they also show positive effects on self‐efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost‐effective.Plain Language SummaryComputer programmes for sexual health promotionSexual health promotion is a major public health challenge. There is huge potential for health promotion via technology such as the Internet, but it is not known whether interventions are effective. An interactive computer‐based intervention provides information, and also offers personalised feedback. We searched databases for studies which were randomised controlled trials (RCTs) of computer/Internet‐based interventions which aimed to improve sexual health. We included trials of computer‐based interventions delivered to people of any age, gender, sexual orientation, ethnicity or nationality. The review evaluated 15 RCTs involving 3917 participants. Results showed that computer‐based interventions have a moderate effect in improving people's knowledge about sexual health in comparison to minimal interventions such as ‘usual practice’ or a leaflet. We also found a small effect on safer sex self‐efficacy (a person's belief in their capacity to carry out a specific action), a small effect on safer‐sex intentions, and also an effect on sexual behaviour (such as condom use for sexual intercourse). We found that computer‐based interventions seem better than face‐to‐face interventions at improving sexual health knowledge, but there were insufficient data to analyse other outcomes. No studies measured potential harms (apart from reporting any deterioration in outcomes). Interactive computer‐based interventions for sexual health promotion are feasible in a variety of settings. They are effective tools for learning about sexual health, and they also improve self‐efficacy, intention and sexual behaviour, but more research is needed to establish whether computer‐based interventions can change outcomes such as sexually transmitted infections and pregnancy, to understand how interventions might work, and to assess whether they are cost‐effective.

Commentary on ‘Interactive computer‐based interventions for sexual health promotion’ with a response from the review authors

AbstractThese are commentaries of a Cochrane review, published in this issue of EBCH, first published as: Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Interactive computer‐based interventions for sexual health promotion. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD006483. DOI: 10.1002/14651858.CD006483.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Summary of ‘Interactive computer‐based interventions for sexual health promotion’

AbstractThis is a summary of Cochrane review, published in this issue of EBCH, first published as: Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Interactive computer‐based interventions for sexual health promotion. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD006483. DOI: 10.1002/14651858.CD006483.pub2. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Interactive computer-based interventions for sexual health promotion

Sexual health promotion is a major public health challenge; there is huge potential for health promotion via technology such as the Internet. To determine effects of interactive computer-based interventions (ICBI) for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes. We searched more than thirty databases for randomised controlled trials (RCTs) on ICBI and sexual health, including CENTRAL, DARE, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsycINFO. We also searched reference lists of published studies and contacted authors. All databases were searched from start date to November 2007, with no language restriction. RCTs of interactive computer-based interventions for sexual health promotion, involving participants of any age, gender, sexual orientation, ethnicity or nationality. 'Interactive' was defined as packages that require contributions from users to produce tailored material and feedback that is personally relevant. Two review authors screened abstracts, applied eligibility and quality criteria and extracted data. Results of RCTs were pooled using a random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. We assessed heterogeneity using the I(2) statistic. Separate meta-analyses were conducted by type of comparator: 1) minimal intervention such as usual practice or leaflet, 2) face-to-face intervention or 3) a different design of ICBI; and by type of outcome (cognitive, behavioural, biological outcomes). We identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta-analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self-efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer-sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta-analysis of biological outcomes and analysis of cost-effectiveness.In comparison with face-to-face sexual health interventions, meta-analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face-to-face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome.No studies measured potential harms (apart from reporting any deterioration in measured outcomes). ICBI are effective tools for learning about sexual health, and they also show positive effects on self-efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost-effective.

Estimating Development Cost for a Tailored Interactive Computer Program to Enhance Colorectal Cancer Screening Compliance

The authors used an actual-work estimate method to estimate the cost of developing a tailored interactive computer education program to improve compliance with colorectal cancer screening guidelines in a large multi-specialty group medical practice. Resource use was prospectively collected from time logs, administrative records, and a design and computing subcontract. Sensitivity analysis was performed to examine the uncertainty of the overhead cost rate and other parameters. The cost of developing the system was $328,866. The development cost was $52.79 per patient when amortized over a 7-year period with a cohort of 1,000 persons. About 20% of the cost was incurred in defining the theoretic framework and supporting literature, constructing the variables and survey, and conducting focus groups. About 41% of the cost was for developing the messages, algorithms, and constructing program elements, and the remaining cost was to create and test the computer education program. About 69% of the cost was attributable to personnel expenses. Development cost is rarely estimated but is important for feasibility studies and ex-ante economic evaluations of alternative interventions. The findings from this study may aid decision makers in planning, assessing, budgeting, and pricing development of tailored interactive computer-based interventions.