Website Intervention Research Articles

The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study.

BackgroundDespite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge for persons with OA regarding the many different treatments available to them.ObjectiveOur objective was to evaluate outcomes after usage of a Web-based resource called My Joint Pain that contains tailored, evidence-based information and tools aimed to improve self-management of OA on self-management and change in knowledge.MethodsA quasi-experimental design was used to evaluate the My Joint Pain website intervention over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments, and progress-tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed both baseline and 12-month questionnaires (users: n=104; nonusers: n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity, positive and active engagement in life, emotional distress, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t tests were used to compare changes between groups for the heiQ and chi-square tests to identify changes within and between groups from baseline to 12 months for each OAQI item.ResultsBaseline demographics between groups were similar for gender (152/195, 77.9% female), age (mean 60, SD 9 years) and body mass index (mean 31.1, SD 6.8 kg/m2). With the exception of health service navigation, mean effect sizes from all other heiQ domains showed a positive trend for My Joint Pain users compared to the nonusers, although the differences between groups did not reach statistical significance. Within-group changes also showed improvements among the users of the My Joint Pain website for self-management (absolute change score=15%, P=.03), lifestyle (absolute change score=16%, P=.02), and physical activity (absolute change score=11%, P=.04), with no significant improvements for the nonusers. Following 12 months of exposure to the website, there were significant improvements for users compared to nonusers in self-management (absolute change score 15% vs 2%, P=.001) and weight reduction (absolute change scores 3% vs –6%, P=.03) measured on the OAQI.ConclusionsThe My Joint Pain Web resource does not significantly improve overall heiQ, but does improve other important aspects of quality of care in people with hip and/or knee OA. Further work is required to improve engagement with the website and the quality of information delivered in order to provide a greater impact.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada).

BackgroundOppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families™ Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent–child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour.Methods/designThis protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child’s sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization.DiscussionThe Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems.Trial registrationClinicalTrials.gov # NCT01750996

Chinese My Trauma Recovery, A Web-Based Intervention for Traumatized Persons in Two Parallel Samples: Randomized Controlled Trial

BackgroundGuided self-help interventions for PTSD (post-traumatic stress disorder) are a promising tool for the dissemination of contemporary psychological treatment.ObjectiveThis study investigated the efficacy of the Chinese version of the My Trauma Recovery (CMTR) website.MethodsIn an urban context, 90 survivors of different trauma types were recruited via Internet advertisements and allocated to a randomized controlled trial (RCT) with a waiting list control condition. In addition, in a rural context, 93 survivors mainly of the 2008 Sichuan earthquake were recruited in-person for a parallel RCT in which the website intervention was conducted in a counseling center and guided by volunteers. Assessment was completed online on a professional Chinese survey website. The primary outcome measure was the Post-traumatic Diagnostic Scale (PDS); secondary outcome measures were Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy Scale (CSE), Post-traumatic Cognitive Changes (PCC), and Social Functioning Impairment (SFI) questionnaires adopted from the My Trauma Recovery website.ResultsFor the urban sample, findings indicated a significant group×time interaction in post-traumatic symptom severity (F 1,88=7.65, P=.007). CMTR reduced post-traumatic symptoms significantly with high effect size after one month of treatment (F 1,45=15.13, Cohen’s d=0.81, P<.001) and the reduction was sustained over a 3-month follow-up (F 1,45=17.29, Cohen’s d=0.87, P<.001). In the rural sample, the group×time interaction was also significant in post-traumatic symptom severity (F 1,91=5.35, P=.02). Post-traumatic symptoms decreased significantly after treatment (F 1,48=43.97, Cohen’s d=1.34, P<.001) and during the follow-up period (F 1,48=24.22, Cohen’s d=0.99, P<.001). Additional outcome measures (post-traumatic cognitive changes, depression) indicated a range of positive effects, in particular in the urban sample (group×time interactions: F 1,88=5.32-8.37, all Ps<.03), contributing to the positive evidence for self-help interventions. Differences in the effects in the two RCTs are exploratorily explained by sociodemographic, motivational, and setting feature differences between the two samples.ConclusionsThese findings give support for the short-term efficacy of CMTR in the two Chinese populations and contribute to the literature that self-help Web-based programs can be used to provide mental health help for traumatized persons.Trial RegistrationAustralia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611000951954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000951954 (Archived by WebCite at http://www.webcitation.org/6G7WyNODk).

Testing of a prototype Web based intervention for adolescent mothers on postpartum depression

PurposeThis article describes testing of a prototype Web site for adolescent mothers with postpartum depression; providing proof of concept. MethodsParticipants (N=138) were recruited from a public school-based program for adolescent parents and completed the Mental Health Acceptability Scale, Stigma Scale for Receiving Psychological Help, and Attitudes Towards Seeking Professional Psychological Help Scale before, and after, the Web site intervention. They also provided feedback on the usability of the Web site. ResultsAttitudes related to depression and treatment (ATSPPH) improved after viewing the Web site (p=.023). Feedback on the Web site indicated that it was easy to use (77%), reflecting highly acceptable score for product usability. ConclusionsThe data provide the foundation for the launch of the Web site from prototype to product and more comprehensive testing. The creation and testing of informational text messages will be added to the Web site to increase the interactivity and dose of the intervention.

Evaluation of an Online Education and Support Intervention for Adolescents With Diabetes

The current study evaluated an online education and support website intervention for adolescents with Type 1 diabetes. Participants were enrolled in an 8-week, online program addressing diabetes-related issues for adolescents. The evaluation comprised an intervention trial in which participants were assigned to an intervention or control group, and pre- and post-intervention measures of social support were administered. Outcomes indicated interventional gains approaching significance in participants' quality of relationships with others external to their family. Post-intervention qualitative interviews with intervention group participants identified beneficial impacts of decreased isolation, knowledge gain, and normalization of experience. Findings suggest that online information and support is an important resource in augmenting clinical care. Implications and recommendations for clinical practice are discussed.

Crowd-Sourced Evaluation: A Qualitative Study of User-Generated Product Review Videos on ExpoTV.com

Background: While user-generated videos are typically associated with humorous or shocking videos far removed from the rigorous world of evaluation, this paper explores the potential for utilizing user-generated videos as evaluation data. This topic is addressed through a qualitative pilot study of product review videos available on the ExpoTV.com website. The findings from this important subset of the evaluation field are analyzed with the goal of identifying themes and insights that could be useful to the broad field of evaluation. Purpose: The primary purpose of this study is to identify characteristics or insights about the user-generated content that could serve as a guide for future studies and the development of new theory or methodology to enlarge the scope and relevance of data used in evaluations. Setting: The ExpoTV.com website Intervention: Not applicable. Research Design: Grounded theory. Data Collection and Analysis: User-generated videos downloaded from the ExpoTV.com website. Analyzed in three stages – In Vivo coding, Axial coding and theme identification. Findings: This article finds intriguing strengths to user-generated video as an evaluation data source because user-generated product review videos consistently demonstrate three important elements of evaluation: they provide a description of the product, explain the broader context for both the product and nature of the specific review, and provide an evaluative conclusion that is logically related to specific evaluative descriptions. Keywords: user-generated video; grounded theory; video data; evaluation methodology

Supporting Tobacco Control

A large and growing literature confirms that well-designed web-based programs can be effective in preventing or treating several chronic diseases. This study examined how the Internet can deliver information and train community activists and specifically tested the effects of web-based technical assistance on local tobacco control coalitions' efforts to use media advocacy to advance their agendas. The authors compared a highly interactive, Enhanced website (intervention) to a noninteractive, Basic text-based website (comparison) in Colorado communities. A total of 24 tobacco control coalitions led by local county health departments and nursing services were enrolled in the project and randomly assigned to use either the intervention or comparison website. A total of 73 local daily and weekly newspapers were identified in the service areas of 23 of the 24 coalitions. A posttest assessment of newspaper coverage was conducted to locate all newspaper articles with tobacco control information published between January 1 and April 9, 2004, the last 3 months of the intervention. Although there was no evidence of a treatment effect on the frequency of newspaper articles on tobacco-related issues, there was, however, evidence that newspapers in counties where the coalition had access to the Enhanced website printed more stories focused on local/regional issues and more anti-tobacco local/regional stories than in the counties where coalitions had access to the Basic website. Coalitions can improve their influence on local media for community tobacco control when high-quality online technical assistance, training, and resources are available to them.

Design element alternatives for stress-management intervention websites

Typical public and military-sponsored websites on stress and depression tend to be prescriptive. Some require users to complete lengthy questionnaires. Others reproduce printed flyers, papers, or educational materials not adapted for online use. Some websites require users to follow a prescribed path through the material. Stress Gym was developed as a first-level, evidence-based, website intervention to help U.S. military members learn how to manage mild to moderate stress and depressive symptoms using a self-help intervention with progress tracking and 24/7availablility. It was designed using web-based, health-management intervention design elements that have been proven effective and users reported they prefer. These included interactivity, self-pacing, and pleasing aesthetics. Users learned how to manage stress by accessing modules they choose, and by practicing proven stress management strategies interactively immediately after login. Test results of Stress Gym with Navy members demonstrated that it was effective, with significant decreases in reported perceived stress levels from baseline to follow-up assessment. Stress Gym used design elements that may serve as a model for future websites to emulate and improve upon, and as a template against which to compare and contrast the design and functionality of future online, health-intervention websites.

Effects of a Multilingual Information Website Intervention on the Levels of Depression Literacy and Depression-Related Stigma in Greek-Born and Italian-Born Immigrants Living in Australia: A Randomized Controlled Trial

BackgroundLittle is known about the efficacy of Internet-based information interventions in increasing depression literacy or reducing depression stigma and depressive symptoms in people from non–English-speaking backgrounds.ObjectiveOur objective was to investigate the effects of Multicultural Information on Depression Online (MIDonline), an Internet-based multilingual depression-specific information resource, on depression literacy, depression stigma, and depressive symptoms in Greek-born and Italian-born immigrants to Australia.MethodIn all, 202 Greek- and Italian-born immigrants aged 48 to 88 years were randomly allocated to an online depression information intervention (n =110) or a depression interview control group (n = 92). Participants allocated to the information intervention only had access to the website during the 1- to 1.5-hour intervention session. The primary outcome measures were depression literacy (depression knowledge), personal stigma (personal stigma toward people with a mental illness), perceived stigma (participants’ views about the probable attitude of the general community toward people with mental illness), and depressive symptoms. Depression literacy, personal and perceived stigma, and depressive symptoms were assessed at preassessment, postassessment, and at a 1-week follow-up assessment. The trial was undertaken at Monash University, Melbourne, Australia. Randomization and allocation to trial group were carried out using a computer-generated table.ResultsFor depression literacy, there was a significant difference between the MIDonline and the control group with those in the MIDonline intervention displaying higher depression literacy scores postassessment (F1,178 = 144.99, P < .001) and at the follow-up assessment (F1,178 = 129.13, P < .001) than those in the control group. In addition, those in the MIDonline intervention showed a significantly greater decrease in mean personal stigma scores postassessment (F1,178 = 38.75, P < .001) and at the follow-up assessment (F1,176 = 11.08, P = .001) than those in the control group. For perceived stigma, there was no significant difference between the MIDonline intervention and the control group at postassessment (F1,178 = 0.60, P = .44) and at the follow-up assessment (F1,176 = 1.06, P = .30). For level of depression, there was no significant difference between the MIDonline intervention and the control group at preassessment (F1,201 = 0.56, P = .45), postassessment (F1,178 = 0.03, P = .86), or at the follow-up assessment, (F 1,175 = 1.71, P = .19). Within group effect sizes for depression literacy were −1.78 (MIDonline) and −0.07 (control); for personal stigma, they were 0.83 (MIDonline) and 0.06 (control); for perceived stigma, they were 0.14 (MIDonline) and 0.16 (control); and for depressive symptoms, they were 0.10 (MIDonline) and 0.10 (control).ConclusionsCurrent results suggested that the Internet may be a feasible and effective means for increasing depression knowledge and decreasing personal stigma in non–English-speaking immigrant populations residing in English-speaking countries. The lack of change in perceived stigma in this trial is consistent with results in other trials examining online depression stigma interventions in English-speaking groups.Trial RegistrationISRCTN76460837; http://www.controlled-trials.com/ISRCTN76460837 (Archived by WebCite at http://www.webcitation.org/5xjxva4Uq)

Distinct chronic pain diagnoses and website usage patterns: a secondary analysis of clinical trial data

Website interventions have proven effective at delivering CBT-type treatment to patients with chronic pain. The ways in which these patients interact with online health sites may differ according to user characteristics, but to our knowledge, no study has examined whether individuals with different pain types use online sites differently. This study sought to quantify differences in participant usage patterns of structurally-similar online health sites, according to chronic pain type. Two hundred eighteen participants (89 back pain, 88 migraine, 41 neuropathic pain) who were randomized to the experimental groups of their respective clinical trials were included in these analyses.

PainACTION.com: An interactive self-management website for chronic back pain patients

The Internet can assist back pain patients in developing self-management skills, but available pain websites offer few interactive self-management strategies or focus on selling products. The aim of this poster is to describe the development and testing of an interactive website called painACTION.com. This randomized, controlled trial examined the hypotheses that, relative to a control condition, painACTION.com participants would report significant improvements in pain, physical functioning, emotional functioning, coping, and self-efficacy. The conditions included Experimental (eight site visits in a month plus 5 monthly boosters) and Control (treatment as usual) groups. Experimental participants were also classified as high dose and low dose based on a median split. Measures (pain, daily functioning, catastrophizing, self-efficacy, pain beliefs, emotional functioning, and work productivity) were administered at baseline, post-intervention, and three- and six-month follow-ups. Experimental participants showed decreased stress over all time points. Experimental participants with high baseline pain increased relaxation, decreased guarding, and decreased helplessness. Experimental participants recruited online evidenced decreased average pain ratings, increased coping self-statements, and decreased worst pain levels. High-dose participants showed increased coping self-statements and decreased stress. The Internet offers a potentially effective vehicle for enhancing self-management in back pain patients. Findings suggest better outcomes with a less severe (lower disability) group online compared to a clinic population. Also, participants with higher baseline pain levels and those at higher website dosages responded better to the website intervention. (The development of painACTION.com was funded by SBIR Grant #9R44DA022802-02 from the National Institute on Drug Abuse; its ongoing maintenance is funded by unrestricted grants from Endo Pharmaceuticals and King Pharmaceuticals.) The Internet can assist back pain patients in developing self-management skills, but available pain websites offer few interactive self-management strategies or focus on selling products. The aim of this poster is to describe the development and testing of an interactive website called painACTION.com. This randomized, controlled trial examined the hypotheses that, relative to a control condition, painACTION.com participants would report significant improvements in pain, physical functioning, emotional functioning, coping, and self-efficacy. The conditions included Experimental (eight site visits in a month plus 5 monthly boosters) and Control (treatment as usual) groups. Experimental participants were also classified as high dose and low dose based on a median split. Measures (pain, daily functioning, catastrophizing, self-efficacy, pain beliefs, emotional functioning, and work productivity) were administered at baseline, post-intervention, and three- and six-month follow-ups. Experimental participants showed decreased stress over all time points. Experimental participants with high baseline pain increased relaxation, decreased guarding, and decreased helplessness. Experimental participants recruited online evidenced decreased average pain ratings, increased coping self-statements, and decreased worst pain levels. High-dose participants showed increased coping self-statements and decreased stress. The Internet offers a potentially effective vehicle for enhancing self-management in back pain patients. Findings suggest better outcomes with a less severe (lower disability) group online compared to a clinic population. Also, participants with higher baseline pain levels and those at higher website dosages responded better to the website intervention. (The development of painACTION.com was funded by SBIR Grant #9R44DA022802-02 from the National Institute on Drug Abuse; its ongoing maintenance is funded by unrestricted grants from Endo Pharmaceuticals and King Pharmaceuticals.)

Creating and Testing a Deaf-Friendly, Stop-Smoking Web Site Intervention

Deaf adults' access to smoking cessation programs is limited due to cultural, linguistic, and geographic barriers. Web-based stop-smoking interventions have demonstrated cessation rates comparable to other interventions. The Internet is widely used by Deaf adults, but difficulties with online English text remain. We found no published accounts of Internet interventions promoting smoking cessation among Deaf individuals. The purpose of our project was to create and pilot test a prototype interactive Web site that provides users with information in American Sign Language related to smoking cessation. We utilized web cams to create real-time "video chat rooms" for virtual support groups and had an "ask the experts" feature. Deaf community members participated in all phases of development and testing, and a Deaf former smoker served as the moderator for the site. Evaluations were positive, with emphasis on interactive and visual aspects of the site.

Effect of a Web Site Intervention on Physical Activity of College Females

To evaluate the effects of a social cognitive theory (SCT) Web site intervention on college female physical activity and to determine if SCT variables mediated physical activity. Ninety-one sedentary volunteers (intervention n = 45; control n = 46) completed questionnaires measuring self-regulation, outcome expectancy value, self-efficacy, and physical activity at baseline, 6 weeks, and 6 months. The intervention increased days of moderate physical activity at 6 weeks, and self-regulation mediated this effect. The effect was not sustained at 6 months. E-communications is an effective method to acutely increase self-regulation skills and moderate physical activity.

A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia.

Family psychoeducation has been found to reduce relapse in schizophrenia but penetration rates are low. In this study, we evaluate the feasibility of an online multifamily group program for relatives of persons with schizophrenia that can be accessed from participants' homes. We explored participation rates and evaluations of a 12-month multimodal website intervention. Using a quasi-experimental design, we compared illness outcomes (factors on the Brief Psychiatric Rating Scale, hospitalizations) of persons with diagnosed schizophrenia, and relative distress outcomes (somatic concerns and anxiety/depression subscales on the Brief Symptom Inventory) from relatives participating in the intervention (n = 26) to archival data we had from comparable dyads who received customary care (n = 16). The majority of participants in the program attended more than half the core online support sessions, expressed high levels of satisfaction, and found the technology easy to access. There appeared to be little impact of online participation on clinical status of persons with schizophrenia or relatives' distress, although there was a trend for fewer hospitalizations in the online group. Small sample size is a factor in interpreting results. Online interventions for relatives of persons with schizophrenia, while feasible, present unique challenges. These include 1) assuring access to the intervention in populations who do not own a computer; 2) addressing privacy concerns; 3) overcoming the special challenges of conducting groups in real time; 4) managing emergent situations adequately; and 5) questions about efficacy.

방문관리와 웹 사이트를 통한 관리 프로그램이 대학생들의 운동지속과 대사증후군 위험요인 변화에 미치는 효과

방문관리와 웹 사이트를 통한 관리 프로그램이 대학생들의 운동지속과 대사증후군 위험요인 변화에 미치는 효과

A Comparison Evaluation Study of Web-Based and Traditional Marriage and Relationship Education

There is growing evidence that self-directed marriage relationship interventions can produce measured benefits. In this study we experimentally evaluate the potential of web-based marriage education, as a self-directed approach, to generate measurable positive outcomes in marriage relationships, compared with traditional marriage education and to a control group. Both website and traditional marriage education interventions produced positive changes to exceed those in the control group. There was no difference in the magnitude of change produced by the traditional versus the website intervention. Implications of the findings for marriage and relationship education are discussed.

Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption

BackgroundThe purpose of this paper is to evaluate costs associated with the online intervention trial, Making Effective Nutritional Choices for Cancer Prevention (MENU), and to connect the findings to the study outcomes.MethodsUsing prospective data collected during the MENU development and implementation phases, we estimated overall costs per person, incremental costs for the three arms of the MENU intervention, and incremental costs per change in fruit and vegetable (F&V) consumption across the studied population. The MENU study was conducted in five HMO sites of the Cancer Research Network. The number of eligible study participants who were enrolled in the study was 2,540. Recruited participants were randomized into (1) an untailored website program, (2) tailored website program, or (3) tailored web program plus personalized counseling (HOBI) via email. The primary measures for these analyses include the total intervention costs, average cost per participant, and the average cost per mean change in daily intake of F&V, stratified by study arm.ResultsThe mean change in F&V consumption was greater in both the tailored arm and statistically higher in the HOBI arm relative to the untailored arm. The untailored arm achieved +2.34 servings increase vs. the tailored website arm (+2.68) and the HOBI arm (+2.80) servings increase. Total intervention costs for MENU participants who completed the 12-month follow-up assessment, by study arm, were estimated to be $197,197 or $110 respectively. This translates to $69 per participant in the untailored web site intervention, $81 per participant in the tailored website intervention, and $184 per participant in the HOBI intervention and a cost per average change in F&V consumption to be $35, $27 and $61 respectively.ConclusionsProviding personalized "tailored" messages and additional personalized support via email generated an additional $12-$115 per participant, over the untailored web program. Incremental increases in F&V consumption associated with the email support arm were associated with considerable increases in intervention costs, suggesting that the most cost effective arm of the MENU study by servings gained was the tailored website.

Randomized trial of a neighborhood environment-focused physical activity website intervention

Objective To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults. Method One-hundred and six (72% women) inactive adults aged 52 ± 4.6 years were randomly allocated to receive access to a neighborhood environment-focused website, (Neighborhood group, n = 52) or a motivational-information website (Comparison group n = 54). Participants also received eleven emails over the 26 weeks. Study outcomes were objectively-monitored website use, and self-reported total walking (min/wk), total physical activity (min/wk) and neighborhood walking (min/wk) collected at baseline, 12 and 26 weeks. The study was conducted between August 2005 and February 2006 in Brisbane, Australia. Results Website use was significantly greater among Neighborhood participants ( p = 0.01). Statistically significant increases in walking and total physical activity were observed in both groups. There was also a statistically significant interaction effect for total physical activity, with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 ( p < 0.05). Further, those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 ( p = 0.05) compared with those who did not. Conclusions A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website. Moreover, its use resulted in meaningful increases in physical activity relative to the comparison website.

A Website to Improve Asthma Care by Suggesting Patient Questions for Physicians: Qualitative Analysis of User Experiences

Background Asthma is one of the most prevalent chronic conditions in the United Sates, yet despite the existence of national guidelines, nearly three fourths of patients with asthma do not have adequate control and clinical adherence to guidelines is low. While there are many reasons for this, physician inertia with respect to treatment change is partly to blame. Research suggests that patients who ask for specific tests and treatments are more likely to receive them.Objectives This study investigated the impact and experience of using an interactive patient website designed to give patients individual feedback about their condition and to suggest tailored questions for patients to ask their physician. The website was designed to be used prior to a physician visit, to increase the likelihood that patients would receive recommended tests and treatments.Methods A total of 37 adult patients with asthma participated in semi-structured telephone interviews aimed at eliciting information about their experiences with the website. Transcripts were coded using qualitative data analysis techniques and software. Themes were developed from subsets of codes generated through the analysis. In addition, 26 physicians were surveyed regarding their impressions of the website.Results Opportunities exist for improving website feedback, although the majority of both patient and physician respondents held favorable opinions about the site. Two major themes emerged regarding patients’ experiences with the website. First, many patients who used the website had a positive shift in their attitudes regarding interactions with their physicians. Second, use of the website prompted patients to become more actively involved in their asthma care. No patient reported any negative experiences as a result of using the website. Physicians rated the website positively.Conclusions Patients perceived that the interactive website intervention improved communication and interaction with their physicians, suggesting that patients can play a role in overcoming the clinical inertia of providers. Although the design and content of the website can be improved upon, the main findings suggest that use of the website is well accepted and is perceived to improve the quality of care that patients receive.

Free Range users and One Hit Wonders: Community Users of an Internet-Based Cognitive Behaviour Therapy Program

Little is known about the predictors of symptom change or the methods that might increase user 'compliance' on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of 'core' online assessments and may increase completion of site questionnaires. MoodGYM Mark I participants were 19,607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38,791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores. Men are predicted to be 0.19 units (SE=0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments. Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.