BackgroundTraditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes.ObjectiveOur aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program.MethodsThe lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol.ResultsA total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors.ConclusionsUsage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on s...

Zusammenfassung Ziel der Studie Weniger als die Hälfte der im Rahmen einer Pflegebegutachtung der Medizinischen Dienste der Krankenkassen ausgesprochenen Rehabilitationsempfehlungen mündet in eine Beantragung, etwa jede vierte in eine realisierte Rehabilitationsleistung. Welche Faktoren die Rehabilitationsbereitschaft und die Inanspruchnahme empfohlener Leistungen zur medizinischen Rehabilitationen beeinflussen, ist bislang weitgehend unbekannt. Die explorative Studie untersucht über die Perspektive verschiedener, im Zugangsverfahren involvierter professioneller Akteur/innen die Einflussfaktoren auf den Rehabilitationszugang über die Pflegebegutachtung. Methodik In leitfadengestützten Expert/inneninterviews wurden Mitarbeiter/innen der Medizinischen Dienste sowie aus Pflege- und Krankenkassen befragt. Die Datenanalyse erfolgte nach der Methode der systematischen Textverdichtung. Ergebnisse Anhand von 53 Interviews mit 56 Prozessakteur/innen wurden individuums- und lebensweltbezogene sowie prozess- und strukturbezogene Einflussgrößen identifiziert. Neben soziodemografischen, gesundheitlichen und persönlichkeitsbezogenen Merkmalen sowie finanziellen Aspekten wurden die rehabilitationsbezogene Einstellungen der Versicherten und eine starke Bindung an die Häuslichkeit als relevante Faktoren identifiziert. Darüber hinaus wirken sich auch leistungsbezogene (z. B. Erwartungen und Wünsche) und strukturelle (z. B. Versorgungsstrukturen) Faktoren aus. Betont wurde die Bedeutung sozialer Unterstützung durch Angehörige. Schlussfolgerung Die Ergebnisse verweisen auf versicherten-, struktur- und verfahrensseitige Einflussfaktoren im Rehabilitationszugang über die Pflegebegutachtung. Sie bilden die Grundlage für mögliche Prozessverbesserungen im Zugangsverfahren und verdeutlichen die Notwendigkeit einer frühzeitigen und ausreichenden Beratung der Betroffenen und Angehörigen.

The Internet offers the potential to efficaciously deliver health interventions at a low cost and with a low threshold across any distance. However, since many web-based interventions are confronted with low use and adherence, proactive dissemination strategies are needed. We, therefore, tested the efficacy of a 1-h patient education session as part of a rehabilitation program and an email reminder 4 weeks later on the publicity and use of a web-based intervention aimed at lifestyle changes in patients with either coronary heart disease or chronic back pain (CBP) and examined adherence predictors. The website www.lebensstil-aendern.de is a cost-free, German-language website providing more than 1000 patient narratives about successful lifestyle changes. To test the efficacy of the dissemination strategies and to examine adherence predictors, we conducted a sequential controlled trial with heart and CBP patients recruited from German inpatient rehabilitation centers. The dissemination strategies were found to be efficient. Use rates, however, remained low. The email reminder and internal health locus of control emerged as notable factors in motivating patients to participate in the web-based intervention. Other factors that have been suggested to be related to nonuse, e.g. sociodemographic characteristics and medical condition, did not predict use or adherence.

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