Background Increased access to the Internet and the availability of efficacious eHealth interventions offer great promise for assisting adults with diabetes to change and maintain health behaviors. A key concern is whether levels of engagement in Internet programs are sufficient to promote and sustain behavior change.Objective This paper used automated data from an ongoing Internet-based diabetes self-management intervention study to calculate various indices of website engagement. The multimedia website involved goal setting, action planning, and self-monitoring as well as offering features such as “Ask an Expert” to enhance healthy eating, physical activity, and medication adherence. We also investigated participant characteristics associated with website engagement and the relationship between website use and 4-month behavioral and health outcomes.Methods We report on participants in a randomized controlled trial (RCT) who were randomized to receive (1) the website alone (n = 137) or (2) the website plus human support (n = 133) that included additional phone calls and group meetings. The website was available in English and Spanish and included features to enhance engagement and user experience. A number of engagement variables were calculated for each participant including number of log-ins, number of website components visited at least twice, number of days entering self-monitoring data, number of visits to the “Action Plan” section, and time on the website. Key outcomes included exercise, healthy eating, and medication adherence as well as body mass index (BMI) and biological variables related to cardiovascular disease risk.Results Of the 270 intervention participants, the average age was 60, the average BMI was 34.9 kg/m2, 130 (48%) were female, and 62 (23%) self-reported Latino ethnicity. The number of participant visits to the website over 4 months ranged from 1 to 119 (mean 28 visits, median 18). Usage decreased from 70% of participants visiting at least weekly during the first 6 weeks to 47% during weeks 7 to 16. There were no significant differences between website only and website plus support conditions on most of the engagement variables. In total, 75% of participants entered self-monitoring data at least once per week. Exercise action plan pages were visited more often than medication taking and healthy eating pages (mean of 4.3 visits vs 2.8 and 2.0 respectively, P < .001). Spearman nonparametric correlations indicated few significant associations between patient characteristics and summary website engagement variables, and key factors such as ethnicity, baseline computer use, age, health literacy, and education were not related to use. Partial correlations indicated that engagement, especially in self-monitoring, was most consistently related to improvement in healthy eating (r = .20, P = .04) and reduction of dietary fat (r = -.31, P = .001). There was also a significant correlation between self-monitoring and improvement in exercise (r = .20, P = .033) but not with medication taking.Conclusion...
The WeBREATHe program is the first evidence-based education program in tobacco cessation designed specifically for pediatric RTs, RNs, and NPs. Engagement in WeBREATHe increased participants' tobacco cessation-related behaviors.
Objective In this project we developed and evaluated a mobile health app to improve adherence to tobacco cessation medication. Methods The study was conducted in three phases: 1) Create app with input from our consultant, focus groups and user testing; 2) Test feasibility of the app; and 3) Develop and user-test the barcode scanner. Results Focus group feedback was instrumental in developing content and creating the user interface. User testing helped to identify problems and refine the app. The feasibility trial provided “real world” testing. We experienced challenges in recruitment due to the inclusion criteria. We had high attrition due to technical issues, medication side effects, enrollment procedures, and lack of personal contact. Among the five retained participants, use of the app was associated with good medication adherence and high consumer satisfaction. Conclusion The small sample size limits the generalizability of the findings and the conclusions that can be drawn from the study. However, the feasibility trial enabled the team to identify ways to improve the conduct of this and other mHealth studies. Practical Implications We should expand RxCoach to include all prescription and over-the-counter tobacco cessation medications, and re-test for feasibility using lessons learned to improve recruitment and retention.
Background: Research has shown the efficacy of family-based behavioral interventions for overweight children, but a major difficulty is access to effective treatment programs. The objective of this study was to develop and test the initial feasibility and efficacy of a web-based family program for overweight 8-to 12-year-old children.Methods: A website was created using concepts from effective family-based behavioral programs and input from focus groups with overweight children, parents, and pediatricians. The website provided information about obesity and healthy lifestyles, assessment of dietary and physical activity habits, interactive dietary and physical activity games, and instruction in goal-setting and monitoring of goals. Children selected a dietary and physical activity goal and a daily step goal with pedometers. Feasibility and pilot testing over 4 weeks was conducted with 24 overweight children referred by a physician. Outcomes were z-BMI, healthy eating and physical activity, and intrinsic motivation and self-efficacy for weight control.Results: Mean number of logins over the study period was 11.4 for the study sample. Eighteen families (75%) returned for the follow-up assessment. Pre-post analyses for these participants showed improvements in intrinsic motivation, ( p = 0.05), self-efficacy ( p = 0.025), physical activity ( p = 0.005), and healthy lifestyle behaviors ( p = 0.001). Comparisons between high and low users of the program indicated that high users reduced their BMI while low users increased their BMI over time ( p = 0.02); high users also improved their dietary intake relative to low users ( p = 0.04). Consumer satisfaction ratings were high.Conclusion: These pilot findings suggest this is a feasible approach for treatment of overweight children and that children who used the web program frequently improved their BMI and dietary intake.
This paper described the short-term results from an ongoing randomized controlled efficacy study of Click City ® : Tobacco, a tobacco prevention program designed for 5 th graders, with a booster in sixth grade. Click City ® : Tobacco is an innovative school-based prevention program delivered via an intranet, a series of linked computers with a single server. The components of the program target theoretically based and empirically supported etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was designed to change one or more etiological mechanisms and was empirically evaluated in the laboratory prior to inclusion in the program. Short-term results from 47 elementary schools (24 schools who used Click City ® : Tobacco, and 23 who continued with their usual curriculum) showed change in intentions and willingness to use tobacco from baseline to one-week following the completion of the 5 th grade sessions. The results demonstrate the short-term efficacy of this program and suggest that experimentally evaluating components prior to including them in the program contributed to the efficacy of the program. The program was most efficacious for students who were most at risk.
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